From: Billi Goldberg <bigoldberg@igc.apc.org>
Subject: ATN #162
Note: Copyright 1992, Dan R. Greening. Non-commercial reproduction allowed.
Archive-Number: 6447
Organization: unspecified
Date: Wed, 11 Nov 92 20:37:37 PST

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J O H N   J A M E S  writes  on  A I D S 
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Copyright 1992 by John S. James; 
permission granted for non-commercial use. 

AIDS TREATMENT NEWS Issue #162, Nov 6, 1992 
   phone 800/TREAT-1-2, or 415/255-0588 

CONTENTS:  [items are separated by "*****" for this display] 

Kaposi's Sarcoma Trial Recruiting:  TNP-470 (AGM-1470), New 
   Kind of Treatment 
WF-10:  Big Claims, Little Information 
Anger at Women's History Study Delay 
After the Election:  Are We Ready? 
Effective Transition:  Interview with Tom Sheridan 
National Commission on AIDS Preparing Presidential 
   Recommendations 
AIDS Treatment Information Sources:  Other Newsletters 

***** Kaposi's Sarcoma Trial Recruiting:  TNP-470 (AGM-1470), 
      New Kind of Treatment 

     A new kind of treatment for Kaposi's sarcoma (KS) has now 
begun human testing at the U. S. National Cancer Institute.  The 
treatment, TNP-470 (formerly called AGM-1470) prevents the growth 
of new blood vessels; KS is associated with excessive growth of 
blood vessels.  The current trial is only for persons with KS; 
however, animal studies have suggested that this class of 
compounds, called angioinhibins, could also be important for 
treating many kinds of solid-tumor cancers.  [For background on 
TNP-470, see "Angiogenesis Inhibitors -- New Approach to Cancer, 
KS Treatments," AIDS TREATMENT NEWS #135, September 20, 1991.] 

Volunteers must: 

* be HIV positive; 

* have KS but no evidence of pulmonary or gastrointestinal KS; 

* be ambulatory and at least well enough to care for themselves; 
and 

* be on a stable dose of antiretroviral therapy for at least a 
month. 

     Also, because the drug has caused small hemorrhages in 
animals at very high doses, this trial has strict exclusion 
criteria for hematological abnormalities, including hemoglobin 
less than 9, ANC less than 1,000, platelets less than 100,000, or 
APTT or PT greater than 120 percent of normal, or known bleeding 
disorders.  Persons are also excluded if they have pulmonary KS, 
actively bleeding or critically located KS, or life-threatening 
KS which is responsive to other treatments.  Other exclusions are 
grade 2 or greater peripheral neuropathy from any cause, seizures 
in the last 10 years, any cancer except completely removed basal 
cell carcinoma of the skin, active severe or life-threatening 
infection, or KS treatment in the last three weeks with 
chemotherapy, interferon, radiation, steroids, or any local KS 
treatment such as intralesional injections.  There are other 
entry criteria, but the ones listed above are most likely to 
exclude potential volunteers.  Because this is the first human 
trial of the drug, the entry criteria are strict both to reduce 
the danger to the volunteers and to allow the most scientific 
knowledge to be obtained; future trials will probably have less 
severe restrictions. 

     As this article goes to press, two volunteers are enrolled; 
as many as 48 will be recruited.  The drug is given 
intravenously, during one hour, every other day.  Eight dosage 
levels will be tested (from 4.6 to 76.3 mg per meter squared 
every other day), with three to six patients at each level, 
unless toxicity prevents the higher doses from being tried.  The 
reason for the schedule with the two-week break is that new drugs 
are not usually tested in humans for longer than the animal 
toxicity trials have run, in this case four weeks; the FDA 
allowed a six-week test after the break, since there was no 
evidence of any cumulative toxicity in the animals. 

Arrangements 

     Volunteers will probably need to stay near Washington, D. C. 
for most of the 12 weeks of the trial.  (The 12 weeks includes a 
two-week rest period, after the first four weeks, during which 
volunteers from outside the Washington area can go home.)  For 
the first two weeks of receiving the drug, each volunteer will be 
an inpatient at the Clinical Center of the National Institute of 
Health, in order to allow careful medical monitoring.  For the 
rest of the time, living expenses can be partially covered for 
those from outside the Washington area.  Persons must pay their 
own expenses for traveling to NIH for the first time to be 
evaluated for this trial; after they are accepted as NIH 
patients, NIH will pay transportation to and from home, in 
addition to the living expenses. 

     For information about volunteering for this trial, call 
Sergio Bauza, R. N., or Kathleen Wyvill, R. N., at the National 
Cancer Institute, 301/496-8959, or James Pluda, M. D., 301/496- 
8398. 

