AIDS TREATMENT NEWS Issue #369, July 27, 2001
phone 800-TREAT-1-2, or 215-546-3776

CONTENTS:

** Global Epidemic, U.S. Response: A Winning Strategy, What
You Can Do
The global effort against the AIDS epidemic is stalling on
the issue of resources. The main reason is that the U.S.
Congress is not hearing from constituents that they care
about the epidemic in poor countries (where about 90% of
the cases are located); many other countries follow the
U.S. lead in how seriously they take the global epidemic.
About 10,000 letters to Congress per month would make all
the difference -- one letter from every 25,000 Americans.
We analyze why it has not happened so far -- and how to
change the course of the worldwide response to AIDS.

** Treatment Interruption: Erroneous Press Report
A July 20 press report on structured treatment interruption
erroneously said it does not work.

** Vaccines: Major Conference Sept. 5-8 in Philadelphia
AIDS Vaccine 2001, one of the most important AIDS
conferences of the year, takes place next month in
Philadelphia.

** IAS Buenos Aires Conference: Medscape CME Summaries
Three excellent summaries from the recent Buenos Aires
conference report on current patient management, new
treatments, and complications of HIV disease.

** FDA: New Email List on HIV/AIDS
Now there is a single source for all AIDS-related
announcements from the FDA.

** Science Project Director Wanted -- Treatment Action
Group (TAG)
TAG, a leading activist organization, is seeking a
scientific policy director.


***** Global Epidemic, U.S. Response: A Winning Strategy,
What You Can Do

by John S. James

*** How to change the lack of political will now blocking
worldwide AIDS control. ***

World consciousness on the HIV epidemic in developing
countries -- about 90% of the global epidemic -- has
changed greatly in the last three years. In 1998 the World
AIDS Conference in Geneva took the theme "Bridging the Gap"
-- meaning the gap between access to treatment in rich and
poor countries. But outside the conference there was no
institutional support for saving lives in poor countries;
once the speeches were done, that was it. And we all knew
it.

Now it is no longer OK to let tens of millions of people
die without treatment when treatment is available. And
especially since the XIII International AIDS Conference
last summer in Durban, South Africa, real changes have
begun. Prices of antiretrovirals have been reduced up to
90% in some poor countries -- either by generic
manufacturers, or by major pharmaceutical companies trying
to head them off. Treatment is now widely recognized as an
important part of HIV prevention and control, especially
since it gives people incentive to get tested and work with
the public-health system. (With no chance of treatment,
they have the opposite incentives.)

The big problem now is funding. Even with the price
reductions many countries cannot pay for the necessary
prevention and treatment programs without help. United
Nations Secretary General Kofi Annan proposed a global fund
of $7 to $10 billion per year to control HIV, tuberculosis,
and malaria; economists agree that the money is available,
and health experts agree that if well spent, it could do
the job. Yet the Global AIDS and Health Fund is going to
start with only a fraction of the amount required -- and
even that includes one-time contributions, multi-year
contributions all counted in a single year, and money
already being spent on AIDS that has been redirected or
renamed to make the Fund look bigger. (For current pledge
totals to the Global AIDS and Health Fund, see
http://www.un.org/News/ossg/aids.htm)

The problem is not lack of money -- many institutions and
some individuals could write a check for the entire amount
required from all countries in the world -- but lack of
political will. In the U.S., we are hearing from political
experts that the biggest problem is not policy
disagreements about what to do about global AIDS, but
rather that global AIDS is not a priority for either
political party -- simply because Congress is not hearing
from constituents that this is a problem for them. These
experts tell us that if Congress received 10,000 calls or
letters per month expressing concern about the global AIDS
epidemic and other infections diseases, the entire
situation would be transformed.

That's about one call or letter per month for every 25,000
people in the United States -- to entirely change our
country's response to the greatest epidemic of modern
times. And it would change much of the world's response as
well. If the world's only superpower takes global AIDS
seriously, many other countries will also.

So why hasn't it happened already?

