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 @SUBJECT:Sci.med.AIDS FAQ part 1 of 4

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 [e-mail].  You
don't have to format it: just send it.

You can skip to a particular question by searching for `Question n.n'.
See Q9.2 `Formats in which this FAQ is available' for details of where to
get the PostScript and Emacs Info versions of this document.

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Contents

 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        Subscribing and unsubscribe to sci.med.aids.
 Q1.5        What is a moderated newsgroup?
 Q1.6        Editorial guidelines.
 Q1.7        How do I submit a posting?
 Q1.8        The moderators.
 Q1.9        Cooperative moderation - and voting on posts.
 Q1.10      If a post gets rejected.
 Q1.11      Discussing sci.med.aids moderation policies.

 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 transmit AIDS?
 Q2.6        What about other insect bites?
 Q2.7        Is there even a remote chance of insect transmission?

 Section 3.  Confidentiality.
 Q3.1        How is blood tested in the United States?
 Q3.2        What if a blood-bank finds out you are HIV positive?

 Section 4.  Treatment options.
 Q4.1        General treatment information.
 Q4.2        AIDS and Opportunistic Infections.
 Q4.3        Guide to Social Security Benefits.
 Q4.4        What if you can't afford AZT?
 Q4.5        What about DNCB?
 Q4.6        Alternative Treatments for AIDS and HIV (please contribute)

 Section 5.  The common debates.
 Q5.1        What are Strecker and Segal's theories that HIV is manmade?
 Q5.2        Other conspiracy theories.
 Q5.3        Is HIV the cause of AIDS?
 Q5.4        Contaminated polio vaccine? (please contribute)
 Q5.5        Who is Lorraine Day? (please contribute)

 Section 6.  Internet resources.
 Q6.1        Ben Gardiner's Gopher AIDS Database
 Q6.2        CDC AIDS Public Information Dataset.
 Q6.3        HIVNET/AEGIS Gateway (BETA VERSION)
 Q6.4        Other USENET newsgroups.

 Section 7.  Other Electronic Information Sources.
 Q7.1        List of AIDS BBSes.
 Q7.2        National AIDS Clearinghouse Guide to AIDS BBSes.
 Q7.3        National Library of Medicine AIDSLINE (please contribute)
 Q7.4        Commercial Bulletin Boards
 Q7.5        Reappraisal of the HIV-AIDS Hypothesis.
 Q7.6        Lesbian/Gay Scholars Directory.

 Section 8.  Non-Electronic Information Sources.
 Q8.1        Phone Information about AIDS.
 Q8.2        Phone Information about AIDS drug trials.
 Q8.3        US Social Security: Information for Organizations

 Section 9.  Administrative information and acknowledgements
 Q9.1        Feedback is invited
 Q9.2        Formats in which this FAQ is available
 Q9.3        Authorship and acknowledgements

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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        Subscribing and unsubscribe to sci.med.aids.
 Q1.5        What is a moderated newsgroup?
 Q1.6        Editorial guidelines.
 Q1.7        How do I submit a posting?
 Q1.8        The moderators.
 Q1.9        Cooperative moderation - and voting on posts.
 Q1.10      If a post is rejected.
 Q1.10      Discussing sci.med.aids moderation policies.

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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.

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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).

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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 September
1993.  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
 772  37000   509   55%  2063     5.5     1%  0.11   1.0%
alt.sexual.abuse.recovery
 781  37000   403   71%   777     6.4     1%  0.17   0.8%
misc.activism.progressive
 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
1207  23000   277   63%   797     1.2    15%  0.05   0.6%
misc.health.alternative
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.

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Question 1.4.  Subscribing and unsubscribe 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 [e-mail].  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: [e-mail]
    Subject:

    subscribe aids Joe Smith

To unsubscribe, send a message to [e-mail] containing
the text
    unsubscribe aids

Please unsubscribe before your account expires.  The moderators get all
sorts of junk mail if you don't.

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Question 1.5.  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.

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Question 1.6.  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 <[e-mail]>, 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.').

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Question 1.7.  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 [e-mail].

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 [e-mail].

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Question 1.8.  The moderators.

Three people currently moderate sci.med.aids.  They are
  Phil Miller       Professor, Biostatistics, Washington University
  Jack Hamilton     Interested layperson
  Dan Greening      Founder sci.med.aids, Director AppWare C++, Novell
  Michelle Murrain  Health issues researcher, Professor, Hampshire College

Phil and Jack and Michelle do most of the moderation.  Dan repairs the
moderation software.  Phil is probably the most liberal moderator, Dan
the most restrictive, Jack and Michelle are in-between.

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

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Question 1.9.  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.

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Question 1.10.  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.
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Question 1.11.  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 [e-mail].

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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 transmit AIDS?
 Q2.6        What about other insect bites?
 Q2.7        Is there even a remote chance of insect transmission?

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Question 2.1.  How is AIDS 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

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.

Effectiveness of 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.

Under laboratory conditions, viruses occasionally have been shown to pass
through natural membrane ("skin" or lambskin) condoms, which contain
natural pores and are therefore not recommended for disease prevention.
On the other hand, laboratory studies have consistently demonstrated that
latex condoms provide a highly effective mechanical barrier to HIV.

