Science Guardian

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Exercise a foe of breast cancer

Even walking reduces a patient’s risk of death from the disease, a study says. But post-treatment exercise is easier to suggest than do.

By LISA GREENE, Times Staff Writer
Published May 25, 2005

Most people who exercise for better health think of the obvious advantages: warding off heart disease, diabetes and weight gain.

But exercise has another, more surprising benefit as well: It can help breast cancer patients cheat death, says a study published in today’s Journal of the American Medical Association.

Women don’t have to be triathletes. Even walking for an hour a week reduces the risk of death from breast cancer by 20 percent for women already diagnosed with the disease, the study found.

“I hope women with breast cancer consider that exercise may improve their length and quality of life,” said Dr. Michelle D. Holmes, assistant professor at Harvard Medical School and the study’s lead author.

Exercise also helps prevent breast cancer, other studies have said. But this study found exercise helps women who already have the disease. The news could have a dramatic effect on their lives, since they are likely to exercise less after getting cancer.

Less than one-third of breast cancer survivors get as much exercise as the government recommends.

“The stress of treatment and a life-threatening illness can be very discouraging to women,” Holmes said.

The study is especially important coming just after another study linking lower-fat diets to lower breast cancer recurrence, said Dr. Larry Norton, deputy physician-in-chief for breast cancer programs at Memorial Sloan-Kettering Cancer Center.

“There seems to be a connection between fat in your body, fat in the diet and recurrence of breast cancer,” he said. “It’s very exciting, because it’s something we can do something about.”

More exercise reduces the risk further. The greatest benefit is to women who exercise the equivalent of walking three to five hours per week. Those breast cancer patients reduced their risk of death by 50 percent. Women who exercised harder could spend less time working out for the same benefit.

The study results impressed Clearwater resident Roberta Mindykowski. She has battled breast cancer for nine years. Mindykowski, 60, had a mastectomy nine years ago. Three years ago, her cancer returned, and two years ago she had more surgery.

Exercise after cancer is easier recommended than done. After her latest surgery, Mindykowski said, her energy disappeared.

“It takes a long time to get your stamina back,” she said.

It wasn’t until a few months ago that Mindykowski resumed regular exercise. Now she’s lifting weights, walking on a treadmill, and taking daily breaks to walk in her office parking garage with co-workers.

“Just doing a little bit of exercise makes you feel so well mentally and physically, it can’t do anything but help you,” she said.

The study looked at data from almost 3,000 patients in the ongoing Nurses’ Health Study who were diagnosed with breast cancer between 1984 and 1998, following them until 2002.

Researchers analyzed how much exercise women reported getting after they were treated for breast cancer. They didn’t include women with the worst prognosis, or women undergoing treatment, since both groups would be less likely to exercise.

Of the study participants, 86 percent survived at least 10 years after diagnosis.

Researchers aren’t sure why women who exercised were more likely to survive. Exercise may help because it lowers the level of estrogen circulating in women’s bodies.

The study found that exercise reduced the risk most for women with the most common kind of tumor, which is stimulated by estrogen. That gives more weight to the idea that the benefits come from affecting estrogen levels, Holmes said.

Other factors also may be at work, Norton said. In the recent diet study, lower-fat diets still affected tumors not stimulated by estrogen. That makes him wonder whether some chemical in fat cells affects breast cancer and that chemical is in turn affected by diet and exercise.

The study’s findings are “fairly convincing,” said Dr. Pamela Munster, breast cancer oncologist at H. Lee Moffitt Cancer Center & Research Institute and assistant professor at the University of South Florida.

Still, the study has limits. Because the women chose whether to exercise, rather than being assigned at random to exercise or not, it’s possible that there was some other difference between the two groups, Munster said. Maybe women who exercise visit their doctors more often, or eat more vegetables.

Researchers tried to account for such factors, Holmes said, but “can’t totally rule it out” that something else might have influenced the results.

Munster would like to see the results confirmed in a randomized trial. But in the meantime, the best bet is to hit the gym, she said.

“Even a woman with breast cancer is still at risk of dying from heart disease,” she said.

Holmes agreed.

“There’s not a lot to lose by exercising,” she said.

Cindi Crisci, 45, of St. Petersburg worked out and watched her diet because her family has a history of heart disease.

Six years ago, Crisci was diagnosed with breast cancer. She walked after her surgeries, through her chemotherapy and her radiation treatments.

“It helped in the healing process,” said Crisci, whose cancer prompted her to get a job with the American Cancer Society. “I firmly believe a positive attitude and staying healthy helped me. … Exercise in general helps the mind, body and soul.”
WHY EXERCISE HELPS

Why would exercise keep breast cancer from coming back, or spreading throughout the body? Researchers aren’t sure. But studies have linked exercise to lower levels of estrogen in the body. And today’s study found that women whose tumors are stimulated by estrogen got even more benefit from exercise. So they believe exercise may help prevent cancer because it lowers estrogen levels.

© 2005 ? All Rights Reserved ? St. Petersburg Times© 2005 ? All Rights Reserved ? St. Petersburg Times

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Source: Dana-Farber Cancer Institute
Date: 2005-05-17
URL: http://www.sciencedaily.com/releases/2005/05/050517143749.htm
Exercise Reduces Risk Of Recurrence And Death In Early Stage Colon Cancer Patients

ORLANDO, Fla.–Patients treated for early stage colon cancer fared significantly better if they exercised regularly at the level of an hour’s walk six times a week, according to a study to be presented at the annual meeting of the American Society of Clinical Oncology.

A person’s risk of having a cancer recurrence or dying was lowered by 40 to 50 percent in the 2 1/3 to 3 years following surgery and chemotherapy for stage III colon cancer, reported a team headed by Jeffrey Meyerhardt, MD, MPH, of Dana-Farber Cancer Institute. The data (abstract 3534) is from the Cancer and Leukemia Group B (CALBG) and will be presented during a poster discussion on Tuesday, May 17, 8 a.m. Level 3, 315A.

Although exercise has previously been shown to lower the risk of developing colon cancer, the new findings are the first to demonstrate a benefit for patients who already have the disease.

“There is a growing body of evidence that there are things you can do in addition to chemotherapy for colon cancer survivors to reduce the likelihood that the disease will recur,” says Meyerhardt. “Until now, when doctors were asked by their patients whether they should exercise, some of them probably said it would be a good idea, but it wasn’t a firm recommendation without data to support it.”

The health benefit was found among patients whose activity levels ranked in the top two-fifths of the group, compared to the lowest one fifth. They exercised at a rate of at least 18 MET-hours (metabolic equivalent tasks) per week, which could be attained through jogging two to three hours a week, playing tennis a few times a week, or walking briskly an hour a day six times a week, explains Meyerhardt, who is an assistant professor of medicine at Harvard Medical School.

The study involved patients reporting leisure-time physical activity approximately 12-18 months after surgery. The patients belonged to the same group in which a separate study headed by Dana-Farber researcher Charles Fuchs, MD, MPH, revealed that regular aspirin use reduce recurrence and death risks by about the same magnitude as exercise.

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In addition to Meyerhardt, the study’s other authors are Fuchs, Denise Heseltine, BA, and Robert Mayer, MD, Dana-Farber; Donna Niedzwiecki, PhD, and Donna Hollis, MS, CALGB Statistical Center at Duke University Medical Center; Leonard Saltz, MD, Memorial Sloan-Kettering Cancer Center; and Richard Schilsky, MD, University of Chicago.

Dana-Farber Cancer Institute (www.danafarber.org) is a principal teaching affiliate of the Harvard Medical School and is among the leading cancer research and care centers in the United States. It is a founding member of the Dana-Farber/Harvard Cancer Center (DF/HCC), designated a comprehensive cancer center by the National Cancer Institute.

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Press Releases

May 17, 2005
Exercise reduces risk of recurrence and death in early stage colon cancer patients
Photo of Jeffrey Meyerhardt, MD, MPH
Jeffrey Meyerhardt, MD, MPH

ORLANDO, Fla.?Patients treated for early stage colon cancer fared significantly better if they exercised regularly at the level of an hour’s walk six times a week, according to a study presented at the annual meeting of the American Society of Clinical Oncology.

A person’s risk of having a cancer recurrence or dying was lowered by 40 to 50 percent in the 2 1/3 to 3 years following surgery and chemotherapy for stage III colon cancer, reported a team headed by Jeffrey Meyerhardt, MD, MPH, of Dana-Farber Cancer Institute. The data (abstract 3534) is from the Cancer and Leukemia Group B (CALBG) and will be presented during a poster discussion on Tuesday, May 17, 8 a.m. Level 3, 315A.

Although exercise has previously been shown to lower the risk of developing colon cancer, the new findings are the first to demonstrate a benefit for patients who already have the disease.

“There is a growing body of evidence that there are things you can do in addition to chemotherapy for colon cancer survivors to reduce the likelihood that the disease will recur,” says Meyerhardt. “Until now, when doctors were asked by their patients whether they should exercise, some of them probably said it would be a good idea, but it wasn’t a firm recommendation without data to support it.”

The health benefit was found among patients whose activity levels ranked in the top two-fifths of the group, compared to the lowest one fifth. They exercised at a rate of at least 18 MET-hours (metabolic equivalent tasks) per week, which could be attained through jogging two to three hours a week, playing tennis a few times a week, or walking briskly an hour a day six times a week, explains Meyerhardt, who is an assistant professor of medicine at Harvard Medical School.

The study involved patients reporting leisure-time physical activity approximately 12-18 months after surgery. The patients belonged to the same group in which a separate study headed by Dana-Farber researcher Charles Fuchs, MD, MPH, revealed that regular aspirin use reduces recurrence and death risks by about the same magnitude as exercise.

In addition to Meyerhardt, the study’s other authors are Fuchs, Denise Heseltine, BA, and Robert Mayer, MD, Dana-Farber; Donna Niedzwiecki, PhD, and Donna Hollis, MS, CALGB Statistical Center at Duke University Medical Center; Leonard Saltz, MD, Memorial Sloan-Kettering Cancer Center; and Richard Schilsky, MD, University of Chicago.

Dana-Farber Cancer Institute (www.danafarber.org) is a principal teaching affiliate of the Harvard Medical School and is among the leading cancer research and care centers in the United States. It is a founding member of the Dana-Farber/Harvard Cancer Center (DF/HCC), designated a comprehensive cancer center by the National Cancer Institute.

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The New York Times
May 24, 2005
New Weight-Loss Focus: The Lean and the Restless
By DENISE GRADY

ROCHESTER, Minn. – If you move, they will measure it. If you don’t move, they will measure that, too, along with what you eat. There are no secrets here, at least no metabolic ones. Not only do they have your number – they have 25 million of your numbers.

They, in this case, are scientists at the Mayo Clinic here. And they learn your secrets only if you have been one of the select few to wear a set of underwear with racy-looking cutouts at the crotch and backside, and pockets holding position and motion sensors dangling a half dozen tangled wires.

In January, the scientists here who designed the underwear reported a striking difference in activity levels between lean people and overweight ones. Their study, published in Science, did not involve deliberate exercise, but it measured – with the help of the sensors – how much people moved about naturally and spontaneously.

