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Archive-name: aids-faq/part1 Posting-Frequency: monthly Last-modified: 2/17/95 AIDS FAQ part 1/10 Welcome to the sci.med.aids, the international newsgroup on the Acquired Immune Deficiency Syndrome (see Q1.1 `What is sci.med.aids?' for more details). This article, called the sci.med.aids "FAQ", answers frequently asked questions about AIDS and the sci.med.aids newsgroup. The FAQ is posted monthly to sci.med.aids and related newsgroups. If you are new to sci.med.aids, please read it before posting articles or responses. If you are a sci.med.aids veteran, please skim the FAQ occasionally. You may find something new here. Please contribute to the sci.med.aids FAQ. Currently there are some gaping holes. Send suggested changes to aids-faq@family.hampshire.edu. You don't have to format it: just send it. Disclaimer: Much of the information here is quoted from other sources. We try to keep things as up to date and accurate as possible. Understand however, that there may be individual parts of this FAQ that you may not agree with, or may not feel is accurate. Feel free to point this out to us, but we reserve the right to leave it as it is. You can skip to a particular question by searching for `Question n.n'. See Q1.13 `Formats in which this FAQ is available' for details of where to get the PostScript and Emacs Info versions of this document. ============================================================= Contents of Entire FAQ (Contained in Part 1 of 10): Section 1. Introduction, General Information, and FAQ Administrative Details Q1.1 What is sci.med.aids? Q1.2 Discussion topics. Q1.3 Sci.med.aids distribution. Q1.4 Periodical Postings on sci.med.aids (please contribute) Q1.5 Subscribing and unsubscribe to sci.med.aids. Q1.6 What is a moderated newsgroup? Q1.7 Editorial guidelines. Q1.8 How do I submit a posting? Q1.9 The moderators. Q1.10 Cooperative moderation - and voting on posts. Q1.11 If a post gets rejected. Q1.12 Discussing sci.med.aids moderation policies. Q1.13 Feedback is invited Q1.14 Formats in which this FAQ is available Q1.15 Authorship and acknowledgements (Contained in Part 2 of 10): Section 2. How to prevent infection. Q2.1 How is AIDS transmitted? Q2.2 How effective are condoms? Q2.3 How do you minimize your odds of getting infected? Q2.4 How risky is a blood transfusion? Q2.5 Can mosquitoes or other insects transmit AIDS? (Contained in Part 3 of 10): Section 3. General HIV/AIDS info Q3.1 Testing Information. Q3.2 Testing Information - Elisa and Western Blot tests (Please Contribute) Q3.3 Symptoms of HIV infection and AIDS (please contribute) Q3.4 AIDS and Opportunistic Infections. (Contained in Part 4 of 10): Section 4. Treatment options. Q4.1 General treatment information. Q4.2 What about "alternative" treatments for HIV/AIDS Q4.2.1 DNCB (Contained in Part 5 of 10): Q4.2.1 DNCB (continued) Q4.2.2 OZONE (Contained in Part 6 of 10): Section 5. Social Services Available. Q5.1 Guide to Social Security Benefits. Q5.2 What if you can't afford AZT? (Contained in Part 7 of 10): Section 6. The common debates. Q6.1 What are Strecker and Segal's theories that HIV is manmade? Q6.2 Other conspiracy theories. Q6.3 Is HIV the cause of AIDS? (Contained in Part 8 of 10): Section 7. Information Sources. Q7.1 Phone Information about AIDS. Q7.2 Phone Information about AIDS drug trials. Q7.3 Phone Information about AIDS treatments Q7.4 US Social Security: Information for Organizations Q7.5 Reappraisal of the HIV-AIDS Hypothesis. Q7.6 American Academy of Allergy & Immunology Physician's Referral and Information Line Section 8. Internet resources. Q8.1 Ben Gardiner's Gopher AIDS Database Q8.2 CDC CDC National AIDS Clearinghouse Internet Services Q8.3 WHO AIDS Cases Information Q8.4 CDC AIDS Public Information Dataset. Q8.5 World Wide Web site on AIDS (French and English) Q8.6 Information about HIV and AIDS related patents Q8.7 ArtAIDS Link Q8.8 HIVNET/AEGIS Gateway (BETA VERSION) - Need update Q8.9 Other USENET newsgroups. (Contained in Part 9 of 10): Section 9. Other Electronic Information Sources. Q9.1 List of AIDS BBSes. Q9.2 National AIDS Clearinghouse Guide to AIDS BBSes. Q9.3 National Library of Medicine AIDSLINE (please contribute) Q9.4 Commercial Bulletin Boards Q9.5 Lesbian/Gay Scholars Directory. ============================================================= Section 1. Introduction and General Information Q1.1 What is sci.med.aids? Q1.2 Discussion topics. Q1.3 Sci.med.aids distribution. Q1.4 Periodical Postings on sci.med.aids (please contribute) Q1.5 Subscribing and unsubscribe to sci.med.aids. Q1.6 What is a moderated newsgroup? Q1.7 Editorial guidelines. Q1.8 How do I submit a posting? Q1.9 The moderators. Q1.10 Cooperative moderation - and voting on posts. Q1.11 If a post is rejected. Q1.12 Discussing sci.med.aids moderation policies. Q1.13 Feedback is invited Q1.14 Formats in which this FAQ is available Q1.15 Authorship and acknowledgements ------------------------------------------------------------------------------- Question 1.1. What is sci.med.aids? "sci.med.aids" is a USENET newsgroup which discusses AIDS and HIV. A gateway forwards articles posted to sci.med.aids to a BITNET listserv mailing list called AIDS. Thousands read sci.med.aids, including people with HIV infections, published authors, researchers, public health officials, and interested individuals. It is carried in several countries, particularly in the Americas and Europe. Sci.med.aids is moderated by a team. When you submit an article to sci.med.aids, it must be approved by a member of the moderation team. ------------------------------------------------------------------------------- Question 1.2. Discussion topics. Sci.med.aids covers topics of interest to people with AIDS (Acquired Immune Deficiency Syndrome), their friends, relatives, and loved ones, AIDS service providers, educators and researchers, and the general public. Some common topics are Causes of AIDS and opportunistic infections. Vaccines for AIDS. Treatments or cures for AIDS and opportunistic infections. AIDS prevention and education. Sci.med.aids carries some regular magazines. Here's a current list: CDC AIDS Daily Summary AIDS Treatment News The Veterans Administration AIDS Info Newsletter If you have the time to add to this list, we invite you to contribute (if you obtain copyright permission, of course). ------------------------------------------------------------------------------- Question 1.3. Sci.med.aids distribution. Sci.med.aids is distributed as a USENET newsgroup, where it has approximately 40,000 readers. At one time USENET was carried primarily at research and educational institutions, but that is changing; a number of commercial services now carry USENET. Here is a breakdown of comparable newsgroups, for the month of June 1994. You can obtain a full list of network traffic by anonymous ftp from ftp.uu.net:/usenet/news.lists/USENET_Readership_report_for_Jun_94.Z +-- Estimated total number of people who read the group, worldwide. | +-- Actual number of readers in sampled population | | +-- Propagation: how many sites receive this group at all | | | +-- Recent traffic (messages per month) | | | | +-- Recent traffic (megabytes per month) | | | | | +-- Crossposting percentage | | | | | | +-- Cost ratio: $US/month/rdr | | | | | | | +-- Share: % of newsrders | | | | | | | | who read this group. V V V V V V V V 54 130000 1387 72% 6769 10.4 12% 0.08 2.8% soc.motss 72 120000 1130 79% 3396 5.0 17% 0.05 2.3% sci.med 86 110000 1301 63% 4001 7.1 13% 0.06 2.6% alt.drugs 139 95000 947 77% 4898 7.8 42% 0.09 1.9% sci.skeptic 156 89000 870 78% 1282 1.7 37% 0.02 1.8% sci.psychology 243 75000 862 67% 4057 9.4 15% 0.11 1.7% talk.abortion ------------------------------------------------------------------------------- 515 51000 512 76% 485 1.6 2% 0.03 1.0% sci.med.aids ------------------------------------------------------------------------------- 553 49000 487 77% 135 0.3 17% 0.01 1.0% sci.med.physics 577 47000 514 70% 257 1.2 0% 0.02 1.0% soc.feminism 653 43000 611 54% 3917 2.2 77% 0.04 1.2% alt.feminism 657 43000 506 65% 770 1.3 56% 0.03 1.0% talk.politics.drugs 791 36000 602 46% - - - - 1.2% alt.homosexuality 885 33000 363 69% 553 0.7 54% 0.02 0.7% sci.anthropology 981 30000 323 70% 680 1.0 9% 0.03 0.7% sci.med.nutrition 1746 11000 210 38% 53 0.1 6% 0.01 0.4% bionet.molbio.hiv 1821 10000 153 50% 205 0.3 6% 0.02 0.3% alt.support.cancer 1847 9700 198 37% 158 0.2 7% 0.01 0.4% bionet.immunology 1870 9400 142 50% 136 0.2 20% 0.01 0.3% sci.med.radiology Sci.med.aids is also distributed as electronic mail by the AIDS listserv. Mail is not as convenient a way to read sci.med.aids as is a newgroup, but mail is available at more sites (including Compuserve, America Online, MCImail, ATTmail and many institutions which have Internet gateways). In additional to these primary distributions, sci.med.aids is redistributed by various bulletin boards and mail gateways. ------------------------------------------------------------------------------- Question 1.4 Periodical Postings on sci.med.aids (please contribute) Various individuals and organizations have graciously posted thier informational newsletters on sci.med.aids. These include: o The CDC AIDS Daily Summary Anne Wilson of the CDC says this of the Daily Summary: "The AIDS Daily Summary has been produced for nearly seven years by Information Inc., a publisher who produces similar electronic newsletters for other topics. Until 1992, the AIDS Daily Summary was a subscription- based service which individuals and organizations were able to receive for a fee. Since 1992, the CDC National AIDS Clearinghouse has contracted with Information Inc. so that the AIDS Daily Summary can be provided free of charge to all interested readers. We encourage duplication and redistribution so that as many people as possible benefit. It is posted daily on CDC NAC ONLINE, the Clearinghouse's online information system and on the AIDSNEWS listserv, which redirects it to Sci.med.aids... Information Inc. is responsible for collecting and editing the information in the AIDS Daily Summary. The titles you see listed are taken verbatim from the original article. Although the editors try earnestly to make the summaries scientifically accurate, this is often difficult because of ambiguous language in the original article. For example, references to the term "infected with AIDS" are sometimes unchanged from article to summary because the editors can not tell from the original whether "HIV-infected" or "person with AIDS" is correct. In general, the editors aim to follow the language and "spirit" of the original article, because an important purpose of the AIDS Daily Summary is to reflect *how* HIV/AIDS is represented in the press. We are always happy to get feedback from readers of the AIDS Daily Summary. We pass on comments about the scope and quality of the coverage to the editors. Comments should be emailed to John Fanning at `aidsinfo@cdcnac.aspensys.com' or `clearinghous@delphi.com'. Anyone interested in being on the AIDSNEWS listserv to receive the AIDS Daily Summary and other news from CDC and the Federal government can send a `subscribe aidsnews' message to `listserv@cdcnac.aspensys.com'. Note that we also have a gopher server at `cdcnac.aspensys.com'." o NAPWA Medical Alert o Kairos House Caregivers Newsletter o VAMC Newsletter The AIDS Information Newsletter is one of several electronic services provided to librarians and health care professionals within the U.S. Department of Veterans Affairs. The newsletter is transmitted from the AIDS Information Center located in San Francisco on alternate Fridays to all VA Medical Centers, sci.med.aids, a number of bulletin boards, and the NIAID gopher server (gopher.niaid.nih.gov). The Center takes full responsiblity for all material; the content does not necessarily reflect the viewpoints or policies of the U.S. Department of Veterans Affairs. o AIDS Treatment News o After All What is "After All?" "After All" is a newly created newsletter directed to those who have lost or are losing a loved one to AIDS. As of March '95 the issues will be monthly. We also hope to get those suffering from this disease to pitch in and help others to better understand the unending suffering this situation is causing . . . for so many! There will be three formats available: Printed Text file on Usenet sci.med.aids and FTP family.hampshire.edu/pub/aids/afterall A full version created with Adobe Acrobat that will include text, graphics and color. You will need the Adobe Reader to view this format. It will be available at family.hampshire.edu/pub/aids/afterall/reader.exe (a self-extracting .zip file). The Premier Issue will be available in January as "angels1". Future issues will be monthly as "Angels2", "Angels3", etc. We need your help. If you like the issue let us know. o (others - please contribute) ------------------------------------------------------------------------------- Question 1.5. Subscribing and unsubscribing to sci.med.aids. The answer to this question depends on your system. You may have to ask your local system administrator. Here are some guidelines valid on many systems: * You may have USENET on your system, especially if you run UNIX or VMS. Here are some commands to try: "rn", "trn", "xrn", "nn", "tin". If they work, try joining the newsgroup "sci.med.aids". That might not work, since some sites limit the newsgroups they receive. All is not lost: you can get sci.med.aids by e-mail. * If USENET is not available you can get sci.med.aids by e-mail. Send a mail message to listserv@rutvm1.rutgers.edu. The message body should contain just the following command: subscribe aids <yourname> Type in your real name (not your e-mail address) instead of <yourname>. A complete message might look like this: To: listserv@rutvm1.rutgers.edu Subject: subscribe aids Joe Smith To unsubscribe, send a message to listserv@rutvm1.rutgers.edu containing the text unsubscribe aids Please unsubscribe before your account expires. The moderators get all sorts of junk mail if you don't. ------------------------------------------------------------------------------- Question 1.6. What is a moderated newsgroup? A moderated newsgroup is one in which all postings must be approved by the moderators before being distributed. The purpose of moderation is to restrict what can appear. Postings which do not adhere to the guidelines for the group will be rejected. ------------------------------------------------------------------------------- Question 1.7. Editorial guidelines. As with any newsgroup, read sci.med.aids for a few days before posting, to see if your question has been answered already, and to get a feel for the tone of the group. Postings to sci.med.aids should: * Write on topics directly relevant to AIDS, HIV, or related topics. * Unconventional medical/research claims must be accompanied by references to the popular press (i.e., major newspaper, magazine, etc.) or scientific press (i.e., Science, Nature, Lancet, Scientific American, Cell, Brain Research, etc.). We require references for unconventional medical/research claims, because some therapies carry with them potential danger. Some unconventional medical/research claims are fallacious. Without this policy, sci.med.aids would have printed several dangerous and undocumented therapies by now. * Political, sociological opinion/analysis articles are acceptable. The interpretation, and even the existence, of this particular policy continues to be the subject of internal debate among the moderators. However, in the past we have printed articles holding both popular and unpopular opinions on topics like "Quarantining HIV Positives" or "who did Clinton appoint to the AIDS Task Force." * Refrain from personally attacking other participants. For example, do not call someone an 'idiot' or say they are 'biased'. Instead, point out the flaws in their argument. If you find yourself getting angry at a poster, and construct a reply, please try to remember this rule. It is often useful to wait a day to see what other reactions have been posted before sending something off in anger. * Send one line "quips" as personal mail to the original submitter, rather than posting. * When posing a question to a previous poster, reconsider whether the question needs to be posted. Perhaps you could ask the question by e-mail and request a posted response. * Do not invoke religion. * Do not break copyright laws. Reprints of articles from other sources must include a statement of permission to reprint. An exception is made for abstracts of articles from scientific journals, which are not usually restricted. If you can't get reprint permission, excerpt or summarize the article. * Do not construct an article with more than 20% text from a previous article, unless it is very old (i.e., months old). The best approach when constructing a response is to tersely summarize the article to which you respond, in square brackets. For example, In article <11233@sci.med.aids>, Dan Greening wrote: > [reasons to not include too much of a prior article] Also, don't forget that many people get this stuff by mail, so huge inclusions clog hundreds of mailboxes, including mine. Thanks. * Do not duplicate something which has recently appeared. The moderators don't always agree on what's acceptable and what's not. If an article is rejected, you should receive a note from the moderators saying why. These notes, and other discussions about the running of sci.med.aids will be distributed on the aids-d mailing list (see Q1.10 Discussing sci.med.aids moderation policies.'). ------------------------------------------------------------------------------- Question 1.8. How do I submit a posting? This depends on the software you are using. On many USENET systems, you can use the command postnews You can also post by sending your article as e-mail to aids@cs.ucla.edu. Because sci.med.aids is moderated, your submission will not appear immediately. Sometimes the delay is very short; often it may be 24 hours or more. It depends on network delays and how busy the moderators are. A tickler program reminds us of postings older than 48 hours. IMPORTANT: Whether you use postnews or e-mail, please format your article exactly the way you want it to appear in the newsgroup. Because our moderation software is somewhat unpolished, editing out notes to the moderators in a posting is quite tedious. If you must communicate directly with the moderators, send a note to aids-faq@family.hampshire.edu. ------------------------------------------------------------------------------- Question 1.9. The moderators. Four people currently moderate sci.med.aids. They are Phil Miller Professor, Biostatistics, Washington University Jack Hamilton Health Care analyst Dan Greening Founder sci.med.aids, Pres., Chaco Communications Inc. Jeff Rizzo Interested hemophiliac with AIDS Lauren Fergusen Librarian Phil, Jack, Lauren and Jeff do most of the moderation. Dan repairs the moderation software. Phil is probably the most liberal moderator, Dan the most restrictive. Various individuals have been moderators in the past, including: David Dodell Founder, Grand Rounds fidonet echo, Dentist Steve Dyer Writer, Gay Community News, Software Consultant Alan Wexelblat Freelance writer, ethicist Tom Lincoln Informatics Director, USC Medical Center Craig Werner MD/PhD Student, Albert Einstein School of Medicine Will Doherty Gay Activist, technical writer Sun Microsystems Michelle Murrain Health researcher and professor, Hampshire College ------------------------------------------------------------------------------- Question 1.10. Cooperative moderation - and voting on posts. Cooperative moderation seeks to limit the burn-out associated with newsgroup moderation, by sharing the workload among several moderators. In addition, it provides a more balanced treatment of contentious issues. An early paper on the sci.med.aids cooperative moderation scheme is D.R. Greening and A.D. Wexelblat, Experiences with Cooperative Moderation of a USENET Newsgroup, Proceedings of the 1989 ACM/IEEE Workshop on Applied Computing. available by FTP from cs.ucla.edu:pub/aids.paper.ps.Z This paper is also available from the UCLA Computer Science Department as a technical report. At present, a voting system has been added to the moderation process. When you submit an article, moderators vote. 2 yes votes post an article, while 2 no votes reject an article. The first threshold to be exceeded determines the result. ------------------------------------------------------------------------------- Question 1.11. If a post is rejected. We reject many articles because of formatting problems, other mechanical problems, or our own confusion, and those articles can be revised quickly (by you) and resubmitted. There are about 73,000 readers of sci.med.aids on USENET alone. Articles posted here are distributed in many forms. We share information with AEGIS, an AIDS bulletin-board network. We have a parallel mailing-list. Some people copy articles from sci.med.aids and provide them to their local library. Activists have even printed out articles from sci.med.aids and distributed them to homeless people with AIDS. If you have important information, we urge you to spend the time to revise your article and resubmit: it will be read. On the other hand, these 73,000 readers are why we are so cautious about posting. Respect your huge audience by spending the time to write a readable and informative article. If you carefully investigate and share important AIDS information through sci.med.aids, you can save lives, make people a little healthier, or reassure someone. All of these are valuable. ------------------------------------------------------------------------------- Question 1.12. Discussing sci.med.aids moderation policies. A separate mailing list, aids-d, has been set up for the moderators and for people who interested in how sci.med.aids is run. Most readers will not be interested in aids-d; its purpose is internal discussion rather than information dissemination, and most articles on aids-d are examples of what moderation has filtered out. If you want to subscribe, send email to aids-d-request@sti.com. ------------------------------------------------------------------------------ Question 1.13. Feedback is invited Please send us your comments on this FAQ. We accept submissions for the FAQ in any format; All contributions comments and corrections are gratefully received. Please send them to aids-faq@family.hampshire.edu ------------------------------------------------------------------------------ Question 1.14. Formats in which this FAQ is available This document is available as ASCII text. We are working on establishing a sci.med.aids archive where other formats (such as postcript, Emacs Info, and HTML) will be stored. ------------------------------------------------------------------------------ Question 1.15. Authorship and acknowledgements The following people contributed to this FAQ: Dan Greening originally assembled and edited this document. Jack Hamilton wrote the introduction and first section. Phil Miller offered periodic edits. Michelle Murrain updated and edited this document in August, 1994, and continues to update and maintain it. Anne Wilson forwarded many valuable articles from the CDC National AIDS Clearinghouse. Robert Walker wrote the section on minimizing the risk of HIV infection. Michael Howe's sci.med.aids response regarding blood banks is reproduced here. Paul M. Karagianis <KARYPM@SJUVM.BITNET> contributed archives answering question about mosquito transmission. Iain Nicholson, who works on Plasmodium falciparum, wrote the section on malaria. Vince Hammer wrote the review of ``Do Insects Transmit AIDS?'' Michael Howe provided references for the question "Does HIV cause AIDS?", and has scanned several documents for this FAQ. Ken Shirriff <shirriff@sprite.berkeley.edu) wrote the sections on Peter Duesberg, and on Strecker and Segal's theories that HIV is synthetic. Eric Raymond <esr@snark.thyrsus.com> wrote about the USSR disinformation campaign. Rob James wrote a description of the US blood testing process. David Wright wrote the reasons why we should not donate blood to get a free HIV test. David Mertz wrote the section on internet access to the gopher database. Michelle Murrain wrote the section on the CDC patient data FTP site. Archive-name: aids-faq/part2 Posting-Frequency: monthly Last-modified: 1/1/95 AIDS FAQ part 2/10 ============================================================= Section 2. How to prevent infection. Q2.1 How is HIV transmitted? Q2.2 How effective are condoms? Q2.3 How do you minimize your odds of getting infected? Q2.4 How risky is a blood transfusion? Q2.5 Can mosquitoes or other insects transmit AIDS? ----------------------------------------------------------------------------- Question 2.1. How is HIV transmitted? The Human Immunodeficiency Virus and Its Transmission - CDC National AIDS Clearinghouse Research has revealed a great deal of valuable medical, scientific, and public health information about the human immunodeficiency virus (HIV) and acquired immmunodeficiency syndrome (AIDS). The ways in which HIV can be transmitted have been clearly identified. Unfortunately, some widely dispersed information does not reflect the conclusions of scientific findings. The Centers for Disease Control and Prevention (CDC) providest he following information to help correct a few commonly held misperceptions about HIV. Transmission HIV is spread by sexual contact with an infected person, by needle-sharing among injecting drug users, or, less commonly (and now very rarely in countries where blood is screened for HIV antibodies), through transfusions of infected blood or blood clotting factors. Babies born to HIV-infected women may become infected before or during birth, or through breast-feeding after birth. In the health-care setting, workers have been infected with HIV after being stuck with needles containing HIV-infected blood or, less frequently, after infected blood gets into the worker's bloodstream through an open cut or splashes into a mucous membrane (e.g., eyes or inside of the nose). There has been only one demonstrated instance of patients being infected by a health-care worker; this involved HIV transmission from an infected dentist to five patients. Investigations have been completed involving more than 15,000 patients of 32 HIV-infected doctors and dentists, and no other cases of this type of transmission have been identified. Some people fear that HIV might be transmitted in other ways; however, no scientific evidence to support any of these fears has been found. If HIV were being transmitted through other routes (for example, through air or insects), the pattern of reported AIDS cases would be much different from what has been observed, and cases would be occurring much more frequently in persons who report no identified risk for infection. All reported cases suggesting new or potentially unknown routes of transmission are promptly and thoroughly investigated by state and local health departments with the assistance, guidance, and laboratory support from CDC; no additional routes of transmission have been recorded, despite a national sentinel system designed to detect just such an occurrence. The following paragraphs specifically address some of the more common misperceptions about HIV transmission. HIV in the Environment Scientists and medical authorities agree that HIV does not survive well in the environment, making the possibility of environmental transmission remote. HIV is found in varying concentrations or amounts in blood, semen, vaginal fluid, breast milk, saliva, and tears. (See below, Saliva, Tears, and Sweat.) In order to obtain data on the survival of HIV, laboratory studies have required the use of artificially high concentrations of laboratory-grown virus. Although these unnatural concentrations of HIV can be kept alive under precisely controlled and limited laboratory conditions, CDC studies have showned that drying of even these high concentrations of HIV reduces the number of infectious viruses by 90 to 99 percent within several hours. Since the HIV concentrations used in laboratory studies are much higher than those actually found in blood or other specimens, drying of HIV- infected human blood or other body fluids reduces the theoretical risk of environmental transmission to that which has been observed - essentially zero. Incorrect interpretation of conclusions drawn from laboratory studies have alarmed people unnecessarily. Results from laboratory studies should not be used to determine specific personal risk of infection because 1) the amount of virus studied is not found in human specimens or anyplace else in nature, and 2) no one has been identified with HIV due to contact with an environmental surface; Additionally, since HIV is unable to reproduce outside its living host (unlike many bacteria or fungi, which may do so under suitable conditions), except under laboratory conditions, it does not spread or maintain infectiousness outside its host. Households, Offices, and Workplaces Studies of thousands of households where families have lived with and cared for AIDS patients have found no instances of nonsexual transmission, despite the sharing of kitchen, laundry, and bathroom facilities, meals, eating utensils, and drinking cups and glasses. If HIV is not transmitted in these settings, where repeated and prolonged contact occurs, transmission is even less likely in other settings, such as schools and offices. Similarly, there is no known risk of HIV transmission to co-workers, clients, or consumers from contact in industries such as food service establishments (see information on survival of HIV in the environment). Food service workers known to be infected with HIV need not be restricted from work unless they have other infections or illinesses (such as diarrhea or hepatitis A) for which any food service worker, regardless of HIV infection status, should be restricted; The Public Health Service recommends that all food service workers follow recommended standards and practices of good personal hygiene and food sanitation. Kissing Casual contact through closed-mouth or "social" kissing is not a risk for transmission of HIV. Because of the theoretical potential for contact with blood during "French" or open-mouthed kissing, CDC recommends against engaging in this activity with an infected person. However, no case of AIDS reported to CDC can be attributed to transmission through any kind of kissing. Saliva, Tears, and Sweat HIV has been found in saliva and tears in only minute quantities from some AIDS patients. It is important to understand that finding a small amount of HIV in a body fluid does not necessarily mean that HIV can be transmitted by that body fluid. HIV has not been recovered from the sweat of HIV-infected persons. Contact with saliva, tears, or sweat has never been shown to result in transmission of HIV. Insects - see Question 2.4 ------------------------------------------------------------------------------ Question 2.2. How effective are condoms? The proper and consistent use of latex condoms when engaging in sexual intercourse--vaginal, anal, or oral--can greatly reduce a person's risk of acquiring or transmitting sexually transmitted diseases, including HIV infection. When condoms are used reliably, they have been shown to prevent pregnancy up to 98 percent of the time among couples using them as their only method of contraception. Similarly, numerous studies among sexually active people have demonstrated that a properly used latex condom provides a high degree of protection against a variety of sexually transmitted diseases, including HIV infection. Condoms are classified as medical devices and are regulated by the Food and Drug Administration. Each latex condom manufactured in the United States is tested for defects, including holes, before it is packaged, and several studies clearly show that condom breakage rates in this country are less than 2 percent. Even when condoms do break, one study showed that more than half of such breaks occurred prior to ejaculation. Update: Barrier Protection against Sexual Diseases - CDC National AIDS Clearinghouse Although refraining from intercourse with infected partners remains the most effective strategy for preventing human immunodeficiency virus (HIV) infection and other sexually transmitted diseases (STDs), the Public Health Service also has recommended condom use as part of its strategy. Since CDC summarized the effectiveness of condom use in preventing HIV infection and other STDs in 1988 (1), additional information has become available, and the Food and Drug Administration has approved a polyurethane "female condom." This report updates laboratory and epidemiologic information regarding the effectiveness of condoms in preventing HIV infection and other STDs and the role of spermicides used adjunctively with condoms.