------------------------------------------------------------------------ ÿ@SUBJECT:Sci.med.AIDS FAQ part 1 of 4 Welcome to the sci.med.aids, the international newsgroup on the Acquired Immune Deficiency Syndrome (see Q1.1 `What is sci.med.aids?' for more details). This article, called the sci.med.aids "FAQ", answers frequently asked questions about AIDS and the sci.med.aids newsgroup. The FAQ is posted monthly to sci.med.aids and related newsgroups. If you are new to sci.med.aids, please read it before posting articles or responses. If you are a sci.med.aids veteran, please skim the FAQ occasionally. You may find something new here. Please contribute to the sci.med.aids FAQ. Currently there are some gaping holes. Send suggested changes to 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 - and voting on posts. Q1.10 If a post gets rejected. Q1.11 Discussing sci.med.aids moderation policies. Section 2. How to prevent infection. Q2.1 How is AIDS transmitted? Q2.2 How effective are condoms? Q2.3 How do you minimize your odds of getting infected? Q2.4 How risky is a blood transfusion? Q2.5 Can mosquitoes transmit AIDS? Q2.6 What about other insect bites? Q2.7 Is there even a remote chance of insect transmission? Section 3. Confidentiality. Q3.1 How is blood tested in the United States? Q3.2 What if a blood-bank finds out you are HIV positive? Section 4. Treatment options. Q4.1 General treatment information. Q4.2 AIDS and Opportunistic Infections. Q4.3 Guide to Social Security Benefits. Q4.4 What if you can't afford AZT? Q4.5 What about DNCB? Q4.6 Alternative Treatments for AIDS and HIV (please contribute) Section 5. The common debates. Q5.1 What are Strecker and Segal's theories that HIV is manmade? Q5.2 Other conspiracy theories. Q5.3 Is HIV the cause of AIDS? Q5.4 Contaminated polio vaccine? (please contribute) Q5.5 Who is Lorraine Day? (please contribute) Section 6. Internet resources. Q6.1 Ben Gardiner's Gopher AIDS Database Q6.2 CDC AIDS Public Information Dataset. Q6.3 HIVNET/AEGIS Gateway (BETA VERSION) Q6.4 Other USENET newsgroups. Section 7. Other Electronic Information Sources. Q7.1 List of AIDS BBSes. Q7.2 National AIDS Clearinghouse Guide to AIDS BBSes. Q7.3 National Library of Medicine AIDSLINE (please contribute) Q7.4 Commercial Bulletin Boards Q7.5 Reappraisal of the HIV-AIDS Hypothesis. Q7.6 Lesbian/Gay Scholars Directory. Section 8. Non-Electronic Information Sources. Q8.1 Phone Information about AIDS. Q8.2 Phone Information about AIDS drug trials. Q8.3 US Social Security: Information for Organizations Section 9. Administrative information and acknowledgements Q9.1 Feedback is invited Q9.2 Formats in which this FAQ is available Q9.3 Authorship and acknowledgements ======================================================================= ======= Section 1. Introduction and General Information Q1.1 What is sci.med.aids? Q1.2 Discussion topics. Q1.3 Sci.med.aids distribution. Q1.4 Subscribing and unsubscribe to sci.med.aids. Q1.5 What is a moderated newsgroup? Q1.6 Editorial guidelines. Q1.7 How do I submit a posting? Q1.8 The moderators. Q1.9 Cooperative moderation - and voting on posts. Q1.10 If a post is rejected. Q1.10 Discussing sci.med.aids moderation policies. ----------------------------------------------------------------------- ------- 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_Jun_94.Z +-- Estimated total number of people who read the group, worldwide. | +-- Actual number of readers in sampled population | | +-- Propagation: how many sites receive this group at all | | | +-- Recent traffic (messages per month) | | | | +-- Recent traffic (megabytes per month) | | | | | +-- Crossposting percentage | | | | | | +-- Cost ratio: $US/month/rdr | | | | | | | +-- Share: % of newsrders | | | | | | | | who read this group. V V V V V V V V 54 130000 1387 72% 6769 10.4 12% 0.08 2.8% soc.motss 72 120000 1130 79% 3396 5.0 17% 0.05 2.3% sci.med 86 110000 1301 63% 4001 7.1 13% 0.06 2.6% alt.drugs 139 95000 947 77% 4898 7.8 42% 0.09 1.9% sci.skeptic 156 89000 870 78% 1282 1.7 37% 0.02 1.8% sci.psychology 243 75000 862 67% 4057 9.4 15% 0.11 1.7% talk.abortion ----------------------------------------------------------------------- ---------------------- 515 51000 512 76% 485 1.6 2% 0.03 1.0% sci.med.aids ----------------------------------------------------------------------- ----------------------- 553 49000 487 77% 135 0.3 17% 0.01 1.0% sci.med.physics 577 47000 514 70% 257 1.2 0% 0.02 1.0% soc.feminism 653 43000 611 54% 3917 2.2 77% 0.04 1.2% alt.feminism 657 43000 506 65% 770 1.3 56% 0.03 1.0% talk.politics.drugs 772 37000 509 55% 2063 5.5 1% 0.11 1.0% alt.sexual.abuse.recovery 781 37000 403 71% 777 6.4 1% 0.17 0.8% misc.activism.progressive 791 36000 602 46% - - - - 1.2% alt.homosexuality 885 33000 363 69% 553 0.7 54% 0.02 0.7% sci.anthropology 981 30000 323 70% 680 1.0 9% 0.03 0.7% sci.med.nutrition 1207 23000 277 63% 797 1.2 15% 0.05 0.6% misc.health.alternative 1746 11000 210 38% 53 0.1 6% 0.01 0.4% bionet.molbio.hiv 1821 10000 153 50% 205 0.3 6% 0.02 0.3% alt.support.cancer 1847 9700 198 37% 158 0.2 7% 0.01 0.4% bionet.immunology 1870 9400 142 50% 136 0.2 20% 0.01 0.3% sci.med.radiology Sci.med.aids is also distributed as electronic mail by the AIDS listserv. Mail is not as convenient a way to read sci.med.aids as is a newgroup, but mail is available at more sites (including Compuserve, America Online, MCImail, ATTmail and many institutions which have Internet gateways). In additional to these primary distributions, sci.med.aids is redistributed by various bulletin boards and mail gateways. ----------------------------------------------------------------------- ------- 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 the moderators before being distributed. The purpose of moderation is to restrict what can appear. Postings which do not adhere to the guidelines for the group will be rejected. ----------------------------------------------------------------------- ------- Question 1.6. Editorial guidelines. As with any newsgroup, read sci.med.aids for a few days before posting, to see if your question has been answered already, and to get a feel for the tone of the group. Postings to sci.med.aids should: * Write on topics directly relevant to AIDS, HIV, or related topics. * Unconventional medical/research claims must be accompanied by references to the popular press (i.e., major newspaper, magazine, etc.) or scientific press (i.e., Science, Nature, Lancet, Scientific American, Cell, Brain Research, etc.). We require references for unconventional medical/research claims, because some therapies carry with them potential danger. Some unconventional medical/research claims are fallacious. Without this policy, sci.med.aids would have printed several dangerous and undocumented therapies by now. * Political, sociological opinion/analysis articles are acceptable. The interpretation, and even the existence, of this particular policy continues to be the subject of internal debate among the moderators. However, in the past we have printed articles holding both popular and unpopular opinions on topics like "Quarantining HIV Positives" or "who did Clinton appoint to the AIDS Task Force." * Refrain from personally attacking other participants. For example, do not call someone an 'idiot' or say they are 'biased'. Instead, point out the flaws in their argument. If you find yourself getting angry at a poster, and construct a reply, please try to remember this rule. It is often useful to wait a day to see what other reactions have been posted before sending something off in anger. * Send one line "quips" as personal mail to the original submitter, rather than posting. * When posing a question to a previous poster, reconsider whether the question needs to be posted. Perhaps you could ask the question by e-mail and request a posted response. * Do not invoke religion. * Do not break copyright laws. Reprints of articles from other sources must include a statement of permission to reprint. An exception is made for abstracts of articles from scientific journals, which are not usually restricted. If you can't get reprint permission, excerpt or summarize the article. * Do not construct an article with more than 20% text from a previous article, unless it is very old (i.e., months old). The best approach when constructing a response is to tersely summarize the article to which you respond, in square brackets. For example, In article <11233@sci.med.aids>, Dan Greening wrote: > [reasons to not include too much of a prior article] Also, don't forget that many people get this stuff by mail, so huge inclusions clog hundreds of mailboxes, including mine. Thanks. * Do not duplicate something which has recently appeared. The moderators don't always agree on what's acceptable and what's not. If an article is rejected, you should receive a note from the moderators saying why. These notes, and other discussions about the running of sci.med.aids will be distributed on the aids-d mailing list (see Q1.10 Discussing sci.med.aids moderation policies.'). ----------------------------------------------------------------------- ------- Question 1.7. 