Contents:

1. Buyers' Club Crisis -- Challenge for AIDS Communities
2. Fewer AIDS Deaths: San Francisco Information
3. FDA Advisory Committee Deadlocks on Delavirdine
4. Albendazole Free from Buyers' Club
5. Books: Impure Science
6. Buyers' Clubs List, December 1996
7. AIDS Treatment News Reader Survey

Buyers' Club Crisis  -- Challenge for AIDS Community by John S. James

The first AIDS "buyers' clubs" were started almost ten years ago to obtain potential treatments which were legal but not readily available. Throughout their history these groups have repeatedly provided the first access to lifesaving treatments before they are approved in the U.S. -- and despite important improvements in the drug-approval process, the clubs still continue to do so (by making available NTZ, for example, or albendazole, before workable formal mechanisms were ready; earlier examples included clarithromycin, ddC, and thalidomide). Today many of these organizations, including some of the oldest and largest, face a new threat to their survival. This year's good news (both real and exaggerated) about protease inhibitors and other antiretrovirals in combination has shifted interest to mainstream treatments -- and led to greatly reduced use of "alternative" treatments and nutritional supplements by persons with HIV or AIDS. The major buyers' clubs have largely relied on product sales to keep their doors open and to support their advocacy and education work. They seldom share in the usual funding of AIDS service organizations. And they often lose money on a lifesaving drug, and on the advocacy, patient education, and other services which they do for free. The buyers' clubs themselves and the larger AIDS community must re-evaluate the mission and funding of these organizations. Their loss would permanently weaken the AIDS empowerment movement, threatening serious harm to individuals whether they use buyers' clubs or not. (For example, providing alternative access to NTZ forced its developer, and the FDA, to act more quickly to provide NTZ by authorized channels to persons with cryptosporidiosis; see AIDS Treatment News #258, November 1, 1996. And when the buyers' clubs began, they forced down exorbitant prices at some health-food stores often used by people with AIDS, by providing a non-exploitative alternative; without the clubs, prices will rise again.) Another critical contribution of the clubs is patient education. Nonprofit organizations, controlled by community boards largely made up of persons with HIV, are more trustworthy than for-profit health-food stores for selecting what products to offer, and what information to bring to peoples' attention. A key issue today and for the future will be more focused uses of "alternative" treatments to supplement mainstream therapies -- for treating specific conditions caused either by HIV infection or its complications, or by drug side effects. It is well known that mainstream research is slow to test potential treatments which are already widely available at little cost, since they offer little profit potential. If such approaches are to be considered and used at all it will usually be through the alternative system, at least for the first several years. And here the buyers' clubs are centrally important for collecting and sharing information, even when the treatment itself could physically be obtained elsewhere. The Economics of AIDS Treatment Organizations The original buyers' clubs (which still exist today, after almost ten years) are part of a second wave of AIDS organizations, which challenged the everybody-dies orientation of the early AIDS era. Other organizations in this second wave include Project Inform, AIDS Treatment News, and treatment committees in some ACT UP chapters and other activist groups. This second wave has generally not shared in the mainstream of AIDS funding -- neither the large events, nor foundation grants, nor participation in government programs (there are exceptions). Ten years ago, when the second wave started, treatment activism was not respectable; because of lack of social support for such a purpose, these organizations had to operate in an "underground" atmosphere, on the borderline of the law, amid charges of "false hope." (One example of the overall lack of support is that manufacturers would often refuse to deal with AIDS organizations when they would have no problem selling the same product to health-food distributors; therefore, discretion and intermediaries had to be used.) Today there are basically three kinds of buyers' clubs. The original organizations use product sales to keep the doors open, and also to support advocacy and troubleshooting when necessary to make important treatments available; many also provide libraries or other client education without charge. Another model is to run a buyers' club as a health-food business, although with more focus on a particular community -- but without advocacy, education, or other services which are not sales related. A third kind of buyers' club operates as a project of a larger AIDS service organization which provides the space and perhaps some staff; sometimes these groups are largely volunteer, with product sold at or near cost. The original kind of buyers' clubs -- which have supported their advocacy work through product sales -- have long had the knowledge, experience, and independence to make critical contributions to patient access to important but unapproved medications. These are the ones most threatened in the current era of redirection of treatment resources toward large pharmaceutical companies and away from other institutions of treatment and care. It should not be difficult to raise the money required to make the difference between failure vs. continued availability of this important community resource -- for two reasons. First, relatively little money is required, as these organizations have been self-supporting for many years; they operate efficiently, and generate income. Second, many people who want to donate to AIDS in some way do not have a particular organization in mind; they would be open to the buyers' clubs if they knew there was a need, and if donation to these organizations were commonly talked about in the community, and were made attractive (for example, by explaining better what an organization does, or by offering options for designating how a contribution would be used). The challenge now is for buyers' clubs and their supporters to develop networks of donors -- either working together with the large service organizations, or separately -- to reduce dependence on product sales, and assure continuation of the critically important work of advocacy, troubleshooting, education, and facilitating research, on treatment options which may be critically important but are being ignored or mishandled by government and industry. [See below for a current list of buyers' clubs and related organizations, and some of the services they offer.]

