...... THE OFFICIAL NEWSLETTER OF THE ':: This Newsletter is published by the National :: Coalition or Gay Sexually Transmitted Disease Services (NCGSTDS). Although errorts will be NATIO,NAL COALITION i... made to present accurate, ractual inrormation, the NCGSTDS, as a volunteer, nonprorit organiza­ a... tion, or its orricers, members, rriends, or ... OF ... agents, cannot assume liability ror articles ... published or advice rendered. The Newsle~ter ... provides a rorum ror communication among the ... GAY STD SERVICES ... nation's gay STD services & providers, and ... encourages literary contributions, letters, ... reviews, etc. The Editor/Chairperson reserves VOLUME 7:5 JUNE/JULY, 1986 S the right to edit as needed, unless specif.ic . ... ****************************************************************; requests to the contrary are received. Articles ror the Newsletter, or inquiries about membership or sUbscriptions may be addressed to Mark P. Behar, PA-C, Chairperson, NCGSTDS, PO Box 239, Milwaukee, WI 53201-0239 (414/277-7671). Please credit the NCGSTDS when reprinting items rrom the Newsletter. We're eager to hear rrom you and will try to answer all correspondence! The NCGSTDS is the proud recipient or the Natio~al Lesbian/Gay Health Education Foundation's JANE ADDAMS-HOWARD BROWN AWARD, ror outstanding errort and achievement in creating a healthier . . :~~~~~~::~!':':~~~'!:::~:~:1r:~:*;:~~r::~;*~~~:*;!;*;: :~;***'~~ II )( I GAY AND L~~:~~: :E~S~:SSOCIATION **********************************************************************************************************************************.* T~~~~ QE ~!~~!§ Conference: Homosexuality-2 ACLU Publishes Pamphlet-19 Congressional Right Wing-57 AIDS Blood Screens-44 Core Physician Educators-20 Legal Journal Has Article-19 Personal Safe Sex Saapler-50 AIDS Epi/Surveillance Update-64 Cosmetics Cover KS Lesions-50 Legal Rights, AIDS Pamphlets-23 Police Forces Ab Test-54 AIDS in Prison-17 Cuba Okay's Mom's Visit-47 'Lesbian/Gay Caucus of APHA-2 Positions Available-18 AIDS Peril Great for Blacks-16 Daily Interfaith-49 Lesbians Suffer AIDS Bias-52 Price Tripled on Ribavirin-56 AIDS Show in SF/London-20 DC Gay Men Practice Safer Sex-3 London Helpline-22 Prison AIDS Pop. Rising-17 AIDS Vigil-46 Docs Refuse to Report Cases-58 Lutheran Pastoral Care-21 Prisoners with AIDS-52 AIDS Virus Mutates-62 Doctor with AIDS Fired-52 Man Sues Over Ab Test-U Promising Report, Paris-23 Aloe Vera Plant-Based Drug-6 Donors Blood to be Traced-43 Mariposa Award to Brad Truax-43 PWA Coalition Newsline-22 Alternate Test Sites-60 Dynasty Actor Has AIDS-47 Media eampaign-20 PWA Switchboard-43 Alumni Reunion at LALGCSC-13 Editorial: Infected vs. Diag.-7 Megaraffle in NYC-12 Racisa, HOIOphobia-17 AMFAR Awards Grants-42 Education Grants by CDC-9 Minneapolis Site of AAPHR Mtg-6 Rate of AIDS Transaission-60 AMFAR Has More PSAs-20 Effects: Learning Ab Status-60 MMWR: Ab-Military, 35:26-37 Red Cross &PHS Offer-21 Animated Kids Video-19 'Electric Billboard Flashes-20 MMWR: Alt Sites, 35:17-25 Red Cross Film: Beyond Fear-21 Atlanta Black &White Men-15 Eliz. Taylor Seeks Funding-13 MMWR: Classification, 35:20-27 Reflect: Sadness/Laughter-13 BARE Facts Debuts Campaign-3 Federal Porno Report-9 MMWR: Dialysis, 35:23-32 Rising Costs of Liabi1;ty-11 Bathhouses Sued by LA County-57 Future of NCGSTDS-4 MMWR: Fatigue/EBV, 35:21-30 Saliva Test-56 Behind Scenes in Paris-24 Genetically Engineered HBV-49 MMWR: HBV-Jet Gun, 35:23-31 Sanitation Workers in NYC-52 Bike-A-Thon in SF-8 Guide to Illness &Health-53 MMWR: Herpes, 35:24-36 Schools Should Have Educ.-53 Billboard Fundraising Proj.-56 H.S. Pupils Don't Know Facts-14 MMWR: Mycobacterium, 35:28-39 Social Pressures Blaaed-47 Bitten Cop: Attempted Murder-52 Haitians Relisted as At-Risk-5 MMWR: NANB Hepatitis, 35:24-35 Spanish AIDS Hotline in LA-15 Black Civil Rights Org.-16 Health Center/Sydney-22 MMWR: Rx Resistant GC, 35:19-26 St. Louis Effort-20 Blacks Hold National Conf.-14 Health Officials Admit-12 MMWR: Transfusion, 35:24-33 Tax EX8lpt Groups Can Lobby-18 Bone Marrow Frozen &Banked-6 Healthy Transm. of Herpes-60 Mobilization Meaorials-43 TB Skin Test Advised-50 Bone Marrow Registry-4 Hepatitis &AIDS Vaccines?-49 Mother's Book-19 Texas Approves Nation's First-51 Boston Forms PWA Coalition-17 Hormonal Look Alike-64 NAN Offers Assistance-8 Touring AIDS Exhibition-51 Boston Walk for Life-8 Human Trials in Testing-42 Nat. AIDS Network Newsletter-7 Transfusion Trial 8egins-24 Calif. Governor Cuts Funds-54 Humorous Approaches-16 Nat. Minority AIDS Council-15 Treatment of Adrenal Insuff.-63 California Vote on LaRouche-55 Immunity &Stress Linked-61 Natural Therapies for Viruses-6 Uganda Sexuality-48 Canadian Efforts-22 Int. Health Research Fnd-47 Navy Court Martials Sailor-57 United Way Shortchanges SF-56 Chicago Compo Prevo Prog.-53 Justice Dept. Opinion-9 NCGSTDS Operates at Loss-3 Virus Transmitted: Neg. Bld.-64 Chicago Women's AIDS Project-18 Kaposi's Linked to Poppers-51 NCGSTDS Semi-Annual Meeting-2 Walk in NYC-8 Chilling Predictions-41 Kennedy Ctr Shuns Play-54 Ne,w IlIIIIIUne Booster?-58 Wash. Archbish. Names Priest-50 Chronic Hep B Carriers-50 Kidney Problems-62 Next Newsletter-59 Washington DC Opens 4th Home-56 CIRID Medical Updates-62 Killing Viruses-63 Nondeadly AIDS Virus: Hope?-48 Who's Who in Sexology-19 City Approves Malpractice-42 Knowing Is Better?!-44 Now I Know Better-13 World Health Org. Challenged-7 Columbus Seeks Director-18 LaRouche-55 Oral Sex May Be Safer-53 Comics Teach About Sex-22 Las Vegas AIDS Photo 10 Card-54 Condition Not Crisis-5 Law Student Sues NBC-54

~***********. ***************************************************************************************************************************' ***** PAGE 2 * THE OFFICIAL NEWSLETTER OF THE NCGSTDS * VOLUME 7:5 * JUNErJULY, 1986 ***** ***********************************************************************************************************************

NCGSTDS SEMI-ANNUAL MEETING AT APHA, SEPTBIBER 29TH

The National Coalition of Gay Sexually Transmitted Disease Services (NCGSTDS) will be hosting its semi-annual meeting in conjunction with the American Public Health Association's Annual Meeting, at the Lesbian &Gay Caucus Suite in the Paddlewheel Hotel, Las Vegas, Monday, Sept. 29, 9am-12. Among the agenda items are: corporate status, tax-exempt status, board of advisors, guidelines &recommendations for healthful gay sexual activity, proposed paddlewheel boat fundraiser on the Mississippi River in conjunction with the AAPHR annual meeting (August, 1987), reports from member services, and future direction of the Coalition. Any additional agenda items must be brought to the attention of the NCGSTDS, POB 239, Milwaukee, WI 53201. Coalition Chair Mark Behar will also be staying in the Paddlewheel Hotel. ************************************************** LESBIAN. GAY CAUCUS OF PUBLIC HEALTH WORKERS ANNOUNCE PRELIMINARY ACTIVITIES The Lesbian &Gay Caucus of Public Health Workers of the American Public Health Association is planning a full schedule of activities at the upcoming APHA Conference in Las Vegas, September 28 through October 2, 1986. The Caucus' Hospitality Suite will be in the Paddlewheel Hotel, and most of the sessions will be held in the Convention Center. The following is a preliminary schedule of LGC activities (asterisk .*" indicates sessions sponsored by the Caucus): ~~~g~~L ~l~~, 9- 12 PI NCGSTDS SEMI-ANNUAL MEETING AT THE CAUCUS SUITE; 2-3:30, Session ~320, Risk for AIDS Among IV Drug Users; 2-3:30, Session 1343, AIDS Education: Program Examples*; 2-3:30, Session ~350, Suicide: ACrisis for Youth &Adults; 2-3:30, Session ~363, Strategies for Improving Services to Women, Teenagers, &Families; 4-5:30, Session 1097, Occupational Health &Safety: AIDS in the Workplace; 4-5:30, Session 1413 Gay Health Care--Past, Present, &Future*; 6 pm Joint Social Hour with the Women's &Socialist Caucuses; !~!!~ ~l~~, 12pm, Caucus Business Meeting; 2-3:30, Session 15~ Alcohol, Drugs and the Sexual Transmission of AIDS; 2- 3:30, Session 1596 Health Education Response to Kids at High Risk; 2-3:30. Session 1597, Persons with AIDS and Their Families: New Service Patterns; 2-5:30, Session 1617, Behavioral, Social, Legal and Youth Issues in AIDS and HTLV-III Testing*; 4-5:30 pm, Session 1649, AIDS Patients: Health, Mental Health &Social Concerns ~!~~!!~~~L l~ll, 8:30-10, Session 1742, Lesbian Health Care Issues*; 2-3:30, Session 1835, Guidelines for Healthful Gay Sexual Activity*; 4-5:30, Session 1914, Computer Applications in School Health ~:11 e~L ~D~~l ~~~~~~ E~D~r~i~!D9 QiDD!r Ih~~!~~~L lql~, 8:30-10, Session 1973, AIDS Education and Surveillance in High Risk Communities; 8:30-10, Session 1976, AIDS in the Schools. For additional information about membership in the Caucus, write to: Alex Tonkinson, Treasurer, L&G Caucus, 3262 Redstone Lane, Boulder, CO 80303. For more information about Caucus activities, contact Brian Dobrow, L&G Caucus Chair, 90 Yukon St., San Francisco, CA 94114. ************************************************** CONFERENCE: HOMOSEXUALITY, WHICH HOMOSEXUALITY? IN AMSTERDAM, DECEMBER 15-18, 1987

An international and interdisciplinary academic congress entitled "Homosexuality, Which Homosexuality· will be held at the Free University of Amsterdam, December 15-18, 1987, and is being organized by the Research Group of Gay/Lesbian Studies at the Free University with the Schorer Foundation. The aims of the congress are: To review and discuss the current state of gay and lesbian studies research and the dilemmas facing the differing orientations to it, particularly the constructivist and essentialist approaches; To promote international collaboration in the development of academic research and documentation projects in the field of gay and lesbian studies; and to assess the practical applicability of various academic views of homosexuality in fields such as social work and equal rights policy. Workshops in four areas of study--history, social sciences, literature and art, and theology--will be formed at the congress, and a fifth section will be devoted to current issues such as social work, legislation, and government policy. In the sections on social sciences and current issues, the Schorer Foundation will coordinate workshops on theory and practice of aid to lesbian women and gay men. The closed' workshops on December 16-17 will be either integrated or segregated by sex, depending on participant's wishes. In addition to those presenting papers, these workshops may be attended by a limited number of interested researchers. Acontribution, payable on registration, will be requested" for participation in the" workshops. On December 18, lectures pertaining to the theme of the congress will be held by internationally known researchers in gay and lesbian studies and will be open to the public. In order to properly coordinate the editing, translation, and distribution of the submitted papers, congress organizers must have abstracts a considerable amount of time in advance. Therefore, a typed abstract in English of not more than 300 words summarizing the paper you would like to submit is due "by October 1, 1986. The first draft of the paper will be due by February 1, 1987 if the abstract is approved. For additional information, contact: Homosexuality, Which Homos,exuality, Free University Bezinn5ngscentrum, P. O. Box 7161, 1007 MC Amsterdam, THE NETHERLANDS (international telephone: Free University Researph Group of Gay/Lesbian Studies--20/548-3812; Marty van Kerkhof--20/258-029; Schorer Foundation--20/246-318; Anja van Kooten Niekerk--20/276-269). ************************************************** ***** THE OFFICIAL NEWSLETTER OF THE NCGSTDS * VOLUME 7:5 * JUNE/JULY, 1986 * PAGE 3 ***** *********************************************************************************************************************** 'B.A.R.E. FACTS DEBUTS CAMPAIGN with thanks to £~!~, (Computerized AIDS Information Network), 4/23/86

Bare, bathhouse and restaurant employees in Los Angeles County announced they will be launching a grassroots AIDS education campaign flying under the banner 'B.A.R.E. Facts' (Bar, Bath & Restaurant Employees). The effort is cosponsored by the C.A.R.E.S. Team of the Los Angeles Gay &Lesbian Community Services Center and Aid for AIDS. The project originated by concerned employees who work in a variety of community businesses. 'These individuals wished to volunteer their time and effort to: 1) Involve and educate owners, managers and employees of any business where individuals 'at risk' might gather; 2) Provide these businesses with a method of showing their concern by having an informed staff member and educational materials available to customers; and 3) 'Encourage businesses to promote AIDS risk-reduction and provide a 'safer environment for concerned individuals to gather and meet like-minded people,' says Hugh Rice, director of the CARES Team program. BARE Facts will be holding seven regional presentations throughout metro LA, with two hour presentations delivered by AIDS authorities and will include general information, signs &symptoms, how the virus is or isn't transmitted, antibody testing information as well as information on risk reduction techniques. Co-sponsoring organizations will also provide the participating bars, bathhouses, and restaurants with a variety of collateral materials including posters, brochures, and cards. At the completion of the training session, a certificate of acknowledgment will be awarded to the participating owners to display in their places of business. For more information, contact: CARES Team, BARE Facts Campaign, 213/464-2273. ************************************************** DC GAY MEN PRACTICING SAFER SEX, HAVE LESS ANORECTAL GONORRHEA with thanks to !h! ~~!h!~g!~ ~l~~!, 7/25/86 Dr. Peter Hawley, volunteer medical director for Washington, DC's Whitman-Walker Clinic, said he believes declining rectal gonorrhea rates demonstrate that many more area gay men are not=w practicing safer sex. Between July 1981 and 1983, said Hawley, the Clinic's VD treatment program diagnosed an average of 312 rectal gonorrhea cases every six months. During the past 6 month period, January to June, 1986, the Clinic diagnosed 110 cases. 'Anal sex [without condoms] is the highest risk for AIDS transfer,' said Hawley. Hawley noted that the number of diagnoses per six months has been declining steadily since 1983. However, statistics also show that while cases used to be evenly divided between white and black men, they are now 'more predominantly black,' said Jason Whiddon, medical services director for the Clinic. Whiddon said that while the Clinic does not keep statistics on the racial breakdown of persons who test positive for' gonorrhea, a recent breakdown of those visiting the VD clinic included 68% blacks, 28% whites, 3% hispanic, 1% others. ************************************************** NCGSTDS OPERATES AT LOSS FOR FISCAL YEAR 1986

The NCGSTDS, for the first time in its 7 year existence, operated at a $204.55 loss in fiscal year 1985-86. Although income from membership was up almost 30% from $6770 in 1984-85 to $9392 in 85-86, the cost of the public~tion and distribution of the Newsletter doubled, partially because of increased costs, but mostly because of increased size of the publication. Total number of pages of Newsletter last year was 251 (average 50.2 per issue), compared with 284 pages (average, 71 per issue) this year, excluding the present issue volume 7:5. From July 1, 1985 to June 30, 1986: Income: Membership--$9392; Guidelines &Recommendations brochure--$694 (total distributed nationwide was 4000 during thi~--fiscal year); donations--$518; miscellaneous--$125; Subtotal Income--$10,729. ~~e~n~~~~ Newsletter $8052 (printing--$5139, postage--$2800, miscellaneous--$113); Guidelines brochure--$409 (printing--$384; shipment--$25); Fact Sheet--$238; General postage--$224.86; Airfares for two yearly meetings--$306; Computer supplies--$172; Telecommunications via CAIN--$231; Long Distance Telephone via Allnet--$612; Donations/Subscriptions to Organizations/Newspapers, etc.--$285; Misc.--$404 (includes envelopes, rubber stamps, typesetting of fact sheet, PO Box reQtal, typewriter supplies, etc.); Subtotal Expenses--$10,933. Bank Account Savings--$3745.

~~l~n~~ ~b~~! (rounded to nearest dollar) year 1979-80 1980-81 1981-82 1982-83 1983-84 1984-85 1985-86 tot inc $526 $2328 $3329 $8278 $9967 $12485 $10729 tot exp 372 751 2877 7604 8817 12068 10933 Net + 154 + 1578 + 452 + 674 + 1150 + 416 - 205

The only one item that is not included in the above financial report is the estimated 'in-kind donations' of volunteer services of the Chairperson/Newsletter Editor. This amounts to an average of 20 hours weekly, or 1000 hours yearly. This amounts to a conservative $15,000 donated time per year (@$15/hour is conservative, since it includes estimated benefits as well; $15/hour is based on the estimated salary of AIDS service agencies directors, without benefits). Anyone having ideas how we can improve our finances, please contact the NCGSTDS, PO Box 239, Milwaukee, WI 53201. Remember that the Coalition is a loosely knit organization, without a concentration of working volunteers in one location. In order to undertake new projects, funds must be obtained to pay for a full-time director. Any ideas? ************************************************** ***** PAGE 4 * THE OFFICIAL NEWSLETTER OF THE NCGSTDS * VOLUME 7:5 * JUNE/JULY, 1986 ***** *********************************************************************************************************************** FUTURE OF NCGSTDS-tlHERE TO FROM HERE? by Ron Vachon, PA, (New York City) March, 1986 with cOMMents by Dennis James, PAC (Boston) &Editorial eo.ents by Mark Behar, PAC

At the recent meeting of the NCGSTDS members in Washington, DC [at the National Lesbian Gay Health Conference/National AIDS Forum, March, 1986], many questions were raised about the state of the Coalition and its future. *How can we better serve the needs of the membership? *How is the change of focus of gay STD services to AIDS-related services impacting on NCGSTDS? *Can our unique and widely acclaimed Newsletter be improved and how can we market it more extensively? *Shou1d we incorporate and become a not-for-profit organization to give us access to funding? Our decision at that meeting was to bring these questions to you, the membership/Newsletter subscribers, for your ideas and input. This article is an attempt to outline the answers to these questions, as I see them. Your reaction to what follows is of utmost importance. NCGSTDS has always existed as a mechanism for collaboration and communication. Any changes in the ways we collaborate and communicate must reflect the needs of us all.

!b! !!~!£~ ~f ~!Q§~ Increasingly, as evidenced by your communications through the Newsletter, gay STD services and providers have by necessity focused their programs on AIDS. This seems to be occurring both because of the decreasing need for STD services (the impact of safer sex) and the increasing demand for AIDS services, both education and medical services. When the Federation of AIDS Related Organizations (FARO; now renamed AIDS Action Council, AAC) was born in 1983, NCGSTDS was asked to temporarily assume responsibility for communications through our Newsletter. The AIDS section of the Newsletter that appeared thereafter has steadily grown to the point that the latest editions are almost entirely filled with AIDS-related articles. With FARO's (AAC's) recent decision to rebuild its national resource center for AIDS education and service delivery, the National AIDS Network (NAN), it is obvious to me that NAN will gradually become THE· mechanism for collaboration and communication between AIDS service organizations: NCGSTDS's membership. Even though NAN has stated that it does not wish to reinvent the ~el, they will be publishing a bimonthly newsletter, the ~~~ ~~Di~~~, a necessary part of building their network/organlzation. ~£§§!Q§ M!~~l!~~!~~ Our Newsletter has been widely acclaimed as the best single source of information on AIDS and grass roots activities on AIDS in the country. Even at the small circulation of approximately 700 copies, the quality and extent of the information in this Newsletter is undoubtedly helpful in networking and in the sheer convenience of a central source. In addition to AIDS, the Newsletter continues to serve its original role in dissemination of information about STDs. Some have suggested that the title :!b! Qffi£i!l ~!~~l!~~!~ Qf ~b! ~£§§!Q§: is one of the handicaps in marketing it to the AIDS service community. Another growing handicap may be the dramatic increase in recent months of AIDS newsletters, many of whom are much more 'slick' than ours.

Q~~liD! Qf ! ~l!D Qf £b!D9!~ 1) Incorporate the organization as a private, not-for-profit national education membership corporation, with STD and AIDS education as its primary purposes, with !ll health education as secondary. [Dennis James: Health education is very seriously missing around issues of STDs, gay &lesbian health and is not being done by anyone at present, including the National Lesbian Gay Health Foundation. AIDS education is being done but there is not coordinated effort or a common curriculum established by all the organizations] 2) Change the name of the organization to something like the 'National Coalition of Gay &Lesbian Health Services.' [Dennis James: I think the present name is fine! ED NOTE--Some have suggested that we omit all references to 'gay/lesbian' altogether from the name, to enhance our marketability to readers, skittish agencies, or potential funders.] 3) Continue the role of collaboration/communication as the focus of the organization. [Dennis James: We must continue in this role.] 4) Increase the focus of the Newsletter to include all lesbian/gay health issues by locating individuals around the country to serve as 'topic editors' and regional or local correspondents. For example, a substance abuse editor, parenting editor, AIDS editor, etc. [Dennis James: This a good idea, but finding persons to take this on may not be easy.] 5) Formalize affiliations with NAN, National Lesbian &Gay Health Foundation, caucuses of national health groups (like APHA) , etc., offering to either provide them with our Newsletter as their official communication piece (one way would be to provide them with space in each issue for their organizational info), or provide them with the 'guts' of each issue, with their own cover page(s). It's Your Turn. The questions raised here and the outline of some potential answers need to be addressed by all of you, ;h;th;r-you-~niy read the Newsletter,provide materials for publication, or attend membership meetings. We all have a stake in what becomes of NCGSTDS. Please send your comments, alternative ideas and views on the future of NCGSTDS to: Mark Behar, PO Box 239, Milwaukee, WI 53201i he will forward your comments to my office in New York. Now more than ever, we need your input. ************************************************** BONE MARROW REGISTRY PLANNED with thanks to ~~!~, 8/1/86 WASHINGTON (AP) The first national bone marrow registry in the United States is expected to be operating early next year with medical profiles on more than 50,000 people that American Red Cross officials describe as heroes. (Continued)" ***** THE OFFICIAL NEWSLETTER OF THE NCGSTDS * VOLUME, 7:5 * JUNE/JULY, 1986 * PAGE 5 ***** *********************************************************************************************************************** ~g ~8~ 8g~!§I8YL ~~!iQ~~ "The real heroes in this effort will be the men and women who agree to be listed on the registry, who will consider donating bone marrow to a person they've never met," said Dr. Jeff McCullough, director of the St. Paul, Minn., Red Cross, where the national registry will be located. "That's about as large a voluntary cOllitl8nt as society can ask of anyone," he said. "The people who are willing to do it, with no aotive of personal gain whatsoever, will make this program possible." The registry is necessary because marrow comes with different characteristics that must be closely matched between donor and recipnt to prevent rejection. The best candidates for donating marrow are brothers or sisters, preferably an identical twin. 'But if no sibling is available. the odds of a match with a random stranger are about one in 10,000, the Red Cross said. Typing bone .arrow can cost $100 per test. With odds of one in 10,000, no one could afford to search for a-donor to match a -particular patient. The only feasible way is the registry, in which volunteers can be typed in advance and kept on file, for future cOlparison with patient needs. Dr. Alfred Katz, vice president for research and development at the Alerican Red Cross, told a recent news conference that the national registry in St. Paul will build on a regional operation established in Minnesota in 1982. About 3,000 marrow donor volunteers are on file there. The Minnesota files will be suppleeented with bone marrow donor files from 30 other Red Cross blood regions and 23 non-Red Cross organizations. By the tile the full registry is under way, he said, the Red Cross hopes to have more than 50,000, typed volunteer donors on file. "The registry has the capability of greatly increasing the number of bone marrow transplants now being perforaed," Katz said. "The program will make transplantation a viable option for thousands of patients with leuk8lia and bone marrow failure' that has been impossible up_ to now." The government's Office of Naval Research awarded the $3.4 million contract in July to establish the registry, run by the Red Cross in collaboration with the Alarican Association of Blood Banks and the Council of Community Blood Centers. Once operational, the registry's cost will be covered through an administrative fee paid by the marrow recipient or his insurance. While the figures are not firm, McCullough said, the fee probably will be less than $1,000. Bone marrow transplants are not routine. But donating bone marrow the soft tissue inside bones that produces red and white blood cells can be more critical in saving a life than donating blood. It is a possible cure when leukemia or other blood disease has destroyed the marrow's cell-producing capability. Red blood cells live only a few weeks; white blood cells only a day or less. When .arrow breaks down, there are no white cells to fight infection and soon, no red cells to carry oxygen. Healthy transplanted marrow sometimes can replace the diseased marrow. But the process of donating healthy marrow is not as simple or painless as donating blood. It usually involves one or two nights in a hospital and a linor surgical procedure using general or local anesthetic. The donor receives all medical services free and is reimbursed for travel expenses. During the operation, four to eight small incisions are made in the back of the hip, and 20 to 30 extractions 'are made by a needle inserted into the hip bone through the incisions. The process takes about 45 minutes. The donor loses 3 percent to 5percent of his or her marrow, an amount the body replaces naturally within two weeks, the Red Cross said. Donors suffer no ill effects other than a sore back that may linger for days. The marrow itself is transfusel into the recipient's blood, where it migrates naturally to the bones and, the doctors hope, takes the place of the old, diseased marrow. Success rates are about 45 percent to 70 percent, the Red Cross said. ************************************************** HAITIANS RELISTED BY CDC AS RISK GROUP by Jon Nordheimer, with thanks to Ih! ~~ y~~~ Ii!!!, 7/28/86 With clusters of AIDS showing up in Florida that do not match the pattern elsewhere in the nati~n the federal Cen~ers for Disease Control is preparing to put Haitians back into a special risk classification. They wlll beCOIe .the flrst group listed at risk by heterosexual transmission, governmental medical officials say. A grea~ number ~f Ha1tians have contracted AIDS from people other than those who are considered at high risk: homosexually act1ve men, 1ntravenou~ drug users, and blood product recipients. At the same time, federal epidemiologists have noted a.small but stati~t1c~11y significant rise in cases of AIDS in non-Haitian heterosexuals infected by having sex~a~ relat1~s with people 1n h1gh­ risk groups. Dr. Harold Jaffe, chief of the epidemiology section of the CDC AIDS Act1v1ty, sald.it was not completely understood why poor, recent immigrants from Haiti appeared to be vulnerable to heteros:xual tra~sm1s~ion.other than that AIDS has already been firmly established in Haiti where, as in central Afrlca, it 1S prlMar1ly a disease of heterosexuals. ************************************************** CONDITION, NOT CRISIS--A NEED FOR VIEWING AIDS IN A DIFFERENT LIGHT by Kevin Scahill, with thanks to Honolulu's bif!liQ!!, The Life Foundation, July, 1986

A change is needed in our thinking about AIDS. Up until now, we've been dealing with AIDS as if we were in a short-term crisis situation. All of our energies were being devoted to AIDS education, AIDS research, AIDS support, etc. The general consensus was that if we did all that we could do, the crisis would get solved sooner and our friends would, stop dying. That's not happening. What is happening is that many of us are getting burned out from working all the time at crisis-level energy. The change that's needed is for us to start seeing AIDS as a £g~Qi!ig~, not a crisis. AIDS is going to be with us for a long, long time to come. We need to start seeing AIDS as just another challenge for us to live with. Our focus needs to shift from the short-term to the long-term. Our focus is not only on AIDS; it's on lifec Let us keep remembering to smell the roses and to do the best we can. ************************************************** ** ***** PAGE 6 * THE OFFICIAL NEWSLETTER OF THE NCGSTDS * VOLUME 7:5 * JUNE/JULY. 1986 ***** ********'************************************************************************************************************ JlI ..EAPOlIS SITE OF AAPHR JlEDICAL JlEETUI6S IN AU6UST. 1981

The Alerican Association of Physicians for HUlin Rights (AAPHR) will be hosting its annual lIeting and medical conference August 3-6, 1987 at the. Hyatt Regency Hotel in Minneapolis. General medical, psychological. and social topics, as well as AIDS. Additional information regarding presentation of papers, workshops. etc., will be forthcoming. AAPHR's '1986 lIdi9al conference and annual Jeeting will be held in London in August. If you are interested in additional infor.ation and are not a member of AAPHR or the NCGSTDS (you will be receiving regular updates in the Newsletters of those two groups), contact: 1987 AAPHR Annual Meeting Committee, 4617 E. 36th St., Minneapolis, MN 55406. ************************************************** IQCE-JIARROW FROIB • BMKED FOR FUTURE USE abstrlcted frOi In Idvertillllnt in the ~!! !2~~ ~!~!y!, 1/14/86 [reported here for your interest--no Cllill are .ade about authenticity! Caveat Elptor!]

The cryotechnology for long term bone marrow storage from healthy persons is now available, according to claims by the New York City .Marrow-Tech Incorporated. Presently healthy individuals (such as gay men not infected .with the AIDS virus, HIV/HTLV-III/LAV/ARV) may oow have a s~ll quantity of bone marrow aspirated from their hip, frozen to -196 degrees Centigrade, and stored in two separate locations indefinitely (as long as the costs are maintained). If needed later, as with any disease or condition that severely incapacitates the immune system (AIDS, cancer, chemo- or radio­ therapy, toxic chemical exposure, etc.), !n~ if ~h! ~!9hn212g~ f2~ ~!21i9!~!ng ~b! 2~!9Y~!2~ im!Yn! !~!~!m 9!11! i! ~!y!122!~' the marrow can presumably be used for helping to reconstitute that crippled immune system. Individuals who do not store their bone marrow now but become ill in the future may not be able to avail themselves of the replication technology if their bone marrow has become diseased. The inventors of the process, called "Marpax," are research hematologists and have published numerous research papers in hematology and related areas. Cost of the service is as follows: aspiration of marrow--$150; maintenance &storage of marrow for first year--$600; annual fee every year thereafter--$100. Recent articles regarding the possible use of bone marrow transplants for AIDS victims indicate that costs Just to find an appropriate donor for typing would be between $600-1000. It is important to stress that no one is claiming that bone marrow transplants are a cure for AIDS. If some day the technology is fully developed, then having some of your healthy marrow stored now could prove to be extremely beneficial for you. A video-tape describing the· process is available from Marrow-Tech Incorporated, and staff members are available to speak to you and/or your physiCian. For additional information, contact: Marrow-Tech Inc., New York Medical Building, 251 E. 33rd St., New York, NY 10016 (212/213-2204). ************************************************** NATURAL THERAPIES FOR CHRONIC VIRAL DISEASES The Journal of Holistic Health and the Human Energy Church are cosponsoring a series of talks on "natural" therapies for AIDS, herpes, cytomegalovirus (CMV), epstein-barr virus (EBV), and hepatitis viruses. These talks are deSigned for professionals as well as the general public. Because of the complexity of this subject, two meetings will be going on simultaneously--one for professionals and one for the general public. The professionals will have an opportunity to share research with fellow practitioners while the public will learn what factors predispose to virus infection and how nutrition affects the immune system. Speakers will present theories and research findings about the immune system and chronic viral diseases from the perspectives of medicine, nutrition, homeopathy, acupuncture, herbology, psychology and spirituality. "The Talks" will be held August 23-24 at The Cathedral Hill Hotel in San Francisco. The cost of the Talks ranges from $85-$175 for the two days depending on your professional status; registration fees increase after August 1. For extra fees, one of three special intensive sessions from 3-5 hours are available: nutrition and the immune system, choosing, growing,· and .preparing "live foods," and teaching practical study design and methods for clinical and homeopathic research. For additional information, contact: The Human Energy Church, 370 W. San Bruno Av., Suite D., San Bruno, CA 94066 (415/873-0139). ************************************************** ALOE VERA PLANT-BASED DRUG RUJIIORS STIMULATE DALLAS COMPANY'S STOCK by Craig C. McDaniel, with thanks to the ~!! !2~~ ~!~1Y!, 5/19/86

Rumors that a Dallas company is onto a possible cure for AIDS have driven the price of its stock up more than 700% in the last year. Stock in Avacare has climbed to 30.25, from 3.75 last May, Q~ll~~ !im~~ ~~~~lg columnist Irwin Frank says. Company president Clinton Howard told Frank that he can't think of anything else behind the rise in stock price, except the speculation that Avacare might find a drug that could help cure AIDS. In fact, the stock rise comes despite several negative financial statements in the company's annual report. Howard's'company has been working on a drug it calls Carrisyn, which is based on the tropical aloe vera plant. While not making any promises, Howard says the drug could stimulate the immune system. "We are talking purely speculatively, and I don't want to give the impression that we have a cure or a treatment for anything. This is all research," he ~aid. "In AIDS you're talking abqut a damaged immune system. Obviously, if you had a safe stimulant to the immune system, there would be potential there,of fighting that disease, too," Howard said, adding, "The status of this company right today is we're investigating the possibility that Carrisyn may be a safe immune stimulant and, of· course, we're very, very excited about it.' ************************************************** ***** THE OFFICIAL NEWSLETTER OF THE NCGSTDS * VOLUME 7:5" * JUNE/JULY, 1986 * PAGE 7 ***** ***********************************************************************************************************************

EDITORIAL: NUMBER OF PEOPLE INFECTED VS. DIAGNOSED by Mark P. Behar, PA-C, NCGSTOS Chairperson/Newsletter Editor Since the recognition of this terrible epidemic in 1981, health workers have been morbidly keeping track of the 'box score' of those people diagnosed with AIDS and those dying of diseases secondary to the syndrome, in the same way we kept 'score' of the fatalities during the Vietnam 'War.' For those of us in smaller communities, this in part has contributed to an active denial process among those members of risk groups who could not personalize the disease process because they did not have any close friends or acquaintances who were ill. In many ways unfortunately, it is still being considered a disease of the coasts, the big cities, of gays &drug users, of someone else, and therefore safer sex practices aren't necessary for me. This double problem, of the box-score mentality; and of the depersonalization of the victim (I don't mean to imply that people with AIDS are helpless, passive 'victims') is quite an obstacle to overcome by public health workers in areas where AIDS is still not taken very serious1y. It is now time to magnify the problem in the minds of the gay community, and begin talking about not the numbers or people diagnosed with AIDS, or mortality rate; we must now begin saying how many people are thought to be i~f!£t!~. CDC epidemiologists have often stated that approximately 10 times the numbers of those diagnosed, reflect those who have AIDS related conditions, and 10 times that number are thought to be actually infected with the AIDS virus, and extrapolating even further, perhaps 10 times that number are thought to be members of high risk groups (heterosexually active men &women and homosexually active men, along with IV/needle drug users, blood or blood product recipients, sex partners of any of the above, or infants born of mothers who are "infected). The goal of safer sex guidelines and risk reduction education is to e~!y!~t fy~tb!~ !~eQ!y~! ~~Q i~f!£tiQ~ with the virus, and in those already infected, to prevent exposing others and to maintain self-health and minimize further exposure to anything adversely affecting the immune system. Thus, it makes sense to talk of not just 22,000 already diagnosed (with about a 50% mortality), but 2,200,000 infected, i.e., 1 out of every 100 Americans!! (To those who are critical of such an estimate, remind them of those who died of AIDS-associated diseases before medical people in your locality even thought of AIDS; they were never included in the official AIDS statistics, which therefore underestimat; the scope and severity of the problem.) When people think of epidemics, they usually mention influenza, cholera, smallpox, syphilis, tuberucosis, leprosy, polio or measles, since all of these diseases devastated many, many people and adversely affected society. But AIDS seems to pale when compared to the bubonic plague, which literally wiped out as much as half of the inhabitants of medieval Europe. We do not wish to instill panic and irrational hysteria among the rest of the population, for we have already seen attempts to implement draconian disease intervention strategies (and in many cases by well meaning public health colleagues, untested and incompletely thought out strategies) such as quarantine and tatooing which would do little to contain this public health crisis. We must, however, get to those members of high risk groups and convince them that safer sex is here to stay, and that gay sexuality is still okay and fun when safer sex is religiously practiced. We must also communicate that the epidemic is growing--over 2 1/4 million are now infected! And between 10-40% of those are expected to develop AIDS or ARC within the next 3-5 years. Can we afford to deal with more panic among our gay communities? Or are they so numb already, that this message won't even register? Will we have the strength to be pallbearers for more of our friends 2 or 3 years from now because we haven't been successful in breaking down those barriers of denial? ************************************************** WORLD HEALTH ORGANIZATION CHALLENGED AGAIN with thanks to Chicago's ~i~~~ ~i!~ Ii!!!, 5/29/86

Stating that "AIDS is no more a United States gay problem than radiation is strictly a Soviet problem,' Miami activist Bob Kunst has challenged the World Health Organization (WHO) to seize the lead in the campaign to find a cure for AIDS and :0 put money behind research into the world wide health problem. According to the !b! ~!!~l~ ~!!!, Kunst's sent,ments were echoed by U.S. Health Secretary Otis R. Bowen who told delegates attending a two-week health conference that Americans are ready to cooperate fully in action against the AIDS "menace." ************************************************** NATIONAL AIDS NETWORK PUBLISHES THE ~!!QB AND RECEIVES GRANT

The National AIDS Network (NAN) is publishing the bimonthly MQ~itQ~, a professionally printed newsletter that will help to align AIDS services and providers in spirit with their colleagues elsewhere in the country, and will hope to fill in many of the gaps which exist as this new field continues to evolve. The MQ~itQ~ will contain a digest of news and features spotlighting the people, programs, and opportunities which presently make up the National AIDS Network. NAN's efforts to establish a national information clearinghouse for its members advanced when the Pacific Mutual Foundation of California awarded $25,000 for the program. The Foundation is funded by the Pacific Mutual Life Insurance Company. According to Pacific Mutual's Public Affairs Coordinator, Suzanned Gilbert-Hoehl, "We thought that NAN's communications programs represented the kind of important, long-range program we wanted to fund." The grant will provide NAN with a computer system and support personnel. Ultimately, NAN will be able to provide its member agencies with an information bank that will help them to more effectively facilitate the delivery of programs and services. The Pacific Mutual grant is part of a growing trend on the part of private and corporate foundations to makes AIDS a priority recipient of their largesse. "For additional information about NAN, or to receive the NAN MQ~itQ~, write or phone: NAN, 729 Eight Street, SE, Washington, DC 20003 (202/546-2424). ************************************************** ***** PAGE 8 * THE OFFICIAL NEWSLETTER OF THE NCGSTDS * VOLUME 7:5 * JUNE/JULY, 1986 ***** ****************~~~*************************************************************************************************** BOSTON IALl FOR LIFE RAISES OYER $300,000 by Ki. ""'i.r, with thanks to Boston', §!y ~!:!1!Y ~!!!, 6/U/86 Approxillte1y 3000 people participated in the June AIDS walk organized by Boston's AIDS Action Committee (AAC). Oroanize~s esti.ate that participants in the six li1e walk raised between $300-350,000. Fifty percent of the proceeds will go to the AAC.with the remainder being split equally among the Fenway Community Health Center's AIDS services, the New England H8IOphi1ia Association, Elizabeth Kub1er-Ross's AIDS Babies Hospice, the National AIDS Network/AIDS Action Council of Washington, DC, and the National Association of Persons with AIDS. ************************************************** WALK IN NEW YORK CITY ATTRACTS 6000, RAISES $700,000 with thanks to !b! !!!h!!:!a!9!:! @l!~!, 5/23/86 Pedestrians from every walk of like turned out May 18 for the "AIDS Walk New York," a fundraising project for the Gay Men's Health Crisis. An estimated 6000 people walked 10 kilometers, and included Mayor Ed Koch, activist Virginia Apuzzo, performer Peter Allen, and actor Joel Grey. A spokesperson for GMHC said that the wa1k-a-thon raised nearly $700,000. ************************************************** BIKE-A-THON IN SAN FRANCISCO ATTRACTS 650 RIDERS, RAISES $225,000 with thanks to !h! !!!h!!:!9!9!:! @l!~!, 5/23/86

One of the biggest AIDS fundraisers in San Francisco was organized by a bicycle club in May, according to ~!Y ~~~! 8~~~~~!~. An estimated 650 bikers rode through the rainy streets of the city, escorted by a women's motorcycle club, Leather &Blue. Bicyclists--which included a 25 person contingent from the San Francisco Police Department--covered 25 and 100 miles and raised an estimated $225,000, which will be distributed to eight AIDS service organizations in the area. **************************************************

NATIONAL AIDS NETWORK OFFERS TECHNICAL TRAINING WORKSHOP, SPECIAL EVENT FUNDRAISERS The National AIDS Network (NAN) is offering a traveling two day Technical Training Program designed for smaller AIDS service organizations, that will provide participants with training in donor solicitation programs and special event planning. In addition, the format includes a forum for evaluating existing programs, and discussing AIDS in the workplace and AIDS in the minority community. The program provides the opportunity for the AIDS service provider to develop many of the skills necessary to administer a successful program. The schedule and topics are flexible, and optional topics include "the politics of AIDS" and "the press and AIDS.' Cost of the traveling seminar is a requested $250 fee plus travel expenses, however financial cons,derations should not stand in the way of your ability to host the workshop. NAN is working out alternative means of financing the cost of the workshop and will design the final format in consultation with the host organization and will provide all training materials. The tentative schedule includes the following topics: establishing of goals for the program; how to develop a case statement for your organization for use in donor solicitation; working lunch break where small groups will develop an outline for a case statement during lunch; AIDS in the minority community and in the workplace; special event planning; erotic safer sex educational workshop; agency sharing one of their patient service delivery programs with the workshop participants; critical review of agency's pamphlets. This is new program ~hould go a long way to cut down on the duplication of efforts by AIDS service providers. If interested in hosting the workshop contact Jay Coburn, Administrative Aide, National AIDS Project, 729 8th St., NE, Suite 300, Washington, DC 20003 (202/546-2424). NAN is also hosting a series of special event fundraisers. Casey Donovan, the erotic film star known for this classic ~ey~ !!:! ~h! §!!:!g, is now featured in the new Gay Men's Health Crisis safer sex video £h!~£~ ef ! b!f!~!m~ and in the recently released Inevitable Love. Donovan has graciously consented to appear as the guest of honor at fundraising cocktai1 parties thr~~gh~~t-the ~~~~try 9~!~!~' during the coming year. These fundraisers will help publicize safer sex educational programs and to help identify new donors to local AIDS service agencies as well as helping to raise funds for NAN and the local AIDS service organization sponsor. Such events are usually held in private homes for 50-100 guests with a ticket price in the $50 to $150 range. Sponsoring groups should be dues-paying members of the National AIDS Network and assume responsibility for coordinating the event. NAN will make arrangements with Donovan and provide local agencies with technical assistance in planning special events. Sponsoring agencies are also asked to cover Donovan's air travel and lodging expenses, and split the net proceeds of the event, 70:30--10cal agency:NAN. Nan will help group the events together regionally, so that sponsoring agencies may share travel costs. If interested in holding such an event, contact Jay Coburn at NAN. ************************************************** ***** THE OFFICIAL NEWSLETTER OF THE NCGSTDS * VOLUME 7':5 * JUNE/JULY, 1986 * PAGE 9 ***** ***********************************************************************************************************************

EOOCATION GRANTS MADE BY CDC with thanks to It!! ~!!h1!!!l~~ ~l!~!, 5/23/86 The federal Centers for Disease Control made public $9.4 million in AIDS education grants to 55 states and municipalities, and announced a call for applications in another $9 million for HTLY-III antibody testing. CDC officials said the education grants also include some antibody'testing programs, which the agency has urged state and local governments to promote as a means of motivating behavior changes in people at risk for AIDS. That approach has long been strongly disputed by AIDS activists who say it detracts from direct education funding and carries threats to civil liberties. According to coe grants management officer Leo Sanders, Maryland was granted $149,728, which includes funds to test approximately 1000 people at VD clinics, '200 working prostitutes' in'the city of Baltimore, and for 8000 antibody testing kits for the state lab. Grants ranged from a low of $59,000 to Wyoming to a high of $749,000 in two grants to the city and state of New York. With those funds, New York City' will for the first time sponsor a large-scale testing program directed at drug-users and prostitutes. New York State will spend money promoting the antibody test and on AIDS education in a variety of settings, including a suggested curriculum for public schools. ************************************************** FEDERAL PORNO REPORT CONDEMNS ADVOCATE, PREGNANT LESBIANS, MEN KISSING by Lou Chibbaro Jr. with thanks to It!! ~!!hi!!!l~~ ~l!~!, 7/11/86 Gay Rights leaders joined civil liberties advocates in criticizing the final report prepared by Attorney General Edwin Meese's special commission on pornography. The text of the 1,906-page report did not include specific sections on gay­ related pornography or homosexuality, but it did contain the names of gay adult-oriented magazines among its list of more than 3000 publications found in 'adults only' bookstores in six cities. The report also included the name of the gay news magazine Ib~ ~gYQ~~~~ among those publications, claiming that its failure to distinguish a gay publication that specializes in news and feature stories from publications specializing only in sexual matter shows that the commission is biased against gays. In a section in which it provides details of the contents of magazines and films found in 'adults only' bookstores, the report includes graphic descriptions of sex acts between gay men and between lesbians as well as between heterosexuals. In one of its descriptions, the report describes a photograph which depicts 'two naked caucasian males standing together kissing.' The commission describes another photograph depicting 'two obviously pregnant, partially clothed, caucasian females, kissing with their tongues, and their distended abdomens touching.' Jeff Levi, executive director of the National Gay and Lesbian Task Force, said he is concerned that the commission's recommendation that citizen's groups form to file complaints, place pressure on prosecutors, and boycott merchants in an effort to crack down on sexually-explicit literature could have a spill-over effect on gay publications. Levi and Carole Vance, a Columbia University anthropologist who has followed the pornography commission's deliberations, said such citizens committees may view gay-oriented literature in general as 'obscene' even though such literature may contain little or no sexually-explicit material. Washington gay/lesbian bookstore owner Deacon Maccubbin said he would 'go to jail' rather than obey any censorship restrictions that may emerge from the porno commission's recommendations. Three of the key figures involved in the commission, called the Attorney General's Commission on Pornography, ~~ve been involved in police investigations of gays in the Washington area. The commission's chairman, Henry Hudson, prosecuted employees of gay male escort services on prostitution charges while he served as Arlington County Commonwealth's attorney. Two of the commission's investigators, DC police Detective Joseph Haggerty and Arlington police vice Detective Edward Chapman,also have investigated gay escort services and made arrests of gays on prostitution-related charges. ************************************************** JUSTICE DEPARTMENT OPINION THAT AIDSPHOBIA &DISCRIMINATION NOT ILLEGAL by Jim Kiely, with thanks to Boston's §!~ ~Qmm~!!!~~ ~!!!, 6/29-7/5/86 and by Rick Harding, with thanks to It!! ~!!h!!!!l~~ ~l!~~, 6/27/86

!n a June 20 memorandum to the Dept. of Health and Human Services, the Justice Department stated that federal civil rights laws do not protect people with AIDS or others at risk of contracting the illness from discrimination by employers. Making a distinction many activists regard as facetious, the memorandum states that it would be illegal to fire or exclude a person from a federal program or federally funded entity solely because they have AIDS or are at risk, but it would not be illegal if the person was feared to be capable of transmitting AIDS. The decision, which greatly differs from earlier recommendations made to the Justice Dept. by legal and medical experts, has been met with a flurry of protest. In preliminary'recommendations to the Department two weeks before the June 20 opinion, staff lawyers suggested that PWAs be recognized as handicapped because of the severe physical toll the illness takes, and that they by protected from job discrimination under Section 504 of the Federal Rehabilitation Act of 1973. The Act protects the handicapped from discrimination in federal programs or by schools, hospitals, employers, etc. that receive federal funds. Citing previous reports from the Centers for Disease Control and other health organizations, the lawyers deemed the risk of transmission of AIDS in the workplace to be negligible and therefore, invalid as grounds for dismissal from employment. In the Justice De~t. opinion, only one of these recommendations was followed. Although the memo stated that PWAs may be considered handicapped, and thus, protected under Section 504, it also concluded that 'an individual's (real (Continued) ***** PAGE 10 * THE OFFICIAL NEWSLETTER OF THE NCGSTDS * VOLUME 7:5 * JUNE/JULY, 1986 ***** *********************************************************************************************************************** ~~§!!~~ ~e~8~! gf!~!9!L Qgn!inY~ or perceived) ability to transmit the disease to others is not a handicap within the meaning of the statute, and therefore, that discrimination on this basis does not fall within Section 504. The CDC and DHHS have consistently stated that AIDS is not spread through casual contact. However, the Justice Dept. appears to have, interpreted the medica1.data as 'medical uncertainty.' The opinion states that any person alleging discrimination on the grounds they have AIDS or are at risk for AIDS must prove they pose no threat. 'The risk of medical uncertainty must be borne' by the person alleging discrimination. In a joint statement released immediately after the Justice Department decision, the CDC and DHHS reiterated the position that 'employees, employers and others can be assured that (HTLV-III] is not transmitted by casual contact within the workplace or school. Reaction from lesbian/gay civil rights activists to the Justice Dept. statement has also been swift. Leonard Graff, legal director of the San Francisco-based National Gay Rights Advocates, told §~~ the opinion is clearly 'based on politics rather than jurisprudence ... The Justice Dept. does not want to seem to be catering th homosexuals, so it has--against the advice of its own 1awyers--p1ayed up a chance of transmitting AIDS through casual contact. It's legitimized homophobia,' Kevin Cathcart, executive director of Gay & Lesbian Advocates and Defenders of Boston, concurred, calling the decision 'a means by which an employer could keep gays out of the work force ... by trumping up concern for employees health.' Responding to the Justice Dept. 's admission that a 'real Q~ ~!~£!iy!g threat of AIDS transmission would be grounds for firing, Sarah Wunsch, director of the Cambridge, Mass. Human Rights Commission, called the opinion 'absurd.' 'If the decision were to be applied to other people who are protected from discrimination, its absurdity would be obvious ... Can you imagine an employer saying, 'I don't hire blacks ••• because (I'm scared] they may transmit sickle cell anemia to our employees?'· While activists agree the opinion fuels workplace discrimination and adds to the misinformation about AIDS transmission, its legal impact remains debatable. The opinion is not a legal ruling, but an interpretation of the law that can be superseded by judicial decisions. In addition it would not affect workplaces that receive no federal funds. According to Abby Rubenfeld, legal director for Lambda Legal Defense and Education Fund in New York, the opinion actually carries little weight because it has not yet been tested in a court of law and because it 'blatantly contradicts health findings of both the Centers for Disease Control and the Dept. of Health and Human Services.' In New York, where Attorney General Robert Abrams issued a press release condemning the Justice Dept. memo;/ state civil rights laws prohibiting discrimination are expected to prevail, according to his office. Abrams' press release accused the Justice Dept. of adopting a 'tortured reading' of Section 504 'in order to exclude a disfavored group from coverage.' In Boston, the City Council adopted a resolution on June 26 by a vote of 8-4, that emphasizes the strength of state and city law to protect any person facing discrimination. The resolution, drafted by gay councilor David Scondras, 'advises employers to adhere to guidelines established by the City and State Departments of Health and the CDC regarding employment.' However, in an allusion to the possible effects of the Justice Dept. 's statement, the resolution concludes, 'until the Justice Dept. clarifies its ruling so as to indicate that people with AIDS are those perceived to be at risk are protected from discrimination, those who undergo AIDS-related diagnostic procedures should seriously consider the need for absolute anonymity.'

