NOVEMBER 8, 1996 GAY PEOPLE's ChroniCLE 5

New drugs, prevention topic of AIDS conference

by Bob Boone

Cleveland-When Congress passed the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act in 1990, it set aside emergency relief funds for cities disproportionately affected by HIV and AIDS and qualified these areas as eligible metropolitan areas, or EMAS.

These areas have been defined by the Department of Health and Human Services as communities having over 2,000 reported cases of AIDS. In March 1995, Cuyahoga, Ashtabula, Geauga, Lake, Lorain, and Medina counties were designated as the Cleveland EMA.

In the aftermath of that event and in the wake of recent medical advances and new techniques in prevention and intervention, the Cleveland Department of Public Health and the MetroHealth System sponsored the second annual conference on HIV and AIDS. Held at the Cleveland Convention Center on Wednesday, October 23, the conference drew over 150 doctors, nurses, social workers, and others, doubling the turnout from last year.

In an update from this summer's 11th International Conference on AIDS in Vancouver, Dr. Leonard H. Calabrese, head of the Clinical Immunology Section at the Cleveland Clinic, summarized the encouraging results from the use of protease inhibitors and the introduction of viral load testing.

Protease inhibitors, under such brand

names as indinavir, saquinavir, and ritonavir, work within cells already infected with the HIV virus to prevent the virus from entering the plasma and spreading to other cells. This is in contrast to reverse transcriptase inhibitors, such as AZT and DDI, which attempt to prevent the virus from entering the original cell.

Taken in tandem, the effects of these two types of drugs has been remarkable. As noted by Calabrese, the combination of AZT, 3TC, and a protease inhibitor can result in a 99.9 percent reduction in the viral load (or concentration of the virus in the blood plasma) for 6 to 12 months and a rise in the CD4, or T-cell, count for the duration-to-date of current clinical trials.

The introduction of the use of viral load, as opposed to merely T-cell counts, as a measure of the progression of HIV/AIDS has brought a dramatic revisiting of treatments and their timing. It has been this monitoring method that has indicated the greater success of two drugs from the outset of treatment in contrast to just one, and that a more aggressive regimen produces better results. Studies have seemed to make it clear, according to Calabrese, that lowering an individual's viral load slows the progression of the disease.

While protease inhibitors are, according to Robert Bucklew, AIDS coordinator for Cuyahoga County through the Cleveland health department, "a major, major, major medical breakthrough that offers hope," he

No protease inhibitors in budget

Continued from page 1

plained that once the use of protease inhibitors is begun, it is "very critical that it be continued, and continued without interruption," since a break in taking the drugs can allow the virus to mutate and become immune to protease inhibitors.

The Ohio health department has recently provided guidelines by which protease inhibitors can be obtained through the HIV Drug Assistance Program. Eligibility stipulations, however, insist that, in addition to the program's existing requirements, individuals must also have T-cell counts lower than 100. Hiller indicated that under the specified terms a "very, very small number of people will thus be able to gain access to protease inhibitors."

He continued that the guidelines clearly ignored the fact that protease inhibitors are the most effective early on in the progression of HIV/AIDS. "We've put this ray of hope out there and then shut the door to it for the vast majority of people who could most benefit."

Reasoning behind the possible lack of requested funding for protease inhibitors for the Drug Assistance Program would appear to be purely financial.

The Ohio Department of Health, along with other state agencies, had reportedly

been asked by the governor to submit a budget totaling just 96 percent of its previous biennial request. The expense of protease inhibitors (some $1,200 per person per month) seemed to place the drugs beyond the affordability of the Drug Assistance Program. Health officials, however, subsequently calculated that, with the program's ability to receive drugs at a reduced cost, $4 million over two years would allow protease inhibitors to be included on the program's formulary.

Proponents for the inclusion of protease inhibitors in the budget have been quick to point out that the Drug Assistance Program serves as the payer of last resort, so that any Medicaid or pharmaceutical firms reimbursements for medication received through the program would go back into the program. This prevents the Drug Assistance Program from paying for medication for any individuals eligible for the medication from other

resources.