* Two reviews summarizing the use of latex condoms among serodiscordant heterosexual couples (i.e., in which one partner is HIV positive and the other HIV negative) indicated that using latex condoms substantially reduces the risk for HIV transmission (2,3). In addition, two subsequent studies of serodiscordant couples confirmed this finding and emphasized the importance of consistent (i.e., use of a condom with each act of intercourse) and correct condom use (4,5). In one study of serodiscordant couples, none of 123 partners who used condoms consistently seroconverted; in comparison, 12 (10%) of 122 seronegative partners who used condoms inconsistently became infected (4). In another study of serodiscordant couples (with seronegative female partners of HIV-infected men), three (2%) of 171 consistent condom users seroconverted, compared with eight (15%) of 55 inconsistent condom users. When person-years at risk were considered, the rate for HIV transmission among couples reporting consistent condom use was 1.1 per 100 person-years of observation, compared with 9.7 among inconsistent users (5). Condom use reduces the risk for gonorrhea, herpes simplex virus (HSV) infection, genital ulcers, and pelvic inflammatory disease (2). In addition, intact latex condoms provide a continuous mechanical barrier to HIV, HSV, hepatitis B virus (HBV), Chlamydia trachomatis, and Neisseria gonorrhoeae (2). A recent laboratory study (6) indicated that latex condoms are an effective mechanical barrier to fluid containing HIV-sized particles. Three prospective studies in developed countries indicated that condoms are unlikely to break or slip during proper use. Reported breakage rates in the studies were 2% or less for vaginal or anal intercourse (2). One study reported complete slippage off the penis during intercourse for one (0.4%) of 237 condoms and complete slippage off the penis during withdrawal for one (0.4%) of 237 condoms (7). Laboratory studies indicate that the female condom (Reality (trademark) **) -- a lubricated polyurethane sheath with a ring on each end that is inserted into the vagina -- is an effective mechanical barrier to viruses, including HIV. No clinical studies have been completed to define protection from HIV infection or other STDs. However, an evaluation of the female condom's effectiveness in pregnancy prevention was conducted during a 6-month period for 147 women in the United States. The estimated 12-month failure rate for pregnancy prevention among the 147 women was 26%. Of the 86 women who used this condom consistently and correctly, the estimated 12-month failure rate was 11%. Laboratory studies indicate that nonoxynol-9, a nonionic surfactant used as a spermicide, inactivates HIV and other sexually transmitted pathogens. In a cohort study among women, vaginal use of nonoxynol-9 without condoms reduced risk for gonorrhea by 89%; in another cohort study among women, vaginal use of nonoxynol-9 without condoms reduced risk for gonorrhea by 24% and chlamydial infection by 22% (2). No reports indicate that nonoxynol-9 used alone without condoms is effective for preventing sexual transmission of HIV. Furthermore, one randomized controlled trial among prostitutes in Kenya found no protection against HIV infection with use of a vaginal sponge containing a high dose of nonoxynol-9 (2). No studies have shown that nonoxynol-9 used with a condom increases the protection provided by condom use alone against HIV infection. Reported by: Food and Drug Administration. Center for Population Research, National Institute of Child Health and Human Development, National Institutes of Health. Office of the Associate Director for HIV/AIDS; Div of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion; Div of Sexually Transmitted Diseases and HIV Prevention, National Center for Prevention Svcs; Div of HIV/AIDS, National Center for Infectious Diseases, CDC. Editorial Note: This report indicates that latex condoms are highly effective for preventing HIV infection and other STDs when used consistently and correctly. Condom availability is essential in assuring consistent use. Men and women relying on condoms for prevention of HIV infection or other STDs should carry condoms or have them readily available. Correct use of a latex condom requires 1) using a new condom with each act of intercourse; 2) carefully handling the condom to avoid damaging it with fingernails, teeth, or other sharp objects; 3) putting on the condom after the penis is erect and before any genital contact with the partner; 4) ensuring no air is trapped in the tip of the condom; 5) ensuring adequate lubrication during intercourse, possibly requiring use of exogenous lubricants; 6) using only water-based lubricants (e.g., K-Y jelly (trademark) or glycerine) with latex condoms (oil-based lubricants (e.g., petroleum jelly, shortening, mineral oil, massage oils, body lotions, or cooking oil) that can weaken latex should never be used); and 7) holding the condom firmly against the base of the penis during withdrawal and withdrawing while the penis is still erect to prevent slippage. Condoms should be stored in a cool, dry place out of direct sunlight and should not be used after the expiration date. Condoms in damaged packages or condoms that show obvious signs of deterioration (e.g., brittleness, stickiness, or discoloration) should not be used regardless of their expiration date. Natural-membrane condoms may not offer the same level of protection against sexually transmitted viruses as latex condoms. Unlike latex, natural- membrane condoms have naturally occurring pores that are small enough to prevent passage of sperm but large enough to allow passage of viruses in laboratory studies (2). The effectiveness of spermicides in preventing HIV transmission is unknown. Spermicides used in the vagina may offer some protection against cervical gonorrhea and chlamydia. No data exist to indicate that condoms lubricated with spermicides are more effective than other lubricated condoms in protecting against the transmission of HIV infection and other STDs. Therefore, latex condoms with or without spermicides are recommended. The most effective way to prevent sexual transmission of HIV infection and other STDs is to avoid sexual intercourse with an infected partner. If a person chooses to have sexual intercourse with a partner whose infection status is unknown or who is infected with HIV or other STDs, men should use a new latex condom with each act of intercourse. When a male condom cannot be used, couples should consider using a female condom. Data from the 1988 National Survey of Family Growth underscore the importance of consistent and correct use of contraceptive methods in pregnancy prevention (8). For example, the typical failure rate during the first year of use was 8% for oral contraceptives, 15% for male condoms, and 26% for periodic abstinence. In comparison, persons who always abstain will have a zero failure rate, women who always use oral contraceptives will have a near-zero (0.1%) failure rate, and consistent male condom users will have a 2% failure rate (9). For prevention of HIV infection and STDs, as with pregnancy prevention, consistent and correct use is crucial. The determinants of proper condom use are complex and incompletely understood. Better understanding of both individual and societal factors will contribute to prevention efforts that support persons in reducing their risks for infection. Prevention messages must highlight the importance of consistent and correct condom use (10). References 1. CDC. Condoms for prevention of sexually transmitted diseases. MMWR 1988;37:133-7. 2. Cates W, Stone KM. Family planning, sexually transmitted diseases, and contraceptive choice: a literature update. Fam Plann Perspect 1992;24:75-84. 3. Weller SC. A meta-analysis of condom effectiveness in reducing sexually transmitted HIV. Soc Sci Med 1993;1635-44. 4. DeVincenzi I, European Study Group on Heterosexual Transmission of HIV. Heterosexual transmission of HIV in a European cohort of couples (Abstract no. WS-CO2-1). Vol 1. IXth International Conference on AIDS/IVth STD World Congress. Berlin, June 9, 1993:83. 5. Saracco A, Musicco M, Nicolosi A, et al. Man-to-woman sexual transmission of HIV: longitudinal study of 343 steady partners of infected men. J Acquir Immune Defic Syndr 1993;6:497-502. 6. Carey RF, Herman WA, Retta SM, Rinaldi JE, Herman BA, Athey TW. Effectiveness of latex condoms as a barrier to human immunodeficiency virus- sized particles under conditions of simulated use. Sex Transm Dis 1992;19:230- 4. 7. Trussell JE, Warner DL, Hatcher R. Condom performance during vaginal intercourse: comparison of Trojan-Enz (trademark) and Tactylon (trademark) condoms. Contraception 1992;45:11-9. 8. Jones EF, Forrest JD. Contraceptive failure rates based on the 1988 NSFG. Fam Plann Perspect 1992;24:12-9. 9. Trussell J, Hatcher RA, Cates W, Stewart FH, Kost K. Contraceptive failure in the United States: an update. Stud Fam Plann 1990;21:51-4. 10. Roper WL, Peterson HB, Curran JW. Commentary: condoms and HIV/STD prevention -- clarifying the message. Am J Public Health 1993;83:501-3. * Single copies of this report will be available free until August 6, 1994, from the CDC National AIDS Clearinghouse, P.O. Box 6003, Rockville, MD 20849- 6003; telephone (800) 458-5231. ** Use of trade names is for identification only and does not imply endorsement by the Public Health Service or the U.S. Department of Health and Human Services. .............................. Recent articles about Condoms (1993-1994) Source: Michael Howe <hivinfo@itsa.ucsf.edu>, AIDS News Service, VAMC Condom Failure Rates (Arranged Chronologically - Reverse Order) 1 AU - Park JS ; Kim CK TI - The effective prevention of HIV by female condom (Femidom). AB - As part of a widely implemented prevention strategy, condom use exemplifies the empowerment of individuals and interaction between people who want to protect themselves and others against HIV infection. The serious consequences of condom failure has placed added emphasis on condom quality. Correct condom use can be learned and practiced with the result being more condom use with less breakage. The newest female barrier, Female Condom (Femidom) could protect against HIV transmission. Female Condom is a lubricated polyurethane bags with a soft ring. As sexually transmitted diseases are a high risk factors in HIV transmission, then the use of Female Condom has an obvious indirect value in HIV control. Comparative studies have been initiated whether female condom will be as good as better than male condom in directly ffecting HIV transmission. Female Condom is a choice for HIV prevention as well as a useful method of contraception. SO - Int Conf AIDS. 1994 Aug 7-12;10(2):288 (abstract no. PC0531). 2 AU - Thompson JL ; Yager TJ ; Martin JL TI - Estimated condom failure and frequency of condom use among gay men. AB - OBJECTIVES. Condoms are designed to bar transmission of the human immunodeficiency virus (HIV), but they sometimes fail. This paper explores the effect of experience with condoms on condom failure among gay men. METHODS. Risk of condom failure (breakage or slippage) on a single occasion is estimated for four sexual acts reported over 12 months by a sample of gay New York City men (n = 741). The estimation procedure assumes that each episode in which a condom is used is an independent event. Evidence is offered to support this assumption. RESULTS. Risk of condom failure in a single episode was fairly high, particularly in anal intercourse, for men who had engaged in each act only a few times in the previous year. It declined rapidly with experience (e.g., to below 1% for receptive anal intercourse after about 10 episodes in the previous year). Condoms failed less often in oral than anal sex, but estimated risk of failure also decreased with experience. CONCLUSIONS. Gay men should be especially cautious the first few times they use a condom; after moderate experience, however, they may expect a low risk of condom failure. SO - Am J Public Health. 1993 Oct;83(10):1409-13. 3 AU - Joffe A TI - Adolescents and condom use. AB - Increasing condom use among adolescents is an essential component of a public health strategy aimed at decreasing rates of sexually transmitted infections and the spread of human immunodeficiency virus infection. This article reviews current data about the contraceptive and prophylactic characteristics of condoms. Data about current levels of use among adolescents and factors demonstrated to affect such use are also summarized. Except where data are scanty or nonexistent, the research studies are limited to those focusing primarily on adolescents and, occasionally, college students. Based on these data, suggestions for increasing condom use among adolescents are presented. SO - Am J Dis Child. 1993 Jul;147(7):746-54. 4 AU - Weller SC TI - A meta-analysis of condom effectiveness in reducing sexually transmitted HIV [see comments] AB - Before condoms can be considered as a prophylaxis for sexually transmitted human immunodeficiency virus (HIV), their efficacy must be considered. This paper reviews evidence on condom effectiveness in reducing the risk of heterosexually transmitted human HIV. A meta-analysis conducted on data from in vivo studies of HIV discordant sexual partners is used to estimate the protective effect of condoms. Although contraceptive research indicates that condoms are 87% effective in preventing pregnancy, results of HIV transmission studies indicate that condoms may reduce risk of HIV infection by approximately 69%. Thus, efficacy may be much lower than commonly assumed, although results should be viewed tentatively due to design limitations in the original studies. SO - Soc Sci Med. 1993 Jun;36(12):1635-44. 5 AU - de Wit JB ; Sandfort TG ; de Vroome EM ; van Griensven GJ ; Kok GJ TI - The effectiveness of condom use among homosexual men [letter] SO - AIDS. 1993 May;7(5):751-2. 6 AU - Richters J ; Donovan B ; Gerofi J TI - How often do condoms break or slip off in use? AB - Men attending 3 sexually transmissible disease clinics and a university health service in Sydney were given a questionnaire asking how many condoms they had used in the past year and how many broke during application or use or slipped off. Respondents were 544 men aged 18 to 54 years. Of these, 402 men reported using 13,691 condoms for vaginal or anal intercourse; 7.3% reportedly broke during application or use and 4.4% slipped off. Men having sex with men reported slightly higher slippage rates than those having sex with women. Breakage and slippage were unevenly distributed among the sample: a few men experienced very high failure rates. A volunteer subsample reported 3 months later on condoms supplied to them: 36 men used 529 condoms, of which 2.8% broke during application or use and 3.4% slipped off. Many of these failures pose no risk to the user, especially those occurring during application, as long as they are noticed at the time, but failure may discourage future use. Research is needed to identify user behaviours related to breakage. SO - Int J STD AIDS. 1993 Mar-Apr;4(2):90-4. 7 TI - HIV infection in European female sex workers: epidemiological link with use of petroleum-based lubricants. European Working Group on HIV Infection in Female Prostitutes. AB - OBJECTIVES: To assess the prevalence of and risk factors associated with HIV infection in European female sex workers, particularly sexual risk factors. DESIGN: Multicentre cross-sectional study performed in nine European countries. METHODS: Female sex workers voluntarily enrolled between September 1990 and November 1991. Face-to-face interviews were conducted in various settings (health care, prostitute organizations, outreach) to collect information on over 150 behavioural, health and sociodemographic variables. Enrollment of intravenous drug users (IVDU) was limited to a maximum of 25% of the total sample. The HIV-1 and HIV-2 antibody status of blood or saliva samples was tested using enzyme-linked immunosorbent assay and confirmed by Western blot. RESULTS: Eight hundred and sixty-six (91.6%) of the 945 interviewees provided blood (n = 824) or saliva (n = 42) samples. HIV seroprevalence was 5.3% [44 HIV-1-positives and two HIV-2-positives (from Lisbon)] overall, 31.8% (35 out of 110) in IVDU and 1.5% (11 out of 756) in non-IVDU [odds ratio (OR), 31.6; P < 0.001]. Lack of condom use (P = 0.002, test for trend) and previous ulcerative sexually transmitted disease (OR, 3.6; P = 0.06) were associated (on logistic regression) with HIV infection in both IVDU and non-IVDU. Previous hepatitis B (OR, 13.8; P = 0.02) and needle-sharing (OR, 4.1; P = 0.04) were associated with HIV infection in IVDU, and low education level (P = 0.02, test for trend), previous transfusion (OR, 9.1; P = 0.003), origin from sub-Saharan Africa (OR, 5.4; P = 0.05) and use of petroleum-based lubricants (OR, 15.2; P = 0.001) in non-IVDU. CONCLUSIONS: HIV prevalence remains relatively low among non-IVDU prostitutes in Europe. While intravenous drug use remains the most important risk factor for HIV, petroleum-based lubricants (used by 10% of women in this study) may be a risk factor for HIV among European female sex workers; over 80% of those interviewed always used condoms with clients. SO - AIDS. 1993 Mar;7(3):401-8. 8 AU - de Graaf R ; Vanwesenbeeck I ; van Zessen G ; Straver CJ ; Visser JH TI - The effectiveness of condom use in heterosexual prostitution in The Netherlands. AB - OBJECTIVES: To assess the extent to which condoms are used effectively in commercial heterosexual intercourse. Data on the number of condoms that had broken or slipped off, the sexual technique during which this had occurred and the perceived cause of failure were collected. The use of non-water-soluble lubricants and non-fortified condoms during anal intercourse, and the demand for a greater variety of condom sizes were also examined. SUBJECTS AND METHODS: One hundred and twenty-seven female prostitutes and 91 male clients from different parts of The Netherlands were interviewed face-to-face between July 1990 and March 1991. RESULTS: Of those who used condoms during vaginal intercourse, 49% of the prostitutes had experienced condom breakage in the previous 6 months, and 16% of the clients in the previous 12 months. The breakage rate was 0.8% for prostitutes and 1.5% for clients. Condom quality was seldom reported as the cause; breakage was generally attributed to human factors, such as rough or prolonged intercourse, incorrect handling of the condom or the use of insufficient lubricant. Prostitutes also identified penis size as a cause. Condoms slipping off before or after ejaculation was reported less frequently than breakage. Thirteen per cent of clients and 36% of prostitutes expressed a need for either smaller or larger condoms. Of the prostitutes, 9% used oil or vaseline as a lubricant. CONCLUSIONS: In view of the low rate of condom failure in heterosexual prostitution in The Netherlands, the potential spread of HIV by this means is small. The use of a greater variety of condom sizes may further reduce the failure rate. Few prostitutes remain ignorant about the adverse effects of oil-based lubricants on condoms. SO - AIDS. 1993 Feb;7(2):265-9. ------------------------------------------------------------------------------- Question 2.3. How do you minimize your odds of getting infected? "Playing the AIDS Odds" (21 Oct 93) Robert S. Walker, Ph.D. Phone: (210)224-9172 Emeritus professor Internet: rwalker@trinity.edu Trinity University, Pol.Sci. 715 Stadium Drive office: 128 Main Plaza, No.310 San Antonio, TX 78212 San Antonio, TX, 78205 Everyone worries about the degree of transmission-risk involved in various activities. Can you get infected from mutual masturbation? From fisting? From using poppers? From this and from that? The real question is, "Is it possible to provide answers with sufficient precision to allow an individual confidently to assess risk and modify behavior in specific situations?" The answer is "No." No one knows enough about either sexual or drug behaviors, and their relation to HIV sero- conversion, to speak with assurance. But this doesn't mean that meaningful recommendations are out of the question. Those interested in risk assessment might read two articles representing different approaches. First: Michael Shernoff, "Integrating Safer Sex Counseling into Social Work Practice, Social Casework: The Journal of Contemporary Social Work, vol. 69 (1988), pp. 334-339. The author offers a scaled list of 30 sexual behaviors from abstinence through fisting to condomless, receptive anal intercourse. The list is graded from "least likely" to transmit virus to "most likely." Some of the relative rankings are arguable, but the biggest problem is that the intervals of the "risk" scale are not equal. For example, #29 is "vaginal intercourse to orgasm without condoms," #30 is "anal inter- course to orgasm without condoms;" these two are separated by the same scaler distance as abstinence (no.1) and solitary masturbation (no.2). But everyone agrees that, anal intercourse is many times more dangerous than vaginal for the receptive partner, not just "one interval" more dangerous. Such lists are not too useful; I doubt that any subscriber to this list needs to be told that solitary masturbation is safer than receptive anal intercourse. Further, until a lot more is known about the relationships between specific behaviors and sero-conversion, the intervals cannot be meaningfully quantified. The second article is Norman Hearst and Stephen B. Hulley, "Heterosexual AIDS," Journal of the American Medical Association, April 22, 1988. The authors calculate probabilities for HIV transmission for different parameters (such as: the area's seroprevalence rate, the infectiousness of a partner, the condom/spermicide failure rate, and the number of sexual encounters). The "odds" of transmission with different parameters (such as: 500 encounters, .01 condoms failure rate, area seroprevalence of .0001, and so forth) are then projected. The resulting odds range from a "low" of 1 chance in 5 billion to a "high" of 1 transmission in 500 encounters. In the lowest risk example, there is 1 in 5 billion chance that HIV will be transmitted when: (1) your partner tests negative; (2) he/she has no history of high-risk behavior; (3) condoms are used in intercourse, and the condom failure rate is .01; (4) the area seroprevalence rate is 0.000001, (5) the infectivity value is 0.002; and (6) there is only one sexual encounter. As behavioral guides, neither approach is very helpful. When the possible sex or drug scenarios become as disparate as they are in real-life situations, and when the odds resemble your chances of winning a major lottery, then stating intervals or odds does not provide much more than a illusion of knowledge and resulting security. I suggest a different approach to thinking about risk. First, do not worry about practices for which there is no documentation of transmission (as distinct from speculation about it). If there is any risk in kissing, masturbation, skinny-dipping or whatever, it is probably much less than the chance of being hit by lightning - and few people worry about that. Focus on those activities, like intercourse and/or injecting drugs, which common sense tells you are risky, if for no other reason than that they have a long history of transmitting other diseases (like syphilis or hepatitis). Such behaviors would clearly include injecting drug use within a group, condomless anal and/or vaginal intercourse, and less clearly oral sex, fisting, or any S&M practice that involved a possible blood exchange. Second, take into account the overall setting within sexual or drug activity is taking place. While it seems that we are all biologically at equal risk, we do not face equal environmental risks. While HIV theoretically can spread uniformly from the North to the South pole, it has not in fact done so. It is one thing to pick up someone at a bar in Brahma, Oklahoma and another in San Francisco, California. The risk involved in employing a prostitute in Des Moines is much less than in Newark, NJ or Washington D.C. where the seroprevalence rate among prostitutes is very high. Similarly, patronizing a Newark shooting gallery or crack house is like asking for AIDS, but the risk of transmission within the West Coast drug scene is much less. For area comparisons see the Centers for Disease Control's quarterly HIV/AIDS Surveillance Report, and/or Jonathan Mann et al, AIDS in the World, Harvard U. Press, 1993. What I am suggesting is that some information plus common sense is a better guide than current statistical or quasi-statistical statements about relative risk. This will remain the case until a great deal more empiric data is amassed about some of our most private behaviors. If you are a person who does not feel comfortable without precise, reliable, quantified guidelines, then your only course is to abstain from activities wherein there is a possibility of transmission. There are many mood-altering substances that do not require injection, and a lot of sexual behavior that does not involve penetration and fluid exchange. With respect to non-sex or drug modes of transmission, all one can say is that there have been no documented cases of transmission through insect bites, shared utensils, shared occupational space or equipment, food handling, and so on. Theoretical risks for an infinite number of imagined scenarios can be computed, but in the actual world there are no data supporting transmission in these scenarios. An excellent survey of 14 principal articles searching for data on other routes of transmission can be found in: Robyn R.N Gershon et al, "The Risk of Transmission of HIV-1 Through Non-Percutaneous, Non-Sexual Modes: A Review," Department of Environmental Health Sciences and Department of Epidemiology, The Johns Hopkins University School of Hygiene and Public Health, distribut- ed by New York City's Gay Men's Health Crisis, AIDS Clinical Update, October 1, 1990. There have been cases of transmission through transfusions /transplants of contaminated whole blood, blood products, donor organs, and dental work. The only thing one can do is to be aware of the possibility, and make sure that those who treat you take all precautions. Currently, the only way to load the dice in your favor is to use common sense in any situation wherein someone else's body fluids might be introduced into yours through sexual or drug behaviors. If one can foresee that there would be opportunity for fluid exchange - blood, semen, vaginal secretions - then a large measure of safety can be had from the use of condoms (see: Condom Faq) and/or your own works for injecting drugs. The only safer course - and it is an honorable and intelligent one - would be to abstain from such activities altogether. What must be kept in mind is that the risk of HIV transmission is totally unlike the risk of losing at the races. Because you cannot recoup the loss represented by infection, you ought not think of the "odds" in the same way. In fact, it is better not to focus on the so- called "odds" at all. Given that (1) infection almost always leads to AIDS (estimates=95%), and (2) that AIDS almost always leads to death (estimates=99%), people must now think of sex or injecting drug use as an all-or-nothing game, . Each time you play, there are only two possible outcomes. If you win you have, perhaps, enjoyed a pleasant encounter; if you lose, you die. And each time you play without regard to common sense evaluation and personal protection, you enhance the possibility that you will lose. Its as simple as that. ------------------------------------------------------------------------------- Question 2.4. How risky is a blood transfusion? The following October 15, 1993 United Press International article, was summarized in the CDC AIDS Daily News Summary. "CDC Study Finds Five Transfusion-Related AIDS Cases Per Year" United Press International (10/25/93) Miami Beach, Fla.--Since screening for HIV began in 1985, very few people have become infected with the virus via blood transfusions, according to experts at the Centers for Disease Control and Prevention. The rate of transfusion-related AIDS cases rose steadily from 1978 to 1984, then fell dramatically when testing began in 1985, said the CDC. Officials report that between 1986 and 1991, the number of such cases may have been as low as five per year. "While the risk of getting AIDS from a transfusion is not zero, this study corroborates other CDC research and published data indicating that the risk is extremely low," said Dr. Arthur J. Silvergleid, president of the American Association of Blood Banks. A total of 4,619 individuals are believed to have been infected through the blood supply. Each year in the United States, about 4 million people receive blood transfusions. ------------------------------------------------------------------------------- Question 2.5. Can mosquitoes or other insects transmit AIDS? From: CDC National AIDS Clearinghouse From the onset of the HIV epidemic, there has been concern about transmission of the virus by biting and blood-sucking insects. However, studies conducted by researchers at CDC and elsewhere have shown no evidence of HIV transmission through insects--even in areas where there are many cases of AIDS and large populations of insects such as mosquitoes. Lack of such outbreaks, despite intense efforts to detect them, supports the conclusion that HIV is not transmitted by insects. The results of experiments and observations of insect biting behavior indiciate that when an insect bites a person, it does not inject its own or a previous victim's blood into the new victim. Rather, it injects saliva. Such diseases as yellow fever and malaria are transmitted through the saliva of specific species of mosquitoes. However, HIV lives for only a short time inside an insect and, unlike organisms that are transmitted via insect bites, HIV does not reproduce (and, therefore, cannot survive) in insects. Thus, even if the virus enters a mosquito or another sucking or biting insect, the insect does not become infected and cannot transmit HIV to the next human it feeds on or bites. There is also no reason to fear that a biting or blood-sucking insect, such as a mosquito, could transmit HIV from one person to another through HIV-infected blood left on its mouth parts. Two factors combine to make infection by this route extremely unlikely-- first, infected people do not have constant, high levels of HIV in their bloodstreams and, second, insect mouth parts do not retain large amounts of blood on their surfaces. Further, scientists who study insects have determined that biting insects normally do not travel from one person to the next immediately after ingesting blood. ........................................ An interesting paper is: Do Insects Transmit Aids? by Lawrence Miike Health Program; Office of Technology Assessment United States Congress; Washington D.C. 20510-8025 September 1987 -- A Staff Paper in OTA's Series on AIDS-Related Issues For sale by the Superintendent of Documents U.S. Government Printing Office Washington, D.C. 20402 This paper indicates that "The conditions necessary for successful transmission of HIV through insect bites, and the probabilities of their occurring, rule out the possiblility of insect transmission of HIV infection as a significant factor in the way AIDS is spread. If insect transmission is occurring at all, each case would be a rare and unusual event." Archive-name: aids-faq/part3 Posting-Frequency: monthly Last-modified: 1/1/95 AIDS FAQ Part 3/10 Section 3. General Information on AIDS Q3.1 Testing Information - Blood Banks Q3.2 Testing Information - Elisa and Western Blot tests (Please Contribute) Q3.3 Symptoms of HIV and AIDS (please contribute) Q3.4 AIDS and Opportunistic Infections. ------------------------------------------------------------------------------ Question 3.1. Testing Information - Blood Banks All blood products in the U.S. are screened by ELISA assays for several infectious agents, including: HIV 1/2, HTLV I/II, HBV, HCV, Syphillis, Hepatitis B core, and a liver enzyme ALT, indicative of hepatic infections. Some blood donations are also tested for CMV, a more common virus that has devestating effects in immunocompromised individuals, such as cancer patients and transplant recipients. In addition to these laboratories, all donors are screened through questionaires that meet or exceed FDA requirements. What if a blood-bank finds out you are HIV positive? The Red Cross and other blood banks routinely test blood donations for HIV antibodies. The Red Cross has specifically asked that people not use blood donation as a way of finding out if they are HIV+. If you think you might be infected, go get a blood test. Many cities offer free anonymous HIV testing. Contact your local public health service office for details. This is particularly important if you think you might have been infected within the last six months, since there's the risk that you are indeed infected, but do not yet have antibodies to HIV. Blood donation is a fine thing to do--but how will you feel if you donate, then a month later you find out through some other means that you're HIV+? We're supposed to be making a gift of life, not death. The following article discusses how blood banks use the information, if you have tested positive for HIV antibodies. In addition to your possible role in killing another person, donating blood to obtain a free HIV test also risks your anonymity. From: McCullough J. The nation's changing blood supply system. JAMA. 1993 May;269(17):2239-45. "The coded identity of potential or actual blood donors who are found to be unsuitable on the basis of medical history or laboratory testing is entered into a donor referral registry (DDR). Before each donated unit of blood is made available for use, the coded identity of the donor is checked against the DDR to ensure that the donor has not been found to be unsuitable during a previous donation. Although potentially infectious donors are so informed and asked not to give blood in the future, this DDR check is thought to improve the safety of the blood supply by serving as an additional way of identifying potentially infectious blood should these donors return. The American Red Cross operates a single DDR with information from all of its 47 reginal centers. However, other blood banks' DDRs act only locally since there is no requirement that different blood banks in the same or neighboring communities exchange this DDR information. The operation of these DDRs costs money, consumes experts' time, and has the potential for many abuses such as failure to obtain informed consent and breeches of confidentiality. The value of a DDR in improving the safety of the blood supply has not been established. An analysis of the value of thse DDRs should be conducted, and based on the results, DDRs should be either eliminated or refined into an appropriate system." See also: Grossman BJ. Springer KM. Blood donor deferral registries: highlights of a conference. Transfusion. 