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 or more. It depends on network delays and how busy the moderators are. A tickler program reminds us of postings older than 48 hours. IMPORTANT: Whether you use postnews or e-mail, please format your article exactly the way you want it to appear in the newsgroup. Because our moderation software is somewhat unpolished, editing out notes to the moderators in a posting is quite tedious. If you must communicate directly with the moderators, send a note to aids-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 and Michelle do most of the moderation. Dan repairs the moderation software. Phil is probably the most liberal moderator, Dan the most restrictive, Jack and Michelle are in-between. Various individuals have been moderators in the past, including David Dodell Founder, Grand Rounds fidonet echo, Dentist Steve Dyer Writer, Gay Community News, Software Consultant Alan Wexelblat Freelance writer, ethicist Tom Lincoln Informatics Director, USC Medical Center Craig Werner MD/PhD Student, Albert Einstein School of Medicine Will Doherty Gay Activist, technical writer Sun Microsystems ----------------------------------------------------------------------- ------- Question 1.9. Cooperative moderation - and voting on posts. Cooperative moderation seeks to limit the burn-out associated with newsgroup moderation, by sharing the workload among several moderators. In addition, it provides a more balanced treatment of contentious issues. An early paper on the sci.med.aids cooperative moderation scheme is D.R. Greening and A.D. Wexelblat, Experiences with Cooperative Moderation of a USENET Newsgroup, Proceedings of the 1989 ACM/IEEE Workshop on Applied Computing. available by FTP from cs.ucla.edu:pub/aids.paper.ps.Z This paper is also available from the UCLA Computer Science Department as a technical report. At present, a voting system has been added to the moderation process. When you submit an article, moderators vote. 2 yes votes post an article, while 2 no votes reject an article. The first threshold to be exceeded determines the result. ----------------------------------------------------------------------- ------- Question 1.10. If a post is rejected. We reject many articles because of formatting problems, other mechanical problems, or our own confusion, and those articles can be revised quickly (by you) and resubmitted. There are about 73,000 readers of sci.med.aids on USENET alone. Articles posted here are distributed in many forms. We share information with AEGIS, an AIDS bulletin-board network. We have a parallel mailing-list. Some people copy articles from sci.med.aids and provide them to their local library. Activists have even printed out articles from sci.med.aids and distributed them to homeless people with AIDS. If you have important information, we urge you to spend the time to revise your article and resubmit: it will be read. On the other hand, these 73,000 readers are why we are so cautious about posting. Respect your huge audience by spending the time to write a readable and informative article. If you carefully investigate and share important AIDS information through sci.med.aids, you can save lives, make people a little healthier, or reassure someone. All of these are valuable. ----------------------------------------------------------------------- ------------ Question 1.11. Discussing sci.med.aids moderation policies. A separate mailing list, aids-d, has been set up for the moderators and for people who interested in how sci.med.aids is run. Most readers will not be interested in aids-d; its purpose is internal discussion rather than information dissemination, and most articles on aids-d are examples of what moderation has filtered out. If you want to subscribe, send email to 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) providest he following information to help correct a few commonly held misperceptions about HIV. Transmission HIV is spread by sexual contact with an infected person, by needle-sharing among injecting drug users, or, less commonly (and now very rarely in countries where blood is screened for HIV antibodies), through transfusions of infected blood or blood clotting factors. Babies born to HIV-infected women may become infected before or during birth, or through breast-feeding after birth. In the health-care setting, workers have been infected with HIV after being stuck with needles containing HIV-infected blood or, less frequently, after infected blood gets into the worker's bloodstream through an open cut or splashes into a mucous membrane (e.g., eyes or inside of the nose). There has been only one demonstrated instance of patients being infected by a health-care worker; this involved HIV transmission from an infected dentist to five patients. Investigations have been completed involving more than 15,000 patients of 32 HIV-infected doctors and dentists, and no other cases of this type of transmission have been identified. Some people fear that HIV might be transmitted in other ways; however, no scientific evidence to support any of these fears has been found. If HIV were being transmitted through other routes (for example, through air or insects), the pattern of reported AIDS cases would be much different from what has been observed, and cases would be occurring much more frequently in persons who report no identified risk for infection. All reported cases suggesting new or potentially unknown routes of transmission are promptly and thoroughly investigated by state and local health departments with the assistance, guidance, and laboratory support from CDC; no additional routes of transmission have been recorded, despite a national sentinel system designed to detect just such an occurrence. The following paragraphs specifically address some of the more common misperceptions about HIV transmission. HIV in the Environment Scientists and medical authorities agree that HIV does not survive well in the environment, making the possibility of environmental transmission remote. HIV is found in varying concentrations or amounts in blood, semen, vaginal fluid, breast milk, saliva, and tears. (See below, Saliva, Tears, and Sweat.) In order to obtain data on the survival of HIV, laboratory studies have required the use of artificially high concentrations of laboratory-grown virus. Although these unnatural concentrations of HIV can be kept alive under precisely controlled and limited laboratory conditions, CDC studies have showned that drying of even these high concentrations of HIV reduces the number of infectious viruses by 90 to 99 percent within several hours. Since the HIV concentrations used in laboratory studies are much higher than those actually found in blood or other specimens, drying of HIV- infected human blood or other body fluids reduces the theoretical risk of environmental transmission to that which has been observed- -essentially zero. Incorrect interpretation of conclusions drawn from laboratory studies have alarmed people unnecessarily. Results from laboratory studies should not be used to determine specific personal risk of infection because 1) the amount of virus studied is not found in human specimens or anyplace else in nature, and 2) no one has been identified with HIV due to contact with an environmental surface; Additionally, since HIV is unable to reproduce outside its living host (unlike many bacteria or fungi, which may do so under suitable conditions), except under laboratory conditions, it does not spread or maintain infectiousness outside its host. Households, Offices, and Workplaces Studies of thousands of households where families have lived with and cared for AIDS patients have found no instances of nonsexual transmission, despite the sharing of kitchen, laundry, and bathroom facilities, meals, eating utensils, and drinking cups and glasses. If HIV is not transmitted in these settings, where repeated and prolonged contact occurs, transmission is even less likely in other settings, such as schools and offices. Similarly, there is no known risk of HIV transmission to co- workers, clients, or consumers from contact in industries such as food service establishments (see information on survival of HIV in the environment). Food service workers known to be infected with HIV need not be restricted from work unless they have other infections or illinesses (such as diarrhea or hepatitis A) for which any food service worker, regardless of HIV infection status, should be restricted; The Public Health Service recommends that all food service workers follow recommended standards and practices of good personal hygiene and food sanitation. Kissing Casual contact through closed-mouth or "social" kissing is not a risk for transmission of HIV. Because of the theoretical potential for contact with blood during "French" or open-mouthed kissing, CDC recommends against engaging in this activity with an infected person. However, no case of AIDS reported to CDC can be attributed to transmission through any kind of kissing. Saliva, Tears, and Sweat HIV has been found in saliva and tears in only minute quantities from some AIDS patients. It is important to understand that finding a small amount of HIV in a body fluid does not necessarily mean that HIV can be transmitted by that body fluid. HIV has not been recovered from the sweat of HIV-infected persons. Contact with saliva, tears, or sweat has never been shown to result in transmission of HIV. Insects From the onset of the HIV epidemic, there has been concern about transmission of the virus by biting and blood-sucking insects. However, studies conducted by researchers at CDC and elsewhere have shown no evidence of HIV transmission through insects--even in areas where there are many cases of AIDS and large populations of insects such as mosquitoes. Lack of such outbreaks, despite intense efforts to detect them, supports the conclusion that HIV is not transmitted by insects. The results of experiments and observations of insect biting behavior indiciate that when an insect bites a person, it does not inject its own or a previous victim's blood into the new victim. Rather, it injects saliva. Such diseases as yellow fever and malaria are transmitted through the saliva of specific species of mosquitoes. However, HIV lives for only a short time inside an insect and, unlike organisms that are transmitted via insect bites, HIV does not reproduce (and, therefore, cannot survive) in insects. Thus, even if the virus enters a mosquito or another sucking or biting insect, the insect does not become infected and cannot transmit HIV to the next human it feeds on or bites. There is also no reason to fear that a biting or blood-sucking insect, such as a mosquito, could transmit HIV from one person to another through HIV-infected blood left on its mouth parts. Two factors combine to make infection by this route extremely unlikely-- first, infected people do not have constant, high levels of HIV in their bloodstreams and, second, insect mouth parts do not retain large amounts of blood on their surfaces. Further, scientists who study insects have determined that biting insects normally do not travel from one person to the next immediately after ingesting blood. Effectiveness of Condoms The proper and consistent use of latex condoms when engaging in sexual intercourse--vaginal, anal, or oral--can greatly reduce a person's risk of acquiring or transmitting sexually transmitted diseases, including HIV infection. Under laboratory conditions, viruses occasionally have been shown to pass through natural membrane ("skin" or lambskin) condoms, which