In order for condoms to provide maximum protection, they must be used
consistently (every time) and correctly. Incorrect use contributes to the
possibility that the condom could leak or break. Proper use should
include the following:

* Put on the condom as soon as erection occurs and before any sexual
contact (vaginal, anal, or oral).

* Leave space at the tip of the condom.

* Use only water-based lubricants. (Oil-based lubricants can weaken the
condom.)

* Hold the condom firmly to keep it from slipping off and withdraw from
the partner immediately after ejaculation.

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.

Latex condoms can provide up to 98-99 percent protection against
pregnancy and most sexually transmitted diseases, including HIV
infection, but only if they are used consistently and correctly.

For more detailed information about condoms, see CDC's fact sheet, "The
Role of Condoms in Preventing HIV Infection and Other Sexually
Transmitted Diseases."

The Public Health Service Response

The U.S. Public Health Service is committed to providing the scientific
community and the public with accurate and objective information about
HIV infection and AIDS. It is vital that clear information on HIV
infection and AIDS be readily available to help prevent further
transmission of the virus and to allay fears and prejudices caused by
misinformation. In addition to research on the virus and its
transmission, the PHS program to prevent the spread of HIV/AIDS includes
counseling, testing, and education. Through these programs, individuals
who have engaged in high-risk behaviors can receive voluntary
HIV-antibody testing for themselves and their partners, and those found
to be infected can be counseled regarding preventive services and
treatment options, as well as how to prevent transmission to others.

For more information:

CDC National AIDS Hotline: [phone]-AIDS
Spanish: 1-800-344-7432
Deaf: 1-800-243-7889

CDC National AIDS Clearinghouse
P.O. Box 6003
Rockville, MD 20849-6003

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Question 2.2. How effective are condoms?

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 [phone].

** 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.

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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: [phone]
Emeritus professor Internet: [e-mail]
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, "Integrat- ing 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.

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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.

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Question 2.5. Can mosquitoes transmit AIDS?

Please see Q2.1 `How is AIDS transmitted?' for general information about
insects and AIDS transmission.

Malaria is transmitted to humans through mosquito bites. Why can't AIDS
be transmitted this way?

Plasmodium, the protozoan that causes malaria, is highly specialized to
infect through a mosquito vector. The gametocytes ingested by the
mosquito from an infected host undergo a further stage of development and
give rise to sporozoites. These migrate through the insects body until
they reach the salivary glands . They are then injected into a new host
by the mosquito along with its saliva which is an anti-coagulant and
needed to stop clotting.

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Question 2.6. What about other insect bites?

From: "Natural History", July 1991, p. 54:

Acquired Immune Deficiency Syndrome (AIDS), the deadly epidemic caused by
the HIV virus, is most often transmitted by contaminated hypodermic
needles or sexual contact. Since mosquitos feed on human blood and may
attack a series of individuals, the question arises: can you get AIDS
from a mosquito bite?

According to Jonathan F. Day, of the University of Florida's Medical
Entomology Laboratory, insects can transmit viruses in two ways,
mechanically and biologically. With mechanical transmission, infected
blood on the insect's mouthparts might be carried to another host while
the blood is still fresh and the virus still alive. Infection by this
means is possible but highly unlikely, because mosquitos seldom have
fresh blood on the outside of their mouthparts. Mechanical transmission
does occur in horses, however, with equine infectious anemia, a virus
closely related to AIDS and transmitted by horseflies. These flies are
"pool feeders"; their bite causes a small puddle of blood to form, and
they immerse their mouthparts, head, and front legs while lapping it up.
If disturbed, however, they quickly move on to another horse, where the
fresh blood of the two hosts may mingle. Blood-feeding mosquitos are much
neater and more surgical; they insert a tube for drawing blood, and by
the time they are ready for their next meal, even on a second host
following an interrupted meal, any viruses from their first meal are
safely stored away in their midgut.

With biological transmission, the pathogen must complete a portion of its
life cycle within the carrier, or vector species. Protozoans that cause
malaria, for instance, go through an extremely complex cycle within the
mosquito, eventually congregating in the salivary glands, from which they
may infect avian, primate, rodent, or reptilian hosts, depending on the
malaria species. The HIV virus, however, does not replicate or develop in
the mosquito; once in the insect's gut, the virus quickly dies. Repeated
studies since 1986 show that AIDS-infected blood fed to mosquitos and
other arthopods does not live to be passed on and that, fortunately,
there is no biological-transmission cycle of AIDS in blood-feeding
arthopods, which frequently ingest the virus as part of their blood meal.

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Question 2.7. Is there even a remote chance of insect transmission?

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."

Miike suggests that there are two theoretical mechanisms by which biting
insects might transmit HIV infections: 1). biological (insect's saliva to
person's blood) and 2). mechanical (HIV-infected person's fresh blood to
another's blood). Based on experimental results, they were able to rule
out biological transmission. This leaves mechanical transmission during
interrupted feeding as a viable mechanism. So it COULD happen; HOWEVER...

"The probability of HIV transmission from an insect bite would be
calculated by multiplying (not adding, because each event's probability
is independent of each other) the following factors: 1) how frequently
interrupted feeding occurs, 2) the probability the the insect had bitten
an HIV-infected person prior to biting an uninfected person, and 3) the
probability that the insect bite contained enough HIV to transmit
infection."

"The frequency of interrupted feeding depends on the type of insect; in
general, the larger the insect and the more painful the bite -- such as
horse flies -- the greater the probability that interrupted feeding will
occur. Other bites, such as from mosquitoes and bedbugs, are usually
unnoticed and therefore usually uninterrupted. With others, such as
ticks, if their feeding is interrupted, the probability of quickly
transferring to another person is extremely low."

"In mechanical transmission, the maximum amount of HIV that insects would
be able to transfer would be the amount of virus in the blood they had
ingested prior to biting an uninfected person. Experience with viruses
actually transferred in this manner has shown that the amount of blood
that might be transferred is limited to the amount of blood on the
insect's mouthparts (on the order of 1/100,000 of a milliliter of blood).
An uninfected person would also have to be bitten within an hour of the
insect's biting an infected person; and both infected and uninfected
persons would have to be in close proximity to each other (a few hundred
feet for mosquitoes and biting flies, in the same household for bedbugs),
or else the insect will not have an opportunity to transfer to another
person if its feeding was interrupted."

"Most HIV-infected persons (70-80 percent) do not have detectable levels
of infectious virus in their blood. Those that do have measurable HIV
have very low levels, much below the levels that are needed for insect
transmission of other viral diseases. Only rarely does an HIV-infected
person have a blood virus level that might contain enough infectious HIV
for insect transmission."

There you go... it seems that you CAN become HIV-infected via a mosquito
bite. Then again, you CAN also win the multi-million dollar lotto game
five times consecutively! 8-) I wouldn't lose any sleep worrying about
either of those.


------------------------------------------------------------------------
Date: 09-06-94                         Msg # 25832
  To: ALL                              Conf: (2120) news.answers
From: [e-mail]         Stat: Public
Subj: Sci.med.AIDS FAQ part 2 o        Read: No
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 @SUBJECT:Sci.med.AIDS FAQ part 2 of 4
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Newsgroups: sci.med.aids,sci.med,soc.motss,bionet.molbio.hiv,sci.answers
soc.answers,news.answers
Organization: Hampshire College

=======================================================================
=======

Section 3. Confidentiality.

Q3.1 How is blood tested in the United States?
Q3.2 What if a blood-bank finds out you are HIV positive?

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Question 3.1. How is blood tested in the United States?

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.

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Question 3.2. 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.

=======================================================================
=======

Section 4. Treatment options.

Q4.1 General treatment information.
Q4.2 AIDS and Opportunistic Infections.
Q4.3 Guide to Social Security Benefits.
Q4.4 What if you can't afford AZT?
Q4.5 What about DNCB? (please contribute)

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-------

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.

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Question 4.2. 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.

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Question 4.3. 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.

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
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CT Rainbow View/Bill Hausler 1:141/991 203-744-0179
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GA Atlanta CDC aids Info Line/ L: 404-377-9563
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MD Baltimore Harbor Bytes/ 207:1/15 301-235-4651
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NE Beatrice S.E. Community/Dick Douglass 1:285/115 402-223-2889
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NE Lincoln TC Forum Univ. Neb./Ed Nemeth 1:285/110 402-472-3338
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NE Lincoln TC Forum Univ. Neb./Ed Nemeth R:8:963/2 402-472-3365
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NJ Bricktown Underground/David Brian 1:107/425 908-262-9666
NJ Cape May Inferno/Glenn Laws 1:266/72 609-886-6818
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NJ Piscataway gLiTcH/JOD 207:1/4 908-968-7883
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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
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NY New York Backroom/Tiger Tom S: 718-951-8256
NY New York City People/Barry Weiser 1:278/720 212-255-6656
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NY New York Utopian Quest L: 516-842-7518
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OH Columbus Black Bag II/Paul Prior 1:226/320 614-293-8810
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OR Eugene Paradox/Ryan Shaw 1:152/38 503-485-1988
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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
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PA Philadelphi Critical Path/Kiyoshi Kuromiya L: 215-463-7162
PA Philadelphi Club Philadelphia/Matt Zarkos 1:273/904 215-626-7398
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PA Pittsburgh Meeting Place/Marc Shannon 1:129/45 412-482-7057
PA Pittsburgh P.A.&W/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
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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
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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
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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
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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
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TX Houston Beehive/Brad Wartman 1:106/41 713-974-6995
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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
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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

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

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Question 7.2. 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 [phone].

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; [phone]
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; [phone]
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, [phone].

Black Bag BBS. . . . . . . . . . . . . . Wilmington, DE; [phone]
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; [phone]
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,
[phone].

Breaking Walls; Building Bridges . . . . . . Concord, CA; [phone]
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, [phone].

Can We Talk - Chicago. . . . . . . . . . . .Chicago, IL; [phone]
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; [phone]
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, [phone].

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; [phone]