From: Billi Goldberg <bigoldberg@igc.apc.org>
Subject: CDC Summary 11/23/92
Note: Copyright 1992, Dan R. Greening. Non-commercial reproduction allowed.
Archive-Number: 6485
Organization: unspecified
Date: Mon, 23 Nov 92 07:58:29 PST

                     AIDS Daily Summary
                     November 23, 1992 
 The Centers for Disease Control (CDC) National AIDS Clearinghouse makes 
available the following information as a public service only. 
Providing this information does not constitute endorsement by the CDC, 
the CDC Clearinghouse, or any other organization. Reproduction of this 
text is encouraged; however, copies may not be sold. Copyright 1992, 
Information, Inc., Bethesda, MD 
**********************************************************************  
 "As H.I.V. Patients Stay at Work, Problems, and Solutions, Emerge" New 
York Times (11/23/92), P. A1  (Navarro, Mireya)
     As more and more HIV-positive people are living longer as a result 
of new treatments, they are also trying to hold onto jobs. Some continue 
working because they need the income or the health-insurance benefits.  
However, many others work as long as they can for other reasons, such as 
the fulfillment and camaraderie they receive through their jobs.  Some 
companies have implemented policies that state that AIDS will be treated 
like any other life-threatening disease.  These companies have also 
accommodated employees with HIV with flexible work schedules and other 
measures.  But at other companies, workers with HIV/AIDS have been 
dismissed, although most states have laws that prohibit firing employees 
simply because they have the disease. Consequently, many HIV-positive 
employees believe they must hide their infection if they want to 
continue working.  Several HIV-positive individuals are concerned about 
being discriminated against or losing their jobs or chances of 
promotion.  Many do not reveal their HIV-positive status until they 
must, such as when they have to explain frequent absences.  Other AIDS 
patients do not file claims for HIV-related treatments in order to hide 
their condition or avoid being dropped from health plans. According to 
employers, fear of transmission of HIV is still a worry for co-workers, 
even this far into the AIDS epidemic. Business groups say that most 
private or public employers have not prepared for the disruptions that 
AIDS can prompt.  This situation is changing, however, due to laws like 
the Americans With Disabilities Act. 

"A Call for Explicit AIDS Education" USA Today (11/23/92), P. 1D  
(Painter, Kim)
     AIDS education implemented in most states still does not give 
students the information they need to prevent HIV infection, according 
to a group that promotes a more explicit approach. Debra Haffner, 
executive director of the Sex Information and Education Council of the 
U.S., said, "We found that states have done a really terrific job of 
putting programs in place, but they still are not meeting young people's 
needs."  The council surveyed all state education agencies and did in-
depth analyses of programs in 34 states.  It revealed that all states 
mandate or recommend AIDS education and most have developed curricula or 
policies.  The group argues that although most programs promote 
abstinence, they offer little advice for teenagers already having sex, 
who account for 54 percent of high school students.  The council's 
research found that five states say schools should provide practical 
information on getting and using condoms.  A total of seven states 
provide what the council considers an accurate definition of 
homosexuality, and eleven offer what the council deems a sufficient 
balance of information on abstinence and safer sex.  Haffner says she 
expects that with the Clinton administration, "the 'just say no' 
approach of the past few years will no longer be seen" in federal 
policies and funding--and that will make a difference in state and local 
programs. 

"Spike Lee Sees AIDS as a Plot" Washington Times (11/23/92), P. D1  
(Grenier, Cynthia)
     The Rolling Stone 25th anniversary special issue includes an 
advertisement that features filmmaker Spike Lee.  The opening text of 
the eight-page ad for United colors of Benetton reads, "We sought 
another powerful voice in the realm of social commentary.  We could 
think of no more qualified individual to break through the static of 
mainstream media in the pursuit of change then filmmaker Spike Lee."  An 
essay by Lee accompanies a portfolio of Benetton ad photos from the past 
eight years.  Near the end of the essay, Lee says, "All of a sudden, a 
disease appears out of nowhere that nobody has a cure for, and it's 
specifically targeted at gays and minorities (i.e. Hispanics and 
blacks).  The mystery disease, yeah, about as mysterious as genocide.  
I'm convinced AIDS is a government-engineered disease."  Rolling Stone's 
vice president for public relations, Lynn Tanzman, said the essay is 
completely Lee's opinion and he is entitled to express it.  She said it 
was not an editorial matter, but a question for the advertising 
department and the publisher. 