contain natural pores and are therefore not recommended for disease prevention. On the other hand, laboratory studies have consistently demonstrated that latex condoms provide a highly effective mechanical barrier to HIV. In order for condoms to provide maximum protection, they must be used consistently (every time) and correctly. Incorrect use contributes to the possibility that the condom could leak or break. Proper use should include the following: * Put on the condom as soon as erection occurs and before any sexual contact (vaginal, anal, or oral). * Leave space at the tip of the condom. * Use only water-based lubricants. (Oil-based lubricants can weaken the condom.) * Hold the condom firmly to keep it from slipping off and withdraw from the partner immediately after ejaculation. When condoms are used reliably, they have been shown to prevent pregnancy up to 98 percent of the time among couples using them as their only method of contraception. Similarly, numerous studies among sexually active people have demonstrated that a properly used latex condom provides a high degree of protection against a variety of sexually transmitted diseases, including HIV infection. Condoms are classified as medical devices and are regulated by the Food and Drug Administration. Each latex condom manufactured in the United States is tested for defects, including holes, before it is packaged, and several studies clearly show that condom breakage rates in this country are less than 2 percent. Even when condoms do break, one study showed that more than half of such breaks occurred prior to ejaculation. Latex condoms can provide up to 98-99 percent protection against pregnancy and most sexually transmitted diseases, including HIV infection, but only if they are used consistently and correctly. For more detailed information about condoms, see CDC's fact sheet, "The Role of Condoms in Preventing HIV Infection and Other Sexually Transmitted Diseases." The Public Health Service Response The U.S. Public Health Service is committed to providing the scientific community and the public with accurate and objective information about HIV infection and AIDS. It is vital that clear information on HIV infection and AIDS be readily available to help prevent further transmission of the virus and to allay fears and prejudices caused by misinformation. In addition to research on the virus and its transmission, the PHS program to prevent the spread of HIV/AIDS includes counseling, testing, and education. Through these programs, individuals who have engaged in high-risk behaviors can receive voluntary HIV-antibody testing for themselves and their partners, and those found to be infected can be counseled regarding preventive services and treatment options, as well as how to prevent transmission to others. For more information: CDC National AIDS Hotline: 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 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? 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. ------------------------------------------------------------------------ Date: 09-06-94 Msg # 25832 To: ALL Conf: (2120) news.answers From: aids-request@CS.UCLA.EDU Stat: Public Subj: Sci.med.AIDS FAQ part 2 o Read: No ------------------------------------------------------------------------ ÿ@SUBJECT:Sci.med.AIDS FAQ part 2 of 4 Message-ID: <17368@sci.med.aids> Newsgroups: sci.med.aids,sci.med,soc.motss,bionet.molbio.hiv,sci.answers soc.answers,news.answers Organization: Hampshire College ======================================================================= ======= Section 3. Confidentiality. Q3.1 How is blood tested in the United States? Q3.2 What if a blood-bank finds out you are HIV positive? ----------------------------------------------------------------------- ------- 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 therapy? How long should it be continued before other drugs or combinations are initiated? Finally it is important to consider: Which drugs should be used following initial therapy? What might we anticipate in the future from drugs in current clinical development? Beginning Therapy -- What and When Probably the easiest question at the moment in the field of HIV therapy is which drug to use to begin treatment. Data from ACTG 116A make it clear that zidovudine is superior to ddI as a monotherapy in previously untreated patients, and data from other studies show the superiority of zidovudine over ddC. An independent "State of the Art Panel" recently convened by the National Institute of Allergy and Infectious Diseases (NIAID) and chaired by Merle Sande, MD, UCSF chief of the medical service at San Francisco General Hospital, found an easy consensus that zidovudine monotherapy is the initial therapy of choice. Even here, however, other opinions may be heard, especially concerning the potential for initial use of combinations of nucleoside analogs. For example, the recent ACTG 155 trial in much more advanced disease tended to show a superiority of the combination of zidovudine and ddC, which was limited to patients with the highest CD4 cells (between 150 and 300). A large study, ACTG 175, is comparing initial combination with monotherapy, but the results from this trial are not anticipated before the end of 1995. In the meantime, combinations including zidovudine with ddI or zidovudine with ddC as initial therapy remain of interest. When best to initiate antiretroviral therapy is probably the most controversial question in the field of HIV management. Extended data from ACTG 019 demonstrate durable clinical progression benefit with the use of 500 mg of zidovudine daily in patients with asymptomatic HIV infection and with CD4 cell counts between 300 and 500, but these data are in apparent conflict with those from the recently completed Concorde Study. Concorde, enrolling more than 1700 patients with any level of CD4 count, compared the initial use of one gram of zidovudine daily with the same therapy deferred until after the person developed AIDS or ARC. After a median treatment duration of three years, and despite a clear and sustained CD4 improvement with the immediate use of zidovudine, there was no apparent benefit in the immediate treatment group either in clinical progression or survival. When the investigators analyzed a subset of the overall group with CD4 counts below 500 cells and after one year of therapy, a benefit similar to that seen in ACTG 019 was observed. Although Concorde was a powerful study, given the size and duration of follow-up, concerns have been raised that the dosage at one gram was excessively high and that the large number of patients allowed to begin therapy before they became symptomatic complicates the analysis. Also adding to the confusion are the recently published results of the European-Australian cooperative Group trial, which tended to find a clinical benefit with the use of zidovudine in patients with CD4 counts up to 750 cells. The State of the Art Panel recommended two broad options after considering the available data--initiating therapy in asymptomatic individuals with CD4 counts under 500 cells, or delaying this therapy until symptomatic HIV disease intervened. Another option favored by many clinicians is to follow patients, delaying therapy until evidence of more rapid disease progression becomes apparent as manifested by rapid declines in CD4 count or by a rise in p24 antigen or, especially, a rise in beta-2 microglobulin. At any rate, the clinician must discuss the various options with each patient, individualizing this decision according to the clinical and laboratory status of the patient and according to the patient's own desires. Duration of Therapy A second difficult question in the field of HIV management is how long to continue initial zidovudine. Again, the ACTG 019 experience would suggest that zidovudine monotherapy has a prolonged period of benefit, especially in patients with higher CD4 cell counts (300-500) when therapy is begun. On the other hand, ACTG 116A seemed to indicate that the initial superiority of zidovudine was lost after as little as two to four months of treatment with this drug prior to treatment with didanosine. Here again, the State of the Art panel could find little room for consensus. When therapy is begun in individuals with CD4 counts above 300, the panel suggested that it should be continued until the CD4 cell count fell below 300. When zidovudine monotherapy is begun in patients with CD4 counts under 300, the additional option of switching to ddI monotherapy after a fixed interval was raised, but again this interval was not defined. Once zidovudine monotherapy has been used, and when it is no longer felt to be effective for an individual, secondary therapy must be initiated. The choice of this therapy, however, is also uncertain. In moderate disease, with CD4 cell counts below 300, switching to ddI was superior to continuing with zidovudine in ACTG trials 116a and 116b/117, while switching to ddC was not of benefit in ACTG 155. On the other hand, from data gathered in CPCRA Trial 002, in patients with more advanced disease, ddI and ddC were equivalent in secondary treatment of patients previously treated with zidovudine who had progressed despite taking that drug or who were intolerant of zidovudine toxicity. In fact, ddC had a slight but significant superiority compared to ddI in terms of survival in this trial. It was hoped that combination therapy following zidovudine would be beneficial but questions have been raised following the results of ACTG 155. In this study, patients previously treated with zidovudine with CD4 cells below 300 were randomized to stay on zidovudine, start ddC monotherapy, or begin zidovudine and ddC combination therapy. Overall, there was no difference in clinical progression or survival among the three study arms. When the baseline CD4 counts are examined, however, it was found that combination therapy was superior in patients with higher CD4 cell counts, especially between 150 and 300. Therefore, it might seem advisable not to delay the introduction of combination therapy until patients have very advanced disease but rather to use such therapy earlier in the disease course. Whether zidovudine and ddI would be as good as zidovudine and ddC has not been investigated. Newer Classes of Drugs Along with new data on existing therapies, more information is available now on newer classes of drugs. These include nucleoside analogs, non-nucleoside reverse transcriptase inhibitors, protease inhibitors, and the tat inhibitor. Nucleoside Analogs. New nucleoside analogs in clinical investigation include d4T (stavudine) and 3TC. d4T has been much more extensively studied and appears effective in raising CD4 count and lowering HIV p24 antigen in a number of Phase 1 trials. It appears safe. Although cases of pancreatitis have been reported, they seem to be extremely rare. Neuropathy is the main toxicity but, again, it appears to be somewhat less than with ddI or ddC. d4T may not be suitable for combination with zidovudine as the two drugs have a negative interaction limiting their activation within the cell. On the other hand, d4T is a well-tolerated drug and may prove to be an alternative to one or more of the existing nucleosides. 