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HomeMy WebLinkAbout006-350-02104, V4ity �1 �S1 { 1 ) o I� Y I a r iI Y ' / `, I •Jif /,�':, +7 IL - •t , ipt p � r rl t i ' ,ky til � T L � •' � r t i J � n � Y 04, �S1 { 1 ) I� Y I a r iI Y ' / `, I •Jif /,�':, i ' ,ky til L � •' � r t � n � AOL am lack Posner er al Public hearing to consider exon o Hutte Cozxnty Code Sect3 on 2436, 4, amok°� ir.aign o andu� t entertainment bus r n adult purs�za t 2827 E i'ries.,, on Property zoned U (ux�classif ied') located dt splanade ntifiad as AP 6-35�21,`Chico. 7/23/86) � idea (Continued open fvom Staff stated that tba e was an error in the co respondence calling the hearing for 3s00 sent to the applicant that the Cr�rwnission take the public input ead but continue and staff recommended p,m. to allow for the possibility of'the a n001 his hearing to 3agta pplicant bcizxg Present Chairman Vercruse stated that they had received a letter ud3th Thomson, bath against the extens�an. She read angio rtheTon 'tucker and from Judith, �'hamson t Mry , �dallace, record the letter Staff explained that the business was established in the �,,2 interim ordinance sur zone. Thera subsequently store adapted by the Board of Su er'lisors, was an establ'ishmen't,of the .hook .stare was legal, > The bock":store~ b ' the ; nonconforming use., d Use Permit was 'applied fax, under 'tyc int a was denied by both the Planning Comm ssioxz and the hoard of Sn interim zone, but stated that this is ora existing nonconforming use, pervisars.taf Commissioner Lambert at that no information on financial �-eeeived by the Comm.i,ss, as requested, ial ha rdship has been q seed, She stated ;that they have riot race ived Y p any information about a?ao is representing the other "%C.rs Ownertitle search indicated ,pt . stated that ol» w ted .r. Pos vmierder is the record 'irirman Vercruse asked if there was anyone present to and there was not. represent the applicant There were 44a. people in the audience opposed to the project. Chairman Vercruse cautioned the public to limit their r.omments to the financial r Commissioner Lambert questioned iftherewas any way of 7cnowing if the ,. representative will be here and staff stated no, Ruth Reims cam laizzed P because this was reported in the paper for lgd3q a, Chairman Verctuse stated that a m. continue this bearingmistake had been made and the to 3 , �}q this afternoon, but they woutd Y Wo publicei to since this was a continued public hearin . had talked to'Caunt Counsel about her concern regarding she g Chairman Vercruse stated that she amortization section of the code was applicable g whether or Section 24-36-2, Regulation of Location, WO ldreq �,. not the adult Qnt,e�rta�nment bUsinesses+ Count ­ to nis instance inasmuch as require a Use Permit for all to receive considez'ation under this clause he must have Y nse�. feels that if the a . applicant does not. S e a use pplic:azt as writin She h wanted County Counsel to give fixer t,his�eopinianhich this j; g h did not feel the Com 'ssiOn was bound by this his, op Section of the Cada Yet"C 00, iIN''` �1x w�1",� FM �t e�.,�t a7 - public hearing to consiAer n exception to Butte, County dod'',t Sectici 4- i. + opt ion Pursuant entettainmment business., an ro ert axnartz a't an of aft adult M7 Esplanad' identified aprop y Zoned U (Unclassified) located at ,P 6 35-'21;, Chico. Staff stated that the consideration today has to be limited to the section of the Cade, 24-361.4, cons.iderration of allowing the aPX ,.I gable to 'Make continue:, and that there''rntist be factual information tpre;sented to�tBg •11etCo�ttmiss coneIerns. SI decision. Counsel is present in fixe event there are questions or, Staff not that a letter ir�srl been received from Mr. b�.amon�d 'an Behalf of tha property owner requesting.. continuance inasmuch as he i to attend the heariixg Staff ° s concern is that long continuances would time line: very close to the time that the. business 'is ta' be s pliable abattd 'andut the suggested that no more than a one meeting continuance should one b County Counsel stated that since there is a request,for tlx p ri ed, continued, and; he understood from staff that it h,a�s`'been the Cotter to'bo olxc PP mrnissio P y> when arta applicant requests a continuance in a timet manner ri � rzox��a�� it. 110 strongly urged the Commission to treat this applicant no dig id +"o grant arxy other applicant as far as granting a conat thiceb fferont h oM the applicant has stated that Fantasy Jand requires 'a gOndahee 7uly 15th 10ttter a financial hardship-c� avoid PP �' extension 1. ,extension is granted�thatat thecend afso' sdatssk�aztahe Lente. that if relocate and not to see �� day k redress in federal cour_s, grecs not e to the Comn;issi.Ott that they; unset t s stxbrgest.ion It was Co In Continue this matter; 2, bo not act on this matter until the Commission has factum, information, He did not believe the attorneys representatiartthat there is a financial hardshix, d which is mere conel.usion, that