Contents:
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1. New Guidelines Advise Later Triple-Drug Treatment for HIV - WPOST
2. AIDS Drug Advances Heralded - WPOST
3. U.S., Brazil Clash Over AIDS Drugs - WPOST
4. New Ideas Sought to Help AIDS Orphans - NYT
5. AIDS and Mad Cow Disease: Two Epidemics That Are Alike - NYT
6. AT HOME ABROAD: OP-ED: Bush and AIDS By ANTHONY LEWIS - NYT
7. Researchers Raise Concerns on HIV Rate - NYT
8. Indian Company Offers to Supply AIDS Drugs at Low Cost in Africa - NYT
9. New Program Aims to Slow Spread of AIDS - Plan is to find those
unaware they're infected and treat them - SFCHRON
10. Minority Groups Facing a Tougher Fight With AIDS - LATIMES
11. High HIV Rates Seen in Young - WPOST

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New Guidelines Advise Later Triple-Drug Treatment for HIV 

By David Brown
Washington Post Staff Writer
Monday, February 5, 2001 ; Page A07 

CHICAGO, Feb. 4 -- New guidelines for human immunodeficiency virus being
released Monday by the federal government advise physicians to start
triple-drug treatment for the disease later than previously recommended.

This suggestion reflects the realization that for all their life-extending
wonders, the potent multiple-drug combinations introduced five years ago
have health hazards and should not be used earlier than necessary.

Those hazards include elevations of cholesterol and other bloodstream fats,
a shift in the distribution of body fat, toxicity to the liver and pancreas,
painful nerve damage in the extremities and possible loss of bone mineral.

Combination drug treatment for HIV, once started, must be continued for
life, which magnifies these risks considerably.

Although the recommendation seems revolutionary in a field in which only a
few years ago the treatment advice "hit hard, hit early" was a battle cry,
experts say it's actually a natural step and unlikely to be controversial.

"This is the way HIV practice has been heading. I don't think this is a sea
change," said Oren Cohen, assistant director for medical affairs at the
National Institute of Allergy and Infectious Diseases, the part of the
National Institutes of Health that helped produce the guidelines.

The guidelines will be released at the start of the eighth Conference on
Retroviruses and Opportunistic Infections, the annual AIDS meeting held in
the United States. The key changes in the 108-page document are cutoff
values for two key blood tests at which doctors should strongly consider
offering antiviral treatment to a patient.

Therapy now should not start until the CD-4 cell count falls below 350 cells
per cubic millimeter of blood. The previous recommendation was to start when
the CD-4 count was below 500. CD cells are a type of infection-fighting
lymphocyte, and their number is a rough gauge of the immune system's
integrity. The normal range is about 800 to 1,000.

For people whose CD-4 counts are above 350, treatment is recommended when
the amount of HIV in the bloodstream exceeds 55,000 viruses per milliliter
of blood. The previous cutoff was 20,000 viruses. (This refers to viral load
as estimated by the RT-PCR technique, the more common of the two methods of
measurement. For the branched DNA test, the new cutoff is 30,000, up from
10,000.)

The guidelines still recommend "highly active antiretroviral therapy"
(HAART) -- the term for various drug combinations -- for all people with
AIDS. That is the stage of HIV infection when symptoms occur and unusual
infections are likely. People who come to medical care within six months of
becoming HIV infected also should be offered HAART. That is because there is
some evidence that early treatment of them may help prime the immune system
to fully suppress the virus for long periods if HAART is subsequently
stopped.

In many ways, this latest change in what constitutes state-of-the-art HIV
treatment recapitulated earlier events in the history of the AIDS epidemic.
When the first antiretroviral drug, AZT, arrived on the scene, its obvious
early benefits to most patients made it popular and highly recommended. Only
later were its problems fully understood. Similarly, two-drug combinations
were highly touted. That strategy, however, led to drug resistance and had
even more side effects.

"So our enthusiasm has shifted yet again to a more conservative approach,"
said Constance Benson, an AIDS researcher at the University of Colorado who
is chairing the retrovirus conference. "I think the difference this time is
that we have more potent, better treatments to fall back on."

The guidelines note there are differences of opinion and no clear-cut data
on the optimal time for starting therapy.

The guidelines have no official authority but are highly respected. They
began in 1998, when the pace of treatment advances became so fast that HIV
experts looked for a way to keep practitioners up to date.

(c) 2001 The Washington Post 



AIDS Drug Advances Heralded 

By David Brown
Washington Post Staff Writer
Tuesday, February 6, 2001 ; Page A05 

CHICAGO, Feb. 5 -- AIDS researchers may be on the verge of producing the
most promising new crop of treatments in years.

Studies presented here today demonstrated progress in the development of
drugs that may help solve many of the knotty problems in AIDS therapeutics
-- bad side effects, drug resistance, and the simple scarcity of options for
people who have run through the nearly two dozen antiviral drugs now on the
market.

The new drug candidates, some tested on small numbers of people and others
only in laboratory experiments, couldn't come at a more opportune time.
About 40 percent of people infected with human immunodeficiency virus (HIV)
ultimately fail on the various drug combinations available today.

The prospect that many new drugs may come to clinical use in a few years was
greeted with both enthusiasm and caution by AIDS researchers at the 8th
annual Retrovirus Conference, the annual midwinter AIDS conference in the
United States.

"It's really exciting," Douglas D. Richman, a researcher at the University
of California in San Diego and one of the conference organizers, said of the
flock of new compounds. "But one should never underestimate the virus's
potential for malice and mischief."

The road to today's HIV therapeutics, however, is littered with the bones of
once-promising drugs. The experts here expect the new wave of
pharmaceuticals -- when and if they arrive -- will broaden treatment, not
revolutionize it.

Paul Volberding, a prominent AIDS researcher at the University of California
at San Francisco, likened the recent history of HIV therapy to the
experience with bacterial pathogens over the last 50 years. Scientific
discovery keeps just ahead of the microbe's ability to evade treatment.

"That's probably the way it's going to be until we get any better ideas. But
there's some optimism that we will be able to continue to provide the
benefit we've seen so far," he said. "We're perhaps buying another several
years or more in terms of what we can do for our current patients," who are
running out of treatment options.

One of the more unusual compounds described yesterday is one called TMC-126.
Synthesized by a chemist at the University of Illinois in Chicago in 1998,
its ability to inhibit HIV's protease enzyme was noticed by researchers at
the National Cancer Institute (NCI), which is in the process of patenting
it. A Belgian company, Tibotec, is researching its potential as a drug at
laboratories in Europe and Rockville.

One of TMC-126's unusual properties is its extraordinary ability to bind to
HIV protease. When mixed in a test tube with the enzyme, only 1 out of every
1 million trillion molecules of the compound is not firmly stuck to the
enzyme.

