Archive-Name: aids-faq1 Last-Modified: 10 Nov 1993 Welcome to the sci.med.aids, the international newsgroup on the Acquired Immune Deficiency Syndrome (see Q1.1 `What is sci.med.aids?' for more details). This article, called the sci.med.aids "FAQ", answers frequently asked questions about AIDS and the sci.med.aids newsgroup. The FAQ is posted monthly to sci.med.aids and related newsgroups. If you are new to sci.med.aids, please read it before posting articles or responses. If you are a sci.med.aids veteran, please skim the FAQ occasionally. You may find something new here. Please contribute to the sci.med.aids FAQ. Currently there are some gaping holes. Send suggested changes to aids-request@cs.ucla.edu. 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. =============================================================================== 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. Q1.10 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? (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 Duesberg's Risk-Group Theory 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 Ben Gardiner's 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 =============================================================================== 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. Q1.10 Discussing sci.med.aids moderation policies. ------------------------------------------------------------------------------- Question 1.1. What is sci.med.aids? "sci.med.aids" is a USENET newsgroup which discusses AIDS and HIV. A gateway forwards articles posted to sci.med.aids to a BITNET listserv mailing list called AIDS. Thousands read sci.med.aids, including people with HIV infections, published authors, researchers, public health officials, and interested individuals. It is carried in several countries, particularly in the Americas and Europe. Sci.med.aids is moderated by a team. When you submit an article to sci.med.aids, it must be approved by a member of the moderation team. ------------------------------------------------------------------------------- Question 1.2. Discussion topics. Sci.med.aids covers topics of interest to people with AIDS (Acquired Immune Deficiency Syndrome), their friends, relatives, and loved ones, AIDS service providers, educators and researchers, and the general public. Some common topics are Causes of AIDS and opportunistic infections. Vaccines for AIDS. Treatments or cures for AIDS and opportunistic infections. AIDS prevention and education. Sci.med.aids carries some regular magazines. Here's a current list: CDC AIDS Daily Summary AIDS Treatment News The Veterans Administration AIDS Info Newsletter If you have the time to add to this list, we invite you to contribute (if you obtain copyright permission, of course). ------------------------------------------------------------------------------- Question 1.3. Sci.med.aids distribution. Sci.med.aids is distributed as a USENET newsgroup, where it has approximately 40,000 readers. At one time USENET was carried primarily at research and educational institutions, but that is changing; a number of commercial services now carry USENET. Here is a breakdown of comparable newsgroups, for the month of 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_Sep_93.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 (kilobytes per month) | | | | | +-- Crossposting percentage | | | | | | +-- Cost ratio: $US/month/rdr | | | | | | | +-- Share: % of newsrders | | | | | | | | who read this group. V V V V V V V V 39 110000 1700 76% 3845 6418.0 6% 0.07 3.6% soc.motss 77 96000 1420 67% 1885 3541.1 11% 0.04 3.0% alt.drugs 131 81000 1203 80% 1571 4064.6 13% 0.06 2.6% sci.med 231 65000 961 61% 1269 2863.5 6% 0.04 2.0% alt.politics.homosexuality 558 44000 647 66% 282 760.5 38% 0.02 1.4% talk.politics.drugs --------------------------------------------------------- 605 41000 615 78% 383 1556.0 2% 0.05 1.3% sci.med.aids --------------------------------------------------------- 724 37000 545 68% 512 1053.6 12% 0.03 1.2% sci.med.nutrition 729 37000 542 77% 53 96.0 12% 0.00 1.2% sci.med.physics 880 32000 481 43% 436 1033.5 8% 0.02 1.0% alt.homosexual 1202 25000 370 41% 326 529.6 9% 0.01 0.8% alt.drugs.caffeine 1320 22000 332 21% 27 62.4 4% 0.00 0.7% alt.sex.homosexual 1343 22000 326 66% 48 89.1 7% 0.00 0.7% sci.med.occupational 1398 21000 314 35% 182 2557.2 0% 0.07 0.7% bit.listserv.gaynet 1412 21000 310 56% 145 510.1 0% 0.02 0.7% sci.med.telemedicine 1425 21000 307 59% 97 353.2 0% 0.02 0.7% sci.med.dentistry 1559 19000 276 48% 99 138.4 8% 0.01 0.6% sci.med.pharmacy 1685 17000 254 42% 235 378.1 0% 0.02 0.5% alt.med.cfs 1888 14000 213 13% 12 29.3 100% 0.00 0.5% clari.news.law.drugs 1916 14000 207 38% 5 19.7 20% 0.00 0.4% bionet.molbio.hiv 2449 3500 52 11% 55 97.5 6% 0.01 0.1% de.sci.medizin Sci.med.aids is also distributed as electronic mail by the AIDS listserv. Mail is not as convenient a way to read sci.med.aids as is a newgroup, but mail is available at more sites (including Compuserve, America Online, MCImail, ATTmail and many institutions which have Internet gateways). In additional to these primary distributions, sci.med.aids is redistributed by various bulletin boards and mail gateways. ------------------------------------------------------------------------------- Question 1.4. 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 listserv@rutvm1.rutgers.edu. The message body should contain just the following command: subscribe aids Type in your real name (not your e-mail address) instead of . A complete message might look like this: To: listserv@rutvm1.rutgers.edu Subject: subscribe aids Joe Smith To unsubscribe, send a message to listserv@rutvm1.rutgers.edu containing the text unsubscribe aids Please unsubscribe before your account expires. The moderators get all sorts of junk mail if you don't. ------------------------------------------------------------------------------- Question 1.5. What is a moderated newsgroup? A moderated newsgroup is one in which all postings must be approved by a moderator before being distributed. The purpose of moderation is to restrict what can appear. Postings which do not adhere to the guidelines for the group will be rejected. ------------------------------------------------------------------------------- Question 1.6. Editorial guidelines. úÿ As with any newsgroup, read sci.med.aids for a few days before posting, to see if your question has been answered already, and to get a feel for the tone of the group. Postings to sci.med.aids should: * Write on topics directly relevant to AIDS, HIV, or related topics. * Unconventional medical/research claims must be accompanied by references to the popular press (i.e., major newspaper, magazine, etc.) or scientific press (i.e., Science, Nature, Lancet, Scientific American, Cell, Brain Research, etc.). We require references for unconventional medical/research claims, because some therapies carry with them potential danger. Some unconventional medical/research claims are fallacious. Without this