A big part of the problem has been the lack of good
legislative vehicles (such as bills or amendments) for
expressing concern -- or rather, the lack of knowledge
about how to use the vehicles that do exist. With the way
Congress works, letters and phone calls should target
actual legislation or other decisions in front of Congress
at the time; otherwise they may never be counted, because
the office staff will probably not categorize, total, and
report them, among the many thousands of communications
that come in to each Congressional office.

To overcome this problem, advocates and the public alike
must understand that what is most important is that
Congress knows the public it represents does care about
AIDS and other epidemics in developing countries. So even
if specific legislation fails, or is flawed, or was not
introduced in a politically astute way, your call or letter
is still important because it adds up to the 10,000
communications per month that Congress needs to get from
throughout the U.S. -- to know that people in their
district care about the global epidemic (and therefore they
need to care about it as well, and act accordingly).

When you write or call it helps to know that you are not
trying to change anyone's position (the Senator or
Representative and their advisers and office staff probably
agree with you already), but to let them know you care
about the issue, and want them to give it the priority it
deserves. You don't need to debate or make technical
arguments.

Political organizers can miss this reality because they are
used to controversial issues where the most important part
of a call or letter is where it makes clear which side the
writer takes. Here it's not an question of sides, but of
priority. Political organizations can also miss the point
because usually their main goal is to pass or block
specific legislation or other policies -- while the main
goal here is cumulative impact on prioritizing the issue.

Also, lobbyists may find it hard to work on both domestic
and international AIDS; but for the public, calls or
letters to Congress or the White House on each of these add
to the total momentum on AIDS, infectious diseases, and
health, increasing the priority (the political will) on
both U.S. and international AIDS.

Next Steps

In August, September, and October of this year
international AIDS will come before Congress many times, as
the new Global AIDS and Health Fund begins. Many AIDS
organizations will put out action alerts when calls or
letters are needed. Remember that what often counts most is
letting Congress know you care about international AIDS,
rather than the particulars of the legislation or amendment
at issue.

We believe that a winning strategy is to use each
appropriate piece of legislation to build cumulative
momentum on this issue. Can we organize friendly contests
on who can get the most communications from constituents to
Congress (and/or to the White House)?

Every U.S. citizen can contribute substantially to better
worldwide control of AIDS and other infectious diseases --
saving millions of lives, contributing to the safety of our
country, and improving the quality of life for everyone. A
few hundred committed, determined activists -- with the
widespread community support they already have -- would be
more than enough to do it.

Better political mobilization would help. We see action
alerts with no date, with misspellings, or with no
indication of whether they are still current. Or the action
alerts are hard to find on a Web site. Some of them direct
users only to an automated email response, without
justifying whether emails to Congress are effective
(despite widespread doubt that Congress listens to email).

Some give little guidance -- for example, urging readers to
write the Treasury Department with no further details. None
seems to have benefited from simple focus groups that ask
supporters not familiar with writing Congress, etc. to
relate what questions and obstacles come up as they try to
respond to the alert. And many apparently lack a winning
legislative strategy -- or if they do have one, they
conceal it well from readers.

Years ago we noted the bad state of AIDS action alerts and
grassroots organizing. Much of the problem stemmed from the
ambivalence of inside-the-Beltway organizations toward
grassroots action: they needed it to be effective, but were
threatened by it as well. The community still urgently need
organizers who define grassroots as their mission, and
learn do it well.

The epidemic will not wait for perfect organization, and
neither can we. Determined individuals throughout the
country can use the information available (and insist on
better information when necessary) to make sure the U.S.
and other governments respond seriously to the worldwide
epidemic -- not only in rhetoric, but in resources as well.


***** Treatment Interruption: Erroneous Press Report

by John S. James

On July 20 an erroneous Reuters report on structured
treatment interruption (STI -- also called structured
intermittent therapy, or SIT), titled "Experts Caution
Against an AIDS Therapy," appeared in several newspapers,
including the Web site of THE NEW YORK TIMES. The report
said that STI does not work, and quoted Dr. Bruce D. Walker
of Harvard as saying it had shown poor results. We were at
the meeting reported -- a two-day clinical discussion
organized by the International Association of Physicians in
AIDS Care -- and in fact the information on STI was mostly
positive, although the physicians agreed that it should be
done in careful research studies and is not ready for
widespread use until more is known.

