gilbert@tcela.COM (Gilbert Cornilliet) (04/25/91)
================================================================ CHOOSING THE BEST HOSPITAL FOR PATIENTS WITH AIDS by Sheila Hutman Is the best hospital the closest, the one with a VCR in the lounge, the teaching/research hospital, the one with the best discharge planning services, or the one with the latest technology? Not an easy question. The decision becomes simpler, however, if you look for the hospital that achieves the best outcomes in treating people with AIDS (PWAs). THE SIGNIFICANCE OF HOSPITAL EXPERIENCE In a recent study, Charles L. Bennett, MD, Assistant Professor at UCLA, and six colleagues used mortality rates for Pneumocystis carinii pneumonia (PCP) as a measure of hospital quality of care. They found that the single most important factor in determining whether or not a patient survived his or her first hospitalization for PCP was the amount of experience the hospital had in treating PWAs. "Previous studies showed a hospital's experience was a key factor in patients' survival for surgical procedures, but this is the first research to show that's the case for a medical condition," said Dr. Bennett, a Health Services researcher and an AIDS clinician. Bennett's group analyzed the hospital records of 257 people infected with HIV who were treated for an initial bout of PCP between October 1986 and October 1987 at 15 private hospitals in California metropolitan areas. In this patient sample, 39 (15.2%) died while hospitalized. The mortality rate for all medical conditions at these hospitals averaged 2.7%. The researchers defined a hospital as familiar with treating PWAs if it discharged more than 30 HIV-infected people per 10,000 annual discharges. AIDS familiarity ranged from 4 to 110 discharges per 10,000. Eight of the 15 hospitals were classified as having little experience with the disease. Severity of illness was estimated by (1) hospital admission from the emergency room or another hospital, (2) the presence of tumors or other infections typically seen in AIDS patients, and (3) a history of prior hospitalizations for AIDS-related illness. In hospitals with little AIDS experience, 33% of PWAs with PCP died. The mortality rate from PCP in hospitals experienced in treating AIDS was 12%. After adjusting for severity of illness, the research team found that the chances of dying in-hospital at a low AIDS familiarity facility are about 3.6 times higher than at a high AIDS familiarity hospital. These results imply that it can make a difference where people with AIDS get their care. Familiarity with the disease facilitates early diagnosis and timely medical decisions. In evaluating a hospital, Bennett recommends finding out how many other AIDS patients have been treated there. While national data from other studies confirms the Los Angeles group's results, the researchers believe that their work should be repeated in various geographic areas, in all risk groups (their subjects were mostly gay men) and among the poor. In their initial study, Bennett and his associates made the following recommendations to improve the quality of AIDS care in the U.S.: 1) establish regional AIDS centers in low incidence cities; 2) promote a rapid but carefully monitored increase in experience for hospitals with low volumes of HIV-infected individuals; 3) provide highly focused educational efforts at low AIDS experience facilities. Bennett's report makes one wonder if a hospital gets better because it learns or if it has better outcomes because people select it for its reputation. A national study by Judy Ball showed that in some cases experience and in others selective referral account for a hospital's success. Both factors lead to better outcomes. PATTERNS OF RESOURCE USE In a second study, Bennett and colleagues presented the patterns of resource use at hospitals with high and low AIDS familiarity. Average charges and resource use did not differ between the two groups. However, there were marked variations in how the resources were used. Among survivors, patients who received care at high familiarity hospitals stayed in the hospital longer, underwent a bronchoscopy more often (making possible the diagnosis and treatment of additional pulmonary infections), stayed in an intensive care unit longer, and accrued higher average total charges than patients at hospitals with low AIDS familiarity. Conversely, among nonsurvivors, a greater intensity of care was received at the hospitals with low AIDS familiarity. These findings suggest that physicians in low experience hospitals might improve the chances of in-hospital survival by more timely and efficient use of resources. It appears that they tend to undertreat early in hospitalization and use high levels of resources when it is too late to save patients who are nearing the end of their lives. Physicians at high familiarity hospitals seem to be better able to judge the severity of PCP infection early and to respond by quickly allocating high levels of