News & Notes
On February 15, the New York State Supreme Court stopped New York City's efforts to take home care away from three Medicaid beneficiaries who, because of their disabilities, need 24-hour care. The city acted under a provision of the New York State fiscal assessment law that allows it to place Medicaid patients in nursing homes unless they can prove that they couldn't do things they need to do from a nursing home. The law also allows people to stay in home care if going into a nursing home is not a medically sound move. In these instances, the city wanted to put these individuals in nursing homes, against their doctors' advice and their own wishes, based on the opinion of a nursing home clerk.
New York State Governor George Pataki has released his 19992000 budget, cutting some $2 million for services provided to the AIDS community through the AIDS Institute. He eliminated, at a meager cost of $1 million, treatment adherence programs that help people stick to the new and complex drug therapies. Permanency planning programs to help parents smooth the transition of their children into new families in the event of their deaths were also reduced by $1 million. Dr. Joshua Lipsman, incoming Executive Director of the Gay Men's Health Crisis, responded to the budget cuts by saying, "We have made real progress in reducing the AIDS death rate and the rate of progression to serious illness. This is not the time to cut these programs. Ignorance costs lives; education saves lives."
The governor did add $4.7 million to the budget to pay for the controversial HIV partner notification program, which is opposed by the HIV/AIDS community. Thus, in essence, partner notification is being funded in large part by money that has been taken away from critical AIDS service programs and from programs helping AIDS orphans.
The proposed budget would also cut Medicaid payment rates for hospitals, nursing homes, home care, and personal care. The rate reductions supposedly would not apply to services for people with AIDS and certain other conditions, but healthcare unions and hospitals say that the cuts will wreak havoc on healthcare delivery and have a devastating effect on the quality of New Yorkers' healthcare. The budget proposes that Medicaid beneficiaries enrolled in managed care plans be charged co-payments for prescription and over-the-counter drugs, projecting savings of $500,000.
Despite mounting evidence of increased HIV infection rates among young people and minorities, President Clinton's FY2000 budget, released at the beginning of February, proposes flat federal prevention funding for the fourth year in a row, as well as an anemic 2 percent increase for substance-abuse treatment programs. Proposed increases in care and treatment that are far below the increases Congress provided last year have also raised concerns among HIV/AIDS activists.
"While President Clinton reversed his predecessors' neglect of AIDS care and research, he will share President Reagan's legacy of failure in HIV prevention," according to Daniel Zingale, Executive Director of the Washington, D.C.-based AIDS Action. "Where President Clinton fights to protect young people from smoking, he stands paralyzed in the fight to protect them from HIV."
For prevention funding at the Centers for Disease Control and Prevention, President Clinton proposed $666 million in funding, which is $9 million more than last year, but below the rate of inflation. Even worse, the budget proposal came just days after the CDC released a study showing an increase in the proportion of gay and bisexual men in San Francisco reporting unprotected anal intercourse -- commonly referred to as "barebacking" -- from 30.4 percent in 1994 to 39.2 percent in 1997, a nearly 30 percent spike. Just as alarming is the epidemic's expansion among young women and into minority communities. African-Americans account for almost half of all new HIV infections and half of new AIDS diagnoses.
Citing increased complacency arising from the misperception that new life-prolonging AIDS drugs are somehow a cure, Zingale points out that half of the 40,000 new HIV infections each year are among young people. "Continued prevention paralysis puts the 'Chelsea Generation' at risk for a new AIDS epidemic," he says. "Because we've failed to make safe sex sexy for a new generation at risk, 'bareback chic' is tragically filling the void."
AmFAR, the American Foundation for AIDS Research, announced in early January that a recipient of one of its 1998 grants targeted for AIDS vaccine research has reported a breakthrough in the development of a possible AIDS vaccine, which was tested in mice.
The researcher is Dr. Jack H. Nunberg of the University of Montana in Missoula. Last year, Dr. Nunberg was one of eleven scientists nationwide to receive AmFAR's vaccine grants, which totaled more than $1.1 million.
Nunberg's vaccine was injected into mice, who were then able to fight off the virus. Blood samples from the mice were tested for their ability to neutralize, or destroy, HIV obtained from patients in the United States, Africa, Thailand, and India. Remarkably -- and in contrast to every other vaccine candidate thus far tested in animals or humans -- the blood of these mice killed 24 out of 25 of the AIDS virus isolates tested.
"Jack Nunberg has some of the most interesting data I've seen for an HIV vaccine approach," said Dr. Robert Gallo, Director of the Institute of Human Virology at the University of Maryland. According to Nobel laureate Dr. David Baltimore, President of the California Institute of Technology in Pasadena, "He has brought a badly needed new concept to how anti-HIV antibodies can be induced by a vaccine."
"The development of a preventive anti-AIDS vaccine is essential to stopping the worldwide epidemic of HIV," said Dr. Mathilde Krim, Founding Co-Chair and Chairman of the Board of AmFAR. "Our mission here at AmFAR is to support those scientists whose research is both innovative and grounded in solid scientific hypotheses."
"We think this policy is uninformed, discriminatory, and fraught with ignorance," according to Lori Midson, a spokeswoman for the Denver-based Colorado AIDS Project. "This means that students that are athletes and HIV-positive will be discouraged from revealing their HIV."
Midson was referring to a policy adopted earlier this year by the Poudre School District in northern Colorado that states that an infected student "may be excluded from participation in school athletics," depending on the assessment of a team of school administrators, public health officials, and the student's parents. The policy, which refers to "students infected with a serious communicable disease, including a diagnosis of an HIV or AIDS-related illness," does not specify whether noncontact sports are included in the exclusion.
The policy is in opposition to the approach generally taken by professional and amateur athletic groups, where athletes with blood-borne diseases such as AIDS and hepatitis are not banned from competition. Instead, most of these athletic associations have adopted sanitary procedures for the safe handling of open wounds and spilled blood.
According to Denver infectious disease specialist Benjamin Young, "National Hockey League players with active bleeding are taken off the ice until bleeding stops; the same thing for basketball players." Citing the experience of Earvin "Magic" Johnson, who played professional basketball after his 1991 announcement that he had the virus that causes AIDS, Young said, "Professional sports elected not to make this a big issue." He went on, "To my knowledge, there is no known case of HIV transmission through sports.
This article was provided by Body Positive. It is a part of the publication Body Positive.