The legal significance of the opinion has been greatly overemphasized, according to to legal experts familiar with government anti-discrimination policies. The memo does not preclude people with AIDS, AIDS-related complex, or the HTLV­ III antibody who are fired from their government or government-funded jobs due to the illness from filing handicap discrimination suits. Nor will the weight of the Justice opinion necessarily make it more difficult to win such suits, the experts say. But the experts agree with gay and AIDS activists and health officials that the real significance of the document is its message to the public that AIDS might be transmitted through casual contact and, therefore, that it is permissible to discriminate against PWAs. According to one federal attorney who handles discrimination complaints for the government, the Justice Dept. opinion will be used by government lawyers to justify firing people with AIDS, if they can win cases with it. The attorney, who refused -to be identified, said that government lawyers use 'the ~Q~~!~ as our guide,' and noted that 'there are plenty of Justice (Department] opinions sitting around out there that we no longer use because they are absurd.' DC attorney David Shapiro, who has represented numerous federal employees in discrimination claims against the government, said he feels that judges will find the opinion illogical. The opinion, written by Assistant Attorney General for the Office of Legal Counsel, Charles Cooper, asserts that although AIDS itself may be a handicap, a person's ability to transmit the disease to others is not a handicap, and employers can fire people with AIDS as long as their reason for doing so is fear of transmission. By producing eminent witnesses, including government researchers, who agree that AIDS is not transmitted through casual contact, Shapiro said he feels it would be 'easy' to discount the Justice Dept. reasoning. Government researchers and public health officials have condemned the Dept. 's opinion which they say refuels public hysteria over AIDS. A statement on which the Justice Dept. opinion pivots, and which is considered especially controversial by health officials and AIDS Activists reads, 'It has been suggested, however, that conclusions of this character (that AIDS cannot be transmitted through casual contact] are too sweeping.' The memo cites two footnotes for the statement which some feel were taken out of context. The first' footnote quotes an article by John Parry in the Mental and Physical Disability Law Reporter as saying, 'Those ,experts who have attempted to give the public the impression that the medical profession is certain how AIDS is transmitted ... may have gone too far in attempting to quell the public's fears.' The citation fails to include, however, the sentence which immediately follows it in the article that says, 'Those individuals who have asserted that'there are reasonable dangers of exposure in public places have definitely gone too far in the other direction, need1ess1y'stirring up public fears.' The second footnote quotes Harvard research scientist Dr. Myron Essex as saying, 'The CDC •.. has been trying to :nform the public without overly alarming them .... Bu~ we outside the government are freer to speak, .The fact is that the dire predictions of 'those who have cried doom ever since AIDS appeared haven't been far off the mark.' !b~ ***** THE OFFICIAL NEWSLETTER OF THE NCGSTDS * VOLUME 7:5 * JUNE/JULY, 1986 * PAGE 11 ***** ***********************************************************************************************************************

~~§!!~~ ~~eA8~~~! Qe!~!~L ~~~inY~ H!~ yg~~ !!~!! M~g~!!~! article from which the quote was drawn, however, does not mention casual transmission but instead goes on to elucidate Essex's belief that AIDS can be transmitted through heterosexual contact. Justice Dept. Attorney Gary Lawson, who conducted research for the Department's opinion and prepared the memo's footnotes, said that the Dept. 's feels that the footnotes were not taken out of context. "We made no attempt to say that actual transmission of AIDS is possible," Lawson said. "We just said that, theoretically, it is not impossible." ************************************************** JUSTICE DEPARTMENT IGNORED AGAIN by Peg Byron, with thanks to !b! ~!!h1ng~gn @l!~!, 7/18/86 and with thanks to the ~!! Y2~~ ~!~1!!, 7/21/86 State and local officials around the country continue to denounce the recent U.S. Justice Dept. opinion that AIDS does not fall under federal protections from employment discrimination. New York City Human Rights Coamissioner Marcella Maxwell said at a recent press conference that since the Justice Dept. announced its opinion her office has received "numerous calls" asking whether discrimination against people with AIDS was still illegal. The Justice opinion affects the federal government and employers receiving federal money but is not binding on state and local hUMan rights policies. "The Commission wants to reassure the people of this city that AIDS-related discrimination will not be tolerated," Maxwell said. New York City Health Commissioner Stephen Joseph joined her, and criticized the Justice Department for "undermining AIDS education efforts and ... inadvertently fostering the irrational fears of the public at large." In Minnesota on July 2, the state's Dept. of Employee Relations (DOER) issued a statement declaring that "AIDS will be treated the same as any illness in the workplace." In pointed contrast to the Justice Dept. view, the Minnesota DOER adopted the guidelines of another federal agency, the Centers for Disease Control, emphasizing that AIDS is not transmitted through normal workplace contact. Just two week s earlier, the OOER issued another state workplace protection which forbade harassment on the basis of sexual orientation. The protection in state employment already existed for a range of categories including race, creed, religion, sex, and disability. In Metropolitan Washington, DC's Montgomery County and "Alexandria officials have already announced that AIDS will continue to be treated as a disability for the purpose of discrimination protection. The District of Columbia has not yet offered an interpretation of the Justice Department opinion.

Others have ~onde~ned the Justice Dept. opinion. The Boston City Council said that the opinion "only serves to exacerbate. lrratl0n~1 fear and fosters a sense of distrust among groups whose voluntary cooperation is critical in the battle agalnst AIDS." Boston and Massachusetts law still offers protection from discriaination. The commissioner of New :ork S~ate's Division of Human Rights, Douglas H. White warned that the opinion does not release the. fro. compllance wlth that state's human rights law. The National Coalition of Lesbian and Gay Elected Officials issued thei first ~t~teme~t since their conf~rence in West Hollywood last November, and called the decision "a calculated attack ~ the. Cl~ll .rlghts of peopl~ wlth AIDS and those perceived at risk" and "counter to the interests of public hedlth and soclal Just~ce. The ~e~01utl0n.urges those concerned to contact the Department of Health and Human Services and insist that they lssue an 0~lnl0n forbldding AIDS-related discrimination. Address mail to: Secretary Otis Brown, Dept. of Health and Human Servlces, 200 Independence Av., SW, Washington, DC 20201 (202/245-6296); copies of correspondence are asked to be sent to: Elected Officials Call to Action, National Gay and Lesbian Task Force 1517 UStreet NW Washington, DC 20009. ' " ************************************************** RISING COSTS OF LIABILITY INSURANCE FORCES AGENCIES TO SELF-INSURE with thanks to the ~2! ~g!l!! !i!!! §!~!1g!, 7/20/86

Al~n Rodda, vice-president for human resources at the American National Red Cross said that because of the AIDS scare, the Red Cross expected to lose all insurance coverage for its blood programs and was planning to self-insure. The Red , " Cross has never been sued in connection with its disaster relief activities, Rodda said. But it has seen a sharp increase in its liability rates for its water safety instructional programs, and its "biggest challenge" is expected with its blood bank operations. Executives of the national organizations of several youth service agencies--including the YMCA, Girls Clubs of America, Camp Fire Inc., and 4-H, say the soaring cost of liability insurance is driving some of them to consider self-insurance or to cancel some of their more risky youth activities. A Boy Scouts of America official said Los Angeles scouts had imposed a special $20 a troop surcharge to help pay a national liability insurance bill that has gone from $2.7 to $9.8 million in the last year. Even with the surcharge, higher risk programs, such as scuba diving and aviation had to be dropped. Marge Gates, national executive director of the Girls Clubs of America said that despite having 250,000 participants in its programs at 240 nationwide operating centers, they decided they were too small to self insure. She said the organization was considering joining other groups in forming an insurance company to provide liability coverage at wholesale rates. ************************************************** ***** PAGE 12 * THE OFFICIAL NEWSLETTER OF THE NCGSTDS * VOLUME 7:5 * JUNE/JULY, 1986 ***** **********************************************************************~************************************************

MEGARAFFLE IN. NEW YORK TO BENEFIT 6 AREA AGENCIES

A clever fundraiser dss:gned to support 6 New York area gay/lesbian agencies in their efforts to meet the medical, legal, political, educational, cultural, and social needs of the community. Some of the prizes include $5000 cash, a one week vacation for 2 by air to Puerto Rico, a show jacket from Lily Tomlin, compact disc player, and dinners, clothes, home furnishings, original art works, books, flowers, champagne and thousands of dollars worth of additional prizes. The funds will benefit: Gay Men's Health Crisis Inc., The Institute for the Protection of Lesbian and Gay Youth, Inc. and the Harvey Milk School, Lambda Legal Defense and Education Fund, Inc., The Lesbian and Gay Community Services Center, Inc., The National Gay/Lesbian Task Force--The Fund for Human Dignity (national gay/lesbian crisisline &AIDS hotline), and Senior Action in a Gay Environment (SAGE). Megaraffle coupons only cost $2.00 each, with a book of 6 coupons for $10.00, with the drawings scheduled for July 13th. For additional information, contact: IPLGY, 112 East 23rd Street, 4th Floor, New York, NY 10010 (212/473-1113). **************************************************

HEALTH OFFICIALS ADMIT PHS ASKED FOR TOO LITTLE MONEY by Peg Byron, with thanks to !h! ~~!hing!Qn ~l~g!, 7/4/86 During a tense moment in a congressional hearing on AIDS treatment research, recently, federal health officials admitted that the government was not doing all it could to find a cure for the usually fatal condition due to a lack of funds. The acknowledgment came only a day after the same officials, with new Assistant Secretary for Health Robert Windom, held a press conference announcing a five-year, $100 million treatment evaluation program. Dr. Walter Dowdle, coordinator of the Public Health Service AIDS Task Force said under questioning at the hearing that his agency could effectively spend more on AIDS research if it had the funds, and even with money added by Congress to the amounts requested by the Reagan administration funding is insufficient. The Health and Human Services Dept. has requested $213 million for AIDS in fiscal year 1987; it initially asked for $126 million last year and received $247 million. Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases (NIAID), who also chairs an interagency task force on experimental AIDS drugs, admitted at the hearing that 5 out of 19 qualified applicants to the new treatment evaluation program went unfunded. 'We probably would be able t~ use more than the 14' treatment evaluation centers that received grants recently, said Fauci. Rep. Sander Levin (D-Michigan) asking Fauci to be candid, questioned why more facilities were not being utilized. Fauci responded, after Levin rephrased the question several times, 'One of the reasons probably could be the limited resources.' 'Money?' Levin asked. 'Yes,' Fauci said. Fourteen medical centers around the country were awarded contracts to study the effects of experimental drugs on AIDS patients. The program will spend $20 million in its first year, involVing up to 1000 patients in controlled clinical trials, and linking researchers with a computerized database system. Fauci estimated it would cost an additional $10 million to fund the other five qualified grant applications. According to PHS estimates, 3000 people are in drug trials now, out of about 10,000 surviving people with AIDS. Over 12,000 people have died since 1979. The hearing, before Rep. Ted Weiss'(D-NY) Subcommittee on Intergovernmental Relations and Human Resources, also strongly criticized the government's withholding of experimental drugs from people with AIDS who are not in research programs, and the use of placebos in studies where a drug shows some promise. Paul Popham. a founder and past president of the Gay Men's Health Crisis. one of the country's first AIDS service organizations. testified about the frustration of patients and doctors who cannot get timely and accurate information about experimental AIDS drugs. Many people with AIDS, said Popham, 'feel there is a point of time where they may go past the point of no return' in their illness while waiting to get into a drug research program. Popham, who has recently been suffering from AIDS himself, criticized the lack of information coordination between drug companies, scientists, and private physicians. Popham was joined in his testimony by a man from Ohio, identified with the pseudonym 'John Smith,' who testified from behind a screen. Because he is from an area with relatively few--about 160--AIDS cases Smith said he was 'unable to secure any experimental drugs that might prolong my life. 'I am sure you agree, that it makes no sense to restrict the availability of drugs when a person is terminal ... And I, for one, do not want to physically decline to a point when I can no longer get out of bed without help before a drug becomes available on a compassionate basis,' said Smith. Compassionate use of experimental drugs, widely practiced for cancer patients, allows treatment with promising drugs by physicians outside of research programs. Weiss asked Smith if he or anyone he knew would take an experimental AIDS drug, even at risk of worsening rather than improving his condition. Smith said he and 20 others in an AIDS group in the Cleveland area would be 'quite willing' to take such a risk. A panel of scientists, including Dr. Mathilde Krim of the American Foundation for AIDS Research (AmFAR), and Dr. Robert, Levine, a Yale medical ethics expert, criticized as inhumane the lack of drugs available on a compassionate use basis. Krim called the scarcity of quantities of experimental drugs such as AZT (azidothymidine), produced by Burroughs-Wellcome Pharmaceuticals, 'artificial' and 'farcical.' Federally-funded AIDS drug studies usually use placebo controls, but are being increasingly criticized as cruel for withholding potentially helpful treatment from people who are terminally ill. 'Placebo-controlled trials in patients with fu1l-blown·AIDS are morally unacceptable,' Krim said. "A physician's first obligation is to the life and well-being of his patients, not to 'objective clinical data',' ************************************************** ***** THE OFFICIAL NEWSLETTER OF THE NCGSTDS * VOLUME 7:5 * JUNE/JULY, 1986 * PAGE 13 ***** *********************************************************************************************************************** ALUMNI OF LOS ANGELES GAY &LESBIAN COMMUNITY SERVICES CENTER REUNION with thanks to Ih! ~!Q!!~ ~!!!, of the LAGLCSC, July-August, 1986 Have you been a staff member, board member, or volunteer at the Los Angeles Gay &Lesbian Community Services Center during the last 15 years? If so, you are invited to attend the Center's 15th anniversary celebration this fall. For additional information, contact Ron Shigaki, 213/464-7400 x251. ************************************************** 'NOW I KNOW BETTER •.• • anonymous letter to the editor, with thanks to In! ~!!n!ng!~n @l!~!, 7/4/86

Up until this morning, I was operating under a very dangerous and foolish misconception about so-called 'safe sex' that I feel I must share in the hope that it will enlighten and inform others. Being basically a 'top,' I was under the false impression that while it was imperative that condoms be used at all times, I honestly understood it to mean only after intercourse was well underway and nearing climax, that it was perfectly fine to indulge in sex initially unprotected [without condom], as long as no climax was reached. Imagine my shock when I was diagnosed with a classic case of frontal gonorrhea--all the while expressing amazement to my doctor that yes, of course I always used condoms! What I didn't tell him was that I did not use them upon the initial insertion. Please note for your own safety and that of your partner--absolutely, positively no insertion can be allowed without a condom, not even for five seconds. I always considered myself extremely well-versed and well-read on safe sex, but somehow this little tidbit slipped by me completely. Surely if the VD [germ] can be transmitted in this way, so too can the AIDS virus. Now I know better--and so do you. ************************************************** REFLECTIONS ON SADNESS AND LAUGHTER by Allen Pugh, PWA Activities Specialist with thanks to e!~~l! ~!!n ~!Q§ ~~~!!! from Shanti Project and San Francisco AIDS Foundation, July, 1986

On many occasions, my Emotional Support 'Client' and I get into some really heavy conversations. We talk about getting in tough with his fears about death and dying, physical concerns, and getting his affairs together. As I talk with other people with AIDS, their family members, friends and 'significant others,' some of those same fears are shared. I am often reminded of a poem by Viola Meakin, entitled: 'Laughter.' 'My heart is like a little lake, Sun kissed and laughing in the light, With banks full brimmed, whose rushes shake With mirthful murmurs day and night: Whose breeze-blown waters flow before To lap the wild and wooded shore With little gurgles of delight.

'So may my soul, when days are gray, Reflect the smiles of God and men, Though sorrow may upstir the day By waters wide of lake and fen. So may I face the winds of fate With joyous faith articulate, And ripple into laughter then.'

So, when days are gray, I try reflecting on the beauty of nature, that friendly smile from a stranger, that friend who is always there, and try to open up and allow the healing experience of laughter to take its course. [For more information about e!Q~l! ~!!b ~!Q§ ~e~~!!, contact: Shanti Project, 890 Hayes St., San Francisco, CA 94117 (415/558- 9644). ************************************************** ELIZABETH TAYLOR SEEKS AIDS FUNDING FROM SENATE with thanks to In! ~~!h!ng!Qn ~l~~!, 5/9/86

Actress Elizabeth Taylor was the star on Capitol Hill, testifying before a Senate appropriations subcommittee to urge 'very significant increases' in funding the AIDS and other biomedical research for fiscal year 1987. Taylor, founder and national chairwoman of the American Foundation for AIDS Research (AMFAR), called on the Senate to approve $50 million for the development of an AIDS vaccine and a '10-fold expansion' of federal programs to develop drugs to treat AIDS. Speaking to the Senate appropriations subcommittee in a packed hearing room, Taylor said that since her friend, actor Rock Hudson, died of AIDS last year, she has 'become familiar with the tragedy of AIDS and acutely aware of research funding needs." Taylor said that her own foundation could only fund 'a fraction of the [150] worthy' AIDS research proposals it has received: Taylor criticized the Reagan administration's budget proposal for FY '87, as 'making no sense.' Reagan has called for $213 million for AIDS programs in FY '87--about $30 million less than approved for FY , 86. ************************************************** ***** PAGE 14 * THE OFFICIAL NEWSLETTER OF THE NCGSTDS * VOLUME 7:5 * JUNE/JULY, 1986 ***** ***********************************************************************************************************************

BLACKS HOLD NATIONAL AIDS CONFERENCE by Rick Harding, with thanks to !h! ~!!ning~Qn ~l!~!, 7/25/86

The reluctance of blacks to recognize the extreme effects of AIDS upon their won community, and the scarcity of AIDS programs targeting directly to blacks has led to an inordinate number of blacks contracting the fatal disease, said speakers at a national 'AIDS in the Black Community' conference held July 18 in Washington's Convention Center. Health officials told the over 400 conference participants that the latest statistics show that blacks comprise 25% of the country's AIDS cases, but only 12% of the overall U.S. population. The rest of the nearly 12 hour conference, the first of its kind in the nation, discussing what has caused those disturbing statistics and what to do about it. In his opening remarks, Gil Gerald, executive director of the National Coalition of Black Lesbians and Gays (NCBLG), which sponsored the conference, said that AIDS is an issue that the black community has "kept in the closet.' The black community's hatred of gays, he said, has caused a denial of the epidemic's existence int he black popu1at.ion. Gerald said that even thought the AIDS crisis is now five-years-01d and is affecting blacks in such great numbers, no major black organization would agree to endorse the Conference. Besides the black community's own denial of the crisis, another major factor causing an escalation of the disease among blacks, according to Gerald and other conference speakers, is the lack of AIDS programs directed specifically at blacks. According to panelist Dr. Benny Primm, president of the Urban Resource Institute in New York City, AIDS is the second leading cause of death in Harlem. But 'not one program exists for education or prevention of AIDS in Harlem,' he said. Panelists in a workshop session on AIDS education for black gay men agreed that white gay-dominated AIDS education organizations are not reaching blacks. Many blacks who are gay identified with black culture rather than gay culture, said California psychologist Dr. Julius Johnson, and consequently are not reached by educational strategies directed specifically at the gay community. Other panelists said that many black men have sex with other men but do not consider themselves gay and therefore, feel they do not have to concern themselves with a "gay problem," such as AIDS:. The panelists also said they believe only those who understand black culture can adequately reach blacks with AIDS education. Henry Chinn, founder of Black Men's Association in Boston, said he believes it is essential for AIDS organizations to elicit the help of black churches in distributing AIDS information. 'Black gays are the bastions of the church,' he said. 'They are the choir members, the deacons, the leaders," Chinn said. Moreover, heterosexual women church members often prove helpful in getting AIDS education into the churches. Tim Offutt, a member of Chicago's AIDS education organization, the Kapuona Network, said his group has successfully sponsored "safer-sex parties," modeled after Tupperware parties, in which 10 to 12 friends are invited to a private home and an AIDS education organization makes a safe-sex presentation. Several panelists suggested that public service announcements on television and radio have been shown to be effective in reaching the overall black community, including black women and IV drug abusers who are also at high risk for AIDS. The panelists emphasized that black organizations and white organizations with a sufficient number of black staff members are the only groups that can reach blacks with AIDS education, and that those groups require government funding to operate effective programs. In a speech before the entire conference, D.C. Mayor Marion Barry said that he recognizes the importance of funding minority AIDS education efforts and that the District has granted a contract for that purpose to a local communications group together with two black gay organizations. When asked about the grant by a reporter after the speech, however, Barry said he did not know why the minority education contract has not been signed, four months after applications for the contract were turned into the city, or why the amount of the contract and its provisions have not been announced. !~~ ~~~~i~g!Q~ ~Q~! reported that it had learned the city was spending $92,874 on the contract. Organizers of the. conference said they believe leaders of AIDS groups with effective black education strategies were able to reach others at the conference who needed information. NCBlG's conference organizer, Craig Harris, said that among the over 400 conference participants from 30 states and Brazil were numerous employees of mainstream AIDS groups and over 30 members of the clergy. Harris also noted that extensive coverage by mainstream media, including newspapers and television stations from Washington, Philadelphia, and new York, helped communicate the urgency of the situation to the public and legislators. [ED NOTE--Reports of the conference were also distributed nationwide by news agencies.) NCBLG Director Gerald and several other AIDS activists met with Surgeon General Dr. C. Everett Koop about increasing AIDS funding for minority education. Harris said he hopes the success and publicity of the conference will encourage major black organizations, such as the' NAACP, the National Urban League, and the Southern Christian Leadership Conference--all of whom refused to endorse the conference, to address the AIDS crisis among blacks and to sponsor efforts to combat it. [ED Note--E1sewhere in this Newsletter, the Southern Christian Leadership Conference (SCLC) is reported to have sponsored a national forum on the AIDS crisis and the black community.] ************************************************** HIGH SCHOOL STUDENTS DON'T KNOW AIDS FACTS with thanks to Detroit's ~~~f!!, 7/23/86

Most high school students are misinformed and have 'scientifically unfou~ded" worries about AIDS, a new ~~le University survey shows. And 80% of the 349 Connecticut students surveyed admit they don't know much about ·the disea,se and lIIould like more information. 'Kids are reflecting information or misinformation that they've received from parents," says Christopher C~nnon, Bridgeport, Connecticut, health director. The study shows 55% thinks AIDS victims shouldn't teach, and 45% say students with AIDS should be kept out of .school. . ************************************************** ***** THE OFFICIAL NEWSLETTER OF THE NCGSTDS * VOLUME 7:5 * JUNE/JULY, 1986 * PAGE 15 ***** ***********************************************************************************************************************

SPANISH AIDS HOTLINE IN LOS ANGELES with thanks to the ~!~ YQ~~ ~!!i~!, 7/7/86 Los Angeles City Councilmember Michel Woo has won approval for funding a Spanish-language AIDS hotline. The funding will cover the operation of a 24-hour hotline for six months. The hotline is part of the AIDS Project/los Angeles. Funding is part of the total budget for the city during fiscal 1986-87. Woo pointed out that an estimated 13% of the AIDS cases reported in LA are from the Hispanic community, andOthat approximately 5000 of the calls received by the present hotline each month are from Hispanics, according to ~eq~!~· ************************************************** NATIONAL MINORITY AIDS COUNCIL by Stephanie Poggi, with thanks to Boston's §!~ ~Q~~i!~ ~!!!, 6/28/86

A National Minority AIDS Council was formally established here, June 10, at the conclusion of a two-day meeting on people of color and AIDS sponsored by the National Institute of Mental Health and the National Lesbian and Gay Health Foundation, According to black gay Reverend Carl Beam, a member of the new council and director of the Minority AIDS Project in Los Angeles, the Council will serve as a vehicle to 'express and address the needs' of people of color with AIDS, Beam stated that despite the 'millions of dollars generated to deal with AIDS,' most people of color still lack

information about the illness. He added that while AIDS continues to be perceived as 'white gay disease,' it is ° disproportionately hitting communities of color. Not only are gay men of color disproportionately affected, but 75-80% of women with AIDS are of color and 60% of infants with AIDS are black. Craig Harris, coordinator of the upcoming national conference, 'AIDS in the Black Community,' scheduled for July 18 in Washington, also commented on the high numbers of women and children of color with AIDS. He said, 'Gay people of color are as concerned about the children and (heterosexual] women who have AIDS as they are about the gay people' who have the disease. Harris said it would be the work of the council to undertake coalition-building between communities of color, national organizations such as the National Coalition of Black Lesbians and Gays, local gay organizations and local groups of people of color, government agencies and health workers of color, government agencies and health workers of color. He added that networking will help groups to share information about existing programs and to expand services. Beam said the council also intends to produce 'culturally sensitive' material to reach communities of color and to lobby that funds for AIDS education go to 'people who know what the issues are (in our communities.]' ************************************************** ATLANTA BLACK &WHITE MEN TOGETHER HELP EDUCATE COMMUNITY ABOUT AIDS by Richard Bono, with thanks to !~! 4Q~~~!1 Qf ~!~ ~!l!~!!, May, 1986

Central to AID Atlanta's (AIDA) efforts to educate blacks about the spread of AIDS is the cooperation it receives from the Atlanta chapter of Black and White Men Together (BWMT). With 115 members, the local group has produced an active AIDS education committee that has conducted risk reduction 'parties' and disseminated news releases and broch~~es about AIDS throughout the gay and straight black communities of Atlanta. "I believe BWMT has a genuine concern about what happens in the gay community,' said Duncan Teague, chairman of the AIDS education committee. 'Because of our concern for the lack of information reaching the minority community,' he said, 'it wasn't hard forming this committee and getting a lot of support.' Established a year ago, BWMT's AIDS education committee has been able to reach Atlanta's

black gay community in ways other groups have not. ° 'BWMT has done quite a bit,' said AID Atlanta Director Rev. Ken South. 'They have provided AID Atlanta with many suggestions on how to reach the black gay community. We could not have made the inroads we have without BWMT." Teague says part of BWMT's success is due to the fact that 'there is nowhere else to turn if you want to reach black gay men (who are] organized.' He nonetheless laments that even their best efforts to educate black gays often hit a dead end. 'Many black gays are ignorant of the facts that concern them,' he said. 'I think because the same creativity that has been used to get the message to white gays has not been used to get the message to black gays, that there is a misconception among a large group of black gays that AIDS is not something they should be concerned with--that it is somehow a white man's disease.' Recent statistics from the CDC reveals that black Americans account for 25% of all American AIDS cases, compared to making up only 12% of the population. Other roadblocks BWMT has encountered involve those black men in the straight community who engage in occasional homosexual behavior, but do not consider themselves gay. "These are the people that are very heard to reach,' said Teague. 'If a brochure about AIDS has the word 'gay' on it, they think they have no reason to pick it up. Or they are even repelled at the idea." The often negative reaction of the straight black community to BWMT limits the group's impact, Teague said. 'Making inroads into the larger black community in Atlanta is difficult,' he said. 'It isn't always comfortable for our members to make their gayness known or their involvement with BWMT." Teague says the blacks that compose roughly half of BWMT membership are not necessarily estranged from the larger black community, but they do not travel in those circles.' In fact, Teague said, 'In our particular organization, I have found, paradoxically, that our white members often have inroads into the black community where our black members do not.' BWMT is an interracial group wh~se membership Teague related amusedly "is so diverse you wouldn't believe.' The chapter's membership includes doctors, lawyers, students, laborers, performers, and said Teague, 'to people who wait tables and dream impossible dreams." , ' ************************************************** ***** PAGE 16 * THE OFFICIAL NEWSLETTER OF THE NCGSTDS * VOLUME 7:5 * JUNE/JULY, 1986 ***** *********************************************************************************************************************** HUMOROUS APPROACHES TO AIDS PREVENTION EDUCATION SOUGHT with thanks to CAIN, (Computerized AIDS Information Network), _/19/86 Anyone knowing of any approa-cnes or citations of educational materials or campaigns for AIDS prevent jon education, using humor to get the messages across, please contact NCGSTDS/Ron Mazur, PO Box 239, Milwaukee, WI 53201 or leave electronic mail directly lo: RMazur. ************************************************** BLACK CIVIL RIGHTS ORGANIZATION HOLDS AIDS FORUM IN ATLANTA by Rick Harding, with thanks to Ih! ~!!hing~2n ~l!~!, 6/6/86

The Southern Christian Leadership Conference (SCLC) sponsored a national forum on the AIDS crisis and became the first major black civil rights organization to discuss the epidemic and how it affects the black community. The May 30 forum, which was held in Atlanta, featured presentations by health care and medical research officials as well as representatives as well as representatives of the gay community. National Coalition of Black Lesbians & Gays (NCBlG) Executive Director Gil Gerald told the group of over 100 health care workers, government agency officials, and concerned members of the community attending the event that the SCLC's "actions come at a time when there are other prominent black organizations who will not touch the subject of AIDS because of its association with the taboo topic of homosexuality.' Gerald said that he hopes the SCLC initiative will prompt other black organizations, which have remained silent on the AIDS issue, to begin addressing the crisis. He said SClC's 'jumping in' should make it easier for others--inc1uding such major organizations as the NAACP and the National Urban League--'to jump in too.' SClC's Projects Director Sandra McDonald, said the attitude of many of the major black organizations parallels the attitude of much of the black community as a whole, which, she said, doesn't 'want to talk about AIDS and link (themselves] with gays.' Like Gerald, McDonald is confident that the other groups will 'come in with us' now that the SCLC has 'taken the first step.' McDonald said the SCLC has approached the National Black Consortium, an association of most of the black civil rights groups in the country, to 'come together as a groyp to talk about the AIDS problem in the (black] community and what can be done to combat it.' McDonald said she did hot think it was ironic that SCLC--which was founded by the Dr. Martin Luther King Jr. and represents members of many conservative black churches--should be the first to address the AIDS issue. 'It is fitting,' she said. 'If we are true Christians, we will accept people who are mistreated for any reason.' Gerald said SCLC President, the Rev. Joseph Lowery, voiced his position on gays at the forum, saying 'we are all God's children,' regardless of race, sexual orientation, or other incidental factors. McDonald stressed that it is not solely the gay issue and the controversy surrounding it that has caused the black community to move slowly in addressing AIDS. She said the media perception that AIDS is predominantly a white disease still permeates the attitudes of many blacks. 'It is still quite rare to see a black person featured in a news interview or a documentary on AIDS,' she said. According to statistics released at the forum, blacks make up 25% of reported cases in the U.S., but only represent 12% of the nation's population. McDonald said the SCLC will continue to challenge blacks' misperceptions of AIDS and is 'in the process of securing funding' to sponsor additional forums in other cities with large black populations and large numbers of AIDS cases, including Washington, DC, and New York City. ************************************************** AIDS PERIL GREAT FOR BLACKS with thanks to the ~!!h!ng~9~ ~9!~ §!~y!£!, 7/20/86 Mandatory blood tests of US military recruits show that blacks test positive for exposure to the AIDS virus at a rate four times as high as whites, public health experts say. Experts cite Defense Department figures as new evidence that AIDS has joined 'the list of other diseases, including cancer, tuberculosis, and hypertension that disproportionately affect blacks in this country. 'Black men are at high risk for everything and AIDS is no exception,' said Henry Chinn, founder of the Black Men's Association of Boston. The military figures, released by the Walter Reed Army Institute of Research, are the result of blood tests of 308,076 recruits conducted from October 1985 through May 1986. Among the 237,586 whites tested, the rate of exposure to the virus was 0.9 per 1000 recruits; among the 55,185 blacks, the rate was 3.9 per 1000. The rate of positive tests for the 15,305 recruits of other racial groups was 2.6 per 1000. Although blacks test positive for antibody to the AIDS virus at a higher rate than whites, white males still account for the majority--60%--of those who have already. developed the disease. Blacks account for 25% of the nearly 23,000 cases of AIDS in the nation, according to federal figures. Public health experts frequently use the results of military recruit testing of indicators of certain aspects of health, but note that comparisons cannot be made with the general population. AIDS exposure among those donating blood tot he Rec ·>oss, for example, is four cases per 10,000 donors, compared with 15 cases per 10,000 military recruits of all races, said Walter Dowdle, AIDS coordinator for the US Public Health Service. However, the military population would be expected to have more cases because most recruits are young men, according to recent Congressional testimony of William E. Mayer, assistant secretary of defense for health affairs. Males account for 92% of all US AIDS cases according to officials at the Centers for Disease Control. Experts at a national conference on AIDS and blacks in Washington, DC, theorized that there may be a greater incidence of bisexual activity and drug use that could account for the larger rate of black recruits testing positive for exposure to AIDS. Representatives of the National Coalition of Black lesbians &Gays, which organized the conference, also ,met with Surgeon General Everett Koop to discuss ways of devoting more federal attention to the problems of AIDS among non­ whites. 'There are major problems with blacks and IV' drug abuse and AIDS nationwide,' said Wayne Greaves, chief of infectious diseases at Howard University Hospital. ************************************************** ***** THE OFFICIAL NEWSLETTER OF THE NCGSTDS * VOLUME 7:5 * JUNE/JULY. 1986 * PAGE 17 ***** **~******************************************************************************************************************** BOSTON FORMS PWA/ARC ORGANIZATION

Boston PWA/ARC is an independent organization forming to meet the growing needs of the Boston community of people with AIDS or AIDS related conditions. Because of the strong need for an informal group of people with AIDS to voice concerns and criticisms to the growing numbers of service-providing 'institutions. the group was formed. For more information. contact: BOS-PWA. 661 Boylston Street. Boston. MA 02116. ************************************************** PRISON AIDS POPULATION NEARING 1000 with thanks to Miami's Ih! ~~l~ ~!!!, and Ih! §!1!!!Q~! §!~ ~~p!~, ·July, 1986 A new survey has found 766 people with AIDS who are in. or have been in American Jails and prisons. Federal officials said the high number of cases is due to intravenous drug abuse by the inmates prior to their being locked up. Those officials say they believe AIDS is not being spread in prison. The survey found about 70' of the AIDS cases in prisons and Jails were in three states. New York. New Jersey. and Pennsylvania. Of the 766 cases. 322 died in custody, 265 were released. and 179 are still in prison. ************************************************** AIDS IN PRISON a letter to the editor by Mark Kostopoulos. with thanks to Boston's §!~ ~~!~~ ~!!!, 6/28/86 The los Angeles· lavender left. a group of lesbian and gay activist. has recently become concerned about the issue of AIDS in our nation's prisons. While there is a lack of care, preventive education and growing discrimination in society in general. conditions in the prisons are. as usual. much worse. There are numerous AIDS related groups doing MUch needed and worthy work but their own biases have led them to almost universally ignore the needs of prisoners. We would like to address the issue in our work. We are depending on prisoners for information to help forlUlate our plans and policies. We would like to hear from anyone with experiences or thoughts about AIDS in the prisons. our attention was first focused on this area when we learned that condoms are not routinely provided to prisoners. We are particularly interested in learning about these policies. The hypocrisy of prison officials who wish to subject prisoners to mandatory HTlV-III antibody testing while not providing prisoners with the basic tools to protect their health is a particular outrage to us. We would like to know concretely wha~ ~: >:.~g on in terms of condoms, clean needles. health care. discrimination. information and education around AIDS. How is this affecting life inside the prisons? What sort of political activities and campaigns could gay liberation groups undertake to improve the situation? We are especially interested in hearing from people int he California system. Our limited resources means that we will not be able to answer all letters. We will present a summary of the responses we receive in a letter to §~~. Address letters to: lavender left. PO Box 17241. Los Angeles. CA 90017. ************************************************** RACISM &HOMOPHOBIA KEY IMPEDIMENTS TO AIDS PREVENTION AND CARE AMONG PEOPLE OF COLOR with thanks to Ih! §!1~!!9~! §!~ ~~e!~, July 1986 In a speech delivered on May 31 to the Southern Christian leadership Conference's (SClC) National Conference on AIDS. Gil Gerard. Executive Director of the National Coalition of Black lesbians and Gays (NCBlG) called on the black community to recognize racism and homophobia as key impediments to AIDS prevention and care among blacks. The SCLC Conference on AIDS was the first AIDS conference organized by a major national black organization in the United States. In his remarks, Gerald charged that, as blacks. "we somehow remove ourselves from lesbian and gay people and then dare to celebrate the lives and contributions of James Baldwin. Audre Lorde. Langston Hughes. Bayard Rustin, Alain Locke. Countee Cullen. Bessie Smith. Porter Grainger. lorraine Hansberry. Wallace Thurmond. Bruce Nugent. and Sylvester--all people we love and appreciate for their contributions to community life." Gerald noted that he was extremely encouraged by the reception he received at the SClC event. According to Gerald. Dr. Joseph Lowery's remarks that "God does not i, i· discriminate against people because of sexual orientation." were just the kind of words we need to hear from religious k and civil leaders at this time of increased stigmatization against lesbian and gay people. lowery succeeded SCLC founder Dr. Martin Luther King Jr.. as head of that organization shortly after his murder in 1968. Gerald was particularly pleased at the SCLC proposal to call for a larger convocation of national black organizations, "including NCBlG." to deal with the issue of AIDS in the black community and eliminate the myth that AIDS is a white gay male disease. "This conference was an important prelude to the futu~e which includes the NCBlG National Conference on AIDS in the Black Community. scheduled for July 18th at the Washington Convention Center." added Gerald. NCBLG, a network of 3000 people. is the only autonomous black lesbian and gay organization in the United States. with chapters in San Francisco. New Orleans. Washington. DC. and Minneapolis. For additional information: NCBlG. 930 F Street. NW. Suite 514. Washington. DC 20004 (202/737-5276). The publications Committee of the NCBLG is proud to announce the premier of a new quarterly newsmagazine. ~l~£~lQ~~. which replaces their former publication, ~~~~~i:Q~f~~~i. In addition to news and views of interest to the international black lesbian &gay community. ~l~£~lQ~~ will include reviews, interviews. poetry, short fiction, a prisoner penpal listing, resources. and announcements. Cover price per issue is $2, with a year's subscription for $6: Address editorial inquiries to ~l~£~LQ~!, POB 2314, Philadelphia. PA 19103; subscription requests should be directed to NCBlG offices in Washington (address above). ***** PAGE 18 * THE OFFICIAL NEWSLETTER OF THE NCGSTDS * VOLUME 7:5 * JUNE/JULY, 1986 ***** *********************************************************************************************************************** POSITIONS AVAILABLE IN SAN FRANCISCO, BOSTON, NEW ORLEANS

ED NOTE: The NCGSTDS frequently receives job listings for positions in AIDS service organizations or STD clinics/services, 'but because of application deadlines prior to the Newsletter's anticipated date of publication, we are reluctant to print them. The San Francisco AIDS Foundation recently sent a packet of job listings for skilled/professional and unskilled (e.g., receptionist, accounting assistant, marketing administrative asst./secretary, accountant, educational events assistant, etc.) positions with the application deadline of July 21. These are part and full time positions. If you are interested in any AIDS service work, we urge you to contact whatever AIDS service agency exists in that particular location, since turn-over of staff is occasionally high. San Francisco AIDS Foundation, 333 Valencia St., 4th Floor, San Francisco, CA 94103.

Boston's AIDS Action Committee is seeking an AIDS service coordinator/client advocate and an administrative assistant with computer and clerical experience. Send letters of inquiry or a resume and cover letter to: . Director of Administration-SW2 [for AIDS service coordinator/client advocate] or -CSA [for administrative assistant], AIDS Action, 661 Boylston St., 4th Floor, Boston, MA 02116.