Fewer AIDS Deaths:  San Francisco Information by John S. James

The most important benefit of AIDS treatment is saving lives, but this is often hard to measure. While large clinical trials offer the most authoritative proof that a treatment is working, "survival endpoint" trials often take years, and present major ethical and practical problems, since no one wants to be assigned to the group which spends months or years receiving a treatment that results in more deaths. Also, clinical trials often test drugs under artificial conditions, such as with a non-representative patient group to get cleaner, more homogeneous data -- or with a design more focused on what a company needs to get its new drug approved than on the practical information doctors and patients need to know. The most direct way to get more real-world information is to ask physicians how their patients are doing. It is clear that patients of HIV-experienced physicians are doing much better now than a year or more ago. But it is hard to get numbers to quantify how much better. A formal research project to obtain comprehensive data should be done, but would take some time to organize. Another way to get some indication of how well treatments are working is to look for major changes in overall AIDS death rates (although other factors also influence death rates, including success of prevention programs years ago, people moving into or out of the area being studied, and the usual pattern of more deaths early in epidemics, when the most susceptible tend to become ill and progress most rapidly). And a practical problem here is that public death statistics can take a long time to become complete, as the official forms move slowly through various institutions. One possible indicator of overall survival (although not considered "scientific") is the decline in published obituaries of AIDS-related deaths. Unlike official statistics, obituaries usually reflect recent deaths, not what happened years ago. In San Francisco, one weekly gay newspaper, the BAY AREA REPORTER, has published obituaries for many years. Recently it has been widely noticed that there has been a big decline in the number of them, especially in the last year; and the November 28 issue published some figures in an editorial, "No More Marking World AIDS Day," and accompanying graph. Obituaries have declined by about half just since January of this year -- which was already a big improvement over previous years. There has been no change in the policy of publishing these notices promptly. The editorial notes that in the worst week, several years ago, the paper received and published 37 death notices. This year, the highest number was 16, in January. This week, and also last week, there were four -- and at least three of those in the last two issues were not AIDS-related. (We called the editor and learned that there will be five death notices in the December 5 issue, which appears after this issue of AIDS Treatment News goes to press.) These figures probably underestimate what is possible with the new treatments, since not everybody has access to the best care. Also, two weeks ago on November 21, the BAY AREA REPORTER published an article, "Are Some Doctors Blowing It," by Stephen LeBlanc of the ACT UP/Golden Gate Writers Pool. The writer interviewed several leading physicians, who reported dramatically improved results for most of their patients -- but they also expressed alarm that many physicians, even in the San Francisco area, are not using the new drugs properly, and the benefit could be lost as viral resistance develops. For a copy of the articles, send an email request to salinasguy@aol.com, or write to Editor Mike Salinas, BAY AREA REPORTER, 395 Ninth St., San Francisco, CA 94103.

FDA Advisory Committee  Deadlocks on Delavirdine by Mark Mascolini

The FDA's Antiviral Drugs Advisory Committee split evenly on whether to recommend accelerated approval of delavirdine, the non-nucleoside reverse transcriptase inhibitor developed by Pharmacia & Upjohn. After reviewing data from three clinical trials at a November 22 hearing, four committee members recommended approval despite delavirdine's variable effects on CD4 count and viral load when combined with AZT, ddI, or both. They argued that the drug seems safe (rash is the only notable side effect) and that it may prove useful for people who have failed or cannot tolerate most other drugs for HIV. But another four members of the committee remained unconvinced that delavirdine's impact on CD4 cells and circulating virus would translate into slower HIV disease progression. Indeed, in the one study that evaluated delavirdine's effect on rates of opportunistic diseases or death, delavirdine plus ddI was no better than ddI alone. Now the FDA must decide whether to approve delavirdine pending the results of an ongoing trial that may confirm a benefit, or whether to deny approval. After the hearing, Dr. Donald Batts of Pharmacia & Upjohn expressed confidence about winning accelerated approval and pledged to work with the FDA toward that end. The study that assessed the effects of delavirdine on disease progression compared the standard dose of ddI plus 400 mg of delavirdine three times daily against ddI plus placebo in almost 1200 people with an average CD4 count of 135. All had taken AZT before and about 25% had taken ddI. An independent panel that looks at results as they come in decided to end the trial early because it judged that there would be no difference between the two groups in rates of disease progression or death. At that point there were 66 deaths in the ddI/delavirdine group and 61 deaths in the ddI/placebo group. There were fewer cases of herpes zoster (shingles) and parasitic infections in the ddI/delavirdine group than in the ddI/placebo group. But there was no major difference between the groups in overall rates of opportunistic diseases. Although CD4 counts were substantially higher and viral load drops greater in the combination group in the first 8 to 12 weeks of the study, those differences disappeared. Another trial found that CD4 and viral load improvements were sustained for a year or more among people with less advanced disease who were taking delavirdine plus AZT. This study compared AZT plus placebo with AZT plus one of three doses of delavirdine: 200, 300, or 400 mg three times daily. There were about 180 individuals in each of the four study groups, and their average CD4 count was between 325 and 340. About 60% had not taken AZT before, while the rest had taken it for fewer than 6 months. After 52 weeks of study, people taking either the 300- or 400-mg doses of delavirdine plus AZT sustained 20 to 30 CD4 cell increases, and this improvement was significantly better than the results in the other two groups. The level of circulating HIV stayed about a half-log (3-fold) below starting levels in the 300 and 400 mg groups for 52 weeks, and this decrease in viral load was again significantly better than the decrease in the other two groups. An analyst from the FDA pointed out that CD4 improvements in the two higher-dose combination arms versus the low-dose combination arm and the AZT-alone arm did not begin to emerge until week 24 of the study and did not become significant until week 40. The FDA noted that there was no CD4 difference until 20% of the study participants had dropped out, and that the dropouts as a group were doing worse when they left the study than those who stayed in. As a result, the FDA told the advisory committee it found the CD4 improvement "suggestive but not convincing" and said that finding should be confirmed in another trial. Because of the tight hearing schedule, the company did not have a chance to challenge the FDA conclusion. But Pharmacia & Upjohn's William Freimuth, M.D., later argued that the year-long CD4 response in the two higher-dose delavirdine groups matches the long viral load response in those groups and so is more than "suggestive." Dr. Freimuth also said the company can demonstrate that most of the dropouts in the study who had been taking delavirdine were doing nearly as well as those who stayed in the study -- and substantially better than dropouts who were taking only AZT. Preliminary results from an ongoing study, ACTG 261, suggested that delavirdine plus AZT and ddI may boost CD4 counts more than AZT/ddI, AZT/delavirdine, or ddI/delavirdine after 40 weeks of treatment. But this improvement was not great in a strict data analysis in which results are figured according to original treatment assignments, even if study participants switch to another group at some point. (Experts believe this kind of analysis is the most reliable.) Further data from this study, two thirds of whose participants were drug naive, should be available in mid-January. In the ddI/delavirdine study, nearly half of the persons taking that combination had some skin rash as a result of one or both drugs, and over 40% of those taking AZT/delavirdine had rash. Thirty-one of 296 people taking ddI/delavirdine left the study because of rash, and 7 of 122 taking AZT/delavirdine did so. The rash emerges in the first weeks of therapy, and Dr. Batts said that 85% of those who get rash can keep taking delavirdine at full dose if they also take an over-the-counter antihistamine. But people taking delavirdine should not take nonsedating antihistamines such as terfenadine and astemizole. Other drugs that should not be taken with delavirdine are rifampin, rifabutin, cisapride, triazolam, alprazolam, and midazolam. Delavirdine doubles levels of clarithromycin in the blood. If treatment includes both delavirdine and ddI, the drugs are better absorbed if they are taken an hour apart. An important and only partly resolved question is the effect of delavirdine on protease inhibitors. So far, studies in healthy people without HIV infection found that delavirdine increases concentrations of saquinavir 4 to 5 times and doubles the concentration of indinavir. Possible interactions with ritonavir are less certain because volunteers took only half the recommended dose of ritonavir in the interaction studies. The company is now studying these combinations in people with HIV. The interaction between delavirdine and saquinavir seems enticing because low blood levels are a major problem with the current formulation of saquinavir. But this combination was associated with liver toxicity in the study with healthy volunteers, so it may prove crucial for anyone who takes the two drugs to have regular liver function tests. Some committee members suggested that the most likely role for delavirdine--if approved--may be for people who have used up other HIV drug options, especially those who have failed with indinavir or ritonavir. But committee chair Dr. Scott Hammer noted that using delavirdine only for advanced disease could bias evaluation of its potential worth. He urged rapid study of the drug in triple and even quadruple combinations to see if it can strengthen regimens when used earlier in infection. All committee members agreed that delavirdine should not be used alone, and some were dubious about combining it with only one other drug.

Albendazole Free from Buyers' Club

Albendazole is a drug used in treating microsporidiosis; recently it has been approved by the FDA for an unrelated use, so it is now available to U.S. physicians. Some buyers' clubs carried this drug before it was available in the U.S. There has never been a large demand (probably largely because microsporidiosis is difficult to diagnose), but access has been important for some people. AIDS Treatment Initiatives (see listing above), the buyers' club in Atlanta, will no longer be carrying albendazole, but has a limited supply of about 140 boxes of three 400 mg tablets each. Since this medicine expires in January 1997, the group will give it away to persons with a prescription for it. There is a standard $6 per order charge for shipping and handling. Mail or fax a request and prescription, including the doctor's name, address, and phone number, and the patient's name, shipping address, and phone number. AIDS Treatment Initiatives can be reached at 404/874-4845 phone, 404/874- 9320 fax.

Books: Impure Science: AIDS, Activism,  and the Politics of Knowledge by Steven Epstein,  University of California Press, 1996 Reviewed by John S. James

This book on AIDS treatment activism is based on the author's sociology thesis at the University of California. A striking difference from most AIDS activism books is that the author followed a methodology of analyzing both mainstream and dissenting views in the same way; this differs from the usual approach which tends to accept a mainstream world view as true, and then tries to "explain" other opinions as various kinds of errors. (Many books on treatment activism pick the authors' favorite heroes -- and often villains as well -- typically chosen arbitrarily depending on whom the author happened to talk to; the need to maintain these arbitrary white-hat/black-hat assignments gets in the way of telling what people said and did, and why it was important.) The strength of Impure Science is in telling what happened; its weakness (for the general reader) is that it tends not to come to conclusions, leaving no easy bottom line to take away. Part I of the book, "The Politics of Causation," looks at the questioning by Dr. Peter Duesberg and others about whether HIV causes AIDS. One looks in vain for Epstein's opinions about Duesberg and his views -- but does get a useful 135- page annotated chronology of the controversy. The longer and more important part II, "The Politics of Treatment," looks at many issues in AIDS treatment activism, for example in drug regulation, and in the design and methodology of clinical trials. Epstein sees CREDIBILITY STRUGGLES as central to the dynamic of science -- and is most interested in what it means, for good and/or for ill, when lay persons and groups develop their own expertise and enter into specialized policy realms previously left to certified experts. By making contemporary history accessible in an unbiased way, Impure Science will have lasting value for scholars, writers, policy experts, AIDS professionals and activists, and others with a deep interest in the subject. But it is probably too specialized to have much effect on the sound-bite world of general public discourse. For treatment activists, the practical bottom line that this reader has taken (or, perhaps, constructed) from the book is support for the view that the key factor influencing technical issues of AIDS research/development/treatment policy is the professional consensus (primarily of scientists and physicians, in academic, government, corporate, private, and other roles, but also including some other AIDS professionals, and lay experts to some extent). When treatment activists have an important concern, the best place to take it for action (if action is possible) is usually this professional consensus -- although of course there are also times to address other centers of influence, such as Congress, or the White House, or the FDA, or the public and the media.

Buyers' Clubs List,  December 1996

Each year AIDS Treatment News has published a list of AIDS buyers' clubs, along with activist groups and PWA Coalition chapters, in one of our December issues. This year we have listed the buyers' clubs separately, and provided expanded information for them. Although AIDS buyers' clubs have existed for about ten years, there has never been an exact definition of what is and what is not a "buyers' club." Most buyers' clubs have 501(c)3 IRS status, meaning that they can receive tax-exempt contributions; but other groups organized as businesses have often been included in buyers' club lists (a matter debated for years but never resolved). Our listing below indicates groups which have 501(c)3 status (or are programs of larger 501(c)3 organizations). How did we decide which to include here? We started with our list from previous years, and also looked at lists kept by some buyers' clubs, and at community consensus or recommendations on which buyers' clubs or other businesses to list. Most of those below have been involved with AIDS (or sometimes other immune illnesses) for years. Some organizations which might qualify were not listed because we could not reach anyone by press time. If you believe we have omitted a group which should have been included (or included a group which should not have been), please let us know. We did not include cannabis buyers' clubs here, as we prefer to list them separately. Notes: All or almost all of the following organizations will provide a product and price list on request. Most will accept cash, check, money order, or credit cards, and can provide fast delivery options -- but policies differ, so ask if you need to make sure. The list below indicates which will accept mail order and international orders. Many focus on low prices, and several have lowered their prices recently. Some carry as many as 200 or more different products; others carry as few as one. Some buyers' clubs require membership so that a release form is kept on file; some offer optional membership for product discounts and other benefits; others do not have membership at all. The list below is alphabetical by state, then by city within the state, and then by name of the organization when there are more than one in the same city. For donors, many of the 501(c)3 buyers' clubs are part of larger AIDS organizations; in these cases, contributors usually can designate a donation to the buyers' club. Call the buyers' club for specific instructions on making a donation. Office hours can change; call to confirm before visiting. Buyers Clubs (U.S.) Being Alive Buyers' Club (a program of AIDS Project Arizona), 602/265-2437, 602/265-9951 fax, bealive@apaz.org, 111 E. Camelback Rd., Phoenix, AZ 85012, hours 9:00 a.m. - 6:00 p.m. Mon.-Fri. Mail order accepted, including international. Newsletter. Library. Referrals. Advocacy. Financial-need discounts to local residents. Membership $10 per year. 501(c)3. Part of larger early intervention program, Being Alive. Specializes in products for gastrointestinal problems. Collaborates on alternative research with the Southwest College of Naturopathic Medicine. Prices set at cost plus 15%. Buyers' club growing rapidly. Travis Wright Memorial Buyers' Club (PACT for Life), 520/770-1710, 520/622-5822 fax, http://www.nevernet.com/mentor/pact, 801 W. Congress St., Tucson, AZ 85745, call for office hours. Mail order accepted, including international. Referrals. Advocacy. Financial-need discounts. Works with separate Wellness Program, which began with CARE Act funding and is seeking grants to extend complementary therapy services, including naturopathic physician, massage, and acupuncture. Donation accepted for massage and acupuncture appointments. Healing Alternatives Foundation, 415/626-2316 recorded message, 415/626-4053 office, 415/626-0451 fax, 800/219-2233 (phone orders by credit card only), haf@out.org email, http://www.out.org/hafbuyersclub, 1748 Market St. Suite 205, San Francisco, CA 94102-5806, 12 noon - 7:00 p.m. Tue. - Fri., and 12 noon - 5:00 Sat. Mail-order accepted, including international. Newsletter. Large and well-organized library. Referrals. Extensive advocacy work for access to drugs. Annual membership $1 to $25 sliding scale. 501(c)3. New medical marijuana program. Observational database projects on viral load (which offers four free viral load tests), and on thalidomide. Healing Alternatives also offers a "doctors' report card," a large notebook of peoples' reports of their experiences with physicians they have seen. CFIDS and Fibromyalgia Health Resource, 800/366-6056, 805/965-0042 fax, health@silcom.com email, 1187 Coast Village Rd. #1-280, Santa Barbara, CA 93108. Mail order only. Two newsletters. Special group discounts. Referrals to support groups, but not medical referrals. Focus on immune modulators. Not tax exempt; parent company is Pro Health, Inc. LifeLink, 805/473-1389, 888/433-5266 toll free, 805/473- 2803 fax, delano@dax.win.net, http://www.lifelinknet.com, 750 Farroll Rd. Suite H, Grover Beach, CA 93433. Mail order only, some international. Thalidomide available. Embrace Life, 800/448-1170, 408/464-7444, 408/476-7717 fax, embrace@bnbcomp.net, 2070-C Wharf Road, Capitola, CA 95010. Mail order available, including international. Drop-in office open but call first to confirm. Much information available but not organized as a library. Denver Buyers' Club (PWA Coalition Colorado), 303/329-9379, 303/329-9381 fax, P.O. Box 300339, Denver, CO 80203. Office visits by appointment only. Mail order available, including international. No credit cards. Newsletter RESOLUTE (which is the major service of the PWA Coalition). Small library available. Advocacy. Products offered at cost, no discounts. 501(c)3. Carl Vogel Center, 202/638-0750, 202/638-0749 fax, 1010 Vermont Ave. NW, #510, Washington, DC 20005-3405, hours noon - 6 p.m. Tue-Sat, noon-9:00 p.m. on Wednesday. Mail order accepted, U.S. only. Referrals. Advocacy. Membership $25, includes a free BIA test, and discounts for members. 501(c)3. Some items require a prescription. Produces quarterly educational symposia and workshops. Vendor of the Alternative Therapy Program of the Washington D.C. AIDS Drug Assistance Program, which provides acupuncture, therapeutic massage, Chinese herbal formulas, and antioxidants. Collaborating with Bastyr University in NIH-funded study of the use and effectiveness of alternative therapies for HIV disease. Provides BIA interpretation to measure lean body mass. AIDS Manasota, 941/954-6011, 941/951-1721 fax, 2080 Ringling Blvd. #302, Sarasota, FL 34237-7030, hours 9:00 a.m. - 5:00 p.m. Mon. - Fri. Mail order accepted, including international, but mail order must be pre-paid. Newsletter. Library. Referrals. Advocacy. No special discounts; all product is cost plus 10% (plus $6 shipping for mail order). 501(c)3. Peer counseling. Massage therapy. Healthy PWA program. Pet support service. Emergency housing assistance. Positively Woman to Woman support group. Annual "Until There Is a Cure" conference. Biggest fundraiser is annual two-car raffle. Wholesale Health, 954/764-1587, 888/666-6743 toll-free, 909 NE 18 St., Ft. Lauderdale, FL 33305. Mostly mail order (local pickup possible), some international. Health Link, 954/565-8284, 954/565-8289 fax, 3213 North Ocean Blvd., #6, Ft. Lauderdale, FL 33308, open Tues. - Fri.., call for office hours. Mail order accepted, including international. Newsletter. Library. Advocacy. Financial-need discounts. Membership $30 per year. 501(c)3. Operates comprehensive medical clinic for people with HIV. In addition to alternative treatments, conventional pharmacy is available. Participates in ADAP. AIDS Treatment Initiatives, 404/874-4845, 404/874-9320 fax, 828 W Peachtree St. NW, Suite 210, Atlanta GA 30308. Extended office hours starting January, 10:00 a.m. - 6:00 p.m. Mon. - Fri. Mail order accepted. Referrals. Advocacy. Membership $25 per year. 501(c)3. Some items require a prescription. Library: Works closely with AIDS Survival Project, a separate organization housed in the same building, which has an extensive library and a treatment resource specialist. Boston Buyers' Club, 800/435-5586 or 617/266-2223, 617/450- 9412 fax, 29 Stanhope St., Boston, MA 02116. Mail order accepted, including international. Newsletter. 501(c)3. New program, Treatment Information Network, will focus on referrals, advocacy, and treatment information services for HIV/AIDS. Currently only selling SPV-30, but will offer a range of nutritional supplements beginning December 16. Located at the Boston Living Center. DAAIR, 212/725-6994, 888/951-LIFE (outside New York State), 212/689-6471 fax, info@daair.org email for information, order@daair.org email for orders, http://www.immunet.org/daair. 31 E. 30th Street, Suite 2A, New York, NY 10016. Hours for ordering by phone Mon. - Sat. 10:00 a.m. - 7:00 p.m., or voicemail any time; hours for walk-in, 3:30 p.m. - 6:30 p.m. Wed. and Fri., and 2:00 p.m. - 6:00 p.m. Sat. Mail order accepted, including international. Financial-need discounts. Membership on sliding scale $5 to $25; anyone can request free Membership Outreach Pack. Introductory meeting every two weeks. Treatment advocacy and education forums; support groups; prayer groups; meditation, movement, and other classes. PWA Health Group, 212/255-0520, 212/255-2080 fax, 150 West 26th Street, #201, New York, NY 10001, hours 10 a.m. - 6:00 p.m. Mon. - Fri., and 12:00 - 4:00 Sat. Orders accepted in English, Spanish, and Portuguese. Mail order accepted, including international. Newsletter NOTES FROM THE UNDERGROUND, Spanish edition NOTAS DE LA CLANDESTINIDAD, and many information packets. Referrals. Extensive advocacy for access to treatments, especially for opportunistic infections. 30% discount for persons with AIDS on Medicaid, Medicare, or in need. Treatment education program, Women's Treatment Project support groups, discussion groups, trainings, programs in jails, customized training workshops with agencies. Canada Canadian Nutrition Club, 613/284-0076, 800/996-8466 toll- free from Canada, 613/283-9306 fax, 275 Brockville St., Smiths Falls, ON K7A 4Z6, hours 9:00 a.m. - 5:00 p.m. Mon. - Fri. Mail order accepted, including international. Library. Referrals. Limited advocacy. Pharmacy on site. Registered nutritional consultant on staff and available for counseling. Supplements Plus, 416/977-3088, 800/387-4761 toll-free, 416/977-3099 fax, remedies@web.net email, 317 Adeline St. West #503, Toronto, ON M5V 1P9, call for office hours. Mail order accepted, including international. Library at three locations in Toronto; HIV, alternative therapy information. Financial-need discounts. Sponsors educational forums.

AIDS TREATMENT NEWS  Reader Survey

What kinds of articles should we publish in the future? We would like to hear from you. Our printed reader survey is also online, at: http://www.immunet.org/atn Copyright 1996 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.