1992;32:868-72. ------------------------------------------------------------------------------- Question 3.2. Testing information (please contribute) We need info for this section - Elisa and Western Blot tests, anonymous, confidential and other testing, reportable states, etc. ------------------------------------------------------------------------------- Question 3.3. Symptoms of HIV and AIDS (please contribute) We need a concise but complete descriptions of symptoms at all stages of HIV infection and AIDS. ------------------------------------------------------------------------------- Question 3.4. AIDS and Opportunistic Infections. AIDS and Opportunistic Infections NIAID BACKGROUNDER: Office of Communications, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland 20892 - September 1993 Opportunistic infections (OIs) cause most of the illnesses and deaths among people infected with HIV, the virus that causes AIDS. The National Institute of Allergy and Infectious Diseases (NIAID) leads the way in U.S. research on these life-threatening infections. As part of the NIAID effort, investigators are defining the optimal therapies, alone and in combination, to prevent and treat OIs. They seek ways to identify infections earlier and recognize resistance to therapies more quickly. What are OIs? The immune systems of most people with HIV gradually deteriorate, leaving them vulnerable to numerous viruses, fungi, bacteria and protozoa that are held in check in people with healthy immune systems. These microbes can become active in HIV-infected individuals, causing frequent and severe disease. NIAID uses a two-pronged approach to the prevention and treatment of OIs: basic laboratory research to learn how these microbes cause disease and clinical research to develop and evaluate promising therapies. Prevention and treatment of one such disease, Pneumocystis carinii pneumonia or PCP, has been a major thrust of the NIAID program. Other NIAID investigations include cytomegalovirus (CMV) infection, Mycobacterium avium complex (MAC) and tuberculosis (TB). Institute research focuses on these infections because, although they occur repeatedly among HIV-infected people, they are rare in the general population and few drugs are available now to prevent and treat them. PCP: The Most Common OI PCP remains the most common, life-threatening opportunistic infection in people with HIV, occurring in up to 80 percent of individuals who do not take preventive therapy. The PCP organism, a microscopic parasite, appears to infect most people during childhood. In people with healthy immune systems, the parasite normally remains dormant, but it may cause disease in those with damaged immune systems. PCP infection is characterized by a dry cough and shortness of breath. Individuals may experience other, less specific symptoms such as fever, fatigue and weight loss for weeks or even months before respiratory problems appear. As PCP infection progresses, the functioning lung tissue becomes clogged, which decreases the transport of oxygen from the inhaled air into the blood. At this point, the oxygen in the blood may be lowered to dangerous or even fatal levels. Without treatment, close to 100 percent of HIV-infected patients with PCP die. During the 1980s, the development of effective therapies led to better management of PCP. Drugs for preventing and treating PCP include aerosolized pentamidine and oral trimethoprim-sulfamethoxazole (TMP/SMX), but both can result in serious side effects that prevent some patients from taking the drugs. TMP/SMX is recommended more often than aerosolized pentamidine for treating and preventing PCP because the combination is effective, tolerated by about half of the patients who take it and may work against other disease-causing organisms as well. In 1992, an NIAID-supported trial proved that TMP/SMX is better than aerosolized pentamidine at preventing a second episode of PCP in people with AIDS who can tolerate either therapy. Although definitive research data are lacking, other agents may be considered in situations in which neither TMP/SMX nor aerosolized pentamidine can be given. The drug atovaquone is approved for patients with mild to moderate PCP who cannot tolerate TMP/SMX. One NIAID study showed that primaquine, an antimalaria drug, with clindamycin is an effective oral therapy for PCP. TMP with dapsone is an alternative treatment. The search for new, more effective, less toxic drugs and combinations of drugs to fight PCP continues. NIAID studies play an important role in this effort. One trial compares three drug regimens--TMP/dapsone, primaquine/clindamycin and TMP/SMX--for oral treatment of mild to moderate PCP. Another protocol looks at an 8-aminoquinoline, an antimalaria drug, while a third trial considers two regimens of TMP/SMX to prevent PCP. CMV: A Herpesvirus Infection with CMV, a virus in the herpes family, may occur throughout life. By age 50, about half of the general population has been exposed to this virus, yet most people do not become ill. After the original infection, the virus may lie dormant and reactivate itself if the immune system becomes suppressed. For people with HIV infection, CMV is one of the most frequent and serious OIs they face. CMV retinitis, an inflammation of the light-sensitive inner layer of the eye, is the most common CMV infection and leads to blindness if left untreated. Infections also may occur in the gastrointestinal tract, lungs, brain, heart and other organs. Both intravenous ganciclovir and foscarnet are approved to treat CMV retinitis. Lifelong maintenance on either treatment is required because the drugs do not kill CMV, they merely slow down its ability to grow. Even with therapy, the rate of relapse is high. NIAID studies of CMV and other herpesviruses have shown that intravenous foscarnet and ganciclovir are equally effective for CMV retinitis, although foscarnet was associated with increased survival for patients in the study. An ongoing trial is testing an oral form of ganciclovir to prevent CMV disease. The oral form of the drug would be much easier and safer for patients to take. MAC: A Bacterial OI Infection with MAC is diagnosed in up to 40 percent of people with AIDS in the United States, making it the most common bacterial OI. Usually, it affects people in advanced stages of HIV disease when the immune system is severely suppressed. The MAC organism is found widely in the environment and is thought to be acquired most commonly through the mouth or gastrointestinal tract. It can spread to the lungs, liver, spleen, lymph nodes, bone marrow, intestines and blood. MAC causes chronic debilitating symptoms--fever, night sweats, weight loss, fatigue, chronic diarrhea, abdominal pain, liver dysfunction and severe anemia. Rifabutin is the first drug to be approved for preventing MAC disease in people with advanced HIV infection. The Food and Drug administration based this approval on clinical studies showing that patients who received rifabutin were one-third to one-half as likely to develop MAC as were patients who received placebo. To prevent MAC disease, a U.S. Public Health Service Task Force on Prophylaxis and Therapy for MAC suggests that patients with HIV infection and fewer than 100 CD4 + T cells receive oral rifabutin for the rest of their lives unless disease develops. In the latter case, multiple drug treatment is needed. CD4+ T cells are immune system cells targeted and killed by HIV. No other drug regimen is recommended currently to prevent MAC. Azithromycin and clarithromycin are promising agents for prophylaxis, but studies of these agents have not been completed. Increasing evidence suggests that treatment can benefit patients with disseminated MAC, especially multiple-drug regimens including either clarithromycin or azithromycin. Therefore, the PHS task force suggests that all regimens, outside of a clinical trial, should consist of at least two drugs, including clarithromycin or azithromycin plus one other agent such as clofazimine, rifabutin, rifampin, ciprofloxacin and, in certain situations, amikacin. They recommend continued therapy for the patient's lifetime, as long as clinical benefit and reduction of mycobacteria are observed. NIAID has several studies under way looking at the roles of clarithromycin and azithromycin, and other drugs such as sparfloxacin, alone and in combination, to prevent and treat this serious disease. TB: An Airborne Disease TB, a chronic bacterial infection, causes more deaths worldwide than any other infectious disease. About one-third of the world's population harbors the predominant TB organism, Mycobacterium tuberculosis, and is at risk for developing the disease. The World Health Organization (WHO) estimates that 4.4 million people worldwide are coinfected with TB and HIV. WHO predicts that by the year 2000, TB will take one million lives annually among the HIV-infected. Because of their weakened immune systems, people with HIV are vulnerable to reactivation of latent TB infections, as well as to new TB infections. Transmission of this disease occurs most commonly in crowded environments such as hospitals, prisons and shelters--where HIV-infected individuals make up a growing proportion of the population. Active TB may occur early in the course of HIV infection, often months or years before other OIs. TB most often affects the lungs, but it also can cause disease in other parts of the body, particularly in people with advanced HIV disease. Of particular concern for people with AIDS is multi-drug-resistant TB (MDR-TB). MDR-TB can occur when patients fail to take their TB medicine for the prolonged periods necessary to destroy all TB organisms, which then become resistant to the drugs. These resistant organisms can be spread to other people. Even with treatment, for individuals coinfected with HIV and MDR-TB, the death rate may be as high as 80 percent, as opposed to 40 to 60 percent for people with MDR-TB alone. The time from diagnosis to death may be only months for some patients with HIV and MDR-TB, as they are sometimes left without adequate treatment options. The initial site of TB infection is in the balloon-like sacs at the ends of the small air passages in the lungs. In these sacs, white blood cells called macrophages ingest the inhaled TB organism. Some of the organisms are killed immediately, while others remain and multiply within the macrophages. If the organism breaks out of the sacs, TB can become active disease. This spreading sometimes results in life-threatening meningitis and other problems. NIAID launched the first large U.S. study to assess TB treatment strategies for people coinfected with HIV and TB. The study is aimed at finding state-of-the-art treatment. NIAID is the lead institute for TB research at the National Institutes of Health, supporting more than 50 research projects related to TB. Other OIs NIAID-supported scientists also study other OIs including fungal infections, herpes simplex virus infections, toxoplasmosis and cryptosporidium infections. Archive-name: aids-faq/part4 Posting-Frequency: monthly Last-modified: 1/1/95 Section 4. Treatment options. Q4.1 General treatment information. Q4.2 What about "alternative" treatments for HIV/AIDS Q4.2.1 DNCB (continued in part 5 of 10) Q4.2.2 OZONE ------------------------------------------------------------------------------- Question 4.1. General treatment information. [This article was published in AIDSFILE, 1993 Sept, Vol. 7, No. 3, p. 1-3. (Copyright 1993 The Regents of the University of California). The Regents grant permission for material in AIDSFILE to be reprinted for use by nonprofit educational institutions for scholarly or instructional purposes only, provided that (1) the author and AIDSFILE are identified; (2) proper notice of the copyright appears on each copy; (3) copies are distributed at or below cost.] Review of Clinical Guidelines - Antiretroviral Therapy Paul A. Volberding, MD Introduction A number of new observations have been made recently concerning antiretroviral therapy for HIV infection. Although new data is always welcome, lately it seems to cause as much confusion as clarification. Caregivers for patients with HIV disease continue to recognize the established benefits of antiretroviral therapy, but new uncertainties have been introduced. These uncertainties mean that we must consider the new information in order to make the best use of available treatments at the same time that we appreciate their limitations. Those who care for patients with HIV disease also anticipate the introduction of new classes of drugs, and we are beginning to determine how we might use these additional agents in our patient care. Review of Clinical Guidelines Antiretroviral therapy clearly has shown activity in delaying the progression and death of patients with HIV infection, especially when therapy has been tested in patients with more advanced disease. But even in asymptomatic HIV infection there is a general agreement of at least a transient clinical benefit from the use of nucleoside analog therapy. It is clear also that antiretroviral therapy improves various laboratory markers of the disease, including immunologic and virologic disease markers, such as CD4 cell counts and HIV p24 antigen levels. Further evidence of the clinical activity of these drugs comes from trials showing a second period of benefit when therapy is changed to a non-cross-resistant agent, for example, switching from zidovudine to ddI. In addition, we are encouraged by symptomatic improvement in patients with advanced disease who are started on antiretroviral drugs. Also, many retrospective epidemiology studies continue to show a survival advantage in patients taking these drugs. Despite continuing agreement on some of the benefits of antiretroviral therapy, we also face growing uncertainties. Recent studies have shown no survival advantage when antiretroviral drugs are used in asymptomatic HIV infection, and any benefit in slowing clinical progression seems to disappear when zidovudine monotherapy, at least, is given for a prolonged period. Questions continue as well about the degree of benefit of antiretroviral therapy for patients with advanced HIV disease. Early clinical trials of zidovudine, for example, were done before the routine used of PCP prophylaxis, which, by itself, delays progression to that common indicator of AIDS. Questions about the current status of antiretroviral therapy include: Which drug or combination is superior as initial therapy? When should this initial therapy begin? What is the duration of the benefit from initial therapy? How long should it be continued before other drugs or combinations are initiated? Finally it is important to consider: Which drugs should be used following initial therapy? What might we anticipate in the future from drugs in current clinical development? Beginning Therapy -- What and When Probably the easiest question at the moment in the field of HIV therapy is which drug to use to begin treatment. Data from ACTG 116A make it clear that zidovudine is superior to ddI as a monotherapy in previously untreated patients, and data from other studies show the superiority of zidovudine over ddC. An independent "State of the Art Panel" recently convened by the National Institute of Allergy and Infectious Diseases (NIAID) and chaired by Merle Sande, MD, UCSF chief of the medical service at San Francisco General Hospital, found an easy consensus that zidovudine monotherapy is the initial therapy of choice. Even here, however, other opinions may be heard, especially concerning the potential for initial use of combinations of nucleoside analogs. For example, the recent ACTG 155 trial in much more advanced disease tended to show a superiority of the combination of zidovudine and ddC, which was limited to patients with the highest CD4 cells (between 150 and 300). A large study, ACTG 175, is comparing initial combination with monotherapy, but the results from this trial are not anticipated before the end of 1995. In the meantime, combinations including zidovudine with ddI or zidovudine with ddC as initial therapy remain of interest. When best to initiate antiretroviral therapy is probably the most controversial question in the field of HIV management. Extended data from ACTG 019 demonstrate durable clinical progression benefit with the use of 500 mg of zidovudine daily in patients with asymptomatic HIV infection and with CD4 cell counts between 300 and 500, but these data are in apparent conflict with those from the recently completed Concorde Study. Concorde, enrolling more than 1700 patients with any level of CD4 count, compared the initial use of one gram of zidovudine daily with the same therapy deferred until after the person developed AIDS or ARC. After a median treatment duration of three years, and despite a clear and sustained CD4 improvement with the immediate use of zidovudine, there was no apparent benefit in the immediate treatment group either in clinical progression or survival. When the investigators analyzed a subset of the overall group with CD4 counts below 500 cells and after one year of therapy, a benefit similar to that seen in ACTG 019 was observed. Although Concorde was a powerful study, given the size and duration of follow-up, concerns have been raised that the dosage at one gram was excessively high and that the large number of patients allowed to begin therapy before they became symptomatic complicates the analysis. Also adding to the confusion are the recently published results of the European-Australian cooperative Group trial, which tended to find a clinical benefit with the use of zidovudine in patients with CD4 counts up to 750 cells. The State of the Art Panel recommended two broad options after considering the available data--initiating therapy in asymptomatic individuals with CD4 counts under 500 cells, or delaying this therapy until symptomatic HIV disease intervened. Another option favored by many clinicians is to follow patients, delaying therapy until evidence of more rapid disease progression becomes apparent as manifested by rapid declines in CD4 count or by a rise in p24 antigen or, especially, a rise in beta-2 microglobulin. At any rate, the clinician must discuss the various options with each patient, individualizing this decision according to the clinical and laboratory status of the patient and according to the patient's own desires. Duration of Therapy A second difficult question in the field of HIV management is how long to continue initial zidovudine. Again, the ACTG 019 experience would suggest that zidovudine monotherapy has a prolonged period of benefit, especially in patients with higher CD4 cell counts (300-500) when therapy is begun. On the other hand, ACTG 116A seemed to indicate that the initial superiority of zidovudine was lost after as little as two to four months of treatment with this drug prior to treatment with didanosine. Here again, the State of the Art panel could find little room for consensus. When therapy is begun in individuals with CD4 counts above 300, the panel suggested that it should be continued until the CD4 cell count fell below 300. When zidovudine monotherapy is begun in patients with CD4 counts under 300, the additional option of switching to ddI monotherapy after a fixed interval was raised, but again this interval was not defined. Once zidovudine monotherapy has been used, and when it is no longer felt to be effective for an individual, secondary therapy must be initiated. The choice of this therapy, however, is also uncertain. In moderate disease, with CD4 cell counts below 300, switching to ddI was superior to continuing with zidovudine in ACTG trials 116a and 116b/117, while switching to ddC was not of benefit in ACTG 155. On the other hand, from data gathered in CPCRA Trial 002, in patients with more advanced disease, ddI and ddC were equivalent in secondary treatment of patients previously treated with zidovudine who had progressed despite taking that drug or who were intolerant of zidovudine toxicity. In fact, ddC had a slight but significant superiority compared to ddI in terms of survival in this trial. It was hoped that combination therapy following zidovudine would be beneficial but questions have been raised following the results of ACTG 155. In this study, patients previously treated with zidovudine with CD4 cells below 300 were randomized to stay on zidovudine, start ddC monotherapy, or begin zidovudine and ddC combination therapy. Overall, there was no difference in clinical progression or survival among the three study arms. When the baseline CD4 counts are examined, however, it was found that combination therapy was superior in patients with higher CD4 cell counts, especially between 150 and 300. Therefore, it might seem advisable not to delay the introduction of combination therapy until patients have very advanced disease but rather to use such therapy earlier in the disease course. Whether zidovudine and ddI would be as good as zidovudine and ddC has not been investigated. Newer Classes of Drugs Along with new data on existing therapies, more information is available now on newer classes of drugs. These include nucleoside analogs, non-nucleoside reverse transcriptase inhibitors, protease inhibitors, and the tat inhibitor. Nucleoside Analogs. New nucleoside analogs in clinical investigation include d4T (stavudine) and 3TC. d4T has been much more extensively studied and appears effective in raising CD4 count and lowering HIV p24 antigen in a number of Phase 1 trials. It appears safe. Although cases of pancreatitis have been reported, they seem to be extremely rare. Neuropathy is the main toxicity but, again, it appears to be somewhat less than with ddI or ddC. d4T may not be suitable for combination with zidovudine as the two drugs have a negative interaction limiting their activation within the cell. On the other hand, d4T is a well-tolerated drug and may prove to be an alternative to one or more of the existing nucleosides. 3TC also appear safe and may be able to help restore sensitivity to zidovudine when the patient's HIV has become resistant. Reverse Transcriptase Inhibitors. The non-nucleoside reverse transcriptase inhibitors, including nevirapine and the Merck "L" drug, were recently thought to have limited value because they induce high-level drug resistance so rapidly. At the Berlin conference, however, one report showed that by increasing the dosage of nevirapine to 400 mg daily, a dose well above the level of resistance, prolonged benefit might be achieved. Also, it was shown that combining zidovudine with nevirapine delays the onset of nevirapine resistance. Thus, these drugs may still find a place in clinical medicine. At the same time, convergent therapy, using three drugs together, was disappointing because of simultaneous resistance to zidovudine, ddI and non-nucleoside reverse transcriptase inhibitors. Protease Inhibitors. Protease inhibitors seem to be gaining some ground. In Phase 1 trials, several of these compounds have evident antiretroviral activity, which was reflected in decreasing HIV p24 and increasing CD4 cell counts. Clinical benefits have not been established nor has the activity of these drugs used in combination with zidovudine been described. Because several structurally different protease inhibitors are being developed by different drug companies, it is hoped that at least one of these compounds will become more widely available soon for clinical use. Tat. While the protease inhibitors appear encouraging, tat inhibitors appear to be clinically inactive. In Phase 1 trials of the Hoffman LaRoche tat inhibitor, little or no antiretroviral activity was seen and it is probably that this class of drugs will not be developed further. Summary Given this complex and seemingly confusing information, what recommendations can be given to the clinician? Most important is to individualize the decision-making and to consider the desires of the patient even more than previously. Some patients gravitate easily to more aggressive therapy, while others prefer a more conservative therapeutic approach. With the former, initiating therapy at or even above 500 CD4 counts, perhaps even with a combination of zidovudine and ddI, may be considered. For more conservative patients, however, following the recommendations of the Concorde study may in order. In other words, defer the initiation of zidovudine monotherapy until the onset of clinical symptoms. Once the choice of initial therapy has been made, all other recommendations must also be individualized. No firm data are available to guide the decision about how long to continue a therapy or even about what to use next. Most of these options have not been compared directly in clinical trials. It would seem advisable to continue therapy longer in patients with relatively earlier disease when therapy is initiated. On the other hand, if patients have more advanced disease, for example, are symptomatic or have CD4 cell counts below 300 when therapy is begun, then a more rapid alteration of therapy to a non-cross-resistant drug or combination should be considered. The goal in each patient is to continue effective antiretroviral therapy for as long as possible, discontinuing the therapy if further benefits appear impossible. Although the results of recent clinical trials are disappointing in some respects, it nevertheless is important to have these data. Only then can we adjust our expectations and our patients' expectations of antiretroviral treatment and learn how to make the best use of the drugs that we have available. Recognizing the increasing need for the development of new classes of more effective drugs in combinations, we must still seek to maintain the optimism that enables progress in our patients' care. Dr. Volberding is a UC San Francisco professor of medicine and Director, UCSF AIDS Program at San Francisco General Hospital. References: ZDV and The AIDS Clinical Trials Group (1989-93): Aweeka FT. Gambertoglio JG. et al. Pharmacokinetics of concomitantly administered foscarnet and zidovudine for treatment of human immunodeficiency virus infection (AIDS Clinical Trials Group protocol 053). Antimicrobial Agents & Chemotherapy. 36(8):1773-8, 1992 Aug. Fischl MA. Richman DD. et al. The safety and efficacy of zidovudine (AZT) in the treatment of subjects with mildly symptomatic human immunodeficiency virus type 1 (HIV) infection. A double-blind, placebo-controlled trial. The AIDS Clinical Trials Group [see comments]. Annals of Internal Medicine. 112(10):727-37, 1990 May 15. [Editor's Note: This article reports the results of ACTG 106.] Fischl MA. Parker CB. et al. A randomized controlled trial of a reduced daily dose of zidovudine in patients with the acquired immunodeficiency syndrome. The AIDS Clinical Trials Group. New England Journal of Medicine. 323(15): 1009-14, 1990 Oct 11. Gelber RD. Lenderking WR. et al. Quality-of-life evaluation in a clinical trial of zidovudine therapy in patients with mildly symptomatic HIV infection. The AIDS Clinical Trials Group. Annals of Internal Medicine. 116(12 Pt 1):961-6, 1992 Jun 15. Hochster H. Dieterich D. et al. Toxicity of combined ganciclovir and zidovudine for cytomegalovirus disease associated with AIDS. An AIDS Clinical Trials Group Study. Annals of Internal Medicine. 113(2):111-7, 1990 Jul 15. Kahn JO. Lagakos SW. et al. A controlled trial comparing continued zidovudine with didanosine in human immunodeficiency virus infection. The NIAID AIDS Clinical Trials Group [see comments]. New England Journal of Medicine. 327(9):581-7, 1992 Aug 27. Koch MA. Volberding PA. et al. Toxic effects of zidovudine in asymptomatic human immunodeficiency virus-infected individuals with CD4+ cell counts of 0.50 x 10(9)/L or less. Detailed and updated results from protocol 019 of the AIDS Clinical Trials Group. Archives of Internal Medicine. 152(11):2286-92, 1992 Nov. Krogstad DJ. Eveland MR. et al. Drug level monitoring in a double-blind multicenter trial: false-positive zidovudine measurements in AIDS clinical trials group protocol 019. Antimicrobial Agents & Chemotherapy. 35(6): 1160-4, 1991 Jun. Meng TC. Fischl MA. Richman DD. AIDS Clinical Trials Group: phase I/II study of combination 2',3'-dideoxycytidine and zidovudine in patients with acquired immunodeficiency syndrome (AIDS) and advanced AIDS-related complex. American Journal of Medicine. 88(5B):27S-30S, 1990 May 21. Sidtis JJ. Gatsonis C. et al. Zidovudine treatment of the AIDS dementia complex: results of a placebo-controlled trial. AIDS Clinical Trials Group. Annals of Neurology. 33(4):343-9, 1993 Apr. Sperling RS. Stratton P. Treatment options for human immunodeficiency virus-infected pregnant women. Obstetric- Gynecologic Working Group of the AIDS Clinical Trials Group of the National Institute of Allergy and Infectious Diseases. Obstetrics & Gynecology. 79(3):443-8, 1992 Mar. Volberding PA. Lagakos SW. et al. Zidovudine in asymptomatic human immunodeficiency virus infection. A controlled trial in persons with fewer than 500 CD4-positive cells per cubic millimeter. The AIDS Clinical Trials Group of the National Institute of Allergy and Infectious Diseases [see comments]. New England Journal of Medicine. 322(14):941-9, 1990 Apr 5. [Editor's Note: This article reports the results of ACTG 109.] See also: Aboulker JP. Swart AM. Preliminary analysis of the Concorde trial. Concorde Coordinating Committee [letter]. Lancet. 1993 Apr 3;341(8849):889-90. Comment in: Lancet 1993 Apr 17;341(8851): 1022-3; Lancet 1993 Apr 17;341(8851):1023; Lancet 1993 May 15; 341(8855):1276; Lancet 1993 May 15;341 (8855):1276-7; and Lancet 1993 May 15;341(8855):1277. Cooper DA. Gatell M. et al. Zidovudine in persons with asymptomatic HIV infection and CD4+ cell counts greater than 400 per cubic millimeter. New England Journal of Medicine. 329(5): 297-303, 1993 Jul 29. Hamilton JD. Hartigan PM. et al. A controlled trial of early versus late treatment with zidovudine in symptomatic human immunodeficiency virus infection. Results of the Veterans Affairs Cooperative Study. New England Journal of Medicine. 326(7):437- 43, 1992 Feb 13. ------------------------------------------------------------------------------- Question 4.2. What about "alternative" treatments for HIV/AIDS? DNCB FACT SHEET Billi Goldberg PURPOSE DNCB (1-chloro-2,4-dinitrobenzene or C(6)H(3)ClN(2)O(4)) is a potent topical contact sensitizer. Studies have shown that, when used regularly, DNCB will boost the cellular immune response resulting in increased numbers of cytotoxic T lymphocytes (CTL) and natural killer (NK) cells . REFERENCES Caulfield CR, Goldberg B. 1993. The Anarchist AIDS Medical Formulary. Berkeley: North Atlantic Books. Gilden D. DNCB Treatment Today. AIDS Treatment News #182 1993:3-7. Hosein S. Immunomodulators. Treatment Update #43 1993;4(3):4-6. Mills LB. Stimulation of T-cellular immunity by cutaneous application of dinitrochlorobenzene. J Am Acad Dermatol 1986;14(6):1089-1090. Stricker RB, Elswood BF, Abrams DI. Dendritic cells and dinitrochlorobenzene (DNCB): a new treatment approach to AIDS. Immunol Lett 1991;29:191-196. Stricker RB, Elswood BF. Topical dinitrochlorobenzene in HIV disease. J Am Acad Dermatol 1993;28(5):796-797. Stricker RB et al. Pilot study of topical dinitrochlorobenzene (DNCB) in human immunodeficiency virus infection. Immunol Lett 1993;36:1-6. DNCB TREATMENT INSTRUCTIONS (Rev. 12/1/93) by Billi Goldberg PURPOSE DNCB is a potent topical contact sensitizer. Studies have shown that, when used regularly, DNCB will boost the immune response resulting in increased numbers of cytotoxic T-lymphocytes (CTL) and natural killer (NK) cells. Articles and studies in The Anarchist AIDS Medical Formulary,(1) AIDS Treatment News,(2) Treatment Update,(3) and scientific journals(4) provide additional information on DNCB that may be helpful. ACTION The mechanism of immunological action of DNCB is due to Delayed Type Hypersensitivity (DTH) which involves the initiation of the Th1 or the cell mediated immune response (CMI). The humoral or antibody system is not directly involved in DTH. The primary infections in AIDS are of an intracellular nature which can only be controlled by the cell mediated immune response; the antibody system is ineffective in controlling these opportunistic infections. DRUGS AND IMMUNOSUPPRESSION Antibiotics, nucleosides analogues and other drug treatments can interfere with the cell-mediated immune response thus negating the systemic action initiated by DNCB. Drugs required for the treatment of infections must be continued until the infections are cleared or controlled. Individuals with AIDS must use PCP prophylaxis; use of other prophylaxis drugs is of questionable value (see Hoover DR et al. 1993. Clinical manifestations of AIDS in the era of pneumocystis prophylaxis. NEJM 329:1922-1926) especially in DNCB users. It is extremely important to avoid all forms of ultraviolet radiation such as sunlight (wear a hat and use sunblockers) and tanning salons. UV light not only suppresses cellular immunity but can increase HIV replication. VITAMINS, MINERALS, AND IMMUNITY Individuals with compromised immune systems fighting chronic infections require supplements of basic vitamins and minerals. Suggested supplements are Multi-mineral tab, Multi-vitamin tab, Beta Carotene (25,000 I.U.), B-Complex, Vitamin C (1000 mg), Vitamin E (400 I.U.), Odorless Garlic (270 mg), and Zinc (30 mg). These supplements should be taken only once a day; overuse of supplements can be detrimental. Zinc can be toxic when over 100 mg per day is used. There are studies that show that the optimal amount of Vitamin C is one to three grams per day with amounts over that causing interference with the immune response.