The New Orleans AIDS Task Force (NO/AIDS Task Force) is seeking qualified candidates for the position of executive director. Qualifications include ability to function within a community non-profit agency, organizational &managerial skills, fundraising experience, budgeting &accounting skills, exquisite ability to communicate and work with community religious people, health department &elected officials, and numerous other special interests. Letters of application and resumes should be sent to: Mr. William C. Crawford, P.O. Box 2616, New Orleans, LA 70176-2616. ************************************************** COLUMBUS SEEKS EXECUTIVE DIRECTOR

Stonewall Union, a nationally recognized lesbian/gay rights organization in Columbus, Ohio, is seeking a full time professional executive director. Responsibilities include office management, community, media &legislative relations, budgeting/fiscal affairs, program/policy development and implementation, volunteer coordination, membership development, and fundraising. Qualifications required include a bachelor's degree, two years' experience in a non-profit organization preferred; equivalent combination of education/experience acceptable. One year of experience in working with gay/lesbian rights in either a salaried or volunteer capacity is required. If interested, send a resume with three references, nominations, or requests for information to: Stonewall Union Search Committee, PO Box 8355, Columbus, OH 43201 (614/299-7764) by September 1, 1986 (postmarked). ************************************************** TAX-EXEMPT GROUPS CAN LOBBY FOR POLITICAL/LEGISLATIVE CAUSES

According to the Internal Revenue Service (IRS), 501(c)(3) tax-exempt not for profit groups and organizati~ns may cho~se an "election H' which legally permits them to influence legislation with financial contributions or 10bbYlng. Sectl0n 501(h) applies to only certain tax-exempt groups (excluded are religious organizations) and after tax year 1976. An organization may lose its exempt status if its lobbying expenditures exceed the permitted amounts by a ce~tain amount. According to gay political leaders, some tax-exempt organizations have pooled their resources to lega~ly hlre a full­ time lobbyist to work for their agencies. For more information, contact a tax attorney, your local l1brary, or the IRS (review sections SOl(h). S01(c)(3), 4911, and 6033,' and request forms S768 and 990). ************************************************** CHICAGO WOMEN'S AIDS PROJECT by Tracy Bairn, with thanks to Chicago's ~!~~~ ~!~~ !!~~~, 5/29/86

While women, both gay and non-gay, are working answering phones, being support managers, and doing other activities around AIDS, there are also women who have formed the Chicago Women's AIDS Project. The project is a feminist-oriented response to AIDS. Of particular concern to the group is the lack of educational and prevention resources available to Chicago women, especially prostitutes. In addition to the lack of educational information 'available, the organizers also voice concern that a feminist presence has not been a part of the Chicago reaction to this disease. The group has several purposes: to educate the women's community in relationship to the politics and homophobia surrounding this disease, as well as to the medical facts; and to educate social service groups about AIDS. Marge Cohen of the Women Organized for Reproductive Choice and who works at Cook County Hospital, said women considered at high risk for the disease include women of color, drug-users and prostitutes. She said the project feels female prostitutes have been victimized, labeled as spreaders of AIDS when actually they themselves are at high risk and their civil liberties are being threatened. The project hopes to schedule a forum on women 'and AIDS for this summer,' and possibly a large

conference for next spring. 'There are many ways in which AIDS effects women, II Cohen said. For e~ample, with artificial insemination, sexual contacts, and ·drug use. 'But women also need a perspective [on AIDS] that ;s not oppressive, not Victim-blaming.' For additional informatipn, contact Cohen: 312/186-0036. ************************************************** ***** THE OFFICIAL NEWSLETTER OF THE NCGSTDS * VOLUME 7:5 * JUNE/JULY, 1986 * PAGE 19 ***** ,**********************************************************************************************************************

ANIMATED AIDS VIDEO FOR KIDS In the last issue of the Newsletter, we reported about a half-hour animated videotape on AIDS aimed towards school children from cartoonist Charles Thompson of Charlottesville, Virginia. We inadvertently omitted a reference as to how to inquire about ordering, etc. Please contact the following for additional information: Health' Alert Division, Creative Media Group, Inc., 123 Fourth Street, NW, Charlottesville, VA 22901 (804/296-6138). The AIDS Alert Video is available for $124.9S (VHS, Beta; $149.9S for 3/4" U-Matic); it is also available in 'filmstrip or slides' cassette, and may be previewed for a small rental. ************************************************** ACLU PUBLISHES Al0S PAMPHLET with thanks to Detroit's ~~Yl!!, 6/2S/86

Recognizing that the rise of AIDS has broad and serious implications for civil liberties, the American Civil Liberties Union of Northern California has published a comprehensive 4-page policy gUide, ~!Q§ !n~ ~iYil ~i2!~!j!!. The guide represents public policy and practice as the ACLU believes it ~hou1d be and not as it currently is. The doculBnt covers testing, employment, public schools, quarantine, surveillance and compulsory tracing, as well as insurance, prisons, and military. Copies of the ACLU-NC AIDS Policy are available free of charge by writing: ACLU-NC AIDS Policy, 1663 Mission Street, #460, San Francisco, CA 94103. ************************************************** MOTHER'S BOOK: 'THE SCREAMING ROOM' with thanks to Portland Maine's Ib! ~!Q§ ~~gJ!e! ~!!!, May, 1986

!b! §~~!!~i~g BQQ~ by Barbara Peabody is the factual account of the author's 28 year old son's struggle with AIDS. Based on Peabody's journal, the title refers to the author's outlet for her anguish and stress over her son's losing battle: she would scream in the shower where no one could hear her. The publisher calls the book a riveting story told without sensationalism: "No one has given the public a human look at the illness, what happens to people who suffer from it, and to their family and friends, how they deal with it and each other, and how they work with medical staff to relieve suffering." Published by Oak Tree Publishers of San Diego, CA, the book's list price is $15.9S. ************************************************** WHO'S WHO IN SEXOLOGY REFERENCE BOOK

The first edition of Ib! tQ~!~Q!!i~Q!l ~b~:! ~bQ iQ §!~QIQ9~ is a project of the Exodus Trust, a California non-profit trust which has as its sole and exclusive purpose to perform educational, scientific, and literary functions- relating to sexual, emotional, mental and physical health. The purpose of the first edition was to provide an introduction to the people who are principle in or related to the field of sexology. The hope is that this first edition will demonstrate the breadth of the emerging professional area, and that the publication will stand as an invitation to those who would like their work recognized by colleagues and peers. The book, although not all inclusive, lists over 1S00 names and organizations from S2 countries dealing in some way with the area of human sexuality/sexology. The book is available from Specific Press, 1523 Franklin Street, San Francisco~ CA 94109, for the cost of $45, plus $4 postage/handling. For additional information, contact Jean Amos, Editorial Staff, 41S/928-1133. ************************************************** LEGAL JOURNAL FEATURES AIDS ARTICLE: A REVIEW/COMMENT by Ed Sikov, with thanks to the ~!! !q~~ ~!!lY!, 6/16/86

"AIOS: Wrong Without Remedy," the cover story of the June 1 ~~~ ~~Y~Q!lL Ib! b!~~:~ ~!9!~lQ! is a better article than its silly title would suggest. (Only a legal magazine would think to describe disease in terms of crime.) The writer, David M. Freeman, makes a solid effort to remain rational on the subject of AIDS, and the result is a reasonably " informative discussion of civil rights and civil liability problems. Of course, Freeman confuses the detection of antibodies to HTLV-III with the detection of the virus itself, and he unquestioningly accepts the word of 'scientists' that HTLV-III is the sale cause of AIDS. Moreover, considering the magazine's readership, it is strange that Freedman doesn't mention Dr. Luc Montagnier's lawsuit against Dr. Robert Gallo over patent rights surrounding the isolation of HTLV-III. The real gem, however, is a supplemental article describing the results of a poll conducted for the magazine by a New York public opinion research firm. The headline reads, "Lawyers oppose most AIDS-related discrimination." Encouraging news, until one sees what kind of discrimination some lawyers li~!. ,According to the pollsters, 41% of American lawyers think that health and life insurance benefits should be denied to persons with AIDS (Though the published results do not reveal whether these hypothetical "AIDS victims" some gay activists fear, "AIDS victims" could be broadly defined as meaning anyone testing positive for antibodies to HTLV-III). Almost a quarter of American lawyers think job discrimination is dandy, a fifth approve of public accommodation discrimination, 13% would like to deny city services to people with AIDS, and 10% want to prevent AIDS patients from receiving medical services. Some encouragement! ************************************************** ***** PAGE 20 * THE OFFICIAL NEWSLETTER OF THE NCGSTDS * VOLUME 7;5 * JUNE/JULY, 1986 ***** ***********************************************************************************************************************

"CORE PHYSICIAN EDUCATORS" TO BRING DOCTORS "UP TO SPEED" with special thanks to !h! ~!~ ~~gJ!~; ~!~ of Portland, Maine, July, 1986

~!Q§ ~gll£~ § b~! (volume 1:9, 5/21/86), report that the American Medical Association is going t? be st~rting.a pilot program to train physicians on AIDS issues. "The program will identify 'core physician educators who w111 br1ng local doctors 'up to speed' on AIDS issues." Plans are to have such a program in place in 46 states by the year's end. ************************************************** ELECTRIC BILLBOARD FlASHES AIDS EDUCATIONAL MESSAGES by Doug Hinck1e, with thanks to !h! ~!!hl~g;gQ gl!~!, 6/6/86

As subway riders approach Washington's Dupont Circle subway escalator, they are dazzled by an electric billboard display that flashes advertising and public service announcements in bright green letters. According to Marci Weis, director of Dupont Action Lights which operates the billboard, says that some 2300 AIDS-related messages cross the board each week, at a cost of $150 per week. The $7800 annual bill is paid for by 14 area businesses, who sponsor 169 different messages every week put together by the city's Whitman-Walker Clinic. Allen Hotlen, program director for WCLY Radio, said "Classy 95" helps pay for the massages because the station markets itself towards the middle and upper-middle class members of the 24 to 44 year old age group and because the station 'has made a commitment to help support a variety of public service announcements." Lewis Gertz of Crown Liquors thinks it's a good idea to support the messages, since many of his customers and several of his employees are gay, and that he is concerned about AIDS. And he adds, 'It was a chance to do a public service announcement at a good price." Other sponsors included bars, bookstores, record stores, video stores, realty company, restaurants, outfitter's store, and a radio station. ************************************************** MEDIA CAMPAIGN IN CALIFORNIA with thanks to Ih! ~!!h!~g;g~ gl!~, 7/4/86

The producers of-two television shows, !h~!:! !~£~!~!~l! and 8!~1 ~!g~l!, have apparently beat out the producer of the gay/lesbian documentary ~g~g !! ~~! in the bid to produce California's media campaign on AIDS, according to !b! ~gyg£~!!! Adair Films, which produced the gay documentary, was one of four bidders on the state contract to produce public service messages, signed a contract with the state's AIDS Mental Health Program in February. But Adair had apparently been awarded the contract without competitive bidding, and the state ordered the company to stop work after it had already spent about $10,000 in production. The state went on to award the contract to Landsburg Productions, a Hollywood-based firm which produces the two television programs which air unusual stories. ************************************************** AIDS SHOW IN SAN FRANCISCO & LONDON with thanks to Boston's §~~ ~~~1!~ ~!~!, 6/29-7/5/86

Graphics, video, film and still photographs by community organizations and individual artists responding to the AIDS crisis are currently being sought for entry into this San Francisco/London exhibition. Interested contributors are asked to write as quickly as possible: J.Z. Grover, 3739 N. Kenmore, Chicago, 11 60613. ************************************************** AMFAR HAS MORE PUBLIC SERVICE ANNOUNCEMENTS ON AIDS with tbanks to Pat Meredity and !b! g!l;l!g~! §!~ ~!~~, June, 1986, and Ib! ~!!~l~ ~!!!, Miami The American Foundation for AIDS Research (AmFAR), a group headed by Elizabeth Taylor, has distributed more than a dozen new public service announcements to television stations across the country. The new PSAs join two earlier commercials distributed in its effort to spread medically accurate information about AIDS. The new announcements feature, among others, Brooke Shields, Matthew Broderick-and Judd Hirsch. In the announcement in which he appears, Hirsch said, 'AIDS is a problem most people don't want to think about, but it's worth knowing the facts. There's no point in being afraid,and if you're sexually active, the~e's no point in being stupid.' ************************************************** ST. LOUIS EFFORT FOR AIDS ESTABLISHING BROCHURE LIBRARY

St. Louis Effort for AIDS (EFA) is currently setting up a reference library of brochures, pamphlets, posters, newsletters and other materials from AIDS organizations nationwide. EFA hopes to coordinate information gathering for the development of educational materials for dissemination to the public and to solidify communication between EFA and other AIDS organizations. Although individual organizations are primarily concerned with the impact of AIDS' in their immediate regions, we are confronted with the nationwide impact as well. For example, the recent Justice -Department ruling regarding discrimination of PWAs and the Chicago court case demanding that a bisexual father produce_~vidence of a negative HIV antibody test before reinstatement of child visitation privileges. EFA win send copies of its educational literature in exchange for your agency's literature. For additional information, contact: Mike Royal, RPH, Secretary, St. Louis Effort for AIDS, 1120 Dolman, St. Louis, MO 63104 (314/421-3914). ************************************************** ***** THE OFFICIAL NEWSLETTER OF THE NCGSTDS * VOLUME 7:5 * JUNE/JULY, 1986 * PAGE 21 ***** *********************************************************************************************************************** RED CROSS AND PUBLIC HEALTH SERVICE OFFER PUBLIC EDUCATIONAL RESOURCES

Shellie Lengel, Director of the Public Health Service's Office of Public Affairs recently announced the availability of several resources that may assist local AIDS educational efforts.. 'Facts About AIDS' is an 8 panel brochure in English or Spanish recently revised in the spring, and may be reprinted without permission. PHS also has available for purchase or free loan, three recently updated videotapes: 'AIDS: Fear &Facts' targeting the general public; 'What If the Patient Has AIDS?' geared to health care workers; and 'AIDS and Your Job,' aimed at emergency nonmedical first responders such as police and fire fighters. For more information about the brochures, contact: PHS, Office of Public Affairs, Washington, DC, 20201. To purchase one or more of the videos [ED NOTE: view first for free!!], write: NAVC, 8700 Edgeworth Drive, Capitol Heights, MD 20743-3701, Attn: Customer Service Section (301/763-1896). To order one or more of the tapes for free loan, write: Modern Talking Picture Service, 5000 Park St., North, St. Petersburg, FL 33709, Attn: Film Scheduling (813/541-5763). Red Cross and PHS created a poster featuring singer Patti LaBelle that promotes use of the PHS's toll-free hotline for recorded accurate information about AIDS. Additional posters can be obtained by contacting a local Red Cross Chapter, or by writing to: InterAmerica Research, 1200E North Henry Street, Alexandria, VA 22314, Attn: Clint Jones. Also available are public service announcements for radio and tv, and nine leaflets about AIDS directed to specific audiences: 'AIDS and the Blood Supply;' 'AIDS, Sex, and You' about safer sex; 'AIDS and Health Care Workers;' 'AIDS and Your Job--Are Their Risks?' 'Caring for the AIDS Patient at Home;' 'AIDS and Your Children;' 'If Your HTLV-III Antibody Test Is Positive;' and two additional leaflets, one for gay and bisexual men, and another one on IV drug use and the respective risk reduction messages for these two groups. Contact your local Red cross Chapter for additional information about these resources. ************************************************** RED CROSS: BEYOND FEAR EDUCATIONAL FILM with thanks to !h! ~1!!!9~! §!~ ~!e!~, June, 1986

Community leaders and members of the press and media were given a preview of the new Red Cross AIDS Documentary, ~gn~ E~~~, at a breakfast meeting at the Baltimore Regional Red Cross Headquarters. §!~gn~ E!!~ is a~ 60 minute documentary that provides an in-depth look at the AIDS crisis in terms that the general public can understand. Narrated by actor Robert Vaughn, the film features three basic segments. 'The Virus' focuses on the known facts about the AIDS virus, and uses animated computer graphics and interviews with top researchers, explaining how the virus works and how it sabotages the body's immune system. 'The Individual' focuses on the risk factors of the disease, identifying who is at risk. how to avoid infection, and clearly emphasizing that casual contacts do not transmit the virus. The final segment, 'The Community,' examines how some cities have responded to the AIDS crisis through education and patient services and considers some of the public policy issues that each community must face. §!~gn~ E!!~ is thoughtful and sensitive to the complex issues involved in the AIOS crisis, and presents the known facts in a positive and non-judgemental fashion. One of the key messages of the film comes through loud and clear: AIDS is a disease, not a moral issue, and its victims are entitled to the same care, support and respect that is due to anyone else. §!~gn~ E!!~ is a part of the American Red Cross' 'AIDS Public Education Program,' comprehensive effort to educate the public about AIDS and how to prevent its spread. The film and supporting information are available on loan to businesses, schools, and other community organizations. Contact your local Red Cross for additional information. ************************************************** LUTHERAN CHURCH ISSUES REPORT ON PASTORAL CARE TO PWAS with thanks to Detroit's ~~H!!!, June 18, 1986

AIDS is a challenge to the church, according to a useful new 8 page report from the American Lutheran Church (ALC) and its Division for Mission and Service in America. The report has been sent to ALC congregations and pastors in an effort to provide information and to stimulate discussion on the serious and frightening disease that has become a worldwide concern. The disease 'calls for an enormous amount of sanity, sensitivity, compassion, and level-headedness on behalf of the church and the society-at-large,' according to Rev. James Siefkes, Director of the division's Mission Discovery project. The report was developed with information from the Centers for Disease Control, Lutherans Concerned/North America (a Christian ministry for gay/lesbian understanding), and a number of AIDS service centers, hospices, chaplains and doctors. Along with the research summaries of facts, figures, and myths of the disease in the paper. it also addresses theological and pastoral issues. 'The congregation through its members and its pastoral ministry can offer reconciliation, support, and consolation. The spiritual needs for faith, hope, forgiveness, reconciliation, human caring and nonjudgmental, unconditional love are present •... For the pastoral care provider. the response to people with AIDS should be the same response as to anyone in pain and distress from serious or terminal illness. Since the majority of the patients with AIDS have thus far been gay men, clergy and church people must come to terms with both the diseases of AIDS and homophobia; that is, fear, distress, and hostility toward gay and lesbian people.' The paper offers several useful sections including: Facts and Myths, Some Reassuring Facts About Transmission, Pastoral Issues, The Question of the Common Communion Cup, Things We Can Do, Recommendations for Reducing Exposure to AIDS. and a full page of resources, references, bibljography and hot-line numbers. Copies of the report are available by writing to: Mission Discoveries,. Division for Service and Mission in America, The American Lutheran Church, 422 South Fifth St., Minneapolis, MN 55415. ************************************************** ***** PAGE 22 * THE OFFICIAL NEWSLETTER OF THE NCGSTDS * VOLUME 7:5 * JUNE/JULY, 1986 ***** *********************************************************************************************************************** PWA COALITION NEWSLINE by Michael Hirsch. Director. PWA Coalition, New York

We are ° the People With AIDS Coalition. Founded in April 1985 by a small group of people with AIDS arid ARC, and our friends and suppo~ters, we are a volunteer, non-profit organization, whose main purposes are to gather and disseminate information pertinent to PWAs/PWARCs and the community at large, and to foster and encourage the philosophy and practice of personal eMpowerment to those diagnosed with AIDS and ARC. In our efforts to educate the community as to the needs and experiences of PWAs/PWARCs, and to express our own feelings regarding our conditions, we have just successfully published the 13th monthly issue of the f!A ~9~1!!!9~ M!!!li~!. The M!~li~! is a powerful tool, serving 3000 PWAs/PWARCs with an open forum to air their views and feelings, an up-to-date calendar on community events, resource information, and traditional and holistic medical news and developments. Although we are New York-based, the issues addressed in each M!!!l!~! are of universal appeal to the AIDS community nationwide. We are sure you will find the material applicable to your organization and the people you serve. Because the information contained in each issue is so vital. we are now making the monthly M!!!l!~! available at bulk subscription rates as follows: 12 copies per issue for $50 per year; 25 copies for $70/yr; 35/$90; 50/$130; 75/$170; 100 copies/$225 per year. Individual subscriptions may be acquired for a minimum donation of $20/year; PWAs/PWARCs, especially those receiving disability or assistance, are not expected to contribute. For additional information, write: PWA Coalition, 263A West 19th St., #125, New York, NY 10011. ************************************************** CANADIAN EFFORTS CONTINUE TO RELEASE AIDS DRUGS with thanks to the ~!! Y9~~ ~!!!y!. 6/16/86 Persons with AIDS Coalition (PWAC) is continuing its efforts to convince the Health Protection Branch (HPB) to release experimental drugs for treatment of AIDS. Physicians who treat PWAs are frustrated because they cannot do more for them. Dr. Hillary Wass is concerned that drugs illegally imported from Mexico may be of inferior quality and there is no medical supervision of those taking them. Health and Welfare Canada will release drugs on 'compassionate grounds,' providing there is a viral testing lab in British Columbia set up to monitor the blood samples. Warren Jensen, the founder of PWAC in Vancouver, reports that the STD Control Center in that city informed him that, after a committee meeting. it was agreed that a lab site ought to be set up. No official word has come as to when this might take place, reports Rob Joyce in Toronto's Ib! §9~~ f91i!i£. Jensen formed the Coalition March 18, and the group held a 'March on Victoria" March 28. Currently volunteers are out on the streets collecting signatures for a petition that will be delivered in June to the HPB. Jensen said people's response to the petition drive has ben supportive. PWAC needs help. For information, contact Jensen at PWAC, Box 136, 1215 Davie Street, Vancouver, British Columbia, V6E lN4 Canada (604/681-2789). ************************************************** HEALTH CENTER BEGINS AIDS EDUCATION IN SYDNEY with thanks to the New York Native. 6/30/86 The Albion Street Center of Sydney:--Aust~;iia began its campaign of posters for AIDS education, May 21. The posters encourage people to call the center's AIDS hotline and information service. Aimed at teenagers, the posters feature a popular drag queen troupe, T.H.E.M. The posters read "T.H.E.M. can read, can you?" The group is pictured reading AIDS literature. Jeffery Jackson, who organized the project, stated, "The posters are not designed to advocate antibody screenings," but to encourage young people to seek information on AIDS and know where they can get advice and counse li ng, reporOts the §~~!!!!~ §~~~ QE~!!~Y!!~. ************************************************** COMICS TEACH ABOUT SEXUAL HEALTH ISSUES IN AUSTRALIA by Kendall Lovett, with thanks to Boston's §~~ ~9~!:!!!!!~ ~!!!, 6/28/86 The Redfern and Marrickville Community Legal Centres have issued a comic book in the Streetwize series that deals with sexual health issues for your people. This latest publication includes heal a dozen comic-style strips covering how to avoid STDs and get treatment, the transmission of AIDS and AIDS prevention--as well as coping with getting your period for the first time and the use of tampons: Streetwize lesbian cartoon artist Prue Borthwick said the ideas for the comics come from young people and youth workers who also comment on the comic drafts before artwork is produced. Intended to be humorous and down-to-earth, Streetwize hopes to provide easy access to information without the usual requisite dose of moralizing. ************************************************** LONDON AIDS HELPLINE FUNDS CUT IN HALF with thanks to the New York Native, 6/30/86 The Terrence Higgins Trust,--Engl;nd's-~ajor AIDS helpline, has received only half the money they applied for'in May. The Trust applied for 200,000 pounds, but only received 100,000. Tony Whitehead, chair of the trust, was "grateful'; for the money, but criticized the government for "failing to recognize the urgency of the AIDS crisis." The grant. will be used for staffing and administrative costs, as well as counseling services. In response to the hck of gevernment funding, the United Kingdom AIDS Foundation was formed. as a charitable organization to encourage AIDS funding from private and corporate sources. The foundation is a collaboration of the trust, doctors involved in AIDS research, and the Body Positive Group, reports John Marshall in §~~ I!~!!. ************************************************** ***** THE OFFICIAL NEWSLETTER OF THE NCGSTDS * VOLUME 7':5 * JUNE/JULY, 1986 * PAGE 23 ***** *********************************************************************************************************************** e8Q~!§!M§ 8~eQ8!§L §bQ~Y e!~!~8~ 1M e~81~ , by Michael Helquist, with thanks to the ~~~bi~g~Q~ ~l~~~, 7/4/86 The WHO offICial said he considered the by MIchael Helqulst whether lhe AZT trials should becontinued. Reports of voedne developmenl spread of AIDS infection among oeedle­ PARIS, FRANCE-As Ihe AIDS "If lhe panel fmds a greal posilive Two. biolechnology 6rms, both based i~ sharing IV drus use" "Ihe mosl rerna rkable epidemic takes hold in every nalion, differenCA: belween lhose receiving the drug the Uruted States, announced al Ihe PAns evenl of 1985" in the .....oing story of researchers, health offICials, aod the general and those receiving the pla""bo, then the confe,renCA: .Ihal they h~d cond.ucted AIDS. He noled thai while AIDS primarily public hope for some breakthrough advanCA: uial wiD be expanded to include more ex~ments In test tubes WIth genetiCally- slrikes Gay men -in northern Europe, the that will signal the beginning of lhe end for palients," Broder told reporlen. If there is englnee!"d agents tha~ su~fully majority of cases in southern Europe ocx:urs some breakthrough advanCA: thai wiU signal nol a great differenCA:, he said, the more protected ~uman cells from In~ by the among drus users. Brunei oommented lhal lhe beginning of the eod for the devastating Umited lrial wm continue. Broder refused to A IDS vnul. Representallv~s from Ihe numher of cases in Europe has been disease. That hope was severely cIuollenged name an approximate time for release of this Genentech Inc. of San F~ a~ doubling every -eighl months, and he during an international conferena: on preliminary review, although he indicated Oncogen orSeattleandothenworkl~wlth estimaled Ihallhe European nalions will see AIDS· held in Paris last week A few TnuI"IIene of Strasbourg, France, said the more than 30,000 AIDS cases by the end of promising reports of possible trea~ents and ::::~::u;:,~tt ~::=w~ ~~~ new experiments were encounging stepa 1988. vaccines brighlened an otherwise gloomy Broder also said thai two relatives of toward the. ev,:"tuaI development of &10 picture of the disease spreading rampandy AZT, named dideoxycytidene and AIDS vleane. Psychosocial .....rch througloOUI Africa, increasing stesdily in dideoxyadenosine, have also been shown to Luc Montagnier, MD, of the Pasteur More than 1,000 !CientiflC papers were Western nations, and threatening new risk block replication of the AIDS virus as well Instilute, discoverer of .the AIDS virus presented in Paris, a number three times groups. as other reuoviruscs in viuo. Both were named LA V, cautioned that it will be along greater than what was offered allast year's Nearly 3,500 resean:hers,. health care shown to be "orally absorbable" during tests time beforea vaccine can be put into general conferena:. The broad range oflopicsofthe professionals, and healtheducatorsattcnded with two laboralory dogs. R.... rche.. use by man. Montagnier explained that the variow; papers revealed how AIl.JS has the three-day international conferenCA:, explain thai the eventual AIDS lreaunenl development of tbe neuustizing antibodies louched nearly every aspect of social and sponsored by the Pasteur Institute and the would be much more convenient if it could that resulted from the recent experiments scienti6c ronduct. Notable at th~ year's French government to scrutinize current be administered in an onolform. Broder said would fint have to be tested in animals ronferen"" was the importance given not efforts to combat AIDS. ConferenCA: he hoped to have dideoxycytidene ready for sensitive to the human viris, that is, only 10 virology aod cUnical research but organi.... said that more than 400 the forst pha .. ofclinicaltrials this summer. chimpanzees. He said the simian also to psychosocial r.... rch studies. registrants from the United States had The American researcher emphasized experiments should be,concluded by the end Several r.... rcbers noted an increasing C8nCA:Ued their plans to attend the gathering; that his studies involve subjects diagnosed of the year. number or AIDS patients with various nevertheless, American and French with fuD-blown cases of AIDS. symptoms of damage to the cenusl nervou.< participants dominated the meetings. "I think it is very important to challenge Africans acknowledge AIDS ..... system and the brain. Paul Volbetding, MD, Representatives from Asia, Australia AIDS first in a fulminant stage," he said. "I Noting lhat AIDS was first reported in of San Francisco General Hospital Africa, and South America-as weD as ~ believe AIDS itself is a curable disea ..." Africa in 1983, Dr. B.M. Klpita of commented thai hospitals and health few researchers from Eastern European Other r.... rchers have suggested thai it Kinshasa, Zaire, told his colleagues that the resources could race a severe crisis if more nations-also participated in the scienlific may be 100 late to offer much help to people disease was present almost everywhere in and more AIDS patients develop dementia SCS'lions. This gathering also marked the with AIDS itself rather thin those with Africa, but especially in ""nlral Africa. and other symptoms of brain damage. grealest parlicipation and release of symptoms, a condition termed ARC. or "The scope of AIDS in Africa is not yel Richard W. Price, psychosocial AIDS information by African health officials and AIDS-related complex. known,~ Kapita said, "and the reason for researcher from New YDrk, estimated that rtsearchers. C.S. Crumpacker, MD, of Boston this is at least in pari because of Ibe as many as 90 percent of patients will repofIed that the drug ribavirin was found indifference of some African governments." develop some degree of cognitive disorder belpful to patient' in a firsl-phase study he, Although African nations from Algeria to as a result of their infection with the AIDS Hopeful reportl oa 1..... _1 conducted. During lbe eighl-week study,' virus. The symptoms ItIOSI frequendy American r.... rchers provided some South Africa have reported more than 900 6ve patients with AIDS and 6ve with AIDS Clses to the World HeaUh encountered include poor concenustion, gUnuner of hope with reports of early tests IOseve~ ARC" were given oral doses of Organization, Kapita critici.. d those forgetfulness, loss of balance, leg weakness, with bone marrow USnsplants and with the ribavirin. Seven of the subjects became and social withdrawal. For ,Some AIDS virus-negative during the trial; when the nations that have still not given any drugs AZT and rihavirin. Anlbony S. Fauci, in.ormation. He suggested that a more patients, Price observed, dementia is the drug was stopped. all but two subjects MD, head of the National Institule of significant approach to understandins primary-and sometimes the ooly­ Allergy and InfecOOw; Diseases in Bethesda, developed the virus apin. Crumpacker manifestalion of lbeir infection. noted that nbavirin was able to cross the AIDS in Africa would be to IooIc at the Maryland, announced that for Ibe first lime prevalenc:e or infection rather than just the In another area of psychosocial research, a person with an immWlc system ,severely blood-brain banier and thus offered some Jeffrey S. Mandel, PhD, MPH, of San hope thai it will beabletocurtaa theactivily actual ca ... of the disease. Other researchers damaged by AIDS had apparently regained remarked that non-African health olflCials Francisco, reported that two out of three his notmal health and had been able to of the virus in the brain. He added Ihat no Gay or bisexual men who are seropositive patient developed opportunistic infections should reali.. that disease surveillance is return to work. difficult in African nalions; they explained or have ARC have not discussed their health Fauci said Ihal the successful treatment during the trials, that the presence of thrush concerns with family members or in the patients declined, and that side e(fects that many governments do not undertake involved a combination of a bone marrow significant moniloring of Jll8laria eithor. . employers. This lendency also holds uue for transplant,lransfusions oflymphocytes, and were minimal. one out or three men with AIDS, accotditij an anti-viral drug. He cautioned thai the Crumpacker said he was aware lhal Earlier in June the World Health to the San Francisco stody. Mandel therapy has been effective for only one of many people with AIDS and ARC have Organizalion (WHO) estimated thai alleast 50,000 Africans may have contracted emphasized that this reluctance to disclose Ibree patients 10 receive it and that the obtained n'bavirin from sou""," in Mexico one's health status correlates with hesitancy possible recovery has been sustained for' and that they are self-administering the AIDS since 1980 and a pooaoble one to two million people on the continenl may be to be open ahout one's ..xual orientation. only 10 monlhs to dale. The dev.\opmenl is drus, sometimes under the sopervision of "These men may be endangering their nevertheless important, he nuintained. lheir private physicians. Although he said he symplomless carriers of the virus believed to ca .... AIDS. In North and South American health by delaying needed and timely because il indicates for the firsl time the was wiDing "to give any advice he can" to medical care," Mandel obeervul '"Many than possibilily of resloring an AIDS-damaged these patients' physicians, he said he thinks and in Europe, more 25,000 cases of AIDS have been repoc1

The National Gay Rights Advocates announced the availability of a free 8 page pamphlet designed to help non-lawyers understand a number of legal issues they might be faced with after being diagnosed with AIDS, The pamphlet, entitled "AIDS and Your Legal Rights,' answers such questions as: 'Can I be evicted from my apartment because I have AIDS?' 'What public benefits can I ge\?" 'Who will make my financial and medical decisions if I'm too ill to make them for myself?' "and 'Can my insurer refuse to pay AIDS or ARC-related claims?' To obtain a free copy, send a self-addressed stamped envelope to National G9Y Rights Advocates, 540 Castro Street, San Francisco, CA 94114, ************************************************** ***** PAGE 24 * THE OFFICIAL NEWSLETTER OF THE NCGSTDS * VOLUME 7:5 * JUNE/JULY, 1986 ***** ***********************************************************************************************************************

TRANSFUSION TRIAL BEGINS with thanks to g~!M, 7/29/86

SAN FRANCISCO .(AP) A blood bank that provided contaminated blood given to a woman who died of AIDS was more concerned about profits than patients, an attorney for the victim's family recently said. "Irwin (Memorial Blood Bank) was concerned that if it began to publicize the AIDS threat of the high risk group, it would lose donors ... which would cut down on the amount of blood it could sell and the amount of profit," said attorney Fred G. Meis, representing the family of Frances Borchelt. Mrs. Borchelt, 72, died on June 17, 1985, almost two years after receiving blood transfusions during elective hip surgery. Her husband Robert filed a $2 million lawsuit blaming the San Francisco blood bank, the Medical Society of San Francisco and Seton Medical Center in Daly City for his wife's death. Orthopedists Clifford Raisbeck and Charles Owen and anesthesiologist Gordon Clees also were named in the suit. As early as 1982, Meis said, blood bank officials became aware AIDS could be spread through blood transfusions from high-risk groups that included sexually active homosexual men. But he said the ·blood bank, which provides blood to at least 45 Northern California hospitals, was negligent in its blood screening process. He said a test developed during that period could have been used to detect the AIDS virus in donated blood, but that the blood bank did not use that test because it was too expensive. Meis said the blood bank's donors were supposed to fill out questionnaires regarding their medical histories so blood from high-risk groups would not be taken. But he said the card from "Donor C," whose blood was given to Mrs. Borchelt, was not properly completed. The man was later identified as a homosexual who had had at least 50 sexual partners a year. Attorney Duncan Barr, representing the blood bank, countered that there were no effective tests for AIDS at the time, and that the only real hope of eliminating the virus from donated blood was if high-risk volunteer donors did not give blood. Barr said "Donor e" had originally told the blood bank he was not a member of a high-risk group. He said the blood bank found out that he was a homosexual only after Mrs. Borchelt contracted AIDS and the blood was traced. He said the bank did not do the test for AIDS suggested by Meis because it was "ridiculously expensive" and had not been proven effective. "Everything Irwin did was not only within the standard of care of the time, but it went beyond the standard of care ... They were a leader," Barr said. Meis also said that during Mrs. Borchelt's surgery, the anesthesiologist gave her the transfusion needlessly because she only lost about 750 cubic centimeters of blood, not enough to require a transfusion. Attorney David Lynch, representing Raisbeck and Owen, said she lost about 1,900 cubic centimeters of blood, or about 35 to 40 percent of her total volume. **************************************************

BEHIND THE SCENES IN PARIS ------by-Michael Helquist, with thanks to the ~~~h!ng~Qn §l~~!, 7/4/86 reCDJIIilion for Ibe hard work of Gay An American obsener of \he Gay people fighting a public heallh crisis Ibat successfully negotiale !he controversies less of a strange cone

************************************************** CENTERSFOR DISEASECONTROL May 2,1986/ Vol. 35/ No. 17 TABLE 5. Alternate testing site activities - United States, 1985