Equally important is the compound's ability to continue to block the
protease's activity (which is crucial to the HIV's ability to replicate)
even when the enzyme has mutations that make it resistant to all six
protease inhibitors now on the market. This capacity is a function of the
compound's structure, which remains thermodynamically stable in the presence
of a whole range of shapes of the mutant enzyme.

"We're not entirely sure why it's able to do that," said John Erickson, a
chemist who left NCI to work with the compound at Tibotec.

TMC-126 has not been tested in humans yet, and whether this property, which
Erickson and his colleagues have labeled "resistance repellance," will hold
up in human tests is unknown.

In another presentation, Kathleen E. Squires of the University of Southern
California described a 48-week study of a protease inhibitor drug produced
by Bristol-Myers Squibb called BMS-232632. It was tried against nelfinavir,
a popular protease inhibitor, in combination with other antiretrovirals.

About 65 percent of people getting the BMS compound, and a similar fraction
getting nelfinavir, had the amount of virus in their blood fall to
undetectable levels. However, people on the experimental drug had only a
slight rise of cholesterol (and that mostly from an increase in HDL, the
"good cholesterol"), and no rise in triglycerides, another bloodstream fat.

All current protease inhibitors have been associated with a rise in
bloodstream fats -- a problem experienced by about 70 percent of patients
taking that class of drugs.

Joe Eron of the University of North Carolina at Chapel Hill reported that
T-1249, one of a new class of experimental AIDS drugs called fusion
inhibitors compounds, substantially reduced viral load when given as a
once-a-day shot, much like insulin. There were a large number of side
effects, most of them mild, such as pain and swelling at the injection
sites.

While clearly less practical than pills, injected fusion inhibitors may
offer a treatment alternative for people who have failed every other
therapy. As their name suggests, this class of compounds blocks HIV from
entering cells, rather than stopping its replication once the virus is
inside.

(c) 2001 The Washington Post 



U.S., Brazil Clash Over AIDS Drugs 

By Stephen Buckley
Washington Post Foreign Service
Tuesday, February 6, 2001 ; Page A01 

RIO DE JANEIRO, Feb. 5 -- Brazilian health officials and nongovernmental
organizations are accusing the United States of threatening a critical
element of this nation's successful anti-AIDS program as part of an
increasingly bitter trade dispute over Brazil's effort to manufacture more
generic drugs.

In a sign of how tense the clash has become, the Brazilian government has
announced that if world market prices of two patented anti-AIDS drugs
manufactured by U.S. and Swiss firms are not reduced by June, Brazilian
companies will be allowed to produce the medicines no matter what the firms
say.

The dispute is part of a larger campaign by developing nations to get large
pharmaceutical companies to lower prices of their drugs, whose generic
versions often cost 80 to 90 percent less than the brand-name product. The
price of drugs for the treatment of AIDS and other life-threatening
illnesses is one reason Brazil, South Africa and India, among others, have
begun to develop, or are in the midst of developing, generic versions of
them.

"The prices of these drugs are beyond the realm of this world," said Paulo
Teixeira, director of Brazil's national health program. "What we desperately
need is a global negotiation over the prices of these medicines."

The U.S.-Brazilian dispute began when the United States complained to the
World Trade Organization last May about a provision of Brazilian patent law
that says a foreign company must forfeit patent rights to a product after
three years if the company does not begin to manufacture the product in
Brazil during that time. The United States argued that this measure is
designed to force international companies to make products in Brazil and
thus violates WTO rules.

After seven months of unsuccessful negotiations, the United States asked the
WTO on Jan. 8 to form a dispute panel -- akin to a trade court -- to hear
arguments from both governments and issue a ruling. The WTO panel is
expected to announce a decision in June, at the earliest.

Some experts on patent law and advocates for AIDS patients say the symbolic
and political weight of the U.S. challenge may be more important than its
legal or practical ramifications. Brazil, they point out, has been a
champion of generic drug production and has offered assistance to other
countries seeking to set up similar programs.

"Why hassle Brazil?" said James Love, director of the Consumer Project on
Technology, a Washington-based consumer group. "Because they're going around
touting their model" for fighting AIDS "and the big drug companies are going
ballistic because of that."

U.S. officials deny their recourse to the WTO panel will block Brazil's
production of generic drugs or hurt its anti-AIDS effort, saying
Washington's only concern is what they describe as the protectionist part of
Brazil's patent law. The country already makes seven anti-AIDS drugs.

"We have no intention of doing anything to keep them from making [anti-AIDS]
medicines," a U.S. trade official said. "They know that, and we know that.
But they've clearly decided that the best defense is a good offense."

"We're not attacking the Brazilians," a U.S. Embassy official in Brazil
said. "This is really about a specific portion of law, and the question is:
Who owns the patent?"

Brazil has earned praise for its anti-AIDS campaign, which has included free
distribution of combinations of drugs, known as antiretrovirals, to about
100,000 Brazilians infected with HIV, the virus that causes AIDS, or who
have contracted AIDS. At least 580,000 Brazilians are either HIV-positive or
have AIDS, but the number of new cases has stabilized, and the number of
AIDS-related deaths has begun to fall in recent years.

Teixeira said Brazil intends to manufacture two patented anti-AIDS drugs --
efavirenz and nelfinavir -- even while the case is being considered by the
WTO panel if its deliberations drag on past June. At least 15,000 of the
nation's AIDS patients take efavirenz, and another 22,000 take nelfinavir,
according to the Health Ministry.

New Jersey-based Merck & Co. sells efavirenz under the trade name Stocrin
for an annual wholesale price of $4,800 per course of treatment. Rights to
nelfinavir are shared by Switzerland's Hoffman-La Roche Inc. and the
U.S.-based Pfizer Inc., which sells it as Viracept for a wholesale price of
$7,100 a year.

Brazil has been paying the going rate, but if Brazilian companies were to
make those drugs, health officials here argue, each would cost less than
half its current price. If Brazilian companies cannot manufacture them, then
"the prices are just going to continue to be exorbitant, which means people
are going to die over a purely economic question," said Willian Amaral,
secretary general of the Rio de Janeiro Grupo Pela Vidda, an AIDS support
group.

U.S. trade officials contend that even if the WTO rules in favor of the
United States, its rules allow countries to manufacture generic equivalents
of patented medicines in case of a national emergency. And Brazil has
asserted that the AIDS crisis -- once seen as likely to cripple the
working-age population -- is a national emergency.

Staff writer Barton Gellman in New York contributed to this report.