(1) N-acetyl-L-cysteine (NAC) and other anti-oxidants such as curcumin, interfere with lymphocyte proliferation and immunological functions (i.e., IL-2 and IL-2R, cellular adhesion molecules, lymphotoxin, and production of colony stimulating factors) in infected and uninfected cells by inhibiting Nuclear Factor-kappa B (NF-kB).(2) Most herbs are polysaccharides that initiate a systemic antibody response or Th2. Studies have shown that activation of this Th2 response will shutdown the cell-mediated immune response (Th1) required to control the infections involved in AIDS. Herbs, therefore, should not be used indiscriminately or on a regular basis unless it can be shown that they initiate cellular immunity or delayed-type hypersensitivity. If the immunological action of any herb is not known, it should not be used. INFORMATION AND AVAILABILITY DNCB information and kits can be obtained from DNCB Now!, 2261 Market Street, #499, San Francisco, CA 94114 or call (415) 954-8896. Starter kits are available for a suggested donation of $25.00 which includes postage and treatment instructions. Single vials of DNCB require a $6.00 suggested donation which includes postage. For an additional donation of $5.00, an information packet of literature on DNCB and cell-mediated immunity will be sent. DNCB kits, individual vials, and information packets will be supplied free of charge to those unable to afford them. INITIAL APPLICATION (if previous DNCB user, start with 0.2% solution) 1. Using a Q-tip, apply the 10% SOLUTION to the inner LEFT forearm in a 2" x 2"-square. (Do not use with thymic peptides or cytokines.) 2. After a few minutes, apply the Q-tip with the 10% SOLUTION a second time on the same 2" x 2"-square location. 3. Let dry for a few minutes and cover with a large adhesive bandage, making certain that the adhesive does not touch the application site. Do not remove bandage or wash the application site for at least ten hours. 4. Do not, under any conditions, apply DNCB again until two weeks has elapsed even if there is no reaction at the application site. AFTER TWO WEEKS 1. Using a Q-tip, apply the 2% SOLUTION to the inner RIGHT forearm in a 2" x 2"-square. 2. After a few minutes, apply the Q-tip with the 2% SOLUTION a second time on the same 2" x 2"-square location. 3. Let dry for a few minutes and cover with a large adhesive bandage, making certain that the adhesive does not touch the application site. Do not remove bandage or wash the application site for at least ten hours. 4. In less than seventy-two hours, the skin at the application site should be bright red, itchy, and slightly raised. If this happens, start weekly applications as per the next section. 5. If there is no reaction, continue with weekly applications of the 10% SOLUTION (alternating arms each week) until there is an appropriate response at the application site, then start weekly applications. AFTER ONE WEEK AND EACH WEEK THEREAFTER 1. Repeat numbers 1 to 4 above using the 2% SOLUTION, using a different application site for each weekly application. Stinging at the site within one hour after application is a sign of an appropriate dose that will result in a good reaction, but this does not occur in all individuals. 2. It is advisable to move the application site each month between the inner arms, inner thighs, and trunk (stomach, rib cage, and chest). It is especially important to apply DNCB on the upper and lower trunk areas more often that other sites, since the lungs and gastrointestinal tract are primary sources of opportunistic infections. When applying to the trunk area, use a 3" x 3"- square. Every six weeks or more often if there are infections, it is advisable to use extra DNCB by applying the Q-tip one additional time to the trunk area application site. To initate an increased immune response, DNCB can be applied to more than one site during the weekly application (such as two trunk sites, arm and trunk, thigh and trunk, neck and trunk, etc.). It can also be applied at or near swollen lymph nodes. 3. If the application site is not bright red and slightly raised in twenty-four to seventy-two hours, the solution is too weak. For the next application, either increase the solution strength or apply one extra application with the Q-tip. 4. If the skin at the application site has raised blisters or open sores, decrease the strength of the application by either applying only once with the Q-tip, or using a weaker solution, such as 0.2% or 0.02%. 5. If the present application site becomes bright red in twenty-four to seventy-two hours or any previous application site changes color, you are considered sensitized and need only to continue applications on a weekly basis. 6. Do not use DNCB more than once a week, no matter what conditions or circumstances occur. If severe contact dermatitis or itching occurs, apply calamine lotion, aloe vera, cocoa butter, or Bactine directly to the rash. The use of cortisone or hydrocortisone creams is not recommended, as they have systemic immunosuppressing effects. An overly strong reaction resulting in dermatitis is a sign of an excellent immune response and is positive not negative. The dermatitis will heal in time and will not leave a scar. DNCB can be applied to Kaposi's sarcoma lesions at the same time as the weekly application. DNCB must be used weekly to be effective and to initiate appropriate systemic immune responses. REFERENCES (1) Caulfield CR, Goldberg B. 1993. The Anarchist AIDS Medical Formulary. Berkeley, CA: North Atlantic Books. (2) Gilden D. 1993. DNCB Treatment Today. AIDS Treatment News 182:3-7. (3) Hosein S. 1993. Immunomodulators. Treatment Update 43 :4(3):4-6. (4) Mills LB. 1986. Stimulation of T-cellular immunity by cutaneous application of dinitrochlorobenzene. J Amer Acad Dermatol 14:1089-1090; Stricker RB, Elswood BF, Abrams DI. 1991. Dendritic cells and dinitrochlorobenzene (DNCB): a new treatment approach to AIDS. Immunol Lett 29:191-196; Stricker RB, Zhu YS, Elswood BF. et al. 1993. Pilot study of topical dinitrochlorobenzene (DNCB) in human immunodeficiency virus infection. Immunol Lett 36:1-6; and Stricker RB, Elswood BF. 1993. Topical dinitrochlorobenzene in HIV disease. J Am Acad Dermatol 28:796-797. (5) Hoover DR, Saah AF, Bacellar H., et al. 1993. Clinical manifestations of AIDS in the era of pneumocytstis prophylaxis. NEJM 329:1922-1926; and Osmond D, Charlebois E, Lang W. et al. 1994. Changes in AIDS survival time in two San Francisco cohorts of homosexual men, 1983 to 1993. JAMA 271:1083-1087. Archive-name: aids-faq/part5 Posting-Frequency: monthly Last-modified: 10/8/94 Sci.Med.AIDS FAQ Part 5/10 (6) Munster AM, Loadholdt CB, Leary AG, Barnes MA. 1977. The effect of antibiotics on cell-mediated immunity. Surgery 81:692-695; Anderson R, Oosthuizen R, Maritz R, et al. 1980. The effects of increasing weekly doses of ascorbate on certain cellular and humoral immune functions in normal volunteers. Am J Clin Nutr 33:71-76; and Ramirez I, Richie E, Wang YM, van Eys J. 1980. Effect of ascorbic acid in vitro on lymphocyte reactivity to mitogens. J Nutr 110:2207-2215. (7) Aillet F, Gougerot-Pocidalo MA, Virelizier JL, Israel N. 1994. Appraisal of potential therapeutic index of antioxidants on the basis of their in vitro effects of HIV replication in monocytes and interleukin 2-induced lymphocyte proliferation. AIDS Res Hum Retro 10(4):405-411; Staal FJT, Roederer M, Raju PA, et al. 1993. Antioxidants inhibit stimulation of HIV transcription. AIDS Res Hum Retro 9;299-306; Nabel GJ. 1993. The role of cellular transcription factors in the regulation of human immunodeficiency virus gene expression. In: Cullen BR, ed. 1993. Human Retroviruses, New York: IRL Press, 61; Go C, Miller J. 1992. Differential induction of transcription factors that regulate the interleukin 2 gene during anergy induction and restimulation. J Exp Med 175:1327-1336; and Baeuerle PA, Henkel T. 1994. Function and activiation of NF-kB in the immune system. Ann Rev Immunol 12:141-179. HOW DNCB WORKS by Billi Goldberg DNCB is applied weekly on the skin at various sites which initiates contact sensitivity. The Langerhans cells in the skin at the application site pick up the DNCB antigen, migrate from the skin, change into veiled dendritic cells, continue their migration to the nearest lymph node, change into interdigitating dendritic cells. Once in the lymph nodes, they present the DNCB antigen to CD4 helper cells, thus initiating a Th1 response or cell mediated immune response or Type IV Delayed Type Hypersensitivity response (they can all be considered the same thing). The CD4 helper cells then proliferate forming more helper CD4 cells which then circulate and activate effector cells (primarily macrophages) to rid the sysem of the DNCB antigen. At the same time CD4 memory cells are produced adding to the CD4 memory pool for the DNCB antigen (hapten). Each time DNCB is applied, these memory cells are activated thus initiating a systemic Th1 response to DNCB. The longer DNCB is used, the response becomes faster, more potent, and more effective because there are more circulating DNCB CD4 memory cells to initiate the immune response. The result of this specific systemic Th1 response to DNCB is the non-specific activation of macrophages. Many of these macrophages are infected with HIV and other intracellular pathogens that cause AIDS but are unable to present these pathogen antigens due to infection. The microbial pathogens of AIDS are of the facultative or obligate intracellular type. The activation of these macrophages result in phagocytosis of the pathogens which are then presented by macrophages to CD4 and CD8 memory cells specific for the presented pathogen. The activated helper and cytotoxic T lymphocytes initiate specific systemic responses to destroy the presented pathogens. This results in more activated macrophages, more pathogens presented, more T memory cells activated, more infected cells destroyed, ad infinitum. Since pathogens can be presented on both the Class I and Class II MHC (major histocompatibility complex) of the antigen presenting cells, cytotoxic T lymphocytes, natural killer cells, neutrophils, and killer macrophages are also activated to accomplish the destruction. There is also an excellent probability that dendritic cells (the most potent antigen presenting cells in the immune system) are also activated in the lymphoid tissues to present intracellular and extracellular antigens thereby activating even more T lymphocyte memory, helper, and effector cells thus increasing the Th1 response against the pathogens involved in AIDS. It is extremely important to remember that the antibody/Th2/humoral response is not directly involved in fighting the infections of AIDS. The denial of this fact is the primary reason that there has been no progress in realistic treatments for AIDS. In point of fact, there is research to show that activating the antibody or Th2 response may suppress the Th1 response. This would allow the intracellular pathogens to be uncontrolled since their control depends on the Th1 or cell-mediated immune response. There is also research to show that immune complexes (HIV + antibody) can be internalized through the antibody receptor (Fc) of monocytes and macrophages thus spreading and increasing HIV infection of these cells. Delayed Type Hypersensitivity is an extremely effective and potent immune modulator that forces priming and activation of macrophages that are non-responsive due to infection. DNCB, then, acts like an adjuvant or biological response modifier. These phenomena have been researched in-depth and are considered a factual part of scientific knowledge. On page 1292 of the recent edition of The Merck Manual is the following: "Skin malignancies have regressed after induction of delayed hypersensitivity to dinitrochlorobenzene (DNCB) and subsequent direct application of DNCB to the tumor." Below are the scientific explanations of what happens. This process has been an integral part of the scientific literature for many years. Meltzer and Nacy have explained it brilliantly. DNCB is not new; it has been used for decades. But, since the cost of DNCB is minimal and there is no profit to be made, it has been ignored. The following is from Chapter 28 titled "Delayed-Type Hypersensitivity and the Induction of Activated, Cytotoxic Macrophages" by Monte S. Meltzer and Carol A. Nacy in Fundamental Immunology (1989), second edition, published by Raven Press. Page 775: "Contact sensitivity is a variant form of DTH in which certain reactive chemicals (usually small molecular weight compounds or metal ions that can diffuse into the epidermis) covalently bind to skin proteins and create neoantigens. Such neoantigens prime or sensitize the exposed animal to a second cutaneous application of the reactive chemical (contactant). A portion of the neoantigen is host derived. Thus an animal exposed to trinitrochlorobenzene (TNCB or picryl chloride) solution epicutaneously responds to a repeated cutaneous exposure with a vigorous DTH response. Intradermal injection of TNCB covalently bound to an irrelevant protein such as albumin fails to elicit this response. Neoantigens induced in the epidermis are taken up by Langerhans cells. These highly efficient, antigen-presenting dendritic cells migrate into the dermis, enter lymphatics, and travel to the cortical region of the draining lymph node where they present the antigen to CD4+ T cells. Application of normally sensitizing chemicals to skin devoid of Langerhans cells (skin treated with corticosteroids, UVB light, or cellophane adhesive tape) does not induce contact sensitivity and may produce specific immunologic tolerance to the contactant." Pages 766-767: "Coincident with the development of DTH during infection is a widespread activation of free and fixed mononuclear phagocytes throughout the body. Tissue macrophages develop profound alterations in morphology, cell proliferation, phagocytosis, and the capacity to destroy intracellular and extracellular microorganisms. Each of these changes is dependent on interactions with sensitized lymphocytes. These systemic changes in the antimicrobial activity of immunologically activated macrophages may explain observations made as early as 1936 that animals responding to reinfection with one microorganism (bacterium A) [ed. DNCB] acquire the ability to resist nonspecifically infection with antigenically unrelated pathogens (bacterium B, C, or D). Unlike the long-lived, antigen specific, DTH response, this nonspecific element of acquired resistance is short lived and can only be reexpressed by further exposure to the original microbe (bacterium A) [ed. DNCB]. "Thus the DTH response to foreign antigens induces a series of immune reactions whose ultimate purpose is the short-term accumulation of nonspecifically cytotoxic, macrophage effector cells. Mononuclear phagocytes rapidly and preferentially accumulate at sites of infection. These inflammatory cells co-locate with antigen-reactive, sensitized T cells and undergo dramatic changes in their functional state. The activated macrophages that result are pleuripotent cytotoxic effector cells which destroy viruses, bacteria, fungi, single and multicellular parasites, allografts, and tumor cells. This complex network of cell-mediated reactions is controlled by an even more complex interaction of various cytokines, those released by the T cell, the macrophage, and even the target cell. DTH reactions are not self-destructive overreactions to foreign antigens, but rather tightly controlled body defenses against tissue allografts, infection, and neoplastic change." ------------------------------------------------------------------------------ Question 4.2.2 OZONE OZONE / OXYGEN Prepared by Martin A. Majchrowicz Spring 1994 Ozone, the fusion of three oxygen molecules to create O3, is an incredibly unstable molecule that breaks down very easily into a stable O2 molecule and an O1 charged molecule. In nature, oxygen more frequently occurs in the O2 state which is far more stable. Ozone is more commonly known as the layer of the atmosphere which protects plants and animals from the damaging effects of ultraviolet radiation from the sun. It is also known as a pollutant that builds up in the lower part of the atmosphere on warm days as a result of chemical reactions, driven by the heat of the sun, when nitrogen dioxide and hydrocarbons from vehicle exhaust react with oxygen. In this form, ozone can cause irritation and sometimes damage to the mucosal membrane of the respiratory tract and the eyes. Ozone can also be useful in the treatment of water. Known as a strong oxidant, ozone can be used in the water purification process as a method of killing bacteria and other microorganisms in the water supply. Due to its antibacterial, antifungal, and antiviral properties, some believe that ozone can be used as a method of treating a variety of diseases including HIV/AIDS. This practice has become quite controversial. Most researchers believe ozone has no medical use. However, ozone proponents claim that the Western medical "establishment" wants to "crush" this cheap and effective method of treating HIV/AIDS, cancer, and a variety of other acute and chronic fatal diseases. There arc several different forms of ozone therapy which are sometimes referred to as superoxidation or hyperoxidation. Ozone therapy can be administered in three different ways. One method is removing blood from the patient, bubbling ozone through the blood, and infusing the blood back into the patient. Another form is the rectal ozone machine which generates ozone gas and blows it directly into the patients rectum. The last and potentially most dangerous form of ozone therapy is intravenous or intramuscular injections of ozone gas. This literally entails injecting ozone gas directly into the vein or muscle of the patient. Hydrogen peroxide injections are sometimes used as part of, or independent of, ozone therapy. Those who recommend hydrogen peroxide also recommend peroxide also recommend drinking and bathing in it. The hydrogen peroxide used for such therapy is a different strength than what can be purchased in a drug store. MECHANISM OF ACTION As there are many different forms of ozone therapy, there are as many different theories as to how ozone therapy can be useful. The most simplistic of these theories is that since disease-causing organisms, including viruses, die in the presence of high concentrations of oxygen, by increasing the oxygen concentration in the body with ozone, this will kill HIV and other viruses and bacteria. This theory is also coupled with the fact that since we breath oxygen everyday, it is "obviously" safe to be injected or infused into the body with no toxicity or side effects. When ozone is created, it quickly degrades from an O3 molecule to an O2 and an O1 The first theory suggests that the O2 molecule will kill free viruses, meaning viruses that are not hiding in CD4 cells. Since there is very little free HIV in the blood, the real problem of HIV infected cells and their ability to produce more HIV is not solved. This theory can be taken one step further by claiming that the O1 molecule, an oxidant, is the useful aspect of ozone degradation reaction, and this is what will kill free viruses as well as "diseased cells" (cells infected with HIV). The rationale for this theory is based on the fact that healthy human cells can protect themselves from the oxidative stress of O1. However, viruses, microbes, and "diseased cells" lack the ability to protect themselves from oxidants, therefore they are destroyed by ozone. Healthy cells. those that are not infected with HIV, will not be damaged by the ozone. As opposed to the first theory, this second theory suggests that ozone is not only effective against free virus but also against cells that are already infected with HIV. However, neither of these theories has been proven in any laboratory studies. One laboratory study suggests that ozone may act directly on HIV by inducing viral particle disruption, reverse transcriptase inactivation, and/or perturbation of the ability of the virus to bind to its receptor on target cells. Bocci, a researcher in Italy, has put forth a very different theory of how ozone may be effective against certain diseases. Bocci recognizes that ozone decomposes very rapidly and very little virus is actually free in the blood. He suggests that the benefit of ozone may be due to its ability to enhance the functioning of the immune system and induce the production of certain cytokines such as tumor necrosis factor (TNF) and interferon (IFN). STUDIES While laboratory studies that show ozone can kill HIV in vitro (in the test tube) exists, there is little evidence to suggest that ozone is an effective anti-HIV/AIDS therapy in humans. Carpendale reports using ozone to treat diarrhea of unknown origin in five men with a wide range of CD4 cells. Of the five men, the four with the highest CD4 counts experienced a decrease in diarrhea. The one patient with cryptosporidium and a CD4 cell count of 75 did not respond to ozone and eventually died. The four men who responded had relatively high CD4 counts (193, 130, 209, & 435) and may have resolved regardless of therapy. Many times, diarrhea in people with HIV can spontaneously resolve. Due to the small number of patients and the nature of their symptoms, it is difficult to conclude that ozone had a definite effect on their diarrhea. Carpendale also reports on two asymptomatic patients who used ozone for five years. One patient who began with 907 CD4 cells showed an increase of CD4 cells to 1286 at the beginning of the third year and an increase of the CD4/CD8 ratio. Although the follow-up supposedly lasted five years, there is no data past this point. The second patient began with 309 CD4 cells, increased to 831, but then stabilized between 500-700. After six years, this patient "suddenly" died of pneumonia and disseminated coccidiomycosis (a fungal infection). The CD4 cell trends mentioned in this report are nothing extraordinary considering the final outcomes. Both patients experienced transient increases in their CD4 cell counts and moderate increases in their CD4/CD8 ratios. There was no mention of whether or not other medications were used. This report does not provide a clear benefit of ozone therapy. In addition to these extremely limited studies, there are supposedly hundreds of cases of people being "cured" with ozone including complete alleviation of symptoms and becoming HIV negative (using ELISA, Western Blot, and PCR). None of these reports has ever been substantiated. Proponents of ozone claim that these reports cannot be made public due to the fear that those doctors involved will have their licenses revoked. However, nothing is preventing patients with HIV/AIDS from coming forward and claiming that they have been "cured". COMMENT Until recently, it was thought that ozone therapy was at least a safe alternative, and attempts had not been made to discourage people from seeking it as an option. However, after two reported cases of death involved with ozone therapy, we at APLA strongly caution people about the risks involved with ozone therapy. The three main issues are safety, price, and effectiveness. Proponents of ozone repeatedly make accusations that the "medical establishment" is against ozone because it is an inexpensive approach and that finding a cure using ozone will threaten pharmaceutical companies. The average cost of a rectal ozone machine is $5000, while some "underground" physicians charge as much as $30,000 for IV ozone treatments. We have known of several people with HIV/AIDS who purchased ozone machines and reported little to no benefit. One ozone "doctor" in Mississippi claims to be doing a "super secret" study with the government. This "doctor" said that "all the patients need to know is it'll cost them about $1000 a week and they don't have to worry about anything after that. They have to worry about their board and room, but that's about all." If it wasn't for the study, this therapy would cost $4000 a week. When questioned about which governmental agency was sponsoring the study, he responded, "I'm not at liberty to say who's doing it." The decision is yours to decide who is really profiteering. In an article by Ed McCabe in AIDS Patient Care (December 1992), McCabe claims that "over 300 AIDS patients" have become HIV negative through using ozone. In an attempt to verify this information, we asked McCabe if we could speak with people who have become HIV negative. We were provided with four names of people, two men who became HIV PCR negative and two men who became p24 negative (which is not incredibly significant). The protocol these men received included hydrogen peroxide baths, chelation ("a method of removing toxins from the blood"), nutritional supplements, hyperbaric oxygen chambers, and a variety of other herbs and homeopathic substances. One of the men who became p24 negative reported feeling better immediately afterwards but no sustained benefit six months later. The other said he probably felt better just because it was an opportunity for him to get away from work and his home for a while. He also reported that the "doctor" in Mississippi who administered the therapy was not a real doctor, and that after being told he would be treated for free was charged $1000 for lab work. Of the two men who were reported to become HIV PCR negative, one reported that he was not PCR negative but feels ozone has been beneficial in some way. The other man could not be contacted after repeated phone calls and messages. All three men contacted mentioned how upset they were that McCabee claims that people are being "cured" and becoming HIV negative from using ozone therapy. Ed McCabe is a journalist who lectures around the world promoting ozone therapy through his books and videos. Safety remains to be the most important issue. We have been told of two deaths that were a direct result of intravenous ozone therapy. These two people were receiving ozone therapy from a particular "doctor" who practiced in San Francisco and Las Vegas. This "doctor" is unable to be reached for an interview. One of these cases is currently under investigation. To date, there are no studies that can clearly demonstrate how ozone works. In addition, there are no human studies that have shown that ozone can be effective. Reports of people becoming HIV negative have not been confirmed. With reports of two deaths as a result of IV ozone therapy, the safety, as well as the trust of those who administer and promote ozone therapy, remains questionable. REFERENCES Bocci, V: Ozonization of blood for the therapy of viral diseases and immunodeficiencies. A hypothesis. Medical Hypotheses. 39:30-34, 1992. Carpendale, MT, Freeberg, JK: Ozone inactivates HIV at noncytotoxic concentrations. Antiviral Research. 16(3): 281-292, 1991. Carpendale, MT, Freeberg, J, Griffiss, JM: Does ozone alleviate AIDS diarrhea? Journal of Clinical Gastroenterology. 17(2):142-145, 1993. Carpendale, MT, Griffiss, J: Is there a role for medical ozone in the treatment of HIV and associated infection? Proceedings of XI Ozone World Congress, September 1993. Fowkes, SW: Oxidative Medicine. Forefront Health Invest McCabe, E: Ozone therapies for AIDS. AIDS Patient Care. December 1992. Wells, KH, Latino, J, Gavalchin, J, et al: Inactivation of human immunodeficiency virus type 1 by ozone in vitro. Blood. 78(7):1882-1890, 1991. Archive-name: aids-faq/part6 Posting-Frequency: monthly Last-modified: 1/1/95 AIDS FAQ Part 6/10 Section 5. Social Services Available Q5.1 Guide to Social Security Benefits. Q5.2 What if you can't afford AZT? ------------------------------------------------------------------------------ Question 5.1. Guide to Social Security Benefits. U.S. Department of Health and Human Services Social Security Administration SSA Publication No. 05-10020 September 1993 A Guide to Social Security and SSI Disability Benefits For People With HIV Infection About This Booklet Social Security can provide a lifeline of support to people with HIV infection. That lifeline comes in the form of monthly Social Security disability benefits and Supplemental Security Income payments, Medicare and Medicaid coverage, and a variety of other services available to people who receive disability benefits from Social Security. If you are disabled because of HIV infection, this booklet will help you understand the kinds of disability or Supplemental Security Income programs. What's Inside Part 1 -- Background Information The first section provides some brief background information about HIV infection and Social Security. Part 2 -- What Benefits Are You Eligible For? This section explains the nonmedical rules and eligibility factors for Social Security Disability Insurance benefits and Supplemental Security Income Disability payments. Part 3 -- How Does Social Security Define "Disability?" This section explains Social Security's definition of "disability" and how it relates to claimants with HIV infection. Part 4 -- How Does Social Security Evaluate Your Disability This section explains how Social Security evaluates disability claims involving HIV diseases in general. And it includes up-to- date information about the way we process claims, especially those involving women and children with HIV infection. Part 5 -- How Do You File For Disability Benefits? This section includes information about when and how to apply for disability, what steps we take to ensure that your claim is processed quickly and accurately, and most important, what things you can do to help the process along. Also included is information about situations when we can presume a person is disabled and make immediate payments. Part 6 -- Helping You Return To Work This section provides an overview of special rules designed to help you return to work. Part 7 -- What you Need To Know About Medicaid And Medicare This section includes a brief overview of the kinds of benefits available from the Medicaid and Medicare programs. For More Information ***************************************************************** PART 1 -- BACKGROUND INFORMATION Acquired immunodeficiency syndrome (AIDS) is characterized by the inability of the body's natural immunity to fight infection. It is caused by a retrovirus known as human immunodeficiency virus, or HIV. Generally speaking, people with HIV infection fall into two broad categories: 1) those with symptomatic HIV infection, including AIDS; and 2) those with HIV infection but no symptoms. Although thousands of people with HIV infection are receiving Social Security or Supplemental Security Income disability benefits, we believe there may be others who might be eligible for these benefits. Social Security is committed to helping all men, women, and children with HIV infection learn more about the disability programs we administer. And if you qualify for benefits, we are just as committed to ensuring that you receive them as soon as possible. You should also be aware that the Social Security Administrations's criteria for evaluating HIV infection are not linked to the Centers for Disease Control's (CDC) definition of AIDS. This is because the goals of the two agencies are different. CDC defines AIDS primarily for surveillance purposes, not for the evaluation of disability. PART 2 -- WHAT BENEFITS ARE YOU ELIGIBLE FOR? We pay disability benefits under two programs: Social Security Disability Insurance, sometimes referred to as SSDI, and Supplemental Security Income, often called SSI. The medical requirements are the same for both programs, and your disability is determined by the same process. However, there are major differences in the nonmedical factors, which are explained in the next two sections. Social Security Disability Insurance Benefits: The Nonmedical Rules Of Eligibility Here are examples of how people qualify for SSDI: o Most people qualify for Social Security disability by working, paying Social Security taxes, and in turn, earning "credits" toward eventual benefits. The maximum number of credits you can earn each year is 4. The number of credits you need to qualify for disability depends on your age when you become disabled. Nobody needs more than 40 credits and young people can qualify with as few as 6 credits. o Disabled widows and widowers age 50 or older could be eligible for a disability benefit on the Social Security record of a deceased spouse. o Disabled children age 18 or older could be eligible for dependent's benefits on the Social Security record of a parent who is getting retirement or disability benefits, or on the record of a parent who has died. (The disability must have started before age 22.) o Children under the age of 18 qualify for dependents benefits on the record of a parent who is getting retirement or disability benefits, or on the record of a parent who has died, merely because they are under age 18. For more information about Social Security disability benefits in general, ask Social Security for a copy of the booklet, Disability (Publication No. 05-10029). How Much Will Your Benefits Be? How much your Social Security