policy, sci.med.aids would have printed several dangerous and undocumented therapies by now. * Political, sociological opinion/analysis articles are acceptable. The interpretation, and even the existence, of this particular policy continues to be the subject of internal debate among the moderators. However, in the past we have printed articles holding both popular and unpopular opinions on topics like "Quarantining HIV Positives" or "who did Clinton appoint to the AIDS Task Force." * Refrain from personally attacking other participants. For example, do not call someone an 'idiot' or say they are 'biased'. Instead, point out the flaws in their argument. If you find yourself getting angry at a poster, and construct a reply, please try to remember this rule. It is often useful to wait a day to see what other reactions have been posted before sending something off in anger. * Send one line "quips" as personal mail to the original submitter, rather than posting. * When posing a question to a previous poster, reconsider whether the question needs to be posted. Perhaps you could ask the question by e-mail and request a posted response. * Do not invoke religion. * Do not break copyright laws. Reprints of articles from other sources must include a statement of permission to reprint. An exception is made for abstracts of articles from scientific journals, which are not usually restricted. If you can't get reprint permission, excerpt or summarize the article. * Do not construct an article with more than 20% text from a previous article, unless it is very old (i.e., months old). The best approach when constructing a response is to tersely summarize the article to which you respond, in square brackets. For example, In article <11233@sci.med.aids>, Dan Greening wrote: > [reasons to not include too much of a prior article] Also, don't forget that many people get this stuff by mail, so huge inclusions clog hundreds of mailboxes, including mine. Thanks. * Do not duplicate something which has recently appeared. The moderators don't always agree on what's acceptable and what's not. If an article is rejected, you should receive a note from the moderator saying why. These notes, and other discussions about the running of sci.med.aids will be distributed on the aids-d mailing list (see Q1.10 `Discussing sci.med.aids moderation policies.'). ------------------------------------------------------------------------------- Question 1.7. 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 aids@cs.ucla.edu. Because sci.med.aids is moderated, your submission will not appear immediately. Sometimes the delay is very short; often it may be 24 hours. It depends on network delays and how busy the moderators are. A tickler program reminds us of postings older than 48 hours. IMPORTANT: Whether you use postnews or e-mail, please format your article exactly the way you want it to appear in the newsgroup. Because our moderation software is somewhat unpolished, editing out notes to the moderators in a posting is quite tedious. If you must communicate directly with the moderators, send a note to aids-request@cs.ucla.edu. ------------------------------------------------------------------------------- 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 do most of the moderation. Dan repairs the moderation software. Phil is probably the most liberal moderator, Dan the most restrictive, Jack in-between. Michelle is new, so it's too early to tell. 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 ------------------------------------------------------------------------------- Question 1.9. Cooperative moderation. 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. ------------------------------------------------------------------------------- Question 1.10. Discussing sci.med.aids moderation policies. A separate mailing list, aids-d, has been set up for the moderators and for people who interested in how sci.med.aids is run. Most readers will not be interested in aids-d; its purpose is internal discussion rather than information dissemination, and most articles on aids-d are examples of what moderation has filtered out. If you want to subscribe, send email to aids-d-request@sti.com. =============================================================================== 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? ------------------------------------------------------------------------------- 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) provides the 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 úÿ 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: 1-800-342-AIDS Spanish: 1-800-344-7432 Deaf: 1-800-243-7889 CDC National AIDS Clearinghouse P.O. Box 6003 Rockville, MD 20849-6003 ------------------------------------------------------------------------------- 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 úÿ cannot be used, couples should consider using a female condom. Data from the 1988 National Survey of Family Growth underscore the importance of consistent and correct use of contraceptive methods in pregnancy prevention (8). For example, the typical failure rate during the first year of use was 8% for oral contraceptives, 15% for male condoms, and 26% for periodic abstinence. In comparison, persons who always abstain will have a zero failure rate, women who always use oral contraceptives will have a near-zero (0.1%) failure rate, and consistent male condom users will have a 2% failure rate (9). For prevention of HIV infection and STDs, as with pregnancy prevention, consistent and correct use is crucial. The determinants of proper condom use are complex and incompletely understood. Better understanding of both individual and societal factors will contribute to prevention efforts that support persons in reducing their risks for infection. Prevention messages must highlight the importance of consistent and correct condom use (10). References 1. CDC. Condoms for prevention of sexually transmitted diseases. MMWR 1988;37:133-7. 2. Cates W, Stone KM. Family planning, sexually transmitted diseases, and contraceptive choice: a literature update. Fam Plann Perspect 1992;24:75-84. 3. Weller SC. A meta-analysis of condom effectiveness in reducing sexually transmitted HIV. Soc Sci Med 1993;1635-44. 4. DeVincenzi I, European Study Group on Heterosexual Transmission of HIV. Heterosexual transmission of HIV in a European cohort of couples (Abstract no. WS-CO2-1). Vol 1. IXth International Conference on AIDS/IVth STD World Congress. Berlin, June 9, 1993:83. 5. Saracco A, Musicco M, Nicolosi A, et al. Man-to-woman sexual transmission of HIV: longitudinal study of 343 steady partners of infected men. J Acquir Immune Defic Syndr 1993;6:497-502. 6. Carey RF, Herman WA, Retta SM, Rinaldi JE, Herman BA, Athey TW. Effectiveness of latex condoms as a barrier to human immunodeficiency virus- sized particles under conditions of simulated use. Sex Transm Dis 1992;19:230- 4. 