Testing Pretest Persons Post-test Percent * Area sites sessions tested sessions positive" * * * UNITED STATES 874 93.917 79,083 55.499 17.3 * * New England * * Maine 4 42 42 42 9.5 * N.H. 1 73 429 53 9.8 *:>:*-1 Mtl'lR 284 HTLV-III/LAV Antibody Testing at Vt. 19 0 110 110 2.7 * m MORBIDITYAND MORTALITYWEEKLY REPORT Alternate Sites * Mass. 7 1,400 600 450 11.8 *0-n R.I. 1 308 695 214 10.6 * -n Conn. 0 0 0 0 * ...... *0* ...... Human T-Lymphotropic Virus Type 111/ Mid-Atlantic *>*r- Lymphadenopathy-Associated Virus Antibody Testing at Alternate Sites Upstate N.Y. 8 2,376 1.697 1.254 9.0 * N.Y. City 275 7,042 2.032 2.032 30.7 *m*:z: N.J. 4 1,844 1.818 246 13.5 *U>*>E On March 2. 1985. an enzyme-linked immunosorbant assay (ELISA) test to detect antibod- Pa. 7 2.204 1.608 1.333 10.1 *m* r- ies to human T -Iymphotropic virus type III/lymphadenopathy-associated virus (HTLV-IIII E.N. Central *-1 LAV) was licensed by the U.S. Food and Drug Administration to screen blood and plasma col- Ohio 7 3.174 2.780 2,500 17.2 *m*:0 Ind. 9 3.338 827 756 18.1 * lected for transfusion or manufactured into other products. Since it was recognized that many III. 3 280 221 0 13.1 *0*-n * individuals in groups at high risk for AIDS might want testing to determine their antibody Mich. 5 2,633 1.897 303 15.1 *-1*:>: status. federal funds for alternate testing sites were made available so that HTLV-III/LAV anti- Wis. 30 1.050 1.021 1.010 12.2 *m W.N. Central * body tests could be obtained free of charge outside the blood-bank setting. A primary goal *:z: Minn. 4 1,730 1,717 1.614 *0 13.8 *U>*'" was to protect the nation's blood.,supply by limiting the potential for donation of false- Iowa 11 947 947 67 7.1 *-1 negative units. The alternate sites were also needed to ensure that individuals wishing to be Mo. 12 1.241 1.026 851 18.6 **U> 0 N. Dak. 2 120 120 120 5.0 * tested would receive appropriate pretest counseling. post-test counseling. and referral for 5. Dak. 2 4 4 4 50.0 * medical evaluation. if indicated. Nebr. 11 235 199 141 * * 24.6 * Cooperative agreements between CDC and 55 state and .local health departments began Kans. 18 651 306 289 9.8 * S. Atlantic *< April 26. 1985. The cooperative agreements were for a 90-day period. since they were in- *0 Del. 7 785 198 190 8.1 *r-*c: tended to defray start-up costs only. Most agreements were subsequently extended for an Md. 26 1.586 1,467 952 12.7 *3*m additional 90 days without additional funding at the request of the individual health depart- D.C. 2 1.269 1.235 1.235 19.0 **-:1 Va. 5 687 611 587. 15.1 *"' ments. Preliminary data on the activities supported by the cooperative agreements were *<.11 W.Va. 7 269 240 178 11.7 * reported to CDC in September 1985 and January 1986. As of September 6. 1985. at least N.C. 93 923 711 461 18.3 * * one alternate testing site had been established by 52 of the 55 project areas; an estimated S.C. 46 1.131 1,064 990 12.0 * Ga. 10 525 554 161 12.3 * 518 sites had been established nationwide; and 21.200 persons had been tested. Fla. 23 6.074 5.8.11 3,756 21.4 *c:*<- Activities increased substantially during the last quarter of 1985. By December 31. 1985. E.S. Central *:z: *m*-...... 874 testing sites had been established in 53 project areas (Table 5). This total included 275 Ky. 5 417 152 132 17.1 *<- Tenn. 5 946 684 513 13.0 *c:* r- sites in New York City located in private physicians' offices. Nationwide. 79.100 persons had Ala. 5 564 518 70 16.4 *.*-< been tested. Pretest counseling had been provided to 93.900 persons. and post-test counsel- Miss. 14 150 143 0 18.2 **~ ing. to 55.500. A total of 17.3% of the individuals tested at these sites had repeatedly reactive W.S. Central * Idaho 1 137 '380 109 e.4 * Wyo. 1 0 39 1 0.0 * NO * <.11 Colo.~~ ~RIt4-rc.M.f.10 ~ 4.252 .". 4.252 r 4.252 {< 41.5 * N.Mex. 6 434 243 170 17.3 * Erratum: Vol. 35, No. 17 Ariz. 1 662 427 427 20.1 * * Utah 21 216 416 148 39.4 * * Nev. 3 984 458 63 13.8 * * p.285 In the article. "Human T -Lymphotropic Virus Type III/Lymphadenopathy-Associated * * Virus Antibody Testing at AHernate Sites." the figures in Table 5 for Colorado are in- * correct. The correct figures are: Testing sites-10; Pretest sessions-4,316; Per- * 'On at least two ELISA tests. * sons tested-4.316; Post-test sessions-4.316; and Percent positive-12.0. * 2. CDC. Update: Public Health Service Workshop on Human T-Lymphotropic Virus Type iii Antibody TABLE 5. Alternate testulg site activities - United States, 1985 (Continued) Testing - United States. MMWR 1985 ;34:4 77 -8. 3. Ward JW. Grindon AJ. Fiorino PM. Laboratory and epidemiological evaluation of an enzyme immu­ Testing Pretest Persons Post·test Percent noassay for antibodies to human T -Iymphotropic virus. type iii. JAMA (in press). Area sites sessions tested sessions positive" 4. CDC. Recommendations for assisting in the prevention of perinatal transmission of human T-Iympho­ tropic virus type iii/lymphadenopathy-associated virus and acquired immunodeficiency syndrome. * * Pacific MMWR 1985;34:121-6.731-2. * * Wash. 18 * * 3,136 2.569 2.330 12.7 5. CDC. Additional recommendations to reduce sexual and drug abuse-related transmission of human * * Oreg. 15 829 * 1.435 829 21.2 T -Iymphotropic virus type iii/lymphadenopathy-associated virus. MMWR 1986;35: 152-5. * Calif. 51 17.121 17.546 11.552 13.7 * .... 6. Handsfield HH. Dunphy CA. 80nin P. Unpublished data. ' * :. San Fran. 2 5.898 5.898 5.047 19.9 **m en Alaska 5 824 915 77 9.3 * Hawaii * "-> 1 793 658 599 17.3 TABLE 6. Reported AIDS cases and tests for HTLV-III/LAV antibody performed at alter­ * en Guam 0 0 0 0 nate sites, for 10 project areas - United States, 1985" * P.R. 2 595 904 351 40.7 :* * V.1. 0 0 0 0 Project area Reported AIDS cases t HTlV-lII/lAV tests Tests per case * Pac. Trust Terr. 0 0 0 0 * .... * ::I: 'On at least two ELISA tests. New Yorkfit y 2.140 2.032 1.0 * m California 1.923 23.444 12.2 * 0 Florida 516 5.811 11.3 * " Texas 483 7.564 15.7 * (")- New Jersey 460 *:.* - Reported by Div of Sexually Transmitted Diseases, Center for Prevention Svcs. CDC. 1.818 4.0 * .-­ Colorado 61 4.252 69.7 * Editorial Note: Many of the project areas reported they had underestimated the difficulty of *m* :z: Ohio 53 2.780 52.5 *€*(.1) establishing alternate sites on a short-term basis. Start-up delays were common because of Oregon 33 1.435 43.5 *m* .-­ administrative procedures and such factors as general hiring freezes and the development of Iowa 13 947 12.9 .... * .... systems to assure strict confidentiality of all records related to counseling and clinicallabora­ Alaska 5 915 183.0 :=* m tory test results. Moreover, the initial demand for services was less than most areas had antic­ *0 United States 8.072 79,083 9.8 ipated. The number of tests performed in each area depended on many factors. including ac­ :"* .... * ::I: cessibility of services. perception of the benefits or risks of testing, and awareness of the exis­ 'This table shows five project areas with the highest number of reported cases and five project areas *m with the highest rates of tests per case. * tence of services by those at risk. The utilization of the sites varied widely in both high and * :z:(") tprovisional totals reported to MMWR through week 52. 1985. *en* low AIDS-incidence areas (Table 6). perhaps indicating that demand for testing depends on * (.I) §Includes the separately funded San Francisco project area. * .... * <::> the degree to which it is encouraged and made accessible for persons at risk. In one project * (.I) area with a high test-to-case ratio. testing was actively promoted by both public health au­ * CENTERSFOR DISEASECONTROl. * thorities and AIDS risk-group representatives ( 11. May 16. 1986/ Vol. 35/ No. 19 * * * The gO,al of protecting the blood supply by providing alternate sites at which persons * <: * 0 could be tested was achieved. In addition. experience with the HTLV-III/LAV ELISA tests since 304 Plasmid-Mediated Tetracycline­ *<=* .-­ Resistant Neisserkl gonorrhoeae - *3 licensure in March 1985 has shown them to be remarkably sensitive and specific (2) and to m G~orgia.Massachusetts. Oregon * be useful, not only for preventive purposes. but also for the diagnosis and differential diagno­ * --.I sis of clinical illness. An evaluation of the tests used to screen blood donors in a large metro­ * : of Korea. Antimicrob Agents Chemother 1984;25:7 -9. * m tient was still symptomatic and had a positive urethral culture for N. gonorrhoeae. Sensitivity **0 4. Rice RJ, Biddle JW, Jeanlouis VA, DeWitt WE, Blount JH, Morse SA. Chromosomally mediated resis­ * "'T1 testing by disk diffusion demonstrated a zone size to tetracycline of 13 mm (sensitive strains * "'T1 tance in Neisseria gonorrhoeae in the United States: results of surveillance and reporting 1983-1984. *C">* - vyere defined as having disk diffusion zone sizes greater than 30 mm). The isolate was con­ J Infect Dis 1986; 153:340-5. *>* - 5. CDC. 1985 STD treatment guidelines. MMWR 1985;34(suppI4S):75S-108S. * • firmed by CDC as high-level TRNG with a minimum inhibitory concentration of 32 J.Lg/ml. *%* Bet~eenOctober 22, and December 26, 1985, 'nine other CDC-confirmed TRNG cases * m CENllRSFOR DISEASE CONTROl *Ul*>E were identified at the Multnomah County STD clinic on the basis of disk-diffusion testing re­ May 23,1986/ Vol. 35/ No. 20 * • * m sults. All patients were homosexual males infected at rectal (three patients), urethral (two), *-< rectal and urethral (four), and pharyngeal (one) sites. All four patients treated with tetracycline *::0* m alone were treatment failures, and one of these had developed clinical orchitis since his initial *0* * "'T1 clinic visit. All cases were the same auxotype and serovar class, suggesting the isolates **-< of 334 Classification System for HTlV-lII/lAV *:>: * m were of a clonal origin. Six additional cases of gonococcal disease, including two out-of-state Infections **% cases, were diagnosed by contact-tracing. Two cases were tetracycline treatment failures; *C"> MtlWR *cn*Ul two were TRNG on the basis of disk-diffusion testing (zone size less than 20 mm); and two MORBIDITYAND MORTALITYWEEKLY REPORT *-< *Ul* c:> were not tested. Nineteen contacts, including 15 bathhouse contacts of one patient, could not .. be traced due to lack of adequate identifying and locating information. Current Trends * ..* * In response to this outbreak, the Multnomah County Health Department instituted ceftriax­ * Classification System for Human T-Lymphotropic Virus Type 111/ * one as the drug of choice for all gonococcal infections among homosexual males. Educational *0..* ..::: efforts targeted at both the professional and lay community w!lre intensified toward increas­ Lymphadenopathy-Associated Virus Infections ... *3:*<= ing TRNG awareness. m INTRODUCTION * Reported by B Carlson. F Myers, L Mofenson, H George, Massachusetts State Laboratory Institute, G * ..... Grady. MD, State Epidemiologist Massachusetts Dept of Public Health; RW Hill, CP Schade, J Kolden, J Persons infected with the etiologic retrovirus of acquired immunodeficiency syndrome *<:11* (AIDS) ( 1-4)' may present with a variety of manifestations ranging from asymptomatic infec­ * Mitchell. G Sawyer, M Ware. V Fox. J Karius. H Horton. Multnomah County Dept of Human Svcs; R * Poole. R Miller, R Blumberg. DeKalb County Board of Health, Decatur, Georgia; Sexually Transmitted Dis­ tion to severe immunodeficiency and life-threatening secondary infectious diseases or can­ * * ease Laboratory Program. Center for Infectious Diseases. Epidemiology Research Br, Div of Sexually * cers. The rapid growth of knowledge about human T -Iymphotropic virus type 1111 **<- Transmitted Diseases. Center for Prevention Svcs, CDC. lymphadenopathy-associated virus (HTLV-III/LAV) has resulted in an increasing need for a *%*<= Editorial Note: The geographic dispersion of TRNG strains since the original MMWR report * m system of classifying patients within this spectrum of clinical and laboratory findings attri­ in September 1985 (1) has .been impressive. The rapid onset of the outbreak in Portland and **<-*<= --­ butable to HTLV-III/LAV infection (5-7). * • the large number of untraceable contacts elicited from several of the patients underscore the .. -< Various means are now used to describe and assess patients with manifestations of *. potential for rapid dissemination of new gonococcal strains into a community. * HTLV-III/LAV infection and to describe their signs, symptoms, and laboratory findings. The * <.0 The identification of combined PPNG-TRNG strains in Massachusetts once again demon­ * co surveillance definition of AIDS has proven to be extremely valuable and quite reliable for some * m strates the ability of N. gonorrhoeae to acquire multiple drug-resistant determinants. This in­ ..* epidemiologic studies and clinical assessment of patients with the more severe manifestations cludes such combinations as plasmid-mediated resistance (e.g., PPNG-TRNG)' plasmid and * of disease. However, more inclusive definitions and classifications of HTLV-III/LAV infection * * chromosomally-mediated resistance (e.g., spectinomycin-resistant PPNG) (2,3), or chromo­ * are needed for'optimum patient care, health planning, and public health control strategies, as *>* "CI somally-mediated resistance to multiple antibiotics (4). well as for epidemiologic studies and special surveys. A broadly applicable, easily understood *cn The largest numbers of TRNG cases were described from areas where active surveillance * m classification system should also facilitate and clarify communication about this disease. * programs were in operation. With the exception of testing for f3-lactamase, most areas in the * ~ In an attempt to formulate the most appropriate classification system, CDC has sought the * ..... United States do not routinely perform antimicrobial susceptibility testing on gonococcal iso­ * advice of a panel of expert consultants t to assist in defining the manifestlltions of HTLV -1111 * lates. Therefore, the incidence of resistant strains that do not present as treatment failures is * * LAV infection. * * ..* * not known. GOALS AND OBJECTIVES OF THE CLASSIFICATION SYSTEM * Tetracycline (doxycycline, minocycline) therapy alone is not recommended for the treatment * The classification system presented in this report is primarily applicable to public health * * purposes, including disease reporting and surveillance. epidemiologic studies, prevention and * control activities, and public health policy and planning. * Immediate applications of such a system include the classification of infected persons for * reporting of cases to state and local public health agencies, and use in various disease coding and recording systems, such as the forthcoming 10th revision of the International Classifica­ tion of Diseases. DEFINITION OF HTLV-III/LAV INFECTION conditions resulting from HTLV-III/LAV infection. There is no a priori hierarchy of severity The most specific diagnosis of HTLV-III/LAV infection is by direct identification of the among subgroups A through E, and these subgroups are not mutually exclusive. virus in host tissues by virus isolation; however, the techniques for isolating HTLV-Ill/LAV cur­ Definitions of the groups and subgroups are as follows: rently lack sensitivity for (selecting infection and are not readily available. For public health Group I. Acute HTLV-III/LAV Infection. Defined as a mononucleosis-like syndrome, with purposes, patients repeatedly reactive screening tests for HTLV-III/LAV antibody (e.g., with or without aseptic meningitis, associated with seroconversion for HTLV-III/LAV antibody enzyme-linked assay) in antibody is also identified use sup­ * * immunosorbent whom by the of (15-161. Antibody seroconversion is required as evidence of initial infection; current viral iso­ * * plemental tests (e.g., Western blot, immunofluorescence assay) should be considered both in­ * * lation procedures are not adequately sensitive to be relied on for demonstrating the onset of * * fec!cld and infective (8-101. * infection. * -0 * ~ Although HTLV-Ill/LAV infection is identified by isolation of the virus or, indirectly, by the Group II. Asymptomatic HTLV-III/LAV Infection. Defined as the absence of signs or * ",G) presence virus, a presumptive clinical diagnosis HTLV-Ill/LAV of antibody to the of infection symptoms of HTLV-III/LAV infection. To be classified in Group II. patients must have had no * has been made in some situations in the absence positive virologic serologic test results. * ".. of or previous signs or symptoms that would have led to classification in Groups III or IV.·Patients * CD There is a very strong correlation between the clinical manifestations of AIDS as defined by * whose clinical findings caused them to be classified in Groups III or IV should not be reclassi­ * * CDC ond the presence of HTLV-Ill/LAV antibody (11-141. Most persons whose clinical illness * fied in Group II if those clinical findings resolve. * fulfills the CDC surveillance definition for AIDS will have been infected with the virus ( 12- 74). * --i Patients in this group may be subclassified on the basis of a laboratory evaluation. Labora­ *:x:* ", CLASSIFICATION SYSTEM tory studies commonly indicated for patients with HTLV-III/LAV infection include, but are not * *0* ." This system classifies the manifestations of HTLV-Ill/LAV infection into four mutually ex­ limited to. a complete blood count (including differential blood cell count) and a platelet * ." white * - clusive groups, designated by Roman numerals I through IV (Table 5). The classification count. Immunologic tests, especially T-Iymphocyte helper and suppressor cell counts, are *n **~ - system applies only to patients diagnosed as having HTLV-IlIILAV infection (see previous sec­ also an important part of the overall evaluation. Patients whose test results are within normal * .- DEFINITION OF HTLV-III/LAV INFECTION), Classification in a particular group is not * :z: tion, limits, as well as those for whom a laboratory evaluation has not yet been completed, should * ", explicitly intended to have prognostic significance, nor to designate severity of illness. Howev­ *€ be differentiated from patients whose test results are consistent with defects associated with * .­en er, classification in the four principal groups, I-IV, is hierarchical in that persons classified in a * ",--i HTLV-III/LAV infection (e.g .• lymphopenia, thrombocytopenia, decreased number of helper * --i particular group should not be reclassified in a preceding group if clinical findings resolve, *", [T 4 1T -lymphocytes). * :;0 since c!inical improvement may not accurately reflect changes in the severity of the underlying Group III, Persistent Generalized Lymphadenopathy (PGL). Defined as palpable lym­ *0* disease. * ." phadenopathy (lymph node enlargement of 1 cm or greater) at two or more extra-inguinal * --i Group I includes patients transient signs and symptoms that appear at the time of, or * :x: with sites persisting for more than 3 months in the absence of a concurrent illness or condition * ", shortly after, initial infection with HTLV-III/LAV as identified by laboratory studies. All patients * z other than HTLV-III/LAV infection to explain the findings. Patients in this group may also be * n * G) in Group I will be reclassified in another group following resolution of this acute syndrome. subclassified on the basis of a laboratory evaluation, as is done for asymptomatic patients in *--i* en , Group II includes patients who have no signs or symptoms of HTLV-III/LAV infection. I-'a­ Group II (see above). Patients with PGL whose clinical findings caused them to be classified in *0*en tients in this category may be subclassified based on whether hematologic and/or immuno­ Group IV should not be reclassified in Group III if those other clinical findings resolve. * logic laboratory studies have been done and whether results are abnormal in a manner consis­ * Group IV. Other HTLV-III/LAV Disease. The clinical manifestations of patients in this * * tent with the effects of HTLV-III!L.AV infection. * group may be designated by assignment to one or more subgroups (A-E) listed below. Within * <: Group III includes patients with persistent generalized lymphadenopathy, but without find­ 0 Group IV. subgroup classification is independent of the presence or absence of lymphade­ * r­ ings that wo~ldlead to classification in Group IV. Patients in this category may be subclassi­ *31:* c: nopathy. Each subgroup may include patients who are minimally symptomatic, as well as pa­ * ", fied based on the results of laboratory studies in the same manner as patients in Group II, tients who are severely ill. Increased specificity for manifestations of HTLV-III/LAV infection. * ..... Group IV includes patients with clinical symptoms and signs of HTLV-III/LAV infection if needed for clinical purposes or research purposes or for disability determinations, may be * U"I other than or in addition to lymphadenopathy, Patients in this group are assigned to one or * achieved by creating additional divisions within each subgroup. * more subgroups based on clinical findings. These subgroups are: A. constitutional disease; * * Subgr~-~.~Constitutional disease. Defined as one or more of the following: fever per­ * B, neurologic disease; C. secondary infectious diseases; D. secondary cancers; and E. other * * <- Sisting more than 1 month. involuntary weight loss of greater than 10% of baseline, or diar­ *:z:* c: rhea persisting more than 1 month; and the absence of a concument illness or condition * rn * ...... other than HTLV-III/LAV infection to explain the findings. *<- * .­c: "The AIDS virus has been variously termed human T-Iymphotropic virus type III (HTLV-III), Subgroup B. Neu~oIogicdisease. Defined as one or more ~fthe following: dementia, *­* -< lymphadenopathy-associated virus (LAVI. AIDS-associated retrovirus (ARVI. or human immunodeficien­ myelopathy, or peripheral neuropathy; and the absence of a concurrent illness or condition * cy virus (HIVj, The designation human immunodeficiency virus (HIV) has recently been proposed by a * <.0 other than HTLV-Ill/LAV infection to explain the findings. * co subcommittee of the International Committee for the Taxonomy of Viruses as the appropriate name for * C7> the retrovirus that has been implicated as the causative agent of AIDS (4). ~bgroupC. ~condary infectious diaeases. Defined as the diagnosis of an infectiOUS :* disease associated with HTLV-III/LAV infection and/or at least moderately indicative of a t The following persons served on the review panel: OS Burke, MD, RR Redfield. MD, Walter Reed Army * * Institute of Re.search, Washington. DC; J Chin. MD. State Epidemiologist. California Department of defect in cell-mediated immunity. Patients in this subgroup are divided further into two * * Health Services; LZ Cooper. MD. St Luke's-Roosevelt Hospital Center. New York City; JP Davis. MD. categories: ' * * Stale Epidemiologist. Wisconsin Division of Health; MA Fischl. MD. University of Miami School of Medi­ Category C-l. Includes patients with symptomatic or invasive disease due to one of 12 * cine. Miami. Florida;'G Friedlimd. MD. Albert Einstein College of Medicine. New York City; MA Johnson, * specified secondary infectious diseases listed in the surveillance definition of AIDS§: * MD. 01 Abrams. MD. San Francisco General Hospital; 0 Mildvan. MD. Beth Israel Medical Center, New * :neu,:,ocystis carinii pneumonia, chronic cryptosporidiosis, toxoplasmosis, extra­ : York City; CU Tuazon. MD. George Washington University School of Medicine. Washington. DC; RW * Price. MD. Memorial Sloan-Kettering Cancer Center. New York City; C Konigsberg. MD. Broward County IOtestlOal strongyloidiasis, isosporiasis, candidiasis (esophageal, bronchial, or pulmo­ * Public Health Unit. Fort Lauderdale. Florida; MS Gottlieb. MD. University of California-Los Angeles na,:), cryptococcosis. histoplasmosis, mycobacterial infection with Mycobacterium * Medical Center; representatives of the National Institute of Allergy and Infectious Diseases. National aVlum complex or M. kansasi;' cytomegalovirus infection. chronic mucocutaneous or Cancer Institute. National Institutes of Health; Center for Infectious Diseases. CDC, disseminated herpes simplex virus infection, and progressive multifocal leukoen­ cephalopathy. tion of particular syndromes will evolve with increasing knowledge of the significance of cer­ Category C-2. Includes patients with symptomatic or invasive disease due to one of six tain clinical findings and laboratory tests. New diagnostic techniques, such as the detection of other specified secondary infectious diseases: oral hairy leukoplakia, multidermatomal specific HTLV-III/LAV antigens or antibodies. may add specificity to the assessment of pa­ herpes zoster. recurrent Salmonella bacteremia, nocardiosis, tuberculosis. or oral can­ tients infected with HTLV-III/LAV. didiasis (thrush). The classification system defines a limited number of specified clinical presentations. Pa­ * Subgroup D. Secondary cancers. Defined as the diagnosis of one or more kinds of cancer tients whose signs and symptoms do not meet the criteria for other groups and subgroups, * * known to be associated with HTLV-III/LAV infection as listed in the surveillance definition but whose findings are attributable to HTLV -III/LAV infection. should be classified in sub­ * * * * of AIDS and at least moderately indicative of a defect in cell-mediated immunity~:Kaposi's group IV-E. As the classification system is revised and updated. certain subsets of patients in * sarcoma. non-Hodgkin's lymphoma (small. noncleaved lymphoma or immunoblastic sarco­ subgroup IV-E may be identified as having related groups of clinical findings that should be **~*::J: * m mal. or primary lymphoma of the brain. separately classified as distinct syndromes. This could be accomplished either by creating * *0* -n Subgroup E. Other conditions in HTLV-III/LAV infection. Defined as the presence of additional subgroups within Group IV or by broadening the definitions of the existing sub­ * .­-n other clinical findings diseases, not classifiable above, that may be attributed HTLV-III/ groups. *n or to **> .­ LAV infection and/or may be indicative of a defect in cell-mediated immunity. Included are Persons currently using other classification systems (6-7} or nomenclatures (e.g .• AIDS­ *. patients with chronic lymphoid interstitial pneumonitis. Also included are those patients related complex. lymphadenopathy syndrome) can find equivalences with those systems and *z* *m*:IE whose signs or symptoms could be attributed either to HTLV-IIVLAV infection or to another terminologies and the classification presented in this report. Because this classification *U> coexisting disease not classified elsewhere, and patients with other clinical illnesses, the system has only four principal groups based on chronology. presence or absence of signs and *.*m * ..... * ..... course or management of which may be complicated or altered by HTLV-III/LAV infection. symptoms. and the type of clinical findings present. comparisons with other classifications * m *"" Examples include: patients with constitutional symptoms not meeting the criteria for sub­ based either on clinical findings or on laboratory assessment are easily accomplished. *0**-n group IV-A; patients with infectious diseases not listed in subgroup IV-C; and patients with This classification system does not imply any change in the definition of AIDS used by **~ neoplasms not listed in subgroup IV-D. CDC since 1981 for national reporting. Patients whose clinical presentations fulfill the surveil­ *::J:*m Reported by Center for Infectious Diseases. CDC. lance definition of AIDS are classified in Group IV. However, not every case in Group IV will *z* ~g Editorial Note: The classification system is meant to provide a means of grouping patients meet the surveillance definition. *U> * ..... infected with HTLV-III/LAV according to the clinical expression of disease. It will require Persons wishing to comment on this material are encouraged to send comments in writing *U>*0 periodic revision as warranted by new information about HTLV-IIVLAV infection. The defini- to the AIDS Program. Center for Infectious Diseases, CDC. * References * * 1. Gallo RC, Salahuddin SZ. Popovic M. et al. Frequent detection and isolation of cytopathic retrovi­ * ruses (HTLV-III) from patients with AIDS and at risk for AIDS. Science 1984;224:500-3. * §This subgroup includes patients with one or more of the specified infectious diseases listed whose *0*< 2. Barn!-Sinoussi F. Chermann JC. Rey F. et al. Isolation of aT -Iymphotropic retrovirus from a patient clinical presentation fulfills the definition of AIDS as used by CDC for national reporting. *c at risk for acquired immune deficiency syndrome (AIDSI. Science 1983;220:868-71 .. *.*3*m ~Thissubgroup includes those patients with one or more of the specified cancers listed whose clinical 3. Levy JA. Hoffman AD. Kramer SM. Landis JA. Shimabukuro JM. Oshiro LS. Isoilltion of Iymphocy­ * presentation fulfills the definition of AIDS as used by CDC for national reporting. topathic retroviruses from San Francisco patients with AIDS. Science 1984;225:840-2. **'" 4. Coffin J. Haase A. Levy JA. et al. Human immunodeficiency viruses [Letter]. Science 1986;232: * 697. * * 5. CDC. Revision of the case definition of acquired immunodeficiency syndrome for national re­ * porting-United States. MMWR 1985;34:373-5. *<-*c* 6. Haverkos HW. Gottlieb MS. Killen JY. Edelman R. Classification of HTLV-III/LAV-related diseases *z*m TABLE 5. Summary of classification system for hllmlllLI=bmphotropic viNS type III/ [Letter]. J Infect Dis 1985; 152: 1095. *<- 7. Redfield RR. Wright DC. Tramont EC. The Walter Reed staging classification for HTLV-III/LAV infec­ * -­ lymphadenopathy-associated ViNS *c tion. N Engl J Med 1986;314: 131-2. *.*-< 8. CDC. Antibodies to a retrovirus etiologically associated with acquired immunodeficiency syndrome * ~ (AIDS) in populations with increased incidences of the syndrome. MMWR 1984;33:377-9. *co*CD Group I. Acute infection 9. CDC. Update: Public Health Service Workshop on Human T -Lymphotropic Virus Type III Antibody *en Testing-United States. MMWR 1985;34:477-8. * Group II. Asymptomatic infection' 10. CDC. Additional recommendations to reduce sexual and drug abuse-related transmission of human * * T -Iymphotropic virus type III/lymphadenopathy-associated virus. MMWR 1986;35: 152-5. * Gr0U9 III. Persistent generalized lymphadenopathy' * 11. Selik RM. Haverkos HW. Curran JW. Acquired immune deficiency syndrome (AIDS) trends in the *>*-0 United States. 1978-1982. Am J Med 1984; 76:493-500. *(i) Group IV. Other disease *m 12. Sarngadharan MG. Popovic M. Bruch L. Schupbach J. Gallo RC. Antibodies reactive with human T­ * Subgroup A. Constitutional disease Iymphotropic retroviruses (HTLV-III) in the serum of patients with AIDS. Science 1984;224:506-8. **CD*~ Subgroup B. Neurologic disease 13. Safai B. Sarngadharan MG. Groopman JE. et al. Seroepidemiological studies of human T­ * Subgroup C. Secondary infectious diseases * Iymphotropic retrovirus type III in acquired immunodeficiency syndrome. Lancet 1984;1: 1438-40. * * Category C-l . Specified secondary infectious diseases listed in the CDC surv',illance definition * * 14. Laurence J. Brun-Vezinet F. Schutzer SE. et al. Lymphadenopathy associated viral antibody in AIDS. * * for AIDSt Immune correlations and definition of a carrier state. N Engl J Med 1984;311: 1269-73. * * Category C-2. Other specified secondary infectious diseases * 15. Ho DO. Sarngadharan MG. Resnick L. Dimarzo-Veronese F. Rota TR. Hirsch MS. Primary human T­ * Subgroup D. Secondary cancers t * Subgroup E. Other conditions Iymphotropic virus type III infection. Ann Intern Mad 1985; 103:880-3. : 16. Cooper DA, Gold J. Maclean P. et al. Acute AIDS retrovirus infection. Definition of a clinical illness * 'Patients in Groups II and III may be subclassified on the basis of a laboratory evaluation. associated with seroconversion. Lancet 1985;1:537-40. * tlncludes those patients whose clinical presentation fulfills the definition of AIDS used by CDC for na­ tional reporting. CENlERSFOR DISEASE CONTROL May 30,1986/ Vol. 35/ No. 21 indirect hemagglutination (reciprocal geometric mean titer [GMT] 292, compared with 31, p = 0.046) and by enzyme immunoassay (GMT 276, compared with 74; P = 0.04). Case patients also tended to have higher titers to HSV-1 (GMT 154, compared with 82) and to HSV-2 (GMT 140, compared with 34). To help evaluate the reproducibility of the EBV serologic test results within a single labora­ 350 Chronic Fatigue Possibly Related to * * Epstein-Barr Virus - Nevada tory, 1 9 sera, obtained earlier from 12 of the case patients and subsequently frozen, were * * retested in the same laboratory. Fourfold or greater variations between the initial and repeated * * titers were detected in 17.6% of the samples tested for anti-EA-D, 26.3% tested for VCA-lgG **-0 MtlWR *G>* ~ * m MORBIDITYAND MORTALITYWEEKLY REPORT and 33.3% tested for anti-EA-R. All sera with fourfold or greater changes in anti-EA-D or VCA­ * IgG had a decrease in titer with the repeat testing, and all those with changes in anti-EA-R had * ...., increased titers. * = Chronic Fatigue Possibly Related to Epstein-Barr Virus - Nevada * Reported by 0 Peterson, MD, P Cheney. MD, Incline Village, M Ford, MPH, 8 Hunt. Washoe County District * * Health Dept, G Reynolds, Acting State Epidemiologist. Nevada Div of Health; Viral Exanthems and Herpes­ * From November 1984 through August 1985, approximately 90 patients evaluated for per­ * ...... virus 8f, Epidemiology Office, Divof Viral Diseases, Center for Infectious Diseases, CDC. * ::z: * m sistent fatigue were diagnosed as having chronic Epstein-Barr virus (CEBV) disease by a two­ Editorial Note: In January 1985, two publications reported the association of a chronic, *0* physician community internal medicine practice near Lake Tahoe, Nevada. The diagnoses were * ..... mononucleosis-like illness with evidence of persistent active Epstein-Barr virus activity among * ..... made by detecting antibody to the diffuse (EA-D) or the restricted (EA-R) components of early * -0 young, previously healthy adults ( 1,2). These patients had no other discernible cause for their * - antigen of EBV, as suggested by two recent studies (1,2). illnesses, and many demonstrated an apparently unusual pattern of anti-EBV antibodies when * .-~ Because of controversy about whether CEBV disease exists, two serologic studies were con­ * ::z: compared with controls. However, several questions have been raised about these studies, * m ducted to evaluate whether a syndrome of chronic fatigue could be statistically associated with * :IE including whether CEBV actually exists (3-5). * .­U> a specific pattern of antibody titers against EBV. Fifteen "case" patients, felt to be the most * m In the Nevada investigation, the 1 5 case patients were more likely to have abnormal EBV * ...... * ...... likely to have CEBV, were identified by interviewing 134 of the 139 patients tested for EBV serologic markers than other patients, and, in addition to increased fatigue, were more likely to * m sElrology in the internal medicine practice between January 1, and August 20, 1985. By defini­ * "" have palpable splenomegaly. These findings suggest that, as a group, these patients have an * 0 * ..... tion, these patients had persistent or relapsing unexplained fatigue for at least 2 months, which abnormality, or abnormalities, associated in some way with high antibody titers to EBV and * ...... forced them to stop usual daily activities for at least 2 weeks. Other less universal symptoms * ::z: CMV. * m included intermittent low-grade fever, sore throat, myalgias, arthralgias, and headaches. All 15 * ::z: The study highlights several problems associated with the diagnosis of CEBV. First, the * 0 patients were white; 13 were female. The median age was years (range yearsl. *G> 40 13-52 clinical syndrome is comprised of a wide range of nonspecific symptoms, and is inadequate for * U> * ...... In the first serologic study, the 15 patients were compared with 118 of the 119 patients diagnosing CEBV without a confirmatory laboratory test. * c::> * U> who had serqlogic testing for EBV (the serologic test results on one patient were not availablel. Second, "elevated" anti-EBV serologic titers do not prove that a chronic illness in an indi­ * All 118 of these patients were white; 79 (66.9%) were female. The median age was 36 years * vidual is due to EBV. There is a great deal of overlap in the antibody titers of case patients and * * (range 10- 71 years). The case patients were more likely to have reciprocal EA-D titers of 160 the general population, indicating that "normal" titers can vary substantially. In a recently pub­ * * <: or higher {45 .5%, compared with 11.6%; P = 0.014) and EBV viral capsid antigen IgG (VCA­ lished study, several asymptomatic persons followed for up to 8 years after recovery from * r­0 ..* c=31:, IgG) 160 or greater (80.0%, compared with 51.7%; P = 0.033) in the first serum tested. No evi­ acute infectious mononucleosis maintained anti-EA titers well into the range considered to indi­ * m' dence of acute EBV infection, manifested by positive IgM titers to VCA, was detected in either cate CEBV (6). ..* --" the cases or the others tested. .. U"I Third, the reproducibility of the serologic tests for EBV is poor, both within and between * Detailed information on physical findings was obtained for all 1 5 case patients and from 11 laboratories. The currently available indirect immunofluorescence technique for EBV serologic * of 1 8 other patients whose duration and severity of illness met the clinical case criteria but tests necessitates a subjective measurement of the fluorescence produced and is subject to * * who, on review of their medical records, had other possible etiologies. Palpable splenomegaly ..* <- variability between cell lots and between individual technicians. Comparability of titers can only *.. c= 11 was noted at some time during the illnesses of 13 of the 1 5 case patients and two of the be confirmed by testing specimens in parallel. *.. ::z:m other patients (p = 0.00021. Currently available data neither prove nor disprove the hypothesis that EBV activity is're­ * -­<- * c= In the second serologic study, blood specimens for EBV serologic testing were collected in sponsible for chronic illness, but is clear that the diagnosis of CEBV using current clinical and * r­ it * -< October 198,5 from the 15 case patients and from 30 age-, sex-, and race-matched controls. laboratory criteria in an individual patient is unreliable. Further examinations of immune function *­* The controls consisted of patients and office workers who had no complaints of fatigue and in these patients, as well as studies for other possible etiologies, are needed to define this syn­ ..* cou:> .. 0> had not previously undergone EBV serologic testing. The sera were tested simultaneously by drome and provide a framework for epidemiologic and therapeutic studies. * the commercial reference laboratory used by the two physicians, by the EBV laboratory at * In the meantime, CEBV should be a diagnosis of exclusion. Physicians evaluating patients * * CDC: and by a laboratory at Georgetown University in Washington, D.C. Case patients tended thought to have CEBV should continue to search for the more definable, and possibly treatable, * .. * * to have higher titers of VCA-lgG and of anti-EA than controls, but the specific test results and conditions that may be responsible for their symptoms, such as endocrine and autoimmune ..* * the tests in which the differences were significant varied considerably among the laboratories. ..* diseases; malignancies; chronic heart, liver, kidney, and pulmonary disease; anxiety and de­ * IgG antibody titers to herpes simplex virus (HSV) types 1 and 2 and cytomegalovirus (CMV) pression; and chronic infectious diseases, such as CMV and tuberculosis. ..* were also measured. Case patients had significantly higher CMV titers than controls, both by The patients reported here are only a portion of the cases reported to CDC with chronic, *.. ~* often severe, debilitating disease diagno~edas CEBV. Further etiologic studies are indicated, The serologic study demonstrated that 21 % of the cohort that attended clinic A between including known viruses such as EBV, CMV, and adenoviruses, in addition to viruses which January 1. and July 1. 1985. had evidence of recent HBV infection. including 27 clinical and have not yet been identified. Once the syndrome is better defined, epidemiologic and therapeu­ 33 subclinical (19M anti-HBc positive) cases. In contrast. none of the 93 new attendees of tic studies can be initiated. clinic A had evidence of recent HBV infection (p < 0.011. When all serologic markers of HBV References infection were examined. 43% of the cohort that attended clinic A between January 1 and ... 1. Jones JF, Ray CG, Minnich LL, Hicks MJ, Kibler R. Lucas DO. Evidence for active Epstein-Barr virus in­ July 1 had evidence of HBV infection. compared with 7% of new attendees at clinic A; 8% of ... fection in patients with persistent, unexplained illnesses: elevated anti-early antigen an'·;'odies. Ann ... persons who attended clinic B on or before July 1; and 6% of persons who began attending * ...* Intern Med 1985; 102: 1-7. .,. .,. clinic B after July 1. .,.* .,. * 2. Straus SE, Tosato G, Armstrong G, et al. Persisting illness and fatigue in adults with evidence of .,. Epstein-8arr virus infection. Ann Intern Med 1985; 102: 7 -16. .,. On initial analysis of the cohort members. exposure to the jet injectors and HCG were both .,.--1 3. Armstrong CW, Wetterhall SF. Epstein-Barr virus and unexplained illness [Letted. Ann Intern Med .,."", significantly associated with the development of acute HBV infection. However. two lots of .,. m 1985,102: 722. .,..,.0 4. Jones SR. Epstein-Barr virus and unexplained illness [Letter). Ann Intern Med 1985; 102:723. HCG used at the clinic during the outbreak (from February 1985 onward) were negative when .,...... 5. Merlin TL. Chronic mononucleosis: pitfalls in the laboratory diagnosis. Hum Patho11986; 17:2-8. tested for HBsAg. Furthermore. stratification of cohort members who received HCG by type .,.0.,. - .6. Horwitz CA, Henle W, Henle G, Rudnick H, Latts E. Long-term serological follow-up of patients for of parenteral inoculation (jet injector only. compared with syringe only) showed that 24% of .,.­.,. > .,. r­ Ep~tein-Barrvirus after recovery from infectious mononucleosis. J Infect Dis 1985; 151: 1150-3, those receiving injections by jet injector had developed acute HBV infection compared with .,.%.,. ... m none of those receiving injections by syringe only (p < 0.01) (Table 1). These two groups had ... :IE CENTERSFOR DISEASECONTROl. June 13, 1986/ Vol. No. 23 .,.U> 35/ ... r­ similar numbers of HCG exposures. with the syringe-only group averaging 31. while the jet ... m 373 HepatitisB Associatedwith Jet Gun *--1 Injection- California injector-only group averaged 27. *--1... m 376 Recommendationsfor ProvidingDialysis Some patients at clinic A reported that they had sustained lacerations and bruising in the ::0 Treatmentto PatientsInfected with ... 0 HTLV-III/LAV course of receiving the jet injections. Written protocols at clinic A specified that the Med-E-Jet ...... --1 injector nozzle be wiped with 70% isopropyl alcohol between injections. and that at the end of ..."", ... m each day. the nozzle retaining cap and the tip be removed and disinfected. As an adjunct to ... this investigation. CDC conducted a series of in vitro and in vivo laboratory experiments to ...:~ cp .,.U> Mtl'lR assess the potential for a contaminated Med-E-Jet to transmit HBV from patient to patient ... --1 MORBIDITYAND MORTALITYWEEKLY REPORT ... C and to assess the potential for HBsAg contamination of this jet injector during actual use . ... U> ... After contaminating the nozzle tip of the jet injector with a known quantity (0.025 ml) of ...... HBsAg-containing serum. the injector was fired into separate 1 -dram vials (to simulate down­ ...... Epidemiologic Notes and Reports stream transmission) and swab samples were taken of the exterior and interior surfaces of the .....::: ...... 0 nozzle. This procedure was repeated 10 times. A second set of experiments was conducted ... C:: ... 3: Hepatitis B Associated with Jet Gun Injection - California using the same procedure but with acetone swabbing to provide mechanical cleaning of the ... m ...... tip before discharge into the vials. In the first set of experiments (no acetone swabbing) • ... In March 1985. during routine investigation of hepatitis B (HB) case reports. an epidemiolo­ ... <11 HBsAg was found in 80% of the injection fluid vials and 87% of the swabs from the exterior ...... gist at the Long Beach (California) Department of Public Health noted that three HB patients and interior nozzle surfaces. Swabbing the contaminated tip of the Med-E-Jet with a cotton ...... had each received injections at the same weight-reduction clinic (clinic A) before disease ... ball moistened in acetone did not significantly reduce the' frequency with which HBsAg was ...... <­ onset. When review of previous case records and questioning of newly reported HB patients found in any of these sites. However. the Med-E-Jet did not become contaminated during ... C:: ... :z: identified five additional HB cases among clinic attendees. the California Department of ... m actual use when five injections were done on an HBsAg-positive chimpanzee. Bleeding did ...... Health Services joined in the investigation of the clinic on July 1. 1985. ...<­ ...... C:: Clinic A belonged to a chain of 29 weight-reduction clinics located throughout southern FIGURE 1. Cases of acute clinical hepatitis B in a weight-reduction clinic. by month of ... -< onset - California. 1984-1985 . ...­... California. Attendees at the clinics typically received a series of daily parenteral injections of ... ~ ... Use of jet ... a) first 6 months of 1985, Clinical history. review of risk factors for acquiring hepatitis B virus ... m injac10r stoppei (HBV) infection. serologic testing for HBV markers (hepatitis B surface antigen [HBsAgl. anti­ :...... , ...... body to HB core antigen [anti-HBcl. and IgM anti-HBc) and quantification of parenteral expo­ ...... sures at the clinic were obtained on 287 (84%) of cohort members. For COMparison. 93 new § ...... attendees (after July 1. 1985) at clinic A and random samples of 100 prior attendees and 70 :... :...... new attendees at the other Long Beach clinic (clinic B) were tested for markers of HBV ... infection. :...... Ultimately. 31 cases of clinical HB were identified among attendees of Clinic A (Figure 11...... Onset dates ranged from January 1984 to November 1985. with the majority of cases occur­ ...... ring between February and November 1985. Only two (6%) of the patients with clinical HB JAN APR had other identified risk factors for acquiring HBV infection in the 6 months before their iIIneSSA!; 1984 1985 1986 this outbreak can be explained only if the jet injector became contaminated repeatedly during occur at the injection sites, even though injections were carefully done according to manu­ use at the clinic. facturers recommendations. Before this outbreak, virtually all epidemiologic observations have indicated that the jet­ The jet injectors were removed from use at clinic A on July 2. No cases have been identi­ injector method of administering parenteral fluids, when properly done, is safe and effective. * * fied among persons treated at clinic A after this date, and no cases associated with any of the * * The current data suggest that, if this type of jet injector (Med-E-Jet) becomes contaminated * * other clinics in the chain have been identified to date. Both the manufacturer and the U.S. with blood, disease transmission can occur and indicate a need for further assessments of the * Food and Drug Administration have been informed of these findings. * '0 possibilities of disease transmission by other types of jet guns. Proper design of jet injectors *Ci')* >­ Reported by R Shah, MD. K Mackey. MPH. H Wallace. DrPH. K Yawata. Long Beach Dept of Public * m to minimize risk of blood contamination of the nozzle tips, training in use of guns, and care in * Health. R Roberto. MD. J Meissinget; MSPH. Infectious Disease Br. Ai Ascher. MD. S Hagens. MA. Viral * (.0) cleaning and disinfection if blood contamination occurs is necessary to ensure the *Continued * ..., and Rickettsial Disease Laboratory. J Chin. MD. State Epidemiologist. California Dept of Health Svcs; Div * of Field Svcs. Epidemiology Program Office. Hepatitis Br. Div of Viral Diseases. Nosocomial Infections safe use of these instruments. * * Laboratory Br. Hospital Infections Program. Center for Infectious Diseases. CDC. References * Editorial Note: This is the first reported outbreak of any disease in which any kind of jet 1. Abb J, Deinhardt F, Eisenburg J. The risk of transmission of hepatitis B virus using jet injection in **-1*:::J: injector has been implicated as the vehicle of transmission. The CDC experiments reported inoculation. J Infect Dis 1981; 144:179. * m 2. Brink PRG, van Loon AM, Trommelen JCM, Gribnau FWJ. Smale-Novakova IRO. Virus transmission *0* here suggest that the Med-E-Jet, if contaminated, could transmit HBV but that it does not * "TI by subcutaneous jet injection. J Med MicrobioI1985;20:393-7. * "TI become contaminated easily during actual use. Once contaminated, however, the Med-E-Jet **0 ..... * ..... could not be easily cleaned by a simple swabbing technique, probably because of inaccessibil­ *>­* r­ ity of contaminated surfaces of the nozzle tip and under the nozzle retaining cap. Furthermore, **:z: **:IE m wiping the nozzle tip with a swab soaked in alcohol or acetone would not be expected to inac­ *CJ> * r­ tivate HBV. To ensure proper decontamination, disassembly and sterilization of the nozzle tip *-1* m * -I would be necessary. * m Other investigators have attempted to assess the risk of HBV transmission by applying jet Current Trends **0 "" injections, using another model of jet injector, to two human chronic hepatitis B carriers and * "TI * -I evaluating injection sites and the injection nozzle for contamination with HBsAg ( 1 I. All swab *:::J: Recommendations for Providing Dialysis Treatment * m samples from injection sites and the exterior surface of the nozzle were negative for HBsAg. to Patients Infected with Human T -Lymphotropic Virus **0*:z: One other study, however, demonstrated transmission of the lactic dehydrogenase (LDH) Type III/Lymphadenopathy-Associated Virus **CJ> Ci') * -I virus between mice by subcutaneous jet injection with a Med-E-Jet (21. In the CDC studies, *CJ>* 0:> Patients with end-stage renal disease who'are undergoing maintenance dialysis and who the estimated volume of contaminating material transferred in downstream injections was * 0.53 ILl (0.53 x 1 0·3mll. Therefore, it can be estimated that viruses that circulate in high titers have manifestations of human T -Iymphotropic virus type III/lymphadenopathy-associated * * in blood, such as HBV (10B/mll and LDH virus (107 /mll, could be transferred during a proce­ virus (HTLV -III/LAV)' infection, including acquired immunodeficiency syndrome (AIDS), or who * are positive for antibody to HTLV-III/LAV can be dialyzed in hospital-based or free-standing di­ *<* dure if gun contamination occurred. The probability of transferring microorganisms present in *0* r­ 3 *c: lower concentration « 1 0 / mll would be correspondingly lower. alysis units using conventional infection-control precautions. Standard blood and body fluid *3 m The extensive transmission HBV infection in this outbreak appears to have resulted precautions and disinfection and sterilization strategies routinely practiced in dialysis centers * of * .... from the unusual-circumstance of multiple repeated jet gun injections in a cohort of patients. are adequate to prevent transmission of HTLV-III/LAV. * 01 Soon after AIDS was recognized in the United States, it became apparent that risk factors * The initial likelihood of a highly infectious (HBeAg-positive) HBV carrier attending the clinic * was low, but after initial disease transmission from such a carrier, patients incubating disease for persons with AIDS were similar to risk factors for persons with hepatitis B virus (HBV) infec­ * * could serve as sources of infection for others, amplifying infection risk through several cycles tion (1). Prevention measures applied to control HBV infection in health-care institutions were * *c:* <.... and ultimately leading to high attack rates in the study cohort. Nevertheless, the magnitude of used as a model to develop infection-control guidelines for patients with AIDS before the iden­ * :z: tification of the etiologic agent and the development of serologic tests for antibody to HTLV-1II1 * m * --­<.... LAV (anti-HTLV -III). Isolation of infected patients and non reuse of a dialyzer by the same patient * .­c: TABLE 1. Hepatitis B virus infections in HCG recipients by method of parenteral inocula­ *-< were initially recommended for patients receiving dialysis in dialysis centers (2). These strate­ * - tion - California, 1985 * gies are not currently believed necessary for preventing HTLV-III/LAV transmission. * .­ consist of using about 500-750 ppm of sodium hypochlorite for 30-40 minutes or .. alysis should contact the Hospital Infections Program, Center for Infectious Diseases. CDC •. ..:zm 1.5%-2.0% formaldehyde overnight. In addition, several chemical germicides formulated ....:oe: Building 1. Room 5065. Atlanta. Georgia 30333 (telephone [4041329-3406). .. .­v> to disinfect dialysis machines are commercially available. None of these protocols or .. m .. -< procedures need to be altared after dialyzing patients infected with HTLV-lll/LAV. References 1. Curran JW. Evatt BL, Lawrence ON. Acquired immune deficiency syndrome: the past as prologue. ..-<.. m Chemical germicides used for disinfection and sterilization of devices in the dialysis .. ::0 Ann Intern Med 1983;98:401-2. .. 0 center are effective against HTLV-III/LAV (4). 2. Favero MS. Recommended precautions for patients undergoing hemodialysis who have AIDS or .. -n .. --I 2. Patients infected with HTLV-III/LAV can be dialyzed by either hemodialysis or peritoneal non-A, non-B hepatitis. Infect Control 1985;6:301-5. .. X 3. Peterman TA, Lang GR, Mikos NJ, et al. HTLV-III/LAV infection in hemodialysis patients. JAMA .. m dialysis and do not need to be isolated from other patients. The type of dialysis treat­ .. 1986;255:2324-6. .. :z: ment (i.e., hemodialysis or peritoneal dialysis) should be based on the needs of the pa­ .. nm 4. CDC. Summary: recommendations for preventing transmission of infection with human T -Iympho- .. v> tient. The dialyzer may be discarded after each use. Alternatively, centers that have .. -< tropic virus type III/lymphadenopathy-associated virus in the workplace. MMWR 1985;34:681. .. 0 .. v> dialyzer-reuse programs, in which a specific dialyzer is issued to a specific patient, re­ 5. Favero MS. Dialysis-associated diseases and their control. In: Bennett JV, Brachman PS, eds. Hospital .. moved, cleaned, disinfected, and reused several times on the same patient only, may in­ infections. Boston: Little, Brown and Company,lnc .. 1985:267-B4. .. .. 6. CDC. Hepatitis-control measures for hepatitis B in dialysis centers. Viral hepatitis: Atlanta, Georgia: .. clude HTLV-III/LAV-infected patients in the dialyzer-reuse program. An individual dialyz­ Center for Disease Control. 1977: HEW publication no. (CDC)78-8358 (Investigation and control .. .. < er must never be used on more than one patient. series, November 1977). ..0.. ,­ 3. Standard infection-control strategies that are used routinely in dialysis units for all dialy­ 7. CDC. Hepatitis surveillance report no. 49. Issued January 1985:3-4. ..C:: .. 31: sis patients and personnel should be used to prevent HTLV-III/LAV transmission. Spe­ 8. Garner JS, Simmons BP. CDC guideline for isolation precautions in hospitals. Infect Control 1983;5: .. m .. -> cifically, these strategies include blood precautions and barrier techniques, such as the 245-325. . .. 9. CDC. Update: Public Health Service workshop on human T -Iymphotropic virus type III antibody .. <.71 use of gloves, gowns, and handwashing techniques, that have been described else­ .. testing-United States. MMWR 1985;34:471-8. .. where (4-8). .. .. 4. Precautions against needlestick injuries, as well as the appropriate use of barrier precau­ CENTERSFOR DISEASE CONTROl. June 20,1986/ Vol. 35 / No. 24 .. .. <­ C:: tions, such as wearing gloves when handling items contaminated with blood or serum, .. :z: 389 Transfusion-Associated HTLV-III/LAV from a .. should be practiced by all personnel caring for all dialysis patients. Such injuries consti­ .. m Seronegative Donor - Colorado .. -­<- tute the major potential risk for HTLV-IIIILAV transmission to personnel. Extraordinary 391 Non-A. Non-B Hepatitis Associated with a .. .­C:: Factor IX Complex Infused during .. -< care should be taken to prevent injuries to hands caused by needles, scalpels, and other Cardiovas,cular Surgery - Arizona ..- ..~ sharp instruments or devices during procedures; when cleaning used instruments; during .. ID .. 00 disposal of used needles; and when handling sharp instruments following procedures. 402 Genital Herpes Infection - United States. ..en 1966-1984 .. After use, disposable syringes and needles, scalpel blades, and other sharp items must be MtlWR ...... placed in puncture-resistant containers for disposal. To prevent needlestick injuries, nee­ MORBIDITYAND MORTAUTYWEEKLY REPORT .. dles should not be recapped; purposefully bent or broken; removed from disposable sy­ .. .. >" ringes; or otherwise manipulated by hand. No data are currently available from controlled .. m : m, studies examining the effect, if any, of the use of needle-cutting devices on the incidence .. Transfusion-Associated Human T-Lymphotropic Virus Type 111/ ...... of needlestick injuries. ...., Lymphadenopathy-Associated Virus Infection .. Reported by Hospital Infections Program, AIDS Program, Center for Infectious Diseases, CDC. .... From a Seronegative Donor - Colorado .... Editorial Note: In a study of 520 dialysis patients, 25 were reactive for anti-HTLV-III/LAV by .. .. enzyme immunoassay (EIA), but only four were confirmed by the Western blut technique (3). .. .. In November 1985. a blood donor at a Colorado blood-collection center was found to be .. The rate of falsely reactive EIA tests among these dialysis patients was 4%, much higher than .. seropositive for human T -Iymphotropic virus type III/lymphadenopathy-associated virus the falsely reactive rate for blood donors (0.17%). The rate of truly reactive tests was 0.8%, .. (HTLV-III/LAV)· antibody by both the enzyme-linked immunosorbent assay (ELISA) and West­ .. ern blot methods. He had previously donated at the center in April and August t 985. when he .. had been seronegative by ELISA. Both recipients from the August donation, one of whom had no other risk factors for acquisition of HTLV-III/LAV, were subsequently found to be seroposi- tive. Both recipients of the April donation were seronegative. The donor had probably been in­ fected through sexual contact 12 weeks or less before the August donation. This is the first Reported by CA Raevsky, DL Cohn. MD. FC Wolf. MPA, FN Judson. MD. Colorado Dept of Health. Denver reported transmission of infection from a blood donor that has occurred despite routine Disease Control Svc. SW Ferguson PhD. State Epidemiologist. TM Vernon. MD. Executive Director. Colo­ rado Dept of Health; AIDS Program. Center for Infectious Diseases. CDC. screening for HTLV-III/LAV antibody in blood banks and plasma centers. Details of the donor and recipient investigation are as follows: Editorial Note: This is the first report of HTLV-III/LAV transmission from a person whose Donor. The donor was a 31-year-old man who had donated blood at the same center. in blood tested negative for HTLV -III/LAV antibody at the time of blood donation. As with previ­ ous reports that have documented the presence of the virus in a small number of persons * * April. August. and November 1985. He was seronegative in April (optical densities of Abbott * * ELISA on sample/control = 0.052/0.160) and August (0.034/0.142). but seropositive by who have no detectable antibody. this donor appears to have had a recent infection (1,2). * * Most infected people develop antibody within 2-3 months of infection (2-6), * * ELISA (0.926/0.173) and Western blot in November. His blood from the November donation * ", The current risk of transfusion-associated infection is small. The prevalence of positive * ;,:. was discarded. and physicians of the recipients from the August donation were notified by *m* m the blood center of the possible transmission of HTLV -III/LAV from these blood products. Western blot tests among units screened by the American Red Cross in early 1985 suggests * that 0.04% of all donated units may have been potentially infectious (7). This prevalence de­ * c.> When interviewed in April 1986. the donor stated that he had had sexual contact with one * - male partner. with the first exposure taking place on May 15. 1985. No condoms were used. clined to 0.02% in early 1986 (8). Currently available screening tests detect HTLV-III/LAV an­ * tibody in the great majority of infected persons. Since antibody may not be detectable in * * His only other sexual partner was a man in 1974. He denied intravenous (IV) drug use or his­ *-i* tory of blood transfusion. He had no history of acute viral illnesses or symptoms of acquired blood from donors with very recent infections. the safety of the blood supply also requires *::z:: deferral donation by persons at increased risk for HTLV -III;'LAV infection. *m immunodeficiency syndrome (AIDS) or AIDS-related complex (ARC) in 1985 or 1986. Physi­ of * 0 Donor-deferral programs. initially implemented in blood banks in March 1983 and subse­ ""TI cal examination in December 1985 was normal. Repeat ELISA testing in April 1986 revealed *""TI* * ~ a high absorbency value (> 2.00010.125). and Western blot was once again positive. At­ quently refined. provide all prospective donors with educational information on the practices * ("") *;,:.* ~ tempts at locating previous sera for antibody testing were unsuccessful. associated with an increased risk of HTLV -III/LAV infection. Evidence suggests that most per­ * r­ sons at increased risk have stopped donating blood (9-11). but a few such individuals con­ * :z: Donor's Partner. The donor's sexual partner was a 22-year-old man who corroborated *m*:IE the donor's history of their initial sexual contact on May 15, 1985. He had been homosexually tinue to donate. The donor described in this report said he felt he was not at risk for infection *(1) because he had only one sexual partner. Although a steady sexual relationship with a single * r­ active since 18 years of age. He denied IV drug abuse or history of blood transfusion. After * -im partner is generally safer with regard to HTLV-III/LAV infection than relationships with multi- * -i notification by the donor of his positive antibody status. the partner was tested for HTLV-IIII * "' ple sexual partners. men who have had sexual contact with another man since 1::11 1 mUSl nUL * "" LAV In NovemGer 1985 and was seropositive by ELISA and Western blot; these findings **0 donate blood ( 12). *"TI * are continuing assure effectiveness donor-deferral programs * ::z::-i 'The Human Retrovirus Subcommittee of the International Committee on the Taxonomy of Viruses has Efforts to maximum of ( 13, 14). As an example. blood collection agencies have agreed to implement procedures in * "' proposed the name human immunodeficiency virus (HIV) for this virus. (Science 1986;232:697) *("")* :z: which prospective donors are asked to sign an expanded consent statement. The statement *m were reconfirmed on a separate specimen in April 1986. He had not previously been tested *(1) indicates that the prospective donor has reviewed and understands the informational material *-i for HTLV-III/LAV antibody. * <::> * U> provided and that donors who are at increased risk for transmission of HTLV-III/LAV or other Recipient 1. Recipient 1 was a 60-year-old man who underwent surgery in August 1985. * infectious agents will not donate blood or plasma for transfusion to another person. * He received from 1 5 different donors six units of packed red blood cells, four units of fresh * * References * frozen plasma, and six units of platelets (including one unit from the previously described * <: 1. Salahuddin SZ. Groopman JE. Markham PD. et al. HTLV-III in symptom-free seronegative persons. *0 donor). HE} had been married for 30 years and denied extramarital sexual contact. either heter­ Lancet 1984;11: 1418-20. * r­c: * ~ osexual or hompsexual. or any previous blood transfusions or IV drug abuse. In February 2. Ho DO. Sarngadharan MG. Resnick L. Dimarzo-Veronese F. Rota TR. Hirsch MS. Primary human T­ * rn 1986. he had no symptoms of AIDS or ARC and had a normal physical examination. The Iymphotropic virus type III infection. Ann Intern Med 1985; 1 03:880-3. * .... HTLV-IH/LAV antibody test was positive by ELISA and Western blot and reconfirmed on a 3. Anonymous. Needlestick transmission of HTLV-III from a patient infected in Africa. Lancet 1984; * for reasons unrelated to the blood transfusion and was positive by ELISA and Westem blot. 10. Grindon A. Efficacy of voluntary self-deferral of donors at high risk of AIDS [Abstract] Transfusion * 1984;24:434. * which was confirmed on a separate specimen in April 1986. He had been divorced for 12 * 11. Pindyck J. Waldman A. Zang E. Oleszko W. Lowy M. Bjanco C. Measures to decrease the risk of ac­ * * years and ~asstrLctly homosexual since that time. with multiple partners. * * quired immunodeficiency syndrome transmission by blood transfusion. Transfusion 1985;25:3-9. * * Other investigative findings. The blood donated in April 1985 was given to two recip­ * * 12. CDC. Update: revised Public Health Service definition of persons who should refrain from donating * ients. and both were seronegative by ELISA when tested in May 1986. blood and plasma-United States. MMWR 1985;34:547-8. * One other person was a common donor to recipients 1 and 2 in August 1985. This person 13. Kalish RI. Cable RG. Roberts SC. Voluntary deferral of blood donations and HTLV-III antibody posi­ * tivity [Letter] N Engl J Med 1986;314: 1115-6. * was retested in April 1986 and was negative by ELISA for HTLV-III/LAV antibody. Of the 13 * 14. U.S. Public Health Service. Public Health Service plan for the prevention and control of AIDS and * remaining donors to recipient 1. 11 were seronegative when retested 5 months or more after * the AIDS virus. Report of the Coolfont Planning Conference. June 4 to 6. 1986. Washington, D.C.. * the August donations. Two donors reside outside Colorado and have not been retested. Of U.S. Public Health Service, 1986. * the two remaining donors to recipient 2. both were seronegative when retested 6 months or more after the August donations. -. Reported by D Matthews, R Harmon, MD, Maricopa County Div of Public Health, SJ Englender, MD, LF Non-A, Non-S Hepatitis Associated with a Factor IX Complex Novick, MD, Director, GG Caldwell, MD. State Epidemiologist, Arizona Dept of Health Svcs; Div of Field Infused During Cardiovascular Surgery - Arizona Svcs. Epidemiology Program Office, Hepatitis Br, Div of Viral Diseases. Center for Infectious Diseases, CDC. On June 14, 1985, the Division of Disease Control Services, Arizona Department of Health Services, was notified by infection-control personnel at a local hospital of 13 cases of non-A, Editorial Note: Clotting factor preparations have frequently been linked to the transmission .. 10n-B h.epatitis among patients who had undergone cardiovascular surgery at the hospital of non-A. non-B hepatitis (1.21. These products are prepared from pooled plasma from multi­ ...... juring the preceding 6 months. All the patients had received factor IX complex produced by ple donors. Inoculation of nonheat-treated products into susceptible animals (chimpanzees) is .... 4.lpha Therapeutic Corporation (Brand B) because of bleeding during their surgery associated with development of non-A. non-B hepatitis, In hemophilia patients who routinely ...... * * A systematic review of pharmacy records for 1984 and 1985 determined factor IX com­ receive commercial factor preparations. episodes of non-A. non-B hepatitis are common. and * --i as many as 50% may develop signs of chronic liver disease. probably due to non-A. non-B in­ * :x: ::>Iex usage patterns. Between January 1, 1984, and June 3, 1985, 172 patients had received .. m factor !X complex during cardiovascular surgery (81 Brand A; 90 Brand B; one Brand C). fections. Studies in first-exposed hemophilia patients and in s'urgery patients who receive .. 0 .. "T1 3raQd B factor IX complex was added to the hospital pharmacy in October 1984. clotting factor preparations suggest the risk of non-A. non-B hepatitis in these patients may * "T1 .. -0 Cases ,were identified through questionnaires distributed to all physicians involved with be close to 100% (3.41. Heat treatment of clotting factor products was initiated at about the * - time of the outbreak; however. none of the products used in this outbreak received heat treat­ :~ he care of three groups: the cohort of Brand A factor IX complex recipients who survived :::>1 ment. While all factor IX complex and antihemophilic factor preparations are now treated to nore than 2 weeks following surgery, the cohort of Brand B factor IX recipients who survived *>e.* ..... reduce the risk of viral disease transmission. the methods currently used do not appear to *u more than 2 weeks, and a sample from the cohort of 1,625 cardiovascular patients who re­ *r inactivate the causative agents non-A. non-B hepatitis .. rr· of (5,61. * ...... ceived no factor IX complex during surgery and survived more than 2 weeks (matched to the * ...... Non-A. non-B hepatitis in the United States is probably caused by at least two different * m Brand B group for age. sex, type of operation, and date of surgery within 1 month). Completed * :;0 viral agents Because difficulty in conclusively identifying the causative agents and .. 0 information was received for 55 (74%) of 74 Brand A factor IX complex recipients, 64 (85%) (1.71. of * developing serologic tests, it remains a diagnosis of exclusion. Epidemiologic studies indicate * "" of 75 Brand B factor IX complex recipients, and 59 (79%) of 75 in the matched nonrecipient *.-;**:x: * m sample. *:z*. A case of postsurgical non-A. non-B hepatitis was defined as a patient who developed an FIGURE 1. Cases and probable cases of postsurgical non-A. non-B hepatitis in factor IX *0 *ID*(1) illness with a discrete date of onset following surgery and characterized by: (1) jaundice concentrate recipients. by month and factor IX usage patterns in cardiovascular surgery * ...... patients - Arizona. January 1. 1984-June 3. 1985 **(1) c and/or elevated serum aminotransferase (ALT) levels greater than 2'1, times the upper limit of * normal. lasting at least 1 week; (2) negative serologic tests for IgM hepatitis A virus antibody * (anti-HAV) and hepatitis B surface antigen (HBsAg) during illness; (3) no evidence of underly­ 30 ..* * ~ * It: * ing liver disease or recent history of hepatotoxic drugs in dosages likely to produce liver dys­ o *<*0 CJ Brand A *r­ function. A probable case was defined as above, but with no or incomplete serologic testing ti .. 3:e::: for markers of viral hepatitis. i::!: em Brand B *m The investigation identified 23 cases and seven probable cases of non-A. non-B hepatitis; E 20 *.. -" ~ * date of transfusion to the onset of symptoms; for Brand A. the incubation period was a *.. median of 15 weeks (range 1 -1 9 weeks). Peak elevations in serum transaminases occurred a * * ~ * median of 9 weeks from the date of transfusion. * The attack rate for Brand B factor IX complex recipients was 42% (27/64). significantly ~ *>* " *m*ID higher than the 5% (3/55) attack rate for Brand A recipients (relative risk = 7.7. p < 2 x 10-5) * or the 0% (0/59) in non recipients (p 1 x 10-6). The difference in attack rates between Brand * c..> < * 0.05). * * * The attack rate for Brand B recipients was about 40%. and that for nonrecipients of factor IX !.40NTHAND YEAR * * was 0%, irrespective of quantity of other blood products (Table 1). A similar comparison of * * Brand B to Brand A factor IX recipients showed no differences in receipt of other blood prod­ * ucts; a stepwise multiple regression analysis of all factor IX recipients showed that receiving *.. * Brand B factor IX was the only risk factor significantly associated with hepatitis (p < 0.0001). * Units of Brand B factor IX complex giv.en to surgery patients came from five different lots. * Each lot was associated with cases and probable cases. Attack rates for single-lot recipients * fanged from 14% to 100% (Table 2). -;.-- References that percutaneous or blood borne transmission routes predominate, with 20% of affected per­ 1. Craske J, Spooner RJD, Vandervelde EM. Evidence for existence of at least two types of factor­ sons acquiring infection by "'.)od transfusion, and 15%, by percutaneous drug abuse. Further­ VIII-associated non-B transfusion hepatitis. Lancet 1978;11: 1 051-2. more, non-A, non-B hepatitis now causes 80%-90% of the post-transfusion hepatitis ob­ 2. Enck RE, Betts RF, Brown MR, Miller G. Viral serology (hepatitis B virus, cytomegalovirus, Epstein­ served in this country. Previously, outbreaks have been described in hemodialysis units (8) Barr virus) and abnormal liver function tests in transfused patients with hereditary hemorrhagic dis­ ar-i t)lasmapheresis programs (9). eases. Transfusion 1979; 19:32-8. 3. Fletcher ML, Trowell JM, Craske J, Pavier K, Rizza CR. Non-A non-B hepatitis after transfusion of ~,jon-A,non-B hepatitis associated with clotting factor preparations has been reported to factor VIII in infrequently treated patients. Br Med J 1983;287: 1754-7. be variable in clinical presentation, usually clinically milder with less icterus than other types * * 4. Sugg U, Schnaidt M, Schneider W, Lissner R. Clotting factors and non-A, non-B hepati.tis. N Eng J * * Med 1980;303:943. * * of non-A, non-B hepatitis ( 10). The reasons for the severity of .illnesses reported in this out­ * * break are not known. However, it could be due to either a different viral agent contaminating 5. Colombo M, Mannucci PM, Carnelli V. Savidge GF. Gazengel C, Schimpf K. Transmission of non-A, *>*-0* the clotting factor complex than that in previously reported outbreaks, to higher doses of the non-B hepatitis by heat treated factor VIII concentrate. Lancet 1985;11: 1-4. *G> 6. Preston FE, Hay CRM, Dewar MS, Greaves M, Triger DR. Non-A, non-B hepatitis and heat-treated *m infectious organism, or to host-factor differences. The reasons for significantly different risks * factor VIII concentrates [Letter]. Lancet 1985;11:213. * ..., illness associated the products different commercial manufacturers is also not * 0> of with of 7. Bradley OW, Maynard JE, Popper H, et al. Posttransfusion non-A, non-B hepatitis: phYSicochemical * known but possibly relates to differences in manufacturing processes or to differences in the properties of two distinct agents. J Infect Dis 1983; 148:254-65. * * donor pool that contributed to the respective products. 8. Galbraith RM. Dienstag JL. Purcell RH, Gower PH •. Zuckerman AJ, Williams R. Non-A, non-B hepati­ * tis associated with chronic liver disease in a haemodialysis unit. Lancet 1979;1:951-3. *-i* Because of the high risk of viral hepatitis, recommended use of clotting factor products ::<: 9. Guyer B, Bradley OW, Bryan JA, Maynard JE. Non-A, non-B hepatitis among participants in a plas­ *m* has been limited to persons with known clotting factor deficiencies. In other settings, single­ mapheresis stimulation program. J Infect Dis 1979; 139:634-40. *...,* 0 donor products carry a lower risk and are preferable. At least two outbreaks of non-A, non-B 10. Craske J, Dilling N, Stern D. An outbreak of hepatitis associated with intravenous injection of factor *..., * ...... hepatitis have now been reported in surgery patients treated with clotting factor preparations VIII concentrate. Lancet 1975;11:221-3. *0 *>* ...... (4). Prevention of non-A, non-B hepatitis in this population clearly depends on physicians ad­ * r­ * hering to strict indications for the use of clotting factor preparations and avoiding these prod­ Genital Herpes Infection - United States, 1966-1984 *m* :z ucts when at all possible. * lIE Genital herpes infection remains a major public health problem in the United States. Data *'"**m r- collected by the National Disease and Therapeutic Index (NOT!) from 1966 to 1981 showed * -i TABLE 1. Risk of non-A, non-B hepatitis in surgery patients, by receipt of factor IX and *m*;;0 other blood products - Arizona, January 1984-June 1985. marked increases in the numbers of patient consultations for genital herpes (1,2 r Current * analysis shows continued upward trends in symptomatic genital herpes infections among pri­ *0*..., Factor IX Recipients vate patients in the United States. * -i * ::<: Brand A Brand B Nonrecipients The NDTI survey is a national stratified random sample of data from private practitioners' * m Exposure No. Attack Rate No. Attack Rate No. Attack Rate * :z office-based practices in the contiguous United States (3). This survey is a continuing compi­ *G>*0 All patients 55 5% 64 42% 59 0% lation of statistical information about patterns and treatments of various diseases and repre­ **<:>*'" -i sents a sample of patient-physician interactions. Included in the data coded are: (1) "consulta­ Packed red * '" tions" about genital herpes between patients and physicians, including office visits, house * blood cells * * > 10 units 29 3',<, 33 36');, 4 0% calls, telephone calls, and hospital visits; (2) "office visits," referring to initial or repeat visits * < 10 units 26 8°/0 31 4Sg·o 55 0% for genital herpes; and (3) "first office visits," coded if the patient presents to a physician par­ *0* <: ticipating in the survey for the first time with genital herpes. No laboratory confirmation of the * cr­ Fresh frozen *3 physicians' diagnoses is included in the survey. m plasma * * .... > 6 units 35 9% 33 42[)'(J QO,o The estimated number of physician-patient consultations for genital herpes increased 7 * U1 < 6 units 20 O'ij" 31 42°/1) 52 0% 15-fold between 1966 and 1984, from 29,560 to 450,570 (Figure 2). Office visits account­ * ed for 790,;..of these consultations. Also, first office visits- a more likely indicator of newly ac­ * * Platelets quired infection-increased nearly ninefold, from 17,810 in 1966 to 156,720 in 1984. Al­ : Yes 43 5°'" 52 44(~(J 10 OOln * though a decline in consultations, office visits, and first office visits was evident from 1978 to *c* <­ No 12 8('l0 n 12 330 49 O~'n * :z 1980: the upward trends remain statistically significant for all three types of physician-patient * -.m interaction (p < 0.004). *<­ *c* r­ TABLE 2. Lot-specific attack rates of postsurgical non-A, non-B hepatitis for single-lot The number of first office visits for genital herpes was approximately the same for both *.* -< cardiovascular recipients of Brand B factor IX - Arizona, October 1984-June 1985. men and women. However, over the 19-year span, women made more total office visits for * **co