3TC also appear safe and may be able to help restore sensitivity to zidovudine when the patient's HIV has become resistant. Reverse Transcriptase Inhibitors. The non-nucleoside reverse transcriptase inhibitors, including nevirapine and the Merck "L" drug, were recently thought to have limited value because they induce high-level drug resistance so rapidly. At the Berlin conference, however, one report showed that by increasing the dosage of nevirapine to 400 mg daily, a dose well above the level of resistance, prolonged benefit might be achieved. Also, it was shown that combining zidovudine with nevirapine delays the onset of nevirapine resistance. Thus, these drugs may still find a place in clinical medicine. At the same time, convergent therapy, using three drugs together, was disappointing because of simultaneous resistance to zidovudine, ddI and non-nucleoside reverse transcriptase inhibitors. Protease Inhibitors. Protease inhibitors seem to be gaining some ground. In Phase 1 trials, several of these compounds have evident antiretroviral activity, which was reflected in decreasing HIV p24 and increasing CD4 cell counts. Clinical benefits have not been established nor has the activity of these drugs used in combination with zidovudine been described. Because several structurally different protease inhibitors are being developed by different drug companies, it is hoped that at least one of these compounds will become more widely available soon for clinical use. Tat. While the protease inhibitors appear encouraging, tat inhibitors appear to be clinically inactive. In Phase 1 trials of the Hoffman LaRoche tat inhibitor, little or no antiretroviral activity was seen and it is probably that this class of drugs will not be developed further. Summary Given this complex and seemingly confusing information, what recommendations can be given to the clinician? Most important is to individualize the decision-making and to consider the desires of the patient even more than previously. Some patients gravitate easily to more aggressive therapy, while others prefer a more conservative therapeutic approach. With the former, initiating therapy at or even above 500 CD4 counts, perhaps even with a combination of zidovudine and ddI, may be considered. For more conservative patients, however, following the recommendations of the Concorde study may in order. In other words, defer the initiation of zidovudine monotherapy until the onset of clinical symptoms. Once the choice of initial therapy has been made, all other recommendations must also be individualized. No firm data are available to guide the decision about how long to continue a therapy or even about what to use next. Most of these options have not been compared directly in clinical trials. It would seem advisable to continue therapy longer in patients with relatively earlier disease when therapy is initiated. On the other hand, if patients have more advanced disease, for example, are symptomatic or have CD4 cell counts below 300 when therapy is begun, then a more rapid alteration of therapy to a non-cross-resistant drug or combination should be considered. The goal in each patient is to continue effective antiretroviral therapy for as long as possible, discontinuing the therapy if further benefits appear impossible. Although the results of recent clinical trials are disappointing in some respects, it nevertheless is important to have these data. Only then can we adjust our expectations and our patients' expectations of antiretroviral treatment and learn how to make the best use of the drugs that we have available. Recognizing the increasing need for the development of new classes of more effective drugs in combinations, we must still seek to maintain the optimism that enables progress in our patients' care. Dr. Volberding is a UC San Francisco professor of medicine and Director, UCSF AIDS Program at San Francisco General Hospital. References: ZDV and The AIDS Clinical Trials Group (1989-93): Aweeka FT. Gambertoglio JG. et al. Pharmacokinetics of concomitantly administered foscarnet and zidovudine for treatment of human immunodeficiency virus infection (AIDS Clinical Trials Group protocol 053). Antimicrobial Agents & Chemotherapy. 36(8):1773-8, 1992 Aug. Fischl MA. Richman DD. et al. The safety and efficacy of zidovudine (AZT) in the treatment of subjects with mildly symptomatic human immunodeficiency virus type 1 (HIV) infection. A double-blind, placebo-controlled trial. The AIDS Clinical Trials Group [see comments]. Annals of Internal Medicine. 112(10):727-37, 1990 May 15. [Editor's Note: This article reports the results of ACTG 106.] Fischl MA. Parker CB. et al. A randomized controlled trial of a reduced daily dose of zidovudine in patients with the acquired immunodeficiency syndrome. The AIDS Clinical Trials Group. New England Journal of Medicine. 323(15): 1009-14, 1990 Oct 11. Gelber RD. Lenderking WR. et al. Quality-of-life evaluation in a clinical trial of zidovudine therapy in patients with mildly symptomatic HIV infection. The AIDS Clinical Trials Group. Annals of Internal Medicine. 116(12 Pt 1):961-6, 1992 Jun 15. Hochster H. Dieterich D. et al. Toxicity of combined ganciclovir and zidovudine for cytomegalovirus disease associated with AIDS. An AIDS Clinical Trials Group Study. Annals of Internal Medicine. 113(2):111-7, 1990 Jul 15. Kahn JO. Lagakos SW. et al. A controlled trial comparing continued zidovudine with didanosine in human immunodeficiency virus infection. The NIAID AIDS Clinical Trials Group [see comments]. New England Journal of Medicine. 327(9):581-7, 1992 Aug 27. Koch MA. Volberding PA. et al. Toxic effects of zidovudine in asymptomatic human immunodeficiency virus-infected individuals with CD4+ cell counts of 0.50 x 10(9)/L or less. Detailed and updated results from protocol 019 of the AIDS Clinical Trials Group. Archives of Internal Medicine. 152(11):2286-92, 1992 Nov. Krogstad DJ. Eveland MR. et al. Drug level monitoring in a double-blind multicenter trial: false-positive zidovudine measurements in AIDS clinical trials group protocol 019. Antimicrobial Agents & Chemotherapy. 35(6): 1160-4, 1991 Jun. Meng TC. Fischl MA. Richman DD. AIDS Clinical Trials Group: phase I/II study of combination 2',3'-dideoxycytidine and zidovudine in patients with acquired immunodeficiency syndrome (AIDS) and advanced AIDS-related complex. American Journal of Medicine. 88(5B):27S-30S, 1990 May 21. Sidtis JJ. Gatsonis C. et al. Zidovudine treatment of the AIDS dementia complex: results of a placebo-controlled trial. AIDS Clinical Trials Group. Annals of Neurology. 33(4):343-9, 1993 Apr. Sperling RS. Stratton P. Treatment options for human immunodeficiency virus-infected pregnant women. Obstetric- Gynecologic Working Group of the AIDS Clinical Trials Group of the National Institute of Allergy and Infectious Diseases. Obstetrics & Gynecology. 79(3):443-8, 1992 Mar. Volberding PA. Lagakos SW. et al. Zidovudine in asymptomatic human immunodeficiency virus infection. A controlled trial in persons with fewer than 500 CD4-positive cells per cubic millimeter. The AIDS Clinical Trials Group of the National Institute of Allergy and Infectious Diseases [see comments]. New England Journal of Medicine. 322(14):941-9, 1990 Apr 5. [Editor's Note: This article reports the results of ACTG 109.] See also: Aboulker JP. Swart AM. Preliminary analysis of the Concorde trial. Concorde Coordinating Committee [letter]. Lancet. 1993 Apr 3;341(8849):889-90. Comment in: Lancet 1993 Apr 17;341(8851): 1022-3; Lancet 1993 Apr 17;341(8851):1023; Lancet 1993 May 15; 341(8855):1276; Lancet 1993 May 15;341 (8855):1276-7; and Lancet 1993 May 15;341(8855):1277. Cooper DA. Gatell M. et al. Zidovudine in persons with asymptomatic HIV infection and CD4+ cell counts greater than 400 per cubic millimeter. New England Journal of Medicine. 329(5): 297-303, 1993 Jul 29. Hamilton JD. Hartigan PM. et al. A controlled trial of early versus late treatment with zidovudine in symptomatic human immunodeficiency virus infection. Results of the Veterans Affairs Cooperative Study. New England Journal of Medicine. 