Dr. Walker issued the following correction, which was
widely distributed on email lists:

"I am quite upset to have been grossly misquoted in a
recent report from Reuters regarding my views on STI.
Augmentation of immune responses from STI has been clearly
shown in treated acute HIV infection, and our own studies
continue to show success in the majority of persons who
have participated in a complicated STI trial. Although the
durability of control and the exact clinical benefit in
terms of overall outcome of infection has not been shown,
the results show that at least transient immune control can
be achieved. In contrast to the promising results in acute
infection, similar immune boosting and control of viremia
in chronically-infected individuals appear to be difficult
to achieve. However, there may be benefit from reduced drug
exposure in persons with chronic infection, and there are
also other adjunctive measures that may confer benefit,
such as therapeutic vaccines. At Massachusetts General
Hospital we have a trial that is ongoing looking at
therapeutic vaccination and STI in chronic infection, and
others are soon to open. For now I recommend that persons
not try STI on their own but that these approaches be
supervised in a research setting to enhance safety and to
ensure that we learn the most we can in the most
expeditious fashion. We and others have clearly shown that
the immune response to HIV can be boosted after a person
becomes infected, and we have to believe that we can be
smart enough to induce even better responses that will lead
to persistent clinical benefit."

Another physician's name was misspelled in the article
(making the erroneous report easy to find through computer
searches -- look for "Steerer").

Comment

The reason for concern is that patients may change
treatment decisions or drop out of clinical trials, based
on wrong information.

What happened here is that this story was not written by
Reuters Health, the unit which usually writes medical
stories for the wire service, but by a reporter from
another Reuters unit who had never covered an AIDS meeting
before. And this event was hard to report because it was
not intended for media (although not closed to the press
either). IAPAC brought together some of the leading HIV
physicians and clinical researchers in the country to
discuss difficult issues in antiretroviral treatment, so
that guidelines for physicians can be prepared. The two-day
meeting itself was excellent, and we look forward to the
guidelines, which should be published in a few weeks.

This incident illustrates that news reports on medical
subjects too often include serious errors. Media stories --
in treatment newsletters as well as the general press --
can be used as leads for further investigation, but should
never be the main reason for changing treatment decisions.


***** Vaccines: Major Conference Sept. 5-8 in Philadelphia

AIDS Vaccine 2001, a major scientific conference on AIDS
vaccine development, will take place September 5-8 at the
Philadelphia Marriott. Sponsors include the U.S. National
Institutes of Health, U.S. Centers for Disease Control and
Prevention, UNAIDS, the World Health Organization, and the
Agence Nationale de Recherches sur le SIDA, in France. The
organizing committee is David L. Baltimore, Ph.D., Beatrice
H. Hahn, M.D., Norman L. Letvin, M.D., Douglas D. Richman,
M.D., and Melissa Sordyl. The program committee includes
scientists from China, France, India, Kenya, South Africa,
Uganda, and UK, as well as the U.S.

The advance registration deadline has recently been
extended to August 17. After that, persons should register
onsite at the Philadelphia Marriott.

International press note: "Representatives from non-U.S.
media are required to pre-register by Friday, August 24,
2001 in order to receive press credentials to attend the
AIDS Vaccine 2001 conference. On-site media registration is
not available for non-U.S. media due to the need to verify
media credentials in advance" (quoted from the conference
Web site, August 5). This has been a problem in at least
one previous AIDS conference, as reporters are not used to
registering in advance to cover news, and will often not
learn of the requirement in time. We are concerned that
international journalists may be turned away.

Program

The conference has more than 60 sessions. Talks include:
* The Global Need for an AIDS Vaccine (keynote talk in
opening session)
* Lessons from Acute Infection and Relevance to Vaccine
Development
* Innate Immunity
* Candidate Vaccines
* Access and Implementation
* Novel Envelope Immunogens
* Experience with AIDS Clinical Trials in Humans: What
We've Learned
* Design, Oversight, and Review of Phase III Efficacy
Trials
* Therapeutic Vaccines and Immune Response
* The Genesis of HIV Diversity
* Late Breaker and Innovative Strategies Session

In addition there are many poster sessions, mostly on
technical topics.

For more information, see the conference Web site,
http://www.aidsvaccine2001.org


***** IAS Buenos Aires Conference: Medscape CME Summaries

On July 31 the Medscape Web site, named the official
provider of online coverage for the new International AIDS
Society conference which took place July 8-11, 2001 in
Buenos Aires, Argentina, released three Continuing Medical
Education programs for medical professionals. Anyone can
use them for a review of current knowledge in some of the
major areas of HIV treatment. These programs will remain
online for one year.

The Medscape site requires a one-time registration, but it
is cost-free.

Here we list the titles of the programs and the articles
required for CME credit in each one. Each program also has
several other articles available which are not listed here.

I. Current Patient Management:

* New Light Through Old Windows: Fine-tuning the Use of
Approved Antiretrovirals, by Graeme Moyle, M.D., M.B.B.S.

* Pharmacokinetics, Pharmacodynamics, and Pharmacogenomics:
The Continuing Evolution of Pharmacologic Issues in HIV
Disease, by Stephen Becker, M.D.

* Update on Antiretroviral Drug Resistance, by Daniel R.
Kuritzkes, M.D.

* Management of HIV-Infected Women and Mother-to-Child HIV
Transmission, by Alexandra M. Levine, M.D.

II. Novel Therapeutic Strategies

* HIV Entry -- From Molecular Insights to Specific
Inhibitors, by William A. O'Brien, M.D., M.S.

* Investigational Antiretrovirals in Existing Classes, Mike
Youle, M.B.B.S.

* Strategies for Immune Reconstitution in HIV Disease, by
Ronald T. Mitsuyasu, M.D.

* Insights From Basic Science: Implications for HIV
Treatment and Prevention, Mark A. Wainberg, Ph.D.

III. Complications of HIV Disease

* Opportunistic Infections: Still a World-Wide Problem,
Even in the HAART Era, by Henry Masur, M.D.

* New Developments in AIDS-Related Hematology and Oncology,
by Alexandra M. Levine, M.D.

* Adverse Effects of Antiretroviral Therapy: More Noise,
Less Clarity?, by William G. Powderly, M.D.


***** FDA: New Email List on HIV/AIDS

The U.S. Food and Drug Administration has started an email
list anyone can join, to provide AIDS-related information
from the Agency. The official announcement, below, gives
details.

Note: The sign-up process shows users confusing options --
but they can be ignored. Just stay with the defaults
provided, unless you know you want something else.

"An e-mail list has been established by the Division of
Antiviral Drug Products (Center for Drug Evaluation and
Research) and the Office of Special Health Issues (Office
of the Commissioner) of the Food and Drug Administration
(FDA) to provide updates on safety and regulatory issues
related to HIV/AIDS products.

"The purpose of this e-mail list is to give patients,
industry, academia, other government agencies and other
interested parties one source for FDA HIV/AIDS related
information. Information such as product approvals,
significant labeling changes, safety warnings, notices of
upcoming public meetings and alerts to proposed regulatory
guidances for comment will be distributed through this e-
mail list.

"To join the e-mail list, please go to
<http://list.nih.gov/archives/fda-hiv-aids.html>. Your name
and e-mail address is considered confidential and will not
be released.

"If you are interested in regulatory guidance and
requirements for blood safety, you should also register for
the FDA's Center for Biologics Evaluation and Research e-
mail list at http://www.fda.gov/cber/pubinfo/elists.htm

"The HIV/AIDS e-mail list is not intended or designed to
accept comments or input, but merely to disseminate
important HIV/AIDS-related information and alert interested
parties about HIV/AIDS related issues for public comment.

"Information will be distributed through this e-mail list
as it becomes available, rather than on a regularly
scheduled basis.

"For additional information about the FDA HIV/AIDS e-mail
list please contact the Office of Special Health Issues at
oshi@...."


***** Science Project Director Wanted -- Treatment Action
Group (TAG)

On August 5 the Treatment Action Group circulated a 3-page
job announcement and description for Basic Science Project
Director. The full announcement may be available through
http://treatmentactiongroup.org

From the announcement:

Job Description. The Basic Science Project Director will be
responsible for developing and implementing TAG policy,
programs and advocacy projects focusing on basic and
applied research on HIV infection, including:
* Etiology and pathogenesis of HIV infection;
* Epidemiology and natural history of HIV infection;
* Fundamental primate and human immunology;
* HIV virology, viral dynamics, and virus-host
interactions;
* Discovery and pre-clinical development of potential drugs
against new anti-HIV targets;
* Discovery and development of anti-HIV vaccines;
* Discovery and development of anti-HIV (and anti-STD)
microbicides;
* Discovery and development of immune-based therapies
(IBTs) useful for treating HIV infection; and
* Other relevant basic, pre-clinical and early clinical
research relevant to TAG's mission of expediting research
leading to more effective treatments, a vaccine, and a cure
for HIV infection.

The Basic Science Project Director will report directly to
TAG's Senior Policy Director and will work closely with
other TAG policy and program staff and consultants,
developing and implementing advocacy strategies to ensure
the most expeditious, ethical and efficacious development
of useful new drugs, biologics, treatment regimens and
strategies to treat HIV in the USA and internationally.

The Basic Science Project Director will develop, implement,
and advocate for TAG's basic science and immunology
research advocacy efforts with other HIV community
advocates and organizations as well as with the
pharmaceutical, biotechnology and diagnostics industries,
academic and community based researchers, clinicians, U.S.
government agencies such as the Food and Drug
Administration (FDA) and National Institutes of Health
(NIH), and other local, state, and national AIDS research,
treatment and policy-making bodies as well as organizations
such as UNAIDS, the World Health Organization (WHO), and
other multilateral agencies and foundations.

... [background on TAG]

To Apply. Interested candidates should send a letter
expressing their qualifications and interest in the
position with a resume/C.V. and three references with
contact information to:

Basic Science Project Director Search
c/o Regina Gillis
Treatment Action Group (TAG)
350 Seventh Ave. Ste. 1603
New York, NY 10001


***** AIDS TREATMENT NEWS

Published twice monthly

Subscription and Editorial Office:
1233 Locust St., 5th floor
Philadelphia, PA 19107
phone 800/TREAT-1-2 toll-free, or 215-546-3776
fax 215-985-4952 (email is preferred)
email: aidsnews@...
useful AIDS links: http://www.aidsnews.org

Editor and Publisher: John S. James
Associate Editor: Tadd T. Tobias

Statement of Purpose:
AIDS TREATMENT NEWS reports on experimental and standard
treatments, especially those available now. We interview
physicians, scientists, other health professionals, and
persons with AIDS or HIV; we also collect information from
meetings and conferences, medical journals, and computer
databases. Long-term survivors have usually tried many
different treatments, and found combinations that work for
them. AIDS TREATMENT NEWS does not recommend particular
therapies, but seeks to increase the options available.

AIDS TREATMENT NEWS is published 24 times per year, on the
first and third Friday of every month, and print copies are
sent by first class mail. Email is available (see below).
Back issues are available at http://www.aidsnews.org

To subscribe, you can call 800-TREAT-1-2 or 415-255-0588:
* Businesses, Institutions, Professionals: $325/year. Early
email available (see below).
* Nonprofit organizations: $150/year.
* Individuals: $140/year, or $80 for six months. If you
cannot afford a subscription, please write or call about
our sliding scale.
* Outside North, Central, or South America, add airmail
postage: $20/year, $10 for six months.
* Bulk rates and multiple discount subscriptions are
available; contact our office for details.
* Payment can be by check, VISA, Mastercard, American
Express, bank draft, purchase order, international postal
money order, or travelers checks.

Early email: Business, nonprofit and full-rate individual
subscribers can receive an early copy by email, before the
issue is printed--in addition to their regular copy, at no
extra charge. It's OK to direct the email copy to someone
else. Call our office to add email to your subscription.

Free email: Free delivery for individuals (delayed one week).
To subscribe, send a blank email to:
aidsnews-subscribe@yahoogroups.com

ISSN # 1052-4207

Copyright 2001 by John S. James. Permission granted for
noncommercial reproduction, provided that our address and
phone number are included if more than short quotations are
used.