to inquire of the applicaaxt as to, w�xethexarpnatthehar�ominission da�rcct staff evidence to the Commission to show a`financial 'hardship if one exists,, � ' furnish Chairman Vercruse stated that the Commission received a letter daLed r requesting a continuance; subsequently they received the 7/5/86 requesting the extension, and in that letter no facto 1ggvidenaedwagdy��s n d, matter's he applicant was Pxpecting'a decision today on th She ablced Counsel if t i,s County Counsel stated he did riot feed that the applicant was expecting P ng a decision in that ,.the attorney 'asked that this be continued. but that tne- attorney was trying to cover both bases. ike an extension, but he can not be present but to dying that he would 1 is s to grant the extension, if it is not going to cvntif th9;1jjC,y MY'iss then here not going r masons why you should give me a '9C day extension. re; are niy i P�k+�+� County Counsel stated that on the second, gape the 4Nttarne Land would iilse to resolve i.ts differences with tune Co ytstates khat fantasy Commission would grunt Fantasy sand one 90 day extension pp federal Planning agree to close forever, not relocate in the County and not ntasy land wounds federal 'court. ha,;�elt that this means 'that>t Gaut he a if the � i y are not willing to give him a conitinu�tnca Dant wants a cont3:nuande, extension~ Counsel Felt that a letter from the Commission requesting the then he would lige an dis,evicretience of financial hardship was. important because in Code Sactiong24�36 discretionary,, leen if the Commission receives evidence'of fina tion' r°Y is the Cornmfi.ssian does not;, have to grant the extension• also that the,f finding, the activity involved is an investment of mane that a longer $ that, necessary; this finding implies evidence. Y, peraad is. Cha rman Vercrvse outlined on the board the sequence of letters f audience, ox the Commissioner Lambert stated that a letter was 'received from Mrs. Thomson Opposition. She stated that cin a letter from Fantasy Lend they Thomson in coubeing da to stay day. izYess. Commissioner Lambert wanted to know if this wa being d;scussed today. what'they s County Counsel stated that this was no under co he extension. consideration at th s,tMe, only The hearing was opened to the public, Judy Thomson, 1.674 Filbert, Ch:i;co all the owrjers. x questioned if Mr. Diamond was representing 'County Counsel stated that as far as they know he is representingFantasy ntasy Land, Judy Thomson pointed out that according to a letter attached tot e report, on May 29, 1986, Anthony Thomas were beim re resented b h probation Ruby. eved that Mr. Diamond was only representing Mr, y PosMr.ner. Allen submittedeaberabation report. She recommended g Posner. She p mended that the Planning Commission consider, in its decision, than Mr, iamond hardship on behalf of the owners, but Dactuallyaandbehalf of financial She read figures on the book store from exerpts of the probation Mr. Posner, she submitted. She, was against the extension, ach Jim Patterson, Durham, was op posed to probation report recommended $30 000 inhfinesensiandothe actualstated that w the es totaled $23,650 less than recommended, so considerable financial relief has already given to the people requesting the extension. Also, 6000+ people si ned been Petitions against the business, and only 1,02 peo l.e in a n stated that people were concerned about the sale of illegal and obsce favor, lie material. Ile urged this Commission to not give these people, aid extensine on, also stated: that if 1?a$�ner �; n. He legal charges granted an extension he will pxobably face more r` Phil Hrff felt that lir'. evidence; axed he did not�feelnthatstheaCamm` Vleelts already to Y submit the factual. Diamond was stall n fission should grant the continuarlcep and he felt that Mr. L g. He was against th theextension. Charman Vercruse discussed the time lines and deadlines facing,x County Counsel stated that under the existin p d� Po'snerk '� r inanc;e he,can continue to peratc� ,the business until November, i Chairman Vereruse asked Counsel whet would happen �f th this hearing 'today? a Commission voted on County Counsel, stated they should dry so only continuances i.n the past. Y if they have not allowed ca;ntinuances then the Commistionashould t if ithis normally the polis to s one. Y gran, 1 Staff stated that the majority o f tequests for continuances have been granted. ' Commissioner L ' J'nch stated that they almost always absence of the applicant. Yrant�=ci a continuttnce in the continuance where',it has been ralueste& by be unwise ' a f;o not grant the J' Comatissioner Lambert felt that they neeei, d to continue and ship staff to send a letter asking that fact�ial evidencis e of afinating only ihadshi be submitted. nc,.