326(7):437- 43, 1992 Feb 13. ----------------------------------------------------------------------- ------- Question 4.2. AIDS and Opportunistic Infections. AIDS and Opportunistic Infections NIAID BACKGROUNDER: Office of Communications, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland 20892 - September 1993 Opportunistic infections (OIs) cause most of the illnesses and deaths among people infected with HIV, the virus that causes AIDS. The National Institute of Allergy and Infectious Diseases (NIAID) leads the way in U.S. research on these life-threatening infections. As part of the NIAID effort, investigators are defining the optimal therapies, alone and in combination, to prevent and treat OIs. They seek ways to identify infections earlier and recognize resistance to therapies more quickly. What are OIs? The immune systems of most people with HIV gradually deteriorate, leaving them vulnerable to numerous viruses, fungi, bacteria and protozoa that are held in check in people with healthy immune systems. These microbes can become active in HIV-infected individuals, causing frequent and severe disease. NIAID uses a two-pronged approach to the prevention and treatment of OIs: basic laboratory research to learn how these microbes cause disease and clinical research to develop and evaluate promising therapies. Prevention and treatment of one such disease, Pneumocystis carinii pneumonia or PCP, has been a major thrust of the NIAID program. Other NIAID investigations include cytomegalovirus (CMV) infection, Mycobacterium avium complex (MAC) and tuberculosis (TB). Institute research focuses on these infections because, although they occur repeatedly among HIV-infected people, they are rare in the general population and few drugs are available now to prevent and treat them. PCP: The Most Common OI PCP remains the most common, life-threatening opportunistic infection in people with HIV, occurring in up to 80 percent of individuals who do not take preventive therapy. The PCP organism, a microscopic parasite, appears to infect most people during childhood. In people with healthy immune systems, the parasite normally remains dormant, but it may cause disease in those with damaged immune systems. PCP infection is characterized by a dry cough and shortness of breath. Individuals may experience other, less specific symptoms such as fever, fatigue and weight loss for weeks or even months before respiratory problems appear. As PCP infection progresses, the functioning lung tissue becomes clogged, which decreases the transport of oxygen from the inhaled air into the blood. At this point, the oxygen in the blood may be lowered to dangerous or even fatal levels. Without treatment, close to 100 percent of HIV-infected patients with PCP die. During the 1980s, the development of effective therapies led to better management of PCP. Drugs for preventing and treating PCP include aerosolized pentamidine and oral trimethoprim-sulfamethoxazole (TMP/SMX), but both can result in serious side effects that prevent some patients from taking the drugs. TMP/SMX is recommended more often than aerosolized pentamidine for treating and preventing PCP because the combination is effective, tolerated by about half of the patients who take it and may work against other disease-causing organisms as well. In 1992, an NIAID-supported trial proved that TMP/SMX is better than aerosolized pentamidine at preventing a second episode of PCP in people with AIDS who can tolerate either therapy. Although definitive research data are lacking, other agents may be considered in situations in which neither TMP/SMX nor aerosolized pentamidine can be given. The drug atovaquone is approved for patients with mild to moderate PCP who cannot tolerate TMP/SMX. One NIAID study showed that primaquine, an antimalaria drug, with clindamycin is an effective oral therapy for PCP. TMP with dapsone is an alternative treatment. The search for new, more effective, less toxic drugs and combinations of drugs to fight PCP continues. NIAID studies play an important role in this effort. One trial compares three drug regimens--TMP/dapsone, primaquine/clindamycin and TMP/SMX--for oral treatment of mild to moderate PCP. Another protocol looks at an 8-aminoquinoline, an antimalaria drug, while a third trial considers two regimens of TMP/SMX to prevent PCP. CMV: A Herpesvirus Infection with CMV, a virus in the herpes family, may occur throughout life. By age 50, about half of the general population has been exposed to this virus, yet most people do not become ill. After the original infection, the virus may lie dormant and reactivate itself if the immune system becomes suppressed. For people with HIV infection, CMV is one of the most frequent and serious OIs they face. CMV retinitis, an inflammation of the light-sensitive inner layer of the eye, is the most common CMV infection and leads to blindness if left untreated. Infections also may occur in the gastrointestinal tract, lungs, brain, heart and other organs. Both intravenous ganciclovir and foscarnet are approved to treat CMV retinitis. Lifelong maintenance on either treatment is required because the drugs do not kill CMV, they merely slow down its ability to grow. Even with therapy, the rate of relapse is high. NIAID studies of CMV and other herpesviruses have shown that intravenous foscarnet and ganciclovir are equally effective for CMV retinitis, although foscarnet was associated with increased survival for patients in the study. An ongoing trial is testing an oral form of ganciclovir to prevent CMV disease. The oral form of the drug would be much easier and safer for patients to take. MAC: A Bacterial OI Infection with MAC is diagnosed in up to 40 percent of people with AIDS in the United States, making it the most common bacterial OI. Usually, it affects people in advanced stages of HIV disease when the immune system is severely suppressed. The MAC organism is found widely in the environment and is thought to be acquired most commonly through the mouth or gastrointestinal tract. It can spread to the lungs, liver, spleen, lymph nodes, bone marrow, intestines and blood. MAC causes chronic debilitating symptoms--fever, night sweats, weight loss, fatigue, chronic diarrhea, abdominal pain, liver dysfunction and severe anemia. Rifabutin is the first drug to be approved for preventing MAC disease in people with advanced HIV infection. The Food and Drug administration based this approval on clinical studies showing that patients who received rifabutin were one-third to one-half as likely to develop MAC as were patients who received placebo. To prevent MAC disease, a U.S. Public Health Service Task Force on Prophylaxis and Therapy for MAC suggests that patients with HIV infection and fewer than 100 CD4 + T cells receive oral rifabutin for the rest of their lives unless disease develops. In the latter case, multiple drug treatment is needed. CD4+ T cells are immune system cells targeted and killed by HIV. No other drug regimen is recommended currently to prevent MAC. Azithromycin and clarithromycin are promising agents for prophylaxis, but studies of these agents have not been completed. Increasing evidence suggests that treatment can benefit patients with disseminated MAC, especially multiple-drug regimens including either clarithromycin or azithromycin. Therefore, the PHS task force suggests that all regimens, outside of a clinical trial, should consist of at least two drugs, including clarithromycin or azithromycin plus one other agent such as clofazimine, rifabutin, rifampin, ciprofloxacin and, in certain situations, amikacin. They recommend continued therapy for the patient's lifetime, as long as clinical benefit and reduction of mycobacteria are observed. NIAID has several studies under way looking at the roles of clarithromycin and azithromycin, and other drugs such as sparfloxacin, alone and in combination, to prevent and treat this serious disease. TB: An Airborne Disease TB, a chronic bacterial infection, causes more deaths worldwide than any other infectious disease. About one-third of the world's population harbors the predominant TB organism, Mycobacterium tuberculosis, and is at risk for developing the disease. The World Health Organization (WHO) estimates that 4.4 million people worldwide are coinfected with TB and HIV. WHO predicts that by the year 2000, TB will take one million lives annually among the HIV-infected. Because of their weakened immune systems, people with HIV are vulnerable to reactivation of latent TB infections, as well as to new TB infections. Transmission of this disease occurs most commonly in crowded environments such as hospitals, prisons and shelters--where HIV-infected individuals make up a growing proportion of the population. Active TB may occur early in the course of HIV infection, often months or years before other OIs. TB most often affects the lungs, but it also can cause disease in other parts of the body, particularly in people with advanced HIV disease. Of particular concern for people with AIDS is multi-drug-resistant TB (MDR-TB). MDR-TB can occur when patients fail to take their TB medicine for the prolonged periods necessary to destroy all TB organisms, which then become resistant to the drugs. These resistant organisms can be spread to other people. Even with treatment, for individuals coinfected with HIV and MDR-TB, the death rate may be as high as 80 percent, as opposed to 40 to 60 percent for people with MDR-TB alone. The time from diagnosis to death may be only months for some patients with HIV and MDR-TB, as they are sometimes left without adequate treatment options. The initial site of TB infection is in the balloon-like sacs at the ends of the small air passages in the lungs. In these sacs, white blood cells called macrophages ingest the inhaled TB organism. Some of the organisms are killed immediately, while others remain and multiply within the macrophages. If the organism breaks out of the sacs, TB can become active disease. This spreading sometimes results in life-threatening meningitis and other problems. NIAID launched the first large U.S. study to assess TB treatment strategies for people coinfected with HIV and TB. The study is aimed at finding state-of-the-art treatment. NIAID is the lead institute for TB research at the National Institutes of Health, supporting more than 50 research projects related to TB. Other OIs NIAID-supported scientists also study other OIs including fungal infections, herpes simplex virus infections, toxoplasmosis and cryptosporidium infections. ----------------------------------------------------------------------- ------- Question 4.3. Guide to Social Security Benefits. U.S. Department of Health and Human Services Social Security Administration SSA Publication No. 05-10020 September 1993 A Guide to Social Security and SSI Disability Benefits For People With HIV Infection About This Booklet Social Security can provide a lifeline of support to people with HIV infection. That lifeline comes in the form of monthly Social Security disability benefits and Supplemental Security Income payments, Medicare and Medicaid coverage, and a variety of other services available to people who receive disability benefits from Social Security. If you are disabled because of HIV infection, this booklet will help you understand the kinds of disability or Supplemental Security Income programs. What's Inside Part 1 -- Background Information The first section provides some brief background information about HIV infection and Social Security. Part 2 -- What Benefits Are You Eligible For? This section explains the nonmedical rules and eligibility factors for Social Security Disability Insurance benefits and Supplemental Security Income Disability payments. Part 3 -- How