benefit will be depends on your earnings history. Generally, higher earnings translate into higher Social Security benefits. You can find out how much you will get by contacting Social Security and asking for an estimate of your benefits. We'll give you a form you can use to send for a free statement that contains a record of your earnings and an estimate of your benefits. In addition to checking your benefit, we encourage you to use this statement to verify that your earnings have been properly recorded in our files. It's important that you do this because any missing or unreported wages could lower your Social Security benefit or even prevent you from qualifying for disability benefits. If you find a problem, contact your local Social Security office right away, show them proof of your actual wages, and the record will be corrected. This can be particularly important for people who have tested positive for HIV but have not developed symptoms, so that any potential benefits will not be delayed by wage correction efforts. Disabled widows, widowers, and children eligible for benefits as a dependent on a spouse's or parent's Social Security record receive an amount that is a percentage of the worker's Social Security benefit. Supplemental Security Income: The Nonmedical Rules Of Eligibility SSI is a program that pays monthly benefits to people with low incomes and limited assets who are 65 or older, or blind, or disabled. As its name implies, "Supplemental" Security Income "supplements" a person's income up to a certain level that can go up every year based on cost-of-living adjustments. The level varies from one state to another, so check with your local Social Security office to find out more about SSI benefit levels in your state. We don't count all the income you have when we figure out if you qualify for SSI. And if you work, there are special rules we use for counting your wages. Again, check with Social Security to find out if you can get SSI. In addition to rules about income, people on SSI must have limited assets. Generally, individuals with assets under $2000, or couples with assets under $3000, can qualify for SSI. However, when we figure your assets, we don't count such items as your home, your car (unless it's an expensive one), and most of your personal belongings. Your Social Security office can tell you more about the income and asset limits. For more general information, ask for a copy of the booklet, SSI (Publication No. 05-11000). PART 3 -- HOW DOES SOCIAL SECURITY DEFINE DISABILITY? In this section, we'll explain the criteria you must meet in order to be considered "disabled." First, we'll explain in general terms how Social Security defines and determines disability. Then we'll discuss how it applies to people with HIV infection. The General Definition Of Disability Disability under Social Security is based on your inability to work because of a medical condition. You will be considered disabled if you are unable to do any kind of "substantial" work for which you are suited. (Usually, monthly earnings of $500 or more are considered substantial.) Your ability to work must be expected to last at least a year. Or, the condition that keeps you from working must be so severe that you are not expected to live. For children, we decide how the condition affects their ability to function--to do the things and behave in the ways that other children of the same age normally would. How This Definition Of Disability Applies To People With HIV Infection A person with symptomatic HIV infection is often severely limited in his or her ability to work. In other words, if the evidence shows that you have symptomatic HIV infection that severely limits your ability to work, and if you meet the other eligibility factors, the chances are very good that you will be able to receive Social Security or SSI Benefits. On the other hand, some people with HIV infection may be less impaired and able to work, so they may not be eligible for disability. PART 4 -- HOW DOES SOCIAL SECURITY EVALUATE YOUR DISABILITY? Social Security works with an agency in each state, usually called a Disability Determination Service (DDS), to evaluate disability claims. At the DDS, a disability evaluation specialist and a doctor follow a step-by-step process that applies to all disability claims, thus assuring a consistent approach to evaluating disability. First, the DDS specialists decide whether your impairment is "severe." This simply means the evidence must show that your disability interferes with your ability to work. The next step in the process is deciding whether the disability is included in a list of impairments. This list describes, for each of the major body systems, impairments that are considered severe enough to prevent an adult from doing any substantial work or in the case of children under the age of 18, impairments that are severe enough to prevent a child from functioning in a manner similar to other children of the same age. Recently we published a list of impairments for HIV infections. In this list, we have included many conditions associated with symptomatic HIV infection, including some that specifically apply to women and children with HIV infection (See next two sections). Some of the HIV-related conditions included in the HIV list of impairments are shown below. The level of severity that an impairment must meet to be found disabling are also specified in the regulations. o Pulmonary tuberculosis resistant to treatment o Kaposi's sarcoma o Pneumocystis carinii pneumonia (PCP) o Carcinoma of the cervix o Herpes Simplex o Hodgkin's disease and all lymphomas o HIV Wasting Syndrome o Syphilis and Neurosyphilis o Candidiasis o Histoplasmosis Remember: these are just a few examples. You can see a complete list of HIV-related impairments at any Social Security office. The complete list will also include the findings necessary for listed impairments to be considered disabling by Social Security. If you have symptoms of HIV infection that are not specifically included in (or equal in severity to) the impairments on our list, then DDS disability specialists will look at how frequently these conditions occur and how they affect your ability to function. The DDS team will evaluate how well you function in three general areas: daily activities; social functioning; and the ability to complete tasks in a timely manner, which requires the ability to maintain concentration, persistence, and pace. If you have "marked limitations" in any one of these functional areas and repeated manifestations of HIV meeting the criteria in the listings, you may be found disabled. A marked limitation is one that seriously interferes with your ability to function independently, appropriately, and effectively. It does not mean that you must be confined to bed, hospitalized, or in a nursing home. If the specialists decide that you are not disabled at this point because you do not have a condition that exactly matches or is equal in severity to one on our list, then they will look to see if your condition prevents you from doing the work you normally do. If it does not, then we look to see if it prevents you from doing any other type of work you're suited for, based on your age, education, and experience. If it does, you may still be found disabled. Remember, at all steps in the process, your impairment must be documented. Documentation includes medical records from your doctors, as well as laboratory test results, X-ray reports, etc. The HIV infection itself--that is, the presence of the virus--must be documented as well as any HIV-related manifestations. At all steps in the process it is important that we have evidence of signs, symptoms, and laboratory findings associated with HIV infection, as well as information on how well you are able to function day-to-day. The signs and symptoms may include: repeated infections; fevers/night sweats; enlarged lymph nodes, liver or spleen; lower energy or generalized weakness; dyspnea on exertion; persistent cough; depression/anxiety; headache; anorexia; nausea and vomiting; and side effects of medication and/or treatment, as well as how your treatment affects your daily activities. Evaluation Of HIV Infection In Women Statistics show that there is an increasing number of women with HIV diseases. Social Security's guidelines for the immune system recognize that HIV infection can show up differently in women than in men. In addition to following the criteria outlined in the previous section, DDS disability evaluators consider specific criteria for diseases common in women. These include: vulvovaginal candidiasis (yeast infection); genital herpes; pelvic inflammatory disease (PDI); invasive cervical cancer; genital ulcerative disease; and condyloma (genital warts caused by the human papillomavirus). Again, the level of severity necessary for these impairments to be considered disabling is included in the list of impairments. Evaluation Of HIV Infection In Children We also have separate listings for children with HIV infection. These guidelines recognize the fact that the course of the disease in children can differ from adults. As with adults, some children may not appear to have the conditions specified in the guidelines, or may have listed conditions that are not as severe as the guidelines require. When this happens, a functional assessment is made using criteria contained in the lists. A child may be disabled if the HIV-related impairments substantially reduce his/her ability to grow, develop, or engage in activities similar to children of the same age. For more information about disability benefits for children, ask Social Security for a copy of the booklet, Social Security And SSI Benefits For Children With Disabilities (Publication No. 05- 10026). PART 5 -- HOW DO YOU FILE FOR DISABILITY BENEFITS You apply for Social Security and SSI disability benefits by calling or visiting any Social Security office. All Social Security files are kept strictly confidential. It would help if you have certain documents with you when you apply. But don't delay filing because you don't have all the information you need. We'll help you get the rest of it after you sign up. The information you'll need may include: o your Social Security number and birth certificate; o the Social Security numbers and birth certificates for family members signing up on your record; and o a copy of your most recent W-2 form (or your tax return if you're self-employed). If you're signing up for SSI, you will need to provide records that show that your income and assets are below the SSI limits. This might include such things as bank statements, rent receipts, care registration, etc. You'll also need to give us information about how your condition affects your daily activities, the names and addresses of your doctors and clinics where you've received treatment, and a summary of the kind of work you've done in the last 15 years. If you have medical evidence such as reports of blood tests, laboratory work, or a physical, it would be helpful if you brought them with you. In the section below (What You Can Do to Expedite the Processing of Your Claim), we give you some guidelines for providing us with medical and vocational information that will help speed up your claim. But first, we want you to know what Social Security does to make the process work as smoothly as possible. What Steps Has Social Security Taken To Ensure Prompt Processing And Payment Of Disability Benefits? All HIV infection claims are given prompt attention and priority handling. For many people applying for SSI with a medical diagnosis of symptomatic HIV infection, the law allows us to PRESUME they are disabled. This permits us to pay up to 6 months of benefits pending a final decision on the claim. You will qualify for this immediate payment if: o a medical source confirms that the HIV infection is severe enough to meet SSA's criteria; o you meet the other SSI nonmedical eligibility requirements; and o you are not doing "substantial" work (See section, "The General Definition of Disability" in Part 3). If you have symptomatic HIV infection but the local Social Security office cannot provide immediate payment, a disability evaluation specialist at the DDS may still make a "presumptive" disability decision at any point in the process where the evidence suggests a high likelihood that your claim will be approved. (If we later decide you are not disabled, you will NOT have to pay back the money you received.) Special arrangements have been made with a number of AIDS service organizations, advocacy groups, and medical facilities to help us get the evidence we need to streamline the claims process. And many DDS's have Medical/Professional Relations Officers who work directly with these organizations to make this process work smoothly. What You Can Do To Expedite The Processing Of Your Claim You can play an active and important role in ensuring that your claim is processed accurately and quickly. The best advice we can give you is to keep thorough records that document the symptoms of your illness and how it affects your daily activities, and then to provide all of this information to Social Security when you file your claim. Below are some guidelines you can follow: o Document the symptoms of your illness early and often Use a calendar to jot down brief notes about how you feel on each day. Record any of your usual activities you could not do on any given day. Be specific. And don't forget to include any psychological or mental problems. o Help your doctor help you Not all doctors may be aware of all the kinds of information we need to document your disability. Ask your doctor or other health care professional to track the course of your symptoms in detail over time and to keep a thorough record of any evidence of fatigue, depression, forgetfulness, dizziness, and other hard-to-document symptoms. o Keep records of how your illness affected you on the job If you were working, but lost your job because of your illness, make notes that describe what it is about your condition that forced you to stop working. o Give us copies of all these records when you file In addition to these records, be sure to list the names, addresses, and phone numbers of all the doctors, clinics, and hospitals you have been to since your illness began. Include your patient or treatment identification number if you know it. Also include the names, addresses, and phone numbers of any other people who have information about your illness. PART 6 -- HELPING YOU RETURN TO WORK If you return to work, Social Security has a number of special rules, called "work incentives," that provide cash benefits and continued Medicare or Medicaid coverage while you work. They are particularly important to people with HIV disease who, because of the recurrent nature of HIV-related illnesses, may be able to return to work following periods o disability. The rules are different for Social Security and SSI beneficiaries. For people getting Social Security disability benefits, they include a 9-month "trial work period" during which earnings, no matter how much, will not affect benefit payments; and a 3-year guarantee that, if benefits have stopped because a person remains employed after the trial work period, a Social Security check will be paid for any month earnings are below the "substantial" level (generally $500). In addition, Medicare coverage extends through the 3-year timeframe after the trial work period, even if your earnings are substantial. SSI work incentives include continuation of Medicaid coverage even if earnings are too high for SSI payments to be made, help with setting up a "plan to achieve self-support" (PASS), and special consideration for pay received in a sheltered workshop so that SSI benefits may continue even though the earnings might normally prevent payments. These and other work incentives are explained in detail in the publication, Working While Disabled...How Social Security Can Help (Publication No. 05-10095). For a free copy, just call or visit your nearest Social Security office. PART 7 -- WHAT YOU NEED TO KNOW ABOUT MEDICAID AND MEDICARE Medicaid and Medicare are our country's two major government-run health insurance programs. Generally, people on SSI and other people with low incomes qualify for Medicaid, while Medicare coverage is earned by working in jobs covered by Social Security, for a railroad, or for the federal government. Many people qualify for both Medicare and Medicaid. Medicaid Coverage In most states, Social Security's decision that you are eligible for SSI also makes you eligible for Medicaid coverage. (Check with your local Social Security or Medicaid office to verify the requirements in your state.) State Medicaid programs are required to cover certain services, including inpatient and outpatient hospital care and physician services. States have the option to include other services, such as intermediate care, hospice care, private duty nursing, and prescribed drugs. For more information about Medicaid, contact your local Medicaid agency. Medicare Coverage If you get Social Security disability, you will qualify for Medicare coverage 24 months after the month you became entitled to those benefits. Medicare helps pay for: o inpatient and outpatient hospital care; o doctor's services; o diagnostic tests; o skilled nursing care; o home health visits; o hospice care; and o other medical services. For more information about Medicare, call or visit your local Social Security office to ask for the booklet Medicare (Publication No. 05-10043). FOR MORE INFORMATION For more information or to apply for benefits, call or visit Social Security. It's easiest to call Social Security's toll-free telephone number. The number is 1-800-772-1213. You can speak to a representative 7 a.m. to 7 p.m. each business day. The best times to call are early in the morning, early in the evening, late in the week, and toward the end of the month. The Social Security Administration treats all calls confidentially--whether they're made to our toll-free numbers or to one of our local offices. We also want to ensure that you receive accurate and courteous service. That's why we have a second Social Security representative monitor some incoming and outgoing telephone calls. Note from the AIDS Information Center: This document reflects changes in Social Security rules that took effect on July 2, 1993 and, also, how SSA evaluates claims based on HIV/AIDS. Copies of this publication, available in English and Spanish, can be ordered through Social Security's toll-free number, 1-800-772-1213. The publication numbers are 05-10020 (English) and 05-10920 (Spanish). For bulk quantities call the Public Information Distribution Center at (410) 965-0945. The fax number for ordering publications is (410) 965-0696. ------------------------------------------------------------------------------- Question 5.2. What if you can't afford AZT? PATIENT ASSISTANCE PROGRAM AT BURROUGHS WELLCOME The Burroughs Wellcome Company has announced changes in its Patient Assistance Program (PAP) to make access to its drugs easier for disadvantaged patients. Physicians can now call a toll-free number, once they have determined that a patient is in need, to receive authorization to enroll the patient in the program. Upon authorization, the physician will give the patient a prescription benefit card from PCS Health Systems that can be used at any pharmacy. To qualify, patients must meet the following guidelines: o be a resident of the United States or its territories; o be financially disadvantaged; o have applied for and be awaiting reply from other prescription funding sources; or o not qualify for private or government assistance. The primary patient groups expected to participate are those using Burroughs Wellcome products for HIV and related infections, those with herpesvirus infections, transplant recipients, and those with cancer or congestive heart failure. Enrollment in the PAP must be initiated by a physician. To find out if an individual is eligible, patients should have their physicians call (800) 722-9294. Archive-name: aids-faq/part7 Posting-Frequency: monthly Last-modified: 1/1/95 AIDS FAQ Part 7/10 Section 6. The common debates. Q6.1 What are Strecker and Segal's theories that HIV is manmade? Q6.2 Other conspiracy theories. Q6.3 HIV the cause of AIDS? ------------------------------------------------------------------------------ Question 6.1. What are Strecker and Segal's theories that HIV is manmade? Jakob Segal's theory is that HIV was formed from visna (a sheep virus) and HTLV-I (Human T-cell Leukemia Virus) by US army biological research labs in 1977 or 1978. The virus supposedly escaped accidentally after being tested on prisoners. Robert Strecker's theory is that HIV was formed from visna and BLV (Bovine Leukemia Virus) by the US in the 1970's after 30-40 years of work. The virus was supposedly tested on populations in Africa and was deliberately introduced into the US homosexual community through the hepatitis B vaccination program. The alleged evidence to support this theory: * Visna is very similar to HIV. HIV can be formed by combining the genes of visna and BLV or HTLV. HIV is not similar to primate viruses. The government was interested in biological warfare and was planning to make an immune-system destroying virus. In particular, the DOD Appropriations for 1970 Hearings, 91st Congress, Part 6, p 129 states: There are two things about the biological agent field I would like to mention. One is the possibility of technological surprise. Molecular biology is a field that is advancing very rapidly, and eminent biologists believe that within a period of 5 to 10 years it would be possible to produce a synthetic biological agent, an agent that does not naturally exist and for which no natural immunity could have been acquired. Mr. Sikes. Are we doing any work in that field? Dr. MacArthur. We are not. Mr. Sikes. Why not? Lack of money or lack of interest? Dr. MacArthur. Certainly not lack of interest. [MacArthur provides the following information:] The dramatic progress being made in the field of molecular biology led us to investigate the relevance of this field of science to biological warfare. A small group of experts considered this matter and provided the following observations: * All biological agents up to the present time are representatives of naturally occurring disease, and are thus known by scientists throughout the world. They are easily available to qualified scientists for research, either for offensive or defensive purposes. * Within the next 5 to 10 years, it would probably be possible to make a new infective microorganism which could differ in certain important aspects from any known disease-causing organisms. Most important of these is that it might be refractory to the immunological and therapeutic processes upon which we depend to maintain our relative freedom from infectious disease. * A research program to explore the feasibility of this could be completed in approximately 5 years at a total cost of $10 million.'' * HIV is a new disease that appeared suddenly in the late 1970's without a natural source. * HIV could have been easily synthesized in a laboratory in the 1970's. The evidence is overwhelmingly against these theories. The key problem with these theories is they arose in the early 1980's, before SIV (simian immunodeficiency virus) was discovered and before the relevant viruses were sequenced. The genetic sequences clearly show: * HIV is much closer to SIV (simian immunodeficiency virus) than HIV is to visna, BLV, HTLV or any other known virus. * HIV can't be formed from splicing together parts of other known viruses. Viral genetic sequences can be ftp'd from ncbi.nlm.nih.gov in repository/aids-db. To summarize the other arguments against Strecker and Segal's theories: * The military testimony described a future study to see if making a new agents was feasible, not to actually produce it. More importantly, they are looking for an agent refractory to immunological processes; this means something resisting immunological processes. The quoted testimony and other parts of the testimony state they are looking for a new agent for which people do not have natural immunity; this is entirely different from an agent that destroys the immune system. It is also much easier than producing something like HIV. * Most scientists believe HIV evolved from SIV or a close relative. HIV did not suddenly appear in the late 1970's, but has been found in preserved blood samples from the 1950's. * Biotechnology was not sufficently advanced in the 1970's to produce something like HIV, and it is debatable that it would be possible even now. Since the details of HIV are not understood even now, it is inconceivable that someone could have deliberately designed HIV in the 1970's. Strecker's claim that HIV was introduced via hepatitis B vaccinations is extremely doubtful. McDonald et al, Lancet, 1983 Oct 15, 2(8355):882-4 state the incidence of AIDS in unvaccinated sexually active homosexual men was _higher_ than in vaccinated men, although the rates were too low for statistical significance. Stevens et al, JAMA, 1986 April 25, 255(16):2167-2172 tested blood samples from the beginning of the vaccination program and found that 6.6% were already HIV-positive. Therefore, HIV couldn't have been introduced via the vaccinations. While evaluating these theories, I recommend treating Segal's and Strecker's literature citations with extreme skepticism, as they are both rather casual about the connection between their claims and the contents of the papers. In particular, Strecker provides quotes that do not appear in the cited papers. Finally, since both theories allege a coverup of the connection between visna and HIV, a clear explanation of their relationships may be helpful. The viruses described above are all retroviruses. Retroviruses have three subfamilies: Oncoviruses, Lentiviruses, and Spumaviruses. HTLV is a oncovirus, while the remainder are lentiviruses. The analysis of genetic sequences gives strong evidence for the evolution of lentiviruses. They apparently branched into the primate lentiviruses (HIV-1, HIV-2, and SIV), and the nonprimate lentiviruses (visna, BLV, EIAV, FIV, CAEV, etc.) Thus, HIV and visna have many similarities since they are both lentiviruses, but HIV and SIV are much more similar. (See Fields Virology for more information on retrovirus classification and "The Emergence of Simian Human Immunodeficiency Viruses", Myers et al, AIDS Research and Human Retroviruses, 8(3), 1992 373-386 for more information on lentivirus evolution.) ------------------------------------------------------------------------------- Question 6.2. Other conspiracy theories. One school of thought holds that the "AIDS was a U.S. biological warfare experiment" myth was extensively spread as part of a disinformation campaign by Department V of the Soviet KGB (their `active measures' group). They may not have invented the premise (Soviet disinformation doctrine favored legends originated by third parties), but they added a number of signature details such as the name of the supposed development site (usually Fort Meade in Maryland) which still show up in most retellings. According to a defector who was once the KGB chief resident in Great Britain, the KGB promulgated this legend through controlled sources in Europe and the Third World. The Third World version (only) included the claim that HIV was the result of an attempt to build a "race bomb", a plague that would kill only non-whites. From the CDC AIDS Clearinghouse: "Soviets Secretly Tried to Blame U.S. for AIDS--CIA" Reuters (09/30/93) Langley, Va.--For more than five years, the former Soviet Union attempted to blame the AIDS virus on a plot by U.S. military scientists, according to newly declassified CIA documents. The papers reported that the Soviets launched a campaign in 1983 aiming to tie the emergence of AIDS to American biological weapons research. The disinformation was circulated in 25 different languages in over 200 publications, as well as in posters, leaflets, and radio broadcasts, in more than 80 countries before the campaign was finally abandoned by the Soviets, according to a study cited by the CIA in the documents. The Soviets dropped the campaign in 1988 when the United States refused to cooperate with them on a research program on AIDS, which was by then spreading in the U.S.S.R., said the CIA article. The Soviet campaign was apparently retaliation for the Reagan administration's claims of Soviet-produced "yellow rain," or yellow traces found on vegetation due to a Soviet biological weapon. Reproduction of the above excerpt is encouraged; however, copies may not be sold, and the CDC Clearinghouse should be cited as the source of this information. Copyright 1993, Information, Inc., Bethesda, MD ------------------------------------------------------------------------------- Question 6.3. Is HIV the cause of AIDS? Q: What is AIDS? by Robert Holzman and David Mertz The immune system is responsible for defending the body against bacteria, parasites, viruses and cells identified as foreign such as virally infected, transplanted, and (many believe) malignant cells. The Acquired Immune Deficiency Syndrome (AIDS) is a condition in which a person's immune system is so weakened that s/he becomes susceptible to conditions that occur rarely in those with intact function. The formal case definition includes a large number of indicator diseases deemed, in the words of the original: "at least moderately predictive of cellular immune deficiency". This original definition, free of assumptions regarding etiology, has been modified in accordance with the general acceptance of HIV as the causal agent responsible for the vast majority of AIDS cases. The revised definition also includes certain conditions believed ascribable to advanced HIV infection itself (e.g. wasting). A concise summary of the 1993 case definition may be found in the textbook, Scientific American Medicine section 7, chapter XI, page 2. Q: Why is HIV considered to be the cause of AIDS? The epidemic occurrence, in 1980, of Kaposi's Sarcoma in homosexual men and, in 1981, of certain unusual infections in intravenous drug users, were unprecedented events. While all of the initially recognized diseases were previously known, and most were occasionally seen in persons who were ostensibly immunologically normal, the risk of developing them was strongly associated with the presence of an immunosuppressed state, generally due to therapy for cancer or suppression of graft rejection. In order to identify cases for study and comparison with noncases, an operational definition was developed (see the FAQ question What is AIDS?) The issue for investigators was why so many homosexual men and intravenous drug users were developing such severe immune suppression now, while previously only subtle defects in immunity had been seen in such individuals. Among the earliest suggestions of an infectious etiology was the report (published in Am. J. Med. 1984;76:487-492, but presented orally earlier) that cases of AIDS among homosexuals were not occurring randomly but were clustered among sexual contacts. 