resources to severely ill patients. VIEW FROM A LOS ANGELES HIV SPECIALIST Director of the Immune Suppressed Unit at Sherman Oaks Community Hospital near Los Angeles and private practitioner, Michael S. Gottlieb, MD, fully agrees that the quality of AIDS care in any hospital can be equated with the amount of experience that hospital has in treating AIDS. "I believe that the improved outcomes documented for PCP will be extended to other AIDS-associated conditions," he said. For Gottlieb, numbers of cases alone do not explain the decrease in hospital mortality. "Experience" refers not just to a hospital, but to its physicians and nurses, who have become specialists in HIV care and have chosen to work in this demanding field. Its expert diagnostic and pathology services have a keen interest in this disease. Its ancillary services are efficiently organized to respond promptly. Its departments cooperate with each other. Its administration is committed to the AIDS program, generous with moral and financial support, and quick to move in new directions. For example, only a few Los Angeles hospitals have been willing to invest in the induced sputum test, which facilitates early diagnosis of PCP and leads to improved outcomes. Without it, most patients suspected of having PCP undergo bronchoscopy, which has well-known complications. "Physician interest is the key to developing a strong AIDS capability," Gottlieb said. At Sherman Oaks, it was the physicians who pressed for and implemented changes which enable the hospital to provide top quality care. The patient population also affects the success of AIDS treatment. People who choose a doctor with a high index of suspicion about HIV infection and see him or her early stack the deck in their own favor because they are diagnosed and treated sooner. Compliant patients have even more favorable prognoses. In areas where there are few AIDS specialists, Gottlieb added, patients must wait to be seen and tend to be sicker when they are admitted to the hospital. This reduces their chances for successful outcomes. Patients who are treated with compassion in the hospital do much better than those who are made to feel like lepers. Patient satisfaction, functional status, length of stay, and other quality of life measures also can be used to evaluate hospital care. "If there are regional differences in the quality of care," Gottlieb said, "they may be related to the system of payment." Since Medicaid is more available to PWAs in the northeast than in California, more of them receive the care they need. In New York, New Jersey, and Delaware, regional centers have been established for Medicaid HIV patients. These centers receive increased state funding specifically for the treatment of AIDS. Medicaid patients also can be treated at all other facilities. As the Medicaidization of AIDS proceeds, the east coast model may be important for California. The quality of care on the west coast would benefit from the designation of regional treatment centers and special reimbursement for both physicians and hospitals that treat PWAs. Elaborating on the Bennett study suggestion that regional AIDS centers be established in low incidence areas, Gottlieb recommended that these centers be designated now through a competitive process in which hospitals submit proposals stating what they could offer. VIEW FROM A SAN FRANCISCO NEUROSURGEON Philip R. Weinstein, MD, a neurosurgeon at UCSF, provides another perspective on quality of care. He, too, feels that the most important determinant of the quality of care is the individual physician. He believes that UCSF offers neurosurgical care that ranks with the best in the world because its exceptionally qualified neurosurgeons work as a team with highly skilled nurses, physicians from other specialties, and providers of auxiliary services. However, the nature of that care varies from doctor to doctor. Some provide personal attention and emotional support as well as professional expertise. Others give only their expertise. It is up to the patients and their personal physicians to choose the doctor who suits them best. The quality of the nursing staff has a lot to do with patients' perceptions of their care. This is because the nurses spend eight hours a day on their hospital unit. Although the doctor is the leader of the health care team, he or she may see a patient for ten minutes or less. The role of nurses is especially vital in teaching institutions, where they are often the only ones who take the time to comfort patients and their families. To attract good nurses, a hospital and its physicians must treat them as important, respected members of the staff. Like doctors, nurses thrive on the challenge of using their skills where they are needed most and working at the forefront of their field, Weinstein said. (Sheila Hutman is a Los Angeles based medical writer. She can be reached through the Being Alive office.) ================================================================ FREE PLANE TICKETS, ACTIVISTS' SUPPORT GROUP AND OTHER THINGS by Fran Mc Donald, social services editor As far as I'm concerned, the drink and airline of choice are now Pepsi and Continental because they, in association with Aid for AIDS, are offering all members of AFA up to two free round-trip tickets to anywhere in the continental U.S. Membership in AFA has the same requirements we're familiar with in similar organizations, such as an AIDS diagnosis (AFA in particular requires an original, not a photocopy) and income limits. If you are not already a member of AFA, they are at 8235 Santa Monica Bl., West Hollywood 90046, phone 213.656.ll07. Contact them for application material. A gesture like this sets a wonderful example to would-be corporate sponsors to demonstrate a sense of civic responsibility at the same time as great benefits can be reaped from what is advertising of the best kind. Indeed, it's the sort of gesture that prompts me to do any flying on Continental only and to serve only Pepsi products in my home. SUPPORT GROUP FOR ACTIVISTS One of the people who responded to my item last month about California cheating SSI recipients and my suggestion to write letters of protest, has a good idea, a support group for activists. As he said, the intensity of the work can certainly cause burn-out and this is a time when we need to keep such activists fully operational. I know we derive a certain strength from just knowing that the work we do is the humane, morally right thing to do; but sometimes the camraderie, mutual concern, and sense of sharing to be had in a support group can be a shot in the arm. If you agree, please call me and let's make such a group a reality. As a post-script, I have not cared for the word activist to describe myself ever since the intended target of my crusade of the moment called me a rabble-rouser, on WGN-TV in Chicago. Something about it appealed to me, maybe the alliteration. Anyway, from now on if you talk about me, please be sure to refer to me as "that rabble-rouser from Being Alive" just so everyone is certain to know you're talking about me. SPECIAL LIGHTWEIGHT BLANKET I came across something while shopping for myself that might be useful to you. It's the Space Brand Emergency Blanket, which weighs only 2 oz. and folds up to the size of a pack of cigarettes. It was originally made for NASA but is now available to the public. It retains up to 80% of the heat your body releases, so is ideal if you want a lot of warmth but not the weight and volume of regular blankets. I also thought it might be good to throw around yourself at a ball game or a picnic, when you want to be warm but not be bundled up like Nanuk of the North. The price is right (only $2.99) and is available at sporting goods and camping stores such as Big 5, Fedco, Adventure l6, and R.E.I. If for some reason you have trouble finding it, just call me. Incidentally, the blanket is being merchandised as an integral part of the earthquake preparedness kit we all should have, and I bought one for just that purpose. RENTERS' CREDIT UPDATE I want to apologize for the incorrect phone number given in last month's item about the California Renters' Credit. The correct number is 800.852.57ll. Also, I have learned that new forms for the retroactive credit will be ready by May. If you want one, call me and I'll see that you get one as soon as they're ready. In the meantime, fill out your state tax return for l990 to get last year's credit, $60 if you're single. PAST OFFERINGS Several readers who have only recently started reading the Being Alive Newsletter have asked me what things have I written about in past issues and are the items mentioned still available (yes, everything is still available). If you'd like a list of those items, call me and I'll send it to you. And I'll be happy to send anything on the list that you want. (Fran McDonald has been in Social Services for 20 years and welcomes your calls at 213.664.4772.) ================================================================ NUTRITION UPDATES by Brian A. Smith, D.C. GLUTATHIONE AND THE IMMUNE SYSTEM I wrote an article regarding glutathione for the June 1990 Being Alive Newsletter. As I wrote in that article, glutathione, made of three amino acids, is required for proper immune function and free radical oxidation. HIV+ people have demonstrated a decreased level of glutathione in the blood (30% decrease) and lung tissue (60% decrease). The cause of this deficiency has not yet been determined. The possible results include impaired immune function and an increase in oxidative damage which may enhance HIV gene expression. (Please refer to the article for a more detailed explanation.) At the time I wrote that article there was no information about benefits realized by increasing glutathione levels. My opinion was that a normalization of these levels would allow better immune function and decrease the damaging oxidative stress that is apparently increased in HIV+ people. Now, from Cornell University Medical College comes preliminary research that glutathione does suppress the spread of HIV in a test tube. Dr. Alton Meister, co-author of the study (published in the Proceedings of the National Academy of Science, Feb. 10, 1991) and chairman of the Department of Biochemistry at Cornell, said that up to 90% of the spread of the virus can be blocked by two forms of glutathione and one of its constituent amino acids. The reduction of virus production appears to be proportional to the amount of glutathione. He also stated that glutathione deficiency may contribute to the breakdown of the immune system. Readers of the Being Alive Newsletter should be pleased to know that they have been informed about glutathione since June 1990. PRACTICAL APPLICATIONS In the February 1991 issue of the Being Alive Newsletter I detailed a case history of an actual HIV+, pregnant patient who had a low platelet count. I continue with this case. After the trial of gamma globulin which increased the platelets to 139,000, they dropped to 71,000. This was expected since the effects of gamma globulin are transient. The platelets continued to rise with the nutritional protocol designed for this patient. They peaked above 80,000, which is still low; normal is 150,000 to 400,000. As the patient's "due date" approached, her platelet count started to decline once again. A larger dose of gamma globulin was given; however, the response was less, to 110,000. This time her platelets dropped to 60,000 and stayed there. Her Ob/Gyn refused to allow a vaginal delivery for fear of hemorrhage of the mother or infant. Another dose of gamma globulin was injected along with the steroid prednisone, in an effort to increase the platelet count. She went into labor before the drugs could work and by that time the platelet count had dropped to 39,000. At this time a second hematologist was called in and voiced his opinion that the low platelets may have caused by Disseminated Intravascular Coagulation (DIC). The DIC could be a result of the fact that this patient had a second fetus which died in the 14th week of pregnancy. If the lab tests support this possibility, there is little anything could have done, conservatively and medically, until this second fetus was removed. The fact that we had positive response from a nutritional protocol and reversed the platelet decline speaks highly for the effect of properly applied nutritional therapeutics. We were able to forestall the administration of medications the patient didn't want to take and which, ultimately, would probably not have worked. The good news is that this patient is a happy mother now, via cesarian section. We will monitor both mother and baby continuously. The umbilical cord will be checked for viral markers to help determine if the baby has the virus. We plan to perform a viral culture at two months if possible. The baby may be HIV antibody positive for up to two years before the body clears the antibodies away. (Dr. Brian A. Smith is a chiropractor who has been involved in the care of HIV+ individuals since commencing practice in Los Angeles. He can be reached at 213.559.6584.) ================================================================ AIDS AND CHEMICAL DEPENDENCY by Danny G. Jenkins, CSAC The American Society of Addiction Medicine's 5th Annual Conference, "AIDS and Chemical Dependency" took place in San Francisco in February. The conference provided a forum for Chemical Dependency (CD) professionals to discuss the evolving HIV spectrum disease as it relates to alcohol and other drug use. This year's conference offered national evidence of the growth in HIV's prevalence in alcohol and other drug using (not just intravenous drug using) populations, women, and people of color. Particularly insightful highlights included: - a focus on the rising seroprevalence in crack users, and the link in crack addiction, quick sex for crack, and HIV infection; - full discussions on the issues facing women at risk and women with AIDS, such as under-reporting, lack of access to health care, the inapplicability of AIDS-definable diseases to women, and incompetent/insensitive programming; - some initial reports, though scarce, on the impact of alcohol and other drug use on HIV progression; - the promising utilization of antabuse and naltrexone, traditionally used for CD treatment, as immune modulators. Sadly, there was a blatant lack of representation by people with HIV spectrum disease and people of color in the planning and facilitation of this event. Their presence is especially vital in broadening the perception of those working in the field, and particularly those who come with the desire to learn about the reality of the disease to date. During the conference, a number of points emerged as crucial signposts in working in the fields of both chemical dependency and HIV. LIVING WITH AIDS AND THE PRINCIPLES OF RECOVERY The qualities of proactive living with AIDS are similar to the principles of recovery. These include assertiveness, acceptance, positive attitude, personal responsibility, commitment to life, a "partnership" with the treatment team, being self-nurturing, working with others who are HIV infected, and being emotionally connected with others. Melvin Pohl, M.D., one of the co-chairs of the conference, and Dr. Richard Elion, M.D., eloquently expressed this position, one which is well known to those of us working with HIV-infected persons in treatment. Of key importance here is recognition that these mechanisms are not readily in place, and take time, care, patience and hard work to develop. NEEDLE EXCHANGE PROGRAMS Comprehensive model needle exchange programs work, not just to reduce the transmission of HIV through needle-sharing, but also to link persons ready for treatment to appropriate programs. Edith Springer, M.S.W., a dynamic gift to the field in New York, and Camille Aracabe, who carried the message of ACT/UP San Francisco, were well congratulated for their powerful presentation. It appears that needle-exchange programs, which are well linked to treatment, work so effectively, that the issue of inadequate treatment slots becomes an even more obvious dilemma. Ms. Springer wrapped it up by saying, "You can't provide treatment to a dead drug addict - and if we don't change our system, that's what we'll have, and plenty of them." NEED FOR ONE-STOP CD AND HIV CARE One-stop CD and HIV care is necessary to provide timely, competent care to substance using persons. HIV care programs, including case management and early intervention, prove most successful in retaining chemically dependent persons, when offered on-site by treatment providers who have experience in working with them. If it is agreed that we cannot afford to allow these persons to slip through the system, we must modify our efforts to correlate with their priorities and immediate needs. An example of two barriers to compliance are: (1) little trust by alcohol/drug users in the system which has historically resisted their integration, misunderstood their needs, and judged their behaviors moralistically; and (2) a lack of skills, resources, and experience on behalf of alcohol/drug users to navigate their way through a system which is cumbersome, fragmented, and insensitive, and which was designed to assist the empowered, assertive, and insured. This is especially evident for those early in treatment or recovery, whose coping mechanisms are underdeveloped, and who very naturally turn to a substance to medicate their feelings or deal with a difficult situation. DEALING WITH THE DUALLY DIAGNOSED Services must become "User Friendly" to be effective. The "Harm Reduction" Model, developed by Ms. Springer, may facilitate our effective work with alcohol/drug users, and will inevitably teach us a great deal about ourselves. While abstinence from substances may be a final goal, it should not be our only goal, and short term objectives toward achieving this goal might include "not sharing works" and "safe injection." In order to be effective, services and the helper/client relationship must be client driven, whether the client is clean/sober, or using/drinking. This is crucial when dealing with dually diagnosed persons, in which frequent relapse is the norm, and a choice against abstinence is not unusual. This pre-supposes that alcohol/drug users must be afforded the same rights as anyone else, including the right to use and/or drink, a concept which may be difficult for many to accept. The prohibition of persons using/drinking in research protocols and drug trials exemplifies a lack of willingness to respect those rights. How else are we to learn the differences in the way HIV drugs affect chemically dependent persons, to proactively address the reality of the changing epidemic? How willing are we to adapt our regimens to the needs of these very special populations? Or will alcohol/drug users, already burdened with racism, classism, sexism, and poverty, also be considered a throw-away population by the HIV service system? (Danny G. Jenkins is the Director of HIV Services at the Tarzana Treatment Center, 818.996.1051.) ================================================================ CLINICAL TRIALS AND YOUR PRIMARY HEALTH CARE PROVIDER by Sally Kruger Many people without adequate health care insurance have difficultly in paying for a primary health care provider. If you fall in this category, clinical trials can go a long way toward helping you with your medical care. At some locations, such as Harbor-UCLA, the medical care, laboratory work and medication involved in the clinical trial are provided free of charge. So if you are feeling well, do you still need to go to the trouble and expense of having a primary health care provider while enrolled in a clinical trial? There are two very good reasons for having such a provider. First, you need to have a place to go in the event of a medical emergency. If there is a chart set up on a patient with basic medical history and baseline physical and laboratory work, both the patient and physician will benefit from this information. Second, a good basic workup on an HIV+ patient should include such basic lab work as screening to test for current or past exposure to syphilis, hepatitis serology, and toxoplasmosis titer (to test for exposure to a small parasitic organism that can infect HIV+ persons). In addition, patients who are immunocompromised should have a tuberculin skin test and be immunized with pneumovax, influenza vaccine and hepatitis vaccine (if hepatitis antibodies are not detected). These laboratory tests and vaccinations are not part of a clinical trial. On the other hand, even if you can afford the cost of primary health care, there are several advantages to participating in a research protocol. You may receive a medication that is helpful to you and you may be helping to get a beneficial drug licensed. Additionally, the lab results from the study can be provided to the patient to share with his/her doctor. In conclusion, trials are meant to supplement and complement the role of the physician in primary care, not to replace it. ================================================================ COMPOUD Q: TRICHOSANTHIN AND ITS CLINICAL APPLICATIONS a book by Qingcai Zhang, MD reviewed by Gilbert Cornilliet If you want to know more about trichosanthin (aka Compound Q), this book is for you. It is written by someone who knows Q very well. Dr Zhang comes from the Shangai hospital where Q has been used for almost two decades on over 100,000 patients. Today, Dr Zhang is in continuous contact with the researchers there. The author now lives in Long Beach and is well known by the AIDS community for his work with AIDS patients (by monitoring community trials of Q and by bringing the expertise of Chinese Medicine to restoring compromised immune systems). In this book, you will learn about the use of the original herb in Traditional Chinese Medicine, the chemical composition of the purified form used today, its pharmacology, its clinical applications in China (as an abortion inducer and also to treat some forms of cancer). The most important part of the book is devoted to the application of Q to AIDS treatment: how it works, the clinical findings (both in official and unofficial trials), the effect on the usual markers (p24, T-4 cells counts), the description and treatment of the side effects. Compound Q was written in mid 1990 and summarizes the knowledge about Q at that time. Studies are continuing but are not confirming Q as the miracle drug that we hoped it would be (see the report on Q published in the March issue of this Newsletter). To obtain a copy, contact the Oriental Healing Institute, 1945 Palo Verde Avenue, suite 208, Long Beach, CA 90815. The price is $21.95. ================================================================ TEENS REACH TEENS WITH HIV/AIDS INFORMATION by Wendy Arnold, MPH The Peer Education Program of Los Angeles (PEP/LA) is a non-profit organization in which multi-cultural teens are first recruited from L.A. County high schools, residential facilities and placement centers and then trained in HIV/AIDS information and communication skills. The trained volunteer peer educators lead small group discussions in youth facilities and academic settings. There they talk very openly, honestly and accurately about why teens are at risk for HIV infection, how to avoid an exposure to HIV and how to elevate the care, compassion, respect and normalcy of people living with HIV/AIDS. TRAINING OFFERED During the nine hour `formal' training and bi-monthly in-service meetings (held the 2nd and 4th Tuesday of the month, 5-7 pm, at the West Hollywood Presbyterian Church), the 12-19 year olds learn about transmission, prevention and behavior modification. We do not get inundated with medical semantics that can overwhelm some teens. It's the basics and not "the transmission of the human immuno-deficiency virus that suppresses the immune system as evidenced by the beta-2-microglobulin test, p24 antigen test and trend analysis of CD4s leading to Acquired Immuno-deficiency Syndrome..." We talk about "how you get it," "how you don't get it (casual contact)," and "how can you protect yourself." COMMUNICATION SKILLS Of equal importance to the accuracy of medical information is the heightening of communication skills. PEP/LA empowers teens to make the right choice with regards to the risk-taking behaviors associated with HIV infection. The peer educators feel that given all the information about the dangers of unprotected sexual activity and the sharing of needles (including tattoos and earpiercing), teens have the full capability to take individual and collective responsibility to promote positive sexuality and positive health. Much to the chagrin of many administrators of the L.A. Unified School District and several parents at Venice High School (where PEP/LA kids spoke with more that 2200 students in January 1991), PEP/LA teens feel that it is unrealistic to tell adolescents "to just say `no' to sex!" While