***** WF 10:  Big Claims, Little Information 

by John S. James 

     In late October the Associated Press reported on the testing 
of an AIDS drug, called 'WF 10', in Thailand.  The story 
generated much interest after it was reported on television and 
radio as "a breakthrough in AIDS therapy" that "completely 
abolishes the ability of free virus particles to infect cells." 

     The AP story for newspapers reported that the drug was made 
in Switzerland and had been tested in 70 people with AIDS at 
Bamrasnaradura Hospital near Bangkok, by a German researcher, Dr. 
Friedrich-Wilhelm Kuehne, described as recognized in wound 
healing.  It said that the drug had been administered since 1991, 
and quoted Dr. Kuehne saying that the drug had been given to 500 
patients without serious side effects.  Neither of the stories we 
have seen has included any information about what the drug is, 
how it is supposed to work, or how it is used. 

     An AIDS TREATMENT NEWS computer search of AIDSLINE, a 
database produced by the U. S. National Library of Medicine which 
includes citations to AIDS-related articles published in over 
3,000 different journals, found no reference to WF 10 or to Dr. 
Kuehne.  A search of the last 25 years of MEDLINE, which contains 
citations and often abstracts for millions of journal articles in 
all fields of medicine, was similarly fruitless.  (AIDSLINE 
contains the AIDS-related entries of MEDLINE, plus additional 
entries for AIDS conference presentations which do not appear in 
MEDLINE itself.) 

     We also searched the last 17 years of EMBASE, a European 
database comparable to Medline.  EMBASE is often better than 
MEDLINE for researching the newest and most experimental drug 
trials, because it indexes hundreds of European and other 
journals which are not covered by Medline and seldom seen by U. 
S. scientists and physicians.  EMBASE had two references to 
articles co-authored by FW Kuehne, published in 1977 and 1978; 
both concerned wound healing. 

     This is all we know so far.  If anyone has more information 
about WF 10, we would appreciate hearing from them. 

Comment 

     The new-drug stories which flash onto the media and then 
disappear create unwanted stresses for patients subjected to 
repeated cycles of excitement and disappointment.  This is why 
researchers are expected to present their results first to a 
professional forum where their work can be evaluated.  There may 
still be newspaper publicity, but then other professionals can at 
least respond intelligently, helping to balance the story. 

     But we cannot be too quick to condemn, because it is also 
true that physicians or other researchers without connections 
seldom have any viable opportunity to obtain a fair evaluation of 
a treatment they believe in.  AIDS TREATMENT NEWS gets requests 
from persons, especially in developing countries, wondering where 
they can go next with what they think might be a useful AIDS 
treatment.  We have not yet found advice to give them that we can 
be happy with.  Even in the U. S., dozens if not hundreds of 
promising leads generated by recognized scientists in major 
research centers get published in journals and then sit unused, 
because there is no mechanism to research them further; 
university scientists can seldom afford to move a drug into 
clinical development, and usually no company chooses to do so. 
What is needed is an unbiased professional team which can quickly 
scan all these leads and make sure that the most promising ones 
get further attention. 

     We believe that major AIDS treatment improvements are still 
as likely to come from unexpected discoveries as from rational 
drug development.  Unless the system is open to chance 
discoveries and unanticipated observations -- and it is seldom 
open today -- the best opportunities may be lost.  This is why we 
avoid dismissing new-drug stories too quickly, even when the 
early information is less than convincing. 

***** Anger at Women's History Study Delay 

by Nancy Solomon 

     Doctors, researchers and activists say a two-year delay of a 
study that could help  understand the progression of HIV disease 
in women is hampering efforts to prolong the lives of women with 
AIDS. 

     A natural history study of women with HIV was promised by 
the National Institutes of Health during the December 1990 Women 
and HIV Conference in Washington D. C.  But the Request for 
Applications (RFA), the governmental process that allows 
researchers to apply for funding and participation in the study, 
has not yet been released. 

     "We could have good answers by now," said Dr. Judith Cohen, 
an epidemiologist who studies HIV in women at the University of 
California, San Francisco.  "While we waited the last year, 
10,000 more women were diagnosed." 

     A similar study of men,  the Multicenter AIDS Cohort Study 
(MACS), has been following the progress of more than 5,000 gay 
and bisexual men since 1984, and has spent $100.3 million. 

     The National Institute of Allergies and Infectious Disease 
(NIAID) is coordinating the women's study, called the Women's 
Interagency HIV Study, and has allocated $5 million for 1993.  A 
nurse in the epidemiology branch said that the RFA was just 
approved by the head office at the NIH and that it should be 
published by mid-November at the earliest. 