"Winning Designs for Living With AIDS" Boston Globe (11/20/92), P. 33  
(Campbell, Robert)
     An AIDS exhibit was featured at "Build Boston", the array of 
exhibits and talks about architecture and construction that was held 
last week at the World Trade Center.  The AIDS exhibit consisted of 
winners of a national competition, in which architects were asked to 
design housing for AIDS patients.  Along with being a personal and 
medical tragedy, AIDS is also an architectural crisis.  About 80 percent 
of AIDS patients will need special housing at some time.  The 
contestants were asked to come up with designs to convert a half a block 
of Boston into apartments for AIDS patients.  The intention was to 
create a model community that could be used as a standard for the rest 
of the country.  The winning design, by David Kaplan and George Nakatami 
of Santa Monica, Calif., incorporates housing thoughtfully into the 
neighborhood.  David Lee, the current president of the Boston Society of 
Architects, said, "Nobody could undertake this design task without 
realizing the devastating physical challenges produced by AIDS.  But the 
result shows that you can have an architecture of social concern without 
sacrificing quality of design, or even joyousness.  As competitors were 
told, this is a competition about people living with AIDS, not dying."  
Interviewed AIDS patients indicated that they wanted to live in places 
that could support their needs without feeling like nursing homes. 

"Who Will Get the AIDS Blame Now?" Washington Times (11/23/92), P. E1  
(Charen, Mona)
     Avoidable risky behavior, not the lack of federal funding, is the 
reason for the spread of the AIDS epidemic, writes columnist Mona 
Charen.  Since the AIDS epidemic began in the early 1980s, Republican 
presidents have been blamed by homosexuals for its spread.  But now that 
there is a Democrat in the White House, the claims against the 
Republicans will come back to haunt them, says Charen.  It became a 
point of pride to support increased funding for AIDS research and care, 
even when the federal dollars for AIDS drastically exceeded funding for 
other more prevalent conditions like cancer.  It also became 
conventional wisdom that AIDS patients were dying unnecessarily and that 
a more focused government effort could halt the progress of the disease.  
Some even felt that AIDS was affecting homosexuals, blacks, and drug 
addicts disproportionately because Republican presidents were 
unsympathetic to these people.  A new study discovered that in small 
towns, almost one-third of gay men said they engage unprotected anal 
intercourse on a regular basis.  Nine percent said they are already HIV-
positive.  Several of those who admitted to this behavior said they 
believed that their risk of getting the disease was slight or nil.  It 
seems hard to believe that anyone living in a small town could be 
ignorant of the way HIV is transmitted.  The media continually relay 
facts about AIDS everyday.  If a person is still having unprotected anal 
intercourse in 1992, it is not because the government has been reluctant 
to explain the facts to him, but because the person chooses not to know 
the truth, concludes Charen. 

"City Scenes: AIDS Group has No Buddy for Joe" Boston Globe (11/20/92), 
P. 25  (Cullen, Kevin)
     A Boston AIDS patient is angry with an area AIDS organization for 
neglecting him.  Joe Scarantino, who was diagnosed with HIV years ago, 
became sick last December and requested a "buddy," a volunteer who 
provides companionship and help around the house, last spring from the 
AIDS Action Committee.  He says that when he continued to request a 
buddy he was considered a troublemaker by AIDS Action workers.  "They 
tell me the reason I can't have a buddy is I'm too angry and I say the 
reason I'm so angry is I'm being treated like a child.  Dealing with 
AIDS Action is not the only thing going on in my life.  I have to deal 
with my illness, with rejection by friends and family."  He added, "AIDS 
Action started out with all the right ideas, but in many ways it's 
become a huge bureaucracy, filled with bureaucrats.  I keep asking, 
'Where's the compassion?'"  AIDS Action spokesman Tom McNaught said 
individual cases cannot be discussed due to confidentiality rules, even 
if someone waives confidentiality. McNaught said, "Last year we served 
1,696 people with AIDS and HIV.  We have 201 trained buddies.  Clearly, 
there's not enough.  Not everybody who wants a buddy gets one.  We don't 
put them in a situation where they're at risk.  Sometimes people want a 
buddy   because they need therapy or a boyfriend or girlfriend." 

"News in Brief: District of Columbia" Advocate (11/17/92) No. 616, P. 26
     Acting on a request by the Centers for Disease Control,  
Washington, D.C., health officials announced on Oct. 13 that they would 
improve attempts to find people who tested HIV-positive at  district-
funded clinics but did not return to obtain their test  results.  About 
70 percent of those who tested HIV-positive at  district-funded clinics 
since 1990 had not returned to learn  their results, according to an 
article in The Washington Post. 