Does Social Security Define "Disability?" This section explains Social Security's definition of "disability" and how it relates to claimants with HIV infection. Part 4 -- How Does Social Security Evaluate Your Disability This section explains how Social Security evaluates disability claims involving HIV diseases in general. And it includes up-to- date information about the way we process claims, especially those involving women and children with HIV infection. Part 5 -- How Do You File For Disability Benefits? This section includes information about when and how to apply for disability, what steps we take to ensure that your claim is processed quickly and accurately, and most important, what things you can do to help the process along. Also included is information about situations when we can presume a person is disabled and make immediate payments. Part 6 -- Helping You Return To Work This section provides an overview of special rules designed to help you return to work. Part 7 -- What you Need To Know About Medicaid And Medicare This section includes a brief overview of the kinds of benefits available from the Medicaid and Medicare programs. For More Information ***************************************************************** PART 1 -- BACKGROUND INFORMATION Acquired immunodeficiency syndrome (AIDS) is characterized by the inability of the body's natural immunity to fight infection. It is caused by a retrovirus known as human immunodeficiency virus, or HIV. Generally speaking, people with HIV infection fall into two broad categories: 1) those with symptomatic HIV infection, including AIDS; and 2) those with HIV infection but no symptoms. Although thousands of people with HIV infection are receiving Social Security or Supplemental Security Income disability benefits, we believe there may be others who might be eligible for these benefits. Social Security is committed to helping all men, women, and children with HIV infection learn more about the disability programs we administer. And if you qualify for benefits, we are just as committed to ensuring that you receive them as soon as possible. You should also be aware that the Social Security Administrations's criteria for evaluating HIV infection are not linked to the Centers for Disease Control's (CDC) definition of AIDS. This is because the goals of the two agencies are different. CDC defines AIDS primarily for surveillance purposes, not for the evaluation of disability. PART 2 -- WHAT BENEFITS ARE YOU ELIGIBLE FOR? We pay disability benefits under two programs: Social Security Disability Insurance, sometimes referred to as SSDI, and Supplemental Security Income, often called SSI. The medical requirements are the same for both programs, and your disability is determined by the same process. However, there are major differences in the nonmedical factors, which are explained in the next two sections. Social Security Disability Insurance Benefits: The Nonmedical Rules Of Eligibility Here are examples of how people qualify for SSDI: o Most people qualify for Social Security disability by working, paying Social Security taxes, and in turn, earning "credits" toward eventual benefits. The maximum number of credits you can earn each year is 4. The number of credits you need to qualify for disability depends on your age when you become disabled. Nobody needs more than 40 credits and young people can qualify with as few as 6 credits. o Disabled widows and widowers age 50 or older could be eligible for a disability benefit on the Social Security record of a deceased spouse. o Disabled children age 18 or older could be eligible for dependent's benefits on the Social Security record of a parent who is getting retirement or disability benefits, or on the record of a parent who has died. (The disability must have started before age 22.) o Children under the age of 18 qualify for dependents benefits on the record of a parent who is getting retirement or disability benefits, or on the record of a parent who has died, merely because they are under age 18. For more information about Social Security disability benefits in general, ask Social Security for a copy of the booklet, Disability (Publication No. 05-10029). How Much Will Your Benefits Be? How much your Social Security benefit will be depends on your earnings history. Generally, higher earnings translate into higher Social Security benefits. You can find out how much you will get by contacting Social Security. CA Clovis Clovis Co of Fresno/Rod Jessen R:8:910/512209-323-7583 CA Concord DVMCC/Drew Blanchard 1:161/203 510-827-0804 CA Concord Grateful Med/T.C. Dufresne 1:161/63 510-689-0347 CA Concord Grateful Med/T.C. Dufresne A:94:5100/3510-689-0347 CA Danville Dear Theophilus/Mark Spaulding 1:200/703 510-831-8436 CA El Cajon Camelot 619-447-7869 CA El Cajon El Cajon Network Central 1:202/1522 619-447-7869 CA FountainVal Ye Olde BBS/Dallas Jones 1:103/552 714-968-1899 CA Fresno LightHouse/Danny Davis R:8:910/524209-252-7968 CA Gardena Gardena/Mark Bishop 1:102/255 310-555-1212 CA Hayward New Big Board/Cliff Wilson 1:204/10 510-670-2940 CA Irvine Wellspring/Steve Clancy 714-725-2700 CA Irvine Wellspring/Steve Clancy 714-856-5087 CA Irvine Wellspring/Steve Clancy 714-856-7996 CA Los Angeles Empty Bed Pan/Stu Carlson 1:102/733 310-478-0451 CA Monterey Nitelog/ RelayNet 408-655-1096 CA No.Highland Silverado Express/Rod Abbott 1:203/1102 916-344-8146 CA N.Hollywood L.A.ValleyCollege/Tom Klemesrud 1:102/837 818-985-7150 CA Northridge Silent Partner/Jim Schooler 1:102/910 818-832-4585 CA Pacifica Chemist'sComPort/Larry McGee 1:125/190 415-359-6036 CA Sacramento Omar's Corner/Brian Greendahl 1:203/164 916-641-2413 CA San Diego Hillcrest Community/MichaelBlair1:202/703 619-291-0544 CA San Diego Mushin/Brad Chesbro 1:202/604 619-535-9580 CA San Diego Patient Advocate 1:202/742 619-546-4334 CA San Diego Telesis/ 1:202/740 619-497-0288 CA San Diego West Coast Connection/ RelayNet 619-449-8333 CA San Francis aids Info/Ben Gardiner L: 415-626-1246 CA San Francis Breath of Fresh Air hiv/aids 1:125/120 415-488-1461 CA San Francis Fog City/Bill Essex 1:125/100 415-863-9697 CA San Francis Fog City/Bill Essex 207:1/5 415-863-9697 CA San Francis Fog City/Bill Essex 207:1/5 Members Only CA San Francis Recovery/Rick Gorin 1:125/9 415-255-2188 CA San Francis STUDS!/Hans Braun 1:125/572 415-495-2929 CA San Francis STUDS!/Hans Braun S: 415-495-2929 CA San Mateo HTG/Outreach/Allan Hurst 1:204/462 415-572-9594 CA San Mateo PCBL/Les Kooyman 1:204/501 415-572-9563 CA SanJuanCapi hiv/aids Info/Sr.Mary Elizabeth 1:103/927 714-248-2836 CA SantaFeSprngHelping Hands/Rick Venuto 1:102/433 310-948-5919 CA Santa Rosa Sonoma Online/Don Kulha 1:125/7 707-545-0746 CA Simi Valley Library/Gary Vedvik 1:102/1006 818-999-4391 CA Torrance Art Gallery-South/Mike Reeves 310-791-7278 CA Tujunga Mysteria/Phil Hansford 1:102/943 818-353-8891 CA Vacaville Net/Don Morse 1:161/611 707-746-6091 CA Vallejo Power Station/Joe Martin 1:161/123 707-552-0462 CO Bailey BaileyInfoExchange/Chris Stone 1:104/825 303-674-0147 CO Col.Springs Socialism OnLine/Randy Edwards 1:128/105 719-392-7781 CO Col.Springs FireNet Leader/Wood/Sanders 1:128/16 719-591-7415 CO Denver Denver Exchange/James Craig 1:104/909 303-623-4965 CO Denver Denver Exchange/Sex Pistol 207:1/0 303-623-4965 CO Denver Denver Exchange/Sex Pistol 207:1/104 Members Only CO Denver Denver Exchange/Sex Pistol S: 303-623-4965 CO Denver Max Manlove's/Max Manlove 1:104/431 303-863-0227 CO Denver Welcome Home/Dave Wilson 1:104/433 303-839-8665 CO Ft. Collins EMCC #2/Mike Coppock 1:306/31 303-484-6663 CO Littleton GC Fido/Steve Raymond 1:104/19 303-795-1215 CO WestAdamsCo Telepeople/Marshall Barry 1:104/69 303-426-1866 CT Rainbow View/Bill Hausler 1:141/991 203-744-0179 CT Branford Lifestyles (Gay)/Rick Sande 1:141/107 203-481-4836 CT Meriden Nusing Network/Michael Rostock 1:141/896 203-237-1131 CT Milford LambdaConn/Jeffrey Lizotte 1:141/215 203-877-6667 CT New Haven NHGCS Network/Kenny Teel 1:141/650 203-624-8990 CT Newington First Impressions/Corey Keaton 1:142/667 203-667-9666 CT No.Branford Hippocampus/Aaron Waxman 1:141/205 203-484-4621 CT Wallingford Vampire Connection/John Melillo 1:141/808 203-269-8313 CT W.Jordan Lake Wobegon/Robert Klaproth 1:311/19 801-568-3866 CT Yalesville Emerogronican/Steven Ambrosini 1:141/666 203-949-0189 DC Washington COCKpit 1:109/196 202-862-5497 DC Washington DC Information Exchange MetroLink 703-836-0748 DC Washington GLIB/Jon 207:1/3 703-578-4542 DC Washington GLIB/Jon 207:1/3 Members Only DC Washington OASH/Ted Foor 1:109/166 202-690-5423 DE Bear Obsession/Bob Chalmers 1:150/135 302-836-7145 DE Wilmington Black Bag Medical/Ed DelGrosso 1:150/140 302-994-3772 DE Newark Black Bag/Edward DelGrosso A:94:3020/1302-994-3772 FL Stetson University Legal L: 800-624-9091 FL Boynton College Board/Charles Bell 1:3638/13 407-731-1675 FL Davie Samurai Palace/ 305-587-018 FL DeLand Colosseum/Robert Gary 1:3618/28 904-734-9951 FL Hialeah LatinConnection/AdrianaFernandez1:135/323 305-826-0778 FL Hollywood Dracula's Castle/Robert Fonner 1:369/24 305-964-2696 FL JacksonvilleCharlie's/Charles Deskin 1:112/69 904-396-4931 FL LifeLine 1:112/73 904-276-4724 FL Miami Tech-80/Bert Sainz 1:135/55 305-264-8155 FL Miami Lakes Telcom Central/Ray Vaughan 1:135/23 305-828-7909 FL Miami ShoresTown Crier/Orville Bullitt 1:135/36 305-785-0912 FL NewPtRichey Ground Zero/Sean Fleeman 1:3619/25 813-849-4034 FL NewPtRichey Special Place/Bob Dipalma 1:3619/19 813-372-7525 FL No. Miami Jailhouse/Kenny Star 1:135/34 305-944-6271 FL Orange Park OverbytesIndustries/Jaime Gibson1:112/92 904-278-0771 FL Orlando Compu-Link/Bill Wenzel 1:363/1571 407-240-7864 FL Orlando Nurse Corner/Pat & Jim Keller 1:363/15 407-299-4762 FL Palm Beach Adonis/Hung+ S: 407-881-8641 FL PalmBchGard Custom Computers/John Skakandy 1:3646/1 407-743-1112 FL PampanoBeac Backstreet/Bob Kecskemety 207:1/17 305-941-0216 FL Port Richey Special Place/Bob Dipalma 1:3619/19 813-372-7525 FL Raiford MedLink Node 1/Bill Matthews 1:3600/3 904-431-1913 FL StPetersbur #1 Computers/Robert Dempsey 1:3603/260 813-521-3149 FL StPetersbur #1 Computers/Robert Dempsey 1:3603/260 813-527-1556 FL StPetersbur Mercury Opus/Emery Mandel 1:3603/20 813-321-0734 FL Sarasota Courts of Chaos/Lanier Kingsley 1:137/124 813-923-1055 FL Cocoa MOTSS/Don Wilcox 1:374/41 407-779-0058 FL Talahassee Dreamland/David Barfield 1:3605/900 904-224-3545 FL St.PetersburAfterMidnite/Dell Edwards 1:3603/103 813-823-3163 FL Tampa AlternativeJames Floyd 1:377/51 813-882-8939 FL Tampa PrideNET USA!