�.al P ComInissioncer Lynch requested'that the letter also state a time line to have G1Yn �.n ormatidn 'back to Planningso .this information will be received.. by foie Commission in their packets and not passed out the day of the meeti� ,ng. Commissioner Lamtae t felt t�iat they needed to -know if there was so representing the applicant. some else Chairman Vetcr'use stated that continued this she 'fag willing to cover all the bases and hearing, open, to August 13, 19861 at 10:30 a. Count m� County Counsel stated that it was the a available for the meeting. pplcant s responsibility to make himself Chairman 'Vercxuse felt that, in view of the possible Idea to have on record that the Commission allowed. the litigation it was a good opportunity,to pi„esent his caseo applicant every ow A;L' Co M.Iok1A.'41 �y r � t v � etc : 15�-:Ary Reimers Box 1507 T7.lba, Ci -y, CA 95992 , 13-- 06-23-03 =i.s Beal �,0� Bax:,ato a WayHarbert Humber 1675 c ? son. city, NV 89 )'Ol Rollins fid. #G Burlingame, CA 9401.0 06-23-04,.05 Stere A. Young I g 423 GOIden Drive H'Oward: Lee li PZ..=.r�a 1,01na, CA 91 752 Santos Way Chico, CA 95920 06-23-40 WillUam Harry Bell 123-9 Miangrove Avenue Everett. Beich CA 95926 1834 Mangrove Ave. Suite66-35-10 E Chico, CA 95920 Xj�neth Colgan 752 Brookwood Way eh;c , CA 95926 6-35-21 06-04-4.--02 act Paster 1. 19550 Montauk Drive Mohammed Khan Sa:rat.`ogar,. CA 950770 P..O.• Bax 66 Butte City, SCA 9592t, 06-35-122,r etc. 06--04-4_..02-6 Cam. Greenberg 4.3 FaIrIvay Drive Michael Lee Davis Chic, CA 95928 P.O. Bax 475 Biggs, CA 9591 0+6-•37-07 6--35-21 DouaT as Gix llon 3:52~Vallombrosa Ave'. Jack Posner, e,� el " i � & C'��.cc C"A, 9592,. 1625' r The ;; Al anted. a # 2 San Jose, CA 95126 0'6-37-(5 r 06 lrassen Ave 1848 Via. l "logy Pass Rd. concOrd r CA 94520 HECl-P`i; DIAMONb & GEEiVfifEL1 M.1rtvYN L. HECHr +POOER JON 0IAM1bN0 A LAW C0$4 ATION FY.C7NALD 5 15418 SUNSET I30ULE GRENVsti'Rp TELCF+NL�:lilint � CFIELD F�ACIrIC PAWSAD.ES« CAL►FOFttJ'tA<' 0232 +� h. CHC"ER HORN, JR. ��Is1 uG�a��I�l 1JOV-1ARQ t'JOS`3 {a.13I 4%ciw<4 m `;rtVCN MEN U's«611cY.�,�19 MA,t 'I MItiKIN BACK! WEMLIPM pAl9A A (i OWNALP L. SAL'+'T.MAN CDMPU:TEA MAI►maK VIA 3rSURCE ON TNI,PMAII., June 12r l9"8G JUN i8 � 84. A. Kircher, Di reel n 7 County Centex vrec r of Planning Oroville, Cnlj. ornia 95965 Ike: nta�and, 28�lanade, cl�ico,-C Dear NS Kircher: On November. 28, ,1983 You 'wrote to MY clients advising,them that they had to cease operating their ;adult entertal,nMent 2827 Esplanade because the business did net meet t4; cquiress at of Butte Count.'( Code , Section 24-36.2. t4A r;3`Cjt r@lttlQnts .had to shut down by November 28, 1986, You advised t�zem that they You also indicated in the letter that an additional eri could be granted by the Planning Commission Uri p ode time uaryt Section 24-36.9.. P to Code Accordingly, pursuant to that Section request is hO eb the planning Co:aunission extend the time to�r the... �� y made that business to contintip operating as an adult business. s 7,and is necessary y` y in ocic r to prevent undue financial hardshn'pexte'nsion Please let me,lenow what is necessary for the erfe request for az extension. F coon of this there a hearing? �o What procedures ap you provide? you want evidence? Is In addition, please let me o w what can be clone to the Fantasy - land bookstore: and arcade to render it a no�^y-adult businessnow, the meaning of your. code. w� th.in number of videth rental outletsY n Butte Coet rare a substantias. considered to be adult businesses notwi.thstahat apphref.tly are that not cthey carry �a Number of wr;at, percentage of merchandiseult af anon --adult o. act deo P please let us know duce�d to the location to render it a non=adulLnbusinesnwso iitro- meaning of Your code. thin the w I 00�' AGENDA INFOftTJON rrr2erHEC1-1T, DIAMOND Oct 1016 nr L. �r e wr & G R �'E N F- 1E: l.. 0 cnrlUk„Y=) J©t+l PIAMCSi.r P. 4 LASS"!^bRPn�iYAnt7w •'A�` x+!'+NAl:tS S. r*REE:NPcELp 1.:415',raUNSF'T E?pULErJyyR Rye 1p. 1Tr, ! 4ClPIC PALI5ADF,S C4LXFOK`hP14, 7=LEXFd47Sv ; x I N 14131 IIS4- w, �'w1L:1•rE:R arCar�W, ..lr�.. 9<)272-31SE5� (�v13r tyt"i21 VONALD L, 870,413ae sAf rx1�N i'GrLb>x 'M t"J'V'tiA l7 is43 M G75S _ ANG4y�C�ts.a Cx,i1Ga 4:14� r,'r4`•:u'F: HErN . _ FFPG 11aM PA1'F>A 6 4�Mpl1rER MA, ,rL80 y'r.1> G 4CtCE 014, TE:LtMAIL September 25r MarLzn J. Nichols OCT,6, 19'86 Chief Administrative Officer County of Butte RforA 25 County Center 'Drive Orovj1ler California 95965-3380 Rc:Adult Entertainment Business A 635"21: Dear Mr. Nichols.° I have your letter of Se the date of of the pt+�irtber 17, 19$6 Publlc hearing for thi, advising �reh Posner of the Planning Commission. denying oux Truest for tZm�?. appeal frt�m thr� decision of You indicated that the an ctnnivn of l9gG at 3:30 P.M. Public il�'-axing' V.as set for 00tober Please advise the Board of ;5tape�visors that, r.o Mr. Posner will bo a on9 in pere on loch to have the Board Consider �thia matson. Ratl e.r a"fit o cif August 18, r we wo'll.d prefer I985 to the Clerle of the Board c:•f Supeof,rlty letter the oasis of my earlier �.ett��-s to the Pia 1sors and on If either ening Commiss.�on. your any member of the Board of SuperviscArs Counsel, or anyone else has l can be an, e the County reached by tele � guestlons concern' ho In � one. g our proposal We do want youthe matter hoard but no one will Please let -me )rnow the decision of the wi ll appear in Person.t, '�a a n )c Board, a..' so ncerel.yr HE1,CH7.'r DIAMOND By. OCT 2 y - ER� ` DIAM ON D cc: crack Posner, I„ lip MAI 7 ykil ro Avenue, Suite:C rraent 95,96 , 534.466 orf r ' 'S Ben rvisirie pi^ole `, anion cif icer n, �Y r, "SJ (� VT (�,rl�I' J�.7►tl d+ 6 i+J '9'V if-7E�:riiX�t:a.ai�Z CO URT OF THE Chi co ,T rrc��rillt�, California COUNTY or B41T7 E, S7A7 �—�`"�'"" at" � �J."»s c t !r OF . ©EPARTMFNY_____ Thefeople Of The State of California Plaintiff r<1Ctic]rt No: C" .W219�59 I'r�abr�tlon No, A,.. 13.34k;r ----- R k PQ nen. P RASA Defendant "v4 dant TIOt'OFf=ICER"SFI�,au, tC�rt�tn ng .1 ._ Ln E D i S t; "" .--' n �; a t'� � t+ i �c `�� o -�----,. degree and/or enhancement rtanc convicted by....� _ any �r iaalJ ----_;defensecounsel Roder T}ianori`�-.".» DATESIfwV'CAS `t Pacific pa � —;"tW. 1.. 15 Sttrtl;1e rT3iSr d i s tt �► ► Dateoffense committed: � �.. "7 6CA 3 to 2-1"85 DateConvicted' 2-18-86 date arrested or Piked, :Fuu'thercourt hearin✓A-�no trice aqui; g -nheduled for: 6-» 11-86 at 1---�..� a mCUSTODY STATUS:, Jail P'resehtOMCO credits as of 6_11-861 tikerrr rtvc' abouts; 19550 ftntauk Drive_.days knVelti tinyg `� �� ncd : D�ttc Caunt,� Sheriff a Saratn�'a, CA 95070 a ,arresting aVency. N/A s Off ice, Djsizrict A t�t;Urriey PRIOR O0NV"ICTIONS (CH No: Unknown " .�.Misdgsneanor 1 13-067Government Cada Fine Required? Yes,. No &X, w, 44 the oApose to sid of the i,tw,` qty, �aoacher `spectrums could v -sell in hav g v Wn i son fo ro G b'� pz cat`es'"t'" wou:td deal di ffere�n�? p fit; �'t;�i ou y' with aoh'',of ;}� sl; a seal; +t7c�.ng CLIA 4, obrlvicted o� irtcli�rlduals the sar€fie ofi'snse. �� aarallel can t O'Ven thomp + uld, be drat, in the 'presr;nt r? ► and ce tai nl sho m N ,Y differences ap sar bstwe h ,,,� attea.. Certainly► distinct p '� xbsner on 7 Thomases oir the 'othox^. N1r. Posraax� • the snC' band, and; , h e 8 in the operation leis companions xn�r,.sted twcnt Y thous d61j.ar tj much. The Present dere approximately' eight •times that to t:ton ndant maintained > and a rn tot- that of the , a; an tlly' int�er,es�t; :in the limited Q.Pera. x� P�rs t "`hn r;� s m'Lnor i�r i 4 p�htnershi 12 , Mterest; and b r : i rp and aP,reeme t t with jtr. 1Posner ° 3 the her s Of z3 vomer , no say, Wa i�atsoeve� their wr, itten ,the was pla;,cer3 X11 'notice over e operation. MrR 14 tion eras ; 3mm-.neat, and t two years a o that `er imina p��o c Is .1 have been appe�a�s that IRr. end i7rs. Thom as may t3ir�ct,t y' .i1� informed �JY the Dus•t10 n •y` 40t as did"f'icu�,t' for thy, o�ficor to iAttorney; ix accept i t is Mis�,interpretation ,o f the :��� �� 1 �' �'�. PbFoenero s re:t�her obvious 18 Further , 984 letter, differences mei 19 eca;nohtic circums�t��nC.Psp r be seen in the defendant►5 r "" As no•tect in elatj ro 20 Thomas have bath 17eerl salar1ed e their reporl�s , m to ' `► „r� and r�rs, 21 grofiis wages of leas than fif � p gees for ManY.Years Mid'o' ` t,y thousand 'e 2► arnin� e �t}a .per has' bedn mew a � e� ,' rr _dol arse nua� Yp ,' �,t;h�ou k � . a ►�i"i.cer be c n�,h } 1p� 2, htaa�drea�tY�a z�;es�t }ae'P�ciably r'pe°�►. finar�c s , rr, lt,; tit�c .lsaxai�P,c�s' x, ep s tcn't ., �rh of lve 2 Badu �' re s ° k, ai 2s'irr~ isi a icon m ssurnpFti�on that each -aif the other ''fide bsvai'e c� 2' pasne:r.s so.e�mee,Rased on t}fie r S.,inesaes rye r, Q.I I1.h, 'eb Mr,` F r ' W ' L all EMailable informat�o 2a its the, e sato rt �.w__ . ion, �. land 2,s is deserving Of a n ��� ��':ticer be�..ieves � ° �kr� Fased upon fox .:qac} r greater degree of hat Mr, Fanner 3o ter to p nis}a ent the of whom • `� h his ca—. Considerin ' 'i a � PA 83,74,9 has been the defendant+s ro1.e, in the ente-xv"'Owme.rtded, 2 as apposed to investment, and his Misinterpreted: and the f h ofa.t,s .� � ,,`.;�.., ac <. � � l b,� �, pr 3�l beli.eve the 17i trio i, tarns Y'awwar •?�` a ... W . _1 berg e _ h should be subjected tb ��o ,. onlhing letter, - 35 fine an each of. the �� c �... � this a�`fi�:er Y the maximum pertains 3� counts" but a period of inoarc�:ra h� b es ch, . to run Cons�ecl tiVely. n for' r • J, i an , (unriamed) attorne Y were going, to invest ' b ke ° ac d out" • � but that 'he latt+��' � r phis aPPe:,s to ha^�® te�.ephone cal i to them. Prompted �� � �t�sne r o s ori"4 Thi mhom-l'� also infoj,`�jed th' dUri ' r� ;�, Pr •�agreet ez�t discussions with Mr„ Posner. g t; I-) l y 8 1f any kind of , Y:hoy Problems aro , he(Posner) wocx d c� rr talo; the rxp"f �, The partnership agreement was ultimately, 7 Thoma putting up thc: more si�rr I ' ,the 8 a substantial. �aortiQrt oft o do the remadeJ4 M . Thomas d0kn first nda.catiox they work himsel f y received csf an Thal' advised tklat xo were about fwo ar three months aft e y advised + r�'� with the busjnoo� xitO xx from the parties- froze whops the Pened When that .iear��cd 2 being Poketedp y had bought it khat the building 13 according :they then discussed the,,:,'matte Wts to thereWith qtr, were infox�sed khat he 11handl ��►�(I 14 situa.tionk and that no was h�ndx�ngr° the,' 15 wire repoxecSly ►nide° atPBables ex,sted' sa�til�,r`epxesonta 16 Diamond. later date by Mr.'' Po t� oris 17 osner s at�toxney ° A(��, .+men asked about the iiatri 18 1984, both of Ati:orn�.. Mr, arsdJlrs Tho �yys letter of Ma X9 prosecutor informed this rare .claimed the may."sl Y ne�r�a� sa�J it � the + M cerCainty that it r that at she �, s was over unable to s,ily with 21 auulsod that either Mr. Poa.nert to therm. In a or Mr. Diamond any base, the Thom, „! ?�= about it at a aztorxd later date, but said it turas 1°hei may have told them .?3 In ret ''b Ni ng takers care of°^ w� t}�ey :hauld have ,. acid Ms `" t�t� sGuredkie believe :hat s advisor or. att assistance of th j e r leve~ i orney prior to an �twent � t�wn,rer, lie Wsign�.Yx the: partnesr''' Y 2 7M y Profess to be j j, eve that ,t bl' 6 .. L_ hey wro ,` ess �'ass�ar..,n bha Who ,sho`dedkres° thgri<<bor�s`,�r" r brad 'ia��., that ilaey tou`d the r, si . bu g i '�0 «Ih s w,..;.. • M1U,µ .a,. 6:�.'. r , w..on�J wR .�� *'+d a � ire ..,b '' 'tae ape,, x on x p g a t 30. Mr thougZ �Lt�Cu h as' s Thoma' ... ,, - - � d, rir ,�... ,., • anci 4 v ;S1 that the sa stx�s __.,.,. �' y are - smd during 32 p rso ally repulsed b g Lha► interView book sures, anci that theirinvestmentthe stock -in. ttad of adult 33 which - they now r was a business one only, egret from both Y r w RECOR , an economy c and criminal, Pros be 3� PRIOR � p tilt h part write;tw can detect no record o;� P of Mr, Thomas fl save Prior laW vic►latint7s a �s on the �9$�. speeding, peedxng ti. kct � Which 'Was - , MYRI e tk t,4 i rw.y+ik' � � satisfied b upr Y a bail forfeiture inPl aca7count."TNFORMAT ON: I i�rrTj,, Attached to the pres3ent` repast . wi �.l be fi twa'letters of personal reference with rP found copies o 5 Tht�mas • -let' to t�tr, and Mrs a I Also attached will be round 7 Pertaining to Nr. and Aire � joint »n�racial statement 8 to this write r oaa June 2m' Thomas, whi:oh eras s401ariy , Presented s PERSONAL PII,S'i'O�ty 10 As indicated, the def endarat 11 been born on ril 2?' is a Calie, native, havjtj p 1 ,2 iza Stevenson, Both 12 his father in Newman ,- his 'mother» iaaustirae'� parents are living , z on the ps.xt of any other famiiy members aa:�e'',' N �.egal. d fficult og' 14 Mr, Thomas repd.t`ttid, 13 subse uent trainira .a 1 4�i high School graduates has had some cl ~ lG he did a 4- ear tg i -n the building' trades. Y our of duty in, rile A �' p 'e ibtis'3y indicato , 17 discharge as a Ootporai. in duly of 19523�> reoc-iving an honorable 10 he has been employed as For `tlj,, yea hast 2� years,, 10 a stationary engineer b sr agCla va Coutaty;Y grossing a monthly equivalent salary of $2p527. FYi.gi re,s 2'0 Financial condition is set forth in the at present 1. D SCUSSION AND E/AL AI �y � tact�ed When interviewed, bath 1jr. � � � s and �rs„ Officer as laving essentially sincere h �mpr�ssed thea x hr�mas PM a probably normal intelligence* ' hard �r�rlt �n y !� indi.viduals of � yr iasOd' do ` u to in Qrmation 'eceiv i t Mr �.. ed .t s a�'f w�' li t r ttlaa a r raw h 11f"x h tt Id lir �r it ria at' kiost y' x e F taoras n asyPand Opera In ' a pa�.�'- I partici �t sai. hhf9�i t�sedD this',a` �,y yr a f�yrgyr P s �.!t r"n 'p'f�"'p (�I 1�,tj4, .'.ems.M y�, �.yy'�1 ,dr 1pr „4. .a a�+4 A.11 ,A."•gin (?4r4MAA invested"�'.o s/ 4fl �� { � p6fl yp ay d k '1 fiN' t 'l that Money rho W . b Ppz�rp. �rh �► prof its arid' tca tail caztxv recd p `iny;-,keturn ,fo-�q 'a` ythA �nlitp~ u,q y{�yy p.q,.T .q.A♦r���yxyit", h•{/��wyyo�pperatl.o 7,�" W� '+��Y q M \./ A44ii WV • r A} (.inn u` IF �t1.b � 04 eW IF•Vfli8CL v7 � "M!f' �G&WB aced notion i... the root have, bea prsaa�al�„ n v a M __ a 3� w � � ,i . _. lette�c. ��' �i� In a May 5 19$ .. � �P ,...: .. memorandum to thin ,a ed "'formation as to ,sentences department, dour � request p�rtment the r� communities o both before and after 197 for siwi.lar crimes in other ►'similar cx^times" nerrot,► �� �� :P�aterpreing the phrase} ly (other . adult book stores"c��ve P ging L I I w t 1 V 1 V j m f I AMW w e y� riot uC+~ount f,OV da) ilig s at an adults only' outlet does proportion of the total, sales as it Oddsfo,x fillner Or vidtxo tapes. Moreso than :or films or r man o to es y s the i0noaziriob Oed p sold by mail, usually as a result of 40V ttisemdntO pi,acnd Iii similar magazines,, in pornographic books cod,tainiriq text,, arid. even in more mainstream but sexu'allx or,ienteri pulalicatlann� 1 There is some indication that 'tho vl.tfeb taps hdti hurt tli" pornographic g phic magaz ne industry as well as the pornographic moti,rifi picture industry. The retail pricer �cr'' such magazines, w.ithiri the recent past commonly in the range oe i+tbm ten to kwenky fiq�y, p magazine, 9 g Ci idal areas Ilk eiy'to qq i per: Ya azihe are in some eb rid It dollars substantially discounted, and adult establishments 4ppeae to bq offering an J,+ycreasing percentage of Vidoo tapes and a decrea;sinq percentage Of klookrs and magazines. 4.2..3 ; ..Ae„ tail' ®� ve,i Apart 966m mail order, and apatt from the xantal of pornographic video, tapes in general use Video retail eiut;let;i, most pvrrrographic material -reaches the Cttihsumer through retail establishments specializing in this rcratOrial, Thema, c,ttlets, which we refer to as "adults only" 'outl,sts or estar-ilishments, usually limit entry to those eighteen yeurzi of -age or older; but the strictnes,,a of the enforcement of the .limitation .to adults varies considerably from outlet to outlet, At times these retail out1ety will take the form of theaters in which only material of thin variety is shoran, and at times they will be "adults only" outlets sriecialiting in books and magazines. ZriGre4singly, 159 j . 17 �i f r and various items or sexual par4phevnaj,, a are likely ro be oold, the bulk of rLhe stock of these estnbIlahments csansitsts of pornographic magazines, frequently arrangod, 6y Sexual prefOLr ntlF There can be little doubt that rrhe rartgo 4if sexual preferencng catered, to by magazines is vii', than, 411,14 of ant's other form o'f pornography. As the ,Listing �itles° j,,AtI)r in this repai t makes clear, virtually any conrerivatile, and rluityi aew � inonnceivabie, sexual preferences are featured in thtn 'uar16ua speci/AI magazines, and materials featuring sado_ftiiesochismr baati.alityr urination and defecation in c)xual cOn%OXt, and sgbstantially more LMusual ptacticess even damn those acts a significant portion of what is rivailable. 4.3 xri_ Role of Ort, riized Crime We have spent ai consWerable amount 0L° our time attFrmpting to deternii,e what her there it a connOction between the pornography industry, and what is -commonly taken to be "organized crime." After hearing from a l;erge numbot of witnesses, mostly law enforcement Personnel, after reading a number of reports prepared by various lam enforcemen4 Agoncitis, and after consulting gtources such as triaX transaoeipts, published descriptions, and the1>;ke, we believe that such a connection does exist, We recognize that the 'stataita,Wnt that there is a connection between the pornography industry and organized cYime is contrary to the conclusion reached by the President's Commission on Obscenity and Pornography in 1970. That Commission concluded X91 p l,d3i One of the best ''kho'Wh can be choosy about theirartners, male models described his own ex, eriehoun in illuminating be>nitit nern you're a nobody, it doeAn e t occur to you , ;to bo brave and ask:, even thougr you 'have 'a lot, at stake, 1' didn't, worry too much about that UnGlil the H6rpes,'stuff' started to become real. Up until .><902, I had one clap share. I went and received shnta gar it. I don't knot, Lf I ever had it or not. But,Zhad contact with a known carrier. In '82, we got preqnant for the :',first time, and having Herpes was the ciitllbeentrer between a vaginal birth and a Caesarian dbdtlon Which made a significant difference to us. And f, didn't have Herpes and,r saw no reason to get it. So G began,saying tate gor calaythat I wouldn't: work VLO anyone that had. Herpes. t had .to do this one parts With someone who had an -actives outbreak of Herpes, and wij cheated the 'scene. ,The person put a..' towel in her t)lighg and I elided up f**"ing the howal. We had no phyOiOhl contact4 iron— rally"1et}32ugh, it turned oris. 4d be a beautiful., scene. When asked Who the Herpes carrier waao 4hw Model replied that he had "kind of shielded it.p1033 w' The advent of Acc,°,i. red mMuno-Ofifiaiency "syndrome (AIDS) might have been expected to produce ci,ratstic changes in sox Industry practices, but the prevallinq attitude seems best 1031 Pacheco Interview, supra note 966`, at 30. 1032 Id.,, See also, Cos Angeles Hoar;ing, Vol. I, George, p. 890 (encountered S.T.D. in fellow perfor*rtrcies),, Lederer Interview, biness always have vagt awl ten hamwho dot;k in the pornography us supra note 969, at 66. ("women some .infection from the -working co'nditi'ons, 'which "'run ``Eroin'bad to simply intolerable. At one point there was an epidemic of hepatitis and mononucleosis. The communicable diseagag spread quickly." I'd. at '66). ,That -a. "sex worker"' population would be high -Ty vulnerable to sexually transmitted diseaona should hardly come as a shack. See, W. Darrow, Ptost;itut on and Sexually Transmitted h�srases in SexuallyTransmititecTp�ieease�t" ti}'T�K.ic.iio mese . . 1033 Id. c' 873 i i I r i 1 'effected in the following, recent- comments in a Nun, t,ehterview ofAmberaYnn, a leading, l n k,' "port, w you afraid dff AI05? o' mah ; arernTCLER. You re a,r3ng s Man a mLi these days, a-re bisexual. Y ctar`a in the business iness p LYNN: There's an incredible,,�tar, through the X-rated- ut Alos sweelssnq girlft fiend,, are fa lm business rir,trt ne7w. g abouW All of my talking �, death that we',l1 find out it, three , a few '�C+ See"re scared Ca Mon left. YnCII: we've only got HUSTLER: Why do you then? continue your j)V0mig0u0us career LYNN: I get a blood about the trk regularly and ata uer gamble h n people I work with, Y careful anyway, -.1d there HeYr life' a fir**Ing can't k of chin is wherry l want to be. I'm reckless. g anything ng elsia, �"haG' d not to say knowknow has been f Far ins Cance, I won, t*** py'q. lousy thau'sa d a'ng a bunch a some yuy I n dollars. 1. , athcti guys not tar a be ause if I get AIDS, thenever• not 1W,0106MO , ?t.h iG to <mp W"h get it and not just Che Just art Contact 1 _ the people I lova and care about tole wark'With, but:C©o,. l ��A Of course, even an occasional -..."._.`..._ high risk sexual contact with .r member of a -group carries such a substantial' rS4Ec Of ex asu AIDS1035 that the gamble p ire to Ids. .Lynn embraces p misguided one. s bt#ems a peculiarly f. -. uru� _17 �s . Along with the insidious t hrat of infectious 1034 Lynn Interview r stir ra nate 977, at x5"0. 1035 ACaulre.d Sep• outran, The Cpidemiolo Imrhtine-deficiencu g r „--------q1 {end Ore ,VC b ( ( the rzs^-k exposure 'On+.p. 103 Ann. ^~�--of the rrrtrn a sexual encounter with an nccasitnal Irtternaf FEed;c;ne Is very hi h HTLV�Txi,/LAt� infeetaott 9 several times higher than ! „•� partner foto a g. y mon. wotran. ) Blattner, E idemioloa r a h�Eterosexual IDFT e i T i and th e _--------� .° f h l"P a n Ma,n or vn r Risk of the Acquire Imrnun T`Lymphot;rop,Ic Virus Inte}»n�x� M t�cine q e-Detll cxency Ynu`n Zome 874 fir, i i i hj.stributidn Some "adults onlym po.negraphic oUtldt owner., buy their prep oaths outright while "�21$6show 1�:E.The initial cost of purchasing a peep i:, iow booth is hoItwean twohq and thirty thousand dollars..2157 x hoeiths ark rented, the at iLe' owner usually shares the profits of tt1 booths with the lixrtaot, s in exchange Cor, the lessor's instal.tat•jdit and rlainte'ance a the booth5,2158 reside the ,booths. Che viewer tfli.y see aPP'roximately two minutesof the movie for tw'ent:y—five CO4U1.xl5� As thenumber t)�' s0xually explicit scones or diversity Of Magual acts increa" a the viewing time decreases -2160 Tokens or quaeher:r are needed to operate the peep shots and can be ohtpi6 d at the cutlet4s satod counter. The average peep show booth has enough room for two. ndult3 to stand shoulder to shoulder, The inside 09 the tooth Is dare,: when the door is closed, except Eor the light which emanates Irom the screen or' enters fromthebottom og the door* The inside walls of the ptrep shaW booths are often covered 2156 New York Hearing, Vol. I, Bookstore Operator, p. 145. 2157 Los Angeles Hearing, Vol. _I, Robert Peters, p. 105. 2158 Id,. at 149. 2159 Washington, D.C., Hearing, Vol. 11, Dennis DeBord, P. 98- 99. 2160 New York Hearing, Vol.. Ir Bookstoee operator, p. 128. 1473 IY�YMrI�®.a. A � '. t'. �� � � '. � � � A � .J� �� ". �. � �, ' iiaa u d m! � < < sF d � h. �,` � :Pr • � fir. y Some AU"I nwpzbers`obl'tCxfr P Itttl 0161111-,qst. cen,ter4 woudtl Ott"Ct't;y .� B�5>4>r•i� Clae Ge4rtr�t�tlet %ar eorzZorns rrtrel ., � � e , • i1,1 �i,fi u S'LF1. 4citit'CzEaorltZl tntztt�rt'4x%b, bitually M-ld are highly infected, alld ()tl1. COI Ile to th0 city fora bi6 X , tlxriL, go to the tte laltices; `and go, back sprt�atit, ialoVer the US,„ I a He Cloosn'tImY contentions that,nlall --ifnot Most patronsofsucheshtibllsl� '. ^T ttie��ts art l'VoCticirtg nnly safe., se,. mid tirlas tltCA stat V*35 tnkting disease. a�#x�libod,yt(%f1lt ; tyAh1Astate» S11,�^ nnerlt tars iitidbOdy t6sting has beer] post. '� iy+ ' One t) by rdletral ofthe resolution en» I Ctlttil�;lkt�; lnl �il�r5k �� top AIDS' b r�pjailJati0n5 t0 b4 Atesta',";stat'iattt�atasestafcouhselirr,�,"�eIW , e$at('s had T il!Eitr:l gV,2kitan8 ab ()Ut tl? , r n�iltCl rt, tca'l7trit tl. nrid anlodonal asp , ' CXziaq_»Citeµ�lr1 Cvants pati►- so thritit naere,ly undcarst3 attenn�ts to ��' testing,�w, lacauses, hrodaels, adt�r' btatrkstorc ;rued"Itmit'!trzrnsnaSssic!nxlfse�urlllvt�tnsnait- 1 t`thtrar�nlq �, t7r, LGvrn larairrteti out that ratlzc�r l>r,t, t y E�rsrble " �ervntrs o!' irtfec- ted diseases in c uc!h place tva drsferrti d r. t`'stita �t W. titan'” to be 'closed Or corltrollud",th a "a�'Sex establl 4sleetG.air✓-�;trrtnrated`2miOjpnuld rapta+,ttlVc �jii'7 t'i alt mdivitlgals would tx iJ, nscafhxe,`entit> tlzesprrrttlof,AI )S. suikh'44" rrrimed�l rrr�kiFn ��tjlr,tlC}u `� cast th,31yf1 tri�lllitan 4tnd wrruld riot change DOL-P-ttesadoptedaresolution to) [11,1t ll the VelvettKltiGr4�rltrrttriyintii durrlatrisi," can Clark, ;�pr�rikitl�; sirs r.he r'Jtrt' Yorke I`hW,i stl 101 till wht�tlaer a person is (111U. at he roup q lnx;nll r,jee to dele �.rtif�,n, ��h ch is r lkir t d Ir rc ticaltr �+ sp l' t tae ' k l' �' he?re, des tee ;nna nle yhers' alas that troll. it`,, ; coil euent fjubhc ct3ntrrr f�lr wfw r-pw hives tr » . bathhouses play a crucial role itt the brtnc4rrlt; i ,.infectedC nc c,ativu, hi nrd 1t s ter�ctainq of AIDS risk, reduction to the fecwted Oer s ��;I,�� �Ilarouit ,Gt�d unln- y tla ��llli yca4I',ija