     "It just takes a long time for RFA to go through the 
approval process," said Miriam Galbraith, a nurse consultant for 
NIAID who is the deputy project officer for the study.  "The idea 
has to be approved before writing the RFA itself." 

     In San Francisco, Dr. Cohen is waiting for the RFA so that 
she can apply for funds for the study.  She is working with Bay 
Area Research Consortium on Women and AIDS (BARCWA), which is 
ready with 450 HIV-positive women to begin the natural history 
study. 

     Once approved, the study would continue to enroll women as 
soon as they know they are HIV-positive and monitor their health 
for four years.  "We just don't have much research on women," Dr. 
Cohen said.  "It is particularly important (to look at) women 
(because) we have a whole set of indirect evidence that something 
else is going on ...women have body parts that men do not." 

     The current standard of care for women with HIV does not 
include information about gynecological problems, Dr. Cohen said. 

     The Centers for Disease Control announced on October 27 that 
it would expand the definition of AIDS illnesses to include 
invasive cervical cancer, pulmonary tuberculosis and recurrent 
pneumonia, after a two year battle by women activists.  This 
decision, while it does not go far enough, is expected to improve 
the standard of care for women, activists said.  Earlier this 
year, the CDC announced plans to expand the AIDS definition to 
include people whose T-cell count is below 200, but criticism 
that the change still did not address women's needs stalled 
implementation. 

     Women continue to have shorter survival rates than men, 
although the gap has narrowed.  Dr. Cohen published research in 
the July 1992 Journal of Infectious Diseases that showed that men 
in San Francisco survive four to five months longer than women in 
San Francisco.  The study examined men and women with comparable 
opportunistic infections. 

***** After the Election:  Are We Ready? 

by John S. James 

     Note:  Due to travel schedules, this issue had to go to 
     press one day before the election.  This article and the one 
     below report on the rethinking of the relationship between 
     AIDS and government which has been stimulated by the chance 
     of a Clinton victory.  This issue is important no matter 
     what happens in the election. 

     If Clinton wins, the AIDS community must immediately attend 
to the transition.  But even if Bush wins, the issues below are 
still critical; the momentum of the rethinking must be continued, 
so that the AIDS community can do better in detailing what needs 
to be done and advocating for it. 

     For several weeks the prospect of a Clinton presidency has 
stimulated new thinking among those concerned with AIDS policy. 
The possibility of a government open to rational and 
compassionate health policies is widely seen as the opportunity 
of a lifetime to improve AIDS research and development of 
treatments and vaccines, to develop effective prevention 
programs, and to reform healthcare delivery for the benefit of 
all.  But the AIDS community must move rapidly to take full 
advantage of these opportunities; some critical times have 
already passed, others are between now and January, and during 
the first 100 days of the new administration. 

     Are we ready?  Over 25 interviews with policy experts have 
given mixed answers.  On a number of clear and easy 
recommendations, problems Clinton could fix almost with the 
stroke of a pen, there is very good consensus within and among 
the AIDS community, the medical community, and, we believe, 
Clinton's team.  Here, actions likely to be taken quickly will 
build momentum and good will. 

     But on the most difficult questions, such as detailed 
recommendations on how to coordinate AIDS research policy and 
management among the many government agencies involved, 
discussion and consensus building have only begun.  And few are 
yet willing to address the issue of which people to recommend for 
particular positions.  Yet these decisions will have to be made 
in the next few weeks or months; to the extent that the AIDS 
community is not ready to participate, they will be made without 
its input.  (The good news, on the other hand, is that thinking 
is fluid and open, without hardened positions or division into 
camps.  People in the AIDS community basically agree on what is 
needed, and agree with what Clinton has said; where we lack 
formal consensus it is because people have not had time to think 
through and discuss the issues, not because of incompatible 
visions or goals.) 

     The article below is an interview with AIDS organizer and 
professional lobbyist Tom Sheridan, who worked on the transition 
four years ago when Bush was first elected, but has not been 
involved this time.  We asked Mr. Sheridan to outline what an 
effective transition might look like, what went wrong in the Bush 
administration, and what the AIDS community should do now.  We 
asked for an ideal picture in order to help guide the real-world 
efforts. 

     We hope to publish a separate article looking in depth at 
the transition proposals and preparations under way, and at some 
of the substantive ideas being discussed. 

***** Effective Transition:  Interview with Tom Sheridan 

by John S. James 

     Tom Sheridan is the founder of The Sheridan Group, a 
government and public relations organization in Washington. 
Previously he was director of public policy at the AIDS Action 
Council. 