/Tony Myers 1:377/24 813-837-5463 FL Tampa T.A.B.B. 1:377/6 813-961-6242 FL Tampa Talen/Don Hardy 1:3603/410 813-895-0364 FL Venice Venice Recovery/John Grossberg 1:137/408 813-492-9592 GA Atlanta CDC aids Info Line/ L: 404-377-9563 GA Atlanta CDC aids Lab Info/ L: 800-522-6388 GA Atlanta hivNET Atlanta/David Coobs 1:133/606 404-622-2070 GA Atlanta Medical Forum/ L: 404-351-9757 GA Atlanta Meet Factory/ S: 404-350-0308 GA Atlanta PC Connect/Louis Kahn 1:133/620 404-565-8250 GA Atlanta Trash Shack/Dennis Dore 1:133/518 404-320-0026 GA Atlanta Trash Shack/Dennis Dore S: 404-320-0026 GA Centerville Mother's Kitchen/Mike Tucker 1:3611/19 912-953-2708 GA Conyers Atlanta Connection/Bill Noel 1:133/205 404-929-0800 GA Lawrencevil Retreat/Andria Duncan 1:133/618 404-339-3660 GA Macon Middle GA Medical/Doug Dozier 1:3611/5 912-477-8741 GA Norcross Pharmacy/Mike Mayer 1:133/601 404-729-1766 GA Smyrna No Frills/ 404-435-9608 GA Valdosta HOT South/Aulton White 1:3645/30 912-242-0496 GA Woodstock Index System/Rodney Aloia 1:133/201 404-924-8472 HI Honolulu GQ Link 1:345/3 808-526-9042 HI Honolulu Homeboy Shopping/David Roberts 1:345/23 808-624-1294 HI Kahalui Modem Mania/Sue Kamalo 1:345/18 808-871-5891 IA Des Moines Silver Xpress/Brad Meyers 1:290/6 515-288-7793 ID BonnersFerr King Morpheous/Jeff Burns 1:346/16 208-257-5801 IL Champaign LawBoard Fido/Fred Grosser 1:233/1 217-352-6118 IL Chicago I Can!/Bogie Bugsalewicz 1:115/738 312-736-7434 IL Chicago I Can!/Bogie Bugsalewicz A:94:3120/2312-736-7434 IL Chicago Lambda Zone/Toby Schneiter 207:1/106 708-696-4298 IL Danville Grapevine/Danny Keele 1:233/30 217-431-8555 IL Moline Rampage/John Buckwalter 1:232/49 309-764-9794 IN Evansville Digital Dreams/Dave Worley 1:2310/220 812-421-8011 IN Evansville TGC Adult/ TNet 812-284-5465 IN IndianapolisPortalToInfinity/Anthony Besisi 1:231/540 317-887-6043 IN Whiting ADAnet EList Coord/Rick Catania A:94:94/98 219-659-0112 KS OverlandPar South of the River/John Schmake 1:280/9 913-642-7907 KS Winfield 9th & Main/Benn Gibson 1:291/21 316-221-3276 KS Witchita Land of Awes/Rex Rivers 1:291/9 316-269-3172 KS Witchita Land of Awes/Rex Rivers 207:1/10 316-269-4208 KS Wichita Q Continuum/Mike Randolph 1:291/1701 316-721-8466 KY Erlander DataNet/Rich Ashworth 1:108/90 606-727-3638 KY Louisville Code III/Ken Murray 1:2320/210 502-368-6908 KY Louisville LiveWire Online/Allen Prunty 1:2320/110 502-933-4725 LA Lafayette Spinal Tap/Ryan Brooks 1:3803/4 318-233-0363 LA New Iberia Circle of Support/ 1:3803/7 318-367-9916 LA New Orleans Leather Connection/RobertGoslin 207:1/111 504-947-2627 LA New Orleans Tulane Med. Ctr. L: 504-584-1654 MA Billerica Chicken Coop/Daniel Shapiro 1:324/295 508-667-7234 MA Billerica Vision/Joseph Oliveira 1:324/279 508-670-0934 MA Boston Five Point/Isaac Obie 1:101/625 617-859-7398 MA Boston StarBase/Ric Giguere 1:101/165 617-739-9246 MA Leicester Lighthouse/George Lafreniere 1:322/605 508-892-8857 MA Leicester Lighthouse/George Lafreniere A:94:6021/5508-892-8857 MA Melrose Den/Ray Gouin 1:101/225 617-662-6969 MA Needham Weed Garden/Holt Lipman 1:101/295 617-444-4061 MA Westminster DarkSide/David Place 1:322/247 508-874-6334 MA Worcester Foundation/Phil Collins 1:322/732 508-797-9563 MD Baltimore Harbor Bytes/ 207:1/15 301-235-4651 MD Baltimoore John's BBS 1:261/1083 410-566-1336 MD Baltimore Writer's Block/Ed Lawyer 1:261/1056 410-945-1540 MD Chevy Chase WorldComm/Matt Clement 1:109/466 301-657-8313 MD Frederick Chipin Block/ MetroLink 301-698-1486 MD GaithersburgNational hiv/aids/Joie Clarke 1:109/727 301-869-6808 MD Wheaton Honey Board/Heather James 1:109/543 301-933-1467 MD Rockville FDA/ L: 800-222-0185 MD Rockville FDA/ L: 301-227-6849 MD Waldorf Brodmann's Place/Dave Brodmann 1:109/806 301-843-5732 MD Waldorf Brodmann's Place/Dave Brodmann S: 301-843-5732 MI Birmingham Alternate One/Ronald Miotke 1:2202/1 313-644-1260 MI Detroit Legend of Roseville RelayNet 313-776-1975 MI Highland Jim's Coffee House/Jim Pesola 1:2202/4 313-887-4330 MI Lansing Flaming Dragon/Jim Knauer 1:159/675 517-336-7846 MI Monroe Fast Eddie's/Ed Dobie A:94:3130/2313-243-0944 MI Mt. Clemens Boat Town USA/Dan Dalton 1:2202/0 313-468-3572 MI Mt. Clemens Boat Town USA/Dan Dalton 1:2202/0 313-468-6982 MI Mt. Clemens Boat Town USA/Dan Dalton 1:2202/18 313-468-0912 MI Mt. Clemens Boat Town USA/Dan Dalton A:94:3130/0313-468-0912 MI Mt. Clemens JADA Editor/Peggy McBride A:94:94/94 313-468-0912 MI Pontiac Fire & IceBill Sims 1:2202/9 313-373-8608 MI Roseville Lyme Light/Anne Bussell A:94:3130/4313-774-5038 MI SterlingHts New Life/Julia Sidebottom 1:2202/2 313-795-5829 MN Andover DRAGnet/Gordon Gillesby 1:282/1007 612-753-1943 MN Andover DRAGnet/Gordon Gillesby A:94:6120/1612-753-1943 MN AppleValley Carolyn's Closet/Carson Kimble 1:282/3015 612-891-1225 MO JeffersonCy Doc In The Box/Mark D. Winton 1:289/8 314-893-6099 MO JeffersonCy Doc In The Box/Mark D. Winton A:94:3140/1314-893-6099 MO Kansas City Shrouded Realm/Terry Goodlett 1:280/27 816-483-7018 MO Kansas City KC aids InfoLink/Scott Cohan 1:280/14 816-561-1186 MO Kansas City GCOMM/Scott Cohan 207:1/110 816-561-1187 MO Springfield ARCAngelExpress/SterlingMunhollo1:284/7 417-864-4573 MO Springfield Art's Toy/Art Rainey 1:284/55 417-866-2284 MO St. Louis Hotflash/Rhett Butler 207:1/105 314-771-6272 MO St. Louis Hotflash/Rhett Butler 207:1/105 800-245-2601 MS Coldwater Coldwater/Rogert Martin 1:123/421 601-562-9385 MS Jackson Kudzu Konnection 601-957-1259 NC Charlotte Exchange/Ron Alspaugh 1:379/24 704-339-0333 NC Charlotte Exchange/Ron Alspaugh S: 704-342-2333 NC Charlotte MetroLink II/Matthew Irvin 1:379/20 704-567-6124 NC Charlotte MetroLink II/Matthew Irvin 207:1/8 704-567-6124 NC Durham Isolated Pawn/David Myers 1:3641/281 919-471-1440 NC Goldsboro Blues' Image/Jim Henry 1:151/808 919-751-2746 NC Goldsboro Swamp Ward/Mike Whatley 1:151/814 919-751-2324 NC Greensboro NC Triad/Richard Epson-Nelms 1:151/2325 919-854-7952 NE Beatrice S.E. Community/Dick Douglass 1:285/115 402-223-2889 NE GrandIsland Central Community/Fred Roeser 1:285/116 308-389-6495 NE Lincoln Medicine Cabinet/Tom Hoover 1:285/207 402-435-0797 NE Lincoln NE EducationHub/Merle Rudebusch 1:285/100 402-471-0897 NE Lincoln TC Forum Univ. Neb./Ed Nemeth 1:285/110 402-472-3338 NE Lincoln TC Forum Univ. Neb./Ed Nemeth 1:285/110 402-472-5370 NE Lincoln TC Forum Univ. Neb./Ed Nemeth R:8:963/2 402-472-3365 NE Omaha Omaha Pub.School/Rich Molettier 1:285/113 402-554-6181 NE Wayne Wayne St.College/Dennis Linster 1:285/111 402-375-7564 NJ Bricktown Underground/David Brian 1:107/425 908-262-9666 NJ Cape May Inferno/Glenn Laws 1:266/72 609-886-6818 NJ Cape May Inferno/Glenn Laws 207:1/11 609-886-6818 NJ Dayton Altered Illusions/Lou Braconi 1:107/345 908-329-3216 NJ FranklinPrk Digital Abyss/Glen Panniche 1:107/398 908-422-4130 NJ Howell File Exchange/Walter Kuzma 1:107/449 908-905-3029 NJ Madison Strand/Gerhard Bartsch 1:107/915 201-822-3658 NJ Metuchen Micro-Fone/John Kelley 1:107/331 908-494-8666 NJ Parlin Central Jersey/Fred Seibal 1:107/600 908-525-9440 NJ Parlin RC's Place/R. C. Mann 1:107/682 908-525-1939 NJ Piscataway gLiTcH/JOD 1:2605/633 908-968-7883 NJ Piscataway gLiTcH/JOD 207:1/4 908-968-7883 NM Albuquerque Route 66 Solutions/Jon Jacob 1:301/28 505-294-4543 NM White Rock ExplodoModeM 1:15/28 505-672-0427 NV Las Vegas Southern NV C.H.A.I.N./M.T.Swift1:209/238 702-656-7654 NV Las Vegas SpiritKnife*LV/aids/hiv/M.Swift A:94:7020/2702-656-7654 NV Reno Advanced System/Richard Dias 1:213/900 702-334-3308 NY CCMC-aids L: 518-783-7251 NY Albany Lower Albany/Phil Losacco 1:267/140 518-465-1072 NY BallstonSpa Access/Maureen Allen 1:267/136 518-885-4192 NY Brooklyn Blacknet/Idette Vaughan 1:278/618 718-692-0943 NY Brooklyn Brooklyn College/Howie Ducat 1:278/0 718-951-4631 NY Brooklyn Brooklyn College/Howie Ducat 1:278/600 718-951-4631 NY Brooklyn KinQuest/Bill Gage 1:278/611 718-998-6303 NY Brooklyn Pier/Michael Stewart 1:278/6969 718-531-9475 NY Clifton Prk Fantasy Land Adult/Tony Manino 1:267/106 518-383-2282 NY Farmingdale SUNY/Gary Glueckert 1:107/270 516-420-0818 NY Great Neck Sacred Palace/Bill Athineos 1:107/256 516-829-8701 NY Hicksville Temporal Odyssey/Matt Faccenda 1:107/266 516-579-0098 NY Merrick Pride/ 1:2619/102 516-785-1557 NY New York Backroom/Tiger Tom 207:1/1 718-951-8256 NY New York Backroom/Tiger Tom S: 718-951-8256 NY New York City People/Barry Weiser 1:278/720 212-255-6656 NY New York Comm Specialties/Howie Ducat 1:278/99 212-951-4631 NY New York Dorsai Mission/Skip Mac-Stoker 1:278/706 718-729-6101 NY New York Utopian Quest L: 212-686-5248 NY New York Utopian Quest L: 516-842-7518 NY No. Babylon LastPlaceOnEarth/KennethOransky 1:107/247 516-243-1949 NY Rochester Cat's Meow #1/Bob Rathke 1:2613/140 716-473-2017 NY Rochester Frog Pond/Nick Francesco 1:260/270 716-461-1924 NY Rochester Recovery Room/Patrick Daugherty 1:2613/207 716-461-5201 NY Scotia Critics Choice/Tim Koral 1:267/135 518-377-7009 NY Syracuse Erie Canal/Ray Bucko 1:2608/31 315-445-4710 NY Waterford Biologicalnightmare/RobLevine 1:267/139 518-233-9529 NY Whitestone Corner Deli/Mike Schiffman 1:278/777 718-352-0821 OH Columbus Black Bag II/Paul Prior 1:226/320 614-293-8810 OH Columbus Mystic Life/Michael Kelly 1:226/520 614-279-7709 OH Dayton Levee/Jim Koz S: 513-222-6107 OH Dayton Olman/James Hale 1:110/247 513-427-9473 OH Dayton Olman/James Hale A:94:5130/ 513-427-9473 OH Galloway Information Exchange/Dan Styers 1:226/210 614-878-0161 OK MidwestCity Sandbox/John Burton 1:147/34 405-737-9540 OK MidwestCity Torii Station/Jim Oxford 1:147/20 405-737-7565 OK OklahomaCit Huggy Bears/Donald Burch 1:147/30 405-949-2090 OK OklahomaCit OK NORML/Michael Pearson 1:147/3 405-282-8777 OK Ponca City Wordshop #2/Wayne Majors 1:3810/1 405-765-0951 OK Tulsa Looking Glass/Arnie Holder 1:170/706 918-838-7575 OR Eugene Paradox/Ryan Shaw 1:152/38 503-485-1988 OR Portland Busker's Boneyard/Hal Nevis 1:105/14 503-771-4773 OR Portland Club/Gary Seid 1:105/98 503-232-0332 OR Portland GayNet/Michael Hile 1:105/76 503-295-0877 OR Portland Land of the Gypsy's/Nancy Porter1:105/18 503-297-0626 OR Portland Land Of The Gypsys/NancyPorter 1:105/18 503-297-0626 OR Portland Medical Education/Jerry Donais 1:105/35 503-256-7758 PA Hatboro Anterra Nework/Steve Ferguson 1:273/736 215-675-3851 PA Kittaning TechnoweenieParadyz/JoAnnKaraffa1:129/196 412-543-6580 PA MechanicsburConnections! BBS --------- 717-795-9925 PA Milford Omega/Gordon Craig 1:268/18 717-296-8560 PA Philadelphi Critical Path/Kiyoshi Kuromiya L: 215-463-7162 PA Philadelphi Club Philadelphia/Matt Zarkos 1:273/904 215-626-7398 PA Philadelphi East Co Bear/John D. Steele 1:273/910 215-755-1917 PA Philadelphi La Dolce Vita/ L: 215-463-7888 PA Pittsburgh Meeting Place/Marc Shannon 1:129/45 412-482-7057 PA Pittsburgh P.A.