40 persons were identified who showed linked transmission over 3 generations of infection. At the time there were four major theories of etiology under investigation: (1) multiple and repeated infections with Cytomegalovirus leading to immune suppression, (2) immunologic exhaustion from multiple previous infections, (3) alloimmunization to lymphocytes, due to intra-rectal injection of sperm, and (4) toxic effects of components of inhalant drugs or genital lubricants. Theories 2-4 were incompatible with the observed pattern of transmission. No credible evidence for theory 1 was ever produced. Three laboratories, Gallo's at NIH, Levy's at UCSF, and Montagnier's at Institute Pasteur (listed alphabetically), almost simultaneously identified a retrovirus in AIDS patients which was ultimately named the Human Immunodeficiency Virus (HIV). The identification of infection with this retrovirus in most (and with subsequent improvements in technique, in almost all) persons with AIDS who were tested raised the question whether this virus was a harmless infector, an opportunistic pathogen, or the actual causal agent of the progressive immunosuppression. Some of the evidence for the last role is summarized below. First, HIV causes a distinct acute illness (the "primary infection") which has been characterized in otherwise healthy (non-immunosuppressed) individuals known to have been or suspected of having been infected at a particular time (e.g. in a laboratory accident) or in whom the appearance of serum antibodies was detected, indicating a recent infection. An causal role for HIV in subsequent immune suppression is suggested by the fact that those whose symptoms of primary infection last more than 14 days subsequently develop AIDS more rapidly than persons who have briefer periods of illness. (Br. Med J. 1989;299:154-157.) Second, HIV infects cells with the CD4 receptor on their surface, cells which are critical for immune function and which, in those with AIDS, are abnormal in function, number, or both. (For a discussion of current concepts of the pathogenesis of HIV-related immune suppression see Science 1993; 262:1011-1018.) Third, HIV infection antedates immune suppression and is the single factor common to all AIDS risk groups. Studies of stored blood indicate that HIV spread in the homosexual population of San Francisco a few years before the epidemic of AIDS-indicative conditions. Moreover, in cases where the date of infection is known exactly or approximately, acquisition of HIV infection precedes the development of immune suppression by substantial periods. Such situations include, for example, transmission by transfusion to adults having cardiac surgery or neonates with hemolytic disease, by breast milk to neonates (including breast milk of a wet nurse to a child without familial risk factors), by clotting factor concentrates to hemophiliacs, by parenteral exposure of laboratory technicians or physicians to blood or viral concentrates, and to spouses of HIV infected persons via sexual transmission. Most telling is the observation that among infants of HIV-infected mothers, only those that acquire HIV infection develop progressive immune suppression and AIDS defining illnesses. Not all accept the causal association between HIV and the immune suppression that leads to an AIDS indicative illness. Peter Duesberg, a retrovirologist at the University of California at Berkeley has been the most vocal scientific critic of this hypothesis. Few of those actively engaged in research on AIDS agree with Duesberg's analysis, and rebuttals may be found in Nature 1990; 345:659-660 and Science 1988; 241:514-517. At least one study (M.S.Ascher, Nature, 1993; 362:103) has been designed in response to his assertions that drug use was a major cause of AIDS associated immune suppression. In that study, cohorts of homosexual and heterosexual men were compared, matched for use of marijuana, cocaine or amphetamines. There was no association between the development of AIDS and use of these drugs. The homosexual cohort used more nitrites than did the heterosexual one, but development of AIDS was related to the presence of HIV infection and not to use of drugs (M.S. Ascher, Lancet, 1993; 341:1223). Those who believe that HIV causes AIDS look to the cases associated with transfusion, congenital infection, or sexual transmission as coming as close to Koch's postulates as is likely to be possible in humans. In the absence of an animal model in which HIV induces immune suppression, it is likely to be impossible to strictly fulfill Koch's Postulates for HIV and AIDS. As the reader studies the debate on the cause of AIDS and forms his/her own conclusions it is important to focus clearly on the arbitrary nature of the case definition as an operational way to detect severe immune deficiency. Even the 1993 revision of the AIDS case definition does not require the documented presence of HIV infection. It is logically possible for there to be more than one etiology, although published data (New Engl. J. Med, 1993; 328:373-379.) indicate that only 299 of 230,179 reported persons with AIDS have been HIV-negative when testing was done (Evidence of HIV infection was sought in approximately half the 230,179 (Duesberg, Science, 1992;257:1848)). In summary, to assert that HIV is the cause of AIDS is to assert that HIV was the cause of the epidemic of immune suppression that appeared in 1980-81. To ascribe this role to HIV it is not necessary to show that HIV is the only cause of immunosuppression in those at risk, nor that cofactors are unimportant in the development of AIDS, nor that every patient who meets the case definition has HIV infection. It is only necessary to show that HIV infection can result in immune suppression and that HIV infection occurred in the appropriate population at an appropriate time to account for the epidemic. Q: What is the evidence against HIV as the cause of AIDS? (see also Section 7.4: The Group for the Scientific Reappraisal of the HIV/AIDS Hypothesis) There are many PWA's and AIDS-activists, and many in the scientific community who remain doubtful that HIV causes AIDS. These doubts arise both from observers of the socio-political history of HIV/AIDS, and from some scientists knowledgeable about retroviruses, epidemiology and immunology. DOUBTS RELATED TO THE SOCIAL HISTORY OF HIV/AIDS Some social critics raise questions about the circumstances in which the HIV/AIDS hypothesis was made public: After a decade of a massively funded, but predominantly unsuccessful, search for viral causes of cancer, in 1984 then Secretary of Health and Welfare Margaret Heckler declared to the national press that an *American* discovery of the (probable) viral cause of AIDS had been made -- without a single peer reviewed article on HIV having appeared. Quickly thereafter, the word "probable" was dropped by the press, and virtually all scientific monies for AIDS research were directed towards HIV. Continuing this trend, suspicious dealings between the US government and Burroughs Wellcome assured the approval and usage of the "anti-viral" drug AZT. In an ad hoc manner, many HIV-scientists thereafter conveniently rejected Koch's Postulates in defense of the HIV/AIDS hypothesis. References: John Lauritsen's 1993 _The AIDS War_ (Asklepios, New York, ISBN 0-943742-08-0), Jad Adams' 1989 _AIDS: The HIV Myth_ (St.Martin's Press, New York, ISBN 0-312-02859-8), and Jon Rappoport's _AIDS Inc._ (Human Energy Press, San Bruno CA 94066.) DOUBTS ABOUT THE SCIENTIFIC VALIDITY OF THE HIV/AIDS HYPOTHESIS Were the only doubts about HIV causation of AIDS those surrounding the "context of discovery," these doubts would be of little interest to anyone but historians of science. The main doubts raised by HIV- skeptics are on the actual scientific evidence for the HIV/AIDS hypothesis. HIV-skeptics consider this evidence to be either weak or non-existent. Beyond the generic concern which HIV-skeptics have that no mechanism for the alleged action of HIV has been demonstrated, the skeptics raise several more specific problems concerning the HIV/AIDS hypothesis. These problems fall into two major categories: Epidemiological and Immunological/Biochemical. Two general starting references to HIV-skeptics are: Robert Root-Bernstein's 1993, _Rethinking AIDS_ (Free Press, New York, ISBN 0-02-926905-9), and Peter Duesberg's article "AIDS Acquired by Drug Consumption and Other Noncontagious Risk Factors", _Pharmoc Ther_ v.55 p.201-277, 1992. DOUBTS BASED ON EPIDEMIOLOGICAL DATA First, HIV and HIV-antibodies are undetectable in a significant percentage of AIDS cases. The exact number of such cases is disputable, and many AIDS cases are simply never tested for HIV or HIV-antibodies: estimates of HIV-negative AIDS cases generally range between 2% and 10% of AIDS cases. Furthermore, Duesberg and others argue that AIDS-defining diseases themselves occur in a large number of people who are not defined as AIDS-cases because of their HIV- negative status. From a philosophical point-of-view it doesn't matter what the exact percentages are: If both AIDS itself, and AIDS- defining diseases, occur without HIV, then HIV cannot be the sole cause of AIDS, though it is possibly one among many contributing causes in those who are HIV+. Second, virtually all, if not all, of those who suffer from AIDS have been exposed to MANY immunosuppressive risks besides HIV, even if most have, indeed, also been exposed to HIV. Many pathogens such as Hepatitis viruses, Herpes viruses including Cytomegalovirus, Herpes simplex, Treponema pallidum, the cause of Syphilis, Epstein-Barr Virus, Mycobacteria, and others, are just as prevalent in AIDS- patients as is HIV. Further, simultaneous infection with a broad spectrum of these pathogens occurs only in those populations at high- risk for AIDS. HIV-skeptics do not believe that any epidemiological evidence exists to single out HIV from the other pathogens characteristic of AIDS. It is likely, they argue, that AIDS-defining immune-suppression is caused by the cumulative effect, or by specific synergistic interactions, of these other pathogens. In addition, virtually all AIDS-patients have been exposed to drugs with known immunosuppressive effects, whether medically indicated, recreational, or both. These exposures include the usage of opiates (medically and recreationally), nitrites, cocaine, chronic high-dosage antibiotics, and chemotherapeutic agents. Finally, virtually all AIDS-patients have been exposed to large amounts of foreign antigenic tissue, whether blood products, lymphocytes or semen. Such exposure is known to trigger auto-immunities similar to those present in AIDS. DOUBTS BASED ON IMMUNOLOGICAL AND VIROLOGICAL DATA First, HIV is non-viremic and chemically inactive in those infected, even those suffering acute immune-suppression. Skeptics argue that the rate of infection of T-cells by HIV is so low that even were HIV to kill every cell it infects, the human body would have no difficulty replenishing those cells. Even so, retroviruses, including HIV which has been continuously grown in the same cell-line since 1984, have never been shown consistently to kill host-cells. Estimates of the exact rate and location of T-cell infection vary, but no estimates place the rate of infection high enough to suggest a serious HIV threat to the immune system, even in the lymphatic system where HIV may be present in higher numbers than in blood. Second, in response to skeptics' objections about rates of T-cell infection, HIV-scientists have proposed a pathogenesis of AIDS in HIV triggered auto-immunities, caused by the similarity of HIV surface proteins to those of immune system cells. However, CD4 homologies by which HIV is alleged to cause auto-immunity or immune-system malfunction also exist for many other pathogens/foreign tissue than HIV -- including many pathogens common in AIDS-patients. No basis has been demonstrated, nor plausibly hypothesized, which singles out HIV/T-cell homologies from other homologies as a mechanism of auto- immune reactions. Third, the long "latency period" between HIV infection and the development of AIDS is unlike the behavior of all other viruses, and contradicts established retrovirology. To skeptics, this latency is little more than an article of faith by HIV/AIDS hypothesizers. Put simply, viruses don't cause disease after long latencies, except when reactivation of a latent virus is triggered by external immune- suppression. In all known viruses, production of antibodies neutralizes the action of the virus, and the virus is eliminated or brought into remission. Exactly the opposite is postulated for HIV; but since no mechanism has been plausibly described for this, little can be argued about it than one's prior convictions about HIV/AIDS causation. Archive-name: aids-faq/part8 Posting-Frequency: monthly Last-modified: 1/1/95 AIDS FAQ Part 8/10 Section 7. Information Sources. Q7.1 Phone Information about AIDS. Q7.2 Phone Information about AIDS drug trials. Q7.3 Phone Information about AIDS treatments Q7.4 US Social Security: Information for Organizations Q7.5 Reappraisal of the HIV-AIDS Hypothesis. Q7.6 American Academy of Allergy & Immunology Physician's Referral and Information Line ------------------------------------------------------------------------------ Question 7.1. Phone Information about AIDS. For general information about AIDS and referrals to other AIDS information sources, call CDC National AIDS Hotline: 1-800-342-AIDS Spanish:1-800-344-7432 Deaf: 1-800-243-7889 ------------------------------------------------------------------------------ Question 7.2. Phone Information about AIDS drug trials. You can obtain information about ongoing AIDS drug trials in the United States by calling the AIDS Trials hotline at 1-800-TRIALSA ------------------------------------------------------------------------------- Question 7.3. Phone Information about AIDS Treatments PHS' AIDS TREATMENT INFORMATION SERVICE BEGINS HHS Secretary Donna E. Shalala today announced the start of the first 800-number service which provides federally approved treatment information by phone or computer for people living with HIV/AIDS and health care professionals. Secretary Shalala said, "As of today, HIV/AIDS patients and those caring for them can call ATIS, the AIDS Treatment Information Service at 1-800-HIV-0440 and speak to a trained health information expert about up-to-date HIV/AIDS treatments." Interim national AIDS policy coordinator Patsy Fleming said, "ATIS represents the kind of innovative, coordinated effort among government agencies -- working together to provide a service that does not fall under the mandate of any individual agency -- that is vital to meeting the continuing challenges of AIDS." Philip R. Lee, M.D., HHS assistant secretary for health and director of the U.S. Public Health Service, said, "In addition to assisting health care providers, the AIDS Treatment Information Service will help people living with HIV/AIDS extend and improve the quality of their lives by helping them make informed decisions about their health care with their providers." Surgeon General M. Joycelyn Elders, M.D., speaking in Atlanta at the National Skills-Building Conference for community based organizations, sponsored by the National Minority AIDS Council, the National Association of People with AIDS and the AIDS National Interfaith Network, said, "Community-based organizations and AIDS service organizations all over America need to help get the work out about ATIS. It provides an invaluable additional resource to people living with HIV/AIDS." The Public Health Service National AIDS Program Office has coordinated development of the service. Six PHS agencies have contributed to its formation and will be funding its operation. These agencies are the Agency for Health Care Policy and Research, the Centers for Disease Control and Prevention, the Indian Health Service, the Health Resources and Services Administration, the National Institutes of Health and the Substance Abuse and Mental Health Services Administration. Project officers from each of the participating PHS agencies will be responsible for oversight of the program. Representatives from AIDS communities across the country have also participated in designing the service. The data-base for ATIS, which is housed at the National Library of Medicine, part of NIH, will be continually up-dated to include all federally approved HIV/AIDS treatment information. The data base can be accessed free via computer. ATIS also can provide access to other, related PHS information services, including: the CDC National AIDS Hotline, providing basic HIV/AIDS information; the CDC National AIDS Clearinghouse, providing HIV/AIDS print and video materials; the AIDS Clinical Trials Information Service, providing information on clinical trials for treatments for HIV/AIDS and associated opportunistic infections; the HRSA-sponsored Warmline, which provides HIV/AIDS treatment information to physicians only; the SAMHSA National Drug Information, Treatment and Referral Hotline, which provides information on drug treatment and community resources; and the SAMHSA National Clearinghouse for Alcohol and Drug Information, which provides information on alcohol and drug abuse treatment and prevention. ATIS staff will not provide treatment advice, but will provide information and advise patients that they need to discuss their treatment options with their physicians. The service is staffed by highly trained health information specialists who are fluent in English and Spanish. Deaf access (TDD) in included. The service is provided Monday through Friday, 9 a.m. to 7 p.m. EST. All calls are completely confidential. ------------------------------------------------------------------------------ Question 7.4. US Social Security: Information for Organizations SSA is committed to disseminating information about its benefit programs to as wide an audience as possible. If your organization has a newsletter, electronic bulletin board, informational database, or other system for housing and disseminating information to people living with AIDS and their caregivers, SSA would like to know about it. SSA wants to work with you to share information about Social Security benefit programs and eligibility criteria. SSA will share or exhibit public information materials if you will inform them of any meetings/conferences. Also, if you believe your staff could benefit from an in-service training program covering SSDI/SSI, Medicare, Medicaid, and other topics, please inform SSA. SSA looks forward to a continuing partnership with your organization to inform the thousands of men, women and children living with HIV/AIDS about the benefits available through Social Security. If you have any questions, or have any additional public information needs, contact Robert G. Goldstraw, Social Insurance Affairs Specialist (AIDS Outreach), Social Security Administration, Baltimore MD 21235. Telephone: (410) 965-4064. ------------------------------------------------------------------------------- Question 7.5. Reappraisal of the HIV-AIDS Hypothesis. Please see Q5.3 `HIV the cause of AIDS?' for introductory information on this question. The Group for the Scientific Reappraisal of the HIV/AIDS Hypothesis (hereafter just 'Group' for short) is an organization of scientists, AIDS-activists and educators, and other concerned persons, currently numbering around four hundred. As their name indicates, the Group wishes for the scientific community to reexamine an hypothesis which they believe to have been prematurely, dogmatically, and even dangerously, accepted. Many or most of the best known AIDS-skeptics are members of the Group, including Peter Duesberg, Robert Root-Bernstein, John Lauritsen, Eleni Eleopoulos, Michael Callen, Jad Adams and Kary Mullis. The Group may be contacted at 2040 Polk St. Suite 321, San Francisco, CA 94109 USA; Fax: 415-775-1379. The Group publishes a newsletter entitled Rethinking AIDS, for which a $25/year donation is requested. The Group came into existence as a result of efforts to get the following four sentence letter published in a number of prominent scientific journals, including Nature, Science, JAMA, The New England Journal of Medicine, and Lancet. As of October 1993, all have refused to do so. "It is widely believed by the general public that a retrovirus called HIV causes the group of diseases called AIDS. Many biomedical scientists now question this hypothesis. We propose that a thorough reappraisal of the existing evidence for and against this hypothesis be conducted by a suitable independent group. We further propose that critical epidemiological studies be devised and undertaken." The members of the Group do not necessarily agree with each other on the precise nature and causes of "AIDS;" all they automatically have in common is disbelief that HIV (sole) causation of AIDS has been scientifically established. ------------------------------------------------------------------------------ Question 7.6 American Academy of Allergy & Immunology Physician's Referral and Information Line American Academy of Allergy & Immunology Physician's Referral and Information Line 800/822-2762 The American Academy of Allergy & Immunology (AAAI) is the largest national professional medical society representing allergists, immunologists, and related allied health professionals. It is comprised of 4600 clinicians, academicians, research scientists and allied health professionals from the United States, Canada, and more than 40 foreign countries. The purpose of the AAAI is to advance the knowledge and practice of allergy and immunology through discussion at meetings; to foster the education of both students and the public; to promote and stimulate allergy and immunology research study; and to encourage the unity of and cooperation among those engaged in the field of allergy and immunology. For more information about the AAAI, including membership information, please contact: Audrey Mudek American Academy of Allergy & Immunology 611 E. Wells Street Milwaukee, WI 53202 414/272-6071 If sending mail, please include a note that you heard about the AAAI through a posting on the Internet. To contact the AAAI via Internet, send e-mail to: paulr@execpc.com Please include your name and mailing address. =============================================================================== Section 8. Internet resources. Q8.1 Ben Gardiner's Gopher AIDS Database Q8.2 CDC CDC National AIDS Clearinghouse Internet Services Q8.3 WHO AIDS Cases Information Q8.4 CDC AIDS Public Information Dataset. Q8.5 World Wide Web site on AIDS (French and English) Q8.6 Information about HIV and AIDS related patents Q8.7 Art-AIDS Link Q8.8 HIVNET/AEGIS Gateway (BETA VERSION) - Need update Q8.9 Other USENET newsgroups. ------------------------------------------------------------------------------ Question 8.1. Ben Gardiner's Gopher AIDS Database The 'gopher' system provides convenient menu-driven access to a wealth of arcana--and valuable information--on the Internet. Daily, more and more resources are made available in gopherspace. Generally, your local gopher client (if one is installed) will be available by typing 'gopher' at your system prompt; your local system administrator should be able to provide further details. Local gopher clients in turn allow convenient access to other remote gopher clients throughout the Internet. One of the most valuable gopher resources for AIDS-related information is the mirror of Ben Gardiner's AIDS-Info BBS database (also available by direct modem dialup -- see below section). This database exists on the University of California at San Francisco Experimental Gopher. It may be reached either, (1) through the menu system of your local gopher: --> More Gophers and Other Internet Services/ --> All Registered Gophers/ --> North America/ --> USA/ --> california/ --> University of California - San Francisco, UCSFYI/ --> Computers and Networking Guide to Services at UCSF/ --> Questions, Answers and Information about Everything/ --> Databases (including Ben Gardiner's AIDS BBS database)/ or, (2) by typing 'gopher itsa.ucsf.edu', and going through the final three menus. However, these particular menus are subject to change. The most convenient means of reaching the database is by adding the below information to your '.gopherrc' file. This will set a bookmark in your personal gopher for the AIDS-Info BBS, which may be reached by typing 'v' from anywhere within the gopher system. The information to add, using your favorite system editor, is: Type=1 Name=Databases (including Ben Gardiner's AIDS BBS database) Path=1/.i/.q/.d Host=itsa.ucsf.edu Port=70 The University of California at San Francisco Experimental Gopher also provides gopher gateways to a wide variety of Biology and Medical resource gophers. The UCSF gopher may be reached as described above ('gopher itsa.ucsf.edu'), or most simply by adding the following to your '.gopherrc' file: Type=1 Name=Bio and Medical Gophers and Info. Sites Path=1/Bio and Medical Gophers and Info. Sites Host=itsa.ucsf.edu Port=70 ------------------------------------------------------------------------------ Question 8.2 CDC National AIDS Clearinghouse Internet Services CDC National AIDS Clearinghouse Internet Services The CDC National AIDS Clearinghouse is pleased to announce our new Internet services, including a listserv of AIDS-related news, an anonymous FTP site, and a gopher server. The CDC Clearinghouse also maintains an Internet mailbox to which users may send questions about Clearinghouse services, orders for free publications and general inquiries. To correspond with the Clearinghouse, send email to "aidsinfo@cdcnac.aspensys.com". AIDS News Listserv Address: listserv@cdcnac.aspensys.com A listserv (short for "listserver," the computer server that runs the list) is an automated mailing list that sends electronic mail messages to a large group of users who subscribe by sending signup messages to the listserv. The CDC National AIDS Clearinghouse maintains a read-only mailing list for individuals who wish to receive AIDS-related documents from CDC, including the AIDS Daily Summary, selected Morbidity and Mortality Weekly Report articles, CDC National AIDS Hotline Training Bulletins, and factsheets. The listserv also distributes press releases from other Public Health Service agencies such as the National Institutes of Health. To subscribe, Internet users should send the message "subscribe aidsnews firstname lastname" to the address above, where your real first and last names are substituted for "firstname" and "lastname." Anyone with email access to the Internet, including members of such networks as America Online and CompuServe, can subscribe to the AIDS News Listserv. File Transfer Protocol (FTP) Site Address: cdcnac.aspensys.com FTP allows users to download files from host computer sites all over the world. An "anonymous FTP" site means that users do not have to have an individual ID or password to connect to the host. The CDC Clearinghouse's anonymous FTP site contains files of documents such as the current HIV/AIDS Surveillance Report, AHCPR's clinical practice guidelines, pathfinder guides to AIDS information, and in the future, the Clearinghouse's Standard Search Series. To obtain files: 1) FTP to the address "cdcnac.aspensys.com" 2) Type "anonymous" when asked to login. 3) Enter your complete Internet address (e.g., "johndoe@delphi.com") when asked for password. 4) Change to the public directory and the CDC NAC subdirectory with the command "cd /pub/cdcnac". 5) To download the file with basic information about CDC NAC's FTP site and the available files, type the command "get readme". 6) To download other files, type the command "get filename", where "filename" is the name of the file. If downloading a binary (non-text) file, such as WordPerfect files ending in ".wp5" or compressed files ending in ".exe" or ".zip", be sure to type the command "binary" and press [Enter] before using the "get" command. If using Mosaic or similar Internet software, the universal resource locator address is "ftp://cdcnac.aspensys.com/pub/cdcnac". Gopher Server Address: cdcnac.aspensys.com A gopher server is a host computer with a simple menu interface leading to text files of documents and other options. A gopher is structured in a hierarchical or outline format with menus and submenus leading to different levels of choices, like folders or directories. The CDC Clearinghouse's gopher site contains the AIDS Daily Summary, AIDS-related Morbidity and Mortality Weekly Report articles, tables from the HIV/AIDS Surveillance Report, and other CDC documents. Basic HIV/AIDS-related information is available, as well as information about prevention, treatment, and living with HIV. To reach the CDC Clearinghouse gopher, point your gopher client to the address: "cdcnac.aspensys.com" Select CDC NAC from the first menu. To point directly to the CDC NAC gopher, point to the address "cdcnac.aspensys.com 72" (port 72). If using Mosaic or similar Internet software, the URL is "gopher://cdcnac.aspensys.com:72". ------------------------------------------------------------------------------ Question 8.3. WHO AIDS Cases Information The latest figures on the The Current Global Situation of the HIV/AIDS Pandemic are now available on the web using the URL: http://gpawww.who.ch/gpahome.htm There also is a gopher version available at gpagopher.who.ch For those with email only, the figures can be obtained by sending an email message to gpadoc@who.ch with the command GET EMSERVE AIDSCASE in the message text. A complete list of documents available from this service can be retreived using the GET EMSERVE INDEX command. These servers also contain additional publications and documents developed by the Global Programme on AIDS, World Health Organization. ------------------------------------------------------------------------------ Question 8.4. CDC AIDS Public Information Dataset. You can get the CDC AIDS public information Dataset via anonymous ftp. Michelle Murrain has set up a small AIDS ftp site, which has the most recent dataset (data through 1992). She gets each year's version (usually in June-July) and puts it there. It contains a line of data on each individual, including transmission category, OIs diagnosed, date of diagnosis, etc. The ftp site is: family.hampshire.edu directory, /pub/aids The name of the file is PIDS92Q4.DAT (BEWARE the file is 16 MB!!) There is also a Women and AIDS bibliography there. If anyone has resources they would like to share with folks via FTP let her know and she'll be glad to add them. Contact Michelle Murrain via mmurrain@HAMP.HAMPSHIRE.EDU ----------------------------------------------------------------------------- Question 8.5 World Wide Web Site on AIDS (French and English) I'd like to inform you of (part of) a WWW server on AIDS and HIV in french and partly in english. It contains extensive lists of ressources in France, and also pointers to many other ressources on the Internet. The entry point in english is http://www.ircam.fr/solidarites/sida/index-e.html ------------------------------------------------------------------------------ Question 8.6. Information on AIDS and HIV related patents The US Patent and Trademark Office recently made available to the Internet all AIDS and HIV-related U.S. Patents. The patents include detailed research information. http://patents.cnidr.org or send e-mail with the word "help" in the message body to ezgate@cnidr.org ------------------------------------------------------------------------------ Question 8.7.. ArtAIDS Link The ArtAIDS LINK URL http://artaids.dcs.qmw.ac.uk:8001/ ================ The ArtAIDS LINK is a collaborative art project and Internet event open to all digital artists. The ArtAIDS LINK is located on the World Wide Web, to commemorate and celebrate the fight against AIDS. The LINK starts with original digital image files commissioned from international artists, to enable an infinite chain of images (and soon other digital media) to be created by modification and/or development of the originals. New work can also be added to the LINK, in response to the theme or aspects of the contributed images. Not all the artists involved work on AIDS issues, but its theme is that *WE ARE ALL INVOLVED*. The LINK symbolizes that involvement. Participants can browse the ArtAIDS gallery and information pages, which are regularly updated to reflect the submission of modified digital art. Anyone can register to give notification of participation, and to identify their contributions. Initial contributions are expected to be single image files; no restrictions are placed on file size, although the preferred formats are: * 24-bit TIFF (RGB), 640x480 pixels, IBM PC byte order, with LZW compression. * Adobe Photoshop (2.5), 640x480 pixels Other file types are welcome, but please check with the technical coordinator first. Animation, multi-media, audio, MIDI and font files are welcome, and you should contact the technical coordinator for further information. Files created on an Apple Macintosh should be binhex'd before contributing. The ArtAIDS LINK will become active on World AIDS Day, 1st December 1994, hosted by Queen Mary and Westfield College, University of London. This was preceded by an Internet video conference launch, using the MBONE, on 28th December and hosted by University College London. The LINK will close in March 1995, and re-open in November 1995, prior to World AIDS Day 1995. We are seeking sponsorship to help maintain the LINK; please contact Andrew Nimmo if you are interested. Project Coordinator: Q Love (Roarke Associates) Technical Coordinator: Andrew Nimmo (email A.D.Nimmo@dcs.qmw.ac.uk) Project Curator: Peter Ride (Cambridge Darkroom Gallery) ArtAIDS LINK: http://artaids.dcs.qmw.ac.uk:8001/ ArtAIDS Email:ArtAIDS@dcs.qmw.ac.uk> ===================================================================== ArtAIDS is a collaborative project for CRUSAID, a leading UK AIDS fund-raising charity, with the Cambridge Darkroom Gallery, Queen Mary and Westfield College (University of London), University College London, Roarke Associates and the BBC Networking Club. The ArtAIDS LINK is supported by funding from the Arts Council of England. ------------------------------------------------------------------------------ Question 8.8. HIVNET/AEGIS Gateway Frequently Asked Questions About AEGIS What is AEGIS? AEGIS--AIDS Education Global Information System--is a global freeway to a world of people, knowledge, and resources. A non-profit bulletin board service (BBS), AEGIS is the world's largest non-government database on HIV (the human immunodeficiency virus) and AIDS (acquired immune deficiency syndrome). The AEGIS database contains nearly 2 gigabytes of information, stored in over 158,000 files of information, with about several hundred new files added monthly. Users can read and download more than 26 different full-text publications, the National Library of Medicine's CLINICAL ALERTS, AIDS DRUGS, AIDS TRIALS, and AIDSLINE databases (more than 100,000 files), the National AIDS Clearinghouse's recourse data (more than 15,000 files), Law Library containing dozens of full-text AIDS-related judicial decisions and legal commentaries, a FUNDING RESOURCE database and global events calendar. Users also can connect directly to the White House (ONAP/OASH) BBS, FDA BBS, and NIH BBS in Rockville, MD. Additionally, AEGIS provides gateways to a number of AIDS-related conferences or "electronic town-halls" in English, Dutch, German, and Spanish, where users can seek and share information. AEGIS is the cornerstone of the Global Electronic Network for AIDS, an international consortium of electronic bulletin boards, and regularly uploads information to more than 150 BBSs in North America, Europe, Africa, Asia, and Australia. While there are no formal agreements or obligations between AEGIS and its affiliates, AEGIS asks and expects affiliates to share the information it provides without charge. Who can use AEGIS? Anyone with a computer and a modem can use AEGIS at any time from almost any place in the world. Typically, users include persons with HIV/AIDS and their friends and families, health care providers and AIDS service organizations, educators and researchers, and affiliated bulletin board systems that download AEGIS files for toll-free use by their members. AEGIS is as user-friendly as it is powerful. AEGIS screens are straightforward and easy to understand even by computer novices. AEGIS is "keyword searchable", so topics can be found by typing in a few simple instructions. Ease of use will be further enhanced in 1995, when AEGIS introduces a point-and-click graphical user interface. Is AEGIS a free service? Since 1990, AEGIS has been free to the user and has depended entirely upon donations to operate. A serious system crash in December of 1994, demonstrated the danger of trying to operate a service as important as AEGIS on an annual budget well under $20,000. In 1995, AEGIS is reorganizing to establish the fiscal strength it needs to secure the service and continue its growth. AEGIS will institute user fees designed to cover half its operating costs. However, it is integral to its mission "to find and operate AEGIS in ways that minimize economic barriers to its use." As a matter of policy, AEGIS will continue to make free access available to people with HIV/AIDS and the organizations that support them. What is the purpose of AEGIS? 