"News in Brief: Utah" Advocate (11/17/92) No. 616, P. 27
     A senior Mormon church official who said AIDS is a "plague  abetted 
by the immoral" has been chastised by AIDS activists and  religious 
leaders.  Dr. Russell Nelson, a member of the Council  of the Twelve of 
the Church of Jesus Christ of Latter-day Saints, made the statement at a 
church general conference Oct. 4.  Nelson told the conference that "an 
epidemic has been forecast--a plague fueled by a vocal few who exhibit 
greater concern for civil  rights than for public health."  LaDonna 
Moore, executive  director of the Utah AIDS Foundation, said Nelson's 
remarks were  a "saddening display of judgment and indifference coming 
from a  representative of a church which espouses Christian ideals."  
She added, "It is so ironic that these statements should come during  
AIDS Awareness Month."  Rev. Peter Eaton, association rector at  St. 
Paul's Episcopal Church in Salt Lake City, said, "AIDS is a  disease, 
not a disgrace."  In addition, St. Paul's rector Rev.  Caryl Marsh said, 
"Do we question the morals of a person with  leukemia, cancer or heart 
disease?"  Joseph Walker, spokesman for the Mormon Church, said Nelson 
would not respond to the censure.  "He has said what he wanted to say," 
Walker remarked.  

"The Relation Between Hospital Experience and Mortality for  Patients 
With AIDS" Journal of the American Medical Association (11/18/92) Vol. 
268,  No. 19, P. 2655  (Stone, Valerie E. et al.)
     AIDS patients attending hospitals with more experience dealing with 
the disease are more likely to live longer than those who  are admitted 
to less-experienced hospitals, write Valerie E.  Stone et al. of the 
Boston City Hospital in Boston, Mass.  The  researchers studied 151 
women and male IV drug users and a random sample of 149 all male non-IV 
drug users diagnosed with AIDS  during 1987 in Massachusetts.  In 806 
hospitalizations at 40  hospitals, inpatient mortality was 13.2 percent.  
Relative risk  of mortality at low AIDS experience hospitals was 2.16 
times that of high AIDS experience hospitals.  Using logistic regression 
to  control for age, sex, race, HIV transmission mode, severity,  payer, 
admission type, hospital ownership, and teaching status,  low hospital 
experience with AIDS remained a significant  predictor of inpatient 
mortality.  Comparisons of 30-day  mortality by hospital AIDS experience 
showed similar results.  In addition, length of stay and intensive care 
unit use were  substantially higher at low-experience hospitals after  
controlling for severity of illness.  Moreover, the better  outcomes in 
high-experience hospitals do not seem to be the  result of more 
intensive use of resources as measured by  admission to the intensive 
care unit, length of stay, or cost,  the researchers conclude. 

"Immunodeficiency and the Risk of Death in HIV Infection" Journal of the 
American Medical Association (11/18/92) Vol. 268,  No. 19, P. 2662  
(Phillips, Andrew N. et al.)
     HIV-positive patients who are closely followed-up seldom die  
before the CD4 cell count has fallen to 50 ul, which is a count  many 
patients remain above for up to 12 years after  seroconversion, write 
Dr. Andrew Phillips and colleagues from the University College and 
Middlesex School of Medicine in London,  England.  The researchers 
studied 111 patients with hemophilia  who seroconverted to HIV-1 between 
1979 and 1985.  Kaplan-Meier  estimates were used to calculate the risk 
of death and indicated  that almost half of patients alive 12 years 
after seroconversion  will have a CD4 cell count that is above 50 ul.  
About 35 percent remain above 200 ul.  A total of 37 patients died of 
HIV-related  illnesses, and there was a 52 percent probability of HIV-
related  mortality by 12 years from seroconversion.  Mortality risk was  
closely related to severe immunodeficiency.  There was only a 15  
percent chance of HIV-related death occurring before a CD4 count  of 
below 50 ul had been reached.  There was an average of one  HIV-related 
death per 96.7 patient-years of observation before  the CD4 count had 
fallen below 50 ul, as compared with one death  per 2.5 patient-years of 
observation after the CD4 count had  fallen below this level.  The risk 
of HIV-related death is small  before the CD4 cell count reaches a level 
of 50 ul but rises  rapidly thereafter, the researchers conclude. 

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