&W/Doug Segur 1:129/228 412-381-6878 PA Wyndmoor WyndowIntoReality/Jeff Nonken 1:273/715 215-242-4485 RI Providence Eagles Nest/Mike Labbe 1:323/126 401-732-5290 RI West Warwic AdvantageVoice&Data/Joe Caparco 1:323/113 401-885-5695 RI Warwick GAYtway/Blind Faith 1:323/121 401-435-6544 RI Warwick GAYtway/Blind Faith 207:1/20 401-739-1380 SC Central Spawl/David Scott 1:3639/18 803-653-4536 SC Charleston Big Dog's/Dan Folk 1:372/62 803-769-6131 SC Columbia Dog Alley/Maddog 207:1/16 803-926-9110 SC Goose Creek Medical Forum/Shelley Crawford 1:372/106 803-824-0317 SC Greensville Evolution/John Hames 1:3639/17 803-244-9556 TN Brighton Unbridled Desires/Ken McCleaft 1:123/415 901-476-3097 TN Chattanooga Cove/Joel Davenport 1:362/960 615-855-9956 TN Chattanooga Cove/Joel Davenport A:94:6151/1615-855-9956 TN East Ridge TEL(Medical BBS)/Oliver Jenkins 1:362/621 615-622-6099 TN Memphis Personals/John Heizer 1:123/22 901-274-6713 TN Memphis Personals/Lucky Ernie 207:1/12 901-274-6713 TN Bartlett Riverside/Gary Wilkerson 1:123/424 901-452-6832 TN Bartlett Riverside/Gary Wilkerson S: 901-452-6832 TN Nashville Meharry Medical College RelayNet 615-327-6175 TN Red Bank Eternal Flame/Jack Whaley 1:362/940 615-875-0290 TX Amarillo Town Crier/Matt Montgomery 1:3816/126 806-358-7032 TX Austin Health-Link/Bruce Baskett 1:382/5 512-444-9908 TX Austin Lambda Link/Joshua 1:382/25 512-873-8299 TX Austin Lambda Link/Joshua 207:1/109 512-873-8299 TX Austin RiverCityExchange/George Sharpe 1:382/4 512-327-5376 TX Beaumont Super Collider/Pat Presley 1:3811/320 409-833-8583 TX Bedford Metroplex Mailbox/Kyle Hearn 1:130/1008 817-268-1422 TX Bryan Lazy Jane's 1:117/128 409-268-1181 TX CorpusChristBlueWater/Tony Honaker 1:160/260 512-883-7839 TX Dallas DaBBS Dallas/Dale Becker 1:124/2126 214-821-7732 TX Dallas Dallas Mandate/Mark Taylor 1:124/6503 214-528-1816 TX Denton ComputerGeeksAnon/George Toon 1:393/42 817-380-0186 TX Fort Hood Serving with God's Love/D.Wright1:395/22 TX Fort Worth Crystal Palace/Lisa Mashburn 1:130/1005 817-370-9591 TX Fort Worth Stallions Coral/Stallion 207:1/107 817-545-7317 TX Irving aids Chat Line/John Pfeifer 1:130/55 214-256-5586 TX GrandPrairi Puss N Boots/Aaron Davis 1:124/3103 214-641-1822 TX Houston A Womyn's Line/Anna Mayes 1:106/8160 713-647-9057 TX Houston Beehive/Brad Wartman 1:106/41 713-974-6995 TX Houston Last Call/Doug Sutherland 1:106/8366 713-523-8366 TX Houston Medico/Dave Ray 1:106/595 713-895-7945 TX Houston Murphy's Law/Gregg Holland 1:106/365 713-584-0348 TX Houston PIC of the MID Town/Geo. Worley 1:106/31 713-961-5817 TX Houston Pink Triangle/Dereck Thomas 1:106/3802 713-630-0764 TX Houston Private Line/Larry Mers 1:106/5000 713-933-0499 TX Houston Turkey's Roost/Keven Turk 1:106/6235 713-530-6235 TX Port Neches StarGate Seven/Timothy Wilson 1:3811/110 409-727-8141 TX San Antonio ETC MedNet/Bob Jackson 1:387/801 210-829-0346 TX San Antonio Gardens of Avalon/Ed Tillman 1:387/57 210-308-9579 UT West Jordan Midnight Express/ L: 801-565-8330 UT W.Jordan Lake Wobegon/Robert Klaproth 1:311/19 801-568-3866 VA Arlington NAPWA-Link/Richard Smith L: 703-998-3144 VA Norfolk Christian Resources/Mike Olah 1:275/36 804-543-3459 VA VirginiaBch ADAnet File Dist/Warren King A:94:94/99 804-496-3320 VA VirginiaBch Pleasure Dome/Tom Terrific S: 804-490-5878 WA Ellensburg Joe's Oasis/Ben Roth 1:344/92 509-962-3536 WA FederalWay Big Easy/Danny Stephens 1:343/85 206-661-1457 WA Olympia Radio Point/Jay Andrews 1:352/111 206-943-1513 WA Seattle Seattle aids Info/Steve Brown L: 206-323-4420 WA Seattle Stage Seattle/Randy 207:1/102 206-286-1850 WA Seattle U. of Wash. HHS/Cindy Riche 1:343/35 206-543-3719 WA Tumwater Elder's Council/Daniel Smerken 1:352/458 206-357-8992 WA Tumwater Elder's Council/Daniel Smerken A:94:2061/2206-357-8992 WI Milwaukee Back Door/Paul Parkinson 1:154/700 414-744-9385 WI Milwaukee Back Door/Paul Parkinson 207:1/108 414-744-9385 MI Milwaukee Back Door/Paul S: 414-744-9385 WI Milwaukee Starcom/Rick Gardner 1:154/69 414-445-6969 Canada (FidoNet Zone 1) AB Calgary Message-Line [K-12] 403-244-4724 AB Calgary Rainbow Connection/Brent Rector 1:134/172 403-244-0794 AB Edmonton Ten Forward/Tom Hall 1:342/1 403-424-3258 AB Edmonton Toys For Boys/Alex Solski 1:342/24 403-497-7816 AB Lethbridge Lost Planet/Terry Fleming 1:358/16 403-381-3185 AB Lethbridge Terminal/Laz Gottli 1:358/17 403-327-9731 BC Kelowna Dementia 9.4 1:353/294 604-765-5746 BC Nanaimo ADAnet Canada/Celia Corriveau A:94:94/10 604-756-3177 BC Vancouver Lambda Speaks/Warren Cox 1:153/756 604-681-3667 BC Vancouver PC-WorkShop/Ervin Jay 1:153/767 604-682-0914 BC Vancouver PC-WorkShop/Ervin Jay 1:153/797 604-687-0913 BC Vancouver PC-WorkShop/Ervin Jay 1:153/798 604-689-0437 BC Vancouver Phaonica * aids/hiv/Ed Parker 1:153/732 604-683-2144 ON Gloucester Coven's Den/Sorceress 1:163/436 613-746-5559 ON Hamilton Villa Gryphus/Kelly Ryan 1:244/106 416-545-5789 ON Mississauga Canada Remote System/Rich Munro 1:229/15 416-579-6302 ON Ottawa AlterNet/Paul Hannon 1:163/113 613-230-9519 ON Hull Cookie Jar 1:243/40 819-778-7956 ON Ottawa Chaos Central/Neal Bouffard 1:243/50 613-228-7268 ON Ottawa Echo Valley/Michelle Chartrand 1:243/26 613-749-4550 ON Ottawa Mother's Board/Perry Davis 1:243/38 613-728-4122 ON Ottawa Mother's Board/Perry Davis 207:1/203 613-728-4122 ON Richmond Abacus-I/John Gyulasi 1:153/968 604-272-4311 ON Richmond Ultimate/Steve Allan 1:243/52 613-838-4812 ON Toronto ADAnet Ability OnLine/ A: 416-650-5411 ON Toronto Dungeon/Trojan Horse S: 416-926-8734 ON Toronto Dungeon/Trojan Horse S: 416-926-8739 ON Toronto Gay Blade/Phil Dermott 1:250/214 905-882-4800 ON Toronto Gay Blade/Jock Strap S: 905-882-4800 ON Toronto Gay Blade/Phil Dermott 207:1/202 905-882-4800 ON Toronto Kaikatsu na Sakaba/Phillip Catt 1:250/470 416-778-7334 ON Toronto LeftoverHippies/Lesley-Dee Dyla 1:250/824 416-466-8195 ON Toronto QNet3/ A: 416-745-8133 PQ Montreal S-TEK/Eric Blair 207:1/201 514-597-2409 PQ Montreal S-TEK/Eric Blair S: 514-597-2409 PQ BellefeuilleEchoMailCoordinator/Ray Beriau 1:242/90 514-433-1105 Latin America (FidoNet Zone 4) PA Panama City Century XXI 4:920/50 011507638075 Overseas - Africa (FidoNet Zone 5) Senegal Edna/Kate White 5:7711/1.25011221217627 Overseas - Asia (FidoNet Zone 6) HK Island /T.K.Kang A:94:94/6 852-855-0569 Overseas - Australia (FidoNet Zone 3) Armadale AlternativeAccess/Michael Bates 3:632/502 61-3-5000067 Burwood, NSW Eagle One/Terry Harvey 3:712/704 61-2-7453500 Cairns Far Northern News/Noel Roberts 3:640/531 61-7033-1553 Canterbury Pride/Addam Stubbs 3:632/353 61-3836-6782 Carnegie Orion/Peter Fortey 3:632/338 61-3885-0002 Carnegie Orion/The Phoenix S: 61-3885-0002 Fitzroy Big Tedd's #2/Robbie Bates 3:634/381 61-3417-1669 Greensborough Cool World/Gary Greer 3:635/564 61-3-4320716 Sandgate Soft-Tech/Alwyn Smith 3:640/201 61-7269-6355 Overseas - Belgium (FidoNet Zone 2) Marchienne CarrefourSante/PhilippeRasquinet2:293/3211011-32-71518162 Overseas - France (FidoNet Zone 2) Paris hivNET/Jean-Luc Dalous 2:320/303 33-1-42544519 Overseas - Germany (FidoNet Zone 2) (Cont'd.) Berlin A&M Soft/Michael Vogt 2:2403/34 49-30-3915186 Berlin hivNET/Joerg Schulze 2:242/1205 49-304542605 Berlin Kumpelnest/Matthias Ganick 2:2403/43.349-30-4026340 Rutesheim SCHWUBBS GAyBBS/Roland Teich 2:246/1603 49-7152-56330 Haar OASE/Wolfgang Roth 2:246/25 49-89-6883262 Hamburg SGBB/Thomas Blaesing 2:2403/43.549-40-8505958 Muenchen Medical System/Arnulf Bultmann 2:246/63 49-89-295223 Muenchen Tadzio Gay/Daniel Schroeder 2:246/75 49-89-657447 Nuremberg Mustang/Ralf Ulbrich 2:246/8 49-91-1505669 Seeheim MoonBeam/Christoph Vaessen 2:2405/11 49-62-5786308 Velbert Oganpipe/Michael Smetten 2:243/7011 49-2051-56866 Overseas - Italy (FidoNet Zone 2) Roma sidanet/Massimiliano Fiorenzi 39-6-86801371 Overseas - Netherlands (FidoNet Zone 2) Paradise! 2:280/712 31-36-5314728 Aalten BIB/Freek Kempink 2:500/279 31-5437-74203 Amsterdam ArtNet/Martin Cleaver 2:280/204 31-20-6163698 Amsterdam Black Box/Stefan de Droog 2:280/403 31-20-6255563 Amsterdam Broomcupboard/Jochem Broers 2:500/296 31-20-6362575 Amsterdam Cyberspace/Sico Bruins 2:280/404 31-20-6754650 Amsterdam hivNET Testlab/Matthew Lewis 2:280/419 31-20-6125918 Amsterdam hivNET/Tjerk Zweers 2:280/413 31-20-6647461 Amsterdam PCN/John Kessel 2:280/415 31-20-6962860 Amsterdam Utopia/Felipe Rodriquez 2:280/308 31-20-6273860 Apeldoorn Dutch Health/Ruud vd Linden 2:500/211 31-55-337951 Breda Pro Deo/Marco Blaauw 2:285/201 31-76-223378 Breugel MadCat's/Lodewijk Otto,MD 2:284/120 31-4990-60548 Den Haag Gay-Biseks CRUISING/Ben Fama 2:281/532 31-0703450380 Diemen FsFan/Hans Hoekstra 2:280/304 31-20-6958426 Heerlen hivNET-Limburg/Lucas Vermaat 2:284/306 31-45-231754 Leiden CommPoort/Dennis Hammerstein 2:281/403 31-71-124350 Pijnacker Gaypalace/Andre Degenhart 2:285/163 31-1736-99126 Rijswijk Interface/Ron Huiskes 2:281/506 31-70-3361380 Rotterdam hivNET/Simon Bignell 2:285/818 31-10-2130501 Schiedam Bommel's/Nitz Neder-Helman 2:285/800 31-10-4700939 Waddinxveen Monade/Olaf Boezelijn 2:281/709 31-1828-11894 Overseas - Oceania (FidoNet Zone 3) Burwood, NSW Eagles/Terry Harvey A:94:8610/161-274535006 Stanmore NSW /Colin Lean A:94:94/8 61-2569-5130 Overseas - Sweden (FidoNet Zone 2) Stockholm Gay Telegraph/Bengt Ericsson 207:1/301 46-8-6530808 Overseas - United Kingdom (FidoNet Zone 2) Spartacus/Barry Kingston-Wyatt 2:255/27 03-273-509152 Flaversham DataServeSystems/GrahamJenkins 2:440/23 44-795590170 Locksheath United Europe/George Cordner A:94:94/9 44-489-577514 London Gnfido/Karen Banks 2:254/70 44-71-6081899 London hivNET/Ron Dixon 2:25/555 44-81-6956113 London Out/Damien Marcus 2:441/55 44-71-4908493 London POS+NET/Ron Dixon 2:25/555 44-81-6956113 London Quadris Technics/Michael Pereira2:441/99 44-81-6499408 ----------------------------------------------------------------------- ------- Question 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