1) To develop, maintain, and enhance a global online network where people can confer, seek, and exchange information on HIV and AIDS. 2) To develop, maintain, and enhance a comprehensive, up-to-date database of information related to HIV and AIDS. 3) To increase local, national, and global awareness of the AEGIS among persons with HIV and AIDS, researchers, health care providers, educators and others affected by HIV/AIDS. 4) To fund and operate AEGIS in ways that do not create economic barriers to its use. Why is AEGIS needed? - As of July, 1994, there have been 3,430 persons with AIDS in Orange County, 72,433 in California, and 388,365 in the United States. A quarter million Americans have been lost to this epidemic. - In some parts of the world, new infections have soared ten-fold in four years. - 17 million people worldwide are infected with HIV, the human immunodeficiency virus. By the year 2,000, between 40 and 110 million people will be HIV-infected. - The 'magic bullet' to cure or prevent HIV disease has not been found, and AIDS cannot yet be considered a manageable chronic disease. - People with or affected by HIV/AIDS often are isolated by cultural, geographic, and economic barriers. In these times, the question is how must we fight AIDS and relieve the human suffering it causes? We believe the answer will be found in the transformation of information into knowledge. For that to happen, information must be freely available, easily accessed, and widely disseminated. It must be used. AEGIS employs the latest telecommunications tools to make information about HIV/AIDS available to anyone who needs it. In this way, we seek to relieve some of the suffering and isolation caused by HIV/AIDS, and foster the understanding and knowledge that will lead to better care, prevention, and a cure. What is the history of AEGIS? AEGIS is a classic grassroots success story. In the mid-1980s, Orange County resident Jamie Jemison saw the potential of an online bulletin board service devoted to HIV/AIDS. The BBS he called AEGIS, however, was ahead of its time. The cost and limitations of computers and modems at that time for both a BBS and individuals were substantial barriers to their use. AEGIS remained a dream until he and Sister Mary Elizabeth connected in mid-1991. In 1990, she had launched the "HIV/AIDS Info BBS", motivated by a stay in a small Midwest farm community where she met several persons living with AIDS. They were profoundly isolated by illness, small town fears, and geography. In their need, she saw a way to put her technical skills to a spiritual use. Sr. Mary Elizabeth suggested joining forces with Mr. Jemison. However, he had gone on to other pursuits and ceded the use of the name AEGIS to Mary Elizabeth. Ever since, she has made AEGIS her life's work, building AEGIS into a service the Centers for Disease Control calls "the best of its kind." Is AEGIS a religious organization? Since 1990, AEGIS has been a service of the Sisters of St. Elizabeth, a 501c(3) religious community. As such, AEGIS is spiritually motivated. But it has no religious agenda and makes no religious statement beyond the belief that "a virus has no morals." The community was organized in accordance with the precepts of the Episcopal Church, but it has not met the requirements for formal recognition at this time. AEGIS is now the primary community service activity of the Sisters of St. Elizabeth, and is operated solely by its founder. AEGIS is now in the process of reorganizing as a 501(c)3 charitable and educational nonprofit organization, with bylaws and a Board of Directors. This step is intended to clarify the mission of AEGIS, and to involve more people in protecting and enhancing its viability and effectiveness. How well known is AEGIS? AEGIS is widely recognized by those involved in AIDS/HIV issues and familiar with bulletin board services. Feature articles have been written about AEGIS in the Los Angeles Times, the San Francisco Examiner, and the Computer Shopper, as well as several AIDS service organization newsletters. However, AEGIS needs to become better known in the HIV/AIDS community, particularly among AIDS service organizations and people with HIV/AIDS who are novice computers users. What are the barriers to using AEGIS? 1) Lack of awareness is the biggest barrier. AEGIS has never had the resources to engage in any formal marketing and has relied on word-of-mouth and occasional articles to increase awareness. 2) Resistance to technology ("modem phobia") is another barrier. Even among computer users, there is the perception that modems are difficult to understand, install, and use. For the average computer user, e-mail, the Internet, cyberspace, etc. are still esoteric concepts, not practical tools. 3) Cost of equipment and/or phone carrier charges is a third factor. The cost of computers and modems drop each year, the equipment still represents a substantial investment for many individuals. Is AEGIS a start-up service? No! AEGIS is a mature, robust, fully operational service with a global network of users. Is AEGIS unique? The "Guide to Selected AIDS-Related Electronic Bulletin Boards and Internet Resources," published by the CDC National AIDS Clearinghouse, contains information on dozens of computerized AIDS-related services. Only AEGIS is given a separate appendix, which contains an overview of AEGIS and a 10-page list of over 150 AEGIS affiliates in North America, Europe, Africa, Asia, and Australia. It says of AEGIS: "This comprehensive information collection is current and easily accessible; simply stated, this is one of the best." There are few significant alternatives to AEGIS. One of the newest is the AIDS/HIV Forum, a product of HandsNet, a nonprofit company whose clients are human services agencies. Its AIDS/HIV forum has received a two-year establishing grant from the Henry J. Kaiser Family Foundation. AEGIS is different from HandsNet in three ways. HandsNet targets only AIDS service organizations in this country. AEGIS is available to anyone and any organization, and is global in reach. HandsNet has a graphical interface. AEGIS does not, although it is praised for its ease of use. HandsNet charges fees that will average about $400 a year per agency. AEGIS is free to the user and seeks contributions from those who believe in its mission. In California, CAIN--the Computerized AIDS Information Network--is sponsored by the State Office of AIDS. Like AEGIS, CAIN includes e-mail, an interactive bulletin board forum, and databases of AIDS information. CAIN is far less comprehensive and up-to-date than AEGIS. CAIN also resides on the Delphi network and is available by subscription only. What makes AEGIS unique is that it is a single, all-inclusive AIDS/HIV resource with a global reach that is free to the user. You can access AEGIS by having your computer dial 714.248.2836. Communications protocols are 8N1/Full Duplex. AEGIS supports v.34 (28,800 bps) on all lines. How does AEGIS operate? Since its inception, AEGIS has been managed by Sister Mary Elizabeth, its founder and system operator (sysop). Like many founders of grassroots organizations, she is a singular person doing the work of many people. AEGIS is now her life's work and she is on the job nearly every waking hour. Since 1990, Sister Mary Elizabeth has operated AEGIS on an annual budget considerably less than $20,000. AEGIS has received no government or foundation support, and has depended solely on contributions of money, equipment, and space from individuals who believe in its mission. In addition, its founder has worked as a consultant, with those fees going to maintain the service. In 1994, Sister Mary began to be more direct in asking users for contributions. This effort has had, at best, a modest success. A recent system crash, which kept AEGIS down from Sunday, December 4, to Wednesday, December 7, 1994, resulted in a number of donations and offers of assistance. If this was a "blessing in disguise", it was in demonstrating that AEGIS is not secure at the present level of funding. To protect AEGIS, the organization has entered a second evolutionary stage. As an initial step, AEGIS is reorganizing as a 501(c)3 nonprofit educational and charitable organization with a Board of Directors. A Business Plan is under development which will set goals and explore a variety of funding options, including foundation grants, government grants, and user fees. Some of the goals that have been identified are: - To have a salaried, full-time system operator (sysop)/coordinator. At this time, this position is being filled without pay by Sister Mary Elizabeth. - To train a half-time technical assistant in all aspects of maintaining the system, so that AEGIS is not fully dependent on its founder. This position is new and remains vacant. - To hire an executive director with primary responsibility for development and marketing. This position is new and currently is being filled by Christopher Quilter on a volunteer basis. - To become a node on the INTERNET. - To develop and maintain a more redundant and robust system better protected from crashes and better able to recover when they occur, and to acquire the technology that will augment the system's power and features. - To find and implement telecommunication options that make access to AEGIS easier and more affordable for the user. Christopher Quilter January 12, 1995 ------------------------------------------------------------------------------ Question 8.9. Other USENET newsgroups. Questions about AIDS come up occasionally in sci.med and soc.motss. The newsgroup bionet.molbio.hiv may or may not be available at your site--it discusses technical issues related to the molecular biology of HIV. As with any newsgroup, including sci.med.aids, you should read these for a few days before posting, to see if your question has been answered already, and to get a feel for the tone of the group. Misc.health.aids, a new unmoderated newsgroups is available for open dialogue about AIDS and HIV, and often focuses on alternative treatments. Archive-name: aids-faq/part9 Posting-Frequency: monthly Last-modified: 1/14/95 AIDS FAQ Part 9/10 ============================================================= Section 9. Other Electronic Information Sources. Q9.1 List of AIDS BBSes. Q9.2 National AIDS Clearinghouse Guide to AIDS BBSes. Q9.3 National Library of Medicine AIDSLINE (please contribute) Q9.4 Commercial Bulletin Boards Q9.5 Reappraisal of the HIV-AIDS Hypothesis. Q9.6 Lesbian/Gay Scholars Directory. ------------------------------------------------------------------------------ Question 9.1. List of AIDS BBSes. Norman Brown's Consolidated List of aids/hiv Bulletin Boards Compiled For All People Affected By hiv/arc/aids ABBS9310.DOC - 1993 Revision #9 - Updated to 1 October 1993 Compiled by Norman R. Brown - Copyright (c) 1993 CORRECTIONS Send NetMail to Norman Brown at FidoNet 1:104/909, GayCom 207:1/104, 94:3130/0 on ADAnet, N.BROWN1 on GEnie, norman.brown@tde.com -OR- n.brown1@genie.geis.com on Internet The acronyms "aids/hiv/arc" are in lower case in this document in order to lessen their appearance of importance for the reader. Check with your sysop as to whether it should be in upper or lower case on your | particular bulletin board when making reference to particular echoes. This list is published and available for FREQ'ing as ABBS on or near the 1st of each month from: Phone Number Fidonet ADAnet GayCom Black Bag 302-994-3772 1:150/140 94:3020/1 ------- Denver Exchange 303-623-4965 1:104/909 --------- 207:1/104 Doc In The Box 314-893-6099 1:289/8 94:3140/1 ------- Erie Canal 315-445-4710 1:2608/31 --------- ------- hiv/aids Info 714-248-2836 1:103/927 --------- ------- hivNET-Amsterdam 31-20-6647461 2:280/413 --------- ------- SCHWUBS 49-71-5256330 2:244/52 --------- ------- Southmed Sydney 61-2583-1027 3:712/700 --------- ------- LambdaConn 203-877-6667 1:141/215 --------- ------- The shareware program FONDIR*.ZIP is also available from the same bulletin boards. Both files are available on GEnie, as well, in the Medical Forum, Page 745;3 as well as LiveWire, Page 400;7. They are also available on a new network called NVN (National Videotex Network) on the aids Forum. They are also available on the Internet. To receive them through the Internet mailing list, please see further instructions on page 16 of this document. Copyright 1993 by Norman R. Brown for all people affected by hiv/arc/aids. All rights reserved. For individual use only. Permission is granted for posting this list in the file areas of public bulletin boards, provided no charge is made for access. Bulletin board users may print or copy this list for their own use or for limited sharing with others in their hiv/aids or computer-user organizations, or for posting in such places as public libraries. Please do not place in a BBS message area other than in brief response to a specific question. Unauthorized publication, in whole or in part, in any other form or any commercial use of the material contained herein is expressly forbidden. Norman Brown's Consolidated List of aids Bulletin Board Systems Primarily, this list includes all of the known BBS's which participate in the aids/hiv-related ADAnet, FidoNet, GayCom, MetroLink, RBBS-NET, RelayNet and TNet conferences marked with an asterisk in the footnote column below. This list is compiled from ORIGIN lines in messages reaching San Francisco, CA; Denver, CO; and Washington, DC; plus information learned from other sources. Please remember when using information from it that much of it changes each month. Available aids-Related Conferences (Echoes) ECHO NAME TOPIC MODERATOR Z:NET/NODE FN ------------------------------------------------------------------------------ act up ACT UP discussion Bearded Crewman 1:141/107 * aids.data aids data. No discussion Mary Elizabeth 1:103/927 * aids.dialogue aids-related support disc. Jeffrey Lizotte 1:141/215 * aids.hiv aids-related discussion Bert Sainz 1:123/316 F* aids.spirit spiritual discussion/aids Kenny Teel 1:141/650 * aids.women aids discussion for women Angie Kersnick 1:129/228 * aids/arc aids-related discussion Mary Elizabeth 1:103/927 F* taa aids-related discussion Johnny Chased 207:1/1 G* hiv dateline hiv+ persons Randy Dodson 1:379/24 hiv/arc/aids aids-related discussion Hans Braun 1:125/572 S* " " Jay Lightner S* Living w/hiv aids-related discussion White Eagle 1:125/572 S* ------------------------------------------------------------------------------ F Available on FidoNet "Backbone" in most Fido regions. G Available only to GayCom subscribers. L Local BBS S Available only to StudsNet subscribers. * Participants included in this list. ********** ST U.S. State or Canadian Province SYSOP System Operator Z: FidoNet Zone, or other network, as follows: n: FidoNet (where n is: Zone 1 - North America; Zone 2 - Europe, etc.; Zone 3 - Oceania; Zone 4 - Latin America; Zone 5 - Africa; or Zone 6 - Asia. A: ADAnet 207: GayCom private gay network L: Local only; primarily aids/hiv, but does not carry echoes R: RBBS-NET Relaying Networks: MetroLink RelayNet TNet Conversion to a Dialing Directory You can convert ABBSyymm.DOC into a dialing directory for most major communications programs by using a shareware program called FONDIR, available on many BBS's. To use ABBSyymm.DOC together with FONDIR simply enter this command at theDOS prompt: FONDIR ABBSyymm.DOC /O:? /L:nnn- /A:1- /M:x where: "ABBSyymm.DOC" is the name of the file; "?" is the code for your software: + = ProComm+ 1.1 K = K9 Express 8.8 3 2 = ProComm+ 2.0 L = Ultiterm 2.0 3 A = PCanywhere 3.11 M = Telemate 3.01 - see FONDIR.DOC 3 B = Boyan 5.0 O = Mirror 3 1.01 3 C = PC Talk 1.39 P = Procomm 2.4.3 3 D = A Dialer 2.0 Q = Qmodem 4.5/5.0 3 E = Pilot 2.0 R = Rcomm 2.1 3 F = Commo 5.0 T = Telix 3.15 3 G = GT Powercomm 17.00 U = Unicom 3.0 3 I = Pibterm 4.1 Y = Carbon Copy Plus 4.01 3 "nnn" is your local Area Code; "A:1-" adds the long-distance access code. 3 "x" is the maximum speed of your modem: 1 = 1200; 2 = 2400; 4 = 4800; and 9 = 9600. ST City Bulletin Board/SYSOP Z:Net/Node Phone # (1+) United States (FidoNet Zone 1) AL Birmingham ADAnet Zone Coord/Bill Freeman A:94:94/0 205-854-5863 AL Birmingham Int.Tech.Coord/Marlin Johnson A:94:94/97 205-254-3344 AL Birmingham Torch Song/Festus S: 205-328-1517 AL Pinson ADAnet One Hub/Bill Freeman 1:3602/24 205-854-9074 AR N LittleRockGrapeVine/Ferret Face RelayNet 501-753-8121 AZ Phoenix Cade/William Richards 1:114/113 602-931-3468 AZ Phoenix Cloud 9/Tom Thurston 1:114/184 602-225-0512 AZ Phoenix Meat Rack/Rick Haubert 1:114/188 602-273-6956 AZ Phoenix Messenger/Howard Marshall 1:114/183 602-547-9513 AZ Phoenix Shadow Keep/Jandar 1:114/188 602-395-0500 AZ Tucson Western Connection L: 602-881-8283 CA Anaheim Meditation, etc./Bob Johnstone 1:10/227 714-952-2110 CA Benicia Task Force/Don Morse 1:161/513 707-747-5738 CA Claremont Intermania/Rick Walker 1:218/502 909-624-2246 CA Clovis Clovis Co of Fresno/Rod Jessen 1:205/48 209-323-7583 CA Clovis Clovis Co of Fresno/Rod Jessen R:8:910/512209-323-7583 CA Concord DVMCC/Drew Blanchard 1:161/203 510-827-0804 CA Concord Grateful Med/T.C. Dufresne 1:161/63 510-689-0347 CA Concord Grateful Med/T.C. Dufresne A:94:5100/3510-689-0347 CA Danville Dear Theophilus/Mark Spaulding 1:200/703 510-831-8436 CA El Cajon Camelot 619-447-7869 CA El Cajon El Cajon Network Central 1:202/1522 619-447-7869 CA FountainVal Ye Olde BBS/Dallas Jones 1:103/552 714-968-1899 CA Fresno LightHouse/Danny Davis R:8:910/524209-252-7968 CA Gardena Gardena/Mark Bishop 1:102/255 310-555-1212 CA Hayward New Big Board/Cliff Wilson 1:204/10 510-670-2940 CA Irvine Wellspring/Steve Clancy 714-725-2700 CA Irvine Wellspring/Steve Clancy 714-856-5087 CA Irvine Wellspring/Steve Clancy 714-856-7996 CA Los Angeles Empty Bed Pan/Stu Carlson 1:102/733 310-478-0451 CA Monterey Nitelog/ RelayNet 408-655-1096 CA No.Highland Silverado Express/Rod Abbott 1:203/1102 916-344-8146 CA N.Hollywood L.A.ValleyCollege/Tom Klemesrud 1:102/837 818-985-7150 CA Northridge Silent Partner/Jim Schooler 1:102/910 818-832-4585 CA Pacifica Chemist'sComPort/Larry McGee 1:125/190 415-359-6036 CA Sacramento Omar's Corner/Brian Greendahl 1:203/164 916-641-2413 CA San Diego Hillcrest Community/MichaelBlair1:202/703 619-291-0544 CA San Diego Mushin/Brad Chesbro 1:202/604 619-535-9580 CA San Diego Patient Advocate 1:202/742 619-546-4334 CA San Diego Telesis/ 1:202/740 619-497-0288 CA San Diego West Coast Connection/ RelayNet 619-449-8333 CA San Francis aids Info/Ben Gardiner L: 415-626-1246 CA San Francis Breath of Fresh Air hiv/aids 1:125/120 415-488-1461 CA San Francis Fog City/Bill Essex 1:125/100 415-863-9697 CA San Francis Fog City/Bill Essex 207:1/5 415-863-9697 CA San Francis Fog City/Bill Essex 207:1/5 Members Only CA San Francis Recovery/Rick Gorin 1:125/9 415-255-2188 CA San Francis STUDS!/Hans Braun 1:125/572 415-495-2929 CA San Francis STUDS!/Hans Braun S: 415-495-2929 CA San Mateo HTG/Outreach/Allan Hurst 1:204/462 415-572-9594 CA San Mateo PCBL/Les Kooyman 1:204/501 415-572-9563 CA SanJuanCapi hiv/aids Info/Sr.Mary Elizabeth 1:103/927 714-248-2836 CA SantaFeSprngHelping Hands/Rick Venuto 1:102/433 310-948-5919 CA Santa Rosa Sonoma Online/Don Kulha 1:125/7 707-545-0746 CA Simi Valley Library/Gary Vedvik 1:102/1006 818-999-4391 CA Torrance Art Gallery-South/Mike Reeves 310-791-7278 CA Tujunga Mysteria/Phil Hansford 1:102/943 818-353-8891 CA Vacaville Net/Don Morse 1:161/611 707-746-6091 CA Vallejo Power Station/Joe Martin 1:161/123 707-552-0462 CO Bailey BaileyInfoExchange/Chris Stone 1:104/825 303-674-0147 CO Col.Springs Socialism OnLine/Randy Edwards 1:128/105 719-392-7781 CO Col.Springs FireNet Leader/Wood/Sanders 1:128/16 719-591-7415 CO Denver Denver Exchange/James Craig 1:104/909 303-623-4965 CO Denver Denver Exchange/Sex Pistol 207:1/0 303-623-4965 CO Denver Denver Exchange/Sex Pistol 207:1/104 Members Only CO Denver Denver Exchange/Sex Pistol S: 303-623-4965 CO Denver Max Manlove's/Max Manlove 1:104/431 303-863-0227 CO Denver Welcome Home/Dave Wilson 1:104/433 303-839-8665 CO Ft. Collins EMCC #2/Mike Coppock 1:306/31 303-484-6663 CO Littleton GC Fido/Steve Raymond 1:104/19 303-795-1215 CO WestAdamsCo Telepeople/Marshall Barry 1:104/69 303-426-1866 CT Rainbow View/Bill Hausler 1:141/991 203-744-0179 CT Branford Lifestyles (Gay)/Rick Sande 1:141/107 203-481-4836 CT Meriden Nusing Network/Michael Rostock 1:141/896 203-237-1131 CT Milford LambdaConn/Jeffrey Lizotte 1:141/215 203-877-6667 CT New Haven NHGCS Network/Kenny Teel 1:141/650 203-624-8990 CT Newington First Impressions/Corey Keaton 1:142/667 203-667-9666 CT No.Branford Hippocampus/Aaron Waxman 1:141/205 203-484-4621 CT Wallingford Vampire Connection/John Melillo 1:141/808 203-269-8313 CT W.Jordan Lake Wobegon/Robert Klaproth 1:311/19 801-568-3866 CT Yalesville Emerogronican/Steven Ambrosini 1:141/666 203-949-0189 DC Washington COCKpit 1:109/196 202-862-5497 DC Washington DC Information Exchange MetroLink 703-836-0748 DC Washington GLIB/Jon 207:1/3 703-578-4542 DC Washington GLIB/Jon 207:1/3 Members Only DC Washington OASH/Ted Foor 1:109/166 202-690-5423 DE Bear Obsession/Bob Chalmers 1:150/135 302-836-7145 DE Wilmington Black Bag Medical/Ed DelGrosso 1:150/140 302-994-3772 DE Newark Black Bag/Edward DelGrosso A:94:3020/1302-994-3772 FL Stetson University Legal L: 800-624-9091 FL Boynton College Board/Charles Bell 1:3638/13 407-731-1675 FL Davie Samurai Palace/ 305-587-018 FL DeLand Colosseum/Robert Gary 1:3618/28 904-734-9951 FL Hialeah LatinConnection/AdrianaFernandez1:135/323 305-826-0778 FL Hollywood Dracula's Castle/Robert Fonner 1:369/24 305-964-2696 FL JacksonvilleCharlie's/Charles Deskin 1:112/69 904-396-4931 FL LifeLine 1:112/73 904-276-4724 FL Miami Tech-80/Bert Sainz 1:135/55 305-264-8155 FL Miami Lakes Telcom Central/Ray Vaughan 1:135/23 305-828-7909 FL Miami ShoresTown Crier/Orville Bullitt 1:135/36 305-785-0912 FL NewPtRichey Ground Zero/Sean Fleeman 1:3619/25 813-849-4034 FL NewPtRichey Special Place/Bob Dipalma 1:3619/19 813-372-7525 FL No. Miami Jailhouse/Kenny Star 1:135/34 305-944-6271 FL Orange Park OverbytesIndustries/Jaime Gibson1:112/92 904-278-0771 FL Orlando Compu-Link/Bill Wenzel 1:363/1571 407-240-7864 FL Orlando Nurse Corner/Pat & Jim Keller 1:363/15 407-299-4762 FL Palm Beach Adonis/Hung+ S: 407-881-8641 FL PalmBchGard Custom Computers/John Skakandy 1:3646/1 407-743-1112 FL PampanoBeac Backstreet/Bob Kecskemety 207:1/17 305-941-0216 FL Port Richey Special Place/Bob Dipalma 1:3619/19 813-372-7525 FL Raiford MedLink Node 1/Bill Matthews 1:3600/3 904-431-1913 FL StPetersbur #1 Computers/Robert Dempsey 1:3603/260 813-521-3149 FL StPetersbur #1 Computers/Robert Dempsey 1:3603/260 813-527-1556 FL StPetersbur Mercury Opus/Emery Mandel 1:3603/20 813-321-0734 FL Sarasota Courts of Chaos/Lanier Kingsley 1:137/124 813-923-1055 FL Cocoa MOTSS/Don Wilcox 1:374/41 407-779-0058 FL Talahassee Dreamland/David Barfield 1:3605/900 904-224-3545 FL St.PetersburAfterMidnite/Dell Edwards 1:3603/103 813-823-3163 FL Tampa AlternativeJames Floyd 1:377/51 813-882-8939 FL Tampa PrideNET USA!/Tony Myers 1:377/24 813-837-5463 FL Tampa T.A.B.B. 1:377/6 813-961-6242 FL Tampa Talen/Don Hardy 1:3603/410 813-895-0364 FL Venice Venice Recovery/John Grossberg 1:137/408 813-492-9592 GA Atlanta CDC aids Info Line/ L: 404-377-9563 GA Atlanta CDC aids Lab Info/ L: 800-522-6388 GA Atlanta hivNET Atlanta/David Coobs 1:133/606 404-622-2070 GA Atlanta Medical Forum/ L: 404-351-9757 GA Atlanta Meet Factory/ S: 404-350-0308 GA Atlanta PC Connect/Louis Kahn 1:133/620 404-565-8250 GA Atlanta Trash Shack/Dennis Dore 1:133/518 404-320-0026 GA Atlanta Trash Shack/Dennis Dore S: 404-320-0026 GA Centerville Mother's Kitchen/Mike Tucker 1:3611/19 912-953-2708 GA Conyers Atlanta Connection/Bill Noel 1:133/205 404-929-0800 GA Lawrencevil Retreat/Andria Duncan 1:133/618 404-339-3660 GA Macon Middle GA Medical/Doug Dozier 1:3611/5 912-477-8741 GA Norcross Pharmacy/Mike Mayer 1:133/601 404-729-1766 GA Smyrna No Frills/ 404-435-9608 GA Valdosta HOT South/Aulton White 1:3645/30 912-242-0496 GA Woodstock Index System/Rodney Aloia 1:133/201 404-924-8472 HI Honolulu GQ Link 1:345/3 808-526-9042 HI Honolulu Homeboy Shopping/David Roberts 1:345/23 808-624-1294 HI Kahalui Modem Mania/Sue Kamalo 1:345/18 808-871-5891 IA Des Moines Silver Xpress/Brad Meyers 1:290/6 515-288-7793 ID BonnersFerr King Morpheous/Jeff Burns 1:346/16 208-257-5801 IL Champaign LawBoard Fido/Fred Grosser 1:233/1 217-352-6118 IL Chicago I Can!/Bogie Bugsalewicz 1:115/738 312-736-7434 IL Chicago I Can!/Bogie Bugsalewicz A:94:3120/2312-736-7434 IL Chicago Lambda Zone/Toby Schneiter 207:1/106 708-696-4298 IL Danville Grapevine/Danny Keele 1:233/30 217-431-8555 IL Moline Rampage/John Buckwalter 1:232/49 309-764-9794 IN Evansville Digital Dreams/Dave Worley 1:2310/220 812-421-8011 IN Evansville TGC Adult/ TNet 812-284-5465 IN IndianapolisPortalToInfinity/Anthony Besisi 1:231/540 317-887-6043 IN Whiting ADAnet EList Coord/Rick Catania A:94:94/98 219-659-0112 KS OverlandPar South of the River/John Schmake 1:280/9 913-642-7907 KS Winfield 9th & Main/Benn Gibson 1:291/21 316-221-3276 KS Witchita Land of Awes/Rex Rivers 1:291/9 316-269-3172 KS Witchita Land of Awes/Rex Rivers 207:1/10 316-269-4208 KS Wichita Q Continuum/Mike Randolph 1:291/1701 316-721-8466 KY Erlander DataNet/Rich Ashworth 1:108/90 606-727-3638 KY Louisville Code III/Ken Murray 1:2320/210 502-368-6908 KY Louisville LiveWire Online/Allen Prunty 1:2320/110 502-933-4725 LA Lafayette Spinal Tap/Ryan Brooks 1:3803/4 318-233-0363 LA New Iberia Circle of Support/ 1:3803/7 318-367-9916 LA New Orleans Leather Connection/RobertGoslin 207:1/111 504-947-2627 LA New Orleans Tulane Med. Ctr. L: 504-584-1654 MA Billerica Chicken Coop/Daniel Shapiro 1:324/295 508-667-7234 MA Billerica Vision/Joseph Oliveira 1:324/279 508-670-0934 MA Boston Five Point/Isaac Obie 1:101/625 617-859-7398 MA Boston StarBase/Ric Giguere 1:101/165 617-739-9246 MA Leicester Lighthouse/George Lafreniere 1:322/605 508-892-8857 MA Leicester Lighthouse/George Lafreniere A:94:6021/5508-892-8857 MA Melrose Den/Ray Gouin 1:101/225 617-662-6969 MA Needham Weed Garden/Holt Lipman 1:101/295 617-444-4061 MA Westminster DarkSide/David Place 1:322/247 508-874-6334 MA Worcester Foundation/Phil Collins 1:322/732 508-797-9563 MD Baltimore Harbor Bytes/ 207:1/15 301-235-4651 MD Baltimoore John's BBS 1:261/1083 410-566-1336 MD Baltimore Writer's Block/Ed Lawyer 1:261/1056 410-945-1540 MD Chevy Chase WorldComm/Matt Clement 1:109/466 301-657-8313 MD Frederick Chipin Block/ MetroLink 301-698-1486 MD GaithersburgNational hiv/aids/Joie Clarke 1:109/727 301-869-6808 MD Wheaton Honey Board/Heather James 1:109/543 301-933-1467 MD Rockville FDA/ L: 800-222-0185 MD Rockville FDA/ L: 301-227-6849 MD Waldorf Brodmann's Place/Dave Brodmann 1:109/806 301-843-5732 MD Waldorf Brodmann's Place/Dave Brodmann S: 301-843-5732 MI Birmingham Alternate One/Ronald Miotke 1:2202/1 313-644-1260 MI Detroit Legend of Roseville RelayNet 313-776-1975 MI Highland Jim's Coffee House/Jim Pesola 1:2202/4 313-887-4330 MI Lansing Flaming Dragon/Jim Knauer 1:159/675 517-336-7846 MI Monroe Fast Eddie's/Ed Dobie A:94:3130/2313-243-0944 MI Mt. Clemens Boat Town USA/Dan Dalton 1:2202/0 313-468-3572 MI Mt. Clemens Boat Town USA/Dan Dalton 1:2202/0 313-468-6982 MI Mt. Clemens Boat Town USA/Dan Dalton 1:2202/18 313-468-0912 MI Mt. Clemens Boat Town USA/Dan Dalton A:94:3130/0313-468-0912 MI Mt. Clemens JADA Editor/Peggy McBride A:94:94/94 313-468-0912 MI Pontiac Fire & IceBill Sims 1:2202/9 313-373-8608 MI Roseville Lyme Light/Anne Bussell A:94:3130/4313-774-5038 MI SterlingHts New Life/Julia Sidebottom 1:2202/2 313-795-5829 MN Andover DRAGnet/Gordon Gillesby 1:282/1007 612-753-1943 MN Andover DRAGnet/Gordon Gillesby A:94:6120/1612-753-1943 MN AppleValley Carolyn's Closet/Carson Kimble 1:282/3015 612-891-1225 MO JeffersonCy Doc In The Box/Mark D. Winton 1:289/8 314-893-6099 MO JeffersonCy Doc In The Box/Mark D. Winton A:94:3140/1314-893-6099 MO Kansas City Shrouded Realm/Terry Goodlett 1:280/27 816-483-7018 MO Kansas City KC aids InfoLink/Scott Cohan 1:280/14 816-561-1186 MO Kansas City GCOMM/Scott Cohan 207:1/110 816-561-1187 MO Springfield ARCAngelExpress/SterlingMunhollo1:284/7 417-864-4573 MO Springfield Art's Toy/Art Rainey 1:284/55 417-866-2284 MO St. Louis Hotflash/Rhett Butler 207:1/105 314-771-6272 MO St. Louis Hotflash/Rhett Butler 207:1/105 800-245-2601 MS Coldwater Coldwater/Rogert Martin 1:123/421 601-562-9385 MS Jackson Kudzu Konnection 601-957-1259 NC Charlotte Exchange/Ron Alspaugh 1:379/24 704-339-0333 NC Charlotte Exchange/Ron Alspaugh S: 704-342-2333 NC Charlotte MetroLink II/Matthew Irvin 1:379/20 704-567-6124 NC Charlotte MetroLink II/Matthew Irvin 207:1/8 704-567-6124 NC Durham Isolated Pawn/David Myers 1:3641/281 919-471-1440 NC Goldsboro Blues' Image/Jim Henry 1:151/808 919-751-2746 NC Goldsboro Swamp Ward/Mike Whatley 1:151/814 919-751-2324 NC Greensboro NC Triad/Richard Epson-Nelms 1:151/2325 919-854-7952 NE Beatrice S.E. Community/Dick Douglass 1:285/115 402-223-2889 NE GrandIsland Central Community/Fred Roeser 1:285/116 308-389-6495 NE Lincoln Medicine Cabinet/Tom Hoover 1:285/207 402-435-0797 NE Lincoln NE EducationHub/Merle Rudebusch 1:285/100 402-471-0897 NE Lincoln TC Forum Univ. Neb./Ed Nemeth 1:285/110 402-472-3338 NE Lincoln TC Forum Univ. Neb./Ed Nemeth 1:285/110 402-472-5370 NE Lincoln TC Forum Univ. Neb./Ed Nemeth R:8:963/2 402-472-3365 NE Omaha Omaha Pub.School/Rich Molettier 1:285/113 402-554-6181 NE Wayne Wayne St.College/Dennis Linster 1:285/111 402-375-7564 NJ Bricktown Underground/David Brian 1:107/425 908-262-9666 NJ Cape May Inferno/Glenn Laws 1:266/72 609-886-6818 NJ Cape May Inferno/Glenn Laws 207:1/11 609-886-6818 NJ Dayton Altered Illusions/Lou Braconi 1:107/345 908-329-3216 NJ FranklinPrk Digital Abyss/Glen Panniche 1:107/398 908-422-4130 NJ Howell File Exchange/Walter Kuzma 1:107/449 908-905-3029 NJ Madison Strand/Gerhard Bartsch 1:107/915 201-822-3658 NJ Metuchen Micro-Fone/John Kelley 1:107/331 908-494-8666 NJ Parlin Central Jersey/Fred Seibal 1:107/600 908-525-9440 NJ Parlin RC's Place/R. C. Mann 1:107/82 908-721-4204 NJ Piscataway gLiTcH/JOD 1:2605/633 908-968-7883 NJ Piscataway gLiTcH/JOD 207:1/4 908-968-7883 NM Albuquerque Route 66 Solutions/Jon Jacob 1:301/28 505-294-4543 NM White Rock ExplodoModeM 1:15/28 505-672-0427 NV Las Vegas Southern NV C.H.A.I.N./M.T.Swift1:209/238 702-656-7654 NV Las Vegas SpiritKnife*LV/aids/hiv/M.Swift A:94:7020/2702-656-7654 NV Reno Advanced System/Richard Dias 1:213/900 702-334-3308 NY CCMC-aids L: 518-783-7251 NY Albany Lower Albany/Phil Losacco 1:267/140 518-465-1072 NY BallstonSpa Access/Maureen Allen 1:267/136 518-885-4192 NY Brooklyn Blacknet/Idette Vaughan 1:278/618 718-692-0943 NY Brooklyn Brooklyn College/Howie Ducat 1:278/0 718-951-4631 NY Brooklyn Brooklyn College/Howie Ducat 1:278/600 718-951-4631 NY Brooklyn KinQuest/Bill Gage 1:278/611 718-998-6303 NY Brooklyn Pier/Michael Stewart 1:278/6969 718-531-9475 NY Clifton Prk Fantasy Land Adult/Tony Manino 1:267/106 518-383-2282 NY Farmingdale SUNY/Gary Glueckert 1:107/270 516-420-0818 NY Great Neck Sacred Palace/Bill Athineos 1:107/256 516-829-8701 NY Hicksville Temporal Odyssey/Matt Faccenda 1:107/266 516-579-0098 NY Merrick Pride/ 1:2619/102 516-785-1557 NY New York Backroom/Tiger Tom 207:1/1 718-951-8256 NY New York Backroom/Tiger Tom S: 718-951-8256 NY New York City People/Barry Weiser 1:278/720 212-255-6656 NY New York Comm Specialties/Howie Ducat 1:278/99 212-951-4631 NY New York Dorsai Mission/Skip Mac-Stoker 1:278/706 718-729-6101 NY New York Utopian Quest L: 212-686-5248 NY New York Utopian Quest L: 516-842-7518 NY No. Babylon LastPlaceOnEarth/KennethOransky 1:107/247 516-243-1949 NY Rochester Cat's Meow #1/Bob Rathke 1:2613/140 716-473-2017 NY Rochester Frog Pond/Nick Francesco 1:260/270 716-461-1924 NY Rochester Recovery Room/Patrick Daugherty 1:2613/207 716-461-5201 NY Scotia Critics Choice/Tim Koral 1:267/135 518-377-7009 NY Syracuse Erie Canal/Ray Bucko 1:2608/31 315-445-4710 NY Waterford Biologicalnightmare/RobLevine 1:267/139 518-233-9529 NY Whitestone Corner Deli/Mike Schiffman 1:278/777 718-352-0821 OH Columbus Black Bag II/Paul Prior 1:226/320 614-293-8810 OH Columbus Mystic Life/Michael Kelly 1:226/520 614-279-7709 OH Dayton Levee/Jim Koz S: 513-222-6107 OH Dayton Olman/James Hale 1:110/247 513-427-9473 OH Dayton Olman/James Hale A:94:5130/ 513-427-9473 OH Galloway Information Exchange/Dan Styers 1:226/210 614-878-0161 OK MidwestCity Sandbox/John Burton 1:147/34 405-737-9540 OK MidwestCity Torii Station/Jim Oxford 1:147/20 405-737-7565 OK