450 1966-1972 * MEN WOMEN * 400 * 1973-1978 * .. * * * 350 ,_ ~ * * I 1979-1984- * CONSULTAT IONS I IlIIllIIIIIIIII * ...... "'~ 300 I * :c / * m / I *0* ! 250 * -n ~ I I * -n '" , " , II O,'FICE VISITS *0* - ~ 200 I ~ ;:-- ',rr __ .. * - .. *>* r­ 150 / - // r--...... / * z r ... * m ... I I"'~ *:E: 100·, ,,/ iu *U> f:..· / / '-----.. ! * r­ r * m 50 ~.I , / ,/ '- ,/' 'FIRST VISITS * ...... &' -",. /-- ...... " ,- TO OFFICE * ...... * ;;0m o -----~~... I·-+--+-+ I 1966 1968 1970 1972 1974 1976 1978 1980 1982 19a4 *0* * -n YEAR ...... * :c AGE-6ROUP (YEARS) .. m *0*.. z References gynecologists (36'10 of total), general practitioners (19%), dermatologists (13%)' internists *U>*'" 1. CDC, Genital herpes infection - United States, 1966-1979. MMWR 1982;31: 137 -9. ..* =...... (12%), and urologists (5%1. Office visits to all other types of specialists accounted for the re­ 2, Becker TM, Blount JH. Guinan ME. Genital herpes infections in private practice in the United States, *U> maining 15%, 1966 to 1981. JAMA 1985;253: 1601-3. ..* 3, Coding manual and descriptive information for the national disease and therapeutic index diagnosis * Reported by Div of Sexually Transmitted Diseases, Center for Prevention Svcs, CDC, ..* * volume. Rockville, Maryland: IMS America Ltd .. 1984. * Editorial Note: The trends in symptomatic genital herpes infection reported here are com­ * 4, Chuang TY, Su WPD, Perry HO. IIstrup OM, Kurland LT. Incidence and trend of herpes progenitalis: a *0*< parable to data reported from a population-based study in Rochester, Minnesota, where inves­ 15-year population study. Mayo Clin Proc 1983;58:436-41. *3..* r­e:: tigators found a consistent annual increase in the incidence of genital herpes from 1965 to 5, Mertz GJ, Schmidt 0, Jourden JL, et al. Frequency of acquisition of first-episode' genital infection * m with herpes simplex virus from symptomatic and asymptomatic source contacts. Sex Transm Dis * ..... 1979 (4 I. The Rochester study also showed a similar age distribution for patients with symp­ .. at tomatic genital herpes infections, as in this report. 1985; 12:33-9. * 6. Rooney JF, Felser JM, Ostrove JM, Straus SE. Acquisition of genital herpes from an asymptomatic ..* These data do not show the actual number of genital herpes cases in the United States, Pa­ sexual partner. N Engl J Med 1986:314: 1561-4. ..* * tients with genital herpes may seek care in public health-care facilities and from other private .. CENTERSFOR DISEASE CONTROl July 4,1986/ Vol. No. 26 * ambulatory-care providers, Therefore, the total number of visits are minimum estimates, How­ 35/ *z*<-*e:: ever, the data are useful in describing trends in health-care seeking for genital herpes by pri­ * m vate patients over the 19-year period. .. -­c- 421 HTLV-III/LAV Antibodv Prevalence in U.S. ..*e:: r- At least five other factors may have affected the trends in genital herpes measured by the Military Recruit Applicants *­* -< NDT/: * ~ * <.0 1. Recent media attention-especially since 1982-may have increased both physicians' *en* co and patients' awareness of the signs and symptoms of genital herpes, thus increasing * the numbers of patients seen in recent years, MtlWR * * MORBIDITYAND MORTALITYWEEKLY REPORT * 2. A patient seen by a surveyed physician for the first time for genital herpes may not ac­ **-0 tually represent a newly diagnosed case. *..> 3. Asymptomatic infections are increasingly recognized to be common and would not be Current Trends *..*'" m represented in the survey (5,6 I. *c..>* *...... 4. Many of those with symptomatic genital herpes may not seek medical attention at all. Human T-Lynphotropic Virus Type III/Lymphadenopathy-Associated ...... 5. The licensing of topical acyclovir by the U.S. Food and Drug Administratj.'n in 1982 for Virus Antibody Prevalence in U.S. Military Recruit Applicants *.. .. treatment of genital herpes may account for some increase in numbers of patients seen .. .. : in the most recent years of this survey. From October 1, 1985, through March 31, 1986, as part of medical evaluation of individu­ .. Despite these caveats, upward trends of genital herpes among private patients probably als volunteering for military service, the U.S. Department of Defense tested 308,076 recruit .. applicants for serologic evidence of infection with human T -Iymphotropic virus type 1111 .. reflect a true increase in the numbers of cases of this sexually transmitted disease nationwide. .. lymphadenopathy-associated virus (HTLV-III/LAV), the etiologic retrovirus of acquired immu­ .. nodeficiency syndrome (AIDS): Blood samples were obtained at 71 Military Entrance Pro­ cessing Stations. The screened population consisted predominately of young adults in their late teens (54%) and early twenties (33% were 20-25 years oldl. Eighty-five percent were differences by Hispanic ethnicity, (4) ThE! geographic distribution of seroprevalence among re­ male, and 77% were white. Sera were tested by a single contracting laboratory using a com­ cruits is generally consistent with the incidence of cases, both by region and by urban versus mercial human T -Iymphotropic virus type III (HTLV -ilil enzyme-linked immunosorbent assay rural residence. More detailed geographic analysis will be possible when cumulative data are (ELISA) test (Electronucleonics, Inc.l. All samples repeatably reactive by ELISA were also sub­ available from screening additional recruits. jected to confirmation testi II.' by the Western blot. Blots were considered positive if antibod As in the case with serologically positive blood donors ( 141. recruit applicants with con­ * * ies to gp 41 andlor p24+p55 were detected. Recruit applicants with confirmed HTLV-IIII firmed positive antibody are informed of their status and its implication regarding infection * * LAV antibody are excluded from military service. with HTLV-III/LAV; they are counseled on reducing the risk of transmission to others through * * * , The mean prevalence of confirmed positive tests was 1 .5 per 1,000 recruit applicants. An­ sexual contact, sharing IV needles, or other exchanges of blood or body fluids. *l>**en "" tib(lr:y prevalence increased progressively with age (Table 1). a pattern consistent throughout Counselling and testing for HTLV-III/LAV antibody should be offered to persons who may * m * the country (Table 2l. The seroprevalence was higher among the 265,361 men of all ages, have already been infected as a result of intimate contact with the seropositive recruit appli­ * c..> * 00 1,6/1 ,000, than among the 42,715 women, 0.6/1,000. The ratio of male-to-female preva­ cant (i.e., sexual partners, persons with whom needles have been shared, infants born 'to sero­ * * lence rates was 3: 1, Prevalence also varied by race: for the 237,586 whites, the rate was positive mothers). In addition, seropositive individuals should be interviewed by 8f1 expe­ * * 0,9/1,000; for the 55,185 blacks, 3.9/1,000; and for the 15,305 applicants of other racial rienced investigator to determine their risk factors for infection. This, coupled with observa­ *-1* * ::>:: groups, 2.6/1,000, The relationships of seroprevalence rates by sex and race remain when tion on suitable controls, would facilitate determining modes of acquisition and evaluating cur­ * m the data are adjusted by age. rent trends in risk of exposure to the virus in these populations. *0* * "T1 * "T1 Seroprevalence rates (Table 2) were highest in the coastal regions of the country other The continued analysis of data emerging from the HTLV-III/LAV serologic screening of *­*(") military recruit applicants will permit the examination of the extent and the trends over time of than New England. Rates were lowest in New England and in the inland regions. Based on pre­ * -l> liminary analysis by county, the highest HTLV-III antibody rates were found in recruit appli­ infection with the causative agent of AIDS in this sentinel population. * r- * :z: cants from major urban centers arid lowest in those from rural areas, * m *U>*:IE Reported by the Health Studies Task Force, Office of the Assistant Secretary of Defense (Health Affairs); * r­ TABLE 1. Prevalence of HTLV-III/LAV antibody' among military recruit applicants. by * m Dept of Virus Disease, Div of Preventive Medicine, Walter Reed Army Institute of Research; Survel1/ance * -I and Evaluation Bf. AIDS Program, Center for Infectious Disease, CDC. age - United States, October 1985-March 1986 * m,., Editorial Note: Although there is considerable knowledge regarding the distribution of *0* Age (yrs) No. tested Positives/l,ooot * "T1 'The AIDS virus has been variously termed human T-Iymphotropic virus type III (HTLV-III), * -I 0.2 * ::>:: lymphadenopathy-associated virus (LAV), AIDS-associated retrovirus (ARV), or human immunodeficien­ 17 59,113 * m 0.4 cy virus (HIVI. The designation human immunodeficiency virus (HIV) has recently been proposed by a 18 61.452 * :z: 0.8 * (") subcommittee of the International Committee for the Taxonomy of Viruses as the appropriate name for 19 43.978 *en 20 29,835 1.1 * U>-I the retrovirus that has been implicated as the causative agent of AIDS) (Science 1986;232:697). * 0 21-25 73,998 2.5 * U> reported cases of AIDS in the United States ( 1). there has been much less information about ;;!:26 39,700 4,4 * All ages 308,076 1.49 * the prevalence of infection with HTLV-III/LAV. Studies of HTLV-IlI/LAV antibody prevalence * * have primarily involved selected high-risk groups, including homosexual men (24%-68% posi­ 'Western blot confirmed. **< * ° tive) (2-5). intravenous (IV) drug abusers (2%-72% positive) (6-8). and hemophilia patients tRates/l.000 tested. *3*<=* r­ (40%-88% p"ositive) (9-11l. The limited published data from blood-bank screening programs, * m where persons in high-risk groups are specifically discouraged from donating, indicate a con­ * ..... * 0'1 firmed antibody prevalence nationally of less than 0,4/1,000 ( 12). TABLE 2. Prevalence of HTLV/III antibody' per 1,000 military recruit applicants tested, * The Department of Defense medical evaluation program provides additional information * by region and age group - United States, October 1985-March 1986 * * on the geographic and demographic factors associated with HTLV-III/LAV infection in the * United States, The population of individuals volunteering for military service may not be repre­ Age group (yrs) *<-* Region t No. tested 17-20 21-25 ;;!: 26 All ages *:z:*<= sentative of the U,S. population at large due to the spontaneous, if partial, self-exclusion of * m * ...... hemophilia patients, actively homosexual men, and current IV drug abusers. However, the * <­ 0.3§ 1.0§ 1.9§ 0.6 *<= data suggest the following: (1) While the highest seroprevalence occurs among those over New England 14.131 **-< r­ Mid-Atlantic 43.196 0,9 4,4 10,1 2.8 * - 25 years old, the age of acquisition of confirmed antibody (and by implication, infection) can EN Central 55.943 0,2§ 2.0§ 2.2 0.8 * * <.0 often be in "the late teens and early twenties. Age at diagnosis of reported AIDS is older, with a W,N, Central 26.850 0.2 1.1 1.4 0.6 * co * en median of 32-35 years, depending on risk group, race, and sex. Only 0.7% of reported cases S, Atlantic 50.854 0.7 § 3.3 5.7 § '1.9 * E,S, Central 21.027 0.4 2,2 1,1 0.9 * among adults/adolescents occur between 13 and 20 years of age; 6.5% develop between 21 * * W.S, Central 34.782 07 § 2.5 2.6 1.4 * * and 25 yea~s;the r,emaining 92,8% are diagnosed at or after 26 years of age, (2) The ratio of * * Mountain 19.015 0,3 1,8 2,6 1.1 * * seroprevalence between male and female recruit applicants is 3: 1, This is much lower than Pacific 39.260 0.7 1.5 4.7 1.5 * the ratio of 1 3: 1 observed among all AIDS cases, but like the 3: 1 ratio among other AIDS pa­ All 11 308.076 0.5 2.5 4.4 1.5 * * tients if homosexual and hemophilia-associated cases are excluded. (3) The ratio of sero­ 'Western blot confirmed. * prevalence rates of black to white recruit applicants (4: 1) is intermediate between the 2,6 * tDefined in notifiable diseases table (Table III), * relative risk for blacks among all AIDS patients (25,2% of cases are among non-Hispanic §Rate based on five or fewer positives. * * blacks, who comprise 11,5% of the population [13]) and the 8,3 relative risk for blacks 11Includes data from Puerto Rico. Virgin Islands. Guam. American Samoa, Northern Marianas, and the * among AIDS patients not associated with either homosexuality or hemophilia (blacks com­ Trust Territories. prise 52.0% of these casesl. The data do not yet permit a detailed analysis of seroprevalence References past 32 years has been 5%. The failure of tuberculosis morbidity to decline as expected in 1. Peterman TA, Drotman DP, Curran JW. Epidemiology of the acquired immunodeficiency syndrome 1985 is probably related to the occurrence of tuberculosis among persons with acquired im­ (AIDS). Epidemiol Rev 1985;7: 1 -21. 2. Phair J. Prevalence and correlates of HTLV-III antibodies among 5000 gay men in 4 cities. Multicen­ munodeficiency syndrome (AIDS) or human T -Iymphotropic virus type II\/Iymphadenopathy­ ter AIDS Cohort Study (MACS) [Abstract]. 25th Interscience Conference on Antimicrobial Agents associated virus (HTLVILAV)· infection. Several reports have indicated that mycobacterial * and Chemotherapy. Minneapolis: America Society for Microbiology, 1985:229. disease is common among AIDS patients and among persons at risk for AIDS (2-9). The * * 3. Collier AC, Barnes RC, Handsfield HH. Prevalence of antibody to LAV/HTLV-III among homosexual most common mycobacterial species isolated from patients with diagnosed AIDS is Myco­ * * men in Seattle. Am J Public Health 1986;76:564-5. * * bacterium avium complex (MAC). although in some groups in which tuberculous infection is * * 4. Schwartz K, Visscher BR, Detels R. Taylor J, Nishanian P, Fahey JL. Immunological changes in lym­ * -I phadenopathy virus positive and negative symptomless male homosexuals: two years of observa­ highly prevalent, disease caused by M. tuberculosis is more common (10-12). Even among *:::1: * m tion [Letter]. Lancet 1 985;11:831 -2. * 0 5. Darrow WW, Jaffe HW, O'Malley PM, et al. Sexual practices and HTLV-III/LAV infections in a 'The Human Retrovirus Subcommittee of the International Committee on the Taxonomy of Viruses has * """ * """ cohort of homosexual male clinic patients, San Francisco [Abstract]. 6th International Meeting of proposed the name human immunodeficiency virus (HIV) for this virus (Science 1986;232:6971. *n* - the International Society for STD Research. Brighton: International Society for STD Research, * - *>* r­ 1985:31. *:z:* 6. Levy N, Carlson JR, Hinrichs S, Lerche N, Schenker M, Gardner MB. The prevalence of HTLV -Iil/LAV groups in which MAC is the most common mycobacterial pathogen, M. tuberculosis accounts * m ,antibodies among intravenous drug users attending treatment programs in California: a preliminary *­*CI> for a substantial proportion of the mycobacterial isolates, The association between myco­ *r­*m report [Letter]. N Engl J Med 1986;314:446. bacterial disease and AIDS raises several important clinical and public health issues that are *-1 7. Weiss SH, Ginzburg HM, Goedert JJ, et al. Risk for HTLV-III exposure and AIDS among parenteral *-1*m drug abusers in New Jersey [Abstract]. Atlanta: International Conference on Acquired Immunodefi- addressed below. *::0 ciency Syndrome (AIDS). 1985:44. *0* 8. Spira T J, DesJarlais DC, Bokos D, et al. HTLV-III/LAV antibodies in intravenous drug (IV) DIAGNOSIS OF TUBERCULOSIS IN PATIENTS LIKELY TO HAVE HTLV-III/LAV **"""*-1 abusers-comparison of high and low risk areas for AIDS [Abstract]. Atlanta: International Confer­ . INFECTION *m*:::1: ence on Acquired Immunodeficiency Syndrome (AIDS), 1985 :84. Clinicians should consider the diagnosis of tuberculosis in patients with, or at risk of, *:z:**n :;1. MagO! IVIV. leguTU:=ler \.le, nanUWerK.-L.60er \,.,. L.t:WI:>. oJn, IVldytll VVL • .:l'fJt:IU oJ""'."'1t:Vcll~(ICt: allu sero· HTLV-II\/LAV infection, even if the clinical presentation is unusual (4,13,141. Available data *a>*(1) conversion of human T -Iymphotropic retrovirus (HTLV-III) antibody in patients with hemophilia [Ab­ indicate that extrapulmonary forms of tuberculosis, particularly lymphatic and disseminated *-1 stract]. Atlanta: International Conference on Acquired Immunodeficiency Syndrome (AIDS). *0*(1) (miliary), are seen much more frequently among patients with HTLV-III/LAV infection than 1985:74. :* Jason J. McDougal JS, Holman RC, et al. Human T -Iymphotropic retrovirus type 1111 among those without such infection. Pulmonary tuberculosis in patients with HTLV-III/LAV in­ 10. * * lymphadenopathy-associated virus antibody. Association with hemophiliacs' immune status and * fection cannot readily be distinguished from other pulmonary infections, such as Pneumocys­ * blood component usage. JAMA 1985;253:3409- 15. tis carinii pneumonia, on the basis of clinical and radiographic findings. Patients with tuber­ *0*< 11. Goedert JJ, Sarngadharan MG, Eyster ME, et al. Antibodies reactive with human T cell leukemia *r­*c:: viruses in the serum of hemophiliacs receiving factor VIII concentrate. Blood 1985;65:492-5. culosis may have infiltrates in any lung zone, often associated with mediastinal and/or hilar *m*3: lymphadenopathy. Cavitation is uncommon, Appropriate specimens to establish a culture­ 12. Schorr JB, Berkowitz A, Cumming PO, Katz AJ, Sandler SG. Prevalence of HTLV-III antibody in * .... American blood donors [Letter]. N Engl J Med 1985;313:384-5. confirmed diagnosis of tuberculosis include respiratory secretions, urine, blood, lymph node, * <.n 13. U.S. Bureau of the Census. Table 49: general characteristics of persons by Spanish origin and race: bone marrow, liver, or other tissue or body fluid that is indicated clinically. All tissue specimens * 1980. In: 1980 Census of Population. Volume 1: Characteristics of the Population. Washington, * * D.C.: U. S. Department of Commerce, 1980: 1-52 (General population characteristics, [PC should be stained for acid-fast bacilli and cultured for myc·obacteria. In the presence of undi­ * agnosed pulmonary infiltrates, bronchoscopy with lavage and transbronchial biopsy (if not * 80- 1 -B 1] United States summary). *c...**c:: 14. CDC. Provisional Public Health Service inter-agency recommmendations for screening donated contraindicated) may be needed to obtain material for both culture and histologic examination. *:z:*m blood and plasma for antibody to the virus causing acquired immunodeficiency syndrome. MMWR A tuberculin skin test should be administered, but the absence of a reaction does not rule out * '"'­ *c...*c:: 1985;35:1-5. the diagnosis of tuberculosis because immunosuppression associated with HTLV-III/LAV in­ **-< r­ fection may cause false-negative results. *­ July 18, 1986/ Vol. 35/ No. 28 * ~ * <0 * co TREATMENT OF MYCOBACTERIAL DISEASE IN A PATIENT WITH HTLV-III/LAV * en INFECTION : * * 448 Diagnosis and Management of Chemotherapy should be started whenever acid-fast bacilli are found In a specimen * Mycobacterial Infection and Disease in from a patient with HTLV-III/LAV Infection and clinical evidence of mycobacterial dis- *>* -0 Persons with HTLV-III/LAV Infection *a> 8aS8, Because it is difficult to distinguish tuberculosis from MAC disease by any criterion * m MtlWR other than culture, and because of the individual and public health implications of tuberculosis, * *<0* (.0) MORBIDITYAND MORTALITYWEEKLY REPORT it is important to treat patients with a regimen effective against tuberculosis. With some ex­ * ceptions, patients with tuberculosis and HTLV-III/LAV infection respond relatively well to * * standard antituberculosis drugs (15); however, their treatment should include at least three * * Current Trends * * drugs initially, and treatment may need to be longer than the standard duration of 9 months * Diagnosis and Management of Mycobacterial Infection and Disease (16), The recommended regimen is isoniazid IINH), 10-15 mg/kg/day up to 300 mg/day; * * in Persons with Human T-Lymphotropic Virus Type 1111 rifampin (RIFI. 10-15 mg/kg/day up to 600 mg/day; and either ethambutol (EMB), 25 mg/ * Lymphadenopathy-Associated Virus Infection kg/day, or pyrazinamide (PZAI. 20-30 mg/kg/day. The last two drugs are usually given only * during the first 2 months of therapy. The addition of a fourth drug may be indicated in certain * In 1985, the number of new tuberculosis cases reported to CDC was essentially the same situations, such as central nervous system or disseminated disease or when INH resistance is as that reported in 1984 (11. In contrast, the average annual decline in morbidity during the suspected. An initial drug-susceptibility test should always be performed, and the treatment EXAMINING PATIENTS WITH CLINICALLY ACTIVE TUBERCULOSIS OR LATENT regimen, revised if resistance is found to any of the drugs being used. The appropriate dura­ TUBERCULOUS INFECTION FOR HTLV-III/LAV INFECTION • tion of treatment for patients with tuberculosis and HTLV-III/LAV infection is unknown; how­ As part of the evaluation of patients with tuberculosis and tuberculous infection, risk fac- tors for HTLV-III/LAV should be identified. Voluntary testing of all persons with these risk fac- ever, it is recommended that treatment continue for a minimum of 9 months and for at least 6 .. .. months after documented culture conversion. If INH or RIF is not included in the treatment .. .. tors is recommended (22). In addition, testing for HTLV-III/LAV antibody should btl consid­ .... 'regimen, therapy should continue for a minimum of 18 months and for at least 12 months fol­ ered for patients of all ages who have severe or unusual manifestations of tuberculosis. The a .. lowing culture conversion. After therapy is completed, patients should be followed closely, presence of HTLV-III/LAV infection has implications regarding treatment (see above), alerts and mycobacteriologic examinations should be repeated if clinically indicated. a~.. m the physician to the possibility of other opportunistic infections, and allows for counselling .. about transmission of HTLV-III/LAV infection (23). Testing for HTLV-III/LAV antibody is e~pe­ ..-~ Some clinicians would take a different approach to treatment than that outlined above, to .. cially important for persons over age 35 with asymptomatic tuberculous infection, because .. .. cover the possibility of MAC disease. Although the clinical significance and optimal therapy INH would not usually be indicated for persons in this age group unless they 'are also HTLV-1II1 .. of MAC disease in these patients is not well defined, and there are no definitive data on the ef­ LAV seropositive. .. -4 .. x ficacy of treatment, one regimen. commonly used to treat MAC disease substitutes rifabutin PREVENTIVE THERAPY .. m (ansamycin LM 427) for rifampin, combined with INH, EMS, and clofazimine. Rifabutin and HTLV-Ill/LAV seropositivity in a person of any age with a significant tuberculin reaction is .. ."0 clofazimine are experimental drugs available to qualified investigators only under investiga­ ..." an indication for INH preventive therapy (16). Although it is not known whether INH therapy .. -n tional new drug protocols. Rifabutin is distributed by the CDC Drug Service (telephone: [4041 is as efficacious in preventing tuberculosis in HTLV -III/LAV -infected persons as in other .. -> 329-3670)' and clofazimine, by Ciba-Geigy: (telephone: [2011277-5787). If M. tuberculosis .. r­ groups, the usually good response of HTLV-Ill/LAV-infected persons with tuberculosis to .. :z: .. m is isolated from a patient receiving this four-drug regimen, treatment should be switched to standard therapy suggests that INH preventive therapy would also be effective. Before in­ ..... r.n one of the three-drug regimens outline'd above (iNH, RIF, and EMS or PZA). If MAC is isolated .. r­ stituting preventive therapy, clinically active tuberculosis should be excluded. .. m -4 from a patient who has been started on a three-drug regimen, the clinician may continue the .. -4 Developed by Center for Prevention Svcs, Center for Infectious Diseases, CDC, with consultation from: .. m three-drug regimen or switch to the four-drug regimen of INH, EMS, rifabutin, and clofazimine. RS Holzman, MD, New York University Medical Center. New York City; PC Hopewell, MD, San Francisco ..,,::0 Although experience is very limited, patients with disease due to M. kansasii should re­ General Hospital Medical Centllr. California; AE Pitchllnik. MD. University of Miami Medical Centllr. Flori­ .. ."0 spond to INH, RIF, and EMB. Some clinicians advocate the addition of streptomycin (SM). da; LS Reichman, MD, University of Mtldicine and Dentistry of New Jersey, New Jersey Medical School, :-4.. x 1 gram twice weekly, for the first 3 months. Therapy should continue for a minimum of 15 University Hospital, Newark, New Jersey; RL Stoneburner. MD, New York City Dept of Health. .. m .. :z: months following culture conversion. References ..n 1. CDC. Tuberculosis-United States, 1985-and the possible impact of human T-Iymphotropic .."G) r.n . Monitoring for toxicity of antimycobacterial drugs may be difficult for patients who may· .. -4 virus type IIIl1ymphadenopathy-associated virus infection. MMWR 1986; 35: 74-6. .. 0 be receiving a variety of other drugs and may have other concomitant conditions. Because .. r.n 2. Cohen RJ, Samoszuk MK, Busch 0, Lagios M. ILetterl. Occult infections with M. intracellulare in .. hepatic and hematologic abnormalities may be caused by the mycobacterial disease, AIDS, or bone-marrow biopsy specimens from patients with AIDS. N Engl J Med 1983;308: 1475-6. .. other drugs and conditions, the presence of such abnormalities is not an absolute contraindi­ 3. Wong B, Edwards FF, Kiehn TE, et al. Continuous high-grade Mycobacterium avium-intracellulare .. * cation to the use of the treatment regimens outlined above. bacteremia in patients with the acquired immunodeficiency syndrome. Am J Med 1985;78:35-40. : 4. Pitchenik AE, Cole C, Russell BW. Fischl MA. Spira TJ. Snider DE. Jr. Tuberculosis. atypical myco­ *0*< INFECTIO,,! CONTROL .. r­e: bacterioSis. and the acquired immunodeficiency syndrome among Haitian and non-Haitian patients .. 31 Recommendations for preventing transmission of HTLV-III/LAV infection to health-care in south Florida. Ann Intern Med 1984; 101 :641-5. .. m workers have been published (1 7). In addition, infection-control procedures applied to patients 5. Macher AM, Kovacs JA. Gill V. et al. Bacteremia due to Mycobacterium avium-intracellulare in the :.. .. tients with HTLV -III/LAV infection are not yet available. (AIDS! in Haiti. N Eng J Med 1983;309:945-50. ..*co en EXAMINING HTLV-III/LAV-INFECTED PERSONS FOR TUBERCULOSIS AND TUBERCU­ 11. Maayan S. Wormser GP. Hewlett D. et al. Acquired immunodeficiency syndrome (AIDS! in an eco­ * nomically disadvantaged population. Arch Intern Med 1985; 145: 1607-12. * LOUS INFE~TlON * 12. Goedert JJ. Weiss SH. Biggar RJ. et al. Lesser AIDS and tuberculosis (Letter!. Lancet 1985;ii:52. ..* ..* Individuals who_are known to be HTLV-III/LAV seropositive should be given a Mantoux .. * 13. Sunderam G. Maniatis T. Kapila R. et al. Mycobacterium tuberculosis disease with unusual manifes­ .. * .. skin test with 5 tuberculin units of purified protein derivative as part of their clinical evaluation. tations is relatively common in acquired immuno-deficiency syndrome (AIDS! (Abstractl. Am Rev * RespDis 1984;129 (part2t:A191. ..* Although some f~lse-negativeskin test results may be encountered in this setting as a result : 14. Pitchenik AE. Rubinson HA. The radiographic appearance of tuberculosis in patients with the ac­ of immunosuppression induced by HTLV-Ill/LAV infection, significant reactions are still mean­ ..* ingful (20). If the skin test reaction is significant, a chest radiograph should be obtained, and quired immune deficiency syndrome (AIDS! and pre-AIDS. Am Rev Resp Dis 1985; 131 :393-6. ..* 15. Sunderam G. McDonald RJ. Maniatis T. Oleske J. Kapilii R. Reichman L8. Tuberculosis as a manifes­ .. if abnormalities are detected, additional diagnostic procedures for tuberculosis should be un­ tation of the acquired immunodeficiency syndrome (AIDS), JAM A 1986; 256: 35 7 ·61 .. dertaken. Patients with clinical AIDS or other Class IV HTLV -III/LAV infections (21 ) should re­ 16. American Thoracic Society. Treatment of tuberculosis and other mycobacterial diseases. Am Rev ..* ceive both a tuberculin skin test and a chest radiograph because of the higher probability of RespDis 1983;127:790-6. false-negative tuberculin reactions in immunosuppressed patients. ***** THE OFFICIAL NEWSLETTER OF THE NCGSTOS * VOLUME 7:5 * JUNEI JULY, 1986 * PAGE 41 ***** ************************************************************************************************************************

17. CDC. Recommendations for preventing transmission of infection with human T -Iymphotropic virus type III/lymphadenopathy-associated virus in the workplace. MMWR 1985;34:681-95. 18. CDC. Guidelines for prevention of T8 transmission in hospitals. Atlanta. Georgia: U.S. Department of Health and Human Services. 1982: HHS publication no. (CDC) 82-8371. 19. American Thoracic Society/CDC. Control of tuberculosis. Am Rev Resp Dis 1983; 128:336-42. 20. American Thoracic Society. The tuberculin skin test. Am Rev Resp Dis 1981; 124:356-63. - 21. CDC. Classification system for human T -Iymphotropic virus type III/lymphadenopathy-associated virus infections. MMWR 1986;35:334-9. 22. CDC. Additional recommendations to reduce sexual and drug abuse-related transmission of human T -Iymphotropic virus type III/lympadenopathy-associated virus. MMWR 1986;35: 152-5. 23. CDC. Human T-Iymphotropic virus type III/lymphadenopathy-associated virus antibody testing at' alternate sites. MMWR 1986;35:284-7. *************************************** with thanks to Ih~ ~~!iQ~:~ ~~~l!h, the American Public Health Association, July, 1986 Chilling Predictions of Future ofA.IDS Editor's Note: The fol/owing are ex· to the Centers ror DiseaBe Control. The infection depends largely upon efrective in the proportion of heteroeexual trans. cerpt. from the predictions and rteom· empirical model predicts that caeel will approaches to decreaH sexual tran8mis. mission over the next five yeau. mendations on acquired immune defi­ continue to increase through 1991, that lion, tran,miuion among IV drug usen: A central goal of local disease control there will be nearly 16,000 CaReR reported and perinatal transmiNion from inrected programs ,hould be to reach the greateRt ('i~ncy syndrome from the recent con­ in 1986, and more than 74,000 C81H pro· mothen. number of HTLV·IIIILAV infected per· ference spon.,ored by the Public Health jected (or 1991. The estimatee ror 1991 Public heallh activities directed toward lIOn, with tellting and counseling. At pre· Service In &rkeky Springs. West Virgi· range from 46,000 to 90,000. the control and prevention of AIDS have Bent. only a small proportion of the ai­ nia (see page one), They a~ presented • More than 70 percent of the caBe8 required ,igniricant funding and ataffing ready infected popUlation has been here because of their importance to the will be diagnosed among homosexual or at national. slate. and local levels. The reathed. bisexual men. and 25 percent of the cases projected increates in AIDS and HTLV- • Serologital testing of penons whose public health community. will occur among IV drug ahuser. with IIJILAV inrection over the next five behavior places them at risk should be en· ROme overlap to continue between the years will pose ,ubstantial continuing couraged and made widely available. groups. demands for resourceR ror theae efforts. • Setr·referral or an infected penon', Five yeanJ have elapsed since the initial • Additional cases in heterosexual men Inrormation Base sexual and needle·sharing contacts report of PIlf'lImncyslilr carinii pneumonia and women are projected.; the 1,100 (7 • Information is needed to better deter- should be encouraged. In BOme areas or from Los Angele!t marked the recognition percent of the total) ror 198$ will increaBe mine the size of the population at greatest JlOPulations, additional contact notifica' of whal has become known 8S AIDS. By to nearly 7.000 (more than 9 percent) by ri8k in the United. Statea. tion activities may be offered to infected 1984. a human retrovirus, HTLV­ 1991. • Better information is needed on the .penons by the health agency. IIIILAV, had been determined to be the • Through 1985. rewer than 60 percent number of persons infected with HTLV. • For penon. who know that they are etiologic agent of AIDS and, by early of caBe8 were diagnosed in persons outside IIIILAV. Exten.ive and repeated .eroepi- infected with HTLV·III/LAV yet con· 1985, serologic lesls for antibody to the New York City and San Francisco, but by demiologic surveys are needed to deter~ tinue to practice high risk eexual or virus were licen8ed and widely available. 1991 more than 80 percent or cases are mIRe the incidence and prevalence or in- needle-sharing activities, temporary invo­ In retrospect. when AIDS was initially predicted to be reported rrom other Ita tel fection by age, race. ethnicity, ,ex, luntary isolation should be con'idered an reported. in June 1981, some five years al­ and localitiel_ geographic area and sexual prererence.· option only in rare instances and after ready had elapsed since the introduction • Current information 18 inlurficient States should be encouraged to obtain due prOCeB8. Enforced ieolation i. not a of IITLV·JlI/LAV into the United State., to predict the future incidence or HTLV· and report data on incidence and preval. practical way to minimize .pread or the and three years had elapsed. since the IIIILAV infection in heterosexual popula· ence to CDC ror publication. . infection, since infected penone remain first clinical cases had occurred.. AIDS tions, but incfealea in hetel'08exual trane­ • The United State. should continue to infectiou! for life. EdUcation. counaeling. cases have been reported from all 50 minion are likely. play 8 role in undentanding and aaisting and extenlion or aocial lervices - indud­ states, the District of Columbia, and four efforts to control the diaeaH worldwide. ing drug treatment - are the main inter· territories. Casea have been reported Antiviral Unlikely particul.,ly in are.. with seemingly die- vention. for dealing with thirpi-oblem from more than 100 count.ries. ferent epidemiologic patternl. and are appropriately applied to recalcit- Studies of the molecular biology of ForSeveral Years HTLV·JlIILAV have revealed that a copy Information and Education rant inrected penons and their potential of the viral genetic material becomes an A sare and effective antiviral agent is • PHS should explore the advantagee coneentin. partnen. integral and permanent component of the not likely to be in general use for the next using paid radio. TV and printed medii Vi tl I d B de DNA of an infected individual. As a several yeare. Experimental pror:lucts are adverti.ing a. well a. public ...rvice an. as Y ncrease ur n result, such an individual is likely a car­ also under study for treatment or oppor· nouncemento to inform ihe public on To Health Care System rier of the virus for the rest of his life t.unistic infections and neoplaams aaeo­ Over the period or J988 to J99J. AIDS and, for purposes of public health control. ciated with HTLV·IIIILAVinfection. !1~~a~~;.L~~!I/:':a~ i~!:~~~on.iepart. ments. state and local boards of educa. and aasocisted condltio"?'tII place an 'n­ is assumed. to be capable of transmitting Con~lu8ionfil tion, colleges, universities, and other or. creasing burden on the health care deliv­ the viru!' lo olh(~r~. • Further expansion of the multi­ The HTLV·III/LAV genome has been institutional. multidisciplinary approach ganizationsshould support and encourage ery Iystem through an increaaed number completely sequf>nced and the function of to identiry and develop agents for the comprehensive education about A]DS of patients and incr-eased coats of care. !!Ieveral of it!!! genes are known. Considera­ treatment and prevention of HTLV· and HTLV-IIIILAV infection. The burden will be .hared by a .argor ble differences in some genes have been III/LAV infection and associated diseases, • Health care providers need current in. number of communitiee, including some found among variou!! isolates. In addition, including central nervous sy!tem diseaee. formation and training on the diagnoais, which will have a lea complete capacity related viruse!l have been identified in is nece8B8ry. Part of this erfort must be psychoeocial counseling and management for reeponee. There will be increaRinll or HTLV-IIIILAV infected personl. fragmentation and lees health care con· man and nonhuman primates. These the establishment of a large capacity trol of eervicel provided ir more non· related viruses cause a range of different screening program to measure the antivi­ medical,less tradition.land eome unethi· di.!lea!'e!'. Studies in animall'll indicate the ral, immunomodulators and toxic effects IV Drug A bUlle cal provider. become involved. feasibility of vaccination again~t retrovi­ of newly identined natural and synthetic PHS Htimateo that the direct health ruses, and one veterinary vaccine ie compounds. . MUllt Be Target availahle ror the prevention or feline • A system for classifying HTLV· • IV ~rug abu,ers .se~ve al. the !"ajor. ~::~~o~~7:nbiii:~:~~Di";~I;;:;~ leukemia virus. IJI/LAV aS8OCiated. diseue manifesta­ reservOir for traneml!lslOn o~ l-:alectlon to sums represent 1.2 to 2.4 percent ol the tions which is useful in the design, imple­ heterosexual adults and thetr Infanll, 8S expected lotal US personal health care ex.­ 54,000 Deaths mentation and analyses or therapeutic well a8 among themsel.ves. As a grou~, pendituree in 1991 of about $650 billion. trials must be developed. they are not well orgaOlzed, ofte~ poorly BecauBe people with AIDS are con­ Predicted in 1991 • The most erncient design of dinical ~ucat~. and tend to have .Iess mterac- centra ted in certain urban centere, how­ The rollowing projections are based on trials of candidate antiviral agents will tlon with the health care dehv~~ IYlte!" ever. these costs will be disproportionate' the Cente" ror Disease Control (CDC) require the use of placebo controls. than other groups who partiCipate In Iy bome surveillance data and epidemiologic stud­ • Since antiviral drugs currently high risk behaviora. Efforts to change . iel'll of populations at high risk to infection under development are likely to repreRS drug abuse behavior must proceed with Conelullione: with the virus. rather t.han eliminate the AIDS virus in· the understanding that addictive heha· • Develop a coordinated lederal, .tate. • Twenty to 30 percent of the estimated fection. long·term therapy is expetted vior is not often changed without specific and local fesponH to manage the health 1 to 1.5 million Americans infected with and with it the emergence of drug­ drug treatment. serviCt."8 and henlth rinancing erisi" posed IITLV·IIIILAV a. of June 1986 are pro· resistant strains. • A systematically increa!led. capacity by the escalating AIDS epidemic. This re· jected to develop AIDS by the end of for treating IV drug abuaen i!l needed. l!lponse mUllt renect the plur81i,tic charat­ f 1991. The latency period between infec­ Vaccine Likely to Until adequate capacity ill available; per- ter of the American health care ,yste-m. tion and overt AIDS average. four or sons in need of treatment ,hould be and must involve the coordinated partid­ more years in adults. Therefore, mORt per­ Take Several Years prioritized. pation of the public, private and volun· sons who will develop AIDS between A number of vaccine candidates for • Until treatment capacity ill adequate tary settof1l. as wen as ambulatory, in· 1986 and 1991 will be those who are al· human beings are currently under devel­ ror pel'BOns who continue to abu8e IV hOllpital and long term care providers; ready infected with HTLV ·III/LA V. opment and limited clinical testing for drup, studies are needed to evaluate the • Emphasize the needs of in,titulional • Based on an empirical model that BOrne could begin within two years. Field efficacy and. reaflibility of promoting and community-based providen for train· use" reported cases of AIDS, by the end oC trials to demonstrate erficacy may reo ufer use of drug paraphernalia (for ing, continuing edutation. and plychOlo~ 1991, the cumulative tases of AIDS in quire additional yean. A vaccine for example, increased availability or sterile cial8upport; the US meeting the CDC survemance general use is not anticipated before the ~pedle8 or "wo~k'· and education n:gord- a Upon requut, lulst Illte, local definition will total more than 270,000. next decade and its use would not afrect 109 use or stenle needles and !Iharmg of' governments. and community·ba!led or­ During 1991 alone, more than 145,000 the number of persons infected by that needles. ganizations to assess. develop and imple­ CR.!IeS of AIDS will require medical care time. ment comprehensive servite delivery sys· and over 54.000 AIDS patienbl are pre­ Prevention of terns of core for AIDS patient. in a cost­ dicted to die, bringing the cumulative Control Depends on erfective manner; numher of deaths due to AIDS to over Sexual Transmission • Utilize ~ludiefl of the special health 179.000. Cutting Transmission Sexual contact will remain the primary "ervices need!' and harriers to prevention • In 1985. 9.000 cases of AIDS were di· .. In the absence of a vaccine and therapy, mode of HTLV·III/LA V infection for the or HLTV·III/LAV infection in Blacks and agnosed in the United States and reported prevention and control of HTLV-Ill/LAV for~eeable future, with greater increase . Hispanics. *************************~************************ ***** PAGE 42 THE OFFICIAL NEWSLETTER OF THE NCGSTDS * VOLUME 7:5 * JUNE/JULY, 1986 ***** *************************************************************************************************************************

THE HUMAN TRIALS IN TESTING THE CURRENT HOPES FOR A CURE by --Ro~ --F. Wood---- with---- thanks------to-- the--- Washington Blade L ~L~~L~§ uncomfortable wilb), one genenOy had 10 Roy F. Wood, aUlhor oj ResOcss CompIIcatlona They explained the aspiration lechnique sunonder six 10 eighl small lubes of blood Four people bad srarted the drug Iwo carefully and I agrffil. It diun', ,ound like Rednecks: Gay Tales of a Chansing Sourh, • plus Ibree or four very large ones. weeks before mysd~ rout the week before much fun-and wasn'l-my auitude was (/lin. 10 lYashiJ'glon. D.C. /ast December After the bIoodIcl\ins. il was on for (and the last foor aboul a week and I half . ,hal I was here 10 he helpful. Whallhey did Ij 10 participate in drug lrittis Dl Ihe x­ rays and EKGs. Dy the lime I was Jinished before I was removed rrom rhe drug.) Of was take a large nffille, deaden a Spol above National l,.,titUles oj Health. Till! jollowing wirh aU thai and ready 10 receive the first Ihesc 16, five have already been taken 01[ my hip, insert the needle, and withdraw a is Itis /irsi-penon accounI-- wrinen in . dose or the medicine (or druc-don'lknow the prOlOCOI. (One died, bul of complica­ tiny bil of" marrow. They wanted the February-oj Whol il was like 10 IOke pim in as I'd classify il as a wteJiclne, wbich I reel tions. ~ I helieve. directly relaled 10 the marrow 10 see why my blood plalelel counl tlws.drugtrittisojIlPA-13. Mr. lYooddied indicates il is heneIiciaI), il had aU lost dropped. in a hospilOl neGr his hom. in Alhe"", dru&-) somcIhin& in termS orboth fear and So when I started my lilSt day, some guys Dlood platelelS! Those linle rascals were GeorgiD, April II jrom complicalions maaic-I simply wanled \0 Bel back \0 my hotel and bad already been on the stuff IWO weeks. my bane throushoul lhe whole program. lWOCiateJ wilh AIDS. H. ""s in his txJr/y take a breakl and compJications were devdopi",_ I've I'm nol sure whal their full purpose is, bUI forties. HPA-23 is I clear, WllCr-Iooki",COIlCOI>- never been sure just how much we were they play. major role in lhe cloning faclor. I . lion. II was \0 be liven 10 me five days a aauaIIy IOId about lite side-eft'ccts. other believe one is supposed 10 ha ve II leasr I SO by Roy F. Wood w..... ror eighl weeks, intravenously. My than whal we miBbl have IOId each other. of them. (Everylhing is rounded 01T: 150 My doctor worked very hard IflCr I was fil1l dose was anti-dimlClic- Nodling Also, there _med 10 me 10 be an over­ equals ISO,OOO.) AI the beginning of my diaSROsed in July or last year as having happened. and I was free \0 leave ror the abundance of manied people in the second week, lI)ine had dropped down 10 AIDS. None of Ihis silling around wlilins day. AU or us on the propam were "oul­ program-6ve.1 believe oulofthesi.... n.1 46. At 40 one is removed from the program. 10 die; we had 10 do something, find • palien.. " and, if IlOl £rom the D.C ...... couJd never he sure if Ihesc people bad 1be bone marrow business was to see program, examine possibilities! Frankly, I stayed in hotels lround the Medical CenlCr. AIDS because of ..xURI conlaCl or from whether or not my marrow was still would have preferred 10 have remained at NIH paid a stipend for the """' of the hotel ollter reasons (blood, drup, elC.) produci", pI.teI.... If il was, then lbey bome, wbere I have conslructed a peaceful and livi", while on the program. The group was odd, I feJ~ in aoollter way. could logically assume the druc was the life, and simply IClithe virus 10 gel ",",. AI I did not last the entire program. (I wenl Otbe, IhaII myself, 00 one ever menlioned problem. Happily (I suppose) il did lum oul rhe same lime, I was finaOy led 10 the inlO my levenrh week and was Iaken oft' on being Gay (with rhe exceplinn or one guy 10 be the drug. conclusion rhal I OUShl 10 Iry I remedy or a Wednesday-actuaOy I received 32 days who would brinB bis lover out 10 the clinic The nexl couple of weeks were spen~ by Iwo if lltey were ...ilable-and affordable. of the drug as opposed 10 the complete 40). rrom time 10 lime). My impression was thai me al any rate, in bopiogthe plaleJelS would Whal I gOl myselr inlO was an Dull was in illOll8 enousb 10 hear a 101 and mosl people were ashamed of wby rhey remain high enough thaI I mighl.remain on perim.nlal drug program allbe Nalional walCb other people's reactions- were there and of their G.y""". Thank lhe prosram. They wenl up and down, then Inslilules or Health (NIH) in Washinglon, As lime wenl along, I golthe impression goodness I've never had thai dilflCllllY and levelled 01[ for a lime around 60. NOI very ~.C. thai many of the BUys on the program (or never will. high, but su1Iic:ienl. GdO", involved in such programs strikes "prorocol" as il is ""lied .1 NIH) really had Most or lhe complicalions I heard aboul me much rhe same way as whall bear aboul bigh hopes of r=ivi", some henefil. were severe headaches .nd lemble slOmach The plaleleb drop gelling involved wirh lite Social Securily I did noI. Thing. like ·miracle" cures pains. Many of us developed skin problems, Then,the reading OIl my 32Dd day of the Adminisullion: come prepared 10 wail don't happen 10 me, probably because I myself included, alrhough a large ponion of drua was 24, and as il remained 01 24 the awhile-a 10", while. Obviously anyone don'l believe in miracles. Besides, as we mine slCmmed, Ilhink, from going off olher followi", d.y as weD, 01[ the program I applying couJd weD be dead before Iny were loid hefore signins lbe luthorizations, medication-I was one. (No OIher medicine is came. decision is made. lite ptupOSeof the program we were on, was . allowed wbileon HPA-23,exceptTylonol.) Frankly, al linll was cxrremdy pleased. I came 10 D.C. AuJUS! 20, 198', (al my nollO find • cure in the finl place-il was 10 . I slill have some large acne-like sores on my The las! few days before wming off the own expense, lhe only part or lhe business I measure side-e1Tecls and lesl various desrees cbest and back. pnogram I spenl simply counling the lime had 10 pay for). and they drew I vial or IWO or dooages. The only encouragemenl we Bul oolbing happened thai first day. I unlil I wuld leave for borne. I .nlicipaled thai being removed from lhe prOlocol or blood and conducted a brief inlCn'iew. were oIfered w.. lha~ in \eslluhes,the drug didn'l £ain~ go inlO convulsions. or anylhing Two \0 six weeks, and rd hearsomclbi",,1 bad eirher inhibilcd or hailed the growtb of so dramatic. Nor was the rest of the first would soon have me wi",ing my way back was \DIlL II was aaually laIC NIWemher the AIDS virus. The assumplion was thai w.... out of Ibe ordinary. Various people 10 the sunny soulh, in this case, Goorsia. before an)'lhiDc more was said. Then il was the druc miabl do the.me ror us. if il dido'l wlnled me 10 keep a journal during lite Bu~.1as, four days Ifter I wasoffthedrus I back \0 WashioIlOn, £or drawinclols more kill us IirsI. We were, as far as NIH was procram. I did nul There simply was nOi was su11 sitting in a D.C. holCl room. Th~y needed to IlU1 a "saUium scan" on me to see blood; an eateosiv.. detailed e.. minalion; coaccmed, fil1l people II> be &iVeD the enousb malCrial 10 wrilC about Even wirh II¥' if I bad wntracled pneumonia. and an interview With a doctor who would drug. HPA-23 was used on some people in (Ol1lpIiL';.Itions. 11/0.\1 of thc -'~ Ja,'" I he workinS on lhe program. This lrip was France (includins Rock Hudson), bUI fI.:l· •..'i,l·J thc Jrug \\crc fllUlillC: glllhl·liinil. Should you pal1klpa"? made 10 D.C. Ihe finl week in Deo:mher, menlioning lhe French cxperimenlS al NIH gl·t thl· IIP:\·~3. kit'C. II.JlJI\" ;lIl' ,lull lit The queslion logically arises: would I do and a couple 10 days laler, I was accepled was like waving that proverbial red nag, so I dramatll.:!oo. . il apin? If you come down with AIDS inlO the program. December 16 "und me al have no idea if anyrbing was learned in \,"'hat did harr"!O. w mc. hll!llD III 111\ ouShl you consider gelli", inlO some sort or NIH 10 begin an eillhl-week prngram with France. ~'\:ond \\lock. On Tu~~lal and \\·t·lll1l'~d .. \. program with a (relalively) untried drug? rhe drug HPA-23. On Ihe Monday I hegan Ihe program, I I cxpcri~nl:\."d a great affillUnt Ilf an;&! In my e",.. bavi", made an effort 10 do Anyone undergoing treatmenl wirh an became Numher 12, oul of 12. Since Ihen hl\."cJin~. "fhey a~kcJ nle if I \\ ()uld unJcrgll somdhi", posilive aboul my alness. I will experimenlal drug has, I suppose, • riahllO lhe lotal numher of people involved has ~mlclhmg i.:l.:t11. wouldn'l gel rid of my anim.1s in spile of the "Phlebolomy," (a word I was alwlYS unc is free to say yes or nl); one mighl abtl faa we are advised 10 do so). Bei", II home lea\"c the program at any puinl, \ ..·ilh nu and sumvi", only Ihree Or four monrhs repercussions. would be belter ror me Iban livinS two or rh ... yean here and there chasi", ·cu.... • ****************.********************************** AMFAR AWARDS GRANTS by Peg Byron and Lisa M. Keen, with thanks to !h! ~~!h!~g!~ ~l~~!, 5/30/86 The American Foundation for AIDS Research (AmFAR) awarded more than $1.1 million to 20 research projects, its first since consolidating the AIDS Medical Foundation of New York with the National AIDS Research Foundation of Los Angeles. The grants, which averaged $58,000 each, ranged from a study to develop 'noninvasive diagnosis of pneumocystis carinii in AIDS' to 'Regulation of HTLV-IlI gen~ expression' to 'AIDS Public and Civil Liberties: the ethical issues.' ************************************************** CITY APPROVES CLINIC MALPRACTICE INSURANCE FOR 2 YEARS with thanks to !h! ~!!b!~g!~ ~l!~!, 6/6/86 The Washington, D.C. City Council Committee on Human Services unanimously approved a bill to provide medical liability insurance to the city's 'free clinics'--including the Whitman-Walker Clinic, The bill would,cover liability for negligence in providing health care and related services to the clinics which can not obtain private' policies at a r.easonable cost, The coverage, which under the bill would last for two years, has been provided on a temporary basis to the clinic since their private policies were canceled in January'. Whitman-Walker Clinic Administrator Jim Graham said the bill is 'absolutely essential' for the Clinic to be able to continue its services. Graham blamed the national liability insurance crisis for causing malpractice coverage to skyrocket_ He said the lowest price policy the Clinic has been able to find is for $38,000 per year., compared with a policy it had last year for $2300_ ********l***************************************** ***** THE OFFICIAL NEWSLETTER OF THE NCGSTDS * VOLUME 7:5 * JUNE/JULY, 1986 * PAGE 43 ***** ************************************************************************************************************************

DONORS BLOOD TO BE TRACED with thanks to Detroit's ~~y!!!, 6/11/86 Blood collection agencies in the United States will search for people who received transfused blood from donors later found to have been exposed to the AIDS virus. The American National Red Cross, the American Association of Blood Banks and the Council of Community Blood Centers will look for people who received blood before March, 1985, when all blood collection agencies began using a new test to screen blood for the presence of the AIDS virus. Although the AIDS epidemic began in 1979, officials are not yet decided on how far back they need to investigate. Health officials and doctors will tell people who .received blood before that date that they may have been exposed, according to a Red Cross official. Those people could be tested for exposure. ************************************************** MARIPOSA FOUNDATION PRESENTS AWARD TO BRAD TRUAX with thanks to Detroit's ~~y!!!, 5/21/86

The Mariposa Education and Research Foundation announced that it has selected prominent San Diego physician [and NCGSTDS member!] Brad Truax, MD, to receive the 19B6 Mariposa Foundation Award for outstanding contributions to moving society closer to recognizing the dignity of every human being. The award, which includes a check for $1000, was presented by the Mariposa Foundation' at the annual awards dinner of the Fund for Human Dignity, May 12 in New York. Last year's recipient of the Award, former director of the National Gay Task Force Ginny Apuzzo, presented the 1986 award to Dr. Truax. In Southern California, Truax is widely known as the 'gay mayor of San Diego.' One of that city's leading physicians and humanitarians, he serves as clinical professor in the Dept. of Family Medicine at the University of California in San Diego and on the San Diego Human Rights Commission. He co-founded San Diego Physicians for Human Rights, as well as the United San Diego Elections Committee, was a delegate to the Democratic National Convention, and served several terms as President of the San Diego Democratic Club .. ************************************************** PWA SWITCHBOARD OFFERS SERVICES IN SAN FRANCISCO People with AIDS Switchboard is an organized group of people with AIDS (PWAs) and people with AIDS related complex (PWARC) concerned with helping other PWAs and PWARCs deal with the emotional and practical p~o~;cms of the disease. A call-in hotline was established in order to provide telephone counseling, information, calendar events, and referrals for all PWAs, PWARCs, and their friends, families, and loved ones. Although not professional counselors Switchboard volunteers are willing to share their experiences and providing information can be very helpful to others. PWA Switchboard is a joint project co-sponsored by the San Francisco AIDS Foundation and People With AIDS, San Francisco, with offices located at the San Francisco AIDS Foundation. The Switchboard operates Monday-Friday, 1-4pm, and receives referrals from anywhere in the country, or from AIDS service providers by dialing 415/861-7309. ************************************************** MOBILIZATION MEMORIALS IN 70 CITIES WORLDWIDE by Marcos Bisticas-Cocoves (& Loie Hayes in Boston), with thanks to Boston's §!~ ~~1;~ ~!!!, 6/7/86

People gathered in nearly 70 cities on Memorial Day to COmmemorate those who have died from AIDS and support those who are living through the present health crisis. Organizers call the third annual candlelight memorials the largest action around AIDS to date. The memorials were coordinated by Mobilization Against AIDS, a San Francisco-based national political action group. The 'candlelight actions' initiated by Mobilization ranged from religious services, to silent vigils, to marches followed by rallies. The theme of this year's memorial was 'Still Fighting for Our Lives.' Frank Richter, one of the national coordinators of the event, said, 'We chose Memorial Day for this because people with AIDS are at war, they are fighting for their lives. People with AIDS have displayed a lot of courage in the face of adversity, they've been in the forefront of battles for services and funding.' Richter said that the goal of the memorials 'is to show that people allover the country, not just people in big cities, are concerned about AIDS, that they are supportive of people with AIDS. We want to show that the appropriate response to disease is caring and support, and to put a lie to the doctrine that people are to be blamed for being sick, or that they're morally culpable for what's happened to them.' Nearly 90 cities planned to hold some kind of memorial on May 26, however only about 70 cities were able to follow through with their plans. One notable exception was Tokyo, which canceled its plans due to fear of harassment. In San Francisco, crowd estimates ranged from 5000-15,000 for a march and rally. In Oklahoma City, the first memorial included an all-night vigil attracting nearly 75 vigilers. In New York, about 500 people gathered in Greenwich Village's Sheridan Square. In Lynchburg, Virginia, home of the Reverend Jerry Falwell, about 25 people turned out for a vigil and church service. According to local organizer Doug Deaton, the Lynchburg service proceeded without incident. 'The people in Lynchburg are so conservative,' said Deaton, 'that they didn't even show up to protest." In Boston, about 800 walked from the Boston Common to Old South Church for an ecumenical religious service. Local organizers were unanimous in their support for future actions. However, Paul Boneberg, of Mobilization, said the memorials cost his group between $5-10,000. 'We have to recover our seed money if we're going to do this again,' said Boneberg, 'and the community has to ask itself, do they want this to happen next year?" ****************************************.**.++++++ ***** PAGE 4' * THE OFFICIAL NEWSLETTER OF THE NCGSTDS * VOLUME 7:5 * JUNE/JULY, 1986 ***** ************************************************************************************************************************

KAN SUES OVER ANTfBODY TEST RESULT DISCRIMINATION with thanks to £~!~, (Computerized AIDS Information Network), 5/1/86 A 30-year-old man from Brick Township, New Jersey, who lost his job after mentioning he had tested positive for AIDS antibodies has sued his employer, Dumar, Inc., a Branchburg Township roofing company, alleging he was the victim of unlawful discrimination. 'The employer said, 'I've had enough of your personal problems on the job,' and fired him,' after he had mentioned that an earlier blood test was positive for antibody to the AIDS virus, said Jeffrey Fogel of the New Jersey chapter of the American Civil Liberties Union. The state's Civil Rights Division has filed an application to intervene in the case, said Deputy Attorney General Susan Reisner, believing AIDS is a handicap under New Jersey's anti­ discrimination law. 'Unless the employer can demonstrate that the handicap actually interferes with the ability to perform work or causes a hazardous condition to other workers, then you may not discriminate against those workers,' said Fogel. . **************************************************

KNOWING IS BETTER?! with thanks to Detroit's £~~i!!, 7/23/86 Some gay men dread getting AIDS so much that they're relieved finally to learn they have the deadly disease. Researchers found that for some gay men, not knowing whether suspicious symptoms will turn into AIDS is worse psychologically than knowing they have the disease. The study surveyed AIDS patients, men with AIDS-related complex­ sometimes known as pre-AIDS, in which victims show some symptoms but don't have the disease--and a control group of healthy homosexual men. Depression and anxiety showed up in 76% of the AIDS-related complex group, compared with 59% for people with AIDS and 41% for the' control group. **************************************************

AIDS BLOOD SCREENS--CHAPTERS 2 AND 3 by Joanne Silberner, with thanks to §~i!~~! ~!!!, 7/26/86 [EO NOTE--Science News and specifically medical reporter Joanne Silberner have consistently provided outstanding quality, d~pth:- ~nd- readability of issues dealing with AIDS and health. We once again encourage our readers to subscribe to this excellent weekly publication: call 1/800/247-2160 for new subscriptions; rates: $29.50 for one year; $50 for 2 years. You will be satisfied!!] In March 1985, the US Food and Drug Administration approved the marketing of several blood screens that detect antibodies to the AIDS virus. The nation's blood banks immediately began screening L_ ...3tad blood and pulling positive units from their shelves. The screens have been credited with halting new infections from blood or blood products. But while the tests are very sensitive--they identify just about all contaminated blood-­ they also have their problems: *They give positive results for some blood that would not transmit AIDS. In fact, says Max Essex, an AIDS researcher at Harvard University, 'Ninety to 95% of the people who test positive don't really have the virus.' Included in this group are people who test positive because they have other cross-reactive antibodies, unrelated to the AIDS virus. *Of the apparently healthy 'true positives' it does identify, the type of screen used today does not pinpoint which people will go on to develop AIDS within 5 years--a fate that will befall an estimated 20- 30% of them, according to CDC officials. *A small number of people whose tests come up negative actually have AIDS virus in their blood, and at least one person has contracted the virus from an 'antibody-negative' donor. In the wake of such difficulties, researchers and industry have been searching for a second generation blood screen, and several are expected to be approved by the FDA in the next few months. While the 2nd generation tests, like the first generation, detect antibodies rather than the virus itself, they are more specific and less prone to false positives. Unfortunately, they won't be any better than the 1st generation tests at picking out people who harbor the virus but have not raised antibodies against it. To detect these antibody-negative, virus positive people will take 3rd generation tests that hunts for the virus itself. Such tests are already being developed by several companies. The blood screens are the first practical application of AIDS laboratory research. Since there is a s yet no cure for AIDS, screening blood, sticking to safe sexual practices and avoiding intravenous drug abuse are the only steps that can be taken against [infection]. The American Red Cross, while following the development of the 2nd and 3rd.generation screens, is expressing confidence in the sensitivity of the current antibody screen despite its problems.' 'Since the initiation of the screen there has not been a report of any transfusion-associated AIDS,' says Jos~ph O'Malley, a medical specialist at the American Red Cross in Washington, DC., 'although .recently there has been, one case of seroconversion [development of antibodies]." The seroconversion, detailed in the June 20 ~~~B [see else~here in Newsletterj, occurred in a 60 year old man who had received blood during surgery in August 1985. The blood, which had (Continued) ***** THE' OFFICIAL NEWSLETTER OF THE NCGSTDS * VOLUME 1:5 * JUNE/JULY, 1986 * PAGE 45 ***** ************************************************************************************************************************

~!Q~ ~~QQQ ~~~~~M~~ ~2n~!n~!g tested negative, came from a donor who was homosexually active 'with one partner; a blood sample taken several months after the donation that caused the seroconversion retested positive. 'The blood was [initially] nonr~active due to the fact that the donor was in a 'window' period between infection and seroconversion,' says O'Malley. 'As a homosexual, the individual should not have donated blood. The only way around a case like this.is to develop a test for the virus itself.'

Both the 1st and 2nd generation screens are ELISAs (enzyme-linked immunosorbent assays). They are augmenting the crude screening-simply requesting that members of high-risk groups not donate b100d--on which blood banks have been depending. In an ELISA, blood serum is added to small wells containing bits of the AIDS virus, which has been recently renamed HIV (human immunodeficiency virus) by an international committee of virologists. If there are HIV antibodies in the blood, they'll stick to the virus. To detect such antibodies, a second, enzyme-linked antibody is added. which will attach to the antibody-virus complex, if present. When a chemical with which the enzyme reacts is added, the.enzyme itself changes color, signaling the presence of antibody. The problem with the 1st generation ELISA, which costs about $4 per sample, is that nonspecific cellular debris from the initial cell culture in which the virus was grown can be present in the well with the virus, Some people test positive not because they have antibodies to the virus but because they have antibodies to the cell in which it was grown. Included in this group are monogamous women who, in the course of bearing several children, were exposed to foreign white blood cells and developed antibodies to them.

The American Red Cross, which collects and distributes half the blood donation in the nation, rechecks initial positives with two more ELISAs. If either is positive, the blood is considered a repeat reactive. About 1% of Red Cross donors are initially reactive; about 0.3 to 0.35%--30 to 35% of initial reactives--are repeaters. Repeat reactive blood is tested with what is called a Western Blot, or immunoblot assay. In this procedure, which costs about $65, suspect blood is added to blotting paper that contains AIDS virus proteins of different sizes. Antibodies specific to the particular proteins will stick. As with ELISA, an enzyme-linked antibody is added; in this case, when a chemical with which the enzyme reacts is added, the complex turns color and can be detected visually. About 0.025% of the Red Cross donors-­ roughly 8% of· the repeat reactives on the ELISA test--wind up with positive Western Blots. The CDC estimates that 1-1.5 million apparently healthy individuals in the US are antibody positive and thus presumably Western Blot positive. Red Cross notifies donors· who are Western Blot positive but not those who are Western Blot negative, even if they are repeatedly reactive. To safeguard the blood supply however, the Red Cross discards any blood testing repeatedly reactive on ELISA irregardless of their Western Blot results. A variation on the current ELISAs received FDA approval in February. Made by Genetic Systems Corp. of Seattle, the test is more a cousin than a 2nd generation descendant: it is an ELISA that uses a viral isolate provided by the Paris based Pasteur Institute and grown in a different cell line that reduces the number of false positives caused by reactivity against non-AIDS proteins. The antibody screens produced by other US companies are based on a virus and cell line developed at the National Institutes of Health (NIH) in Bethesda, and patented by the US government. That patent is currently being contested by the Pasteur Institute of Paris, which claims that NIH researchers depended on viral isolates the French group had shared with them, and that Pasteur's earlier patent application should be the valid one. The US patent office put the onus on NIH to prove that its antibody detection method predates Pasteur's.

The primacy question could become moot when screens that use proteins produced by genetic engineering rather than by HIV itself are approved. The benefit, notes Hubert Schoemaker, president of Centocor, a biotechnology company, is that these screens don't use the cell-grown virus. This eliminates the cellular debris that causes nonspecific reactions, so that· a positive reading will reflect true HIV antibodies. In addition, he notes, genetically engineered proteins eliminate the hazard of working with live virus. Centocor, based in Malvern, Pennsylvania, has a recombinant protein product Schoemaker believes is near FDA approval. But the 2nd generation antibody tests won't take care of everything. False negatives, says Harvard's Essex, are 'still a limitation in the 1st and 2nd generation test. Some percentage of people infected with the virus--the best figure used is 5%, but nobody knows exactly--don't have detectable antibody.' Included in the antibody negative, virus positive group are people who picked up the virus only recently and haven't yet produced antibodies. It can take weeks or months following infection for antibodies to appear int he blood. Jay Levy of the University of California at San Francisco has used immunofluorescence to find antibody negative, virus positive blood. In the procedure, he treats potentially infected cells with a chemical that opens them up, allowing viral antibodies to enter. These antibodies, in turn, can be identified by fluorescent tags. 'We have seen [in the same blood sample] a positive by immunofluorescence and negative by ELISA and immunoblot,' says Levy. '1 think its rare, but it does occur.'

The only way to find antibody ~egative, virus positive samples is by checking for the virus directly instead of the antibody footprints, This is the goal of the 3rd generation tests. Detecting virus is difficult because HIV generally (Continued) ***** PAGE .6 * THE OFFICIAL NEWSLETTER OF THE NCGSTDS * VOLUME 7:5 * JUNE/JULY, 1986 ***** ************************************************************************************************************************ ~!q§ ~bQQQ ~RE~3L ~QI.!ti!!~ is present in only low concentrations. At the moment, such testing is impractical. 'The only sure way of showing [the virus] is there is to grow it out,' says O'Malley. 'But that's extremely difficult and expensive.', The virus has to be grown in'cell cultpres kept alive while it replicates.' 'Even some of the largest medical research groups in the country have been tripped up trying to isolate the virus,' says O'Malley. In one type of 3rd generation test, DNA probes use one side of the virus's double helix to seek out its complementary half. L.R. Overby of Chiron Research Labs in Emeryville, California, says 'There's no evidence even with [easy to use] probe technology that there's sufficient virus to be detected that way.' The company has been working on a probe, but it is being designed as a research and clinical tool, not as a simple screen. It may prove useful for determining whether a person with symptoms of AIDS actually has HIV, says Overby. Centocor is also working on a method to detect AIDS virus. Theirs is not a DNA probe but will depend on antibodies that bind to the virus's genetic material. Such direct testing, however, won't necessarily be more practical than antibody tests for screening blood, he believes. Cetus Corp. of Emeryville, CA is going for a DNA probe in a novel manner. Because the virus's concentration in the blood is so low, they have developed a series of chemical steps that will reproduce any HIV present in a blood sample. A subsequent DNA probe will have a greater amount of HIV to survey and, therefore, a much greater chance of determining whether the blood is infected. Researchers from UCSF are working on another way to test for the virus. At the International Conference on AIDS in Paris earlier this summer, Jacque Homsy described a test for an AIDS virus protein that involves pitting suspect blood against known levels of recombinantly produced protein and measuring its ability to bind to antibody that is specific to the protein. If the blood being tested contains that particular virus-bound protein,the protein will compete with its recombinant twin, and less of the recombinant protein will bind to the antibody. Conversely, if all the recombinant protein is bound, it means no virus is present. The test, Homsy claims, yields few false positives and can detect as few as 100 infected cells in a blood sample. Tests for virus are expected to eliminate the handful of exceptions that slip through the current screening process. 'If you include screening for risk groups and pick out antibody positives, you get the majority of the dangerous [blood] out,' says Thomas Merigan, a specialist in infectious diseases at Stanford University. 'It would be nice to have them all out.' **************************************************AIDS VIGIL SEPT. 5-7 . with thanks to ~~!~ {~Q!2Yi!~!!!~ ~!P§ !!!fQ~!!!!Qn M!!!Q~~l, 7/25/86 More than 200 congregations that make up the Universal Fellowship of Metropolitan Community Churches will be participating in a 50 hour International AIDS Vigil of Prayer to be held during the weekend of September 5-7, 1986. Vigil coordinator, Rev. David Farrell, pastor of Metropolitan Community Church in San Diego, says that the Vigil will accomplish three things. Farrell sees the Vigil as a spiritual statement of support for all persons who have been affected by AIDS, as a forum to provide education on AIDS and related issues and as a vehicle to stimulate volunteers and community financial support on behalf of persons living with AIDS through love offerings received for local AIDS Projects and AIDS Charities. During the Vigil, Metropolitan Community Churches will be offering special worship services which address the spiritual concerns of those living with AIDS as well as those of their families and friends. Sanctuaries of many churches will be open continuously during the 50 hours of the Vigil so that persons of any faith or spiritual belief can reflect or pray silently. Local AIDS service organizations will be providing information booths and assisting the congregation in organizing lectures, educational panels and discussion groups on the various issues surrounding AIDS. For many, this will be the first time that they will have access to accurate medical information on AIDS and to viewpoints concerning the social and personal issues created by the health crisis. Farrell and his San Diego congregation held a highly successful local vigil during the first weekend of January, 1986. That vigil received favorable media 'attention and support from San Diego's religious and secular community. All churches and religious organizations throughout the United States and Canada are being invited to participate. These organizations are being asked to send a representative to the MCC Vigil so that they can then familiarize their congregations with the Metropolitan Community Churches' concerns. In addition, each organization is being asked to devote some time, either in prayer, reflection or by sermon, to the spiritual and emotional needs of those affected by AIDS during the Vigil weekend. 'This Vigil is NOT about lifestyles,' emphasizes Farrell. It is an outreach to the entire community, giving pastors and their congregations an opportunity to lend spiritual support. 'We need to get the disease talked about and address 'the issue of what a truly Christian response should be.' Farrell believes that an International AIDS Vigil of Prayer will provide all churches with a forum in which to minister to the concerns of persons living with AIDS and their families and friends. 'Many churches haven't perceived AIDS as their issue. We are attempting to change that perception by increasing their knowledge of the issues involved, pointing out that persons with AIDS, and especially their friends and families are often members of THEIR congregations.' Since his congregation's local Vigil in January, Farrell has been traveling throughout the United States and Canada, organizing the International Vigil. The Board of Elders of the Universal Fellowship of Metropolitan Community Churches has endorsed plans for the Vigil. Farrell has also approached other religious groups, such as the National Council of Churches, offering information and resource packets about the Vigil. 'I think the church has an obligation to be a teacher in a time of international crises,' says Farrell; 'You don't have to be religious OR gay to be involved in this weekend. You just have to be concerned for the welfare of those affected by the disease. This weekend will emphasize both the ~piritual support of the community and be informative at the same time.' Farrell recently celebrated ten years as pastor of the MCC San Diego and has been an active member of the church for over 15 years. During his service to the MCC, David has become a respected leader of the gay, lesbian and religious communities. For more information, contact the Rev. David Farrell, Coordinator, International AIDS Vigil of Prayer, 619/280-7744. "'.++,., ...... , ...... l...... ***** THE OFFICIAL NEWSLETTER OF THE NCGSTDS * VOLUME 7:5 * JUNE/JULY, 1986 * PAGE 47 ***** ,************************************************************************************************************************

'DYNASTY' ACTOR HAS AIDS with thanks to Chicago's ~!~~~ ~!~~ Ii!!!, 7/17/86

TV actor Paul Keenan confirmed he has AIDS. Keenan, 30, who is gay, appeared on the TV show Qy~~!~~ in 1982 and ,1984, and has appeared in several other television programs. He is the second actor on that show who has announced he has AIDS; last year, before his death, Rock Hudson publicly announced he had AIDS. ************************************************** INTERNATIONAL HEALTH RESEARCH FOUNDATION FORMS with thanks to the ~!~ YQ~~ ~~~!Y!' 6/2/86

"Receptive anal intercourse might not be the only thing on the minds of AIDS researchers at the CDC; But then again, it might be.' So reads an advertisement for the newly formed International Health Research Foundation (IHRF) in North Miami Beach. The Foundation hopes to support independent research into areas the government is ignoring, such as African Swine Fever Virus, other arboviruses (carried by insects), mosquitoes, and the environment. The Foundation was established by AIDS researchers Drs. Jane Teas, James Hebert, John Beldekas, and Mark Whiteside. One of the greatest impetuses of investigation is why there are no satisfactory explanations for the high rate of AIDS in the rural Florida community, Belle'Glade. The town has a population of 16,500 but has the disproportionately high caseload of 250. Teas and Hebert found a farm with 146 pigs in Belle Glade, many of them very ill; preliminary blood tests found the presence of HTLV-III antibody. You can imagine how pork producers feel about any inferred relationship between pigs and AIDS, let alone research into such a connection. Despite roadblocks by private lobbying groups as well as the Public Health Service and the Department of Agriculture, among other agencies, the strength of conviction may be the source of inspiration for the new Foundation. For more information, or for sending a tax-exempt donation: The International Health Research Foundation, 1780 Northeast 168th Street, North Miami Beach, Florida 33162. ************************************************** CUBA OKAYS MOTHER'S VISIT TO DYING SON WITH AIDS by Kim Westheimer, with thanks to Boston's §!~ ~Q~!Y~i~~ ~!!!, 6/29-7/5/86 After a year-long battle with Cuban authorities, Estrella Hechaverria was allowed to travel to Boston to see her son, just days before he .died of AIDS. Cuban authorities had earlier denied her a visa, claiming they feared she would 'return to Cuba with the virus.' Following the visa denial in May of this year, Hechaverria's son, Luis Valdes, his lover, Steven Yost, and longtime family friend, Jose Rey, sent letters to the Massachusetts Congressional delegation and to Senators Kennedy and Kerry. Finding no success, they met with black activist and candidate in the Eighth District Congressional race, Mel King. According to John Demeter, media coordinator for the King campaign, King immediately called the Cuban Interests Section and began negotiations that led to Hechaverria's receiving a visa. King spoke with officials about transmission of AIDS, insisting that Hechaverria would not receive AIDS from visiting Valdes. David Aronstein of the Boston AIDS Action Committee said they had also been working to obtain a visa for Hechaverria during the last year. The situation was looking hopeless, he said, until King's contact with Cuban,officials. Upon securing the visa, King, the AIDS Action Committee and Valdes' co-workers from Oficina Hispana worked to raise funds for a special charter flight for Hechaverria. Hechaverria had not seen her son since his 1980 departure from Cuba. ************************************************** SOCIAL PRESSURES BLAMED FOR BLOOD SCREENING FAILURES by Rick Harding, with thanks to !b! ~!!hi~g~~ @l!~!, 7/11/86 Although the safety of the nation's blood supply has greatly improved since HTLV-III (hereafter referred to as HIV] antibody blood screening began 16 months ago, a National Institutes of Health panel reported that the most effective method of controlling AIDS infection through blood transfusions is still for gays and others at high ~~sx for the syndrome to refrain from giving blood. Released in the wake of reports of a recent case in which blood from a newly infected person slipped through screening tests without detection, the report recommends that there be 'continuing vigorous efforts to educate the public and facilitate anonymous self-deferral at the time of blood donation.' The panel noted that '(b]ecause of real or perceived social pressures,' some people at high risk of transmitting AIDS may 'feel compelled to donate blood.' The panel report recommended that blood banks institute a system which would allow donors to check off a confidential form to ensure that their blood is discarded after donation. The panel's 19-page report was released at the close of a three-day public conference to assess 'the impact of routine [HIV] antibody testing of blood and plasma donors on public health.' The report notes that although the primary focus of blood collection centers should be to protect the blood supply, an important secondary focus should be to notify and counsel people who test positive for the HIV antibody. Although several invited speakers, including an attorney representing the Lambda Legal Defense and Education Fund reported on how antibody testing is having an impact on the gay community in particular, the panel opted to keep the scope 9f its report narrow and to consider only how the tests are having an impact on blood donors. The report does note, however, that '[q]uestions can be raised' about using the test for 'purposes other than protection of the blood supp'ly." When the report was read, several audience members, including a representative of the American Red Cross, urged the panel to reconvene at a later date. ***** PAGE 48 * THE OFFICIAL NEWSLETTER OF THE NCGSTDS * VOLUME 7:5 * JUNE/JULY, 1986 ***** ************************************************************************************************************************

NON-DEADLY AIDS VIRUS CREATES HOPE FOR VACCINE with th4nks to ~~!~, 8/1/86

WASHINGTON (AP) Cancer researchers have created a non-deadly version of the AIDS virus, raising hopes the mutant can be used to develop a treatment or vaccine for the always-fatal disease, according to a recent report. The laboratory-altered version wouldn't destroy the genuine AIDS virus that has killed more than 12,000 Americans but could compete with it in a victim's body, suggests the report by National Cancer Institute researchers in the August 8 edition of the journal Science. Thus, if an AIDS victim were given the altered version, it would go after the same immune-system cells the AIDS virus attacks, but with one crucial difference: It wouldn't kill them. And after those crucial cells were infected with the altered virus, the killing AIDS couldn't get in. Most of that, however, is still theory, and no human tests are even scheduled at the moment. Researchers still need to learn much more about other, possibly negative effects the altered virus might have on people, said one of the researchers, Flossie Wong­ Staal. Some researchers, including some at the National Cancer Institute, oppose even the general idea of putting the virus into people, she said. However, she added, "logistical problems" with such a tactic might seem less in light of the fact that infected people who might eventually be treated seem otherwise headed for sure death from AIDS. Animal tests could begin soon, she said in a telephone interview. At the very least, creation of the altered AIDS virus provides a heartening first indication the disease's deadliness and ability to spread "are not intrinsically coupled," the report said. Experimental treatments up to now have occasionally succeeded in slowing the spread of the virus or even stopping it for a time, but there has been little apparent progress toward reversing its effects and restoring the damaged immune system. Researchers also are continuing work aimed at developing a vaccine, which likely would contain some form of the AIDS virus. The advantage of basing it instead on the non-deadly mutant, if that could be done, would be in putting a layer of safety between the original virus and the person who would be getting the vaccine, she said. The altered version of the AIDS virs was created by removing pieces of a key gene during laboratory experiments, the Scie~ce report says. In addition to opening up a possible treatment avenue, the finding that virus replication and deadliness aren't necessarily linked also sheds new light on the overall base of AIDS knowledge. **************************************************

UGANDA SEXUALITY, AIDS STUDIED by Paul Raeburn, AP Science Editor, with thanks to ~~!~, 7/29/86 KAMPALA, Uganda (AP) Dr. Fred Kigozi may be the man who "writes the Kinsey report for Uganda." as one of his colleagues puts it. Kigozi, a psychiatrist and a member of Uganda's fledgling AIDS research team, has begun the first comprehensive study of the sexual habits of Ugandans, to try to understand how AIDS is spread. Almost nothing is known about the sexual behavior of Africans living in the AIDS belt that spans the continent. Because heterosexual activity is believed to be the primary means of AIDS transmission there. an understanding of sexual behavior is essential to any attempt to control the disease's spread. "Ugandans are sexually active," said Wilson Carswell, a surgeon at Mulago Hospital and a member of the AIDS research group. "Whether they are more sexually acti~e than Amerians and Europeans. I don't know. I would guess. not necessarily." Kigozi has so far conducted interviews with about 30 AIDS victims and 30 people without AIDS. He agreed to share preliminary findings if it was clear he was speaking on his behalf. not in any official capacity. Among the earliest findings, he said, is that "homosexuality; or anal or oral sex, does not exist," he said. Heterosexual promiscuity does seem to be a factor, however. "If you look at the number of partners, the victims have had more than twice as many as the controls," he said. Most AIDS patients are 20 to 30 years old, and most have families, he said. "People tend to pair up quite early on," he said. "They drop out of school at 17 or 18. In fact, it's interesting; there were more married couples in the AIDS group than in the controls." Prostitution has so far not emerged as an important means of transmission, Kigozi said. But, he added, "It's too early to conclude anything with great confidence. 'We're going on.' Carswell is expanding the testing for AIDS antibodies he originally began to map the extent of Uganda's epidemic. Carswell was part of a group that mounted a 36-hour field trip last summer to Masaka, about 80 miles southwest of Kampala near the Tanzanian border. Uganda's epidemic of AIDS or slim, as it's often called began there in 1982. "There were three physicians, two surgeons and a virologist, which isn'.t a great epidemiology task force," Carswell said. "It's very amateur .... Basically, I'm only a bush surgeon." Nevertheless, the amateurs accomplished a lot. They examined 71 patients aged 17 to 60 and found that in all slim had been transmitted heterosexually. They confirmed it was caused by the AIDS virus, as had been suspected·. . They also recorded a number of patients who had all the symptoms of slim but did not test positive to AIDS. These patients could be victims of a different strain of AIDS virus, or of anot~er virus altogether. This was particularly interesting in light of the discovery this year of a new AIDS virus by researchers at the Pasteur Institute in Paris. The virus, called LAV-II, was found in two residents· of· Guinea-Bissau, a small West African nation. The two patients, like some cf the Ugandans, had AIDS but no evidence of exposure to the original AIDS virus, designated LAV or HTLV­ III. ************************************************** ***** THE OFFICIAL NEWSLETTER OF THE NCGSTDS * VOLUME 7:5 * JUNE/JULY, 1986 * PAGE 49 ***** ************************************************************************************************************************ DAILY INTERFAITH WORLD-WIDE MOMENT OF MEDITATION with thanks to ~~!~< 7/31/86 A world-wide moment of prayer and meditation is being held for people with AIDS and AIDS related conditions for five minutes every day at 7pm (local time for your area). Allover the world, people are joining together in one spirit and one mind to end the AIDS crisi, each in their own way. We ask people of faith to pray; those who pra~tice meditation or visualization to meditate or visualize; for those who do metaphysical work to know the truth. We ask all people to take this moment to be of one spirit and of one humanity. The daily AIDS meditation &prayer is sponsored by the AIDS Interfaith Network and the Healing Project of San Francisco (415/552-3038). ************************************************** GENETICALLY ENGINEERED HEP B VACCINE EXPECTED IN JANUARY with thanks to !h~ ~!~h!Qg~~ ~l!~~, 7/25/86 The makers of Heptavax B, the currently available hepatitis B vaccine, announced that a new genetically engineered version of the vaccine will be available by January, 1987. Recombivax HB was developed by Merck, Sharp, &Dohme after the Pennsylvania-based company realized that many high-risk groups for hepatitis--sexually active gay men and hospital employees with frequent exposure to blood and blood products--were not taking the vaccine because they were afraid they could contract AIDS from the blood products used to make Heptavax. Many studies have demonstrated that the three purification steps used in producing Heptavax kills the AIDS virus. Recombivax is produced using yeast rather than blood plasma, and still require 3 vaccination injections at a cost of about $100. The vaccine represents the first genetically engineered vaccine approved by the Food &Drug Administration. [ED NOTE--Those of us working in health care settings know that the main reason for patients at high risk to not seek the hepatitis B vaccine is not fear of AIDS-­ but rather the relatively high cost that frequently is not reimburseable by insurance companies, the hassle of not only 3 separate visits over a 6 month time for the actual injections, but also the initial screening and post vaccine antibody tests, and the general feeling that 'hepatitis won't infect me--it's not a problem.' Let's remember this when we read reports in a year or two about Merck's disappointment that the new vaccine's sales are just as sluggish as the old. We told 'em so! See back issues of the Newsletter.] ************************************************** HEPATITIS &AIDS VACCINE DEVELOPMENT NEAR? with thanks to ~~!~, 8/1/86

PASADENA, Calif. (AP) Scientists have pinpointed the part of the hepatitis B virus that infects the liver, saying their discovery raises hope for possibly developing an AIDS vaccine. They say it also bolsters the chance of developing a cheaper, better hepatitis vaccine. A segment of a protein called "preS" on the surface coating of the hepatitis B virus was identified as the "binding site" that attaches the virus to the cells it attacks, much like a plug fits into a socket, the researchers reported in Friday's issue of the journal Cell. If the scientists also can locate the binding sites used by AIDS and other viruses to infect cells, it might be possible to develop vaccines against such diseases, said the New York Blood Center and the California Institute of Technology scientists. That's because the binding site remains almost constat among various strains of the same virus, providing an unchanging target for a vaccine. Other parts of the.virus' surface proteins can change, which is why some vaccines fail against new strains of a virus such as influenza. The researchers hope to create inexpensive proteins that mimic the binding sites of various viruses, including the one believed to cause acquired immune deficiency syndrome, said Blood Center virologist-biochemist A. Robert Neurath. The same team previously created a version of the preS protein, and showed it provoked the human body to produce antibodies against the real hepatitis virus. In February, they reported such antibodies actually destroyed the virus when tested in rabbits. They don't know yet if they can create a protein that mimics the binding site on the AIDS virus and could be used in an AIDS vaccine, Neurath said during a telephone interview. "It's a possibility that needs to be investigated," said Dr. James Maynard, chief of the hepatitis branch at the Centers for Disease Control. Even if a man-made protein could be created to mimic the plug on the AIDS virus, it isn't known if the protein would provoke creation of antibodies that really would prevent AIDS, he said in an interview from Atlanta. Maynard said a new hepatitis B vaccine based on the Blood Center-Caltech research probably would be cheaper, but not necessarily more effective than either the conventional vaccine or a genetically engineered version approved last week by the Food and Drug Administration. Those vaccines use a protein called "S" to induce immunity to hepatitis. Neurath contends a vaccine that also contains preS would be more effective. Maynard said that may prove correct, but remains controversial. The conventional, three-dose hepatitis vaccine is derived from infected human blood and costs more than $100. The version approved last week is made by altered yeast that produce part of the hepatitis virus to provoke tibodies. The vaccine's maker has said its price will be comparable to the existing vaccine. Neurath said a cheaper vaccine is needed because most of the world's 200 million hepatitis B carriers live in poor Asian and African nations. Hepatitis B, the most serious form of hepatitis, infects the liver ,and causes nausea, jaundice and abdominal pain. About 1 million of the carriers are in the United States, where the about 4,000 people die annually from hepatitis-related cirrhosis of the liver, 600 from hepatitis-related live~ cancer and 250 from severe infection. ************************************************** ***** PAGE 50·* THE OFFICIAL NEWSLETTER OF THE NCGSTDS * VOLUME 7:5 * JUNE/JULY, 1986 ***** ************************************************************************************************************************ TB SKIN TEST ADVISED WHEN ANTIBODY TEST IS POSITIVE with thanks to !n!!~n~l ~~!g!n! ~!!!, 5/1-1./86

Individuals with positive HTLV-III antibody tests should receive a tuberculin skin test, according to Dr. Arthur E. Pitchenik, of the University of Miami Medical School. Seropositive persons may be at high risk of developing T-cell immunosuppression, so those with positive tuberculin skin tests also may be likely to have and transmit tuberculosis. Isoniazid prophylaxis is indicated for those with positive TB skin tests. Tuberculosis is the only AIDS-related infection that spreads to healthy people by the aerosol route. Chmoprophylaxis is likely to be effective since the disease responds well to antibiotic treatment, even among people with AIDS, Pitchenik said. ************************************************** WASHINGTON ARCHBISHOP NAMES PRIEST AS LIAISON TO GAY COMMUNITY by Lou Chibbaro Jr., with thanks to !h! ~~~h!ng!Qn ~l~~!, 6/27/86 Washington, DC Archbishop James A. Hickey named Father John P. Gigrich, a local priest who frequently celebrates mass for gay Catholics, as the archdiocesan coordinator of ministry to persons with AIDS. Hickey, who heads the Catholic Archdiocese of Washington, DC, also named Gigrich as his special assistant for ministry to gay and lesbian Catholics. Gigrich is associate pastor of the District's St. Matthew's Cathedral, and will remain in that post while taking on his additional positions, according to the ~~!hQlig §!~n~~~~, the official publication of the Washington Archdiocese. Members of the Washington chapter of the gay Catholic group Dignity, said they were pleased with Gigrich's appointments, noting that he had been working unofficially as II minister to persons with AIDS and to gay Catholics for many years. Gigrich told the ~l~~! he has celebrated mass for the Washington Dignity periodically since the chapter formed in the early 1970s, and has counseled PWAs for the past three years as well as officiating at funerals for PWAs. Gigrich said he has also served as a 'pastoral volunteer' for the Whitman-Walker Clinic and is a member of the board of directors of the Clinic's Schwartz Housing Services, which provides housing to persons with AIDS in need of shelter. In addition, he has headed a support group for PWAs. ************************************************** CHRONIC HEPATITIS B CARRIERS NEEDED FOR PLASMAPHERESIS with thanks to Chicago's ~in~~ ~!!~ !i~!~, 5/15/86

As part of its ongoing program to help stop the spread of hepatitis B, Chicago's Howard Brown Memorial Clinic announced it is seeking plasma donors to aid in production of the hepatitis B vaccine. The process, known as plasmapheresis, is similar to donating blood and takes about two hours. Suitable donors will be paid $50 for each donation. Anyone who has chronic hepatitis B, or is currently recovering from the infection, may qualify as a donor. 'Not only will the donor be paid for his time, he will also be helping HBMC, which receives medical supplies each time he donates. These materials help the clinic in testing and prevention o.f hepatitis,' said Norman Altman, HBMC research director. 'With all the current publicity about AIDS, many people have forgotten about the dangers of hepatitis B,' Altman said. 'But hepatitis B, which can be prevented, is still a major health concern in the gay community. Although hepatitiS B infection appears mild at times and is often undetected, the health consequences can be devastating.' The clinic offers screening during regular hours for hepatitis B, as well as low-cost vaccination which provides immunity to the hepatitis B virus. For more information about the plasma donation program or hepatitis B screening and vaccination contact the Clinic: 312/871-5777. ************************************************** COSMETICS TO COVER KAPOSI'S LESIONS with thanks to e!Q~l! ~i!h ~!Q§ ~~~~!! from Shanti Project and the San Francisco AIDS Foundation, July, 1986

Debra Povanzano, professional cosmetologist, is introducing cosmetics which she claims can cover up Kaposi's sarcoma lesions! Povanzano has done make-up and hair for television artists appearing on 'As The World Turns' and 'The Guiding Light.' She has been nominated for an Emmy Award in the 1986 Daytime Emmy Awards competition. Povanzano would like to contact anyone interested in exploring her products. Although her studio is in New York, you may direct inquiries to her associate in San Francisco, Morgan Manning (415/864-0709). ************************************************** PERSONAL SAFE SEX SAMPLER KIT DEVELOPED BY EXODUS TRUST

The Personal Safe Sex Sampler Kit was developed to help in the prevention of AIDS and other sexually transmitted diseases. The kit can be used by health educators to explain safe sex practices in a positive and non-threatening manner. It contains a generous sample which has a laboratory-proven safety record of effectiveness in killing the AIDS virus. The kit is accompanied by a sex education brochure of risk reduction guidelines and ways to enjoy t'hesafe sex products. The kit contains: several brands of lubricant and rubber sheaths (several brands of condoms, iatex gloves, etc.) and other materials. All products in the kit were tested by the AIDS Research Department Clf The ,Institute for Advanced Study of Human Sexuality in San Francisco, and all items bear the Institute's Safe Sex Seal of Recommendation. The kit is packaged and distributed by Trimensa Corporation. For more information, contact: The Exodus Trust, 1523 Frankli, St., San Francisco, CA 94109 (415/928-1133). ************************************************** ***** THE OFFICIAL NEWSLETTER OF THE NCGSTDS * VOLUME 7:5 * JUNE/JULY, 1986 * PAGE 51 ***** ************************************************************************************************************************ , KAPOSI'S (ONCE AGAIN) LINKED TO POPPERS with thanks to Chicago's ~in~Y ~i!Y Ii!!!, 7/17/86 The incidence of Kaposi's sarcoma (KS) in cases of AIDS has dropped from 34% in 1981 to 14% today, and CDC researchers are beginning to speculate that the reason why is a decline in the use of amyl and butyl nitrites, or 'poppers,' reports ~~ ~~~~~Q!~ The incidence of KS in non-gays with AIDS is less than,S'. ************************************************** TOURING AIDS EXHIBITION Response to the AIDS crisis inside gay/lesbian communities has been swift and largely positive: support groups, fund­ raising efforts, safe-sex campaigns, public education programs, hospices and more, have' been founded and funded. All of these organized responses have employed the visual and media arts as part of their educational and funding campaigns. The AIDS Show exhibition, is' testimony to these community and individual responses to the crisis as reflected in p~;ter;:-pa;phiets, video, film, etc. The exhibition will be organized to reflect the two directions from which AIDS image-making primarily comes: community organizations and individual artists. The exhibition will be sponsored by and open at The Ohio State University Gallery of fine Art in Columbus. The show will open during National Gay Pride Week in June, 1987, and will afterward tour in two different versions--one for gallery and museum exhibition spaces; a second in simplified format for exhibition by community organizations. The proposed catalogue will include an introduction by curator Jan Z. Grover, an essay by British critic Simon Watney, and statements from representatives of gay rights-AIDS care organizations.' The Ohio State University Gallery exhibition will be accompanied by a number of COMMunity-generated panels, workshops, and events on AIDS-related graphics/publishing and AIDS health issues. Graphics, film, video, photographs, fliers, posters, brochures, illustrations, PSAs by community organizations an individual artists responding to the AIDS crisis are needed for this touring exhibition and catalogue. Contact: J.Z. Grover, c/o The Ohio State University Gallery of Fine Art, 128 North Oval Mall, Columbus, OH 43210, 614/422-0330. Send slides or VHS tapes with background information/resume before November 3D, 1986. For more information about THE AIDS SHOW, contact Nancy Robinson, Public Programs Coordinator, at the above address and phone. ************************************************** TEXAS APPROVES NATION'S FIRST AIDS CENTER by Craig C. McDaniel, with thanks to the ~~ !Q~~ ~!!j~!, 6/30/86

A Houston hospital will be converted into the nation's first AIDS research and treatment facility. under a plan approved June 6 in Austin by the University of Texas System Board of Regents. The board agreed to allow state college medical faculty to work with American Medical International, Inc. (AMI), to establish the Institute for Imauno1ogical Disorders in one of AMI's 11 Houston-area hospitals. Some health officials and Houston gay leaders have attacked or expressed reservations about the idea, saying such a facility could become a 'leper colony' or make it harder for indigent AIDS patients to get care. AMI describes the lSD-bed facility as a 'free-standing in-patient hospital dedicated to research to research and treatment of immunological and infectious diseases, with initial focus on AIDS>' The agreement permits staff members at the University of Texas (UT) Health Science Center and UT System Cancer Center (M.D. Anderson Hp~pital and Tumor Institute) to direct medical and research activities for the new center. AMI agreed to convert Citizens General Hospital to the AIDS Institute. Conversion is expected to be finished in 'several weeks.' 'The UT System is pleased needed, not only in Houston but in the entire state of Texas,' said Dr. Charles B. Mullins, a university vice chancellor. 'Our faculty physicians are excited about using their expertise in conjunction with AMI and putting a halt to this medical dilemma. We hope the research that evolves out of this project will have worldwide importance.' Critics of the plan include Dr. James Haughton, director of Houston's Health and Human Services Department. He had said that providing a place in which AIDS patients can be segregated will make it appear the patients should be segregated. 'I don't see the need for it,' he said. Gay leaders agree, but say privately that Haughton's warning is ironic, especially after he supported an unsuccessful attempt by state health officials to add AIDS to the quarantine list. Houston AIDS patients, mostly homosexuals, who have cancer (such as Kaposi's sarcoma) have been treated without charge at wofld-reknowned M.D. Anderson, a state-run hospital that must, by law, treat any Texas resident who has cancer. AIDS patients unable to pay for other medical care had relied on M.D. Anderson hospital for their treatment. Leaders of the AIDS Foundation of Houston worry that these patients may be barred from the University of Texas hospital and forced to the for-profit AMI Institute. 'We do have some ongoing concerns,'said Curtis Dickenson, executive director of the AIDS Foundation. 'There is the appearance that Texas and M.D. Anderson are beginning to withdraw from AIDS activities. If they are going to continue treating AIDS patients with cancer, that's great.' Houston lawyer Donald L. Skipworth, chairman of the foundation's board, said, 'I don't like the idea of an AIDS-only hospital. AMls a for-profit organization. They're not going to be interested in providing for the indigent.' University hospital officials deny those charges, saying AMI would provide care for those who cannot afford the huge costs of treating AIDS 'to the extent of their ability.' Another concern about the AMI facility is its distance from the inner city, where most AIDS victims live, The AIDS hospital will be about ten miles north of downtown Houston. Skipworth said in a telephone interview that his organization and the gay community are giving the plan the benefit of the doubt. 'We have to look at the alternatives,' he said, citing recent rejections of funding for AIDS counseling programs in Houston and the state Health Department's efforts to have AIDS added to a list of quarantinable diseases. 'We are in the state of Texas and Texas is not a good place to be sick.' --- ************************************************** k*** PAGE 52 * THE OFFICIAL NEWSLETTER OF THE NCGSTDS * VOLUME 7:5 * JUNE/JULY. 1986 ***** <**********************************************************************************************************************

LESBIANS SUFFER FROM AIDS BIAS with thanks to !h! ~~!~!~g~~ §l~~!. 6/6/86

Even though lesbians are considered perhaps the group at lowest risk of contracting AIDS. they are in a high risk group for suffering from the increased discrimination that has emerged from the epidemic. according to speakers at a recent forum in the District. Nancy Polikoff. staff attorney for the Women's Legal Defense Fund and one of the speakers at the forum. 'AIDS: Its Impact on Us as Women.' said that some lesbian mothers. in court battles over custody or visitation rights. have found judges prepared to consider all homosexuals--male and female--at risk of transmitting and contacting the disease. In one case. she said. a Judge of the West Virginia Supreme Court was asked whether a lesbian should be considered as 'unfit' to parent her child. 'We don't have much of that around here.' Polikoff said the judge replied. But. said Polikoff. the Judge added that if a lesbian were before him in a custody case. he would have to give closer scrutiny to the matter because of the AIDS epidemic. 'We are becoming homophobic within our own community.' said Colevia Carter. community relations specialist with the DC Dept. of Corrections and the DC Human Rights Commission. She believes that lesbians tend to discriminate against our gay brothers. ************************************************** PRISONERS WITH AIDS IN NEW JERSEY MOVED INTO SEPARATE UNIT with thanks to the ~!! yg~~ ~~!!Y!. 5/19/86

Prisoners with AIDS have been placed in a separate unit of the Trenton State Prison as of April 15. There are 23 known cases of AIDS in the prison. The 14 PWAs moved into the unit were chosen because they do not require acute medical attention. James Stabile. a spokesperson for the New Jersey Department of Corrections. said the prisoners were moved mainly due to security. rather than for medical reasons. because. 'The other inmates don't want to be near them.' The PWAs are allowed to cook for themselves and have greater mobility than the other prisoners. When their conditions worsen. they will be moved into a hospital unit in the prison. reports James Roberts in Au Courant. ************************************************** ------SANITATION WORKERS IN NYC DUMP ON CO-WORKER WITH AIDS with thanks to !~ ~~!~!~g~~ §l!~!. 6/27/86 Forty New York City sanitation workers protested the return of a co-worker with AIDS by locking the entrance of their Harlem district garage with garbage trucks and refusing to work. The city responded to the walk-out by suspending them for the day. docking each about $115 in pay. according to a sanitation department spokesperson. When sanitation worker Levy Wallace. 34. of Brooklyn. who was out sick since December and on light duty since mid-March. had his first day back at his old job. 18 garbage truck workers called in sick. Wallace. described by department spokesperson Al O'Leary as ' hard worker' and 'pleasant.' voluntarily transferred to an office job. 'He was very concerned about causing problems for his co-workers.' O'Leary told the ~l!~!. 'He wanted things to go well.' Mayor Ed Koch emphasized after the incident that city workers with AIDS would be protected from discrimination. Sanitation Commissioner Brendan Sexton said the department would have stood by Wallace if he wanted to keep his truck job. which pays about $20 more per shift. The walk-out left about 150 tons of garbage on East Harlem's streets. ************************************************** BITTEN DEPUTY CHARGES ATTEMPTED MURDER by Stephanie Poggi'. with thanks to Boston's ,§!~ 2~!:!i!~ ~!!!. 6/7/86

A Fort Lauderdale. Florida prisoner with AIDS has been charged with attempted murder after officials said he bit a sheriff's deputy on the finger. according to the Boston ~lQ~!. Deputies at the Broward County Jail said Kelly Dobbins. 26 threatened and then bit deputy Harold Bennett. May 23. There are no known cases of persons contracting AIDS by being bitten. ************************************************** DOCTOR WITH AIDS FIRED IN DISTRICT with thanks to e~11!~!1~h!~ §~~ ~!!!. and !h! §~1~1!g~! §!~ e~~!~. July. 1986

A suburban Washington. DC physician was fired from the clinic where he had worked for two and a half years because he has AIDS. even though public health authorities say medical personnel with the disease pose no threat to their patients. The doctor. who requested that his name not be revealed. was diagnosed with AIDS early this year while undergoing treatment in the Fairfax. Virginia hospital. After his release, he notified Primary Care Associates, operators of two clinics int he area, that he would be able to return to work in February. but they told him he was not welcome. The hospital had told his employers the nature of his illness. The doctor has filed suit in US District Court in Alexandria against Primary Care Associates. Jim Graham, director of the area's Whitman-Walker Clinic, expressed surprise at the firing. 'You would like to believe that of all people doctors would understand that AIDS is not casually tran~mitted.' ************************************************** ***** THE OFFICIAL NEWSLETTER OF THE NCGSTDS * VOLUME 7:5 * JUNE/JULY, 1986 * PAGE 53 ***** ****************************************************************************************************f*******************

SCHOOLS SHOULD INCLUDE AIDS EDUCATION with thanks to Detroit's g~Yi!!, 7/2/86

Schools shouldn't fire teachers with AIDS or dismiss students with the virus, a report released advises. What they should do ~s include AIDS education in the curriculum 'to educate and stop the spread of this horrendous disease,' says Roberta Welner, executive editor of A!Q§~ !m~~£~ Q~ ~h! §£hQQ1!~ Weiner, who interviewed 100 people knowledgeable about AIDS, hopes the report will serve as a guide for school districts faced with an AIDS dilemma. The book sells for $65 and can be ordered from Capitol Publications, Circulation Dept., 1300 N. 17th St., PO Box 9672, Arlington, VA 22209. ************************************************** CHICAGO CITYWIDE COMPREHENSIVE AIDS PREVENTION EDUCATION PROGRAM (CAPEP)

The Chicago Citywide Comprehensive AIDS Prevention Education Program (CAPEP) is a new program designed to help eliminate not only the spread but also the fear of AIDS, and is designed to begin operations September 1, 1986. A variety of positions in health education and management will be posted shortly, requiring experience or backgrounds in public health, AIDS education, program administration and related areas, should send a curriculum vitae to: David Ostrow, MD, PhD, CAPEP Office, Chicago Department of Health, Room 233, Daley Center, Chicago, IL 60602. CAPEP will be sponsoring a logo contest for the 'agency. Inquiries may be addressed to the above address. ************************************************** GUIDE TO ILLNESS AND HEALTH: STEVEN JAMES' TOTALLY SUBJECTIVE, NON-SCIENTIFIC TEN STEP GUIDE by Steven JaMS, with thanks to the ~~ gQ!l!H~ ~!!!l!~!, June/July, 1986 tlQ~ !Q @!~ §!£~~ 1) Don't pay attention to your body. Eat plenty of junk food, drink too much, take drugs, have lots of unsafe sex with lots of different partners--and, above all, f!!l g~!l~~ ~~QY~ !~. If you are over-stressed and tired, ignore it and keep pushing yourself. 2) Cultivate the experience of your life as meaningless and of little value. 3) Do the things you don't like, and avoid doing what you really want. Follow everyone else's opinion and advice, while seeing yourself as miserable and 'stuck.' 4) Be resentful and hyper-critical, especially towards yourself. 5) Fill your mind with dreadful pictures, and then obsess over them. Worry most, if not all, of the time. 6) Avoid deep, lasting, intimate relationships. 7) Blame other people for all your problems. 8) Do not express your feelings and views openly and honestly. Other people wouldn't appreciate it. If at all possible, do not even know what your feelings are. 9) Shun anything that resembles a sense of humor. Life is no laughing matter! 10) Avoid making any changes which would bring you greater satisfaction and joy. tlQ~ !Q @!~ §i£t!~ iIf YQ~:~! ~l~!~g~ §i£~l~ 1) Think about all the awful things that could happen to you. Dwell upon negative, fearful images. 2) Be depressed, self-pitying, envious, and angry. Blame everyone and everything for your illness. 3) Read articles, books, and newspapers, watch TV programs, and listen to people who reinforce the viewr~int that there is ~Q tlQ~~. You are powerless to influence your fate. 4) Cut yourself off from other people. Regard yourself as a parish. Lock yourself up in your room and contemplate death. 5) Hate yourself for having destroyed your life. Blame yourself mercilessly and incessantly. 6) Go to see lots of different doctors. Run from one to another, spend half your time in waiting rooms, get lots of conflicting opinion and lots of experimental drugs, starting one program after another without sticking to any. 7) Quit your' job, stop work on any projects, give up all activities that bring you a sense of purpose and fun. See your life as essentially pointless, and at an end. 8) Complain about your symptoms, and if you associate with anyone, do so exclusively with other people who are unhappy and embittered. Reinforce each other's feelings of hopelessness. 9) Don't take care of yourself. What's the use? Try to get other people to do it for you, and then resent them for not ding a good job. 10) Think how awful life is, and how you might as well be dead. But make sure you are absolutely terrified of death, just to increase the pain. tlQ~ !Q §~~~ ~!ll iQ~ @!~ ~!~~!~L If YQ~:~! ~Q~ §Q ~!ll 1Q ~!gi~ ~i~hl~ 1) Do things that bring you a sense of fulfillment, joy, and purpose, that validate your worth. See your life as your own creation, and strive to make it a position one. 2) Pay close and loving attention to yourself, tuning in to your needs on all levels. Take care of yourself, nourishing, supporting, and encouraging yourself. 3) Release all negative emotions--resentment, envy, fear, sadness, anger. Express your feelings appropriately; don't hold onto them. Forgive yourself. 4) Hold positive images and goals in your mind, pictures of what you truly want in your life. When fearful images arise, re-focus on images that evoke feelings of peace and joy. 5) Love yourself, and love everyone else. Make loving the purpose and primary expression in your life. 6) Create fun, lOVing, honest relationships, allowing for the expression and fulfillment of needs for intimacy and security. Try to heal any wounds in past relationships, as with old lovers, and mother and father. 7) Make a positiVe contribution to your community, through some form of work or service that you value and enjoy. 8) Make a commitment to health and well-being, and develop a belief in the possibility of total health. Develop your own healing program, drawing on the support and advice of experts without becoming enslaved to them. 9) Accepting yourself and everything in your life as an opportunity for growth and learning. Be grateful. When you fuck up, forgive yourself, learn what you can from the experience, and then move on. 10) Keep a sense of humor. ************************************************** ***** PAGE 54 * THE OFFICIAL NEWSLETTER OF THE'NCGSTDS * VOLUME 7:5 * JUNE/JULY, 1986 ***** ************************************************************************************************************************ CALIFORlUA 8OVERIOR CUTS 40' FROM AIDS ASSISTANCE with thinks to Chicago', !i~~ ~i!~ Ii!!!, 7/17/86

California Governor George Deukmejian slashed the 1986-87 state AIDS budget by 40\, reducing expenditures towards the worst health crisis to face the state in history to $28.8 million. The governor's action repeated a similar slashing veto of the past year. Most severely cut were programs in support of persons with AIDS and ARC, closely followed by education and prevention programs, reports the ~!~ ~r!! B!P9r~!r. ************************************************** LAW STUDENT SUES NBC-TV FOR ERROR IN AIDS STORY with thanks to Miaai's !h! !!!~l~ ~!!!, and !h! §!l!i!Q~! §!~ e!2!~' July, 1986 A Yale law school student who claims NBC television incorrectly minimized the danger AIDS presented to heterosexuals has filed a federal lawsuit against the network. Arvind Shankar is seeking a retraction of the story, or equal time to present his side, and unspecified punitive damages to be donated to AIDS research. The suit involved ,a January 21 newscast anchored by Tom Brokaw, that said a woman with a steady sexual partner, who was not in any high-risk group, was .ore likely to die in a car accident or be murdered than to get AIDS. Not so, says Shankar. He said a non-promiscuous heterosexual woman's chances of getting AIDS in New York City or San Francisco are 'pretty similar to a soldier's chance of dying in World War I.' Shankar, a California doctor studying at Yale, said a woman's actual chances of contracting AIDS are close to one in 400, rather than one in a million as NBC allegedly reported. ************************************************** POLICE IN SAN DIEGO FORCE GAY MAN TO BE ANTIBODY TESTED by Jim Fauntleroy, with thanks to Boston's §!~ ~~~!!~ ~!!!, 7/20/26/86

In an apparent violation of California state law, a gay man was forced to submit to an HTLV-III blood test after being arrested at the Gay Pride Parade, according to the ~~~2£!~!. ~rian Barlow was arrested during a confrontation between parade participants and a group of fundamentalists. Police allege that Barlow bit two of the officers during the scuffle. Barlow refused to submit to a test at a nearby hospital, but claims that he was later forced to do so at the San Diego jail. Barlow has sued the department for violating California state law which forbids any such test being made mandatory and which requires that the results from the test be kept confidential. ************************************************** KENNEDY CENTER SHUNS 'NORMAL HEART' by Barry Adkins, with thanks to the ~!! !2~~ ~!!!~!, 7/21/86

A deal between the producers of Larry Kramer's blockbuster play about AIDS, Ib! ~2~m!1 tl!!~~, and the Kennedy Center in Washington, DC fell through as a result of the recent Supreme Court ruling upholding sodomy laws in Georgia. Kramer told the ~!1!~! that Roger Stevens, head of the Kennedy Center, had made a 'verba1 agreement' with producers Michael Frazier and Randy Johnson to produce the show at the center this fall. On June 30, the day of the high court's ruling, however, Kramer said Frazier received a call from Stevens calling the show off. Kramer stated that Stevens did not feel the Board of Trustees of the center would approve the play's production in light of the ruling. Concurring with Kramer, Johnson, the man who produced the play in Los Angeles starring actor Richard Dreyfus, said the decision was 'a combination of the Supreme Court ruling, ReaganomiCS, and homophobia.' Johnson said that conservatism in the nation's capital colored the decision. '1 think they're scared of the subject. They're afraid to let people see what the government is doing to suppress gay rights and th~ issue of AIDS,' he said. Alan Wasser, general manager of theater at the Kennedy, said that it was 'very unlikely' the Supreme Court ruling had any affect on the decision. Wasser explained that Stevens makes all of the decisions regarding artistic productions at the center, and to his knowledge, Stevens does not normally consult with the Board of Trustees on such matters. Wasser said he met with Stevens on June 14 where a list of potential productions was presented. Half of the plays were cut, including The Normal Heart. 'It was my sense that it wasn't a very good script,' he said. Kramer reported that his play has 'brok;~ -;;;;y -b~;- office record in London's Royal Court' where Martin Sheen is starring in the play. Sheen had agreed to do the Kennedy Center production, Johnson said. '1 want the show to play in Washington,' Johnson said. 'It's played in every major city, except there.' Ib! ~2~!!1 tl!!~1 was the longest running show at New York City's Public Theater. ************************************************** LAS VEGAS AIDS PHOTO 10 CARD REJECTED with thanks to the ~!! !gr~ ~!1!Y!, 5/19/86

The Clark County Health Department has proposed that photo identification cards be issued on a voluntary basis to anyone who has submitted to the ELISA test for antibodies to HTLV-III, the so-called 'AIDS virus,' and tested negative. The plan was proposed by Dr. Otto Ravenho1t, chief of the health department. The cards would be issued at a cost of $20 each and expire after 30 days. Wes Davis, president of the Las Vegas ~id for AIDS of Nevada, attacked.the proposal, citing the fact that the ELISA test is not diagnostic. Davis called the idea 'counterproductive,' and ~aid the only benefits would come to the health deDartment, 'because they will get $20 every 30 days,' reports the §gb!ID1!D §ygl!. The ~!11Y! was told by the Clark County Health Dept. that the proposal was rejected April 24th by the Clark County Board of Health. • ************************************************** ***** THE OFFICIAL NEWSLETTER OF THE NCGSTDS * VOLUME 7:5 * JUNE/JULY, 1986 * PAGE 55 ***** ************************************************************************************************************************ CALIFORNIA TO VOTE ON LAROUCHE AIDS QUARANTINE by Jim Kiely, with thanks to Boston's §~~ ~~n!~~ ~!!!, 7/6-12/86

California state .officials confirmed that followers of Lyndon LaRouche have gathered enough signatures to place an initiative on the November ballot that could lead to the quarantine of people with AIDS. Earlier, the office of the Secretary of State had announced the signatures did not pass an initial verification An initiative requires .393,000 signatures to become a ballot item. Gay and lesbian activists in the state, who began organizing three months ago when it became clear the LaRouche camp was making progress, are geared up for battle. 'We have a major educational campaign ahead of us,' said Paul Boneberg, of the San Francisco-based Mobilization Against AIDS. Boneberg added, 'If the vote were held today, [the initiative] would probably pass.' The initiative calls .on the state department of health to consider AIDS a communicable, infectious disease and to enforce the state health and safety code that applies to such diseases. According to Doug Warren, a lawyer with the California American Civil Liberties Union, that translates the initiative into a call for quarantine. 'Already people with typhoid and other communicable diseases can legally be placed under house arrest by the board of health. With the passing of this initiative, it could also happen to people with AIDS.' While most lesbian and gay activists here appear to agree with Warren, some activists and lawyers do not believe quarantine would result if the initiative passed. Anne Jenning, a lesbian activist and a lawyer with the California State Attorney General's office, said the initiative would change nothing. She said AIDS is already considered an infectious disease by the state board of health, but that health officials have not chosen to quarantine individuals. 'AIDS is not typhoid. The means of transmitting HTLV-III are extremely limited,' said Jenning. In addition to advocating quarantine, the initiative could pave the way for mandatory testing of people suspected of having AIDS and for dismissal of any 'carrier of the disease' from public health Jobs and employment in the food industry. The wording of the initiative fails to explain the term, 'carrier,' drawing no distinction between a person with AIDS and a person who has tested positive for the AIDS virus. The meaning of 'carrier' 'can only be left to the imagination,' said Warren. However the initiative would be used, gay and lesbian activists are wasting no time organizing a statewide campaign to defeat it. According to Boneberg, Mobilization Against AIDS has already conducted numerous meetings across the state, out of which the California AIDS Network (CAN) has emerged. CAN is a political and health committee which hopes to attract thousands of people in the fight against the initiative. The official title of the LaRouche group promoting the quarantine measure is PANIC (Prevent AIDS Now Initiative Committee) .. With offices in San Francisco and Los Angeles, PANIC serves as clearinghouse for initiative materials and volunteers. No officials of PANIC were available for comment to §~~. **************************************************

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Project Inform, a San Francisco based AIDS Issues and Research Foundation, has confirmed that the price of the anti­ viral 'drug Ribavirin has been tripled by the manufacturer, ICN Pharmaceuticals in Costa Mesa, California. The price went from $6.95 'to 20.50 for a box of 12 capsules of ribavirin, which is thought to be helpful against AIDS and ARC and is beCOMing MOre acceptable both among medical workers and among patients, and is thought to be legally used by between 3-10,000 Americans under the supervision of their doctors. Ribavirin is presently one of the few available treatments for AIDS and ARC patients which has substantial credibility among medical researchers, and although not yet licensed in the US, the FDA permits importation of the drug from Mexico and other countries for use by individual patients. This extreme price increase appears to be the first instance in the public forum of profiteering in the AIDS epidemic. Since the drug is not licensed by the FDA, its cost is not covered by insurance plans. The cost for treatment with the drug is now about $300 per month, which most patients must use indefinitely in combination with at least one other drug. ICN is currently beginning eight clinical trials of ribavirin in a $10 million joint venture with Eastman Kodak of Rochester, New York, ************************************************** SALIVA TEST MAY PROVE RELIABLE FOR SCREENING with thanks to !n~!~n!l ~!~!n! ~~, 5/1-1(/86

Testing saliva for the presence of antibodies to the AIDS virus may provide a reliable way to screen for exposure to the virus, according to David W. Archibald, DMD. of Harvard's School of Public Health. The possibility of developing such a test after Archibald and associates showed that antibodies to the AIDS virus were present in the saliva of people exposed to the virus. The finding helps explain why saliva does not appear to be very infectious in the transmission of AIDS. Despite earlier studies that detected the virus in saliva. there are no reported cases of AIDS being passed on through the saliva. This may be due to saliva containing a low goncentration of virus, or that antibodies in saliva bind to the virus and inactivate it. In a recent study, except for/people with AIDS, everyone who was seropositive for HTLV­ III antibody .also had detectable salivary antibodies to the virus. The low antibody concentrations usually found in saliva may be reduced in PWAs as a result of their immunodeficient state. It now is 'theoretically possible' that the saliva could be used generally as a test for infection to the AIDS virus. ************************************************** WASHINGTON, DC OPENS UH FACILITY FOR PWAs with thanks to !h!~!!n !!l~!~ ~l!n!~ A!Q§ f~gg~!~, June 1986 The J. Charles Gilbertson House as the fourth facility of the Schwartz Housing Services of Washington, DC's Whitman­ Walker Clinic, and is the first apartment building for PWAs. The facility has five one bedroom and efficiency apartments. The addition of the facility will enable' the housing service to respond to a variety of persons with special needs. Current residents of the Gilbertson House include couples, families, and infants. The four houses, which can accommodate up to 24 places, are now filled to capacity. A fifth house is planned for opening in the summer. ************************************************** BILLBOARD FUNDRAISING PROJECT SUCCESSFUL IN LOS ANGELES with thanks to the ~!! yg~~ ~!~!Y!' 6/2/86 AIDS Project/Los Angeles (APLA) unveiled a 15 x 48 foot billboard listing the names of the 20 people who helped raise $10,000 for APLA. The unveiling is part of Projec~ Billboard, started by Dean Doser of Gannett Outdoor Co., along with Richard Gross and Bill Rampelt in September, 1985. Doser and Gross encouraged donors by telling them their names would appear in the advertisement. Gannett Inc., donated the billboard. The money was presented to APLA executive director Paula Van Ness. For more information about the project, call 213/271-2627. ************************************************** UNITED WAY SHORT CHANGES SAN FRANCISCO AIDS • GAY SERVICE AGENCIES with thanks to !h! !!!h!ng~2n @l!~!, 6/13/86 The United Way chapter in the Bay Area collected $41 million during 1985, but distributed less than 2% of those funds to gay or AIDS-service related organizations. That's not fair, say some activists, and they're meeting with United ~ay officials to press for an increase. The ~!~ ~~!! 8!~g~~!~ quoted one activist, businessman Arthur la~ere: as sugge~t~ng that 'at least 10%' of the $41 million raised 'are gay dollars,' and criticized United Way for havlng no recognltl0n that there is a health crisis in our community.' Currently, only two gay organizations are 'member agencies' of the Bay area United Way and, thus, eligible to receive an annual allocation from the money raised. Ten other gay organizat~ons have been designated as 'special needs' groups, and receive funding even though they are not official member ~gencles. Those 12 groups received $338,991 from United Way this year. Another $279,689 went to gay groups through Unl:ed Way from donors who earmarked their contributions to those specific groups,. Tim Dayonot, a spokesman for .. the Unlted Way chapter, said the charity cannot dispense funds according to the percentage of. population each needy group comprises, but said 'ongoing meetings' are taking place with gay leaders to work on a solution. ************************************************** ***** THE OFFICIAL NEWSLETTER OF THE NCGSTDS * VOLUME 7:5 * JUNE/JULY, 1986 * PAGE 57 ***** ************************************************************************************************************************ , BATHHOUSES SUED BY LOS ANGELES COUNTY HEALTH DEPARTMENT by John A. Fall, with thanks to the !!! YQ~~ !!~i!!, 7/21/86 The Los Angeles County Department of Health Services took its alleged war against AIDS one step further May 28 by filing suit against four local bathhouses, claiming the establishments have not observed the county's siX-MOnth-old bathhouse regulations, which among other things, requires bathhouses to hire "monitors· for every 20 patrons to detect the occurrence of any proscribed sexual activities. The owners of the Meatrack, the Compound, the Midtowne Spa, and the Melrose Baths are accused in the suit of maintaining or permitting to be maintained ·conditions which facilitate and encourage high risk sexual activities by patrons. Said activities contribute to the spread of the AIDS virus and constitute a pubic health menace.· High risk sex includes anal intercourse or fel"atio with or without a condom, and oral-anal contact. Bathhouses must ensure that monitors remove patrons observed to engage in high risk activities, and a daily log of the names of those patrons removed must be maintained. Lighting and structures, such as walls and doors, must not impede the observations of monitors. Melrose Bath owner Marty Benson said ·the nUMber one thing that has brought respect to the gay community is the right to have adult consensual sex, [and] that right is being taken away by the health department. I don't see them asking the Sheraton Hotel to do what they are asking me to do.· ************************************************** NAVY COURTMARTIALS AND EXPELS SAILOR by Lou Chibbaro Jr •• with thanks to !b! !!!b!ng~~ @!!~!. 6/27/86 Asailor who was court-martialed at a Virginia Beach naval base for refusing to take the HTLV-III antibody test told a military judge he began receiving telephone death threats shortly after he informed his commanding officer of his decision not to take the test. Petty Officer Second Class Phillip J. Nolan, 25, was sentenced at the June 23 court­ martial proceeding to 45 days in the brig at the Navy's Atlantic fleet headquarters in Norfolk, Virginia. In addition, Capt. Daniel J. Zemniak, serving as military judge, lowered Nolan's rank to that of E-1, the lowest rank for an enlisted person, and gave Nolan a bad conduct discharge. Nolan had been charged with one count of disobeying an order, for refusing to have his blood tested for HTLV-III (HIV) antibody, and one count of failing to deploy with his ship. Nolan told the court-martial that he did not board his ship, the aircraft carrier John F. Kennedy on May 6 because he received several anonymous telephone calls indicating his life would be endangered if he sailed with the ship. Nolan also testified that he received ·threats· from the ship's captain, Commander Alan M. Gemmill, who denied making such threats. Gemmill testified that he was ·stern· with Nolan concerning Nolan's refusal to be tested, but that he never threatened Nolan. Gemmill also testified that he reassured Nolan that he would be safe onboard the ship. Nolan's court-appointed military attorney told the court-martial proceeding that the test violated his client's constitutional right to privacy and amounted to an illegal ·search and seizure.· But Navy prosecutors said the test was ·medically necessary· to protect the health of all military personnel. Navy officials said Nolan is the first known member of the military to refuse to be tested since the test was made mandatory for all 2.2 million members of the US armed services. Navy spokesperson Mickie Jakubec said no questions were raised at the court-martial about Nolan's sexual orientation. The decision is expected to be appealed. ************************************************** CONGRESSIONAL RIGHT-WING FANATICS NOVE TO STOP DC INSURANCE MEASURE by Lou Chibbaro Jr. with thanks to !h! !!!b!ng~~ @!!~!, 6/20/86 Republican Representative William Dannemeyer (California) and Republican Senator Jesse Helms (North Carolina) announced that they plan to introduce resolutions in the House and· Senate to veto a D.C. City Council approved bill that prohibits insurance companies from denying coverage to persons who test positive for the AIDS antibody. At a press conference on Capitol Hill, Dannemeyer, leaders of the New Right Christian groups, and the Rev. Cleveland Sparrow, the head of the DC Chapter of the Moral Majority, said the City Council insurance bill sets a dangerous precedent by providing ·special privileges· to gay men and others at risk of contracting AIDS. ·Drug addicts, prostitutes of all kinds, and homosexuals will flock to DC to get health insurance they can't get elsewhere,· Sparrow told the press conference. ·Our children will be at risk,· Sparrow continued, adding. ·the resident and the tourist will risk concentrated exposure to this hideous disease.· Under the District's home rule charter, Congress may veto bills passed by the City Council if both the House and Senate approve a ·resolution of disapproval· by simple majority votes, and if the President signs the resolution. The insurance bill forbids health, life, or disability insurers from denying, canceling, or refusing to renew insurance coverage because a person has tested positive for the [HIV] antibody or because the individual tests positive on any other test for the 'probable causative agent' for AIDS. A spokeswoman for the industry's two leading trade groups--the American Council of Life Insurance and the Health Insurance Association of America--said the groups declined invitations by Dannemeyer to join in the effort to seek a Congressional veto of the Ray bill. 'We have always supported home rule,' said Amy Biderman. media information manager for the health insurance groups. Two Congressional committees will consider the disapproval resolution, however they tend to favor autonomy for the District and are expected to bottle the resolutions up until the 3D-day Congressional review period ends. New Right leaders are expected to call for a discharge petition, which can override the committee and send the resolution to the floor of the House for a vote. But. a discharge petition requires signatures from 218 House members, and officials said the possibility of this occurring is remote. Chances of favorable consideration by the Senate subcommittee are also remote. ************************************************** ***** PAGE 58 * THE OFFICIAL NEWSLETTER OF THE NCGSTDS * VOLUME 7:5 * JUNE/JULY, 1986 ***** ************************************************************************************************************************

Ne. IIIIINE BOOSTER?? by Ann Giudici Fettner, with thanks to the ~~ YQ~~ ~!~!Y!' 6/23/86

Dinitrochlorobenzene (ONCB) is one of those quirky substances that seem to turn up now and then when a doctor uses his or her head to make connections. When he was at Stanford University, dermatologist Bruce Mills participated in a study of children who were covered with warts. These kids, who had a specific, tiny immune defect, were at the least, in social agony. Nothing seemed to help this strange, unattractive expression of viral infection, until Mills tried painting of a few warts here and there with DNCB. Within months, !ll the warts were in remission. When Mils began practicing in San Francisco, at about the same time AIDS made its appearances, he saw numerous patients--gay and straight--with what he describes as 'purple spots.' Remembering his experience with the children's warts, he decided to try ONCB. 'In the non-gay patients, the spots resolved spontaneously,' Mills said in a telephone interview. He began treating patients with AIDS and ARC, and has Just published a letter in the Journal of the American Academy of Dermatology. His results, if they stand up, are amazing. Between 40 and 50 of Mill's private-practice patients have been treated, many since December 1984. According to Mills, his results include 600-800 total white-cell counts improving to 2000-3000; anemia and low platelet counts normalizing, as have IgG, IgA, and IgE immunoglobulin measures; restored mitogen responses; and 'patients report they feel better.' In those with rheumatic manifestation, many were able to stop taking anti-inflammatory medications. The mechanism by which this 'active organic molecule' works is largely still mysterious. Thought to be unable to respond to any contact-sensitizing agent (because of the anergy created by destruction of T-cells), all of Mills's patients eventually were able to react to the DNCB-painted skin areas. Mills spoke to the Kaposi's sarcoma study group at the University of California at San Francisco in May, at a meeting attended by Dr. William Epstein, President of the Americap Academy of Dermatology, who described Mills's results as 'fascinating.' Epstein will be using DNCB in his own studies' at the School of Medicine. Here are the particulars you may want to .know about {or to pass on to your own doctor]: Mills uses a coin-sized 2% solution in acetone, which is applied to the upper arm, covered with gauze and paper tape. This is left on overnight and washed off the following day. He does this weekly, until the immune parameters begin to improve. The solution is then cut to less than 1% over subsequent weeks. Mills says it 'takes a while to see improvement,' but reports that virtually all patients--including those on chemotherapy, interleuken-2, etc.--appear to realize some benefit. DNCB costs little and is available from chemical supply houses, where it is sold for photographic purposes. When I was working for the Arthritis Foundation, they fought a constant battle to prevent patients from using DSMO (dimethyl sulfoxide), a cheap industrial solvent. The only trouble was, it worked. Doctors were using it on themselves for muscle pains and winking at patients' use, and all the big-time athletes swear by it for torn ligaments, etc. The problem is that no one stands to make any money from a substance like this, despite its medicinal efficacy.. So no one bothers to explore its possibilities. If you're interested, get your physician to contact L. Bruce Mills, MD, 450 Sutter Street, 12304, San Francisco, CA 94108. ************************************************** DOCTORS REFUSING TO REPORT AIDS CASES DUE TO STIGMA by Wayne King, with thanks to the ~!! YQ~~ I!!!!, ca. 5/26/86

The man who died was 32 years old, a nurse, never married, a resident of a section of San Francisco that is predominantly homosexual. His death occurred within weeks after serious respiratory problems developed, and his body was cremated. . It seemed to be a classic case of AIDS. But the death certificate listed 'respiratory failure' as the immediate cause of death and 'adult ,respiratory distress syndrome' as the underlying cause. It made no mention of AIDS or of any of the illnesses that Federal health officials have established as defining AIDS. This case illustrates a dilemma facing physicians who treat people with AIDS: There is the need to provide accurate data, both for public health policy and for continuing research, but doctors also want to protect victims and their families. The case of the San Francisco nurse is being cited by a California organization as an example of the problem. The physician who treated the nurse, while declining to discuss the cause of death, said: 'I have a tendency not to put AIDS on the death certificate. That is public information, and if the wrong person sees it, it could be a problem for the family.' A New York internist said: 'We're more concerned about the patient's happiness. The patient may say, 'I don't want to tell my mother I'm homosexual, have AIDS and am dying." Indeed, more than a score of doctors around the country, most of whom spoke anonymously, said they declined to report all the AIDS' cases they treated. They cited the stigma associated with AIDS, the refusal of some insurance companies to honor claims of victims, and the reluctance of some funeral homes to embalm the victims. Public health officials say that although some doctors may not be fully disclosing AIDS cases, checks on the reporting system assure a count of cases that is 90 to 95 percent accurate. [ED NOTE: If some doctors are not reporting, than how can public health officials assure a 90-95% reporting accuracy?!] A Houston physician, whose practice is almost exclusively people with AIDS, said PWAs or their families often requested that· they not be identified. 'They become outcasts,' he said. 'Even when they die, the insurance companies try to wea~el out of paying the death claim, saying it was a pre-existing disease. And a lot of ' funeral homes won't accept the boqy, and if they do, it's usually cremated without embalming.' In general, insurance companies seek to screen out people who are at risk of expensive and fatal diseases. Once a policy is granted, most companies deny benefits if a policyholder ~ho has a (Continued) ***** THE OFFICIAL NEWSLETTER OF THE NCGSTOS * VOLUME 1:5 * JUNE/JULY, 1986 * PAGE 59 ***** ************************************************************************************************************************

DOCTORS REFUSING TO REPORT AIDS CASES L Continued --serTous-dTseise~- does-nofTilfTtii ln-s-uran-ci-colllpany when applying and dies of it within two years. Disputes between insurance companies and AIDS victims are often complicated by the years-long incubation period for the disease. Several doctors noted that some apparent cases of AIDS do not Deet the strict criteria adopted by the CDC for defining and reporting the disease. Health officials in fact say there is underreporting for all diseases that should be reported to authorities, sexually transmitted diseases in particular. Health officials say a relatively accurate count of cases is assured by the fact that most AIDS victims eventually end up in a hospital that makes a report to local health officials and ultimately to the CDC. However, health officials in Houston said at least one large hospital that treats PWAs does not report its cases, and PWAs and their doctors in several other cities also said SOlI hospitals do not report all cases. Dr. Bernard Ackerman, a pathologist heading the testing laboratory at New York University Medical Center, said that in the last five years. his lab had diagnosed 2500 cases of Kaposi'& sarcoma, 95' of them for private physicians treating AIDS victims outside the hospital. 'I think it's unlikely 1'. seeing lOre than half the cases in the country,' said Ackerman. When he made that observation, Just under .000 cases of Kaposi's had been reported nationwide. His experience suggests that some doctors who are getting positive lab tests are not reporting the cases, or at least are not promptly reporting them. Laboratories do not report results of AIDS tests to the health authorities. only to the physician requesting the test. A 35 year old administrator of a Houston organi~tion for gay rights said that in October he was diagnosed with Kaposi's. He has since seen three doctors in the Houston area and said all agreed to his request that his case not be reported. 'It was like I really didn't need to ·ask,' he said, adding that although he had no fear ~f losing his Job, he did worry about his insurance. A study of AIDS cases in California suggests that a reluctance by doctors to report AIDS cases may be greater when the disease strikes married lin. Dr. Gary F. McHolland and Wes Weller, in an academic actuarial study, compared the number of AIDS cases reported to the State of California through June. 1985. with the number of death certificates listing AIDS-related diseases. The researchers found that at least 17% of those listed as having died of AIDS related diseases had never been reported as having the disease. For married men. the figure was 35%. 'The estimated 17% understatement,' their report said, could result frOi a nuaber of factors. including incomplete reporting. But, it went on, a lore likely cause 'relates to the rigid CDC classification of cases. 'It has become increasingly recognized that not all AIDS cases meet the strict CDC criteria for defining an AIDS cases,' the report said. 'For example. a person could be infected with the AIDS virus and have AIDS-related diseases, and in the opinion of the treating phYSician have AIDS, yet not meet the strict CDC case definition because certain laboratory tests were not performed (e.g., patient refuses). Also, a person could die from pneu.ocystis carinii pneumonia (PCP), with AIDS indicated as an underlying cause on the death certificate, but still not I88t the strict CDC case definition.' As for the 35% figure on married men, McHolland said, 'They don't want the world to know, even thOugh the reporting is very confidential.' The possibility of significant under reporting of AIDS among married .en has 'serious public health implications,' in hi~ view. 'Wives may be more exposed than they think.' In California, the American Association of Women Voters, the group that cited the case of the San Francisco nurse, says it has other evidence Lr underreporting. But Dr. Dean Echenbert, director of disease control for that city's Dept. of Public Health, said he did not think underreporting posed a serious problem. He said San Francisco and other cities with a Significant number of people with AIDS maintained 'a system of active surveillance' that includes scrutiny ~f palhology and infectious disease reports. death certificates. and autopsy and coroner's reports. The reluctance of SOlI doctors to list AIDS as a cause of death emphasizes the unusual emotional context surrounding the reporting of the disease. An AIDS researcher associated with Harvard Medical School, discussing whether the disease was ever left off death certificates, said. 'We do it all the time. We routinely honor the request of the family and don't put it on.' 'I feel a moral obligation to protect the patient and his or her family,' he added. He cited a recent case in which AIDS was put on the death certificate of a young man from a religious family. The funeral home, upon seeing the certificate, refused to allow a wake with an open casket. 'Backlash from the diagnosis is tremendous,' he added. But the doctor emphasized that the cases in which AIDS is not specifically mentioned on the death certificate do not get lost. They are still reported. as required. to the Boston Dept. of Health through a coded system that allows for confidentiality. Doctors often ascribe the cause of death to the specific disease that caused it, rather than to AIDS. This is acceptable practice, although California requires that AIDS be listed as a cause of death. The Boston doctor cited the case of a young gay man who died of AIDS in Boston. His mother, who was taking the body back to a small town in Indiana for burial. was concerned that the funeral home would get a copy of the death certificate and the information would become known in town. Physicians are ambivalent about the need to inform funeral homes about the cause of death of an person with AIDS. Sume places will not accept the bodies of AIDS victims for embalming because of fear that lortuary aides will be infected. John E. Rudolph Jr., general manager of a Houston funeral home, said embalmers wore double gloves. double gowns and masks when embalming the body of a person with AIDS. Special care is given to sterilizing instruments after embalming. 'It's very easy to cut the skin through a glove,' he said. ************************************************** NEXT NEWSLETTER

Article submissions for the next issue of the ~~§§IQ§ Qffi~i~l M!~21!~~!C, volume 8:1. August/October, are due by September 5.. 1986. Anticipated publication and mailing will be in late September. early October. Address articles to: NCGSTDS. PO Box 239. Milwaukee. WI 53201. Thanks!! ************************************************** ***** PAGE 60 * THE OFFICIAL NEWSLETTER OF THE NCaSTDS * VOLUME 7:5 * JUNE/JULY, 1986 ***** ************************************************************************************************************************

HEALTHY TRABISSICII Of EnTAL HERPES with thinks to ~!~! ~!!!. 6/28/86

People with genital herpes can evidently transmit the infection even if they show no signs of it., In the June 12 ~!! ~~gl!~~ ~2ytn!1 21 ~1~1~!, Jales F. Rooney, Stephen E. Straus and their colleagues at the National Institute of Allergy and Infectious Diseases in Bethesda, document the transmission of herpes by an asymptomatic man. The man was taking part in a trial of weekend-only use of acyclovir, a drug that controls the replication of herpesvirus, and keeping careful records of his symptoas. He had sexual relations with a woman during a symptom-free period; the woman developed genital blisters five days later. Characterization of her virus indicated it was structurally identical to his. The study, say the researchers, provides biochemical proof of asymptomatic transmission, which has been shown with epid8liologic data. Last year Gregory Mertz, then at the University of Washington in Seattle and now at the University of New Mexico in Albuquerque, reported on 66 people with new cases of genital herpes. Of the sources, 62% had had no evidence of oral or genital herpes in the three weeks prior to transmitting the disease; many of them did not even know they had herpes. Mary Guinan of the Centers for Disease Control in Atlanta, a coauthor of that study, estimates that only about a quarter of all people with genital herpes have symptoms. ************************************************** EFFECTS OF LEARNING HTLV-III/LAV ANTIBODY STATUS ON SUBSEQUENT SEXUAL ACTIVITY abstract frOi the !n~!t~!~12n!1 ~!~ ~2nt!~~~!, Paris, June, 1986 Author: Robin Fox, N. Odaka, B.F. Polk, Johns Hopkins University, Baltimore. One thousand one hundred fifty-three gay/bisexual men enrolled in a longitudinal study of the natural history of HTLV-III infection are evaluated every 6 months at which tile they are interviewed and examined, and have specimens taken for laboratory studies. One year after enrollment, participants had the opportunity to learn their HTLV-III antibody status. 68% asked for the test results. Wanting to know was not associated with Ab status, race, education, number of sexual partners, a history of having sex with someone who developed AIDS, perception of swollen lymph nodes, or feelings of depression. Men wanting to know their Ab status were more likely to have generalized lymphadenopathy. All participants were counseled concerning HTLV­ III Ab test results; all were advised to practice 'safe sex.' Of 541 men thus far evaluated at the visit following voluntary disclosure, behavior. change was measured by a change in the number of male sexual partners. 80th seropositive and seronegative men not wanting to know their Ab status reported significant decrease in number of partners. Seropositives who were informed of their Ab status reported 50% decrease in number of partners, while seronegatives who were informed of their Ab status reported no change. Disclosure of a positive Ab test result to participants appeared to decrease further their sexual activity and hence chances of transmitting infection. Disclosure of a negative Ab test on the other hand, did not result in a comparable reduction in sexual activity. Despite the overall national trend of decreasing sexual activity among gay men, the effect of informing gay men of their Ab status may be contrary to the goal of public health programs, which is to decrease the spread of HTLV-III/LAV through sexual activity. ************************************************** ALTERNATE TEST SITES REPORT OVERALL POSITIVITY AT 17% by Peg Byron and Lisa M. Keen, with thanks to !b! !!!h1~g~2n @l!~!, 5/30/86

The Centers for. Disease Control released figures showing that of the 79,083 persons who took the HTLV-Ill antibody test at alternate test sites in 1985, 11.3% repeatedly tested positive and was reported in the May 2 ~2~~i~i!~ ~ ~2~!~11!~ ~!~~l~ 8!22t!· While 21,200 tests were taken during the first 6 months the test was available, more than twice that number of tests were administered in the last four months of the year, a phenomenon which some observers have attributed to the news of actor Rock Hudson's illness and death due to AIDS. The ~~B report said that the antibody test has shown itself 'to be remarkably sensitive and specific and to be useful, not only for preventive purposes [???!!!--ED), but also for the diagnosis and differential diagnOSis of clinical illness.' ************************************************** RATE OF AIDS TRANSMISSION DIVES IN SAN FWlCISCO by Ji. Fauntleroy, with thanks to Boston's §!~ ~2!!Y~!~~ ~!!!, 7/13-19/86

According to the @~~ ~~!! 8!22~!!~, a gay men's health study shows the rate of AIDS transmission in San Francisco has dropped sharply since 1984. Epidemiologist Warren Winkelstein, of the University of California at Berkeley School of ~ublic Health, ~hic~ conducted the study, said 'this drop in the rate of AIDS transmission is directly linked to changes ln sexual behavl0r. In particular, Winkel stein noted a decline in the number of men having anal sex without a condom. The study found that in 1985 the rate of gay men testing positively for the HTLV-III (HIV) virus for the first time was 3-5%. In 1984, the new infection rate was 18\. The study, begun in 1984, is following 800 gay and 20b heterosexually men r~ruited randomly from nei~h~orhoods with the highest gay population. The study also found that 51% of gay men in the Clty are HTLV-III (HIV) posltlve, much less than the two-thirds figure quoted in San Francisco's daily papers The higher figure was based on a smaller study that only included men who had had hepatitis. . ************************************************** ***** THE OFFICIAL NEWSLETTER OF THE NCGSTDS * VOLUME 7:5' * JUNE/JULY, 1986 * PAGE 61 ***** ************************************************************************************************************************ IMMUNITY AND STRESS ONCE AGAIN LINKED by J. A. Miller, with thanks to ~!!ng! M!!!, 5/31/86 and by Judy Foreaan, with thanks to !h! ~~Qn §lg~ Women whose marriages have recently broken up show poorer immune system function than do married women, according to reports linking distressing events in a person's life to depressed immune function. Recent research by behavioral scientist Janice Kiecolt-Glaser and immunologist Ronald Glaser of Ohio State University in Columbus has explored the relationship between marital status and immunity. Earlier epidemiologic studies had indicated that separated and divorced women have increased mortality rates for some diseases. The Ohio scientists have examined illUne function in two groups of 38 women each. The women in one group were married; those in the other group had separated from their spouses during the last six years. The groups were matched for a variety of socioeconomic factors. On, several different measures of how - well immune system cells are functioning, the separated and divorced women showed lower responses than the married women, Kiecolt-Glaser reported at the annual meeting of the American Association for the Advancement of Science in Philadelphia. Within the group of separated and divorced women, those with a continued feeling of attachment to the husband or ex-husband--whether it was persistent anger or longer--reported greater feelings of depression and showed poorer immune system function. Among the married women, those who reported dissatisfaction with their marriages showed a poorer response on three out of sex measures of immune function than did women who rated their marriages more favorably. The less happily married women also reported .ore feelings of depression. Life's stresses do not' have to be as great as the breakup of a relationship to affect the immune system. Kiecolt-G1aser also reports immune system changes occurring among medical students during the school year. In five different studies, employing 20 different assays, she and her colleagues have shown a decrease in immune system activity during medical school final examinations. Among the immune functions suppressed during exams is natural killer cell activity. This activity is thought to be important as a defense against viruses and cancer. In addition, production of interferon, which stimulates natural killer cells, plummeted during final exams. Kiecolt-Glaser reports that she and her colleagues have also found that these periods of stress-related immunosuppression among medical students are associated with episodes of infectious disease. "The heightened distress regularly found in our medical student samples during examinations is probably quite comparable to that elicited by everyday events that are frequently experienced [by the general population]--for example, the several days of frenzied activity that frequently precede vacations," she says. "If emotional distress in these situations is comparable to that of medical students during examinations, then similar immunologic changes may be expected." Among both the separated and divorced women and the anxious medical students, changes in eating and sleeping habits do not explain the observed changes in immune function, Kiecolt-Glaser says. If distress interferes with immune function, reductions in distress might enhance immune, the Ohio scientists reasoned. In both medical students and an elderly population, they have observed that relaxation exercises increase measurable aspects of immune function. "Transient immunosuppression can be produced by heightened and sustained distress," Kiecolt-Glaser concludes. But whether this condition leads to disease depends on factors including psycho1gocia1 resources, prior health and exposure to infectious diseases. She suggests that distress-related immunosuppression has its most important consequences in elderly individuals and others who have preexisting deficiencies in immune function.

In the area of AIDS, another researcher, Andrew A. Monjan, chief of the immunology section of the National Institute of Aging in Bethesda, said that the fear of getting sick with AIDS seems to lead to poorer immune function than denying to oneself the possibility of getting sick. In a study of 5000 homosexually active men, Monjan said, those who did not appear to be infected with the AIDS virus but who were depressed and worried about getting swollen lymph glands had less favorable scores on a test to measure ratios of critical immune cells than those who were not depressed and were not worried. This held true whether or not a person actually had lymphadenopathy, he said. "People without lymphadenopathy who think they have it are as badly off as if they really did have it," Monjan said. In a continuation of experiments that surprised immunologists a decade ago, researchers at the University of Rochester School of Medicine reported that mice and rats can be taught to enhance their immune systems and to suppress them. Like Pavlov's dogs, which became

conditioned to salivate when they heard a bell that they came to associate with feeding, rodents can learn to suppress their immune systems in response to a substance that has no intrinsic effect on the immune system, such as saccharin, if this substance is first paired with a genuine immunosuppressant drug. Immunologist Nicholas Cohen said there is also some evidence that animals can also be trained to enhance their immune systems, and preliminary data show that some animals will modify their behavior as if they were trying to correct immune deficiencies, he said. ************************************************** ***** PAGE 62 * THE OFFICIAL NEWSLETTER OF THE NCGSTDS * VOLUME 7:5 * JUNE/JULY, 1986 ***** ************************************************************************************************************************

KIDNEY PROBLEJIIS MY DEVELOP IN 50' OF PWAs with thanks to !~~!~~!l ~!£!~! ~!!!, 5/1-1./86 As ma·ny as o~e-half of all people with AIDS may develop renal abnormalities, and some present with a progressive nephrotic syndrome that may be fatal in a matter of months, according to Dr. Thomas L. Curry at the Virginia regional meeting of the American College of Physicians. A review of renal failure in PWAs was prompted when in July 1985 a patient presented with symptoms of AIDS and acute renal failure. The person's renal function progressively det~riorated to end stage renal disease over a 6 week period, in spite of beginning maintenance hemodialysis in the fall. Only three studies could be found in the English-language literature dealing with AIDS and renal failure. These studies indicated that the frequency of renal abnormalities may be as high as 50%, with severity ranging from asymptomatic proteinuria to acute renal failure. The high incidence of sepsis, hypotension, and exposure to nephrotoxic agents in this population may predispose patients to renal failure. ************************************************** AIDS VIRUS MUTATES UP TO AMILLION TIMES FASTER with thanks to ~!~£! ~!!!, 6/28/86

Analysis of the molecular structure of AIDS virus DNA shows it mutates up to a million times faster than the standard mutation rate for DNA from other organisms. The high rate of mutation, the researchers suggest, could be what allows the AIDS virus to escape attack by the immune system. Beatrice H. Hahn of the university of Alabama in Birmingham and colleagues report int he June 20 §£1!~£! on a comparison of AIDS DNA taken over the course of one or two years from three people. Each person had been infected with only one AIDS virus, although one man had had sexual encounters with about 1000 men between 1980 and 1985. The exclusivity of infection, the researchers suggest, implies that infection by one AIDS virus may protect against infection by another. Figuring out how that happens, they note, ·could be important in developing methods for the treatment and prevention of AID~.· ************************************************** CIRID MEDICAL UPDATES [Prepared as a public service to the medical community by the Division of Clinical Immunology/allergy, ·Dept. of Medicine, UCLA School of Medicine. These updates represent editorial opinion and should not be construed as otherwise. Published by the Center for Interdisciplinary Research in Immunology and Disease (CIRID) at UCLA and by the UCLA AIDS Center, Andrew Saxon, MD, Editor in Chief. For additional inforaation, or subscriptions, call 213/825-1510.] ~!§~!~§~Q§!§ QE ~ ~~~!~~~ ~~~~~~ !~ ~~!!~~!§ 8~E~88~~ !Q ~ ~!Q§ ~~!~!~::~~~~:~!~§~~ (H. Hollander and D.O. Coutland, ~!2~!r~ ~9~r~!1 9! ~!~1£1~!, 144:373, 1986.) The authors report 5 cases of individuals referred to an AIDS clinic who turned out to have ·pseudo-AIDS;· they had another medical problem but because of real or presumed risk factors for AIDS, they were diagnosed as having AID~ and sent to an AIDS referral center. Two presented with lymphadenopathy, one of which turned out to have tuberculosis, and another had nothing more than a muscle strain. Two cases were referred for pulmonary complications of ·AIDS· and one of these turned out to have a lymphoma while the other had ischemic heart disease. One patient presented with hematologic abnormalities which turned out to be a combination of iron and vitamin B12 deficiency. *****CIRID EO COMMENT: This article makes a simple but meaningful point. Just because individuals have real or presumed risk factors for AIDS, they should not be diagnosed as having HTLV-III/LAV­ related illness without firm evidence in this regard. While HTLV-III related illness is common in high risk individuals in metropolitan centers such as Los Angeles, San Francisco, and New York, other illnesses are just a s likely to occur in these persons. Not only is there potential .for grave medical harm by the over-eager diagnosis of HTLV-IlI-related illness but the prospect for social and emotional harm is enormous. ~~!!~Q~!~§ !Q ~!~Y:!!!l~~Y !~ Y~~~~~A~~~ ~~!!~~!§ ~!!~ ~~~!~ ~~~AB!A~ !~E~~!!Q~§, (D.J. Volsky, et al., ~!~ ~~gl~ ~9~~~ 9! ~!~~, 314:647, 1986.) The authors evaluated serum from patients with Plasmodium vivax or Plasmodium falciparum infection for the concurrence of seropositivity to HTLV-III/LAV. None of these individuals were in a known risk group for AIDS or had any AIDS associated disorders. HTLV-III seropositivity was assayed by ELISA, indirect immunoflourescence, Western Blot and radioimmunoprecipitation. Three of the persons with falciparum and 5 with vivax infection were HTLV-III/LAV antibody ppsitive. Though the titers were low (1:320 or less), they were positive on the battery of the HTLV-III tests mentioned, in addition the antigens that were recognized on Western Blot were those normally seen from patients with AIDS. At the same time there was less than 1% frequency of antibodies to HTLV-III/LAV in healthy blood donors in the area of the study. *****CIRID ED COMMENT: This report is part of an increasing body of evidence that there is some relationship between HTLV-III/LAV seropositivity and malaria infection. Previous reports from Africa as well as South America suggested this. This report shows definitive evidence for an antibody response in 8 or the 24 patients with acute malaria. Since none of the patients in these studies have had any manifestations suggestive of AIDS, the alternate possibility is that there is some other retrovirus(es) that travels with malaria in these areas. The recent report of an HTLV-III/LAV-like agent in Africa (HTLV-IV) that is not associated with evidence of immune deficiency is intriguing in this regard. (NCGSTDS EO NOTE:, Readers are reminded that malar~a is a protozoan infection transmitted through the bite of an infected mosquito (anopheles), transfusion of contaminated blood, or use of a common syringe by drug addicts. This supports the hypothesis of an insect vector, as proposed by researchers studying the unusually high incidence of AIDS in Belle Glade, Florida, and maybe other places??] ************************************************** ***** THE OFFICIAL NEWSLETTER OF THE NCGSTDS * VOLUME 7~5 * JUNE/JULY, 1986 * PAGE 63 ***** ************************************************************************************************************************ ORAL SEX MAY BE SAFER? with thanks to Detroit's ~~Y1!!, 6/25/86

Aletter in the April 4, 1986 issue of the JQy~~~l Qf !h! !m!~1£~~ ~~1£!1 ~!!Q£1!!!Q~ by Drs. David Lyman, Michel Ascher, and Jay Levy, suggests that oral sex might be considered safer than previously thought. The doctors began the San Francisco Men's Health Study in June 1984 and continued it though January 1985. Recruited for the study were 1035 gay and straight men. The 214 heterosexual men who were found to be seronegative for antibodies to the AIDS virus were dropped from the study. The remaining 821 bisexual and homosexual men were divided into three groups; no sexual partners (15 men); oral-genital contact only (56 men); and continued rectal intercourse (750 men). In the first two groups, only 20\ of the men tested positive for ARV, as opposed to 51\ of the men having continued rectal intercourse who tested positive. The study results do not completely exclude the chance for oral sex leading to infection with the AIDS virus. "They do, however, show no excess risk of infection by this route and support the theory that anal-genital sex exposure is the major risk of infection," says the letter. ************************************************** KILLING VIRUSES with thanks to §£1!'l£! ~~, 7/12/86 Viruses are a hardy bunch. They survive exposure to many potent chemicals unscathed, and most compounds that can kill them wipe out the· host cell as well. In Vancouver, researchers at the University of British Columbia are working with a class of phototoxic plant compounds that, they say, show promising though preliminary signs of antiviral activity. Phototoxic compounds can cause allergic reactions, and sometimes illness or death, when they are eaten or touched by an animal that is then exposed to the ultraviolet A radiation in sunlight. But at last month's annual meeting of the American Society for Photobiology in Los Angeles, Neil Towers reported that five such compounds, found in plants of the marigold and sunflower families, appear to be even more toxic to viruses than to animal cells. Towers and James Hudson grew Sindbis virus and mouse-cytomegalovirus in mouse cells, then exposed the cultures to the phototoxins in varying concentrations. According to Hudson, "relatively low" concentrations of the compounds destroyed the viral membranes while leaving the membranes of the mouse cells undamaged. The compounds appear to act on unsaturated fatty acids in the viral membranes, Towers says. Though the viruses were still able to penetrate the host cells, they were "essentially killed," since they were no longer able to replicate. There are other photoxins that appear to have antiviral activity, the researchers say, many of them derived from plants traditionally considered to have medicinal value. Some of these compounds disrupt the virus's genetic material and are more likely to have harmful side effects on the host cells. The researchers have not yet tried the membrane-specific compounds in animals, but if in vitro results are borne out, Hudson says, there is the potential for a new class of drugs, potent against many viruses-b~t-;ithout sOle of the serious side effects that occur with other antiviral drugs. ************************************************** TREATMENT OF AIDS-INDUCED ADRENAL INSUFFICIENCY WITH CORTISOL MAY HELP PROLONG LIFE with thanks to g!!!!~£h g!!~~£!! B!eg~!!~, May, 1986 (HHS/PHS/NIH) Daily administration of cortisol, a steroid hormone normally produced by the cortex of the adrenal gland, can relieve or reduce the severity of some symptoms associated with AIDS. Scientists at the University of California General Clinical Research Center (GCRC) in San Francisco emphasize that the treatment is not a cure for AIDS, which is almost invariably fatal. Instead, the cortisol injections make up for the adrenal gland's failure to provide enough of the natural hormone, cortisol. Replacement therapy could improve management of even prevent some of the severely debilitating symptoms that result from adrenal insufficiency in people with AIDS, namely weight loss, nausea, vomiting, and debilitation. The treatment is likely to be most beneficial to PWAs with severe adrenal insufficiency, who apparently comprise about 10% of the affected population, according to GCRC researchers. Of the 100 people participating in the study so far (as of submission of report for publication), about 10% exhibit primary adrenal failure (Addison's disease). According to Dr. Edward Big1ieri, cytomegalovirus (CMV) infection could have caused adrenocortical dysfunction in three of the PWAs from the initial study. CMV infection, as indicated by the presence of CMV antibodies, is extremely prevalent among homosexuals. About 95% of otherwise healthy homosexual males have CMV antibody, suggesting previous or current infection. "CMV infiltration may destroy certain adrenal pathways, resulting in absent or severely impaired adrenal reserves," Biglieri says. Others problems, however, could contribute to the adrenal insufficiency. Infection with cryptococcus or ~~£Q~~£!!~i~~ ~Yi~~:i~!~~£!ll~l~~!, Kaposi's sarcoma, hypotension from septic shock, or bleeding may predispose the adrenal gland to necrosis and hemorrhage. Bleeding may be caused by disseminated intravascular coagulation, which is characterized in the late stages by profuse hemorrhaging, or from thrombocytopenia, which is characterized in the late stages by a decreased number of blood platelets. "Of course, we are also investigating the possibility of a direct effect of the [AIDS virus] on the adrenals," Biglieri says. He and his colleagues are now planning to study adrenal function in patients with ARC, which is characterized by the early symptoms of AIDS, including fatigue, fever, night sweats, and gradual loss of weight. (Research described in this article was supported in part by the National Institute of Arthritis, Diabetes, and Digestive and .kidney Diseases an~ the General Clinical Research Centers Program of the NIH Division of Research Resources.] ************************************************** ***** PAGE 64 * THE OFFICIAL NEWSLETTER OF THE NCGSTDS * VOLUME 7:5 * JUNE/JULY, 1986 ***** ************************************************************************************************************************

AIDS EPIDEMIOLOGY/SURVEILLANCE UPDATE abstracted from ~!~ ~!~1~ §y~Y!111!n~! B!~Q~~, CDC AIDS Activity

As of July 21, 1986, the Centers for Disease Control AIDS Activity reports a total of 22,815 adult and pediatric cases of AIDS in the U.S. (CDC strict case definition). [The present estimate of all those infected with antibody to the AIDS virus in the United States is 2,281,500, based on those currently diagnosed multiplied by 100; those with AIDS-related conditions but without a specific diagnosis of AIDS is conservatively estimated to be 228,150, based on those currently diagnosed multiplied by 10. --NCGSTDS Editor] ~AI!~~I B!~~ §BQ~~l Homosexually active men account for 73% of all cases; 17% from IV drug users; 1% from hemophiliacs; 2% from heterosexual contacts with PWAs or at risk for AIDS; 2% from blood/blood product recipients; and 5% from those in no apparent risk or unknown risk group. [Note that Haitians are no longer considered a 'high risk' group, yet they had accounted for 3% of all cases. The CDC continues to receive criticism for their atypical 'hierarchical' listing, whereby if homosexually active men are also IV drug users or hemophiliacs, they are only counted in the top, i.e., homosexual, category, therefore confusing and misrepresenting the data. CDC officials admit this situation. --ED] A§~l 22% of the cases are aged 29 or less; 47% from ages 30-39; 21% from ages 40-49; and 10% from ages over 49. BA£!AblgI~~!£ ~A£~§BQ~~Ql 60% of the cases are white; 25% are black; 14% are hispanic/latino; 2% are other or unknown. Note that 60% of the pediatric cases are black, 21% hispanic, 19% white, and 1% are unknwon. §~Q§BA~~!£Ab Q!§IB!~~I!Q~l 55 states and territories, including the District of Columbia &Puerto Rico have reported cases to the CDC; New York &California have the most cases, with 33% &23%. respectively; Florida, New Jersey. &Texas report 6%, 6% &5%, respectively; Illinois, Pennsylvania, Massachusetts, the District of Columbia, and Georgia, each report 2% of the cases; all other areas each report 1% or less. OVERALL MORTALITY: 54%. CASES PER ~!bb!Q~ QE eQe~bAI!Q~l 100.2 overall for the entire U.S.; it ranges from 759~5-pM-in-N~;-Y~~k~ 734.0 pM-i~ Sa~ Francisco, 261.0 pM in Los Angeles. 392.4 pM in Miami, 295.0 pM in Newark, and 50.6 pM elsewhere in the U.S., irrespective of standard metropolitan statistical area. ************************************************** VIRUS TRANSMITTED FROM 'FALSELY NEGATIVE' BLOOD with thanks to Detroit's £~~1!!, 7/2/86

Health researchers reported the first case of a patient becoming infected with the AIDS virus from a blood transfusion that had been tested and showed no signs of the deadly disease. The case, which occurred in 1985 in Colorado, involved a donor who gave blood so soon after a homosexual encounter that he had not yet developed the antibodies that trigger the AIDS blood tests, said officials with the CDC. The chance of a blood recipient getting the virus that causes AIDS remains less than one in 100.000, said Dr. Harold Jaffe, an AIDS specialist with the CDC. But the CDC noted that AIDS antibodies take months to appear in blood tests. For that reason, Jaffe said, 'men who have had sexual contact with another man since 1977 must not donate blood.' ************************************************** HORMONAL LOOK-ALIKE by J. Silberner, with thanks to ~~1!n~! ~!~, 5/31/86 Antibodies against a human hormone that stimulates the immune system also inhibit test-tube replication of the virus associated with AIDS, report researchers from the National Cancer Institute in Bethesda. and George Washington University in Washington, DC. Why antibodies to the hormone would. work against the AIDS virus remains to be discovered, but the results suggest a new path to an AIDS vaccine, the researchers write in the May 30 §£i~n~~. The hormone target is thymosin alpha-I. which promotes the activity of helper T cells, the prime victims of the AIDS virus. The researchers suspected a thymosin-AIDS connection because children with a genetic inability to produce thymosin develop an AIDS-like disease. In a computer match-up of the viral and hormone proteins, they found that about half the components along a short stretch of thymosin are identical to an inner-core AIDS protein. They injected thymosin alpha- 1 into rabbits and added the resultant antibodies to a human cell line infected with the AIDS virus. 'We found we could protect cells [in culture] by adding the antibody,' says Prem S. Sarin of the National Cancer Institute. The researchers are now searching for a vaccine that will stimulate humans to produce their own antibodies against the AIDS core protein. AIDS vaccine work has focused predominantly on the proteins that surround the viral core, on the presumption that the 'envelope' proteins are more exposed to the immune system. But these outer proteins vary from strain to strain of the AIDS virus, complicating the search for a single vaccine. In contrast, the core protein--which GW's Allan L. Goldstein calls 'the Achilles' heel of the virus'-- apparently remains stable. 'We feel we have solved one of the major obstacles to vaccine development--namely, genetic drift,' says Goldstein. For an immune reaction to occur, the core protein must be exposed to antibodies at some point. This may happen, Goldstein suggests, when the virus injects itself into the cell, or if the antibody enters infected cells, or if the core protein is in the envelope as well. Whether the structural similarity between the virus and the hormone is simply coincidental or has a functional explanation. Sarin says, remains an open question. **************************************************