
AIDS TREATMENT NEWS #238, January 5, 1996
   phone 800/TREAT-1-2, or 415/255-0588

CONTENTS:

Getting Your Insurer to Cover New HIV Treatments: A Crash Course

CD8 Cells: Suppressive Factors Discovered

AZT plus 3TC Combination Results Published

Opportunistic Infection Prevention: National Video Symposium
January 11

San Francisco: Cryptosporidiosis Water Warning

Computer Censorship Update

Activist Groups, PWA Coalitions, and Buyers' Clubs, 
U.S. and Canada


***** Getting Your Insurer to Cover New HIV Treatments:
A Crash Course 

by Irwin E. Keller

[Irwin E. Keller, Esq., Interim Executive Director of the 
AIDS Legal Referral Panel of the San Francisco Bay Area, 
wrote the following article for AIDS TREATMENT NEWS.]

Introduction

Most Americans rely on some private insurance system to pay 
for their health care. Insurance, however, is not a 
government-provided service or a utility. It is private 
enterprise, and for that reason insurers have an incentive to 
maximize their profits by providing as little coverage as 
contractually and legally possible, while continuing to 
collect regular premiums from their insureds. Although 
persuading an insurer to pay for human growth hormone 
treatment for wasting syndrome may feel like a fight over a 
basic right to health care, in the eyes of the law it is only 
a dispute over the interpretation of a contract.

If you want cutting edge HIV treatment, it is likely that at 
some point your insurance company will deny a claim for 
benefits, and you will have a dispute on your hands. Although 
not intended to give you specific legal advice, this article 
will introduce you to some legal principles that may be of 
use in getting and keeping your care covered. As in all 
matters, it is important to know your rights and be ready to 
exercise them.

The Requirement of Medical Necessity, and Exclusions for 
Experimental Treatments

Most health insurance contracts require the insurer to pay 
for all health care claims that are "medically necessary," 
unless the treatment is specifically excluded by the terms of 
the policy, such as exclusions for "experimental" or 
"investigational" treatments. If your insurer denied your 
claim, it is important for you to ascertain the exact grounds 
on which it was rejected. Does your insurer claim that the 
procedure or treatment is not necessary, or that it is 
considered experimental, or that it is not approved for the 
particular use to which it is being put? For each of those 
grounds, you may need to respond with different arguments and 
evidence. 

A. Demonstrating the Treatment is Medically Necessary 

Most insurance contracts oblige insurers to pay only for 
procedures that are "medically necessary." Coverage for 
innovative procedures is often denied because these 
treatments may not have sufficient track records to render 
them obviously "necessary."

The law can work to your advantage in this kind of coverage 
dispute. First of all, courts tend to interpret insurance 
contracts liberally in order to provide the broadest possible 
coverage. In the course of your dispute, be sure to remind 
your insurer of this fact. 

The focus of a dispute over medical necessity is less on the 
treatment than on you. Certainly you can and should submit 
evidence that the treatment has been useful for others. But 
especially compelling is evidence that you have undergone all 
the other available treatments for the particular condition, 
and they have not been or have ceased being effective for 
you. If you have been able to use the disputed treatment, 
either paying for it out of pocket or through a trial 
protocol, and have a personal history of benefit from this 
procedure, it will be hard for your insurer to defend the 
position that the treatment is unnecessary.

B. Demonstrating the Treatment is not "Experimental" as 
Defined in the Policy

It is more likely that your insurer will deny a claim based 
on the assertion that the procedure is "experimental" or 
"investigational" in nature. If so, the first thing you must 
do is look at the insurance contract itself, to determine how 
the term "experimental" is defined. The law says that 
ambiguous terms in an insurance contract must be interpreted 
by a court in favor of the insured--not in favor of the 
insurer. The reason for this is that the insurer wrote the 
contract and had the opportunity to make everything clear. It 
therefore should not have the right to benefit from its own 
failure to draft a clear contract.

Many courts across the country have ruled that the term 
"experimental" is by nature ambiguous if it is not defined in 
the policy. Without a specific definition, it can be 
interpreted in numerous ways: procedures performed only for 
research purposes; procedures performed to benefit a patient, 
the results of which will be shared with researchers; etc. If 
"experimental" is not defined in your policy, a court may 
agree with you that the treatment you need is not 
experimental, and should be covered. 

For this reason, many policies do attempt to define 
"experimental." Some policies do so by referring to the 
findings of specific medical authorities, for instance 
whether or not the treatment has been approved by the FDA. If 
the treatment you need is considered experimental by the 
medical body named in the policy, you will not be able to 
effectively argue that the policy is ambiguous. (You could 
perhaps go to court and argue that in the context of HIV 
care, which develops far more rapidly than "official" medical 
bodies can evaluate, a person with HIV would NEVER be able to 
get coverage for the newest treatments if the exclusion is 
constructed this way. Since this catch-22 might cause you 
irreparable harm, the court should not enforce the policy 
exclusion, even though the exclusion itself is clear. Be 
aware that this is a hard type of challenge to win, and you 
should consult with a lawyer to determine if it is worth 
pursuing in your case.)

If, on the other hand, your policy's definition of 
"experimental" does not specifically name a medical authority 
whose determination will be relied on, but instead refers 
more vaguely to "appropriate medical bodies," you can once 
again argue that this definition of "experimental" is 
ambiguous and that the treatment you need is not experimental 
as defined in the policy. 

By pointing out that your policy's definition of 
"experimental" is ambiguous, you create an opportunity to 
demonstrate why the treatment you need is NOT experimental. 
Here are some points your evidence should address: 

1. Are there other insurers (including Medicaid or Medicare) 
that do pay for this procedure? If other insurers interpret 
their own policies to permit coverage, then the procedure is 
not unambiguously "experimental."

2. Are there scholarly articles or other outside 
documentation that this treatment is effective? In addressing 
effectiveness, try to touch upon community experience with 
the procedure, including the procedure's effect on health 
outcomes (long term survival, likelihood of recurrence of the 
condition, risks and side effects) when compared to other 
treatments as well as to no treatment at all. 

3. What is the community experience with this treatment? And 
your doctor's? Certainly your doctor's assessment will be 
central to your position. But since the insurer has 
presumably already heard and discounted your physician's 
recommendation, seek out testimony from other HIV specialists 
in the community to support your doctor's opinion. Find out 
if they consider this procedure to reflect the community 
standard of care. How long have they been using this 
procedure? Some courts have ruled that sufficient history of 
use of a treatment in the community makes it non-
experimental, even without literature on it and even if there 
are side effects to the procedure. 

C. Demonstrating that a Particular Use of a Treatment is Not 
Experimental.

Some insurers will attempt to deny or limit coverage for 
"off-label" uses of an otherwise FDA-approved drug or 
treatment. This means that although a drug may be FDA-
approved for some uses, it is not specifically approved for 
treatment of your condition.

In some states there are statutes specifically addressing 
this question. In California, for example, if an insurance 
policy pays for FDA-approved drugs, it must also reimburse 
for "off-label" uses of these drugs for individuals with 
life-threatening health conditions, provided that you can 
show that the new use is effective. Under the law, you can do 
this by pointing to certain medical authorities, or two 
articles from major peer-reviewed medical journals.

If your state does not have explicit law on the topic of 
"off-label" coverage, you will have to address the problem as 
you would if you were fighting for coverage for an 
experimental treatment, as discussed above. 

D. Making the Economic Argument

Although not relevant for determining whether a procedure is 
experimental, you should make a cost-effectiveness argument 
if there is any way to do so. Insurers, in their zeal to deny 
as much coverage as possible, sometimes lose track of the 
fact that paying for some new treatments may save them money. 
If the procedure is less expensive than the non-experimental 
alternatives, state that. If it is less expensive in the long 
run than not treating the condition at all, say so loudly. 
Even an expensive preventive measure may be more cost-
effective than treating the condition that could have been 
prevented. Or paying for a diagnostic such as a viral load 
test may permit a physician and patient to decide against 
expensive anti-viral therapy. 

Handling Your Dispute

A. Available Legal Remedies

If your insurance claim is denied, you should be able to 
appeal the decision within the insurance company (and you may 
be required to do so before pursuing the case further). 
Although it is still the insurer making the decision, many 
individuals succeed in changing an insurer's mind at the 
appeal level, using the arguments and evidence suggested 
above.

If your insurer does not budge, you can consider suing it for 
failure to pay the claim. If you succeed, you will be 
reimbursed for any money you advanced in order to undergo the 
treatment. In a few instances--namely if your policy is an 
individually purchased policy, rather than a benefit of your 
employment--you can sue your insurer for additional 
damages. For instance you might have a "bad faith" claim if 
the insurer's behavior was particularly outrageous. Or you 
may have a claim for other consequential damages, for 
instance for a worsening of your condition due to their 
failure to pay for a procedure. If your insurer is unwilling 
to settle the case out of court, be aware that a lawsuit 
could take years to complete and may cause you more stress 
than you are willing to put up with. Talk to an attorney and 
consider these questions seriously when determining how far 
you are willing to go. 

If you need the procedure in question immediately, and do not 
have the money to pay for it in hopes you will win your court 
case later, you can consider having an attorney file in court 
for an injunction. By doing this, you would be asking a court 
to interpret the insurance policy and rule in advance that 
the insurer must pay. If you have your medical evidence 
gathered, a hearing could be held within days of filing. This 
procedure can be expensive, and you may be required to post a 
bond while your full court case is pending. 

B. Obstacles to Exercising Your Rights

1. Arbitration Requirements

Some HMOs have provisions in their policies requiring members 
to submit to binding arbitration regarding all disputes with 
the carrier. If you are a member of such a system you will be 
required to have your dispute adjudicated through arbitration 
--a less formal proceeding than a court trial. The 
arbitrators will resolve the dispute based on the same legal 
principles that would guide a court of law. The arbitrators' 
decision will be final, unless there was some impropriety in 
rendering the decision, in which case you could then appeal 
to a court. Simply rendering a decision that is unfavorable 
to you does not give you grounds to appeal. 

2. Employer-Provided Insurance

If you receive your health care coverage through an employer, 
your rights are substantially less than if you individually 
purchased an insurance policy. This is due to a federal law 
known as ERISA (Employee Retirement Income Security Act of 
1974) which was passed to protect employees against the risk 
of their employers squandering their pension money. The law 
addresses not merely retirement plans, but all benefits 
plans, including health benefits. Unfortunately, ERISA says 
virtually nothing about the contents of health benefits 
plans, while at the same time it supersedes all state laws 
touching on those plans.

The net effect is this. All state law-based claims against 
your insurer, such as bad faith, fraud, negligence and 
infliction of emotional distress disappear. You may sue only 
for payment of the claim itself, and not for other damages 
arising out of the insurer's failure to pay. Insurers 
therefore have little incentive to pay your claim, because 
the worst that can happen to them if you sue is that they 
will have to pay the claim and possibly your attorney's fees. 
They will not be on the hook for any greater damages. 

ERISA will also affect how a court rules on the coverage 
question. If the health benefits plan grants the plan 
administrator (the insurance company, or sometimes the 
employer itself in cases of large "self-insured" plans) 
discretion to interpret the terms of the plan, the court can 
only overturn the insurer's coverage decision if that 
decision was "arbitrary and capricious" or an "abuse of 
discretion." In practice, as long as the coverage decision 
reflects a reasonable interpretation of the policy--even if 
the policy language is ambiguous--the insurer will prevail. 
If, however, the policy does not specifically grant that 
discretion to the plan administrator, the court is free to 
examine the coverage decision afresh. 

This is a very basic outline of ERISA and insurance coverage. 
If you have an employer-provided health plan and are in a 
coverage dispute, you will need to consult a lawyer.

Going Public: Using Outside Pressure

A. Organizing a Campaign Against Your Insurer or HMO 

If your insurance carrier refuses to cover a particular 
promising HIV treatment or procedure, such as human growth 
hormone for wasting syndrome, or viral load tests as an 
immune system marker, you may be able to achieve a change in 
the policy by banding together with other HIV positive 
individuals using the same carrier. Although you may be 
skeptical, insurance companies, and especially regional HMOs, 
are concerned about their public image. They must compete to 
attract members, and denying coverage of treatments for 
people with a life-threatening illness does not inspire 
confidence among their potential insureds.

You may wish to seek out activists, through organizations 
such as ACT UP or the People With AIDS Coalition. Consider 
having demonstrations or sending out press releases regarding 
the particular practice. The threat of public exposure is 
especially effective immediately before "open enrollment," 
when employees are choosing their health care delivery 
system. Open enrollment periods most frequently occur around 
the new year. You may wish to consider letters to large 
progressive employers asking them not to renew their 
contracts with this insurer until it changes its policy 
regarding coverage of this treatment.

Remember that a public campaign is a means to achieve your 
purpose (e.g. coverage of certain treatments, changes in 
policy, etc.), and not an end in itself. For that reason, you 
should be sure to inform the insurer of all the steps you are 
taking and when you are taking them, so that it always has 
the option to give in to your demands.

B. Using the Government

Find out for certain which governmental body in your state 
regulates your insurer. In California, for instance, the 
Department of Insurance regulates only a small number of 
health insurers, while the Department of Corporations 
regulates the vast bulk of them, including all HMOs. The 
federal Department of Labor regulates ERISA claims. Find out 
what that body can do for you. Is there a consumer complaint 
line? What powers does it have? Be sure to send that body 
copies of all your correspondence with the insurer. 

Your elected officials may be of use also. No insurer likes 
getting calls from members of Congress. Also, local officials 
may have the power to cease contracting with the insurer for 
health care for city or county employees. Your insurer may 
very much want to keep your county or municipality as a happy 
customer.

Conclusion

Getting proper care for HIV often requires you to be your own 
advocate. With some effort, you can also be an effective 
advocate in dealing with your insurance company. Do not 
accept denials of coverage as "done deals." Find an AIDS 
legal service organization in your area by calling an AIDS 
service provider or a local bar association, and consult with 
a lawyer to learn your rights. The decision to exercise them 
is yours.

For more information: The AIDS Legal Referral Panel, 415/291-
5454, focuses on the San Francisco Bay Area, but can refer 
people to similar agencies throughout the country.


***** CD8 Cells: Suppressive Factors Discovered

by John S. James

Nine years ago researchers at the University of California 
San Francisco Medical Center reported that CD8 cells could 
produce a soluble substance or substances which could slow or 
stop the growth of HIV.(1) When the CD8 cells were taken out 
of the infected cell culture, HIV grew again; when they were 
added back, HIV growth stopped. Direct contact was not 
needed, as the CD8 cells could be in a separate compartment, 
separated from the infected cells by a filter, and they still 
stopped HIV growth. Laboratory studies of samples from 
patients showed that in those whose disease progressed, the 
CD8 cells lost much of their ability to inhibit HIV in this 
way. Unfortunately, efforts to identify the substance or 
substances were unsuccessful; however, other research 
indicated that the mechanism of action seemed to be 
inhibition of the LTR (long terminal repeat) of HIV. 

In December 1995, four such inhibitory substances were 
reported. Three were found by researchers at the U.S. 
National Cancer Institute Laboratory of Tumor Cell Biology, 
then run by Robert Gallo, M.D.; these need to work together, 
as each substance alone had little or no effect.(2) Also in 
December, a separate research team in Germany reported a 
fourth inhibitory substance, in a letter to NATURE. All four 
of these turned out to be substances which were previously 
known. (Note: Several members of the research team at the NCI 
are now joining Dr. Gallo at the Institute for Human 
Virology, a new research center at the University of 
Maryland.)

Gallo's laboratory used fairly straightforward procedures to 
discover three of the substances, which are proteins and 
members of a class called chemokines, substances involved 
with inflammation and which cause cells to move. First, the 
researchers set up a laboratory test to measure the amount of 
suppressive activity in a given sample. Then they selected 
cells which produced large amounts of this factor. To find 
out what it was, cell-free material from the cultures was 
chemically fractionated (separated) and purified in various 
ways, and then tested to see which fractions kept the 
suppressive activity and which lost it. Finally, two fairly 
pure substances could be analyzed by standard methods to 
determine what amino-acid sequence a protein contains. The 
sequences turned out to be identical to those of substances 
already known. Additional tests confirmed that these two were 
indeed correctly identified. (The third substance was tested 
for because it was very similar to one of the first two. It 
also was found to be present in the samples.)

As additional confirmation, antibodies to the three proteins 
were prepared. In cultures from three of four patients 
tested, they blocked all of the suppressive activity; in the 
fourth patient, they blocked 80% of it. Antibodies are quite 
specific in what proteins they recognize; the antibodies in 
this test would have had little activity except to block the 
action of the three proteins they were targeted against, 
showing that those proteins were responsible for the 
suppressive activity.

No one knows if these proteins themselves would be effective 
treatments. Some substances (such as IL-2) are produced by 
the body and tend to be used locally, by nearby cells; 
injecting a large amount systemically may not work the same 
way. But the identification of these three substances is 
certainly important for new-drug development, whether or not 
a final drug turns out to be a cocktail of these three, or 
something else.

Also, measurement of these substances in the blood might 
serve as a marker of AIDS progression, or of the therapeutic 
effects of certain drugs, or of the protective effect of 
preventive vaccines. The researchers noted that clinical 
studies of these newly identified proteins "will be critical 
to define their role in the natural history of HIV 
infection."

References

1. Walker CM, Moody DJ, Stites DP, Levy JA. CD8+ lymphocytes 
can control HIV infection in vitro by suppressing virus 
replication. SCIENCE December 19, 1986; volume 234, pages 
1563-1566.

2. Cocchi F, DeVico AL, Garzino-Demo A, Arya SK, Gallo RC, 
and Lusso P. Identification of RANTES, MIP-1-a, and MIP-1-b 
as the major HIV-suppressive factors produced by CD8+ T 
cells. SCIENCE December 15, 1995; volume 270, pages 1811-
1815.


***** AZT plus 3TC Combination Results Published

Results of a double-blind study comparing AZT plus 3TC (also 
called lamivudine, or Epivir(TM) vs. either drug alone, in 
366 patients with CD4 between 200 and 500 who had previously 
taken little or no AZT, were formally published December 21 
in THE NEW ENGLAND JOURNAL OF MEDICINE.(1) The combination 
clearly showed better and more lasting results than either 
drug alone in CD4 improvement and in decrease of viral load, 
throughout the one year of the study.

These results are not new, as they were presented at 
conferences a year ago. But formal publication is still 
important, because the results are more thoroughly checked 
and more completely described than at the early oral 
presentations.

Another paper in the same issue of the journal reported 
findings from a 32-patient study that 3TC was also effective 
against hepatitis B.

References

1. Eron JJ, Benoit SL, Jemsek J, and others. Treatment with 
lamivudine, zidovudine, or both in HIV-positive patients with 
200 to 500 CD4+ cells per cubic millimeter. THE NEW ENGLAND 
JOURNAL OF MEDICINE. December 21, 1995; volume 333, number 
25, pages 1662-1705.


***** Opportunistic Infection Prevention: National Video
Symposium, January 11

The National Association of People with AIDS (NAPWA) and the 
National Association of Nurses in AIDS Care will sponsor a 
video symposium on prevention of opportunistic infections, 
including discussion of pneumocystis, CMV, and other related 
issues, on January 11 in the following cities: Chicago, 
Houston, Los Angeles, Miami, New York, San Francisco, and 
Washington D.C. The time is 1:00 - 2:30 Pacific time, 3:00-
4:30 Central time, 4:00 - 5:30 Eastern time.

The program is free, but registration is requested. To 
register, and find the location in your city, call the NAPWA 
CMV Prevention Hotline, 800/838-9990.


***** San Francisco: Cryptosporidiosis Water Warning

On December 19 the San Francisco Health Commission voted 
unanimously to order the San Francisco Department of Public 
Health to "inform persons who are immunocompromised about the 
risks of drinking untreated San Francisco tap water," and to 
take other measures to protect public health, due to 
cryptosporidium parasite in the water. Cryptosporidium causes 
cryptosporidiosis, characterized by severe diarrhea; persons 
with a healthy immune system usually recover in one to two 
weeks, but for persons with severe immune deficiencies, the 
infection can be life threatening. According to a fact sheet 
from the California Department of Health Services, persons 
with a serious immune system problem should use distilled or 
properly boiled water; but the low levels of cryptosporidium 
found in California public drinking water systems should not 
be a health concern to the general public.

The San Francisco alert resulted from work by AIDS activists, 
who have intensively studied this issue--not from the city 
AIDS office. "The Health Commission overruled the bureaucrats 
running the AIDS office and admitted that there is a 
problem," commented ACT UP Golden Gate member Bill Thorne.

For more information, contact ACT UP Golden Gate, 415/252-
9200, or fax 415/252-9277. ACT UP Golden Gate has prepared a 
report, CRYPTOSPORIDIUM: CURRENT ISSUES IN BIOLOGY, LAW, 
MEDICINE, AND WATER QUALITY, by Rob Sabados, which is 
available for a $5 suggested donation.


***** Computer Censorship Update

AIDS TREATMENT NEWS has published three articles about the 
computer censorship bill which is now in Congress, attached 
to the major telecommunications deregulation bill (AIDS 
TREATMENT NEWS #237, #236, and #227). This bill would make it 
a felony to transmit most safer-sex information to the public 
by computer. Unintended consequences would damage our 
treatment information work by making it difficult to host an 
uncensored computerized public forum on any topic, and 
difficult to link a Web site to foreign sites. Also, 
universities and other institutions will be pressured to 
block public access to huge databases and archival 
collections now available, due to the cost of hand-checking 
all of it to assure compliance; even if Congress or the 
courts later change the law, the existing tradition of 
openness may never fully recover.

The bill is still in Congress. After our last issue had gone 
to press, it looked like a bipartisan compromise on other 
contents of the telecommunications bill could lead to passage 
by Christmas; President Clinton promised to sign that bill, 
which included the censorship provision. But then the 
compromise fell apart. It is likely that major areas will now 
need to be renegotiated; Congress may act in February. Many 
outcomes are possible, from passage of the current bill, to 
removal or compromise of the censorship provisions, to 
partisan dispute preventing the passage of any 
telecommunications bill until after the presidential 
election. A measure of the confusion is that there has not 
yet been a complete copy of the actual bill embodying the 
House/Senate compromises; Congress had been expected to vote 
final approval of this major legislation long before a 
complete draft even existed.

Whatever Congress does, we will have to face this issue for a 
long time. If the censorship provisions become law, there 
will be years of litigation; if not, the issue will come back 
to Congress again and again. AIDS organizations have not been 
engaged, and were not represented when the censorship 
provisions were adopted. We must start now to work with civil 
libertarians and others so that our voices will be heard 
about legislation which could greatly damage the future 
effectiveness of AIDS services and activism.


***** Activist Groups and PWA Coalitions, U.S. and Canada 

Updated January 1996

Since 1990 AIDS TREATMENT NEWS has published a list of ACT UP 
chapters, PWA coalitions, and buyers' clubs. This year the 
buyers clubs are listed separately. We called these numbers 
and listed only those we could verify; some are home 
telephones, not offices. Within states, the listings are 
alphabetical by city.

For information about ACT UP affiliates, call the ACT UP 
Network, 215/731-1844. For information about other PWA 
organizations, call the National Association of People Living 
With AIDS (NAPWA), 202/898-0414. If you know of organizations 
which you think should be included in next year's directory, 
please call AID TREATMENT NEWS at 800/TREAT-1-2.

Remember that there are well over ten thousand AIDS 
organizations in the U.S. alone; only a few can be included 
in this specialized list. To find out about services and 
organizations in your area, call the National AIDS Hotline, 
800/342-AIDS, 24 hours a day; for the same information in 
Spanish, call 800/344-SIDA, 8 a.m. to 2 p.m. Eastern time, 7 
days a week.


ALABAMA
Birmingham   Birmingham AIDS Outreach   205/322-4197  
Huntsville   AIDS Action Coalition   205/883-2437  
ARIZONA
Phoenix   The Arizona Human Rights Fund   602/530-1660
Phoenix   Being Alive   602/955-4673  
Phoenix   Phoenix Body Positive   602/264-7414  
Tucson   PACT for Life   602/770-1710   
CALIFORNIA 
Long Beach   Being Alive Long Beach   310/434-9022  
Los Angeles   ACT UP/Los Angeles   213/669-7301
Los Angeles   Being Alive   213/667-3262
Oakland   ACT UP/East Bay   510/568-1680
Oakland   Women Organized to Respond to Life-threatening Disease
   (WORLD)   510/658-6930   
Orange County    Being Alive Orange County   714/362-5483  
Redondo Beach   Being Alive South Bay   310/544-2702  
San Diego   Being Alive San Diego   619/291-1400  
San Francisco   ACT UP/Golden Gate   415/252-9200 
San Francisco   ACT UP/ San Francisco   415/522-2907 
San Francisco   Black Coalition on AIDS   415/346-2364  
San Francisco   Positive Families with Children 415/863-3762  
San Francisco   PWA Coalition  415/522-2341  
San Mateo   San Mateo County AIDS Program   415/573-2385  
Santa Barbara   ACT UP/Santa Barbara   805/569-3299 
Ventura   The Unity Pride Coalition   805/650-9546 
West Hollywood   Being Alive   310/358-2281  
COLORADO
Denver   PWA Coalition Colorado   303/329-9379
CONNECTICUT
Bethel   AIDS Project Greater Danbury    203/778-2437
FLORIDA
Clearwater   AIDS Coalition Pinellas   813/449-2437  
Dade County   PWA Coalition   305/573-6010
Ft. Lauderdale   PWA Coalition Broward   305/565-9119
Jacksonville   PWA Coalition   904/387-2992 
Miami   ACT UP/Miami   305/787-1131 
Miami   Body Positive   305/576-1111  
Miami   Cure AIDS Now   305/375-0400  
Miami   PWA Coalition   305/573-6010  
Palm Beach   PWA Coalition   407/655-3322  
Tampa   DACCO   813/623-3500 
Tampa   PWA Coalition Tampa Bay   813/238-2887  
GEORGIA
Atlanta   ACT UP/Atlanta   404/874-6782 
Atlanta   AIDS Survival Project   404/874-7926
Atlanta   Women's Information Service and Exchange 
   (WISE)   800/326-3861, or 404/817-3441
Macon   The Rainbow Center   800/374-2437  
HAWAII
Honolulu   PWA Coalition   808/948-4792  
ILLINOIS
Chicago   Chicago Women's AIDS Project   312/271-2070  
Chicago   Test Positive Aware Network   312/404-8726  
Peoria   Friends of PWAs   309/671-2144  
INDIANA
Indianapolis   The Damien Center   317/632-0123  
IOWA
Davenport   AIDS Project Quad Cities   319/328-5464  
Waterloo   Cedar AIDS Support System   319/292-2437  
KENTUCKY
Louisville   KIPWAC   800/676-5490  
LOUISIANA
New Orleans   PWA Coalition   504/524-3488  
MAINE
Portland   PWA Coalition   207/773-8500  
MARYLAND
Baltimore   AIDS Action Baltimore   410/837-2437 
Baltimore  ACT UP/Baltimore  410/837-5203
Baltimore   PWA Coalition   410/625-1677  
MASSACHUSETTS
Boston   ACT UP/Boston   617/492-2887
Boston   Boston Living Center   617/236-1012  
Boston   Committee of Ten Thousand   800/488-2688 
Boston   Multi-Cultural AIDS Coalition   617/442-1622  
Boston   Positive Directions   617/262-3456  
Hyannis   Cape Cod AIDS Council   508/778-5111  
Provincetown   ACT UP/Provincetown   508/487-3049
Provincetown   Provincetown Positive   508/487-3998  
MICHIGAN
Detroit   ACT UP/Detroit   313/872-2427
Detroit   Friends Alliance   313/831-4400  
Grand Rapids   AIDS Resource Center   616/459-9177  
MINNESOTA
Minneapolis   The Aliveness Project   612/822-7946  
MISSOURI
St. Louis   ACT UP/St. Louis   314/771-4844
NEW JERSEY
Audubon   AIDS Coalition of Southern NJ   609/573-7900
New Brunswick   NJ Women and AIDS Network   908/846-4462
NEW MEXICO
Santa Fe   Northern NM AIDS Center   505/266-0911
NEW YORK
Albany   ACT UP/Albany   518/861-6337
Albany   Damien Center   518/449-7119  
Buffalo   AIDS Alliance of Western NY   716/852-6778  
Long Island   PWA Coalition   516/225-5700  
New York City   ACT UP/New York   212/642-5499
New York City   AIDS Treatment and Data Network 
   800/734-7104, or 212/260-8868
New York City   DAAIR   212/725-6994
New York City   New York AIDS Coalition   212/629-3075  
New York City   PWA Coalition of New York   212/647-1415  
New York City   PWA Health Group   212/255-0520
New York City   Stand Up Harlem 212/926-4541  
New York City   Treatment Action Group (TAG) 212/260-0300
Utica   ACT UP/Utica   315/853-6418
NORTH CAROLINA
Research Triangle Park  ACT UP/Triangle   919/990-1197
OHIO
Columbus   Ohio AIDS Coalition (Statewide)   614/445-8277  
OREGON
Milwaukie   CCARE   503/653-8738   
Portland   Advocacy Council of Oregon and Southwest 
   Washington,   503/284-6807
PENNSYLVANIA
Philadelphia   ACT UP/Philadelphia   215/731-1844
Philadelphia   We The People   215/545-6868  
Pittsburgh   Cry Out!/ACT UP   412/683-9741
SOUTH DAKOTA
Sioux Falls   ACT UP/South Dakota   605/332-3966
TENNESSEE
Memphis   Friends for Life HIV Res.   901/272-0855  
Nashville   Nashville Cares   615/259-4866 
TEXAS
Austin   AIDS Services of Austin   512/451-2273
Dallas   AIDS Resource Center   214/521-5124  
Dallas   AIDS Services of Dallas   214/941-0523  
Galveston   AIDS Coalition of Coastal Texas  409/763-2437 
Houston   PWA Coalition   713/522-5428  
UTAH
Salt Lake City   PWA Coalition Utah   801/484-2205 
VERMONT
Brattleboro   Vermont PWA Coalition   802/229-5754
WASHINGTON
Seattle   People of Color Against AIDS Network   206/322-7061
WEST VIRGINIA
Morgantown   Mountain State AIDS Network   304/292-9000
WISCONSIN
Madison   Madison AIDS Support Network   608/252-6540
WYOMING
Casper   Wyoming AIDS Project   307/237-7833

CANADA

Halifax   PWA Coalition Nova Scotia   902/429-7922
Montreal   CPAVIH   514/282-6673
Ottawa   Canadian AIDS Society   613/230-3580
Toronto   Toronto PWA Foundation   416/506-1400
Vancouver   Pacific AIDS Resource Center   604/681-2122
Victoria   PWA Society   604/383-7494

Buyers' Clubs and Other Suppliers

The following list is in order alphabetically by name of the 
state. All of them provide mail-order service. We cannot 
endorse or recommend specific groups, but we have worked most 
closely with Healing Alternatives Foundation, and with PWA 
Health Group. [Note: Cannabis buyers clubs are not included 
here but will be listed separately in a later issue.]

Being Alive Buyers' Club, 111 E. Camelback Rd., Phoenix, AZ 
85012, 602/265-2437, 602/265-7201 fax.

PACT Buyers' Club, 801 W. Congress St., Tuscon, AZ 85745, 
520/770-1710, 520/622-5822 fax.

DNCB Group, 2261 Market St., #436, San Francisco, CA 94114, 
415/954-8896 (DNCB only).

Healing Alternatives Foundation, 1748 Market St. #205, San 
Francisco, CA 94102-5806, 415/626-4053, 415/626-0451 fax.

CFIDS Buyers' Club, 1187 Coast Village Rd. #1-280, Santa 
Barbara, CA 93108, 800/366-6056, 805/965-0042 fax.

LifeLink, 445 Lierly Lane, Arroyo Grande, CA 93420, 805/473-
1389, 805/473-2803 fax.

Embrace Life, 2070-C Wharf Road, Capitola, CA 95010, 800/448-
1170, 408/476-7717 fax.

Denver Buyers' Club, P.O. Box 300339, Denver, CO 80203, 
303/329-9379, 303/329-9381 fax.

Carl Vogel Foundation, 1010 Vermont Ave. NW, #510, 
Washington, DC 20005-3405, 202/638-0750, 202/638-0749 fax.

AIDS Manasota, 2080 Ringling Blvd., #302, Sarasota, FL 34237-
7030, 813/954-6011, 813/951-1721 fax.

Wholesale Health, 909 NE 18 St., Ft. Lauderdale, FL 33305, 
305/764-1587.

Health Link, 3213 North Ocean Blvd., #6, Ft. Lauderdale,  Fl 
33308, 305/565-8284, 305/565-8289 fax.

Life Extension Foundation, P.O. Box 229120, Hollywood, FL 
33022-9120, 800/841-5433, 305/989-8269 fax.

AIDS Treatment Initiatives, 125 5th St. NE, Atlanta, GA 
30308, 404/874-4845, 404/874-9320 fax.

Boston Buyers' Club [SPV-30], 163 W. Brookline Street, 
Boston, MA 02118-1279, 617/266-2223, 617/424-0122 fax.

PWA Health Group, 150 West 26th Street, #201, New York,  NY 
10001, 212/255-0520, 212/255-2080 fax.

DAAIR, 31 E. 30th Street, #2A, New York, NY 10016, 212/725-
6994, 212/689-6471 fax.

Prince St. Market/Houston Buyers' Club, P.O. Box 131594, 
Houston, TX 77219, 713/880-2338, 713/880-2338 fax.

People Curing AIDS, 1314 Pine St., Seattle, WA 98122, 
206/233-8048 message line.

Canada

Canadian Nutrition Club, P.O. Box Q4, Jasper,  ON K0G 1G0, 
613/284-0076, 613/284-2789 fax.

Supplements Plus, 2304 Bloor Street West, Toronto,  ON M6S 
1P2, 416/977-3088, 416/977-3099 fax.


***** AIDS TREATMENT NEWS
   Published twice monthly

Subscription and Editorial Office:
   P.O. Box 411256
   San Francisco, CA 94141
   800/TREAT-1-2  toll-free U.S. and Canada
   415/255-0588 regular office number
   fax: 415/255-4659
   Internet: aidsnews@aidsnews.org
Editor and Publisher:
   John S. James
Reader Services and Business:
   Richard Copeland
   Thom Fontaine
   Denny Smith
   Tadd Tobias

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

Subscription Information: Call 800/TREAT-1-2
   Businesses, Institutions, Professionals: $230/year.
   Nonprofit organizations: $115/year.
   Individuals: $100/year, or $60 for six months.
   Special discount for persons with financial difficulties:
   $45/year, or $24 for six months. If you cannot afford 
   a subscription, please write or call.
   Outside North, Central, or South America, add air mail 
   postage: $20/year, $10 for six months.
   Back issues available.
   Fax subscriptions, bulk rates, and multiple subscriptions
   are available; contact our office for details.
   Please send U.S. funds: personal check or bank draft, 
   international postal money order, or travelers checks. 
   VISA, Mastercard, and purchase orders also accepted.

ISSN # 1052-4207 

Copyright 1995 by John S. James.  Permission granted for 
noncommercial reproduction, provided that our address 
and phone number are included if more than short 
quotations are used.