OklahomaCit Huggy Bears/Donald Burch 1:147/30 405-949-2090 OK OklahomaCit OK NORML/Michael Pearson 1:147/3 405-282-8777 OK Ponca City Wordshop #2/Wayne Majors 1:3810/1 405-765-0951 OK Tulsa Looking Glass/Arnie Holder 1:170/706 918-838-7575 OR Eugene Paradox/Ryan Shaw 1:152/38 503-485-1988 OR Portland Busker's Boneyard/Hal Nevis 1:105/14 503-771-4773 OR Portland Club/Gary Seid 1:105/98 503-232-0332 OR Portland GayNet/Michael Hile 1:105/76 503-295-0877 OR Portland Land of the Gypsy's/Nancy Porter1:105/18 503-297-0626 OR Portland Land Of The Gypsys/NancyPorter 1:105/18 503-297-0626 OR Portland Medical Education/Jerry Donais 1:105/35 503-256-7758 PA Hatboro Anterra Nework/Steve Ferguson 1:273/736 215-675-3851 PA Kittaning TechnoweenieParadyz/JoAnnKaraffa1:129/196 412-543-6580 PA MechanicsburConnections! BBS --------- 717-795-9925 PA Milford Omega/Gordon Craig 1:268/18 717-296-8560 PA Philadelphi Critical Path/Kiyoshi Kuromiya L: 215-463-7162 PA Philadelphi Club Philadelphia/Matt Zarkos 1:273/904 215-626-7398 PA Philadelphi East Co Bear/John D. Steele 1:273/910 215-755-1917 PA Philadelphi La Dolce Vita/ L: 215-463-7888 PA Pittsburgh Meeting Place/Marc Shannon 1:129/45 412-482-7057 PA Pittsburgh PARIS BBS (RIP)/Doug Segur 1:129/228 412-381-6878 PA Wyndmoor WyndowIntoReality/Jeff Nonken 1:273/715 215-242-4485 RI Providence Eagles Nest/Mike Labbe 1:323/126 401-732-5290 RI West Warwic AdvantageVoice&Data/Joe Caparco 1:323/113 401-885-5695 RI Warwick GAYtway/Blind Faith 1:323/121 401-435-6544 RI Warwick GAYtway/Blind Faith 207:1/20 401-739-1380 SC Central Spawl/David Scott 1:3639/18 803-653-4536 SC Charleston Big Dog's/Dan Folk 1:372/62 803-769-6131 SC Columbia Dog Alley/Maddog 207:1/16 803-926-9110 SC Goose Creek Medical Forum/Shelley Crawford 1:372/106 803-824-0317 SC Greensville Evolution/John Hames 1:3639/17 803-244-9556 TN Brighton Unbridled Desires/Ken McCleaft 1:123/415 901-476-3097 TN Chattanooga Cove/Joel Davenport 1:362/960 615-855-9956 TN Chattanooga Cove/Joel Davenport A:94:6151/1615-855-9956 TN East Ridge TEL(Medical BBS)/Oliver Jenkins 1:362/621 615-622-6099 TN Memphis Personals/John Heizer 1:123/22 901-274-6713 TN Memphis Personals/Lucky Ernie 207:1/12 901-274-6713 TN Bartlett Riverside/Gary Wilkerson 1:123/424 901-452-6832 TN Bartlett Riverside/Gary Wilkerson S: 901-452-6832 TN Nashville Meharry Medical College RelayNet 615-327-6175 TN Red Bank Eternal Flame/Jack Whaley 1:362/940 615-875-0290 TX Amarillo Town Crier/Matt Montgomery 1:3816/126 806-358-7032 TX Austin Health-Link/Bruce Baskett 1:382/5 512-444-9908 TX Austin Lambda Link/Joshua 1:382/25 512-873-8299 TX Austin Lambda Link/Joshua 207:1/109 512-873-8299 TX Austin RiverCityExchange/George Sharpe 1:382/4 512-327-5376 TX Beaumont Super Collider/Pat Presley 1:3811/320 409-833-8583 TX Bedford Metroplex Mailbox/Kyle Hearn 1:130/1008 817-268-1422 TX Bryan Lazy Jane's 1:117/128 409-268-1181 TX CorpusChristBlueWater/Tony Honaker 1:160/260 512-883-7839 TX Dallas DaBBS Dallas/Dale Becker 1:124/2126 214-821-7732 TX Dallas Dallas Mandate/Mark Taylor 1:124/6503 214-528-1816 TX Denton ComputerGeeksAnon/George Toon 1:393/42 817-380-0186 TX Fort Hood Serving with God's Love/D.Wright1:395/22 TX Fort Worth Crystal Palace/Lisa Mashburn 1:130/1005 817-370-9591 TX Fort Worth Stallions Coral/Stallion 207:1/107 817-545-7317 TX Irving aids Chat Line/John Pfeifer 1:130/55 214-256-5586 TX GrandPrairi Puss N Boots/Aaron Davis 1:124/3103 214-641-1822 TX Houston A Womyn's Line/Anna Mayes 1:106/8160 713-647-9057 TX Houston Beehive/Brad Wartman 1:106/41 713-974-6995 TX Houston Last Call/Doug Sutherland 1:106/8366 713-523-8366 TX Houston Medico/Dave Ray 1:106/595 713-895-7945 TX Houston Murphy's Law/Gregg Holland 1:106/365 713-584-0348 TX Houston PIC of the MID Town/Geo. Worley 1:106/31 713-961-5817 TX Houston Pink Triangle/Dereck Thomas 1:106/3802 713-630-0764 TX Houston Private Line/Larry Mers 1:106/5000 713-933-0499 TX Houston Turkey's Roost/Keven Turk 1:106/6235 713-530-6235 TX Port Neches StarGate Seven/Timothy Wilson 1:3811/110 409-727-8141 TX San Antonio ETC MedNet/Bob Jackson 1:387/801 210-829-0346 TX San Antonio Gardens of Avalon/Ed Tillman 1:387/57 210-308-9579 UT West Jordan Midnight Express/ L: 801-565-8330 UT W.Jordan Lake Wobegon/Robert Klaproth 1:311/19 801-568-3866 VA Arlington NAPWA-Link/Richard Smith L: 703-998-3144 VA Norfolk Christian Resources/Mike Olah 1:275/36 804-543-3459 VA VirginiaBch ADAnet File Dist/Warren King A:94:94/99 804-496-3320 VA VirginiaBch Pleasure Dome/Tom Terrific S: 804-490-5878 WA Ellensburg Joe's Oasis/Ben Roth 1:344/92 509-962-3536 WA FederalWay Big Easy/Danny Stephens 1:343/85 206-661-1457 WA Olympia Radio Point/Jay Andrews 1:352/111 206-943-1513 WA Seattle Seattle aids Info/Steve Brown L: 206-323-4420 WA Seattle Stage Seattle/Randy 207:1/102 206-286-1850 WA Seattle U. of Wash. HHS/Cindy Riche 1:343/35 206-543-3719 WA Tumwater Elder's Council/Daniel Smerken 1:352/458 206-357-8992 WA Tumwater Elder's Council/Daniel Smerken A:94:2061/2206-357-8992 WI Milwaukee Back Door/Paul Parkinson 1:154/700 414-744-9385 WI Milwaukee Back Door/Paul Parkinson 207:1/108 414-744-9385 MI Milwaukee Back Door/Paul S: 414-744-9385 WI Milwaukee Starcom/Rick Gardner 1:154/69 414-445-6969 Canada (FidoNet Zone 1) AB Calgary Message-Line [K-12] 403-244-4724 AB Calgary Rainbow Connection/Brent Rector 1:134/172 403-244-0794 AB Edmonton Ten Forward/Tom Hall 1:342/1 403-424-3258 AB Edmonton Toys For Boys/Alex Solski 1:342/24 403-497-7816 AB Lethbridge Lost Planet/Terry Fleming 1:358/16 403-381-3185 AB Lethbridge Terminal/Laz Gottli 1:358/17 403-327-9731 BC Kelowna Dementia 9.4 1:353/294 604-765-5746 BC Nanaimo ADAnet Canada/Celia Corriveau A:94:94/10 604-756-3177 BC Vancouver Lambda Speaks/Warren Cox 1:153/756 604-681-3667 BC Vancouver PC-WorkShop/Ervin Jay 1:153/767 604-682-0914 BC Vancouver PC-WorkShop/Ervin Jay 1:153/797 604-687-0913 BC Vancouver PC-WorkShop/Ervin Jay 1:153/798 604-689-0437 BC Vancouver Phaonica * aids/hiv/Ed Parker 1:153/732 604-683-2144 ON Gloucester Coven's Den/Sorceress 1:163/436 613-746-5559 ON Hamilton Villa Gryphus/Kelly Ryan 1:244/106 416-545-5789 ON Mississauga Canada Remote System/Rich Munro 1:229/15 416-579-6302 ON Ottawa AlterNet/Paul Hannon 1:163/113 613-230-9519 ON Hull Cookie Jar 1:243/40 819-778-7956 ON Ottawa Chaos Central/Neal Bouffard 1:243/50 613-228-7268 ON Ottawa Echo Valley/Michelle Chartrand 1:243/26 613-749-4550 ON Ottawa Mother's Board/Perry Davis 1:243/38 613-728-4122 ON Ottawa Mother's Board/Perry Davis 207:1/203 613-728-4122 ON Richmond Abacus-I/John Gyulasi 1:153/968 604-272-4311 ON Richmond Ultimate/Steve Allan 1:243/52 613-838-4812 ON Toronto ADAnet Ability OnLine/ A: 416-650-5411 ON Toronto Dungeon/Trojan Horse S: 416-926-8734 ON Toronto Dungeon/Trojan Horse S: 416-926-8739 ON Toronto Gay Blade/Phil Dermott 1:250/214 905-882-4800 ON Toronto Gay Blade/Jock Strap S: 905-882-4800 ON Toronto Gay Blade/Phil Dermott 207:1/202 905-882-4800 ON Toronto Kaikatsu na Sakaba/Phillip Catt 1:250/470 416-778-7334 ON Toronto LeftoverHippies/Lesley-Dee Dyla 1:250/824 416-466-8195 ON Toronto QNet3/ A: 416-745-8133 PQ Montreal S-TEK/Eric Blair 207:1/201 514-597-2409 PQ Montreal S-TEK/Eric Blair S: 514-597-2409 PQ BellefeuilleEchoMailCoordinator/Ray Beriau 1:242/90 514-433-1105 Latin America (FidoNet Zone 4) PA Panama City Century XXI 4:920/50 011507638075 Overseas - Africa (FidoNet Zone 5) Senegal Edna/Kate White 5:7711/1.25011221217627 Overseas - Asia (FidoNet Zone 6) HK Island /T.K.Kang A:94:94/6 852-855-0569 Overseas - Australia (FidoNet Zone 3) Armadale AlternativeAccess/Michael Bates 3:632/502 61-3-5000067 Burwood, NSW Eagle One/Terry Harvey 3:712/704 61-2-7453500 Cairns Far Northern News/Noel Roberts 3:640/531 61-7033-1553 Canterbury Pride/Addam Stubbs 3:632/353 61-3836-6782 Carnegie Orion/Peter Fortey 3:632/338 61-3885-0002 Carnegie Orion/The Phoenix S: 61-3885-0002 Fitzroy Big Tedd's #2/Robbie Bates 3:634/381 61-3417-1669 Greensborough Cool World/Gary Greer 3:635/564 61-3-4320716 Sandgate Soft-Tech/Alwyn Smith 3:640/201 61-7269-6355 Overseas - Belgium (FidoNet Zone 2) Marchienne CarrefourSante/PhilippeRasquinet2:293/3211011-32-71518162 Overseas - France (FidoNet Zone 2) Paris hivNET/Jean-Luc Dalous 2:320/303 33-1-42544519 Archive-name: aids-faq/part10 Posting-Frequency: monthly Last-modified: 10/8/94 AIDS FAQ Part 10/10 Overseas - Germany (FidoNet Zone 2) (Cont'd.) Berlin A&M Soft/Michael Vogt 2:2403/34 49-30-3915186 Berlin hivNET/Joerg Schulze 2:242/1205 49-304542605 Berlin Kumpelnest/Matthias Ganick 2:2403/43.349-30-4026340 Rutesheim SCHWUBBS GAyBBS/Roland Teich 2:246/1603 49-7152-56330 Haar OASE/Wolfgang Roth 2:246/25 49-89-6883262 Hamburg SGBB/Thomas Blaesing 2:2403/43.549-40-8505958 Muenchen Medical System/Arnulf Bultmann 2:246/63 49-89-295223 Muenchen Tadzio Gay/Daniel Schroeder 2:246/75 49-89-657447 Nuremberg Mustang/Ralf Ulbrich 2:246/8 49-91-1505669 Seeheim MoonBeam/Christoph Vaessen 2:2405/11 49-62-5786308 Velbert Oganpipe/Michael Smetten 2:243/7011 49-2051-56866 Overseas - Italy (FidoNet Zone 2) Roma sidanet/Massimiliano Fiorenzi 39-6-86801371 Overseas - Netherlands (FidoNet Zone 2) Paradise! 2:280/712 31-36-5314728 Aalten BIB/Freek Kempink 2:500/279 31-5437-74203 Amsterdam ArtNet/Martin Cleaver 2:280/204 31-20-6163698 Amsterdam Black Box/Stefan de Droog 2:280/403 31-20-6255563 Amsterdam Broomcupboard/Jochem Broers 2:500/296 31-20-6362575 Amsterdam Cyberspace/Sico Bruins 2:280/404 31-20-6754650 Amsterdam hivNET Testlab/Matthew Lewis 2:280/419 31-20-6125918 Amsterdam hivNET/Tjerk Zweers 2:280/413 31-20-6647461 Amsterdam PCN/John Kessel 2:280/415 31-20-6962860 Amsterdam Utopia/Felipe Rodriquez 2:280/308 31-20-6273860 Apeldoorn Dutch Health/Ruud vd Linden 2:500/211 31-55-337951 Breda Pro Deo/Marco Blaauw 2:285/201 31-76-223378 Breugel MadCat's/Lodewijk Otto,MD 2:284/120 31-4990-60548 Den Haag Gay-Biseks CRUISING/Ben Fama 2:281/532 31-0703450380 Diemen FsFan/Hans Hoekstra 2:280/304 31-20-6958426 Heerlen hivNET-Limburg/Lucas Vermaat 2:284/306 31-45-231754 Leiden CommPoort/Dennis Hammerstein 2:281/403 31-71-124350 Pijnacker Gaypalace/Andre Degenhart 2:285/163 31-1736-99126 Rijswijk Interface/Ron Huiskes 2:281/506 31-70-3361380 Rotterdam hivNET/Simon Bignell 2:285/818 31-10-2130501 Schiedam Bommel's/Nitz Neder-Helman 2:285/800 31-10-4700939 Waddinxveen Monade/Olaf Boezelijn 2:281/709 31-1828-11894 Overseas - Oceania (FidoNet Zone 3) Burwood, NSW Eagles/Terry Harvey A:94:8610/161-274535006 Stanmore NSW /Colin Lean A:94:94/8 61-2569-5130 Overseas - Sweden (FidoNet Zone 2) Stockholm Gay Telegraph/Bengt Ericsson 207:1/301 46-8-6530808 Overseas - United Kingdom (FidoNet Zone 2) Spartacus/Barry Kingston-Wyatt 2:255/27 03-273-509152 Flaversham DataServeSystems/GrahamJenkins 2:440/23 44-795590170 Locksheath United Europe/George Cordner A:94:94/9 44-489-577514 London Gnfido/Karen Banks 2:254/70 44-71-6081899 London hivNET/Ron Dixon 2:25/555 44-81-6956113 London Out/Damien Marcus 2:441/55 44-71-4908493 London POS+NET/Ron Dixon 2:25/555 44-81-6956113 London Quadris Technics/Michael Pereira2:441/99 44-81-6499408 ------------------------------------------------------------------------------ Question 9.2. National AIDS Clearinghouse Guide to AIDS BBSes. Subject: Guide to AIDS BBSes Date: Apr 2 1993 (396 lines) U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Public Health Service Centers for Disease Control and Prevention CDC National AIDS Clearinghouse A SELECTED GUIDE TO AIDS-RELATED ELECTRONIC BULLETIN BOARDS INTRODUCTION This is a guide to representative electronic bulletin boards containing information about HIV infection and AIDS. This guide is not a complete listing of all AIDS-related electronic bulletin boards, but has been prepared as an introduction to the subject and can be used as a starting point to locate information. This document was prepared by the CDC National AIDS Clearinghouse; please notify the CDC Clearinghouse with any updates or additions. Inclusion of a service does not imply endorsement by the Centers for Disease Control and Prevention, the CDC Clearinghouse, or any other organization. Electronic bulletin board systems, often called BBS's or bulletin boards, are computerized information services that are accessed by using a computer, modem, and telephone line. BBS's meet today's demands for current news on HIV infection and AIDS and provide a convenient means for information exchange among professionals, volunteers, and individuals involved in the fight against AIDS. BBS's can consist of any of the following features: electronic mail, bulletin board forums, searchable databases, and transferrable information files. Electronic mail is a convenient way of sending private messages to others using the same system. Bulletin board forums, sometimes called conferences, are interactive systems for posting public messages to groups of users connected to the same system. Searchable databases can sometimes be accessed through BBSs, providing a quick means of obtaining specific information such as bibliographic references, full-text articles, and information about organizations. Text files of information can be downloaded from most BBS's, then later edited and/or printed at the user's computer. Many BBS's provide gateways to national forums. Messages posted on these forums are "echoed" on networks linking BBS's throughout the country. Some examples of these forums include the FidoNet AIDS/ARC forum, the UseNet SCI.MED.AIDS newsgroup (available on all Internet nodes as the AIDS listserv), the GayComm Talk About AIDS forum, and the AIDS Education and General Information Service (AEGIS) network's AIDS.DATA and AIDS.DIALOG. To access a BBS, your computer (IBM-compatible or Macintosh) must be equipped with a modem (external or internal; 2400+ baud recommended) and communications software (such as ProComm, CrossTalk, or Red Ryder). The modem must be connected to the computer and to a phone line. It is preferable, but not necessary, to use a phone jack separate from any telephones; the phone and the modem can use the same phone line, but not simultaneously. CDC NAC ONLINE CDC NAC ONLINE is the computerized information network of the CDC National AIDS Clearinghouse and gives AIDS-related organizations direct computerized access to the CDC Clearinghouse and its information and bulletin board services. It contains the latest news and announcements about many critical AIDS- and HIV-related issues, including prevention and education campaigns, treatment and clinical trials, legislation and regulation, and upcoming events. CDC NAC ONLINE provides direct access to CDC Clearinghouse databases such as the Resources and Services Database of organizations providing AIDS-related services. The system also features electronic mail, interactive bulletin board forums, and is the original source of the AIDS Daily Summary newsclipping service. CDC NAC ONLINE users include U.S. Public Health Service agencies, universities, health administrators, community-based organizations, and other professionals working in the fight against AIDS. CDC NAC ONLINE is a free service for qualified non-profit organizations and can be accessed by dialing a toll-free number. For a registration form or more information, call the CDC Clearinghouse at (800) 458-5231. OTHER SERVICES Unless otherwise stated, services are free. The phone number listed at the top right of each record is the data-line that can be dialed with a modem. AIDS Info BBS San Francisco, CA; (415) 626-1246 AIDS Info BBS is a long-established comprehensive electronic bulletin board targeted primarily to HIV-positive individuals, persons with AIDS, and others concerned about HIV infection. It contains hundreds of articles including AIDS Treatment News, electronic mail, and an open forum. Anyone can access AIDS Info BBS free. For more information, contact Ben Gardiner, AIDS Info BBS, P.O. Box 1528, San Francisco, CA 94101. AIDSQUEST Atlanta, GA; (404) 377-9563 AIDSQUEST is an electronic bulletin board provided by AIDS Weekly publishers for AIDS Weekly newsletter subscribers. AIDSQUEST replaces AIDS Weekly Infoline, an electronic bulletin board that was previously available to any caller. AIDSQUEST includes DAITA, the Database of Antiviral and Immunomodulatory Therapies for AIDS, articles from AIDS Weekly, statistics from CDC, an interactive forum, and the UseNet echo of SCI.MED.AIDS. Anyone can obtain information about AIDSQUEST by connecting online to the above number. For more information, contact AIDS Weekly, P.O. Box 5528, Atlanta, GA 30307-0528, (404) 377-8895. Black Bag BBS Wilmington, DE; (302) 994-3772 Black Bag BBS, a member of the AEGIS network, is an electronic bulletin board containing information about many medical topics including HIV/AIDS. The Black Bag Medical BBS List is a comprehensive list of medical-related electronic bulletin boards in the United States and abroad. Black Bag BBS also includes AIDS Treatment News, AIDS statistics and the FidoNet echo of the AIDS National Discussion. Donations are encouraged, but anyone can access Black Bag BBS free. For more information, contact Edward Del Grosso, MD, 1 Ball Farm Way, Wilmington, DE 19808. Boston AIDS Consortium SPIN Boston, MA; (617) 432-2511 SPIN, or Service Provider Information Network, is maintained by the Boston AIDS Consortium. It includes AIDS Treatment News, statistics from CDC, and other AIDS-related information. Anyone can access SPIN by connecting online to and typing the username "spin." For more information, contact Harvard School of Public Health, 677 Huntington Ave., Boston, MA 02112, (617) 432-0885. Breaking Walls; Building Bridges Concord, CA; (510) 827-0804 Breaking Walls; Building Bridges is sponsored by the Diablo Valley Metropolitan Community Church and includes general MCC information as well as AIDS dialog and files, including the AIDS Daily Summary. It serves the Oakland/East San Francisco Bay area and is a member of the AEGIS network. For more information, contact Breaking Walls; Building Bridges, Diablo Balley Metropolitan Community Church, P.O. Box 139, Concord, CA 94522- 0139. CAIN By Subscription Only CAIN is the Computerized AIDS Information Network sponsored by the state of California. CAIN contains electronic mail, an interactive bulletin board forum, and databases of upcoming events, educational materials, organizations, and articles. It resides on the Delphi network; charges for connect time are billed by Delphi. For more information, contact CAIN, 1625 N. Hudson Ave., Los Angeles, CA 90028-9998, (213) 993-7416. Can We Talk - Chicago Chicago, IL; (312) 588-0587 Can We Talk - Chicago (CWT) is a publicly accessible, privately operated system. It contains many newsletters, government information, and articles. It offers connections up to 9600 baud. For more information, contact Eddie V, Sysop, Can We Talk - Chicago, 3943 N. Whipple St., Chicago, IL 60618-3519. CESAR Board Washington, DC; (301) 403-8343 Administered by the Center for Substance Abuse Research, University of Maryland, College Park and supported by Governor Schaefer's Drug and Alcohol Abuse Commission. Includes Maryland AIDS statistics. Within Maryland, call (800) 84-CESAR. For more information, contact Center for Substance Abuse Research, 4321 Hartwick Road, Suite 501, College Park, MD 20740, (301) 403-8329. CHEN By Subscription Only CHEN is the Comprehensive Health Education Network sponsored by the Council of Chief State School Officers. It contains general information about HIV issues related to schools. It includes the biweekly HIV/AIDS Education Bulletin Board newsletter. Use of CHEN is free to qualified organizations; however, the purchase of IBM PSINet software is necessary. For more information, contact Council of Chief State School Officers, One Massachusetts Avenue, NW, Suite 700, Washington, DC 20001-1431, (202) 408-5505. Critical Path AIDS Project BBS Philadelphia, PA; (215) 563-7160 The Critical Path AIDS Project has developed an electronic bulletin board for persons with AIDS, researchers, health-care providers, and others. It includes an extensive series of forums, downloadable files including primarily resource and treatment information. Anyone can access the system free by typing "BBS" when first connecting to the system. A 9600-baud connection can be made by dialing (215) 463-7162. A user's manual is available. For more information, contact Critical Path AIDS Project, 2062 Lombard St., Philadelphia, PA 19146, (215) 545-2212. FDA Electronic Bulletin Board Toll-free; (800) 222-0185 The Food and Drug Administration operates a publicly accessible electronic bulletin board. Included are press releases related to AIDS, such as those announcing new drug approvals. To access, dial the above modem and enter "BBS" at the "Login" prompt. Local users in the Washington DC metro area should call (301) 227-6849. Those on an FTS2000 line should dial FTS-394-6849 or 394-5657. There is no charge and users can connect at up to 9600 baud. A users manual and technical support are also available. For more information contact the FDA Press Office, Parklawn Building, 5600 Fishers Lane, Rockville, MD, 20857. Fog City BBS San Francisco, CA; (415) 863-9697 Fog City BBS, a member of the AEGIS network, includes many articles, general information, and the GayComm Talk About AIDS forum. Although a subscription fee is charged for full membership, anyone can call Fog City BBS for free AIDS information by connecting online to and logging on as "AIDS INFO" when prompted for first and last name. For more information, contact Fog City BBS, 584 Castro Street #184, San Francisco, CA 94114-2588, Fax: (415) 863-9718. GLIB Washington, DC; (703) 578-GLIB GLIB, the Gay & Lesbian Information Bureau, is maintained by the Community Educational Services Foundation. It includes treatment information and the GayComm Talk About AIDS echo. Subscription fees vary and may not be required in some cases. GLIB is also available through Bell Atlantic's IntelliGate Service. Anyone can obtain information about GLIB by connecting online as a visitor. For more information, contact Community Educational Services Foundation, P.O. Box 636, Arlington, VA 22216, (703) 379-4568. HEEF Kenney, LA; (504) 443-5546 HEEF is the Health Education Electronic Forum, which replaces the Tulane Medical Center's BBS. A $2.00 subscription fee is requested. Anyone can register on HEEF by connecting and logging on as a visitor. For more information, contact Lifestyle and Health Promotion, 59 Monterey Dr., Kenner, LA 70065-3142. HIV/AIDS Information BBS San Juan Capistrano, CA; (714) 248-2836 HIV/AIDS Information BBS is the hub of the AIDS Education and General Information System (AEGIS), a growing network of HIV-related electronic bulletin boards (see last page). It includes many newsletters and hundreds of files that can be downloaded. It also echoes FidoNet and other networks, and is available via PC Pursuit. Anyone can access HIV/AIDS Information BBS free at connections up to 9600 baud. For more information, contact Sister Mary Elizabeth, Sisters of St. Elizabeth of Hungary, P.O. Box 184, San Juan Capistrano, CA 92693-0184. HNS HIV-NET Tollfree; (800) 788-4118 HNS HIV-NET, sponsored by Home Nutrition Services, is an electronic bulletin board for physicians and other health-care professionals treating HIV-positive patients and those with AIDS. It contains hundreds of files of newsletter articles, bibliographies, and graphics files of pictures of opportunistic infections. There are also a number of different forums, corresponding to different health-care professions. Interested users should dial the data line to register. After being validated or registered by the sysop, they can call back. For more information, contact John Owens, MD, HNS HIV-NET BBS, 9037 Kirby Drive, Houston, TX 77054. The Houston Exchange Houston, TX; (713) 521-2191 The Houston Exchange, a member of the AEGIS network, contains information from the Houston Clinical Research Network, an affiliate of the Montrose Clinic. Anyone can access the Houston Exchange free. For more information, contact Houston Clinical Research Network, 4211 Graustark, Houston, TX 77006, (713) 528-5554. LEGALNET Petersburg, FL; (813) 343-0797 The Stetson University College of Law's Legal Information Network sponsors an online discussion area and a selection of files relating to legal HIV issues. Anyone can access LEGALNET free with connections up to 9600 baud. For more information, contact Stetson University College of Law, 1401 61st Street South, St. Petersburg, FL, (813) 343-0797. LPIES By Subscription Only LPIES is the Laboratory Performance Information Exchange System sponsored by CDC's Public Health Program Practice Office and is available free to HIV testing laboratories and related organizations. Qualified users can register by connecting online to (800) 522-6388. For more information, contact Program Resources, Inc., P.O. Box 12794, Research Triangle Park, NC 27709, (800) 322-4383. NAPWA-Link Washington, DC; (703) 998-3144 NAPWA-Link is the electronic bulletin board of the National Association of People With AIDS and is part of the network maintained by the Community Educational Services Foundation (see GLIB). NAPWA-Link contains electronic mail, announcements, and databases of news articles, drug interactions, and organizations. Users must pay a fee; several membership plans are available. Anyone can connect for online information about NAPWA and NAPWA-Link by logging on as a visitor. For more information, contact the National Association of People with AIDS, P.O. Box 34056, Washington, DC 20043, (202) 898-0414. NCJRS BBS Washington, DC; (301) 738-8895 The NCJRS BBS is the electronic bulletin board of the National Criminal Justice Reference Service. It includes information about publications and services available from the National Institute of Justice AIDS Clearinghouse, such as information about HIV and incarceration. Anyone can access NCJRS BBS free. For more information, contact National Criminal Justice Reference Service, P.O. Box 6000, Rockville, MD 20849- 6000, (800) 851-3420. OASH BBS Washington, DC; (202) 690-5423 OASH BBS is the free and publicly accessible electronic bulletin board of the U.S. Public Health Service, Office of the Assistant Secretary for Health, National AIDS Program Office. It distributes many files of AIDS- related information from the federal government, including the AIDS Daily Summary, Federal Register announcements for funding, and the National Library of Medicine's AIDS Bibliography. OASH BBS has electronic mail, public forums, and file transfer. Anyone can access OASH BBS free; connections up to 9600 baud are available. For more information, contact National AIDS Program Office, Hubert Humphrey Bldg. Room 729-H, 200 Independence Ave., SW, Washington, DC 20201, (202) 690-6248. Ohio AIDS/HIV BBS Columbus, OH; (614) 279-7709 Ohio AIDS/HIV BBS is a relatively new system that branched off from the Mystic Christian & Recovery BBS. It is a member of the AEGIS network. Connections up to 9600 baud are available. For more information, contact Michael Kelly, Sysop, Ohio AIDS/HIV Info BBS, P.O. Box 2970, Columbus, OH 43216. Public Health Network By Subscription Only The Public Health Network is produced for public health administrators by the Public Health Foundation and contains information posted by a number of U.S. Public Health Service agencies including CDC, the National Institute for Drug Abuse, and the Health Resources and Services Administration. A subscription is required and connect fees are charged. For more information, contact Chris Frank, Public Health Foundation, 1220 L St., NW, Suite 350, Washington, DC 20005, (202) 898-5600. Questor British Columbia, Canada; (604) 681-0670 Questor is UseNet system (for Unix users) that echoes the UseNet SCI.MED.AIDS discussion. Anyone can access Questor free by connecting online to the above number. Seattle AIDS Information BBS Seattle, WA; (206) 323-4420 Seattle AIDS Information BBS, a member of the AEGIS network, is targeted to persons with AIDS and HIV infection. It contains electronic mail, bulletin board forums, and hundreds of articles available for viewing and file transfer. Donations are encouraged, but anyone can access Seattle AIDS Information BBS free. For more information, contact Seattle AIDS Information BBS, 1202 E. Pike, Suite 658, Seattle, WA 98122-3918. 888 Online Richmond, VA; (804) 266-0212 888 Online is a member of the AEGIS network and includes all AEGIS files as well as interactive forums. Files can be searched by words in their text. 888 Online also includes information related to alternative lifestyles and recovery. For more information, contact Bill Smith, 888 Online BBS, P.O. Box 15885, Richmond, VA 23227-5885. AEGIS Listed below are the network affiliates of the AIDS Education and General Information System (AEGIS). These BBSs echo messages and exchange files of HIV/AIDS information, including the AIDS Daily Summary. The AEGIS network is also linked to a similar network in Europe called HIVNET. Anyone can log on anonymously to an AEGIS BBS for free. Other BBS services interested in joining AEGIS should contact Sister Mary Elizabeth of the HIV/AIDS Information BBS (which see). AEGIS NETWORK AFFILIATES State BBS Name Fidonet Node Phone Number Arizona The Meat Rack BBS 1:114/188 602.273.6956 California Breaking Walls; Building Bridges 1:161/203 510.827.0804 California The Task Force 1:161/513 707.746.6091 California Fog City BBS 1:125/100 415.863.9697 California The Clovis Co of Fresno 1:205/48 209.323.7583 California HIV/AIDS Info BBS 1:103/927 714.248.2836 Colorado Telepeople 1:104/69 303.426.1866 Colorado The Denver Exchange 1:104/909 303.623.4965 Delaware Black Bag Medical BBS 1:150/140 302.994.3772 Florida MOTSS BBS of Satellite Beach 1:374/41 407.779.0058 Florida Aftermidnite BBS / Tampa 1:377/43 813.831.7587 Massachusetts The Den 1:101/225 617.662.6969 Minnesota Drag-Net / Andover 1:282/1007 612.753.1943 Missouri Doc in the Box 1:289/8 314.893.6099 Missouri KC AIDS InfoLink 1:280/14 816.561.1187 Nevada Las Vegas AIDS Info BBS 1:209/238 702.658.3591 New York Brooklyn College ONLINE! 1:278/0 718.951.4631 New York The Erie Canal BBS 1:2608/31 315.445.4710 North Carolina The Isolated Pawn / Durham 1:3641/281 919.471.1440 Ohio The Mystic Christian 1:226/520 614.279.7709 Oklahoma The Looking Glass BBS / Tulsa 1:170/706 918.743.1268 Tennessee Riverside BBS 1:123/424 901.452.6832 Texas The Houston Exchange 1:106/20 713.521.2191 Texas Puss-N-Boots / Grand Prairie 1:124/3103 214.641.1822 Texas AIDS Chat Line / Grand Prairie 1:130/55 214.256.5586 Texas Loaves & Fishes BBS 8:3000/7 512.444.8790 Virginia 888 Online 1:264/190 804.266.0212 Washington Seattle AIDS Info BBS 206.323.4420 Ontario Mother's Board / Ottawa 1:243/38 613.728.4122 Quebec EC / Bellefeuille, Pq 1:242/90 514.433.1105 Australia SouthMed of Sydney Net 3:712/700 61.2.583.1027 NOTES Several publicly accessible commercial networks have AIDS-related forums, such as The Well [Whole Earth 'Lectronic Network, online registration: (415) 322-7398]; GEnie [the General Electric Network for Information Exchange, voice phone: (800) 638-9636]; and CompuServe [voice phone: (800) 848-8990]. There are also several database vendors that provide gateway access to AIDS-related databases, including the National Library of Medicine [voice phone: (800) 638-8480]; BRS Search Services [(a division of Maxwell Online; voice phone: (800) 456-7248]; and DIALOG [voice phone: (800) 334-2564]. More information about AIDS-related databases can be obtained by calling a Reference Specialist at the CDC Clearinghouse, (800) 458-5231. ------------------------------------------------------------------------------- Question 9.3. National Library of Medicine AIDSLINE (please contribute) If you know how to obtain access to this service, please contribute instructions to the FAQ (e-mail to aids-faq@family.hampshire.edu). ------------------------------------------------------------------------------ Question 9.4. Commercial Bulletin Boards (please contribute) There are AIDS-related areas on Compuserve and America Online. (we need details: how to contact Compuserve and America Online, what the newsgroups are called, etc.) ------------------------------------------------------------------------------ Question 9.5. Lesbian/Gay Scholars Directory. From: "Louie Crew" <lcrew@andromeda.rutgers.edu> Date: Tue, 2 Nov 93 11:06:05 EST I have compiled an E-Mail Directory of Lesbigay Scholars, with now more than 195 persons listed. To be included, fill out the form below and return it to me: lcrew@andromeda.rutgers.edu Do NOT send by snail mail. The E-Directory helps lesbigay scholars connect regarding on-going manuscripts, conferences, and other scholarly projects. I send the Directory to all who agree to be listed, with updates individual by individual. I also make available to one e-mail address by which those listed can post announcements of interest to the entire group. But this is not a discussion list per se--rather, a resource list. Please share this announcement with any friends who might be interested and with any other e-networks where forthright lesbigay scholars might assemble qua scholars. Thank you. Louie Crew Author/editor of _The Gay Academic_ and 950+ others Co-founder of the Lesgay Caucus of the National Council of Teachers of English Founder of Integrity, the lesgay justice ministry of the Episcopal Church Academic Foundations Department, Rutgers University/Newark (Snail mail: P. O. Box 30, Newark, NJ 07101) ============================================================================ Entry Form for E-Directory of Lesbigay Scholars Name: Institutional affiliation: Department: Position: E-mail address(es): Snail mail: Phone(s) FAX: Citations of a sample of yr. previous lesbigay scholarly projects: List/description of yr. on-going lesbigay scholarly projects: