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Internet resources for what you need to know about NYC Health
Five Favorite Sites For Beginners

The Topic
"Health" refers to the health issues facing the city, touching on everything from the mayor to Medicaid to managed care to mosquitoes.
The Context
New York City is one of the biggest public health challenges in the world. With 8 million residents--roughly 2 million of whom are uninsured--the city has the largest number of HIV cases and the largest number of intravenous drug users in the U.S. Efforts to contain a tuberculosis outbreak that threatened the city in the 1990's have been a major success--between 1992 and 1998, the deadly multi-drug resistant cases of TB declined by over 90 percent.

New York City has 20 public hospitals which served 1.5 million people in 1998 alone.

The Reporter
Maia Szalavitz is author, with Dr. Joseph Volpicelli, of "Recovery Options: The Complete Guide: How You and Your Loved Ones Can Understand and Treat Alcohol and Other Drug Problems." She writes frequently on health, science and public policy for the New York Times, New York Magazine, the Village Voice, and other publications.

by Maia Szalavitz

AIDS 2002

As attention to AIDS increasingly focuses on the out-of-control epidemic in Africa and as New Yorkers continue to recover from 9/11, local problems with HIV have ceased to make headlines. Nonetheless, between June of 2000 and December of 2001, over 6,000 new HIV infections were reported in New York City and over 43,000 New York City residents are estimated to be living with HIV. New York state women account for over one-quarter of all women infected in the U.S.; men from New York make up nearly 18 percent of all cases in the country.

Says Terri Smith-Caronia, director of New York City Public Policy for Housing Works, an agency that helps homeless people with AIDS, "We've always been living at Ground Zero in the AIDS community. The crisis is not over yet."

Smith-Caronia points out that while recently, activists have focused their efforts on the black and Latino communities, the epidemic has always hit communities of color here hardest. But it is getting worse: over 80 pecent of newly infected people with HIV in New York are African American, Latino or Asian; 90 percent of recently-infected women with HIV in the city are women of color.

After a concerted lobbying effort, new money devoted to fighting the epidemic in the black and Latino communities was saved from the budget ax. $2.5 million in new city funding and a matched contribution by the state will be allocated this year. The next fight, says Smith-Caronia, is to make that funding stream permanent; right now the funding is a one-shot deal which won't sustain new programs. "That's the next hurdle to overcome," she says, and adds that "It's something we're very happy to see with the new [Bloomberg] administration and something we never would have gotten from [Mayor Giuliani]."

This year's AIDS conference, the major gathering of experts in the field which is now held every other year, took place in Barcelona, Spain and concluded July 12. No major breakthroughs were reported -- and discouraging news about how people infected with one strain of HIV can become infected again with another threw a damper on hopes that the vaccines being studied in large clinical trials now will prove effective.

Howard Josepher, executive director of Exponents, Inc., a New York non-profit organization that trains current and former drug users in HIV prevention and offers addiction treatment and case management, attended the meeting. He says, "They say that a vaccine is still five years away. But that's precisely what they said in Durban [at the last AIDS conference] two years ago."

Resistance to a new class of HIV fighters, the fusion inhibitors, has already been seen. Research presented at the conference demonstrated that antiviral drugs alone will never cure AIDS, because the virus hides in certain human immune cells which can copy it. Since the antivirals only work when HIV reproduces itself, this means that some virus will always be unaffected.

However, the first of these new medications, a drug called T-20, does offer at least some additional time to those whose virus has become resistant to existing medications.

That is, if they can get access to the drugs. Ninety-four percent of people with HIV -- some 40 million people -- live in developing countries, but only two percent of those who could benefit from anti-HIV "cocktails" in those countries currently receive them.

The meeting was riven by protests demanding increased funding for medications and prevention for the developing world. Economist Jeffrey Sachs, now director of the Earth Institute at Columbia University, who launched the Global Fund to Fight AIDS, Tuberculosis and Malaria at the Durban conference, told a recent meeting of science journalists that if the industrialized nations devoted just 1.5 percent of their gross national products to global health, major infectious diseases could be brought under control. He theorizes that the high death toll from disease is an important part of the reason why so many African countries have not been able to overcome widespread poverty.

At a press conference following the AIDS meeting, Sachs said the U.S. should give $3.5 billion to the Global AIDS Fund to get the ball rolling. As a proportion of their total spending, other developed countries devote far more money to foreign aid, and even with recent increases, the U.S. has only put $500 million into the fund. In an analysis published in the Lancet, the World Health Organization said that an additional 45 million people will become infected with HIV by 2010, but that 29 million deaths could be averted if the global fund met its $10 billion per year target. Currently, the fund has only $2.1 billion committed to it.

With treatment so expensive and complicated and a vaccine proving so difficult to develop, prevention efforts are increasingly important. Recently, a number of organizations have begun to push the idea of developing a product called a microbicide. The ideal microbicide would be a lubricating gel that could be used without a condom to prevent the virus from entering the body.

If the gel was tasteless and odorless (or had a mild or pleasant taste and smell), it could be used by women without the knowledge of their partners and by those who can't or won't use condoms. At least five candidate products are scheduled to start late-phase clinical trials this year. Because the big pharmaceutical companies don't see microbicides as money-makers, however, funding remains a major obstacle. The Gates foundation recently donated $50 million to the effort and the Rockefeller Foundation and the British government are also studying microbicides. But the cost for a clinical trial for just one product would be at least $500 million.

One of the most interesting and furthest-advanced in the testing process is a microbicide called Carragard, developed by the Population Council. It contains carrageenan, a red substance made from seaweed which is already widely used in ice cream, baby food and soups as a thickener which doesn't affect flavor. David Phillips, senior scientist at the Population Council, has been studying microbicides for at least eight years.

"I started with anything I could get from the [chemical supply] catalog," he says, adding that the literature already suggested that carrageenan might be a good candidate since it was known to have antiviral properties. "It was just one of the things I tried - I didn't even know it was used in foods." This use gives the product an edge, however, because the FDA has already accepted it as safe for human consumption.

In animals, Carragard protects against herpes, gonorrhea and genital warts as well as HIV, which may mean there is a larger market for the product in the West than manufacturers have anticipated. In the U.S., for example, nearly 20 percent of the adult population is infected with genital herpes . An unintrusive way of preventing this embarrassing infection might really catch on.

But while studies of Carragard in humans are planned for South Africa, Thailand and New York, money to complete the clinical trials process is still far short of what is needed. Microbicide development is one of the few bright spots in the current AIDS picture - and an area where investment now would seem likely to produce impressive and relatively fast results. The longer we wait, the more expensive and difficult the fight becomes.

Maia's Favorite Five Sites For Beginners:

  • New York City Department of Health - Includes health alerts (including West Nile info), information on restaurant sanitary conditions and information on various health-promotion programs.
  • New York State Department of Health - More health data for New Yorkers including information on how to sign up for Child Health Plus and Family Health Plus-- the insurance programs for those who are presently not covered by other plans.
  • Medscape - This site, aimed at doctors, allows you to search Medline, the database of medical journals, for free. Abstracts of most journal articles are available for free as well. Once you have some basic knowledge about a condition you are researching, you can look here to get a sense of what is going on in terms of study in the area. There is a companion consumer-focused site, CBSHealthWatch, which is linked.
  • American Cancer Society - Half of all Americans will face cancer at some point in their lives-- and the New York and Washington-based American Cancer Society web site provides a wealth of information for those dealing with the disease. Includes links to other major cancer sites and resources.
  • AIDS Information - A sort of "AIDS central" for New York city with links to major HIV/AIDS organizations and information sites.

Other Recommendations:

  • Quackwatch - Debunks medical scams and inflated claims made by "alternative" medical practitioners.
  • - A consumer health information site, affiliated with CNN.
  • Citizen Action - Healthcare is one of the primary focuses of this New York advocacy group. Includes information on New York's health plans for low income people lacking insurance.
  • Oncolink - An incredible research resource for cancer patients and others concerned about this disease.
  • National Alliance for the Mentally Ill - An organization of advocates for people with mental illness which includes information on treatment and support for various disorders like depression, bipolar disease and schizophrenia.
  • Insure Kids Now - Information on New York state's insurance program for poor kids and information on other state's policies, from the federal government and the governors' association.

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Gotham Gazette is published by Citizens Union Foundation and is made possible by support from the Robert Sterling Clark Foundation, the John S. and James L. Knight Foundation, the Altman Foundation,the Fund for the City of New York and donors to Citizens Union Foundation. Please consider supporting Citizens Union Foundation's public education programs. Critical early support to Gotham Gazette was provided by the Charles H. Revson Foundation, Rockefeller Brothers Fund and the Alfred P. Sloan Foundation.

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