The heavier ones tended to sit, while the lean ones were more restless and spent two more hours a day on their feet – standing, pacing around and fidgeting. The difference translated into 350 calories a day, enough for the heavy people to take off 30 to 40 pounds a year, if they would get moving.

The researchers believe the tendency to sit still or move around is biological and inborn, governed by genetically determined levels of brain chemicals. And that tendency influences weight – not the other way around, the researchers say.

The Mayo researchers call the type of movement and calorie burning that they study NEAT, for nonexercise activity thermogenesis. The leader of the research team, Dr. James Levine – a nutritionist, an endocrinologist and a professor of medicine – has defined the term as “the energy expenditure associated with all the activities we undertake as vibrant, independent beings.” Those activities include “occupation, leisure, sitting, standing, walking, toe-tapping, guitar playing, dancing and shopping,” he writes. His team has even measured the energy burned in gum-chewing (11 calories an hour, if you chew six pieces at a time).

“This is probably the only place in the world that can do this kind of research,” Dr. Levine said.

Other researchers have praised the work, particularly the team’s painstaking and precise measurements of calories consumed and the way they are burned.

Dr. Rudolph Leibel, an obesity researcher at Columbia University, called the Science paper “great,” and added, “I believe the data; it’s done correctly and an interesting set of findings.”

Nonexercise activity can account for a significant portion of the calories burned in a day, anywhere from 15 percent in a sedentary person to 50 percent in someone who is very active. Standing takes more energy than sitting, and strolling along at just one mile an hour burns twice the calories of sitting.

Dr. Levine and his colleagues believe that if scientists can understand nonexercise activity better and identify what drives it, what makes people want to move around, they may be able to harness it to help the millions who are struggling to control their weight.

“Can we really find something to help people?” Dr. Levine asked. “We want to examine how to change people’s NEAT. There is this gap. Can we close it?”

He advocates this approach because the usual weight loss remedies usually fail. People have a hard time sticking with exercise programs and diets, and Dr. Levine argues that the very number of diet books and weight-loss plans is proof in and of itself that none of them work. “If one worked, we’d all be following it,” he said.

Studying activity and metabolism in people and animals has been a lifelong fascination, Dr. Levine said, explaining that he started measuring movement in snails and bacteria during his boyhood in London. He trained in medicine there, came to the Mayo Clinic as a resident in 1992 and then joined the faculty.

Today he runs a research group with a dozen scientists, specialists in physiology, nutrition and computing. They study nonexercise activity not only in obese adults and children, but also in the elderly, people with anorexia nervosa and populations threatened by starvation in Africa and India.

They have even investigated the significance of chubby cheeks, noting that people who deposit fat in their faces tend also to build up harmful stores inside the abdomen, which are linked to heart disease. Some members of the team also work with animals, trying to characterize the rich palette of brain chemicals that control activity levels and weight.

Although he spends most of his time on research, Dr. Levine is still a practicing endocrinologist who treats patients one afternoon a week, and he says he sees firsthand how intractable obesity can be, and what physical and emotional suffering it can cause.

Many of his patients are very obese. One was so heavy she could barely get out of a wheelchair, he said. He suggested an initial goal of simply standing up three times a day, and then trying to walk for 15 seconds at a time. For her, working her way up to two minutes of walking was a major milestone, he said.

Obese people are so stigmatized that even some doctors, perhaps unconsciously, withdraw from them, Dr. Levine said, noting that patients have told him he was the first physician who ever shook their hand or actually examined them.

“The key is to provide a nonjudgmental, compassionate environment,” he said.

The study published in January included 10 lean men and women and 10 slightly obese ones, all of whom described themselves as “couch potatoes” who did not exercise much. The object was to measure and compare their nonexercise activity, and also to determine whether it changed when they were put on special diets that made them gain or lose weight.

They wore the special underwear, which measured posture and movement every half second around the clock for 10 days in a row on several occasions, yielding 25 million points of data on each participant.

To make sure the researchers knew exactly how many calories the subjects were eating, dietitians prepared all their food for weeks at a time, a total of 20,000 meals.

“These studies cost a fortune,” Dr. Levine said. Each costs hundreds of thousands of dollars, paid by grants from the National Institutes of Health.

“Every food item is weighed to within a gram, and each meal costs $30,” he said.

In addition, the 20 participants were paid $6,000 each for their time. And the overweight ones were given advice and personalized plans to help them lose weight.

This was the study that found that the lean subjects spent much more time on their feet than did the obese ones.

What convinced the researchers that the tendency to be inactive led to obesity, and not the other way around, was that the activity levels did not change when the diets were altered to make the obese people lose weight and the lean ones gain it. If the common wisdom were true – that being heavy is what makes people sluggish – then the overweight people should have acted more energetic when they lost weight, and the lean ones should have slowed down when they gained.

But that did not occur.

If activity levels are governed by biology, then it may seem hopeless to try to change them, Dr. Levine acknowledged.

“But the counterevidence to that is, our biology as a species really hasn’t changed in decades and centuries, and yet obesity rates have dramatically increased in the last 15 years,” he said.

Activity levels have declined, and he and many other obesity researchers say that decline, more than increases in eating, is to blame for rises in obesity.

What has changed is the artificial environment: there is far more opportunity today than in the past to be sedentary. And some people may be genetically predisposed to seize that opportunity.

“We all like and dislike different things,” Dr. Levine said. “None of us can quite quantify it.”

In a biological way, not a personal one, he said, obese people seem to like inactivity.

“Given an environment that lets people sit for hours and hours a day, they will,” he said.

A solution, then, may be to change the environment, to make moving around easier and sitting still less convenient.

The team’s recent paper in Science noted, for instance, that in 1920 before cars were common, people in Rochester walked an average of 1.6 miles a day to and from work, which burned about 150 calories a day. Few people do that today; many live too far away to talk to work, but, Dr. Levine suggests, many could build short walks into the day.

This is not a new idea, he acknowledges. Plenty of experts have been advising people to find small, relatively painless ways to burn extra calories, like taking the stairs instead of the elevator and parking at the far end of the lot to make themselves walk a bit.

But for this kind of thing to make a real difference, people would have to commit to changing their habits and their environment. When it comes to this mission, Dr. Levine may be his own best guinea pig.

“If anyone in the world is going to do this it’s obviously going to be me,” he said.

At meetings, he stands instead of sitting. Talking on the telephone, he paces around. In his office he has a treadmill in place of a desk. He got it last year when he saw the data from the study comparing lean people and obese ones.

“My computer is stationed over the treadmill,” he said. “I work at 0.7 miles an hour.”

A stand-up desk might seem simpler, but he prefers the treadmill.

“Standing still is quite difficult,” he said. “You have a natural tendency to want to move your legs. Zero point seven is the key. You don’t get sweaty, you can’t jiggle too much. It’s about one step a second. It’s very comfortable. Most people seem to like it around 0.7.”

He has installed a second treadmill alongside his own, and he encourages visitors to hop on and stroll while they talk to him. It takes some getting used to, but, he says, envious colleagues at Mayo have been clamoring for treadmill desks.

“Walking at work, first of all it’s addictive,” he said. “It’s terribly good fun. I actually feel happier, particularly in the afternoon. You might think you come home exhausted, but you don’t. You come home energized.”

For him, the treadmill has eliminated the afternoon slump, when a lot of people feel sleepy and crave candy bars or caffeine.

“I’ve become convinced we really can generate an office environment where people are on the move and are happier,” he said.

* Copyright 2005 The New York Times Company

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City

FOR IMMEDIATE RELEASE

Press Release # 053-05

Monday, May 23, 2005

Sandra Mullin/Sid Dinsay/Andrew Tucker

(212) 788-5290; (212) 788-3058 (after hours) NYC COMMISSION ON HIV/AIDS PRESENTS DRAFT REPORT FOR PUBLIC COMMENT

NEW YORK CITY May 23, 2005 The New York City Commission on HIV/AIDS today released for public comment a draft of a report with recommendations on drastically reducing the spread of HIV, significantly improving control of the epidemic in New York City, and further strengthening the City’s position as a national and global model for HIV/AIDS prevention, treatment, and care.

The public is invited to provide written comments on the draft report’s contents and recommendations beginning today through Monday, June 13. Visit http://www.nyc.gov/html/doh/html/ah/ah-nychivreport.shtml to download a copy of the draft report. Comments can be sent to the Commission via email at comments@health.nyc.gov. People can also request copies of the report through 311 and mail comments to HIV/AIDS Commission Report, 125 Worth Street, CN 28, New York, NY 10013.

New York City continues to be the epicenter of the HIV/AIDS epidemic in the United States. There are more than 100,000 people living with HIV/AIDS (PLWHA) in the City today, representing approximately 1 out of 6 people living with HIV/AIDS in the United States.

Many of these people have not been diagnosed. Each year in New York City, there are still approximately 4,000 people newly diagnosed with AIDS and 1,700 deaths from AIDS. About 1,000 people each year – 3 people every day – first learn they are HIV-positive at the time they receive an AIDS diagnosis, up to a decade after they become infected. In the 25 years since the emergence of HIV/AIDS, the epidemic has changed dramatically. Today, more than 80% of new AIDS diagnoses and deaths are among African Americans and Hispanics, who comprise half of the CityÂ’s population. Black men are nearly 3 times more likely to be living with HIV/AIDS than other New Yorkers, with black men age 40-54 about 7 times more likely. A third of new HIV and AIDS diagnoses in NYC are among women, more than 90% of whom are black or Hispanic.

“HIV/AIDS prevention and care continue to be among our most critical public health priorities,” said New York City Health Commissioner and Co-Chair of the Commission, Thomas R. Frieden, MD, MPH. “More needs to be done to expand voluntary HIV testing, distribute condoms more widely, expand harm reduction, and improve treatment outcomes. We thank the Commission for putting together these critical recommendations.”

Recommendations include:

Improve Prevention

1. Make condoms much more widely available

2. Expand harm reduction programs

3. Expand drug treatment programs and facilitate referrals

4. Expand Prevention With Positives initiatives

5. Improve HIV prevention among HIV-negative people with continued risk-taking behaviors

6. Expand social marketing programs that work

7. Improve HIV/AIDS health education in schools

8. Reduce HIV-related stigma in order to improve HIV prevention, testing, and treatment

9. Evaluate prevention programs and expand those that work

Expand Voluntary Testing and Linkage to Care

10. Increase voluntary HIV testing and linkage to care of those who test HIV-positive

1. Advocate for making HIV testing an integrated part of normal medical care

2. Ensure that reimbursement schedules maintain the existing testing and counseling infrastructure

3. Increase citywide availability of HIV testing, especially rapid tests

4. Support a high-visibility social marketing and media campaign

11. Monitor HIV testing closely

12. Evaluate testing programs and expand those that are effective

Improve Treatment Outcomes

13. Preserve and strengthen treatment, case management, and support services to further improve patient outcomes

14. Increase housing opportunities and improve allocation based on client needs

15. Expand mental health, behavioral health, and harm reduction services and co-locate them with HIV/AIDS care

16. Increase access to care by:

1. Further improving health care worker and community staff training;

2. Enhancing patient education and empowerment; and

3. Disseminating information on service availability to PLWHA and service providers

Scott E. Kellerman, MD, MPH, Assistant Commissioner for HIV/AIDS Prevention and Control, added: “The Commission’s draft recommendations will significantly strengthen our response to the epidemic. We welcome input from the community to ensure that we are addressing the needs of New Yorkers living with HIV/AIDS and are doing everything we can do to stop the spread of HIV and control the epidemic.”