To insure that funding for protease inhibitors will be included in the upcoming budget, the North Coast HIV/AIDS Coalition has called for concerned individuals to write to Governor Voinovich and to the director of the Ohio Office of Budget and Management, R. Gregory Browning. The Coalition may be contacted at 216621-0766 ext. 106.

and other health officials have been quick to point out that they are not a cure.

As described by Calabrese, a cure for HIV would involve eradicating the virus not just from the blood plasma, but from the socalled privileged sites, such as the brain and the rest of the central nervous system.

The continued lack of any cure for AIDS served to emphasize the conference's second objective, in addition to drug and treatment updates, of the re-direction of prevention techniques. To this discussion, the opening ceremony included an address by Dr. Jeffrey Kelley, director of the Center for AIDS Intervention Research at the Medical College of Wisconsin.

"People have become very knowledgeable about HIV infection," Kelley said, but he maintained that knowledge has not equaled behavior modification. Triggered by such factors as alcohol and loneliness, risky behavior has not ceased. In fact, some 40,000 to 80,000 new HIV cases have been reported in each of the recent years. Some 10 percent of gay men in rural areas are reported to have HIV, while that figure climbs as high as 50 percent in such urban areas as New York and San Francisco. In light of such statistics, Kelley contended that prevention certainly remains as important as ever and, with the new three-pronged drug treatments costing about $1,200 per month per person, prevention is clearly more economical.

According to Kelley, prevention education must re-focus, however, and target the instigators of high-risk behaviors. He cited goals in intervention training of building individuals' skills and self-esteem, training people to be assertive enough to discuss safer sex and to say no to risky behavior.

A key focus for a number of the conference leaders was intervention within the African American community, which makes up some 40 percent of the 900,000 reported cases of HIV nationwide.

Within Cuyahoga County, while African

American men who have sex with men comprise less than 1.5 percent of the population, they equal 25 percent of people with AIDS in the county, according to Bucklew. Stating that Cleveland's gay community is racially divided, he asserted that "fighting racism is more than political correctness; it's about saving lives."

In addition to the stunning figures regarding HIV and African American gay men, according to figures presented at the Harvard AIDS Institute Leading for Life summit on October 22nd, African American women constitute two-thirds of all HIV cases among women and more children with AIDS are African American than all other races and ethnic groups combined.

In light of such statistics, African American leaders at the Harvard summit issued a call for action to urge community leaders and government officials at all levels to "support, develop, and enhance community-based programs" for prevention, care, and education of HIV/AIDS.

Toward that end, Carolyn Cockfield, the Taskforce's African American education coordinator, conducted a workshop at the Cleveland conference which focused on outreach within the African American community. Stressing the use of materials that convey solid family values and strong maternal images, she maintained the need for intervention workers to learn about the people with whom they will be working and what symbols and messages would be most effectively received.

Robert Bucklew stated that he hoped the conference would draw attention to the HIV crisis within the African American community and would increase the support for all HIV/AIDS agencies. Reflecting the goal of all the conference attendees well into this second decade since the emergence of HIV/AIDS, Bucklew succinctly concluded, “Our mission is to stop the virus from spreading."

Show You Care This Holiday Season Witha Tree or Wreath From

The AIDS Housing Council

of Greater Cleveland

Your purchase will help provide a home for Cleveland area men, women and children with HIV/AIDS who might not have had a place to celebrate the holidays this year.

Each tree is guaranteed by our growers

to meet or exceed these standards upon delivery.

Quantities are limited, so order early to ensure availability.

Choose from the following

LINES

Julie A. Blaine

Stylist Perm Specialist Colorist

$

There's Money to Be Made...

##

...By Selling Your Stuff in the Gay People's Chronicle Classifieds Page!

Only 50+ Per Werdi!

20 Word Minimum

4 1/2-5 ft. Fraser Fir.......

..$50.00.

5 1/2-6 ft. Fraser Fir.....

.$60.00

6 1/2-7 ft. Fraser Fir..........

.$70.00

..$35.00

Plus shipping and handling

24 in. Fraser Fir Wreath........

Order From the

AIDS HOUSING COUNCIL

of Greater Cleveland, Inc.

(216) 651-6400

One-half of the proceeds of each tree or wreath goes directly to the AIDS Housing Council of Greater Cleveland

to providehousing services for people with HIV/AIDS.