we will always emphasize that the very best way to keep yourself protected from HIV is not to experiment with sexual activity and drug use, we say that if they know someone who is sexually active, or if they themselves have started sexual exploration (a normal teenage activity), we recommend the proper use of a latex condom. PEP/LA is controversial because of our openness, but our innovative approach does elevate a teen's feeling of self worth to make that right decision. This is achieved by sharing information with target youth in four education sessions. We do not believe that it is possible to adequately discuss birth-control, relationships, value clarification, sexuality, decision-making skills, STDs, and AIDS in one 45 minute health class. We encourage group participation through role-playing exercises in which teens see both sides of a situation, learn resistance skills and adapt negotiation strategies. PWAS INVOLVED Of particular importance to all PEP/LA activities, trainings, and educational outreach is the participation of people living with HIV/AIDS. PEP/LA is tightly coordinated with the Being Alive Speakers Bureau and it is a privilege to share our HIV/AIDS awareness with these very worthy individuals. When the speakers attend meetings, the peer educators quickly learn that PWAs are normal, wonderful people. Too often the media stereotypes someone with AIDS as a person with a disgrace and not a disease. The PWAs humanize the epidemic; they make it real not only by emphasizing the importance to take precautions against HIV but also in breaking the stigmas of fear and isolation. Often, there is an initial apprehension at the first interaction, but within minutes, the PEP/LA teens are hugging and nurturing Sharon or Mark or David or One entire outreach session is entitled "Meet an HIV-positive or AIDS-diagnosed Friend": the peer educators encourage the personal testimonies of Being Alive speakers at high schools, group homes, health fairs and peer counseling conferences. OPPORTUNITIES SOUGHT PEP/LA is an enthusiastic, dynamic and successful program in which teens talk to teens about HIV/AIDS. We invite opportunities to share these messages of prevention, communication and non-discrimination with youth organizations who will benefit from our honest, empathic and vitally important discussions. PEP/LA will help decrease the rising incidence of HIV infection in adolescents and will elevate the respect and dignity of friends who are living with HIV/AIDS. For more information on PEP/LA, contact: Wendy Arnold, PEP/LA, 5410 Wilshire Blvd., #203, Los Angeles, CA 90035, 213.937.0766. ================================================================ AIDS STORIES WANTED by Jeffrey Wayne Ericson If you or someone you know is HIV+ or is suffering from or has died from AIDS, I am interested in publishing your personal story im my book AIDS Letters. This books offers a unique opportunity for those of you who have been touched by AIDS to lend support to others by sharing your experience. If you need to speak with me directly, call me collect at 714.850.3021. Otherwise, write to: AIDS Letters, 4521 Campus Drive, Suite 101, Irvine, CA 92715. All materials will be held in strict confidence. ================================================================ LOCAL RESOURCES AA & AIDS: 213.274.1783 / 876.6899 ACT UP/LA: 213.669.7301 Aid for AIDS: 213.656.1107 AIDS Inter-Faith Council of S.C.: 213.250.9564 AIDS Healthcare Foundation: 213.462.2273; Med Group: 213.662.0492 AIDS Project Los Angeles: Client Services: 213.962.1600 Hotlines: 213.876.AIDS Toll-free S. CA: 800.922.AIDS Necessities of Life Program: 213.962.1600 Alcoholics Together Center: 213.663.8882 All Saints AIDS Service Center: 818.796.5633 Being Alive Long Beach: 213.495.3422 Being Alive South Bay: 213.316.5487 Beth Chayim Chadashim: 213.931.7023 Cara a Cara: 213.661.6752 City of Angels AIDS Hospice: 213.871.2044 The CORE Program: 213.656.8201. Friends For Life (HIV+ heterosexuals): Phil : 213.450.1907, Scott: 213.687.9809 Gay and Lesbian Community Services Center: 213.464.7400 Hay House: 213.394.7445 Hemophiliacs with AIDS: 818.796.5710 or 818.793.6192 Hemlock Society: 503.342.5748 Inland AIDS Project: 800.451.4133 Jewish Response to AIDS: 213.653.8313 Milagros AIDS Project: 213.261.2722 Minority AIDS Project: 213.936.4949 Mothers of AIDS Patients (MAP): 213.542.3019 NIH Drug Hotline: 800.TRIALS A Northern Lights Alternatives (The AIDS Mastery): 213.461.0261 Pacific Center for Counseling and Psychotherapy: 213.859.0359 PLUS (Positive Living for US): 213.962.8197; TTD 213.962.8398 Project Inform: 800.334.7422 415.558.9051 Shanti Foundation: 213.962.8197 voice 962.8398 TDD South Bay Free Clinic: 540.8222 Spanish Language AIDS Hotline: 800.222.7432 (SIDA) Toll-free S.CA Only Staying Alive LA Buyers' Club: 213.748.1295 Stop AIDS LA: 213.659.4778 W. Hollywood Cares: 213.659.4840 ================================================================ End of Being Alive Newsletter (April 1991 - part 2/2)