     ATN:  What would a good presentation to a presidential 
transition team look like? 

     TS:  From a substantive standpoint, you need a fully expert 
and politically savvy document, one that all of the major leaders 
of the AIDS community have participated in; you need a consensus 
document from the community.  The recommendations must be so well 
done and thoroughly researched that they are unassailable.  If 
you ever give people information they can't trust, you're in big 
trouble; at this level of politics, you must give extremely 
accurate and useful information. 

     The document must be very specific.  If you think that NIH 
should change how it does business, for example, you would want 
to tell how the changes should be set up, who would be in charge, 
what the components of the research objectives should be, what 
the budget would look like, etc.  If it required a legislative 
component, you would spell that out as well (which Congressional 
committees the legislation would go through, etc.) 

     I would also recommend having a dossier on potential 
personnel, and the jobs that would be ideal for them. 

     ATN:  Most of those I have interviewed don't want to discuss 
people yet. 

     TS:  That is unfortunate.  For one thing, there is going to 
be an AIDS policy coordinator ("AIDS czar"). 

     ATN:  There is talk about this being two persons, one in the 
White House and one in HHS (Dept. of Health and Human Services). 

     TS:  What is most important to understand is what Bill 
Clinton thinks of this issue.  Clinton wants somebody in the 
White House.  I imagine this person will be in charge on these 
issues, and not share responsibility with someone at HHS, but 
oversee responsibility for all AIDS issues.  This is not just an 
HHS role; the AIDS czar at the White House is also going to be 
looking into issues like mandatory testing of Job Corps 
applicants, and the defense department.  For example, the recent 
controversy over the $20 million dollars appropriated 
specifically to study the gp 160 vaccine raises huge issues over 
how well we're coordinating the research on a Federal level.  $20 
million to one drug because of a lobbyist.  [Note: Sheridan had 
represented Genentech in opposing the earmarking of that money 
for studying a particular kind of vaccine.  Many others have 
agreed with this position; for background, see "Lobbying for an 
AIDS Trial," Science, October 23, 1992, pages 536-539.] 

     Clinton wants somebody in the White House to be in charge. 
The politics is, what does Bill Clinton intend?  Do we agree with 
his commitment to this?  I think we do.  Then the issue is what 
can we do to use this position and this commitment to the best 
possible advantage for people with HIV. 

     The first level of a good (transition) document and 
presentation is to understand what the politics is giving you, 
and then take advantage of those things.  In social work, there's 
an old saying that says start where the client is.  In this case 
the client is Bill Clinton, and we need to know where he is.  I 
think we do know, that he's with us by and large.  He knows what 
he's doing, and is willing to do what we think is good to do, but 
we need to be coordinated in our approach. 

     We should not have multiple and conflicting recommendations 
going into the transition team.  If the National Commission wants 
to coordinate this, that's not a bad idea.  But these decisions 
need to be made now. 

     Also, we should be coordinated with, but not necessarily the 
same as, what the gay and lesbian community is doing in getting 
gay and lesbian people appointed to positions in the new 
administration. 

     ATN:  This kind of thinking has been lacking.  In the last 
few months, when a Clinton victory became possible, many people 
started saying, "Oh -- we better start working out what we want." 

     TS:  The onus of responsibility here, in taking advantage of 
any change of political leadership, is on the shoulders of those 
in the AIDS community who claim leadership.  Our inability to 
coordinate our efforts, to better present substantive 
information, and to have consensus on recommendations, will hurt 
us.  We have to agree with each other before we can expect the 
President of the United States and the whole administration to 
agree with us.  But on the big picture, we have had difficulty 
allowing people to lead. 

     ATN:  I'm hearing wide agreement on the need for consensus 
if we are going to have influence in the transition.  But to get 
that, people are staying with generalities. 

     TS:  That reflects our politics, our inability to have tough 
conversations with each other, to sit and work out consensus. 
That's not simple.  But if we can't do it, we have lost the 
opportunity.  If we don't know what we want, how are we expecting 
to tell the United States government?  If you put out platitudes, 
if you don't take the opportunity to talk about people who would 
be good, if you can't put away personal ego, vendetta, jealousy, 
then we're in the wrong epidemic. 

     ATN:  It might help to outline what you did in the 
transition in 1988. 