7. Trussell JE, Warner DL, Hatcher R. Condom performance during vaginal intercourse: comparison of Trojan-Enz (trademark) and Tactylon (trademark) condoms. Contraception 1992;45:11-9. 8. Jones EF, Forrest JD. Contraceptive failure rates based on the 1988 NSFG. Fam Plann Perspect 1992;24:12-9. 9. Trussell J, Hatcher RA, Cates W, Stewart FH, Kost K. Contraceptive failure in the United States: an update. Stud Fam Plann 1990;21:51-4. 10. Roper WL, Peterson HB, Curran JW. Commentary: condoms and HIV/STD prevention -- clarifying the message. Am J Public Health 1993;83:501-3. * Single copies of this report will be available free until August 6, 1994, from the CDC National AIDS Clearinghouse, P.O. Box 6003, Rockville, MD 20849- 6003; telephone (800) 458-5231. ** Use of trade names is for identification only and does not imply endorsement by the Public Health Service or the U.S. Department of Health and Human Services. ------------------------------------------------------------------------------- Question 2.3. How do you minimize your odds of getting infected? "Playing the AIDS Odds" (21 Oct 93) Robert S. Walker, Ph.D. Phone: (210)224-9172 Emeritus professor Internet: rwalker@trinity.edu Trinity University, Pol.Sci. 715 Stadium Drive office: 128 Main Plaza, No.310 San Antonio, TX 78212 San Antonio, TX, 78205 Everyone worries about the degree of transmission-risk involved in various activities. Can you get infected from mutual masturbation? From fisting? From using poppers? From this and from that? The real question is, "Is it possible to provide answers with sufficient precision to allow an individual confidently to assess risk and modify behavior in specific situations?" The answer is "No." No one knows enough about either sexual or drug behaviors, and their relation to HIV sero- conversion, to speak with assurance. But this doesn't mean that meaningful recommendations are out of the question. Those interested in risk assessment might read two articles representing different approaches. First: Michael Shernoff, "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. ------------------------------------------------------------------------------- Question 2.4. How risky is a blood transfusion? The following October 15, 1993 United Press International article, was summarized in the CDC AIDS Daily News Summary. "CDC Study Finds Five Transfusion-Related AIDS Cases Per Year" United Press International (10/25/93) Miami Beach, Fla.--Since screening for HIV began in 1985, very few people have become infected with the virus via blood transfusions, according to experts at the Centers for Disease Control and Prevention. The rate of transfusion-related AIDS cases rose steadily from 1978 to 1984, then fell dramatically when testing began in 1985, said the CDC. Officials report that between 1986 and 1991, the number of such cases may have been as low as five per year. "While the risk of getting AIDS from a transfusion is not zero, this study corroborates other CDC research and published data indicating that the risk is extremely low," said Dr. Arthur J. Silvergleid, president of the American Association of Blood Banks. A total of 4,619 individuals are believed to have been infected through the blood supply. Each year in the United States, about 4 million people receive blood transfusions. ------------------------------------------------------------------------------- Question 2.5. Can mosquitoes 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. ------------------------------------------------------------------------------- Question 2.6. What about other insect bites? úÿ 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. ------------------------------------------------------------------------------- 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. ****************************************************************************** Archive-Name: aids-faq2 Last-Modified: 10 Nov 1993 =============================================================================== 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? ------------------------------------------------------------------------------- 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. ------------------------------------------------------------------------------- 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) ------------------------------------------------------------------------------- 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 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 úÿ 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. ****************************************************************************** Archive-Name: aids-faq4 Last-Modified: 10 Nov 1993 =============================================================================== 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. ------------------------------------------------------------------------------- Question 6.1. Ben Gardiner's Gopher AIDS Database The 'gopher' system provides convenient menu-driven access to a wealth of arcana--and valuable information--on the Internet. Daily, more and more resources are made available in gopherspace. Generally, your local gopher client (if one is installed) will be available by typing 'gopher' at your system prompt; your local system administrator should be able to provide further details. Local gopher clients in turn allow convenient access to other remote gopher clients throughout the Internet. One of the most valuable gopher resources for AIDS-related information is the mirror of Ben Gardiner's AIDS-Info BBS database (also available by direct modem dialup -- see below section). This database exists on the University of California at San Francisco Experimental Gopher. It may be reached either, (1) through the menu system of your local gopher: --> More Gophers and Other Internet Services/ --> All Registered Gophers/ --> North America/ --> USA/ --> california/ --> University of California - San Francisco, UCSFYI/ --> Computers and Networking Guide to Services at UCSF/ --> Questions, Answers and Information about Everything/ --> Databases (including Ben Gardiner's AIDS BBS database)/ or, (2) by typing 'gopher itsa.ucsf.edu', and going through the final three menus. However, these particular menus are subject to change. The most convenient means of reaching the database is by adding the below information to your '.gopherrc' file. This will set a bookmark in your personal gopher for the AIDS-Info BBS, which may be reached by typing 'v' from anywhere within the gopher system. The information to add, using your favorite system editor, is: Type=1 Name=Databases (including Ben Gardiner's AIDS BBS database) Path=1/.i/.q/.d Host=itsa.ucsf.edu Port=70 The University of California at San Francisco Experimental Gopher also provides gopher gateways to a wide variety of Biology and Medical resource gophers. The UCSF gopher may be reached as described above ('gopher itsa.ucsf.edu'), or most simply by adding the following to your '.gopherrc' file: Type=1 Name=Bio and Medical Gophers and Info. Sites Path=1/Bio and Medical Gophers and Info. Sites Host=itsa.ucsf.edu Port=70 ------------------------------------------------------------------------------- Question 6.2. CDC AIDS Public Information Dataset. You can get the CDC AIDS public information Dataset via anonymous ftp. Michelle Murrain has set up a small AIDS ftp site, which has the most recent dataset (data through 1992). She gets each year's version (usually in June-July) and puts it there. It contains a line of data on each individual, including transmission category, OIs diagnosed, date of diagnosis, etc. If you send her your snail mail address she'll send you a copy of the guide to the dataset. Michelle has used the dataset to analyze differences in OI prevalence in women and men (J Women's Health - out soon) and is now in the process of looking at ethnic and gender differences in survival, especially at whether everybody has benefited from recent improvements in survival with AIDS. The ftp site is: dawn.hampshire.edu:AIDS The name of the file is PIDS92Q4.DAT (BEWARE the file is 16 MB!!) There is also a Women and AIDS bibliography there. If anyone has resources they would like to share with folks via FTP let her know and she'll be glad to add them. Contact Michelle Murrain via mmurrain@HAMP.HAMPSHIRE.EDU ------------------------------------------------------------------------------- Question 6.3. HIVNET/AEGIS Gateway (BETA VERSION) After a lot of to-ing and fro-ing, the gateway for the HIVNET/AEGIS message areas is about to go into testing. If you are interested, I would like to invite you to be part of our test group. Thank you for your interest in the HIVNET/AEGIS mailing lists. HIVNET is, as you probably know, a network for HIV and AIDS information and discussion. HIVNET is primarily based in Europe and, together with our sister organization, AEGIS, based in the US and reaching to other continents as well, try to make as much free information available as possible. We distribute both message areas (analogous to Usenet newsgroups) and files, containing periodicals such as Aids Treatment News and the CDC Aids Daily Summary, as well as one-shot documents and reports. HIVNET and AEGIS have been based on Fido protocols and technology, allowing low-cost entry into the net. The file distribution capabilities of Fidonet have been put to good use as well. For this test period, we are gatewaying the following areas to mailing lists, based at NLnet. NLnet, the commercial Internet provider in the Netherlands, has been kind enough to subsidize our connectivity. For the time being, we do NOT wish to distribute these areas as newsgroups, out of concern for the signal to noise ratio. Up until now, these groups have all been extremely high signal in comparison with areas such as sci.med.aids. In the future, if the demand grows enough, we will look into distribution as a separate hierarchy. The configuration is still be tested, so please feel free to report any anomalies. The lists are all resident on inter.nl.net. The available lists are: Fido area List name Source Description --------- --------- ------ ----------- AIDS.DATA AEGIS Read-only - data postings AIDS.DIALOGUE hiv-aids-dialogue AEGIS Discussion area AIDS.DRUGS AEGIS Read-only - NLM Drug desc. AIDS.SPIRITUAL hiv-aids-spiritual AEGIS Spiritual discussion AIDS.TRIALS AEGIS Read-only - NLM Drug trials AIDS.WOMEN hiv-aids-women AEGIS Discussion of women's issues AIDS.NL hiv-aids-nl HIVNET Dutch language discussion and data AIDS.FR hiv-aids-fr HIVNET French language discussion and data HIVNET.GER hiv-hivnet-ger HIVNET German language discussion and data AIDS/ARC hiv-aids-arc FIDONET Discussion - from Fidonet backbone INTERNET hiv-internet HIVNET Discussion and announcements about the lists and gateway If anyone should have an article for submission to AIDS.DATA, it should be sent to hiv-aids-data, which will forward it on to the moderator. Please send me a list of which lists you want to join. After the setup, to join a list or unsubscribe, send a message to the -request address, such as hiv-aids-dialogue-request@inter.nl.net. Submissions go to the list name at inter.nl.net, i.e., hiv-aids-dialogue@inter.nl.net. The file base should be available within the month via anonymous FTP and gopher. There will be a facility to receive announcements of new files. If you wish to join this list as well, let me know. A few notes about the lists and gateway: * E-mail replies to individuals are not really possible at this time, due to limitations in the gatewaying software. At the bottom of this document is a list of working addresses. * The volume on some groups can be pretty high, such as hiv-aids-data. Be warned! it is, however, a very useful source of information. * The gateway itself, at least for the time being, is a ramshackle, Rube-Goldbergesque collection of PD software (FredGate, Waffle), Fido software (Gecho, FrontDoor) and Perl scripts, all running on a poor 386SX in my work room. Later I hope to move the whole thing to a FreeBSD Unix box. First I have to find a machine to develop it on! Any questions can be addressed to either the hiv-internet list (by preference), or to me personally at matthew@ic.uva.nl. I am automatically connecting everybody to the hiv-internet list, at least during the test phase. Thank you for your interest! Best regards, Matthew Working e-mail addresses: Matthew Lewis matthew@hivnet.org Tjerk Zweers Tjerk.Zweers@amsterdam.hivnet.org (aids.data moderator) Sister Mary Elizabeth Mary.Elizabeth@aegis.hivnet.org (aids.data moderator) Jan Langenberg Jan.Langenberg@amsterdam.hivnet.org (aids.nl overseer) Lucas Vermaat Lucas.Vermaat@limburg.hivnet.org (sysop, HIVNET board) Ron Dixon Ron.Dixon@london.hivnet.org (sysop) Any of the users at the following BBS systems in HIVNET are reachable at the address of the system, with the FULL NAME as user name, with '.' instead of spaces: Fido Internet ---- -------- 1:103/927 aegis.hivnet.org 2:25/555 london.hivnet.org 2:280/413 amsterdam.hivnet.org 2:280/419 hivnet.org 2:284/306 limburg.hivnet.org Other systems may follow, as the gateway is expanded. ------------------------------------------------------------------------------- Question 6.4. Other USENET newsgroups. Questions about AIDS come up occasionally in sci.med and soc.motss. The newsgroup bionet.molbio.hiv may or may not be available at your site--it discusses technical issues related to the molecular biology of HIV. As with any newsgroup, including sci.med.aids, you should read these for a few days before posting, to see if your question has been answered already, and to get a feel for the tone of the group. =============================================================================== Section 7. Other Electronic Information Sources. Q7.1 Ben Gardiner's 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. ------------------------------------------------------------------------------- Question 7.1. Ben Gardiner's list of AIDS BBSes. The below list of Bulletin Board Systems is taken from Ben Gardiner's AIDS-Info BBS. First is a summary of telephone numbers, followed by writeups on some of the specific services. úÿ Subject: New Black Bag BBS List Date: Dec 7 1991 (760 lines) AIDSBBS.LST AIDS Bulletin Boards Systems (BBS) 7-4-91 Phone Number | Name of Service - | Baud |Rates or Other Information --------------------------------------------------------------------------- (415) 626-1246 |AIDS Info BBS SFO|300/2400|Free, can be an alias (512) 444-9908 |HEALTH-LINK AUS|300/2400|Free, can be an alias (302) 731-1998 |Black Bag BBS DE|300/1200|List of Medical BBSs &... (215) 755-1917 |ECB Systems |300/2400|Free, can be an alias (602) 235-9653 |St. Joseph's Hosp. PHX|300/1200|Free, Medical BBS (703) 578-4542 |GLIB VA|300/2400|Free, Donations/Over 18 (718) 849-1614 |BACKROOM NYC|300/2400|Charge, Gay BBS/ Gaycomm (800) 926-2792 |NAPWA-Link DCA|300/2400|Charge, 8 Toll Free Lines (206) 323-4420 |Seattle AIDS Info SEA|300/1200|Free, can be an alias (213) 825-3736 |UCLA-DAIMP (AIDS) LAX|300/2400|Free, can be an alias (800) 825-3736 |UCLA-DAIMP (AIDS) LAX|300/2400|Free, Toll Free-CA only (504) 584-1654 |Tulane Med. Ctr. BTR|300/9600|Free (516) 842-7518 |Utopian Quest NY|300/1200|Free, $$ or Services (212) 686-5248 |Utopian Quest NYC|300/1200|Free, $$ or Services (214) 247-5609 |AIDS Info. Exch. HOU|300/1200|Free, Login: Type AIDS (214) 247-2367 | " " " " |300/2400| " " " " (214) 247-8432 | " " " " |300/2400| " " " " (214) 247-8437 | " " " " |300/2400| " " " " (202) 639-8735 |HRCF NET DCA|300/2400|Free, can be alias (206) 543-3719 |U. of Wash. HHS SEA|300/9600|Free, can be alias (415) 863-9697 |FOG CITY SFO|300/2400|Free, Use Name: AIDS INFO (404) 351-9757 |Medical Forum ATL|300/2400|Free (518) 783-7251 |CCMC-AIDS |300/2400|Free (415) 863-9718 |AIDS Action BBS SFO|300/2400|Free (519) 822-0896 |AIDS Info - Canada |300/2400|Free (604) 681-0670 |Questor Project-Canada|300/2400|Free (800) 245-2601 |HOTFLASH STL|300/2400|Charge/GayCom (803) 252-6103 |Paragon SC|300/2400|Charge/Gaycom (713) 521-2191 |Exchange BBS HOU|300/2400|Charge/Gaycom (316) 269-4208 |Land of Awes KS|300/2400|Charge/Gaycom (800) 522-6388 |CDC AIDS Lab Info ATL|300/2400|Registration for labs (617) 245-9464 |Doug's Den BOU|300/2400|Charge/GayCom (301) 235-4651 |Harbor Bytes BLT|300/2400|Charge/GayCom (514) 597-2409 |S-TEK Montreal|300/2400|Charge/GayCom (201) 968-7883 |The Super Stud NJ|300/2400|Charge/GayCom (708) 694-4298 |The Lambda Zone CHI|300/2400|Charge/GayCom [Copyright Ben Gardiner, 1993, for AIDS Info BBS, San Francisco, California, U.S.A., 1-415-626-1246, source of this file. Only non-commercial reproduction is permitted.] ------------------------------------------------------------------------------- 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 (800) 458-5231. OTHER SERVICES Unless otherwise stated, services are free. The phone number listed at the top right of each record is the data-line that can be dialed with a modem. AIDS Info BBS. . . . . . . . . . . . .San Francisco, CA; (415) 626-1246 AIDS Info BBS is a long-established comprehensive electronic bulletin board targeted primarily to HIV-positive individuals, persons with AIDS, and others concerned about HIV infection. It contains hundreds of articles including AIDS Treatment News, electronic mail, and an open forum. Anyone can access AIDS Info BBS free. For more information, contact Ben Gardiner, AIDS Info BBS, P.O. Box 1528, San Francisco, CA 94101. AIDSQUEST. . . . . . . . . . . . . . . . . .Atlanta, GA; (404) 377-9563 AIDSQUEST is an electronic bulletin board provided by AIDS Weekly publishers for AIDS Weekly newsletter subscribers. AIDSQUEST replaces AIDS Weekly Infoline, an electronic bulletin board that was previously available to any caller. AIDSQUEST includes DAITA, the Database of Antiviral and Immunomodulatory Therapies for AIDS, articles from AIDS Weekly, statistics from CDC, an interactive forum, and the UseNet echo of SCI.MED.AIDS. Anyone can obtain information about AIDSQUEST by connecting online to the above number. For more information, contact AIDS Weekly, P.O. Box 5528, Atlanta, GA 30307-0528, (404) 377-8895. Black Bag BBS. . . . . . . . . . . . . . Wilmington, DE; (302) 994-3772 Black Bag BBS, a member of the AEGIS network, is an electronic bulletin board containing information about many medical topics including HIV/AIDS. The Black Bag Medical BBS List is a comprehensive list of medical-related electronic bulletin boards in the United States and abroad. Black Bag BBS also includes AIDS Treatment News, AIDS statistics and the FidoNet echo of the AIDS National Discussion. Donations are encouraged, but anyone can access Black Bag BBS free. For more information, contact Edward Del Grosso, MD, 1 Ball Farm Way, Wilmington, DE 19808. Boston AIDS Consortium SPIN. . . . . . . . . Boston, MA; (617) 432-2511 SPIN, or Service Provider Information Network, is maintained by the Boston AIDS Consortium. It includes AIDS Treatment News, statistics from CDC, and other AIDS-related information. Anyone can access SPIN by connecting online to and typing the username "spin." For more information, contact Harvard School of Public Health, 677 Huntington Ave., Boston, MA 02112, (617) 432-0885. Breaking Walls; Building Bridges . . . . . . Concord, CA; (510) 827-0804 Breaking Walls; Building Bridges is sponsored by the Diablo Valley Metropolitan Community Church and includes general MCC information as well as AIDS dialog and files, including the AIDS Daily Summary. It serves the Oakland/East San Francisco Bay area and is a member of the AEGIS network. For more information, contact Breaking Walls; Building Bridges, Diablo Balley Metropolitan Community Church, P.O. Box 139, Concord, CA 94522- 0139. CAIN . . . . . . . . . . . . . . . . . . . . . . . .By Subscription Only CAIN is the Computerized AIDS Information Network sponsored by the state of California. CAIN contains electronic mail, an interactive bulletin board forum, and databases of upcoming events, educational materials, organizations, and articles. It resides on the Delphi network; charges for connect time are billed by Delphi. For more information, contact CAIN, 1625 N. Hudson Ave., Los Angeles, CA 90028-9998, (213) 993-7416. Can We Talk - Chicago. . . . . . . . . . . .Chicago, IL; (312) 588-0587 Can We Talk - Chicago (CWT) is a publicly accessible, privately operated system. It contains many newsletters, government information, and articles. It offers connections up to 9600 baud. For more information, contact Eddie V, Sysop, Can We Talk - Chicago, 3943 N. Whipple St., Chicago, IL 60618-3519. CESAR Board. . . . . . . . . . . . . . . Washington, DC; (301) 403-8343 Administered by the Center for Substance Abuse Research, University of Maryland, College Park and supported by Governor Schaefer's Drug and Alcohol Abuse Commission. Includes Maryland AIDS statistics. Within Maryland, call (800) 84-CESAR. For more information, contact Center for Substance Abuse Research, 4321 Hartwick Road, Suite 501, College Park, MD 20740, (301) 403-8329. CHEN . . . . . . . . . . . . . . . . . . . . . . . By Subscription Only CHEN is the Comprehensive Health Education Network sponsored by the Council of Chief State School Officers. It contains general information about HIV issues related to schools. It includes the biweekly HIV/AIDS Education Bulletin Board newsletter. Use of CHEN is free to qualified organizations; however, the purchase of IBM PSINet software is necessary. For more information, contact Council of Chief State School Officers, One Massachusetts Avenue, NW, Suite 700, Washington, DC 20001-1431, (202) 408-5505. Critical Path AIDS Project BBS . . . . Philadelphia, PA; (215) 563-7160 The Critical Path AIDS Project has developed an electronic bulletin board for persons with AIDS, researchers, health-care providers, and others. It includes an extensive series of forums, downloadable files including primarily resource and treatment information. Anyone can access the system free by typing "BBS" when first connecting to the system. A 9600-baud connection can be made by dialing (215) 463-7162. A user's manual is available. For more information, contact Critical Path AIDS Project, 2062 Lombard St., Philadelphia, PA 19146, (215) 545-2212. FDA Electronic Bulletin Board . . . . . . . .Toll-free; (800) 222-0185 The Food and Drug Administration operates a publicly accessible electronic bulletin board. Included are press releases related to AIDS, such as those announcing new drug approvals. To access, dial the above modem and enter "BBS" at the "Login" prompt. Local users in the Washington DC metro area should call (301) 227-6849. Those on an FTS2000 line should dial FTS-394-6849 or 394-5657. There is no charge and users can connect at up to 9600 baud. A users manual and technical support are also available. For more information contact the FDA Press Office, Parklawn Building, 5600 Fishers Lane, Rockville, MD, 20857. Fog City BBS . . . . . . . . . . . . San Francisco, CA; (415) 863-9697 Fog City BBS, a member of the AEGIS network, includes many articles, general information, and the GayComm Talk About AIDS forum. Although a subscription fee is charged for full membership, anyone can call Fog City BBS for free AIDS information by connecting online to and logging on as "AIDS INFO" when prompted for first and last name. For more information, contact Fog City BBS, 584 Castro Street #184, San Francisco, CA 94114-2588, Fax: (415) 863-9718. GLIB . . . . . . . . . . . . . . . . . . Washington, DC; (703) 578-GLIB GLIB, the Gay & Lesbian Information Bureau, is maintained by the Community Educational Services Foundation. It includes treatment information and the GayComm Talk About AIDS echo. Subscription fees vary and may not be required in some cases. GLIB is also available through Bell úÿ Atlantic's IntelliGate Service. Anyone can obtain information about GLIB by connecting online as a visitor. For more information, contact Community Educational Services Foundation, P.O. Box 636, Arlington, VA 22216, (703) 379-4568. HEEF . . . . . . . . . . . . . . . . . . . .Kenney, LA; (504) 443-5546 HEEF is the Health Education Electronic Forum, which replaces the Tulane Medical Center's BBS. A $2.00 subscription fee is requested. Anyone can register on HEEF by connecting and logging on as a visitor. For more information, contact Lifestyle and Health Promotion, 59 Monterey Dr., Kenner, LA 70065-3142. HIV/AIDS Information BBS . . . .San Juan Capistrano, CA; (714) 248-2836 HIV/AIDS Information BBS is the hub of the AIDS Education and General Information System (AEGIS), a growing network of HIV-related electronic bulletin boards (see last page). It includes many newsletters and hundreds of files that can be downloaded. It also echoes FidoNet and other networks, and is available via PC Pursuit. Anyone can access HIV/AIDS Information BBS free at connections up to 9600 baud. For more information, contact Sister Mary Elizabeth, Sisters of St. Elizabeth of Hungary, P.O. Box 184, San Juan Capistrano, CA 92693-0184. HNS HIV-NET. . . . . . . . . . . . . . . . . . Tollfree; (800) 788-4118 HNS HIV-NET, sponsored by Home Nutrition Services, is an electronic bulletin board for physicians and other health-care professionals treating HIV-positive patients and those with AIDS. It contains hundreds of files of newsletter articles, bibliographies, and graphics files of pictures of opportunistic infections. There are also a number of different forums, corresponding to different health-care professions. Interested users should dial the data line to register. After being validated or registered by the sysop, they can call back. For more information, contact John Owens, MD, HNS HIV-NET BBS, 9037 Kirby Drive, Houston, TX 77054. The Houston Exchange . . . . . . . . . . . .Houston, TX; (713) 521-2191 The Houston Exchange, a member of the AEGIS network, contains information from the Houston Clinical Research Network, an affiliate of the Montrose Clinic. Anyone can access the Houston Exchange free. For more information, contact Houston Clinical Research Network, 4211 Graustark, Houston, TX 77006, (713) 528-5554. LEGALNET . . . . . . . . . . . . . . . . Petersburg, FL; (813) 343-0797 The Stetson University College of Law's Legal Information Network sponsors an online discussion area and a selection of files relating to legal HIV issues. Anyone can access LEGALNET free with connections up to 9600 baud. For more information, contact Stetson University College of Law, 1401 61st Street South, St. Petersburg, FL, (813) 343-0797. LPIES . . . . . . . . . . . . . . . . . . . . . . By Subscription Only LPIES is the Laboratory Performance Information Exchange System sponsored by CDC's Public Health Program Practice Office and is available free to HIV testing laboratories and related organizations. Qualified users can register by connecting online to (800) 522-6388. For more information, contact Program Resources, Inc., P.O. Box 12794, Research Triangle Park, NC 27709, (800) 322-4383. NAPWA-Link . . . . . . . . . . . . . . . Washington, DC; (703) 998-3144 NAPWA-Link is the electronic bulletin board of the National Association of People With AIDS and is part of the network maintained by the Community Educational Services Foundation (see GLIB). NAPWA-Link contains electronic mail, announcements, and databases of news articles, drug interactions, and organizations. Users must pay a fee; several membership plans are available. Anyone can connect for online information about NAPWA and NAPWA-Link by logging on as a visitor. For more information, contact the National Association of People with AIDS, P.O. Box 34056, Washington, DC 20043, (202) 898-0414. NCJRS BBS . . . . . . . . . . . . . . . Washington, DC; (301) 738-8895 The NCJRS BBS is the electronic bulletin board of the National Criminal Justice Reference Service. It includes information about publications and services available from the National Institute of Justice AIDS Clearinghouse, such as information about HIV and incarceration. Anyone can access NCJRS BBS free. For more information, contact National Criminal Justice Reference Service, P.O. Box 6000, Rockville, MD 20849- 6000, (800) 851-3420. OASH BBS . . . . . . . . . . . . . . . . Washington, DC; (202) 690-5423 OASH BBS is the free and publicly accessible electronic bulletin board of the U.S. Public Health Service, Office of the Assistant Secretary for Health, National AIDS Program Office. It distributes many files of AIDS- related information from the federal government, including the AIDS Daily Summary, Federal Register announcements for funding, and the National Library of Medicine's AIDS Bibliography. OASH BBS has electronic mail, public forums, and file transfer. Anyone can access OASH BBS free; connections up to 9600 baud are available. For more information, contact National AIDS Program Office, Hubert Humphrey Bldg. Room 729-H, 200 Independence Ave., SW, Washington, DC 20201, (202) 690-6248. Ohio AIDS/HIV BBS. . . . . . . . . . . . . Columbus, OH; (614) 279-7709 Ohio AIDS/HIV BBS is a relatively new system that branched off from the Mystic Christian & Recovery BBS. It is a member of the AEGIS network. Connections up to 9600 baud are available. For more information, contact Michael Kelly, Sysop, Ohio AIDS/HIV Info BBS, P.O. Box 2970, Columbus, OH 43216. Public Health Network . . . . . . . . . . . . . . .By Subscription Only The Public Health Network is produced for public health administrators by the Public Health Foundation and contains information posted by a number of U.S. Public Health Service agencies including CDC, the National Institute for Drug Abuse, and the Health Resources and Services Administration. A subscription is required and connect fees are charged. For more information, contact Chris Frank, Public Health Foundation, 1220 L St., NW, Suite 350, Washington, DC 20005, (202) 898-5600. Questor . . . . . . . . . . . British Columbia, Canada; (604) 681-0670 Questor is UseNet system (for Unix users) that echoes the UseNet SCI.MED.AIDS discussion. Anyone can access Questor free by connecting online to the above number. Seattle AIDS Information BBS . . . . . . . .Seattle, WA; (206) 323-4420 Seattle AIDS Information BBS, a member of the AEGIS network, is targeted to persons with AIDS and HIV infection. It contains electronic mail, bulletin board forums, and hundreds of articles available for viewing and file transfer. Donations are encouraged, but anyone can access Seattle AIDS Information BBS free. For more information, contact Seattle AIDS Information BBS, 1202 E. Pike, Suite 658, Seattle, WA 98122-3918. 888 Online . . . . . . . . . . . . . . . . Richmond, VA; (804) 266-0212 888 Online is a member of the AEGIS network and includes all AEGIS files as well as interactive forums. Files can be searched by words in their text. 888 Online also includes information related to alternative lifestyles and recovery. For more information, contact Bill Smith, 888 Online BBS, P.O. Box 15885, Richmond, VA 23227-5885. AEGIS Listed below are the network affiliates of the AIDS Education and General Information System (AEGIS). These BBSs echo messages and exchange files of HIV/AIDS information, including the AIDS Daily Summary. The AEGIS network is also linked to a similar network in Europe called HIVNET. Anyone can log on anonymously to an AEGIS BBS for free. Other BBS services interested in joining AEGIS should contact Sister Mary Elizabeth of the HIV/AIDS Information BBS (which see). AEGIS NETWORK AFFILIATES State BBS Name Fidonet Node Phone Number Arizona The Meat Rack BBS 1:114/188 602.273.6956 California Breaking Walls; Building Bridges 1:161/203 510.827.0804 California The Task Force 1:161/513 707.746.6091 California Fog City BBS 1:125/100 415.863.9697 California The Clovis Co of Fresno 1:205/48 209.323.7583 California HIV/AIDS Info BBS 1:103/927 714.248.2836 Colorado Telepeople 1:104/69 303.426.1866 Colorado The Denver Exchange 1:104/909 303.623.4965 Delaware Black Bag Medical BBS 1:150/140 302.994.3772 Florida MOTSS BBS of Satellite Beach 1:374/41 407.779.0058 Florida Aftermidnite BBS / Tampa 1:377/43 813.831.7587 Massachusetts The Den 1:101/225 617.662.6969 Minnesota Drag-Net / Andover 1:282/1007 612.753.1943 Missouri Doc in the Box 1:289/8 314.893.6099 Missouri KC AIDS InfoLink 1:280/14 816.561.1187 Nevada Las Vegas AIDS Info BBS 1:209/238 702.658.3591 New York Brooklyn College ONLINE! 1:278/0 718.951.4631 New York The Erie Canal BBS 1:2608/31 315.445.4710 North Carolina The Isolated Pawn / Durham 1:3641/281 919.471.1440 Ohio The Mystic Christian 1:226/520 614.279.7709 Oklahoma The Looking Glass BBS / Tulsa 1:170/706 918.743.1268 Tennessee Riverside BBS 1:123/424 901.452.6832 Texas The Houston Exchange 1:106/20 713.521.2191 Texas Puss-N-Boots / Grand Prairie 1:124/3103 214.641.1822 Texas AIDS Chat Line / Grand Prairie 1:130/55 214.256.5586 Texas Loaves & Fishes BBS 8:3000/7 512.444.8790 Virginia 888 Online 1:264/190 804.266.0212 Washington Seattle AIDS Info BBS 206.323.4420 Ontario Mother's Board / Ottawa 1:243/38 613.728.4122 Quebec EC / Bellefeuille, Pq 1:242/90 514.433.1105 Australia SouthMed of Sydney Net 3:712/700 61.2.583.1027 NOTES Several publicly accessible commercial networks have AIDS-related forums, such as The Well [Whole Earth 'Lectronic Network, online registration: (415) 322-7398]; GEnie [the General Electric Network for Information Exchange, voice phone: (800) 638-9636]; and CompuServe [voice phone: (800) 848-8990]. There are also several database vendors that provide gateway access to AIDS-related databases, including the National Library of Medicine [voice phone: (800) 638-8480]; BRS Search Services [(a division of Maxwell Online; voice phone: (800) 456-7248]; and DIALOG [voice phone: (800) 334-2564]. More information about AIDS-related databases can be obtained by calling a Reference Specialist at the CDC Clearinghouse, (800) 458-5231. ------------------------------------------------------------------------------- Question 7.3. National Library of Medicine AIDSLINE (please contribute) If you know how to obtain access to this service, please contribute instructions to the FAQ (e-mail to aids-request@cs.ucla.edu). ------------------------------------------------------------------------------- Question 7.4. Commercial Bulletin Boards There are AIDS-related areas on Compuserve and America Online. (we need details: how to contact Compuserve and America Online, what the newsgroups are called, etc.) ------------------------------------------------------------------------------- Question 7.5. Reappraisal of the HIV-AIDS Hypothesis. Please see Q5.3 `Duesberg's Risk-Group Theory' for introductory information on this question. The Group for the Scientific Reappraisal of the HIV/AIDS Hypothesis (hereafter just 'Group' for short) is an organization of scientists, AIDS-activists and educators, and other concerned persons, currently numbering around four hundred. As their name indicates, the Group wishes for the scientific community to reexamine an hypothesis which they believe to have been prematurely, dogmatically, and even dangerously, accepted. Many or most of the best known AIDS-skeptics are members of the Group, including Peter Duesberg, Robert Root-Bernstein, John Lauritsen, Eleni Eleopoulos, Michael Callen, Jad Adams and Kary Mullis. The Group may be contacted at 2040 Polk St. Suite 321, San Francisco, CA 94109 USA; Fax: 415-775-1379. The Group publishes a newsletter entitled Rethinking AIDS, for which a $25/year donation is requested. The Group came into existence as a result of efforts to get the following four sentence letter published in a number of prominent scientific journals, including Nature, Science, JAMA, The New England Journal of Medicine, and Lancet. As of October 1993, all have refused to do so. "It is widely believed by the general public that a retrovirus called HIV causes the group of diseases called AIDS. Many biomedical scientists now question this hypothesis. We propose that a thorough reappraisal of the existing evidence for and against this hypothesis be conducted by a suitable independent group. We further propose that critical epidemiological studies be devised and undertaken." The members of the Group do not necessarily agree with each other on the precise nature and causes of "AIDS;" all they automatically have in common is disbelief that HIV (sole) causation of AIDS has been scientifically established. ------------------------------------------------------------------------------- Question 7.6. Lesbian/Gay Scholars Directory. From: "Louie Crew" Date: Tue, 2 Nov 93 11:06:05 EST I have compiled an E-Mail Directory of Lesbigay Scholars, with now more than 195 persons listed. To be included, fill out the form below and return it to me: lcrew@andromeda.rutgers.edu Do NOT send by snail mail. úÿ The E-Directory helps lesbigay scholars connect regarding on-going manuscripts, conferences, and other scholarly projects. I send the Directory to all who agree to be listed, with updates individual by individual. I also make available to one e-mail address by which those listed can post announcements of interest to the entire group. But this is not a discussion list per se--rather, a resource list. Please share this announcement with any friends who might be interested and with any other e-networks where forthright lesbigay scholars might assemble qua scholars. Thank you. Louie Crew Author/editor of _The Gay Academic_ and 950+ others Co-founder of the Lesgay Caucus of the National Council of Teachers of English Founder of Integrity, the lesgay justice ministry of the Episcopal Church Academic Foundations Department, Rutgers University/Newark (Snail mail: P. O. Box 30, Newark, NJ 07101) ============================================================================ Entry Form for E-Directory of Lesbigay Scholars Name: Institutional affiliation: Department: Position: E-mail address(es): Snail mail: Phone(s) FAX: Citations of a sample of yr. previous lesbigay scholarly projects: List/description of yr. on-going lesbigay scholarly projects: =============================================================================== 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 ------------------------------------------------------------------------------- Question 8.1. Phone Information about AIDS. For general information about AIDS and referrals to other AIDS information sources, call CDC National AIDS Hotline: 1-800-342-AIDS Spanish: 1-800-344-7432 Deaf: 1-800-243-7889 ------------------------------------------------------------------------------- Question 8.2. Phone Information about AIDS drug trials. You can obtain information about ongoing AIDS drug trials in the United States by calling the AIDS Trials hotline at 1-800-TRIALSA ------------------------------------------------------------------------------- Question 8.3. US Social Security: Information for Organizations SSA is committed to disseminating information about its benefit programs to as wide an audience as possible. If your organization has a newsletter, electronic bulletin board, informational database, or other system for housing and disseminating information to people living with AIDS and their caregivers, SSA would like to know about it. SSA wants to work with you to share information about Social Security benefit programs and eligibility criteria. SSA will share or exhibit public information materials if you will inform them of any meetings/conferences. Also, if you believe your staff could benefit from an in-service training program covering SSDI/SSI, Medicare, Medicaid, and other topics, please inform SSA. SSA looks forward to a continuing partnership with your organization to inform the thousands of men, women and children living with HIV/AIDS about the benefits available through Social Security. If you have any questions, or have any additional public information needs, contact Robert G. Goldstraw, Social Insurance Affairs Specialist (AIDS Outreach), Social Security Administration, Baltimore MD 21235. Telephone: (410) 965-4064. =============================================================================== 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 ------------------------------------------------------------------------------- Question 9.1. Feedback is invited Please send me your comments on this FAQ. We accept submissions for the FAQ in any format; All contributions comments and corrections are gratefully received. Please send them to aids-request@cs.ucla.edu. ------------------------------------------------------------------------------- Question 9.2. Formats in which this FAQ is available This document is available as ASCII text, an Emacs Info document and PostScript. We currently make only the ASCII text available as a posting. We are working on establishing a sci.med.aids archive where the other formats will be stored. ------------------------------------------------------------------------------- Question 9.3. Authorship and acknowledgements The following people contributed to this FAQ: Dan Greening assembled and edited this document. Jack Hamilton wrote the introduction and first section. Phil Miller offered periodic edits. Anne Wilson forwarded many valuable articles from the CDC National AIDS Clearinghouse. Robert Walker wrote the section on minimizing the risk of HIV infection. Michael Howe's sci.med.aids response regarding blood banks is reproduced here. Paul M. Karagianis contributed archives answering question about mosquito transmission. Iain Nicholson, who works on Plasmodium falciparum, wrote the section on malaria. Vince Hammer wrote the review of ``Do Insects Transmit AIDS?'' Michael Howe provided references for the question "Does HIV cause AIDS?", and has scanned several documents for this FAQ. Ken Shirriff wrote about the USSR disinformation campaign. Rob James wrote a description of the US blood testing process. David Wright wrote the reasons why we should not donate blood to get a free HIV test. David Mertz wrote the section on internet access to the gopher database. Michelle Murrain wrote the section on the CDC patient data FTP site. ******************************************************************************