(c) 2001 The Washington Post 



February 5, 2001 

New Ideas Sought to Help AIDS Orphans

By LAWRENCE K. ALTMAN

CHICAGO, Feb. 4 - AIDS has orphaned 12 million children in Africa, nearly
triple the number of political refugees and displaced persons there, and
millions more are expected to be orphaned in coming years, a leading
epidemiologist told the opening session of an AIDS meeting here tonight.

New plans are desperately needed to cope with the growing problem because
"the world does not have any solutions" for the many African communities
that are unable to contend with their high rates of AIDS orphans, the
epidemiologist, Dr. Kevin DeCock of Nairobi, Kenya, said in an interview at
the Eighth Annual Retrovirus Meeting.

"Obviously, it is best for orphans to stay with their families," said Dr.
DeCock, who works for the Centers for Disease Control and Prevention.

But that is impossible for most orphans. With 25 million Africans infected
with H.I.V., the AIDS virus, family members who traditionally would have
taken in an orphaned relative are themselves too sick, already care for too
many other children of their own and for orphans, or have died from AIDS.
Street children roam many communities, increasing the threat of crime and
political instability, Dr. DeCock said.

Orphanhood is only one measure of "a major public health emergency the likes
of which the world has not seen before," said Dr. DeCock, who was invited to
speak because of his years of experience working on AIDS in different
regions of Africa. 

Dr. DeCock called AIDS "Africa's biggest issue since slavery."

Africa and international agencies need to "put aside all preconceived ideas
and develop some radical new thinking about how to care for orphans and
reduce the number of future ones," Dr. DeCock said.

The United Nations AIDS program says that 12 million African children have
lost a mother or both parents to AIDS. The United Nations High Commissioner
for Refugees says that at the end of 1999 there were 3.5 million refugees
and displaced persons and that the number would rise to 6.5 million if
asylum seekers were included.

A successful preventive vaccine is years away, scientists say, and even if
someone suddenly produced one it probably would not prevent the deaths of
people who are already infected. So unless anti-H.I.V. drugs become widely
available in Africa, the orphan problem will remain.

A study in Uganda has shown that 12 percent of uninfected individuals become
infected from their sex partners each year. To reduce the number of new
infections, and ultimately that of orphans, prevention programs for sex
partners in discordant relationships are needed, the study said. 

These and other orphan-prevention programs are inseparable from those aimed
at public health problems like malaria, malnutrition and diseases that can
be prevented by vaccines, Dr. DeCock said. "But public health has not been
brought to bear in a major way on orphanhood and other AIDS problems,
largely because public health systems have collapsed in African countries in
recent decades," he added.

Infection rates in some African countries exceed 20 percent, compared to
less than 1 percent in the United States. If the United States faced rates
similar to Africa's, health officials probably would encourage every citizen
to determine whether they were infected, Dr. DeCock said.

Yet, in Africa, H.I.V. blood tests and other prevention measures are rarely
offered in local hospitals or slums, although developed countries have spent
billions of dollars to combat AIDS there.

Dr. DeCock said that at the largest maternity hospital in Nairobi, where
more than 20,000 women give birth each year, new approaches are needed, like
performing H.I.V. tests rapidly to help prevent mother-to-child transmission
of the virus. Under present conditions, antenatal clinics do not provide
such testing, and even if the tests could be performed, tracking the
findings and notifying patients would be impossible.

The epidemiology of H.I.V. transmission is complicated, and among the many
unknowns is how networks of sex partners influence transmission rates. For
example, someone with many partners can contribute disproportionately to the
spread of a sexually transmitted disease at a community level. Deciphering
such patterns could improve prevention efforts.

Prevention advice needs to be tailored to rates of new infections in
communities. " `Just say no' is equally protective everywhere; just saying,
yes, even only once, carries very different risks depending on who and where
you are," Dr. DeCock said.

The enormousness of the African AIDS orphan problem derives from the fact
that even more African women than men are infected with H.I.V. Elsewhere,
more men than women have AIDS because transmission is primarily by high-risk
groups like gay men and injecting drug users.

Historians examining AIDS in Africa are likely to be troubled by the world's
"extraordinary passivity in the face of such an overwhelming problem," Dr.
DeCock said.

Copyright 2001 The New York Times Company </subscribe/help/copyright.html>  



February 4, 2001 

AIDS and Mad Cow Disease: Two Epidemics That Are Alike

By DONALD G. McNEIL Jr.

PARIS - STRICTLY speaking, there is no connection between AIDS and mad cow
disease. The first is caused by a retrovirus, which overpowers the genetic
material of cells, forcing them to create duplicates. The second is caused
by a prion, an infectious protein that seems to "persuade" other proteins to
imitate its abnormal folds. Whales and mosquitoes have more in common. 

So why even discuss it?

Because, scientists say, the dis similarities end there, and there may be
some lessons for politicians and public health officials in considering how
the two epidemics are alike.

For one, both seem to have originated in a fairly obvious species transfer
that seems to have involved a not-very-obvious trip to the dinner table:
AIDS is believed to be a mutation of a virus from chimpanzees, which are
butchered and eaten in central Africa. Scientists believe that new-variant
Creutzfeldt-Jakob syndrome, the human form of mad cow disease, comes,
obviously, from cattle. 

Cattle, which are not normally carnivores, probably were first infected by
eating meal containing the ground-up carcasses of sheep who died of scrapie,
another prion disease. We play with the food chain at our epidemiological
peril. 

Also, both diseases had gone global before anyone realized it. AIDS started
in Africa, but it wasn't described until perhaps 30 years later, when it
decimated the clienteles of gay bars in San Francisco and New York. It took
another decade for the world to realize that African "slim" was the same
disease and that it was far more widespread in Africa than in America. 

Mad cow was first spotted in Britain in the 1980's, and until recently was
thought to have been contained there. Now bovine spongiform encephalopathy
has been found in France, Germany, Portugal, Spain, Ireland, Switzerland,
Belgium, Denmark, Italy, the Netherlands, Luxembourg and Liechtenstein, and
no one has a clue as to how many people will eventually die of the human
variant. As with AIDS, the incubation period is very long. 

And both, of course, caused panics. Some people became phobic about shaking
hands, sharing a glass of water or letting their children attend schools if
pupils weren't screened for H.I.V. In Europe, sales of beef have plummeted;
in France, the sale of horse meat has gone up by 30 percent. 

Part of that primal fear, suggested Dr. Max Essex, chairman of immunology
and infectious diseases at the Harvard School of Public Health, is that
neither disease is well understood. New flus emerge each year, but the basic
virus structure is known and vaccines are relatively easy to make. But
retroviruses are still fairly new, while prions - which reproduce without
using DNA and are so stable that they resist boiling, alcohol and radiation
- "violate all the principles of cell biology we thought we knew," Dr. Essex
said. 

When scientists can't easily translate a disease into populist terms, the
public gets nervous, he said. The analogy some biologists use to explain
prions is ice-nine, a conceit of the Kurt Vonnegut novel "Cat's Cradle," a
crystal that "teaches" water to stack and crystallize in the same pattern.
The fictional result is not reassuring: it touches the ocean, and the world
freezes. 

Not surprisingly, in the early days of epidemics, scientists flail around.
One 14th-century treatment for bubonic plague was to shave a live chicken's
bottom and strap it to the plague sore (which usually began in the armpit or
groin, so there was some risk of dying of embarrassment first). Since the
purple buboes were egg-shaped, one could see the medieval medical mind at
work.

Modern-day flailing is likely to include fears for the blood supply,
something politicians find easy to stir up. France's great AIDS scandal was
the government's lack of panic; hundreds of hemophiliacs were infected while
health ministers said there was nothing to worry about. Now, fearing mad
cow, the United States has banned blood donations from anyone who lived in
Britain for six months in the 1980's. But there may be no point, since
prions are found in the brain, spine and gut, not in blood, and may not be
transmitted that way.

"We have to make recommendations based on limited information," said Dr.
David L. Heymann, the executive director in charge of communicable diseases
for the World Health Organization, "but it's better to be on the
conservative side and change the rules later."

Official reassurances also played an embarrassing role in mad cow disease.
The epidemic's most enduring image is Britain's agriculture minister, John
Gummer, feeding his 4-year-old daughter a hamburger on TV in 1990 to prove
that British beef was safe.

PANIC can also foster a need to blame someone. Early in the AIDS epidemic,
gay men who didn't want to out themselves had a bitter joke about the
hardest part of having AIDS being breaking the news to your mother that you
were Haitian. Haitians had been demonized because the disease, obscure at
the time, was more common among Haitians, and the first transmission to
American men may have been by a Canadian air steward who had gay sex in
Haiti.

Dr. Essex recalled an African AIDS conference with delegates from Uganda and
Tanzania who agreed that the disease was being spread by truckers on the
highway between Kampala and Dar es Salaam - but each side, he said, insisted
that it had started in the other country. 

This is also a surprisingly familiar pattern in epidemics. In the 1500's,
with the appearance of syphilis in Europe, sailors were rightly suspected,
but the English called it the French pox and the French called it the
Genoese pox. In fact, it seems to have come from American Indians, who gave
it to Columbus's men, some of whom fought at the siege of Genoa. (The Old
World's thank-you gift was smallpox, which did far more damage.) 

Mad cow disease has followed a similar pattern of jingoistic blame. British
beef was banned in 1989 by other Europeans, who hooted at the "rosbifs." But
after cases turned up in France, Italian protesters closed the border to
French beef last year. Until November, Germany's agriculture minister
claimed the country was "immune." Now he is abashed. 

Besides blaming other countries, some blame human sinfulness. Religious
conservatives called AIDS divine revenge on homosexuals, forgetting that it
first killed a lot of hemophiliac children. 

Animal rights groups say omnivorous humans are getting what they deserve for
raising cattle in so beastly a fashion. Throughout the Middle Ages, plague
outbreaks inspired flagellants to walk from town to town whipping themselves
to atone for the sins of others.

Lastly, there is one other similarity between the two diseases: catching
them usually involves a certain amount of fun, which makes them dangerous.

Plenty of people will happily avoid kissing a flu victim - or an Ebola
victim - for a few days, which is all it takes to stop transmission. But
giving up red meat and sex - or even just sausage and unprotected sex -
until all the carriers can be incinerated (in the case of cattle) or
quarantined (in the case of humans) is impossible. Lovers break the rules
secretly; powerful ranching, ground-meal and feedlot industries stall on
letting the rules be changed. As a result, high-risk groups persist,
sometimes secretly, that public health officials must find. 

AND that opens the door to politics, which rarely interferes with
containment schemes for flu or Ebola. Dr. David Nabarro, a W.H.O. official,
recalled disagreeing long ago with an epidemiologist who had published an
article suggesting that AIDS was going to kill vast numbers of Europeans. 

"Aren't you overstating the risk?" he asked. The answer he got was: "It
doesn't matter, does it? Because anything that reduces the number of sexual
partners is a good thing." That, he recalls thinking, was "a very odd
mentality - that it was legitimate to overstate fear because it kept kids
from having lots of sex." 

French scientists and politicians, he said, accepted as a matter of policy
that sex was part of life. As a result, he said, their slogan, from France
to Francophone Africa was: "Save love. Stop AIDS." 

Beefeaters, British or otherwise, await their own motto. 

Copyright 2001 The New York Times Company </subscribe/help/copyright.html>  



February 3, 2001

AT HOME ABROAD

OP-ED: Bush and AIDS

By ANTHONY LEWIS

LONDON -- The most profound and immediate threat to life on earth is the
AIDS epidemic. According to the National Institutes of Health, more than 36
million people in the world now have H.I.V. or full-blown AIDS. Every day
about 15,000 are newly infected with H.I.V., the virus that causes AIDS.

The grimmest figures are in developing countries; in sub-Saharan Africa 8.8
percent of people 15 to 49 years old are H.I.V.-infected. But the United
States and other Western countries are hardly going to be immune from the
consequences of the plague. As millions die around the world, leaving
millions of orphans - as whole societies crumble - our moral posture will be
challenged. So will our economic outlook, based as it is on global
prosperity.

Those realities made it shocking that George W. Bush, in his first major
decision as president, took an action that will increase the spread of AIDS.
That was his decision to deny U.S. aid to family-planning organizations
abroad that inform women about medical options including abortion.

Mr. Bush's press secretary, Ari Fleischer, explaining the decision, said,
"The president does not support using taxpayer funds to provide abortions."
But that was a non sequitur. Government funding of abortions abroad has been
prohibited by law since 1973. The Bush rule says that clinics in developing
countries will lose U.S. funds if they even discuss abortion with their
patients.

What it means on the ground is this: A woman who has AIDS comes to a clinic
somewhere in Africa or Asia. Drugs to prevent transmission of the disease to
newborn infants are not available there. She desperately wants to avoid
bearing the child. But the doctor or nurse cannot advise her on a safe,
legal abortion if the clinic wants to keep its American funds. 

Many family planning groups, knowing that women will not understand a
refusal to discuss abortion, will decide to give up U.S. support. That will
have drastic consequences, because U.S. dollars may provide most of the
contraceptives.

The result? Families will not get contraceptives. Without them, more people
will be infected with H.I.V. - and in due course develop AIDS.

The gag rule on discussing abortion, first imposed by President Reagan, was
dropped by President Clinton. But otherwise the Clinton administration's
record on fighting the worldwide menace of AIDS was unimpressive.

The most shameful action of the Clinton years in this regard was the
pressure Vice President Al Gore put on South Africa to keep it from going
ahead with a plan to impose compulsory licensing on drugs made by the big
international drug companies, so others could make and sell them far more
cheaply. 

The drug issue remains a crucial test of American understanding - and honor.
It was explored by Tina Rosenberg in The New York Times Magazine last Sunday
in one of the most moving and important articles I have read in years.

In the United States and Europe, the anti-retroviral drugs that have made
AIDS a containable disease for many sufferers cost either the patient or the
society $10,000 to $15,000 a year. It has been widely assumed that poorer
countries cannot afford them, and in any event do not have health systems
that could use them effectively. 

Ms. Rosenberg showed that those assumptions are false. Brazil now makes the
drugs itself and has cut the cost by nearly 80 percent; government
commitment has produced clinics to supervise the treatment effectively. Many
lives, and much money, have been saved.

The big drug companies are frantically resisting the precedent. And they
have great lobbying power in the United States, achieved by campaign
donations.

Will George W. Bush find it in him to resist the drug companies? To lead a
great American campaign to get treatment for the H.I.V. and AIDS sufferers
around the world? 

The example of the abortion gag rule gives little ground for hope. There, in
the name of life, he imposed a policy that will produce more death: terrible
death.

I doubt that he did it with knowledge of the consequences. He just wanted to
please his anti-abortion supporters. So perhaps, on the larger issue, he may
still decide that compassion and self-interest both demand serious American
action to fight the AIDS epidemic. 

Copyright 2001 The New York Times Company
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Tuesday, February 6, 2001 

Researchers Raise Concerns on HIV Rate 

By THOMAS H. MAUGH II, Times Medical Writer

CHICAGO--A new study of six U.S. cities, including Los Angeles, shows
alarming levels of HIV infection among young gay and bisexual men,
particularly among African Americans, the Centers for Disease Control and
Prevention said Monday. 

One in every 10 such men is HIV-positive and the proportion climbs to 30%
among African Americans, epidemiologist Linda Valleroy and her colleagues
told the eighth annual Retrovirus Conference. 

The numbers reflect the changing nature of the AIDS epidemic. When the
problem first arose two decades ago, HIV infection was a problem almost
entirely among young white males. Today, according to the CDC, more than
half of the 40,000 new cases of HIV infection in the United States each year
occur among blacks. 

This is the first time that such a study has been conducted, so there are no
comparison data, but officials were surprised at the high rate of infection,
particularly among blacks. 

"That 30% is an amazing statistic," Dr. Helene Gayle, AIDS chief at the CDC,
said at a news conference. "When people think 'gay,' they think 'white.' But
the people still at greatest risk are sexually active gay men, and that cuts
across all races and ethnicities." 

Moreover, only 29% of those who were HIV-positive knew their status, the
study found. That is frightening, experts said, because of the growing rate
of risky sexual behavior among young gay men, which has been documented in
earlier studies. 

The success of treatments using cocktails of anti-AIDS drugs apparently has
seduced many young men into believing that the risks are not as severe as
they used to be, said Dr. Harold Jaffe of the CDC. 

Many also believe that the drug regimens sharply reduce the risk of
transmitting the disease, even though there is no such evidence, said the
agency's Dr. Robert Janssen. 

The numbers confirmed the warnings that AIDS activists in minority
communities have been issuing. 

"It has been very difficult to get the attention that is needed in our
community to really begin to turn this thing around," said the Rev. Alfreda
Lanoix, of the Minority AIDS Project in Los Angeles. 

There is a need for the African American community to "step up to the plate"
to confront notions about homosexuality and deal openly with the AIDS
epidemic, she said, adding that "business as usual is killing our
community." 

In a community that has a high rate of incarceration, many men may be
exposed to the virus in prison; others may engage in bisexual behavior but
do not identify with a white gay or bisexual community--and thus do not
receive information that may be readily available. 

The CDC researchers interviewed more than 2,400 gay and bisexual men ages 23
to 29 in Baltimore, Dallas, Miami, New York City, Seattle and Los Angeles.
The men were questioned and counseled about their behavior, and blood
samples were drawn for HIV testing. 

Overall, 12.3% of the men were found to be HIV-positive, with the rate
ranging from 4.7% in Seattle to 18% in Dallas. Los Angeles was in the middle
at 9.7%. 

Nationally, 30% of blacks, 15% of Latinos and 7% of whites tested positive
for HIV. In Los Angeles, 25% of blacks tested positive, and the percentages
for Latinos and whites were the same as the national numbers. 

About 7% of Pacific Islanders and 5% of Asian Americans tested positive,
according to epidemiologist Trista Bingham of the Los Angeles County Health
Department. 

Although women were not covered in the study, the racial gap there is even
more striking: Three-quarters of all newly diagnosed women are black,
researchers say. 

Cynthia Davis, assistant professor in the department of family medicine at
Charles R. Drew University in Los Angeles, said, "For me, someone who has
worked in the field for 18 years, it's very depressing. Many of these men
are bisexual, which means it's going to increase the rates for African
American women as well." 

About 46% of the men in the six-city survey reported that they had had
unprotected anal sex in the previous six months, Valleroy said. The study
did not specifically address the incidence of risky behavior, but other
studies to be presented at the conference this week are expected to show
that such behavior is rising throughout the country. 

"Risky behaviors are increasing, not decreasing," Jaffe of the CDC said. 

The proportion of young gay men who are HIV-positive increases with age. A
similar study by the same group reported last summer that 7.2% of gay and
bisexual males ages 15 to 22 were HIV-positive, with the rate among black
men soaring to 19%. 

When the data in the new study were broken down by age, Valleroy said, 10.2%
of the 22- and 23-year-olds were found to be HIV-positive, compared with
14.2% of the 26- to 29-year-olds. 

Researchers are not completely sure why young blacks are so
disproportionately represented. But Dr. Carlos del Rio of the Emory
University School of Medicine noted that diseases such as AIDS are most
common among groups that have been marginalized by society, such as gays.
Black gays are perhaps the most marginalized of all, he added. 

"In African Americans, there is a much greater stigma about being homosexual
than there is among whites," he said, and much less support from their
peers. As one expert said, there is no black equivalent of West Hollywood. 
* * *
Times staff writer Jocelyn Stewart contributed to this story. 

Copyright 2000 Los Angeles Times 



February 7, 2001 

Indian Company Offers to Supply AIDS Drugs at Low Cost in Africa

By DONALD G. McNEIL Jr.

PARIS, Feb. 6 - In a move that could force big drug multinationals to cut
the prices of their AIDS drugs in poor countries, an Indian company offered
today to supply triple-therapy drug "cocktails" for $350 a year per patient
to a doctors' group working in Africa. 

The Indian company, Cipla Ltd. of Bombay, a major manufacturer of generic
drugs, made the offer to Doctors Without Borders, which won the Nobel Peace
Prize in 1999 for its work in war-torn and impoverished areas. In Africa the
group sets up small pilot programs to develop models for broader approaches
to combat AIDS, and would distribute the Cipla drugs free.

As part of its program, Cipla would also sell the drugs to larger government
programs for $600 a year per patient, about $400 below the price offered by
the companies that hold the patents. "This is the way to break the
stranglehold of the multinationals," said Dr. Yusuf K. Hamied, chairman of
Cipla, who will meet with the doctors' group on Feb. 15 to discuss strategy.


For two years, Doctors Without Borders has led an aggressive campaign to
force multinationals to cut prices on life-saving drugs for the world's
poorest patients. 

Other parties in the campaign are the Philadelphia and Paris chapters of the
AIDS Coalition to Unleash Power, and the Consumer Project on Technology, a
Washington group started by Ralph Nader. 

The normal cost of the AIDS cocktail in the West is $10,000 to $15,000 a
year. Last May five multinationals, backed by the World Health Organization
and other United Nations agencies, offered to sell their components to poor
nations at sharply reduced prices.

But Cipla and other makers of generic drugs in Brazil, Thailand and other
countries have not been part of the talks with W.H.O., a situation that
Cipla hopes to change with its aggressive entry onto the scene. 

The country-by-country negotiations about how the multinationals distribute
the drugs have gone slowly, and so far only Uganda, Senegal and Rwanda have
agreements. The companies refuse to release figures, but the cost of a
typical cocktail in Senegal is $1,000 a year, according to Doctors Without
Borders. 

Dr. Bernard Pecoul, director of the Access to Essential Medicines project
for Doctors Without Borders, said the Cipla offer, which he learned of only
today, "will let us start up our pilot projects on a larger scale."

The doctors' group has 40 AIDS projects around the world, about half in
Africa, where the infection rate reaches as high as 36 percent. Only five of
these pilot programs are giving out antiretroviral cocktails. With the Cipla
offer, or matching ones from other companies, up to 20 could be distributing
the drugs by the end of year.

Cipla is offering to sell the agency as many doses as it is wants at $350 a
year. Dr. Hamied said that his company would lose money at that price, but
that he would supply "10,000 doses or 20,000 or 30,000, however many they
want."

The $600 price to governments is near Cipla's break-even point, he said, but
costs could drop with greater production. If that happens, he would cut
prices further.

In India he sells the same cocktail for about $1,100 a year. But he denied
that he was trying to grab market share in Africa. "What do I want with
market share?" he asked. "I don't have a monopoly, and the only way to make
real money in drugs is with a monopoly. In this disaster, there is room for
everybody."

Wide distribution of the drugs in Africa is not without critics, given the
attendant need for careful monitoring. Some experts argue that it would be
better to spend the money on providing clean water, controlling malaria and
increasing the use of condoms. But Doctors Without Borders says that the
dangers and side effects of the drugs pale beside the immensity of the
epidemic itself, and that Western testing standards are overcautious.

The typical AIDS cocktail is a combination of any three of about nine
protease inhibitors or reverse transcriptase inhibitors. The chemicals
suppress the human immunodeficiency virus but, as with any chemical therapy,
they are toxic and can damage the liver. In the West, doctors carefully
monitor the levels of the drug in the blood, test for organ damage and check
the levels of the virus in the bloodstream. If the virus mutates to resist
the therapy, the combinations are changed. Careful monitoring may not be
possible in many African settings. 

But with 25 million Africans infected with the AIDS virus, Doctors Without
Borders and other agencies argue, imperfect treatment is better than none.

Dr. Pecoul pointed out that large numbers of infected Africans live in urban
areas where, "with a quite simple clinic, you can deal with anti
retrovirals."

He is also "not convinced" that the batteries of tests routinely ordered for
Western patients are really necessary. "Some people suggest that H.I.V.
testing and clinical followup can be enough," he added. 

The Cipla drug combination is two tablets of 40 milligrams of stavudine, two
tablets of 150 milligrams of lamivudine and two tablets of 200 milligrams of
nevirapine.

In the United States and many other countries, the Bristol-Myers Squibb
Company holds the patent on stavudine, also known as Zerit or d4T;
Glaxo-Wellcome of Britain holds the patent on lamivudine, also known as
Heptovir or 3TC, and Boerhinger Ingelheim G.m.b.H. of Germany holds the
patent on nevirapine, or Viramune.

Western drug companies have shown themselves determined to defend their
patent rights to be sole distributors throughout the world, and Dr. John
Wecker, head of Boerhinger Ingelheim's efforts to negotiate cheaper prices
in Africa, said he did not yet know what his company would do if Cipla
undercut its prices. "We offer a standard quality from the original
manufacturer and can meet any demand that exists out there that can be
delivered with safe procedures," he said.

He refused repeatedly to say at what price Boerhinger Ingelheim sells
nevirapine to Senegal or Uganda, saying, "Affordability is an issue, but not
the major issue."

Representatives from Glaxo-Wellcome and Bristol-Myers did not return phone
calls, but the three companies can be expected to wage a hard fight against
the distribution of generic versions of their drugs.

Late last year, Glaxo-Wellcome threatened to sue Cipla when it tried to sell
Duovir, its generic version of Glaxo's Combivir, a lamivudine/zidovudine
combination, in Ghana. 

Cipla offered the drug for $1.74 a day; Glaxo had cut its price to $2, from
$16. But even though the African regional patent authority said Glaxo's
patents were not valid in Ghana, Cipla backed down and stopped selling
Duovir. 

Asked what he would do if the three drug companies sued to stop him, Dr.
Hamied said: "We won't fight it. I don't look at it as a fight. There's room
for everybody. This is a holocaust in Africa. It's like the earthquake in
India right now - everybody is helping out. I'm not looking to pick
anybody's business; there's room for the multinationals at their price and
room for us at our price, a partnership."

Copyright 2001 The New York Times Company </subscribe/help/copyright.html>  



New Program Aims to Slow Spread of AIDS
Plan is to find those unaware they're infected and treat them 
Christopher Heredia, Chronicle Staff Writer
<mailto:cheredia@sfchronicle.com> 
Wednesday, February 7, 2001 
(c)2001 San Francisco Chronicle </chronicle/info/copyright>  

URL:
http://www.sfgate.com/cgi-bin/article.cgi?file=/chronicle/archive/2001/02/07
/MN148654.DTL
<http://www.sfgate.com/cgi-bin/article.cgi?file=/chronicle/archive/2001/02/0
7/MN148654.DTL> 

Health experts yesterday announced a new national HIV prevention strategy
aimed at testing people unknowingly infected with HIV, with the goal of
reducing the spread of the epidemic by 50 percent by the year 2005. 

The Serostatus Approach to Fighting the HIV Epidemic -- or SAFE -- will use
radio commercials and bus ads to reach out to high-risk communities with the
message: get tested, get treatment and practice safer sex. 

An estimated 200,000 to 250,000 U.S. residents have HIV but don't know it,
contributing to the spread of the deadly disease, say officials with the
Centers for Disease Control and Prevention in Atlanta. 

"Up to now, we've been looking at half of the prevention equation, focusing
on individuals based on factors such as risk behavior, demographic
information like race, sex, age, but never serostatus," said Dr. Robert
Janssen, director of the CDC's Division of HIV/AIDS Prevention. 

Janssen spoke yesterday in Chicago about the new strategy at the Eighth
Conference on Retroviruses and Opportunistic Infections. 

"This new approach will focus on the prevention needs of HIV-infected people
and their currently uninfected partners," he said. 

The $300 million program will aim to increase the proportion of people who
know they are infected from the current 70 percent to 95 percent, then link
them to health care, prevention and treatment services. In doing so, experts
say they can reduce the number of new HIV infections from an estimated
40,000 per year to 20,000 annually. 

Most health experts agree that life-extending AIDS medications have reduced
people's fear of contracting the disease. Others, who are in denial, simply
choose to avoid getting tested regardless of their past risky behavior. 

An estimated 5 million Americans are at high risk for contracting HIV, while
800,000 to 900,000 are currently living with the virus. 

Experts at the conference said only 50 percent of people living with HIV get
treatment. The SAFE program will seek to increase that to 80 percent. 

Some who have been fighting the disease since the mid-1980s in San Francisco
greeted the news with skepticism. 

"I definitely like the idea of getting people tested, into care and engaged
in prevention," said Dr. Thomas Coates, director of the AIDS Research
Institute at the University of California at San Francisco, who was at the
Chicago conference yesterday. 

"What I have reservations about is the fourth piece of the strategy -- the
surveillance part -- which when the CDC talks about it, means names
reporting, " he said. "We're diametrically opposed when it comes to that.
It's a hindrance to people getting the test." 

Coates advocates a formula that preserves anonymity, such as the one used in
San Francisco, in which epidemiologists analyze HIV infection data compiled
from community- and city-run health clinics. Using the information, health
officials come up with estimates of the number of newly infected people. 

Demetri Moshoyannis, executive director of San Francisco-based Bay
Positives, a youth-oriented outreach and support organization for
HIV-infected people 26 and under, said his group has been advocating for
years for HIV positives to know their status. 

"In the early years, nobody wanted to fund this kind of outreach,"
Moshoyannis said. "Now, it's the hot thing. It's great, but it's also a
little frustrating that it took so long to get to this point. I'm happy for
it." 

Moshoyannis called the goal of reducing the number of infections by 50
percent in five years "ambitious." 

"I can't tell you the number of young people I've heard say, 'If I were
positive, I wouldn't want to know,' " he said. "It's an uphill battle. A lot
of people are more comfortable in a state of denial. 

"We have to do a better job encouraging all people to know their status,
young and old alike. It can lead to more proactive behavior, including
taking better care of themselves, choosing medication or other alternatives,
as well as protecting their partners." 

Although health officials are dealing with the complexities of human
behavior, CDC's Janssen said, it's an attainable goal. 

"We think it's doable with a variety of activities, not only through the
media campaign, but with the expanded access to testing as well as
counseling services," he said. 

E-mail Christopher Heredia at cheredia@sfchronicle.com. 

(c)2001 San Francisco Chronicle </chronicle/info/copyright>  Page A3 



Wednesday, February 7, 2001 

Minority Groups Facing a Tougher Fight With AIDS 

Health: Prevention programs used among gay whites do not work in other
communities, critics say, calling for new approaches. 

By JOCELYN Y. STEWART, SHARON BERNSTEIN
<mailto:Sharon.Bernstein@latimes.com> , Times Staff Writers

Charles was young and attractive and viewed the world in a way that would
baffle some. 

AIDS simply did not frighten him. Charles believed in what he saw: His
brother had the illness, but his brother took medications and still appeared
well and healthy. 

Charles simply didn't see himself as being at risk. He had a steady
girlfriend, and although he occasionally had sex with a man, he did not
identify himself as gay or even bisexual. Nor did his family and friends. 

So the young South Los Angeles man passed on using condoms--and in 1996, at
the age of 24, gave himself a one-way pass to an incurable illness. 

"The condom was right there," said Charles, who is now 28 and HIV-positive.
"I just didn't use it. I felt pretty invincible. I figured, it'll be all
right this time. That's how I ended up becoming infected." 

Nearly 20 years after the AIDS epidemic struck the nation, one in 10 young
gay or bisexual men is infected with the disease, according to a study of
six major cities released this week by the U.S. Centers for Disease Control
and Prevention. 

But infection is far more widespread in communities of color. The CDC study
found that the rate of infection among African American men who have sex
with men is 30%. In Los Angeles the rate is 25% for that group and 15% for
Latinos. 

Those who have long fought the disease in the African American community say
that the methods used to stem the tide in the gay white community are simply
not as effective among African Americans. 

"HIV/AIDS must have new and innovative approaches . . . so things can
change," said Cleo Manago, head of the AMASSI Center in Inglewood. 

"The CDC and the public health departments need to reevaluate who they're
funding and why they're funding people to do this work, because clearly it's
not working." 

One difference in the African American community is that, like Charles,
people who engage in homosexual activity may not consider themselves gay.
Different terms, such as "down low," "homo thug" and "same gender loving,"
are sometimes used. 

But the issue goes beyond semantics. 

These are men who are not likely to be in West Hollywood or anywhere else
where information about AIDS is available. They are part of an underground
world living in dangerous ways. And they are hard to reach. 

In their world, perception is everything. AIDS medicines allow those who are
infected to live longer and healthier lives and to continue attracting
partners. 

"If men who are 18, 21, 25 saw the number of men I saw die, it would be very
different," said Wendell Carmichael, 45, who has been HIV-positive since
1986. "They're not seeing that anymore. People are walking around looking
healthy. They're in the gym. They're working." 

The continuing taboo on homosexual behavior in some communities has led many
men to hide their gay or bisexual behavior by dating and marrying
women--with devastating effects. 

In Los Angeles County, 20% of HIV-positive African American men said they
had had sex with women in the past six months, according to a recent county
study. That is compared to 9% of HIV-positive white men who reported sex
with women, and 4% of infected Latino men. 

As a result, the number of black women with HIV and AIDS has skyrocketed. 

"Most women don't even know they're at risk," said Cynthia Davis, an
assistant professor at Charles R. Drew University in Los Angeles. "They find
out when their spouse dies, or when they deliver a sick baby." 

Sylvia Drew-Ivie, director of T.H.E. Clinic, a women's health center in
South Los Angeles, said six women came for treatment of HIV infection just
last week. 

"Married women come in with a string of children behind them," Drew-Ivie
said. "They're infected by their husbands, and they had no idea." 

But even when black men identify themselves as gay or bisexual, they still
may have little or no connection with the white gay community. 

"There's no place for [black] bisexual men to go," said Carmichael. "The
reality is . . . they need programs developed exclusively for them." 

Even locating the men at risk is difficult. "A lot of men are not meeting in
bars," Carmichael said. "There's a whole different mentality of how we
engage each other." 

The meeting places are often smaller settings such as coffeehouses, home
gatherings and workplaces, and the information needed to save lives is not
there, Carmichael said. 

The problem is complicated when ex-convicts engage in high-risk behavior. 

"They come back into the mainstream," said Kevin Spears, 41, who sits on a
county HIV commission. "They have female partners and they may or may not
reveal to their female partners that they were involved in risky behavior. .
. . The authorities who oversee the penal system don't want to have that
conversation. According to their policy, the men are not having sex. If you
talk to the men, they are." 

Reaching Out to Women 

Because of the way the epidemic seems to be spreading among gay and bisexual
men in the county, officials have cut back on efforts to reach out to women
and drug addicts, said Chuck Henry, director of the Los Angeles County
office of AIDS programs and policy. 

But that, unfortunately, feeds the idea that AIDS is not a threat to people
who are not gay. Overcoming that misperception would require outreach
workers to go beyond the usual tactics of talking to men at known homosexual
haunts, such as parks and gay bars. Instead, the subject would have to be
broached at soccer games and church choir rehearsals. 

"That sense of alarm that propelled the white gay male community to organize
against the disease so well in the beginning of the epidemic simply has not
exploded yet in the Latino and African American communities," Drew-Ivie
said. "It just hasn't happened yet." 

But if Charles has any say in the matter, that will begin to change. He has
stopped using drugs and plans to tell his story to young people. In 1998,
his brother died of AIDS, and his death changed Charles' view of the world. 

"I think if I would have seen that before, I would have used a condom every
time," he said. "Because it's not a pretty thing to see somebody die." 

Copyright 2000 Los Angeles Times 


High HIV Rates Seen in Young 

By David Brown
Washington Post Staff Writer
Wednesday, February 7, 2001 ; Page A06 

CHICAGO, Feb. 6 -- Despite nearly a lifetime of safe-sex messages, some
youthful populations in the United States have an astonishingly high
prevalence of infection with the AIDS virus, researchers reported today.

In addition, the ingredients are in place that could make things even worse,
researchers said. More than one-third of the people who know they are
infected continue their high-risk sexual behavior, at least occasionally,
according to new research. A person's tendency to revert to unsafe practices
increases with time, suggesting that "prevention fatigue" sets in as people
with the AIDS virus live longer and healthier lives. The recent rise in
venereal diseases in many cities is evidence that this trend is occurring.

Those are among the insights that emerged this week at the 8th Annual
Retrovirus Conference, the mid-winter AIDS meeting held in the United
States.

The most startling news of prevalence is among young black urban
homosexuals. About 30 percent of them are infected with the human
immunodeficiency virus (HIV), according to a survey of gay men in six
American cities conducted in the past two years by the federal Centers for
Disease Control and Prevention. Among Hispanics, the infection rate was 15
percent, among whites 7 percent and among Asians 3 percent. The cities were
Baltimore, Dallas, Miami, New York, Seattle and Los Angeles.

In the entire sample encompassing all races, only 30 percent of the young
men who were infected knew they were, and many of them were not getting
medical care -- two factors that, theoretically at least, might lead to
steps that would cut their risk of passing the virus on to others. The
chance of doing that was high: 46 percent reported having unprotected anal
intercourse in the previous six months.

A study of older gay men (average age 36) in Seattle showed that the ones
who knew they were infected with HIV were more likely to report infrequent
condom use than did the uninfected men. And about 45 percent of the infected
men had sexual partners who were uninfected.

This risky behavior is seen in non-gay populations, as well. Researchers at
Bronx-Lebanon Hospital Center interviewed 250 HIV-infected people, only 15
percent of whom were gay men. About 40 percent reported having unprotected
sex after learning about their infections. This was more common among women
(50 percent), and most common (65 percent) among people who traded sex for
drugs or money.

Unprotected sexual contact was more common the longer people knew of their
infections. Among people who had learned of their infections within a year,
29 percent had unprotected sex. Among those who had known for five years, 36
percent reported high-risk behavior. And among those who had known for more
than five years, the proportion reporting at least occasional unprotected
sex was 54 percent.

One of the practical effects of that dropping-of-the-guard was evident in
the increase in venereal diseases over time. Only 14 percent of the people
in the sample had a sexually transmitted infection the year after they
learned they were HIV-positive. Among those who had known for more than five
years, 34 percent had contracted an infection.

This last finding is important because sexually transmitted diseases such as
gonorrhea and syphilis greatly increase the chance that a person will either
transmit or acquire an HIV infection. But is that happening now? Data from
the Netherlands presented today suggest it may not be.

Roel Coutinho, a Dutch researcher, reported that at a sexually transmitted
disease clinic in Amsterdam, the proportion of new patients who are men with
rectal gonorrhea or syphilis is back up to what it was in 1985, after
dropping to a low around 1993. However, the number of new transmissions of
HIV does not appear to be rising with it. The reasons are unknown, although
one of them may be that people who are successfully treated with antiviral
drugs and have little virus in their blood are less likely to transmit the
disease.

"We do know that STDs [sexually transmitted diseases] increasing in a
population [is] of great concern. The question of whether that will lead to
a rise in HIV remains to be answered," said Helene Gayle, head of the CDC's
AIDS programs. "But we have all the ingredients with us now to say that it
could."

Elsewhere at the conference, researchers presented data that shed light on
the global AIDS epidemic.

Mario Santiago of the University of Alabama at Birmingham reported that a
team of researchers had, for the first time, diagnosed a simian
immunodeficiency virus (SIV) infection in a chimpanzee in eastern Africa,
near Uganda. The virus is quite different from the SIVs found in
west-central Africa (near Cameroon), which are believed to be the progenitor
of HIV. This supports the theory that HIV was first passed from apes to
humans in west-central Africa.

(c) 2001 The Washington Post