About the Commission

The Commission, a panel of 21 individuals who serve as key policy advisors on HIV/AIDS issues, was created in December 2003. The Commission includes individuals from diverse backgrounds, including executive directors of AIDS service organizations, HIV prevention researchers, and persons who are living with HIV/AIDS. Each member has more than a decade of experience in HIV/AIDS work.

The Commission provides guidance on how New York City can improve prevention, diagnosis, treatment, and control of HIV/AIDS. It supplements the work of the New York City Department of Health and Mental HygieneÂ’s (DOHMH) Bureau of HIV/AIDS Prevention and Control, which manages and coordinates the agencyÂ’s HIV/AIDS activities. It also complements the work of the New York City Prevention and Planning Group, as well as the HIV Health and Human Services Planning Council, which determines how the City disburses funds received under the federal Ryan White Title I CARE Act.

Comments by Commission Members

Spencer Cox, Founder and Executive Director of the Medius Institute for Gay Men’s Health, and a person living with HIV/AIDS said, “This report makes clear that, with the best of intentions, weÂ’ve made HIV testing inaccessible and difficult to administer. Almost a quarter of people with HIV in New York City donÂ’t get diagnosed until theyÂ’re already seriously ill. For most of those people, earlier treatment could have prevented progression to full-blown AIDS. We havenÂ’t been protecting HIV-positive people from discrimination, but abandoning them to disease progression. Now there is finally a consensus that weÂ’ve got to make HIV testing universally available, easy to access, and fully integrated into routine medical care.”

Don C. Des Jarlais, PhD, Director of Research, Baron Edmond de Rothschild Chemical Dependency Institute, Beth Israel Medical Center, and a world-renowned researcher in the field of HIV prevention among injection drug users and syringe exchange programs, said, “New York has had dramatic success in reducing HIV transmission from sharing needles and syringes. We have reduced the rate of new infections among drug injectors by 75%. We now need to urgently address sexual transmission, which is often associated with the use of a variety of different drugs.”

Jay Dobkin, MD, Associate Attending Physician, Department of Infectious Diseases, Columbia-Presbyterian Hospital, said, “Since many aspects of HIV and AIDS have changed over 25 years, it is important to reassess what we do to prevent, diagnose, and treat this potentially devastating infection. The Commission report highlights the enormous progress we have made but also points to areas where much remains to be done. The steps needed to decrease new HIV infections, diagnose cases earlier, and ensure that the full benefit of modern treatment is achieved are not easy and not free of controversy. If fully implemented, the Commission’s recommendations should enable many more New Yorkers to avoid needless infection, illness and death. This makes it imperative that we not accept the status quo.”

Debra Fraser-Howze, President/CEO, National Black Leadership Commission on AIDS, said, “We are pleased with this report, but it is impossible for one document to capture all that needs to be done to fight this epidemic. We welcome community comments and we acknowledge the Department of Health and Mental Hygiene for furthering our efforts.”

Mathilde Krim, Chairperson, American Foundation for AIDS Research (AmFAR), said, “HIV/AIDS is a dark and growing cloud looming over our city. No medical treatment can as yet cure it nor is there as yet – if ever there will be – a vaccine to protect from it. However, much has been learned over the last two decades. HIV’s spread in a population can be hindered by a combination of different approaches and progression of disease from HIV infection to AIDS can be much slowed by antiretroviral therapies. Our city authorities are to be commended for having searched what new or improved means could be applied towards the better control of HIV/AIDS. The interventions recommended here would certainly hasten the day when New York City’s AIDS epidemic can effectively be held in check.”

Frank Oldham, Director of the Harlem Director’s Group, said, “The Commission’s report is the first bold step toward ending the high rates of HIV infection and death in communities like Harlem. The report reflects the Mayor’s and Commissioner’s strong commitment to making New York City the national model for improving HIV services, treatment, and care and, most importantly, improving the lives of people living with HIV/AIDS. As a person living with HIV, I am confident in the report’s findings and commend the Bloomberg administration for moving with such decisiveness on this issue.”

Ana Oliveira, Executive Director of the Gay MenÂ’s Health Crisis, said, “As a member of the Commission, I want to encourage members of the community to read the report and provide feedback so New York City can move to a more advanced level of commitment in the fight against HIV and AIDS. It is only through community participation and collaboration that we will win this battle.”

Tokes Osubu, Executive Director, Gay Men of African Descent, said, “The work of the Commission is a testament of the City’s commitment, under the leadership of the Health Department, to remain at the forefront of the battle to combat the spread of HIV. My hope is that this report will be used as a reference guide by service providers and everyday New Yorkers alike regarding what needs to be done.”

Commission Members

Dennis Walcott, NYC Deputy Mayor for Policy, Co-chair

Thomas R. Frieden, MD, MPH, Commissioner, NYC Dept. of Health and Mental Hygiene, Co-chair

Moisés Agosto-Rosario, Vice President & Managing Director, Community Access

Allan Clear, Executive Director, Harm Reduction Coalition

Spencer Cox, Founder and Executive Director of the Medius Institute for Gay Men’s Health

Humberto Cruz, Executive Deputy Director, Div. of HIV Health Care, NYS Department of Health, AIDS Institute

Don C. Des Jarlais, PhD, Director of Research, Baron Edmond de Rothschild Chemical Dependency Institute, Beth Israel Medical Center, Specialist in HIV prevention among injection drug users

Jay Dobkin, MD, Director, AIDS Center; Physician, Infectious Diseases, Columbia-Presbyterian Hospital

Verna Eggleston, Commissioner, NYC Human Resources Administration

David D. Ho, MD, Director and CEO, Aaron Diamond AIDS Research Center

Debra Fraser-Howze, President/CEO, National Black Leadership Commission on AIDS

Mathilde Krim, PhD, Chairperson, American Foundation for AIDS Research (AmFAR)

Kim Nichols, ScM, MS, Co-Executive Director, African Services Committee

Frank Oldham Jr., Executive Director, Harlem Directors Group

Tokes Osubu, Executive Director, Gay Men of African Descent

Ana Oliveira, MA, Executive Director, Gay Men’s Health Crisis

Jairo Enrique Pedraza, Director of International Programs, Cicatelli Assoc., Inc.

Elaine E. Reid, CSW, Co-Chairperson-Elect, NYC Prevention Planning Group

J. Edward Shaw, Co-Chair, NYC Prevention Planning Group, People Living With AIDS Committee

Terry Troia, Executive Director, Project Hospitality

Rona M. Vail, MD, Clinical Director, HIV Services, Callen-Lorde Community Health Center

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May 24, 2005

New York Proposes Measures to Slow the Spread of AIDS

By ANDREW JACOBS

A commission appointed by the city’s health department has proposed a set of measures to increase condom distribution vastly in prisons, schools and nightclubs, expand needle exchange for intravenous drug users and make H.I.V. testing a routine part of every emergency room visit.

The draft report, issued by the New York City Commission on H.I.V./AIDS, also calls on the city to pay for public awareness campaigns that would address crystal meth abuse among gay men, the strong stigma that AIDS has among African-Americans and the role that people infected with H.I.V. can play in stopping the spread of the virus.

“This report outlines the direction we need to take if we want to halt the epidemic,” said Ana Oliveira, the executive director of Gay Men’s Health Crisis and one of the commission’s members. “The proof of the pudding, however, will be in the implementation.”

Although dollar figures do not accompany its recommendations, many of the commission members said the report, if adopted in its current form, would transform the way the city deals with H.I.V. and AIDS. The panel, whose 21 members included doctors, researchers and advocates for people with AIDS, also calls for increased access to treatment and housing for people with H.I.V. and AIDS.

Dr. Thomas R. Frieden, New York City’s health commissioner, said he was pleased by the proposed recommendations, calling them “a blunt assessment of where we are and a message of optimism.”

If financed and put into effect, the proposals would drastically reduce the spread of H.I.V., he said, and “make New York City a national and global model of how to stop the epidemic.” The report will be formally adopted on June 13 after a public comment period.

The report, 18 months in the making, comes at a time of renewed urgency among public health officials, who say the fight against AIDS has been losing steam even as infection rates remain steady. The growing apathy, they say, may be partly responsible for the appearance of a rare and possibly virulent strain of H.I.V. that was reported last February by the city’s health department.

Although additional cases of that strain have not been documented, panel members said they were concerned that more than 4,000 New Yorkers test positive for H.I.V. each year. More worrisome, they said, is that a quarter of them learn their status only when they are found to have full-blown AIDS.

The report’s most potentially contentious proposals involve ways to increase H.I.V. testing, especially among minorities, the homeless and intravenous drug users. In addition to encouraging more people to get tested, the commission endorsed new state rules governing how data on H.I.V. and AIDS is gathered.

The regulations, which go into effect on a temporary basis next week, streamline H.I.V. testing consent forms and allow health officials to collect detailed information about a patient’s viral load and whether he or she is showing resistance to AIDS medications. Several commission members privately said their willingness to embrace the changes had encouraged the state to adopt the new regulations.

But Tracy L. Welsh, executive director of the H.I.V. Law Project, said she was worried the new rules would chip away at long-established safeguards on the privacy of those infected with H.I.V. “My concern is that this sets the stage for government involvement in private medical decisions,” said Ms. Welsh, who was not a commission member.

While they acknowledged public concerns over privacy, many of the panel’s members said they felt the benefits outweighed the costs. “I’m tired of folks coming through our doors who test positive and who were infected years earlier,” said Tokes Osubu, executive director of Gay Men of African Descent and one of the commission members. “Chances are, they may have been unknowingly infecting other people, and this is something we have to stop.”

(show)

Words From Alive & Well Founder Christine Maggiore

In 1992, I took what is commonly referred to as an HIV test. I had no symptoms of illness, no particular risks or fears, just a new doctor who insisted the test should be part of a regular medical exam. What began as a simple check up turned from routine to life altering when my results came back HIV positive.

Putting aside my shock and shame, I immediately sought out an AIDS specialist. This doctor declared that my test was not positive, not enough to be considered conclusive, anyway. Frightened and confused but hopeful, I followed his recommendations to take the test again along with other lab work to evaluate everything from my cholesterol to T cells.

According to the specialist, the results of this second HIV test were indisputably positive and my progression from somewhat positive to conclusively positive indicated a recent infection with HIV. I accepted his explanation even though the circumstances of my life excluded the possibility of a new infection.

Despite my positive diagnosis, the doctor declared me exceptionally healthy. He also told me that despite my exceptional health, there was nothing I could do to prevent devastating disease and an eventual death from AIDS. According to official estimates, I had between five and seven years to live.

The doctor warned me against wasting money on vitamins and other �foolish� attempts to save my immune system. Instead he advised I wait to become sick and then take AZT, a drug with severe side effects that could possibly make me sicker. I went directly from his office to a health food store in search of the forbidden vitamins. The following day, I began to look for a new AIDS specialist.

Life as I had lived, planned and hoped came to a grinding halt. I lost interest in my job running a clothing company I started in 1986 and had nurtured into a multi-million dollar enterprise. I gave up my goal of earning an MBA and dropped out of business school. Big Sisters of America immediately dropped me from their mentorship program when I confided to having tested HIV positive. Feeling like a cross between a leper and a total loser, I decided to keep my tragedy a secret. I stopped spending time with family and all but a few close friends. Instead, I attended AIDS seminars and joined a support group for HIV positive women where once a week we were encouraged to compare notes on our fears and frustrations, mention any potential symptoms, and lament the lousy deal we’d all been handed.

My AIDS activism began by accident when a friend, moved by my plight, tried to volunteer at AIDS Project Los Angeles (APLA) and was turned away. Incensed that a warm, intelligent woman with the sincerest of motivations would be treated with such disregard, I complained to the men in charge. Before I could finish my reprimand, I had been drafted into their public speaker’s bureau.

Almost immediately, I was touring local high schools and colleges on behalf of APLA. I appeared as the person that HIV should never have happened to�a white, heterosexual, non-IV drug using business professional. APLA booked me for a year’s worth of engagements before I’d even finished their training course. I made audiences laugh, cry, and most importantly scared since I seemed to embody the slogan that everyone is at risk for AIDS.

My suggestions for improving the women’s HIV support group at LA Shanti turned into an invitation to speak for that organization which led to a position on the founding board of yet another AIDS group, Women At Risk.

Although my involvement in AIDS work began unintentionally, I took on my assignments with great passion and deepening sense that these efforts would give meaning to the tragedy that was now my life. I never for a moment imagined a future that might deviate from where I believed I was headed.

But then a year or so into my diagnosis and public service, and after interviewing half a dozen AIDS doctors whose recommendations ranged from immediate drug therapy to world travel, I found an anomaly among AIDS specialists�a doctor who didn’t routinely fill people with toxic pharmaceuticals and lethal predictions. She treated me as an individual rather than an impending statistic, and in doing so noticed my good health. She said I didn’t fit the profile of an AIDS patient, and urged me to take another HIV test. Afraid to raise my hopes, at first I refused. When I finally found the courage to retest, the result was inconclusive. Further testing produced a series of unsettling, contradictory diagnoses: a positive, followed by a negative, followed by another positive.

Confused by a personal situation that defied all the rules I’d been so passionately preaching as a public speaker, I turned for help to the AIDS groups where I worked. Instead of finding answers, I found my questions were dismissed and that persisting with my line of inquiry resulted only in meaningless explanations.

My desire to learn finally led me outside the confines of the AIDS establishment and into a body of scientific, medical and epidemiological data that defied everything I had been taught about AIDS, and everything that I had been teaching others. The more I read, the more I became convinced that AIDS research had jumped on a bandwagon that was headed in the wrong direction.

When it became clear that the information I had found, however life-affirming, was not welcome among the AIDS organizations I belonged to, I decided to start my own. In 1995, together with a few friends gathered from various support groups and other places along the way, I started Alive & Well to share vital facts about HIV and AIDS unavailable from mainstream venues.

In 1996, while trying to write a simple threefold brochure, the first version of my book �What If Everything You Thought About AIS Was Wrong� emerged. That same year, I met a wonderful man who became my husband. We have two beautiful, healthy children, ages six and two, who have never had so much as an ear infection.

In the 12 years since receiving my death sentence, I have taken an unexpected journey from frightened victim to AIDS activist to HIV dissident to spokesperson for new views about HIV and AIDS. I have abundant good health and live without pharmaceutical treatments or fear of AIDS.

The most surprising aspect of my story is that it is not at all unusual�I know hundreds of HIV positives that are alive and naturally well many years after receiving their own dire prognoses. Contrary to popular claims, what we have in common is not some unique genetic quality, but the ability to liberate ourselves us from unfounded fears and embrace our natural ability to live in health.

Through Alive & Well and my book, I hope to share vital facts, inspire essential dialogue and give other people who test HIV positive the chance to consider a destiny that differs from the one we are taught to expect.

(show)

Maggiore on 20/20, August 24, 2001 – Transcript

Ms. Maggiore can be reached at Alive & Well AIDS Alternatives, 11684 Ventura Boulevard, Studio City, CA 91604. Telephone: (877) 92-ALIVE. E-mail: christine@aliveandwell.org. Her book questioning the cause, identification, and treatment of AIDS is available through www.amazon.com or the Alive & Well website at AliveandWell

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Announcer: From ABC News, around the world and into your home. This is 20/20, with Barbara Walters. Tonight – a woman out on a limb. HIV-positive – and having unprotected sex with her husband. HIV-positive – she breast-fed her child. HIV-positive – and pregnant again.

Christine Maggiore: I’m a healthy person. Charlie’s a healthy boy.

Mathilde Krim: I think she’s deluded.

Announcer: The story of a mother hell bent on defying the conventional wisdom that HIV causes AIDS.

Connie Chung, ABC News: There are people who think that you are just like those who did not believe that the Holocaust existed. That’s what you are.

Announcer: Connie Chung with “The Disbeliever.”

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Announcer: And now, from Times Square in New York, sitting in for Barbara Walters, John Stossel.

John Stossel: Good evening, and welcome to 20/20. Barbara Walters has the night off. Our first story may make you angry. You’re about to meet a woman who’s infected with HIV, but she refuses to take any of the drugs which might fight the virus. Now, you could say that’s her choice. It’s her body. But what about her husband, with whom she has unprotected sex? And what about the kids they’re having together? What she’s doing seems cruelly irresponsible. Yet some people cheer it, and she’s now made converts around the world. Connie Chung has some hard questions for a mother we call ‘The Disbeliever.’

Connie Chung: It’s a picture-perfect day in the San Fernando Valley, and Charlie Scovill is celebrating his third birthday. With presents on the lawn, burgers on the grill, and a happy-jump in the backyard. It looks like the American dream. But this little boy’s future may be as fragile as bubbles on a summer breeze. Christine Maggiore, Charlie’s mother, is HIV-positive, and experts say there’s at least a one-in-four chance that Charlie is infected with the virus that causes AIDS. But don’t feel sorry for this little boy – or his mother. She says HIV can’t harm them.

Christine Maggiore: The idea that HIV causes AIDS is an idea that has not been proven to be correct or true.

Connie Chung: Wait a minute! The medical community has been telling us for two decades that HIV causes AIDS. Are you saying that HIV does not cause AIDS?

Christine Maggiore: I’m saying that there are many valid, vital reasons to go back and rethink what we’ve been told.

Connie Chung: Activists attack her. Dissidents admire her. AIDS experts wish she would just go away. But Christine Maggiore’s influence is growing. Her controversial book, What If Everything You Thought You Knew About AIDS Was Wrong?, questions even the most basic medical and scientific findings about AIDS. [To Maggiore:] You don’t even have a college degree. How could all of them, with their years and years of training and research, be so wrong, and you be so right?

Christine Maggiore: I don’t think it takes a medical degree or a scientific degree when your life is on the line.

Dr. Mathilde Krim: I think she’s deluded. And because the reality was too painful for her to accept.

Connie Chung: Presidential Medal of Freedom winner Dr. Mathilde Krim is the co-founder of the American Foundation for AIDS Research, AmFAR, which has raised more than $100 million to research and find a cure for AIDS. A scientist herself, with a Ph.D. in biology, Dr. Krim fears that Maggiore is doing incalculable harm in the fight against AIDS.

Dr. Krim: The problem here is she’s spreading the delusion to others, without any doubt that she’s maybe wrong, you know. And this is terrible. This is what makes me angry.

Christine Maggiore: I could be angry with Mathilde Krim. After all, it’s her paradigm that says I should have started AIDS drug therapies, I should have been living as though I were dying, I should not have had a child, and I should be quietly succumbing somewhere to illness.

Connie Chung: Maggiore never dreamed that she was at risk for AIDS. By the time she was 30, she was a successful entrepreneur, running a million-dollar clothing company in Florence, Italy. [To Maggiore:] Did you use intravenous drugs?

Christine Maggiore: No.

Connie Chung: Were you sexually promiscuous?

Christine Maggiore: No. I would describe myself as a pretty average single adult person. I had been involved in a long-term, what I believed was a monogamous relationship, at least from my end.

Connie Chung: In 1992, two years after the relationship ended, Maggiore took an HIV test during a routine medical exam. [To Maggiore:] Do you remember the moment that you were told you were HIV-positive?

Christine Maggiore: Oh, yeah, very clearly. It was a very long moment. I saw the typical photographs that you see of somebody who has AIDS, and thought that would be my future: that I would leave a miserable, isolated life of illness and an untimely death.

Connie Chung: Maggiore soon learned that her Italian ex-boyfriend had also tested HIV-positive. Believing she was terminally ill, she threw herself into warning others about the dangers of AIDS.

Christine Maggiore: Yes, I encouraged people to take tests. I called them accurate and specific, and I told people that everything added up in the world of AIDS science. And I believed that with my heart.

Connie Chung: Maggiore’s conviction was shaken to the core when a year later, another HIV test came back ‘indeterminate.’ Her next test was positive – and the next one, negative.

Christine Maggiore: I truly believed, based on the day and the result, I was either living or dying.

Connie Chung: Frustrated and angry, Maggiore desperately searched for answers. But the more she read, the more questions she had. She was shocked to learn that HIV tests measure antibodies, not the virus itself, and that no scientist could explain exactly how HIV causes AIDS. Then she came across the writings of Dr. Peter Duesberg, a controversial virologist at the University of California at Berkeley, who had been saying for years that HIV could not cause AIDS.

Christine Maggiore: I realized that what I had been taught, and what I was teaching other people, did not add up. Many times it was simply wrong.

Connie Chung: Maggiore became convinced that AIDS is caused not by HIV, but by known immune-suppressing risk factors such as recreational drug use, toxic AIDS treatments, even poverty and malnutrition.

Christine Maggiore: The diseases that we call ‘AIDS’ can range from chronic yeast infections to certain forms of cancer, to certain kinds of pneumonias. These happen to people who don’t test HIV-positive.

Connie Chung [to Dr. Krim]: Does HIV cause AIDS?

Dr. Krim: Absolutely. Absolutely. The evidence that HIV causes AIDS is as – good as the evidence that exists that polio is caused by a polio virus, and measles by a measles virus.

Connie Chung: At this sold-out benefit concert by the platinum-selling band Foo Fighters, thousands of teenage fans cheered this rebel with a cause.

Foo Fighters Band Member [concert film clip]: Everybody give her a hand!

Christine Maggiore: I encourage all of you to question what you’ve been told about HIV and AIDS!

Connie Chung: Last summer, Maggiore stepped onto the world stage at the 13th international AIDS conference in Durban, where she met with South Africa’s president, Thabo Mbeki. Mbeki reportedly became intrigued by the dissidents’ views while surfing the Net. Protests erupted when Mbeki stunned the world by questioning whether HIV was in fact the cause of the AIDS epidemic devastating his country. AmFAR shot back with this full-page ad in the New York Times. [To Dr. Krim:] Is Christine Maggiore putting lives in jeopardy?

Dr. Krim: I believe she is putting lives in jeopardy, and what she says she has learned draws people to the conclusion that they can throw away their condoms and stop taking medications.

Connie Chung: Mainstream scientists say the evidence is irrefutable. HIV can be found in the blood of almost 100 percent of those diagnosed with epidemic AIDS, and virtually no one without HIV will develop AIDS.

Dr. Krim: To see others, on spurious, disingenuous arguments, fight us and undermine what we’re doing is very, very difficult to accept. And frankly offensive.

Connie Chung: Offensive?

Dr. Krim: Yes.

Connie Chung: Maggiore knows that according to statistics, she has a 95 percent chance of dying from AIDS within the next six years – unless she is treated. But not only has she refused to take anti-HIV drugs, she has consistently broken all the rules, including the warnings about unprotected sex. Her husband, documentary filmmaker Robin Scovill, who provided additional video footage for this report, knew that Maggiore was HIV-positive when they became involved.

Robin Scovill: I just never really bought the premise that if you have sex with the wrong person, you’re going to be infected and your life as you knew it is over. I just never really bought that.

Connie Chung: Shortly after they became intimate, Maggiore discovered she was pregnant.

Christine Maggiore: Well, first we laughed, and then we cried, and then we laughed.

Robin Scovill: Yeah, we – yeah, exactly!

Connie Chung: They had made a decision to play Russian roulette with their own lives. But would they be willing to gamble with their baby’s life as well? Doctors warned that there was a 25 percent chance that Maggiore would transmit the deadly virus to her unborn child – unless she took powerful anti-HIV drugs like AZT. Maggiore refused.

Christine Maggiore: I did not want to expose my growing child to toxins during pregnancy.

Dr. Krim: I can’t believe a mother would put her child at risk. This is where I say good luck to her, because she is taking a terrible chance.

Connie Chung: Because she refused to take AZT, no hospital or clinic would accept Maggiore as a maternity patient. A midwife finally agreed to help her with a natural birth at home. Charles Dexter Scovill entered the world in an inflatable swimming pool in Maggiore�s living room. And, true to her beliefs, Maggiore made yet another radical decision: she began breast-feeding her child, even though experts say HIV can be transmitted through breast milk.

Christine Maggiore [film clip, meeting with San Francisco Mayor Willie Brown, January 16, 1999]: I’m Christine Maggiore, from HEAL / Los Angeles.

Connie Chung: She even breast-fed Charlie, then more than a year old, during this meeting with San Francisco Mayor Willie Brown.

Christine Maggiore [film clip]: And antibodies can’t cause disease, and they don’t predict future illness.

Connie Chung: Maggiore didn’t know it then, but her public display of her private convictions would backfire. When Charlie was 2 1/2, an anonymous call was made to the L.A. County Department of Children and Family Services. The caller complained that Charlie was malnourished and was being breast-fed by his HIV-positive mother.

Christine Maggiore [film clip]: Right as we speak, a representative from Child Protective Services is approaching our front door.

Connie Chung: The woman coming to the door was a county social worker with the power to take Charlie away.

Christine Maggiore: It’s insane. It’s just completely insane. It’s like the world is upside down. But when you’re inside of it, and it’s your life, and your child, and your everything, then it matters a lot.

Connie Chung: Charlie’s pediatrician, Dr. Paul Fleiss, came to Maggiore’s defense.

Dr. Paul Fleiss: Charlie is a very healthy boy. He has never been sick. I think his mother takes very good care of him.

Connie Chung: Charlie was allowed to remain at home. [To Maggiore:] If you are wrong, aren’t you afraid of what you’re saying could profoundly affect not only your own health, but the lives of thousands of people?

Christine Maggiore: I think I’m successful when I get people to think and that’s all I’m asking is for people to think about these issues. What I do is not about a philosophy -

Connie Chung: -I know, but you could affect their lives.

Christine Maggiore: I hope to affect their lives -

Connie Chung: – I mean in a detrimental way. If you’re wrong -

Christine Maggiore: I’m not in a position to be right or wrong. I’m providing people with information that they can use to make informed choices about their life and their health.

Connie Chung: Yet when it comes to her son, Maggiore has chosen to remain uninformed. Like his father, he’s never been tested. [To Maggiore:] A lot of people would think that it was irresponsible of you to not test him. Doesn’t he have a right to know?

Christine Maggiore: I don’t need to risk introducing into his life a label that will wrongly describe him as ill when he’s not.

Dr. Krim: She’s afraid of testing him, she’s afraid of testing her husband, because she’s in denial and she is afraid.

Connie Chung: Experts say that the incubation period between HIV infection and full-blown AIDS is 10 years.

Dr. Krim: She is in fact a rather common occurrence of somebody who is a slow non-progressor.

Christine Maggiore: Mathilde Krim would describe me as ‘a slow progressor,’ as if to make ‘progress’ I need to become ill! Then I’ll be fulfilling my obligation as somebody who’s HIV-positive.

Dr. Krim: She is still in – within, you know, the asymptomatic period. That may last a few more years.

Christine Maggiore: What kind of system is that? What kind of language is that to use to put on me, to describe me? I mean, there are so many people, I’m not an exception. We progress every day in our lives by staying healthy and productive, and off of toxic drugs.

Connie Chung: There are people who think that you are just like those that did not believe that the Holocaust existed, flat-earth theorists. That’s what you are.

Christine Maggiore: Well, what I recall of history is that the flat-earthers were in the majority, and the people who questioned the idea of the flat earth were in the minority, and finally they were listened to.

Dr. Krim: I wish she were right, but she’s not. It would be nice, you know, if it was not – if we didn’t have an HIV virus in this world. But we have it, and we have to learn how to face reality and deal with it.

Connie Chung: Right or wrong, Maggiore remains convinced that she’s beaten the odds. Today she’s five months pregnant with her second child, a daughter. She’s not taking AZT or other anti-HIV medications during pregnancy. As with her first child, Maggiore is rolling the dice against a dreaded disease. And it’s winner-take-all.

John Stossel: If you’d like to talk on-line with Christine Maggiore, go to abcnews.com for more information.

(show)

Interview with Christine Maggiore — 6/9/98

Ms. Maggiore is the founding member of HEAL-LA, an activist group that speaks out against the direction and methods of orthodox AIDS researchers. She is also the author of a handbook titled, “What If Everything You Thought You Knew About AIDS Was Wrong?” published by HEAL.

Interviewed by Sarah Klipfel

Advocate: What do you see as the major points of contention between the dissidents and the orthodox AIDS researchers?

Maggiore: The reliance on antibody tests to diagnose infection when the antibody test can’t do that; the inaccuracy of the antibody test to diagnose what is supposed to be a fatal illness; the notion that HIV has been proven to be the cause of AIDS, which is not correct; and the use of chemotherapy treatments such as AZT and other experimental chemicals like protease inhibitors that all focus on eradication and inhibition of HIV, which has never been proved to be there, and as a treatment for immune suppression. I think those are the main points of contention.

With the inaccurate test, then, do you think that patients are being misdiagnosed?

Well, if you have an inaccurate test that automatically leads to misdiagnosis; and the notion that you can use an antibody test to somehow tell if a person is infected with something is obtuse. … But rather than say that people are being misdiagnosed, I would say that people are being erroneously diagnosed.

Because the test is not an accurate one?

Meaning that there is no such thing as one antibody specific to any disease, so an antibody test in and of itself is inaccurate.

I was wondering about the drug treatment issue that you bring up. Don’t you recommend that people diagnosed with HIV not take the new drug treatments?

Well, it’s not really my recommendation. Its more my opinion after examining the literature that the drugs offer no positive benefit.

What do you say, then, to people who have shown improvement after taking the drugs?

People show improvement with all kinds of things. Placebos, just because, and there’s also that when you introduce more toxic chemicals into your body, each one has a lesser chance of being assimilated fully. And the people who are feeling better are few. The news reports tend to emphasize those, but if you talk to people in real life, a lot of people believe that they’re doing better because their, quote: “viral load” counts are down, that’s another stupid test, but the compromises are that they have diarrhea, their hair is falling out, they develop buffalo humps, liver failure, sudden death, even if you look at the ads for the drugs, they don’t even say anything good if you look at the fine print.

So you don’t think there’s any actual chemical connection to people getting better?

I can’t see a reason scientifically why there would be. If you can’t isolate a virus in people who are, quote: “ill,” why is a chemical that is designed to inhibit viral replication making people feel better? I mean, the virus isn’t even there. If it is having any beneficial residual effects it has nothing to do with the intended effects of the drug. Back when AZT was first released for use, there were all kinds of people claiming that it was life-saving; now they’re all dead.

(We discussed possible speakers for the orthodox side of the debate. Maggiore advocated Public Health officials rather than members of ProjectInform because of their obligation to address possible public safety issues).

Why do you think there’s so much reluctance on the part of the orthodox AIDS researchers to want to advance dissident concerns scientifically and figure out the gaps?

Because if this immune suppression associated with AIDS turns out not to be viral then they’ve spent a good deal of their life and time mistreating people. So that’s lawsuits, guilt.

But if there are already gaps in their arguments that you and other dissidents have found, wouldn’t you think that its inevitable that they will come out?

Yes. And you would think that they would like that to come about sooner rather than later so as to save some people’s lives. But one analogy is that this is like a steamship: once something gets this big, it becomes hard to turn it.

But you’ve already tried talking to people about this issue?

We have, and if you check out our web site aliveandwell.org), that lists the 120 or so people and organizations that we have challenged to a debate with us.

And have any of them come forward to debate with you?

No. And another thing, too, is that they don’t have to. If you’ve got the predominant paradigm on your side, why would you bother to come forth and pit yourself against… what? A little rag-tag group that says you’re doing something wrong? And all you have to do is show up and shake hands and you win awards and government funding. Why would you bother? Its like O.J. appearing before the American public for a little question-and-answer. Why would [he] do that? He’s been found innocent. You have nothing to gain and everything to lose.

But don’t you think the “rag-tag” group is getting bigger?

Oh, absolutely. Doctors and scientists lead rather insulated lives. A lot of the doctors who treat AIDS patients don’t even know about the side effects their own patients are having because the nurses deal with them on that. They’re not really in the mix with the rest of us.

So what do you think the major problem is? Funding? Media attention?

Well, it’s a common thing in a society driven by profit margins that you can’t do anything without making money. The whole thing is a huge money-maker. Its a boom growth industry for the pharmaceutical companies. They’re being subsidized by the U.S. government and the World Health Organization. As people in this country and other industrialized countries move away from AZT as a monotherapy — it’s now considered reckless and irresponsible to do that — they’re able to dump it in the Third World and have different health organizations pick up the tab for poisoning people.

Have you heard about the AIDS vaccine? They’re trying that out in Thailand now.

Yeah. That’s a pretty lame idea. Think about it. People who test HIV positive have antibodies; a vaccine is something that provides you with antibodies as protection. Hello? What synapse busted in somebody’s brain for that to take place? But most people do not know that the HIV test is testing for antibodies. They assume, as I did for the longest time, that it is testing for something that can measure disease. When it’s a life or death thing, you tend to be so paralyzed with fear that you tend not to ask. And then you have a person in authority telling you this.

So it sounds like a major issue is to develop a more accurate test?

Well, first of all you have to find out if the microbe that you’ve been testing for has been substantiated as the cause of the disease. If you go and test AIDS patients, you can find that they test positive in greater numbers for a variety of microbes and bacteria; also people, just general human beings, have between 50,000 and 100,000 retroviruses that just hang out in their bodies. So people will test positive for lots of things. Like birds on a electrical wire during a power failure, it doesn’t mean they caused it. It just means they were there.

What does this mean about the existence of an HIV virus? What about the French research team led by Luc Montagnier in the early ’80s who claim to have found a retrovirus? Is what they found now proven to be incorrect?

Well, there are certain criteria to prove that a retrovirus, in particular, comes from outside your own body. Our human DNA can produce what are called “endogenous” retroviruses. It doesn’t come from outside, it’s just being spit out from within your own body. And it’s stuff that doesn’t do anything. So, first, the whole notion that HIV causes AIDS is based on the studies of a cancer doctor who spent twenty years trying to say that retroviruses cause cancer.

Dr. Robert Gallo.

So, basically he is taking his pet project and applying it to a new problem. That’s hardly a substantial and well-founded way to address a new problem, to blame whatever you have hanging around your lab for causing the problem. It defies logic, in that they studied these things for 20 years because retroviruses don’t kill cells, but then this guy comes along and says: “Oh look at this retrovirus, and its killing the T-cells!” Well, they’ve never shown the virus to be in T-cells, and as a matter of fact, when they culture and grow the conglomeration of particles they call the HIV virus, they grow it in immortal T-cell lines. That is, they’re growing it in T-cells that never die because the HIV doesn’t even bug them.

So they’re setting up an unreal situation.

Yeah, it’s a totally unreal scenario; and rather than say, “Oh, God, in 1984 we took off and went from zero to sixty in the wrong direction, they initiated all these Public Health programs…. They keep trying to explain with this “Oh what a tangled web we weave”-theory way of doing stuff. The web becomes more and more tangled, and HIV becomes more and more mysterious. When the drugs… when people first start with them, the body responds as it would if it were under attack from anything, especially from a poison — it perks you up. They call that the drug “working.” It elicits the body to create more T-cells in response to an attack. And then when the body tires itself out from trying to constantly produce what is being destroyed, they blame that phenomenon of quote: “the drug is no longer working,” on a mutant strain of the virus, rather than saying, “Well, maybe the drug was never working in the first place.”

But didn’t it seem like AIDS was, at first, a new form of old diseases?

They’re all old diseases in the AIDS definition. It’s just that they were showing up where you typically wouldn’t see them. You wouldn’t have found a 24-year-old with Kaposi’s Sarcoma, that was an old Mediterranean man’s disease. Also, it wasn’t something particularly lethal. It was just something you coexisted with, and you looked kind of icky.

So there is something that’s turning these diseases into something lethal?

Yeah. It’s called screwing around with chemicals and not sleeping. When you look back on the original AIDS cases, and you see how these people lived, that [they were] in their mid-20s, their average number of sexual partners was already over 1,000, that they had had syphilis, gonorrhea, chlamydia, amoebic infections, parasitic infections, Hepatitis, all kinds of things over and over again, had spent years on antibiotics, many lived on crystal meth, which means you don’t eat… I mean, malnutrition is the number one cause of immune deficiency in the entire world. Of course you’re going to fall apart in all sorts of ways; and things that would not normally bother a person who has a defense system and is healthier, are going to tear you down. It’s going to make it impossible for your body to defend itself, because your body is so weak. If you look at the most popular AIDS-defining illness in the United States, PCP pneumonia — everyone in the world has PCP bacteria in their lungs. But who gets sick? People who wear themselves out. If you follow what the AIDS definition is in Africa, PCP is not even in the definition.

But how do you explain, then, the presence of HIV in newborns and hemophiliacs?

Newborns? 80 percent are born to moms that are crack-addicted and drug-addicted.

But don’t you think there are the exceptions of people who are otherwise healthy?

Yeah, but those are the ones that tested positive and then they’re thrown on AZT during their pregnancy; or as soon as the baby is born and it is tested and it tests positive for its mother’s own antibodies — the baby doesn’t even have an immune system yet — then they go and put the baby on AZT, a toxic, DNA-chain-terminating, chemotherapy drug. Good luck living through that. Of course they’re going to get sick. You know, I just read an article about a woman who was on AZT during her pregnancy and her baby was born with extremely life-threatening anemia, which is one of the side effects of AZT. Anemia’s not even an AIDS-defining illness; it’s drug-induced.

So you think it’s impossible, then, that any normal, healthy person would contract the disease?

There is not a single one in all of the literature. Not a single one in which HIV has been the only risk factor. Not one. I’ve scoured all of the medical literature — people do all the time who are on, quote, “this side of this issue” — looking for a single case proving that HIV was the only risk factor, that mom wasn’t doing coke or crack, that the baby wasn’t born with some sort of immunodeficiency that was unrelated to HIV or viruses, that the person who went on to get AIDS just tested HIV positive, never went on any drug therapies, never did anything that would compromise their health and suddenly died. It’s just not there.

But you do think there is something there that is making diseases worse than they were?

It’s not “something,” you have to look at the individual person, which is what Western medicine tends not to do, and has completely forgotten about in this case. They’re not saying: “Well, gee, we’ve got Bob over here who’s a hemophiliac and he’s awful sick; and we’ve got Dave over here who’s a drug-using homosexual and he’s awful sick; What’s wrong with Dave and what’s wrong with Bob?” Well, Bob’s been using Factor 8 for the last 15 years of his life, which is the distillation of the blood of 20,000 people he’s never met. That causes an immune response. And Dave over here has been on crystal meth for the last three years, and before that he was having problems with alcohol abuse, he’s had syphilis 15 times, gonorrhea six times… You know, its silly to focus on an “it” in a situation where you have 29 diseases, some are fungal, some are bacterial, some are caused by cell-proliferation, others caused by cell-depletion, and say its one thing. It’s like a dream world for someone who wants to patent one thing as a cure. It’s a dream world for somebody who doesn’t want to take responsibility for their wellness or their illness. In the case of hemophiliacs, I use the word “responsibility” in that a hemophiliac should be told: “You’re putting Factor 8 into your body. I mean, God, sir, this stuff is extremely immuno-suppressive.”

What would you recommend, then? How about research that goes back to only what can be proven about HIV and AIDS?

I would recommend, I mean if I were in charge of everything, remove the “HIV” and treat people for what’s wrong with them.

So, say that there is no such thing as HIV?

Yeah. If somebody shows up at your office with quote: “AIDS” and immune suppression, take a look at their life, take a look at their medical history. If you took HIV out of the picture, you could treat people for what is wrong with them, rather than projecting onto healthy people that there will be something wrong with them, and scaring them into taking toxic chemicals and making something wrong with them. And the people who are genuinely ill, you could help by addressing what’s really wrong with them. If you look at it through the lens of AIDS, the person who has a yeast infection gets the same treatment as the person who has tuberculosis as the person who has cancer. They all get put on the same “cocktail” drugs.

But doesn’t it seem like people may be treated for what is specific to their disease and it’s not working because there is something wrong with their immune system?

Well, if you have an immune system that’s not functioning, that’s something wrong; but its not anything mysterious or strange or contagious, its just that your immune system is broken down. You know, I was misdiagnosed as an adolescent with having a problem with my thyroid that I never had. I was put on a very powerful medicine that caused me to have immune suppression — it depleted the calcium and potassium in my body, it caused me to lose bone marrow, bone density, I was sick a lot, it caused my heartbeat to elevate, and my body temperature to rise, I was losing my hair; and I was on the medicine for 18 years. It took about eight years before it got really noticeable and horrible — kind of like wearing shoes that don’t fit, you just get used to the pain — but I was horribly immune-suppressed because of that, and it took me a while to get better. How I got better was not taking other chemicals. I stopped taking the medicine under the care of a doctor who understood that I never had the problem in the first place. Then I had to rebuild my health. The only way you rebuild your health is through exercise, diet, supplementation, things like that. There’s no chemicals, produced by any pharmaceutical company, that will restore your health.

Which is restoring your immune system as well.

Yeah, I mean, there’s even debate about what the immune system is. The immune system is our entire body, and that even starts with our skin. Burn victims can die, not because the burns kill them, but because their skin is gone and they have nothing to protect them. Our whole body is an immune system, our whole body is a functioning organism, that requires other things to aid its function, to optimize its function; and when you mess with that balance — especially with antibiotics in the stomach area — you’re no longer able to intake the nutrients in food because you’re not digesting properly. Right there you’re on the track to living life as a sick person.

It’s more human and complex than HIV=AIDS=DEATH. Western medicine tends to simplify and look for patentable solutions. I mean, God forbid you tell someone to go on a diet rather than give them Fen-Fen. People are so loathe to doing anything themselves about their health and well-being, they would rather rely on chemists and doctors. But it’s a changing trend, thank God.

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My Bout of So-Called AIDS

By Christine Maggiore

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This document was provided by:

Health Education AIDS Liaison, Toronto

www.healtoronto.com

tel/fax:(416) 406-HEAL

This past March, I had the unsettling experience of being diagnosed with an AIDS defining condition. The news arrived with cruel precision on the 10-year anniversary of my testing HIV positive, coinciding perfectly with the orthodox axiom that we get a decade of normal health before our AIDS kicks in.

The diagnosis was based on a grade 3 Pap smear with cervical dysplasia, a result that insinuates cancer. Devastating enough on its own, my HIV positive label added a layer of complication.

As you may know, cervical dysplasia and cervical cancer were added to the AIDS definition in 1993 causing the number of women classified with AIDS to increase notably. Even though some 65,000 Americans are diagnosed each year with cervical cancers, and only a small fraction of these (about .0015%) are among women that test positive, HIV + cervical abnormalities = AIDS.

I imagined Dr. Matilde Krim cackling with delight at this seemingly tragic turn of events. Director of the orthodox AIDS research group AmFar, Krim had pronounced me “delusional” in a national television broadcast last fall for daring to consider myself healthy. According to the good doctor, I am merely enjoying the so-called latency period between testing positive and getting sick. During her interview, she did everything short of wish I would die of AIDS.

As an outspoken representative for alternative AIDS views, a full time mascot for healthy HIV positives, and a new mother for the second time, tackling this challenge was the last assignment I wanted. The diagnosis was totally inconvenient to my life and work. I fell prey to despair, called my husband and sobbed into the phone. Together, we recovered my rationality. I dried my tears and asked the doctor to perform another test.

Given the unreliability of diagnostics in general, and the fact that Pap smear slides are read by lab technicians for a matter of seconds, this seemed a perfectly reasonable request. She refused, however, imploring me to “stop being in denial,” and acquiesced only after I politely but unrelentingly insisted. Holding my own was emotionally exhausting, and in the end it felt more as if she were humoring me than respecting my judgment.

The second Pap came back grade 2, a slightly less concerning level of diagnosis. According to my doctor, this suggested the presence of Human Papilloma Virus or HPV, a supposedly contagious condition associated with cervical cancer. Since I have never been diagnosed with a sexually transmitted disease, my husband’s never had one, we’ve been together for six years, and all my previous Paps have been normal, I questioned the new results. My skepticism seemed to reinforce her notions I was lolling in denial. Our conversation turned contentious.

I cited information refuting the HPV/cervical cancer hypothesis, Professor Peter Duesberg’s well-referenced deconstruction in particular. I recalled how the assumption that HPV caused cervical cancer had risen to popularity in the late 1970s following the complete failure of the Herpes Virus/cervical cancer hypothesis of the 1960s. That according to studies, half the American adult population is infected with HPV yet only 1 percent of women develop the cancer, and while equal numbers of men and women have HPV, men rarely develop penile cancers.

My doctor responded by recommending I see a specialist.

After much discussion, the new gynecologist acknowledged the presence of HPV only correlates with cervical cancer in some cases, and there is no evidence of a direct, causal relationship.

Both gynecologists agreed I should disregard the second test and consider the one indicating cervical dysplasia to be correct. Both recommended a colposcopy (a fairly invasive and painful procedure), to prepare for a biopsy, and urged me to act promptly. Instead, I decided to gather other opinions from holistic health practitioners.

In consultation with a naturopath, I determined I would follow the gynecologists’ advice and act as if the worst-case scenario were true, that I had cervical dysplasia or cervical cancer. Together, we created a protocol that would serve to better my health no matter what diagnosis – if any – were correct. This program included detox, colon hydrotherapy, digestive enzymes, daily juicing, food combining, some new supplements, and regular exercise – something I’d slacked off on since the birth of my daughter. On my own, I added ozone therapy to the regimen.

Life went on as normal, apart from the whirr of the juicer every morning and arranging for childcare during the ozone infusions.

Although I vacillated between dauntless, nervously hopeful and scared, my confidence in what I know about HIV and AIDS did not waver. What makes sense in times of health makes the same sense in time of health challenge. I felt no temptation to suddenly regard my positive HIV test as an illness in need of treatment. Sometimes I worried how others might interpret or use my situation, but the possibility of cancer did not inspire any panicked denouncing or erosion of what I understand about science, medicine, natural health, HIV and AIDS. If given a choice, I would have preferred not having to deal with another dreaded diagnosis, but as long as life dished it up, I accepted the opportunity to learn.

In August, I had a new Pap smear performed by a third gynecologist. I used an assumed name and did not mention my HIV status. This time the result was normal.

My doctor was at lunch when I called with the good news, so I left a message with the front office manager who was totally unimpressed. She explained, “That happens all the time. Most women get an abnormal Pap after having a baby. We just run the test again and it usually comes back normal. If not, the doctor gives them this little cream and that takes care of it.”

Until that moment, neither doctor had mentioned an abnormal test was normal after childbirth, that second smears are routinely performed in such cases, or that there was any “little cream.”

I have since discovered that the overwhelming majority of my female friends�all HIV negative, some with children – have received abnormal Pap results like mine. For them, a second test was a matter of course rather than a hard won concession. In every case, their results reverted to normal with no therapy.

Testing HIV positive often means being treated differently – with prejudice, based on unfounded assumptions, and as though well informed decisions are elaborate forms of denial. It seemed the dysplasia diagnosis confirmed my doctors’ beliefs about HIV, and my supposed illness was the expected outcome. I felt frustrated, and even humiliated. I had to insist on getting what everyone else receives without discussion�the chance to be a healthy human being until proven otherwise.

Whenever I speak in public someone invariably asks, “If HIV doesn’t cause AIDS, why do a lot of people who test HIV positive get sick and die?” I think a better question is: How does anyone who tests positive remain well?

Between the initial devastation of the diagnosis, the subsequent social isolation, dire predictions by doctors, lab tests measuring out our remaining time, medical care that assumes our inevitable early demise, AIDS organizations poised to usher us into death, negative expectations of friends, family and the public, constant media reports on the incurable fatal virus, pressure to consume toxic drugs, to regard ourselves as infected, abnormal, and ill, pitches to sell off our life insurance, exchange work for disability, and get a handicapped parking pass, and official orders to keep a safe, latex-covered distance from people we love, I wonder how so many of us manage to live.

According to official definitions, I had AIDS a few months ago. I’ll never know if the detox, ozone treatments, and dietary changes “cured” me, if the diagnosis changed along with my name, or as with most women, my cervical abnormalities went away on their own – if they ever existed in the first place. Of one thing, however, I feel certain: My knowledge and convictions prevented me from accepting an unverified diagnosis, engaging in unnecessary invasive procedures, and from believing my ability to live in health had come to a crashing halt.

All too often, our options are limited by medical authorities that encourage us to believe the worst, disregard the facts, deny our intuition, doubt our health, and quietly obey orders. I offer my experience with hopes that those of you also labeled HIV positive will create a foundation of knowledge that supports your choices and that enables you to act in your best interests when faced with life’s many challenges.

With good wishes to all,

Christine

Christine Maggiore, Founder/Director Alive & Well AIDS Alternatives

Alive and Well

11684 Ventura Boulevard Studio City, CA 91604 USA

Tel 818/780-1875

National Toll-free 877/411-AIDS

Fax 818/780-7093

Note: The information on this website is presented for educational purposes only.

It is not a substitute for the advice of a qualified professional

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The New York Times

May 15, 2005

After Its Epidemic Arrival, SARS Vanishes

By JIM YARDLEY

BEIJING, May 14 – Two and a half years after a mysterious respiratory illness from southern China infected thousands of people around the world and brought dire predictions of recurring and deadly plague, the virus known as SARS has again provided a surprise.

It has disappeared, at least for the moment.

Not a single case of severe acute respiratory syndrome has been reported this year or in late 2004. It is the first winter without a case since the initial outbreak in late 2002.

In addition, the epidemic strain of SARS that caused at least 774 deaths worldwide by June of 2003 has not been seen outside a laboratory since then. SARS is not even the nastiest bug in its neighborhood, as health officials warn that avian influenza in Southeast Asia poses a far greater threat.

In cities like Guangzhou and Beijing, once under a state of alert because of SARS, public hysteria about the disease has long since given way to public nonchalance. “Very few people talk about it anymore,” said Cheng De, 22, as he walked through a subway tunnel last month in Guangzhou, the city at the center of the first two SARS outbreaks. “People think it is in the past.”

Health officials in China are also less alarmed, but they warn that SARS could still pose a threat. This caution partly reflects the lack of knowledge about the virus: What caused it to become so virulent in the initial outbreak? Where has it gone? Will it come back?

Most researchers and health officials are not counting on the rosiest scenario – that SARS has simply mutated into oblivion.

“We’d be lucky to believe that, and that would be very nice, but there is no research to support that,” said Dr. Julie Hall, the SARS team leader at the Beijing office of the World Health Organization. “Just because we’ve not seen SARS anymore this year doesn’t mean it is not out in the wild this year.”

Health officials in China are also less alarmed, but they warn that SARS could still pose a threat. This caution partly reflects the lack of knowledge about the virus: What caused it to become so virulent in the initial outbreak? Where has it gone? Will it come back?

Health officials have categorized SARS into three known outbreaks: the worldwide epidemic of more than 8,000 cases that began in November 2002 and ended in June 2003; the second outbreak from December 2003 through January 2004 that involved a milder strain of the virus and caused only four cases; and the nine cases traced to laboratory accidents in China, Taiwan and Singapore between March and May of last year.

Scientists agree that SARS jumped from animals to humans, probably in wildlife markets in the region around Guangzhou, where workers live near the animals they slaughter and sell. In January 2004, Chinese officials ordered a nationwide culling of civet cats from restaurants and wildlife markets after Chinese scientists concluded that the animal was the primary source of the outbreaks. The small, weasel-like animal is considered a delicacy in southern China.

“This year nothing happened because we have very, very strong rules now controlling the wildlife markets,” said Dr. Zhong Nanshan, China’s leading SARS expert, who advocated the cull of civets.

Dr. Zhong, director of the Guangzhou Institute of Respiratory Diseases, said new tests of wild civets from northern China found that none had been exposed to SARS, but as the animals moved closer to the wildlife markets in Guangzhou, the ratio of those exposed to the illness climbed rapidly.

“There must be something happening in the transportation of civets from the north to the markets in Guangzhou,” Dr. Zhong said.

He said his researchers were still trying to determine why civets were so susceptible to the disease and how, specifically, it jumped to humans. It is also unclear what other animals, if any, are carriers of the disease. Rats were initially suspected in the 2003 outbreak in Hong Kong. Ultimately, SARS had a fatality rate of 10 percent, though for people 60 and older the death rate rose to 50 percent.

This year, Dr. Kathryn V. Holmes, a prominent microbiologist who has studied coronaviruses like SARS for more than 20 years, caused an immediate stir in China after giving a speech at the annual meeting of the American Association for the Advancement of Science. News media reports in China quoted Dr. Holmes as saying that SARS no longer existed in the wild and that the virus no longer presented a serious health threat to the world.

In a telephone interview recently, Dr. Holmes, a professor at the University of Colorado Health Sciences Center in Denver, said her comments should never have been interpreted to mean that SARS no longer existed in nature. Instead, she said she was referring to recent research showing that the epidemic strain of SARS that passed from person to person during the initial worldwide outbreak had not been seen since June 2003. This strain mutated after passing from animals to humans in a way that caused it to spread rapidly and become more virulent.

“People are trying to understand which of those mutations was responsible for human-to-human transmission and high virulence in humans,” Dr. Holmes said of one of the fundamental unanswered questions about SARS.

Dr. Holmes credited the fact that SARS had “vanished” this year to the aggressive containment efforts by the World Health Organization and the Chinese government.

“The vanishing was a piece of outstanding coordination throughout the world,” she said. “They controlled the epidemic without having a good diagnostic test for the virus.”

Research on different SARS vaccines is under way at several laboratories in China and elsewhere. Dr. Hall, the World Health Organization expert in Beijing, said the most reassuring discovery about SARS was that it could be contained. But, she noted, the fact that the disease spread quickly throughout the world also showed the potential for more serious diseases like avian flu to cause an epidemic.

“One thing that has come out of SARS is the need to strengthen public health surveillance,” Dr. Hall said. “If SARS revealed the gaps in the system, then avian influenza has increased the urgency to fill those gaps.”

* Copyright 2005 The New York Times Company

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The New York Times

May 11, 2005

AIDS Now Compels Africa to Challenge Widows’ ‘Cleansing’

By SHARON LaFRANIERE

MCHINJI, Malawi – In the hours after James Mbewe was laid to rest three years ago, in an unmarked grave not far from here, his 23-year-old wife, Fanny, neither mourned him nor accepted visits from sympathizers. Instead, she hid in his sister’s hut, hoping that the rest of her in-laws would not find her.

But they hunted her down, she said, and insisted that if she refused to exorcise her dead husband’s spirit, she would be blamed every time a villager died. So she put her two small children to bed and then forced herself to have sex with James’s cousin.

“I cried, remembering my husband,” she said. “When he was finished, I went outside and washed myself because I was very afraid. I was so worried I would contract AIDS and die and leave my children to suffer.”

Here and in a number of nearby nations including Zambia and Kenya, a husband’s funeral has long concluded with a final ritual: sex between the widow and one of her husband’s relatives, to break the bond with his spirit and, it is said, save her and the rest of the village from insanity or disease. Widows have long tolerated it, and traditional leaders have endorsed it, as an unchallenged tradition of rural African life.

Now AIDS is changing that. Political and tribal leaders are starting to speak out publicly against so-called sexual cleansing, condemning it as one reason H.I.V. has spread to 25 million sub-Saharan Africans, killing 2.3 million last year alone. They are being prodded by leaders of the region’s fledging women’s rights movement, who contend that lack of control over their sex lives is a major reason 6 in 10 of those infected in sub-Saharan Africa are women.

But change is coming slowly, village by village, hut by hut. In a region where belief in witchcraft is widespread and many women are taught from childhood not to challenge tribal leaders or the prerogatives of men, the fear of flouting tradition often outweighs even the fear of AIDS.

“It is very difficult to end something that was done for so long,” said Monica Nsofu, a nurse and AIDS organizer in the Monze district in southern Zambia, about 200 miles south of the capital, Lusaka. “We learned this when we were born. People ask, Why should we change?”

In Zambia, where one out of five adults is now infected with the virus, the National AIDS Council reported in 2000 that this practice was very common. Since then, President Levy Mwanawasa has declared that forcing new widows into sex or marriage with their husband’s relatives should be discouraged, and the nation’s tribal chiefs have decided not to enforce either tradition, their spokesman said.

Still, a recent survey by Women and Law in Southern Africa found that in at least one-third of the country’s provinces, sexual “cleansing” of widows persists, said Joyce MacMillan, who heads the organization’s Zambian chapter. In some areas, the practice extends to men.

Some Defy the Risk

Even some Zambian volunteers who work to curb the spread of AIDS are reluctant to disavow the tradition. Paulina Bubala, a leader of a group of H.I.V.-positive residents near Monze, counsels schoolchildren on the dangers of AIDS. But in an interview, she said she was ambivalent about whether new widows should purify themselves by having sex with male relatives.

Her husband died of what appeared to be AIDS-related symptoms in 1996. Soon after the funeral, both Ms. Bubala and her husband’s second wife covered themselves in mud for three days. Then they each bathed, stripped naked with their dead husband’s nephew and rubbed their bodies against his.

Weeks later, she said, the village headman told them this cleansing ritual would not suffice. Even the stools they sat on would be considered unclean, he warned, unless they had sex with the nephew.

“We felt humiliated,” Ms. Bubala said, “but there was nothing we could do to resist, because we wanted to be clean in the land of the headman.”

The nephew died last year. Ms. Bubala said the cause was hunger, not AIDS. Her husband’s second wife now suffers symptoms of AIDS and rarely leaves her hut. Ms. Bubala herself discovered she was infected in 2000.

But even the risk of disease does not dent Ms. Bubala’s belief in the need for the ritual’s protective powers. “There is no way we are going to stop this practice,” she said, “because we have seen a lot of men and women who have gone mad” after spouses died.

Ms. Nsofu, the nurse and AIDS organizer, argues that it is less important to convince women like Ms. Bubala than the headmen and tribal leaders who are the custodians of tradition and gatekeepers to change.

“We are telling them, ‘If you continue this practice, you won’t have any people left in your village,’ ” she said. She cites people, like herself, who have refused to be cleansed and yet seem perfectly sane. Sixteen years after her husband died, she argues, “I am still me.” Ms. Nsofu said she suggested to tribal leaders that sexual cleansing most likely sprang not from fears about the vengeance of spirits, but from the lust of men who coveted their relatives’ wives. She proposes substituting other rituals to protect against dead spirits, like chanting and jumping back and forth over the grave or over a cow.

Headman Is a Firm Believer

Like their counterparts in Zambia, Malawi’s health authorities have spoken out against forcing widows into sex or marriage. But in the village of Ndanga, about 90 minutes from the nation’s largest city, Blantyre, many remain unconvinced.

Evance Joseph Fundi, Ndanga’s 40-year-old headman, is courteous, quiet-spoken and a firm believer in upholding the tradition. While some widows sleep with male relatives, he said, others ask him to summon one of the several appointed village cleansers. In the native language of Chewa, those men are known as fisis or hyenas because they are supposed to operate in stealth and at night.

Mr. Fundi said one of them died recently, probably of AIDS. Still, he said with a charming smile, “We can not abandon this because it has been for generations.”

Since 1953, Amos Machika Schisoni has served as the principal village cleanser. He is uncertain of his age and it is not easily guessed at. His hair is grizzled but his arms are sinewy and his legs muscled. His hut of mud bricks, set about 50 yards from a graveyard, is even more isolated than most in a village of far-flung huts separated by towering weeds and linked by dirt paths.

What Tradition Dictates

He and the headman like to joke about the sexual demands placed upon a cleanser like Mr. Schisoni, who already has three wives. He said tradition dictates that he sleep with the widow, then with each of his own wives, and then again with the widow, all in one night. Mr. Schisoni said that the previous headman chose him for his sexual prowess after he had impregnated three wives in quick succession.

Now, Mr. Schisoni, said he continues his role out of duty more than pleasure. Uncleansed widows suffer swollen limbs and are not free to remarry, he said. “If we don’t do it, the widow will develop the swelling syndrome, get diarrhea and die and her children will get sick and die,” he said, sitting under an awning of drying tobacco leaves. “The women who do this do not die.”

His wives support his work, he said, because they like the income: a chicken for each cleansing session. He insisted that he cannot wear a condom because “this will provoke some other unknown spirit.” He is equally adamant in refusing an H.I.V. test. “I have never done it and I don’t intend to do it,” he said.

To protect himself, he said, he avoids widows who are clearly quite sick . Told that even widows who look perfectly healthy can transmit the virus, Mr. Schisoni shook his head. “I don’t believe this,” he said. At the traditional family council after James Mbewe was killed in a truck accident in August 2002, Fanny Mbewe’s mother and brothers objected to a cleanser, saying the risk of AIDS was too great. But Ms. Mbewe’s in-laws insisted, she said. If a villager so much as dreamed of her husband, they told her, the family would be blamed for allowing his spirit to haunt their community on the Malawi-Zambia border.

Her husband’s cousin, to whom she refers only as Loimbani, showed up at her hut at 9 o’clock at night after the burial.

“I was hiding my private parts,” she said in an interview in the office of Women’s Voice, a Malawian human rights group. “You want to have a liking for a man to have sex, not to have someone force you. But I had no choice, knowing the whole village was against me.”

Loimbani, she said, was blasé. “He said: ‘Why are you running away? You know this is our culture. If I want, I could even make you my second wife.”

He did not. He left her only with the fear that she will die of the virus and that her children, now 8 and 10, will become orphans. She said she is too fearful to take an H.I.V. test.

“I wish such things would change,” she said.

* Copyright 2005 The New York Times Company

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The New York Times

May 8, 2005

The Pope and AIDS

By NICHOLAS D. KRISTOF

S�O PAULO, Brazil

Let’s hope that Pope Benedict XVI quickly realizes that the worst sex scandal in the Catholic Church doesn’t involve predatory priests. Rather, it involves the Vatican’s hostility to condoms, which is creating more AIDS orphans every day.

Nobody does nobler work throughout the developing world than the Catholic Church. You find priests and nuns in the most remote spots of Latin America and Africa, curing the sick and feeding the hungry, and Catholic Relief Services is a model of compassion.

But at the same time, the Vatican’s ban on condoms has cost many hundreds of thousands of lives from AIDS. So when historians look back at the Catholic Church in this era, they’ll give it credit for having fought Communism and helped millions of the poor around the world. But they’ll also count its anti-condom campaign as among its most tragic mistakes in the first two millennia of its history.

“The Catholic Church helps increase AIDS in the world,” said Roseli Tardelli, a Catholic who is editor of the AIDS News Agency in Brazil. She added: “That’s wrong. God doesn’t like it.”

Now that more than 20 million people worldwide have died of AIDS – a toll greater than three Holocausts – there is growing pressure within the church to reconsider its position on condoms.

“If I were pope, I would start a condom factory right in the Vatican,” one Brazilian priest told me. “What’s the point of sending food and medicine when we let people get infected with AIDS and die?”

In his office, that priest keeps a small framed condom behind glass, with a sign: “In case of emergency, break the glass.”

Rosana Soares Ribeiro, the coordinator of a Catholic-run AIDS orphanage in S�o Paulo, says she feels that it’s more important to save lives than to obey church rules. So she tells the H.I.V.-positive teenagers in her care to use condoms when they have sexual relationships.

“My life belongs to God, and God would not want me to allow somebody to be infected with the virus,” she said. “So God will forgive my violation of church rules.”

The countries that have been most successful in controlling AIDS, such as Thailand, Brazil, Uganda and Cambodia, have all relied in part on condoms to reduce transmission.

The Vatican has horribly undercut the war against AIDS in two ways. First, it has tried to prevent Catholic clinics, charities and churches from giving out condoms or encouraging their use. Second, it argues loudly that condoms don’t protect against H.I.V., thus discouraging their use.

In El Salvador, the church helped push through a law requiring condom packages to carry a warning label that they do not protect against AIDS. Since fewer than 4 percent of Salvadoran couples use condoms the first time they have sex, the result will be more funerals.

Fortunately, the Vatican’s policies are routinely breached by those charged with carrying them out. In rural Guatemala, I’ve met Maryknoll sisters who counsel prostitutes to use condoms. In El Salvador, I talked to doctors in a Catholic clinic who explain to patients how condoms can protect against AIDS. In Zimbabwe, I visited a Catholic charity that gave out condoms – until the bishop found out.

“What would Jesus do?” said Didier Francisco Pelaez, a seminarian in S�o Paulo. “He would save lives. If condoms will save lives, then he would encourage their use.”

Even some senior Vatican officials are catching up with reality. One step came when Cardinal Javier Lozano Barr�gan, the Vatican’s top health official, said last year that condoms might be permissible if a husband had H.I.V. and his wife did not.

I wish the cardinals could meet a 17-year-old Catholic girl in S�o Paulo named Thais Bispo dos Santos. She is H.I.V.-positive, goes to Mass each Sunday, wants to have an intimate relationship and marry, and feels betrayed by the leaders of the church she loves.

“Because of their age, they should be wiser,” she said of the cardinals, adding: “I resent that they don’t think of people like me, teenagers with AIDS or H.I.V.”

So if Pope Benedict wants to ease human suffering, then there’s one simple step he could take that would save vast numbers of lives. He could encourage the use of condoms, if not for contraception, then at least to fight AIDS. That choice between obeying tradition and saving lives is stark, and let’s all pray he’ll make the courageous choice.

E-mail: nicholas@nytimes.com