     TS:  In 1988 we got the national leadership of NORA 
(National Organizations Responding to AIDS) together, and we 
asked for substantial input from experts in the research 
community on the NIH part of it.  We identified all key staff 
members and worked with them closely.  In November 1988 we 
scheduled a meeting with the director of the transition team for 
Bush, we met with all the people who had any influence in the 
transition on health and social services issues of AIDS.  Bush 
himself happened to come in on this conversation, and sat for a 
few minutes and discussed what our recommendations were.  We were 
the first ones there, we had our document ready.  We knew there 
would be a new president, and whoever it was, we were going to 
say the same things to them. 

     ATN:  What went wrong in the Bush administration?  Why 
wasn't that early momentum sustained, at least as far as us being 
able to express what we wanted? 

     TS:  We were good at expressing it.  The Bush administration 
had the largest distance I had ever seen between policy and 
politics.  George Bush will do anything politically; he will talk 
to anyone, say anything, he is incredibly "out there" in 
conversations with people.  He would come into the room with AIDS 
activists and talk about the issues, and his hopes for doing 
better, being compassionate. 

     But after that was over, there was never any serious 
presidential leadership.  That's what it takes.  It will take a 
president to say to the heads of the agencies, to the AIDS czar, 
"This is what I want done."  That's what George Bush personally 
was never capable of doing.  He was not capable of saying out 
loud that this was an issue of importance to him.  And that 
message got across to everyone loud and clear. 

     If we still have Bush after the election, then there's a lot 
that needs to be done in terms of pressure points, and serious 
work with the Congress and the president.  But if Bush wins this 
election, I think it's clear that he'll perceive his win to be 
that right-wing coalition; what he will be forced to do is to set 
things up for Dan Quayle in 1996, and that doesn't bode well for 
us at all.  I think we will have a worse, more entrenched, more 
resistant presidency.  With no threat to re-election, I think 
George Bush, having sold his soul already, will simply pay the 
rest of the tab.  The possibility for changes with the re- 
election of a president is very limited -- only a shuffling of 
people within the agencies and the cabinet. 

     ATN:  If Clinton wins, one issue is whether the AIDS czar 
will have to be an M. D. 

     TS:  I don't believe the AIDS czar needs to be an M. D.  He 
or she will probably need a scientific advisor, probably an M. D. 
The central criterion for the AIDS czar job is a personal 
relationship and respect with the president of the United States. 
That is what will get the job done.  If people are not working 
together, that AIDS czar has to be able to go to the president 
directly and get results.  Otherwise what we will have is NAPO 
(National AIDS Program Office) transferred to the White House. 
We don't need that.  What we don't need is another level of 
bureaucracy. 

     We do need political and policy sophistication to get some 
very important work done.  The AIDS community has the opportunity 
now to lay out the blueprint for that substantive work in the 
transition process.  But doing so requires substantive and 
political work internally. 

     ATN:  One concern is that we clearly need more coordination, 
including across institute boundaries at the NIH.  But NIH has a 
strong tradition of independence of the institutes.  And the 
scientists like the investigator-initiated free-form grants, as 
undirective an approach as possible.  The scientific community is 
in a position to drag its feet and hurt things no matter what the 
push is from the top.  How do we avoid that? 

     TS:  We need to recognize that the U. S. Public Health 
Service, and therefore the National Institutes of Health, is a 
government agency.  They are responsible to serve people, 
taxpayers in the U. S.  What they do scientifically is not 
appropriate for political manipulation.  But what they do with 
the money they spend is something they should be held accountable 
for.  We cross those two lines all the time.  Accountability is 
different than manipulation.  Politics is about accountability. 
NIH gets its money through Congress; that's politics.  They're 
accountable to Congress for what they spend and do. 

     But when Congress says spend $20 million for gp 160 (a 
particular kind of vaccine), that's wrong, that's manipulation of 
science using a political process.  These are two different 
things.  But it is naive of scientists to say they don't want 
politics interfering with their work.  They should work for a 
private research entity and not the U. S. government if this is 
their major concern. 

     ATN:  That can be a hard distinction to make. 

     TS:  It shouldn't be.  Government agencies are paid for by 
the taxpayers.  We have the right in a democracy to expect them 
to do things on our behalf.  Reasonable expectations and 
accountability should be clearly understood by government 
scientists. 

     ATN:  But if it boils down to who's in charge, then how do 
you leave the gp 160 to scientific judgment, and still have 
political accountability, that the public wants improved 
treatments? 

     TS:  The public wants improved treatments, and there are 11 
vaccines that have been produced by private-sector initiative, 
and here's $20 million to figure out what works.  But to say 
here's $20 million for one drug because the company has a 
lobbyist, that's manipulation.  There's a certain level at which 
politics can and should ask for accountability; but there is a 
fine line between legitimate accountability and micro management, 
political interference and manipulation.  The NIH wouldn't exist 
without politics; but we have to be very careful about how far 
anyone goes politically to manipulate what it does.  There is 
clearly a distinction (between accountability and manipulation). 
Clinton has already set a tone, that we can do better, and our 
institutions can be more accountable for their work, and should 
be more responsive to the needs of people.  That's a tone that 
gets set only at the presidential level. 

     Another lesson of the gp 160 incident is that we will need a 
much more vigilant advocacy effort, to find out about such 
problems earlier.  To be good politically, you have to be able to 
get things done affirmatively; but you also need to know what's 
going on so that you can protect defensively when necessary. 

     ATN:  How would you summarize what we must do for the 
transition? 

     TS:  You need good substance, very specific, very well 
researched.  You need good people to recommend for key jobs.  And 
you need to do good politics to get that presentation seen, 
talked about, and acted on. 

     ATN:  One 64-dollar question.  Who in the AIDS community 
would you see as taking the lead in this?  The National 
Commission just had layoffs. 

     TS:  The National Commission may be appropriate.  They just 
got an appropriation of over a million dollars; they have the 
money to do it.  I can't think of anything more important for 
them to do.  You don't need legions of people here; you need a 
community that wants to work together, and you need leaders that 
can build consensus, and somebody that understands politics. 
It's not that big a deal. 

     Maybe a foundation could hire someone, a neutral party to 
come in and broker these matters.  It could be a firm, or a 
single person with respect and credibility.  But the time to do 
it has on some level already passed.  This is an immediate 
priority, and if it's not done well, it could put us five steps 
behind where we could be.  If we get Bill Clinton and yet lose 
the ability to take dramatic steps because we didn't do our 
homework well, then somebody is indictable to people with HIV. 
This opportunity is gold, we've never had it before in this 
epidemic.  George Bush was Ronald Reagan in another body; we 
didn't have the mindset, leadership, public statements.  Now we 
have these wonderful tools to use -- but for little gain if we 
let them lie around and we don't build. 

***** National Commission on AIDS Preparing Presidential 
      Recommendations 

     The National Commission on AIDS is developing 
recommendations for the first 100 days of the administration of 
whatever president wins the November 3 election, as well as the 
new Congress.  A one-day hearing is planned in Washington for 
November 17. 

     Also, written statements will be received through November 
23, 1992.  According to the Federal Register notice of October 23 
(page 48402), "Submissions (2 copies) may be of any length (and 
include supporting documents) but must include a two-page 
summary listing specific recommendations directed to Executive 
and Legislative branches."  All material sent to the Commission 
is public and available for review. 

***** AIDS Treatment Information Sources:  Other Newsletters 

by Tadd Tobias 

     When AIDS TREATMENT NEWS began publishing in 1986 there were 
few options for obtaining treatment information.  Today there 
exist well over a hundred different AIDS-related publications 
offering diverse coverage and views.  We have selected the 
following newsletters that may help our readers meet their needs 
for treatment information.  There is some overlap but each 
publication offers a unique perspective and material not found 
elsewhere. 

* Treatment Issues.  Published 10 times yearly by the Gay Men's 
Health Crisis, Medical Information, 129 West 20th St., New York, 
NY 10011.  Suggested donation for individual subscription is $30, 
or $50 for physicians and institutions.  Newsletter covers 
experimental treatment research for HIV disease and related 
opportunistic infections, including advances in prophylaxis and 
prevention strategies.  A recent issue focusing solely on the 
various aspects of HIV disease and women is available, though 
most editions do not have an overall theme but cover a variety of 
subjects. 

* PI Perspective.  Published twice yearly by Project Inform, 1965 
Market St., Suite 220, San Francisco, CA 94103; 415/558-9051 
from San Francisco and from outside the U. S., 800/334-7422 from 
elsewhere in California, 800/822-7422 from U. S. locations 
outside California.  Newsletter covers allopathic treatment 
information including pharmaceutical drug development and 
clinical trials, vaccine development, and AIDS research policy. 
It addresses broad-based community needs like standard of care, 
early intervention strategies, and prophylaxis for opportunistic 
infections. 

* Bulletin of Experimental Treatments for AIDS (BETA).  Published 
four times yearly by the San Francisco AIDS Foundation, BETA 
Subscription Department, P. O. Box 426182, San Francisco, CA 
94142, 800/327-9893.  Subscriptions are free for residents of San 
Francisco, $45 for nonresidents, $90 for organizations. 
Interested individuals should inquire about low cost 
subscriptions.  BETA mainly covers current AIDS research and 
developments in mainstream medicine.  The newsletter devotes 
whole issues to specific topics such as HIV and women, the skin, 
the eyes, etc. 

* Positively Aware.  Published monthly by Test Positive Aware 
Network, Inc., 1340 W. Irving Park, Box 259, Chicago, IL 60613. 
Funded in part by Burroughs-Wellcome for distribution to HIV- 
impacted communities, this community-based newsletter covers many 
aspects of the AIDS epidemic.  It focuses on research, mainstream 
and alternative treatment information, funding alerts, public 
policy issues, social concerns and community events.  Each 
edition also includes a Spanish language section.  Because of it 
location, Positively Aware includes information about clinical 
trials in the Chicago area, as well as local support services. 

* Critical Paths AIDS Project.  Published monthly by Kiyoshi 
Kuromiya, 2062 Lombard St., Philadelphia, PA 19146, 212/545- 
2212.  Subscriptions are free for people with AIDS or HIV, others 
are asked to contribute $50/yr.  Publishes in-depth information 
about treatments, research, and related political issues.  Also 
contains an extensive listing of community events and support 
services in the Philadelphia area. 

* STEP Perspective.  Published three times yearly by the Seattle 
Treatment Education Project, 127 Broadway East, Suite 200, 
Seattle, WA 98102, 800/869-7837.  Although subscriptions are 
free, donations are encouraged.  Newsletter primarily covers 
treatment information including both mainstream and alternative 
approaches.  Some articles address insurance and other practical 
concerns.  A general information packet and a variety of fact 
sheets are available.  Magazine style format allows topics to be 
examined thoroughly by an extensive scientific review committee. 

* TreatmentUpdate (TraitementSida, French language edition) 
published 10 times yearly by Community AIDS Treatment Information 
Exchange, Suite 324 -- 517 College Street, Toronto, Ontario, 
Canada M6G 4A2, 416/944-1916.  Canadian subscriptions are free. 
Individuals in the U. S. are asked to pay $15/year.  Sliding 
scale subscriptions are available.  Funded to serve a Canadian 
audience, it also follows what is happening in the U. S. and 
Europe.  Newsletter covers broad range of AIDS-related treatment 
issues originating from over 100 peer-review journals.  Often 
dealing with experimental and alternative treatments not covered 
in U. S. publications, the articles include innovative approaches 
not in wide use, or not yet thoroughly researched. 

* PWA Newsline.  Published monthly by Bree Scott-Hartland, 
Editor, Newsline Coalition, Inc., 31 West 26th St., New York, NY, 
10010, 212/532-0290.  Subscriptions are $35 a year, free to 
persons with AIDS who cannot afford the expense.  This 
publication is committed to including diverse opinions of the 
many different people affected by the AIDS epidemic.  Examining an 
extensive array of HIV-related community concerns, the editorial 
content consists of reader's submissions and regularly appearing 
departments such as News/Analysis, International Digest, Medical 
Matters, Prisoner Perspectives, and Bulletins (listings of New 
York area events and services). 

* Notes From the Underground.  Published six times a year by the 
PWA Health Group (the New York City buyers' club), 150 W. 26th 
St., Suite 201, New York, NY 10001, 212/255-0520.  Subscriptions 
are $35/individual rate, $75/institution and physician rate, and 
sliding scale for low income individuals.  The newsletter reports 
on issues pertaining to AIDS treatments including background 
information about particular alternative therapies and their use. 
Also covered are experimental pharmaceutical treatments including 
those already approved but not indicated for HIV-associated 
diseases. 

* Treatment and Data Digest.  Published twice monthly by ACT- 
UP/New York, 135 W. 29th St., New York, NY 10001, 212/564-AIDS. 
Subscriptions are $40.  This newsletter is essentially the report 
of the treatment and data committee of ACT UP/New York.  Very 
current information about public policy, clinical trials and 
research issues.  Newsletter often covers first reports about 
issues not yet thoroughly known by the larger AIDS community, 
which usually leads to further investigations by others.  Good 
publication for the latest treatment activism news. 

* I Heard It Through the Grapevine.  Published sporadically by 
Stephen Korsia, experimental treatment specialist, AIDS Project 
Los Angeles, 6721 Romaine St., Los Angeles, CA 90038.  Request 
free subscriptions by mail.  Newsletter gives a strictly 
subjective yet insightful perspective on alternative treatments, 
and is adept at finding research about little known or studied 
treatments.  Recent topics have included garlic, bitter melon, 
shark cartilage, PCM-4, and others. 

* WORLD.  Published monthly by Rebecca Denison.  P. O. Box 11535, 
Oakland, CA 94611, 510/658-6930.  Rates are sliding scale $5 to 
$100 No one denied subscription because of inability to pay. 
Written by and for HIV-positive women to address concerns 
specific to HIV disease and women including treatment information 
and psychosocial issues.  Newsletters also include forums for 
personal testimonies, activist alerts, and events calendar. 

* The Positive Woman.  P. O. Box 34372, Washington, DC 20043, 
202/898-0372.  Sliding scale subscriptions from $12 to $75. 
Published bimonthly by and for HIV-positive women.  As stated in 
the newsletter, its purpose is to provide mainstream and 
alternative treatment information, and to provide "a forum for 
affected people to express their opinions and to evaluate current 
services, legislation and the social impact of HIV/AIDS." 

* Body Positive.  Published monthly by Body Positive Group, 51B 
Philbeach Gardens, London, SW5 9EB, Great Britain.  Subscription 
fees vary.  Information can be requested by mail or by fax at 
011-71-373-5237.  This newsletter provides a European perspective 
of treatment information not seen in similar U. S. publications. 
Recent editorial content has included overviews of opportunistic 
infections, international conference coverage, pregnancy and 
women with HIV, and social issues affecting people living with 
HIV. 

* SIDAhora.  Published quarterly by Moises Agosto, Editor, PWA 
Coalition, 31 W. 26th St., New York, NY 10010, 212/532-0290. 
Suggested donation of $20 (plus additional charge for 
international delivery).  Original material published in Spanish. 
Each edition focuses on specific aspects of the AIDS epidemic and 
its effect within the Latino/Latina community.  Comprehensive 
coverage includes treatment information, women's issues, 
pediatric concerns, public policy, art, and literature. 

***** California Residents:  No Sales Tax on Newsletters After 
      November 1 

     Starting November 1, California will no longer collect sales 
tax on newsletter subscriptions.  However, sales tax will still 
be collected on books of back issues and all other items we sell. 
All our forms are being revised to reflect this change. 

     Sorry, we cannot prorate the tax over the period of the 
subscription.  If the order or renewal was placed before November 
1 (even if received by us after that date), then the full tax is 
due, even if most of the newsletter issues are received after the 
tax is no longer in effect. 

     For new subscriptions or renewals ordered on or after 
November 1 which include the tax by mistake, we will prorate the 
paid amount to extend the subscription, in order to avoid the 
expense and trouble of refunding many small checks.  If anyone 
who pays California tax by mistake (after November 1, and on the 
newsletter subscription only) wants the refund instead, we will 
send it. 

***** 

AIDS TREATMENT NEWS 
Published twice monthly 

Subscription and Editorial Office: 
   P. O. Box 411256 
   San Francisco, CA 94141 
   800/TREAT-1-2  toll-free U. S. and Canada 
   415/255-0588 regular office number 
   415/255-4659 fax 
Editor and Publisher: 
   John S. James 
Medical Reporters: 
   Jason Heyman 
   John S. James 
   Nancy Solomon 
Reader Services and Business: 
   David Keith 
   Thom Fontaine 
   Tadd Tobias 
   Rae Trewartha 

Statement of Purpose: 

AIDS TREATMENT NEWS reports on experimental and 
standard treatments, especially those available now.  We 
interview physicians, scientists, other health 
professionals, and persons with AIDS or HIV; we also 
collect information from meetings and conferences, 
medical journals, and computer databases.  Long-term 
survivors have usually tried many different treatments, 
and found combinations which work for them.  AIDS 
Treatment News does not recommend particular 
therapies, but seeks to increase the options available. 

Subscription Information:  Call 800/TREAT-1-2 
   Businesses, Institutions, Professionals:  $230/year. 
   Nonprofit organizations:  $115/year. 
   Individuals:  $100/year, or $60 for six months. 
   Special discount for persons with financial difficulties: 
   $45/year, or $24 for six months.  If you cannot afford 
   a subscription, please write or call. 
   Outside North, Central, or South America, add air mail 
   postage:  $20/year, $10 for six months. 
   Back issues available. 
   Fax subscriptions, bulk rates, and multiple subscriptions 
   are available; contact our office for details. 
   Please send U. S. funds:  personal check or bank draft, 
   international postal money order, or travelers checks. 
   VISA, Mastercard, and purchase orders also accepted. 

ISSN # 1052-4207 

Copyright 1992 by John S. James.  Permission granted for 
noncommercial reproduction, provided that our address 
and phone number are included if more than short 
quotations are used. 

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Newsgroups: sci.med.aids