xtlal iar;tcu es." 1'hysh'lttrtts i'tar tiu.r,rrn fdi;ghts hrGsi- People wllo most treed to le"" it, hear inter;lcrt dent alvlt! l�hrrit'k, a � `ale biolty r titan, the canarint'nit,k`imbetiouspoolisell- sor, t t�,yprofes- Tlie deletes salsa rtpproved ra repcart 17r� d " old t�NN !fiat tits: " " y i ndorsint; the also government res this C bidence 1, Iu�catnontr,i3trt Lr7s Fin, ekes F ane �utrv''at° lieu oiJaer_that krtoavhlt; test pcalic"' of xlrnwin;� jjlo,, t children with Bele-"MUltsafj�;;gtabell,'Mor'rnl"Umirdtorisk IDS to dsrhraol. But they tad fi'Ric:hw-d E, Di'c res tts:,ed, "Where �,• else Are we poin,r : , • redur titans l�ltw stiira lltca �r7y physicians` for study a resolution urtrinr; pec;ple at anti 117vc, lit ratL:rc Cand condoms rr�,li{ these people rnotlta'suppratq:s trstu'i tvlaeri it's �'alun- rrsl Of Contractart,�Ii�S to undergo c;n abler" end CttGfatt,ia itJternr2tra delegate "We're t uy and !ronnelentiality ,i5 jnlarantee 1. 0171e -linked jinmunosorbent rlssry teat- Saul Levin wraxint d that ecrpie en le grit r , caljuotit:d whelt it's mandatory or tncT for antibnclies to the .-VDS Virus, irrlut la risk sr� aches ",are rnIrar�l� 1' �c he,n I)nvatwy is hot prcatec tccl." 'Commercial sex estnbiishmelnts— r ctcnng to Dr.' I; ortatlay St',TV, alte nnrrte delegate uchasbathhouses,brotheN,sexClubs, w herpc'lrynu ut�ri!blcettae'laelto lOsedown, p uc.ate aasut 7bilitt or petal, e `r'l () test tlne uh- for the i 15tt't! t, of, .olu► acs ba s. and adult bbta6stnres that prn- people �VitFa panaphletM, and nnatertals, leaves Sexual r' vho Ceust Ixlsitive futtctit lltarss Public rrorual intercourse=– ^c " lea es kht i l tt? rte haven't preciouc�l�' become this I Or arny ifther illness C Berl G u�;il kl,e P eserc tate 5 of Mita e ger crsed ;►brtut z,4llorehottses," 4grn. I ojases,read rat�e�uall%»trantitnrtterldis- rnr;ntcdSeaitled��l��ate.�l�inj.�'tnr,rrl. pt'oblemrnavn:lexrtppeAr," Cbasc�s,' Says the resoluttcan. \vllfCtli W And San f.�iE�g¢a altc�rntrtt J. 4�'illi�unn son lie noted that the resmution t.ri C. N r11 -glued that an r1;�vL�y f tldritsemr~rlt pawned easel!" bS lt,!Ce i'rit, , It end',rses siggi�3r,ttlt l'r7riStltiltt lural IstiUUst ?farts br federal, state, grid local hettltla Ur•, Clrlri told MWN' lie dorsa t tivatk cnura51S; � testircr f,i, the purpose of rrtathclt7Uestr➢cHa, (lowilOrr'antrtrl;;ueh raeslplt wh[afrt"quCintsc�a'�establi'alat ernes 'rt u ,t.n� would be ad very lxtwerful Y,F trrblisiunlent5 ,Is "Cle'tined in state shed r at'G unintirr rnud rrlas�tlt rontluuls. Ciuttllec � �s`l„e felt nc aple ter 'r I �st� IIUi'Lwta>o one ;r>�al :,t~atuteS.'` "S'laing't into c' i�[�F`enC"4 t`rllilrnit- j,rt'Cn1C'Lt1n(,l)i;IC;L"alaar"ttiw'Ui..rnCiStlllaU)» {�� �,,r , , [lath dltrl �vould bra � )rc.n7, � s e"c�.lttelllpt to wilterdimm the wording; l ulatiims; those who go) r gIllitrle' rind h�t� , r' Y tc C1111[al�r9dlrac; tlt4' t+st rr a �r C`rltic» andilig l,taol, Ile nc;t,��1F is 311 . j` f. r vat �•� AIDS- �Wh M,a, IS'N, ow K' f IL EpIdenlxol 09y !=C T rz H 51 t,wyN Albert Elnstein Golfe a o_y IVledicin Worldwide epidemioiogic patterns f4reshadmw fu transrther heterose,�u drtfss.ion of AIDS and highlight the need to address s1 0.nd Wrtical of a true p' ublic health emergency as well as to protect vulnerabled n enL,1'10 �s against unwarranted discrimination. Th'e-alt erIatiVeS may lye eitlT�t�4ildualS eptdeM or an oppressive quarantine un arallelecf ira recent rn ither � 1 rii:.,oeked ttory More than two years before the identificatian of art as of the Gauntry 17nve be the «crus that Is believed to ,auseAIDS. opW'emio- trast, the e courcree u� e ;;o iaitic evidence began +, en el Irt the Con»` o accumulate su g gestin P sure iri the general Suggesting Pa ulatlon is believed to boje, ,,$ than I w, [t is es Haat a _bloodborne infectious agent rrti gh't be in- ',1olved to the tran��missiorr of the disease indeed, the Unidt d at tes�ha�c, 1 r �u , the emergence al'r tD5 a,` non g .1ttd million eo ,c In P' g population groins perhaps l.Qt)U ecru raSZs ttpt e .btlen exposed, with ` already known to beat hlgt ride for hepatitis B (male homosexuals, [lrtravenaus dr'u r P As of Apr![ 7, 19i3b, 11 int: United States 19.IBf blood -product recipients) supported g users, and cases o.f AIDS;had been t'twporged; lU,t57, i;,�l' Pportc r1 hypotheses or those patients have dled, :p AOS has already be of a similar mode of transmission Cor the two dis- Come the Ieading Cause ofdtrttjh uses, amekrg men, ttged It was the combination of tflose epidemlolo to 30to39 1n thew York City tanti is the -19 m d Deadd data, plus clinical observations ref the selective g Cause Cor women aged ;�{� to 3S1» and )ugh destruction of a subset of T lymphocytes to AIDS Je e ntrate�� In Nen Yor;, Ulfla."lla, reported �'lortda, IVew . opati edi that ted htbe igsoel to e arrrinetvheth- from all 50 states:ItDS cas�Ns: have {s e a�<eteti r ;�1t more tha f ne disease i fted tic associated with the family half oi` the cases reported I Ile ' ofnewly idcntti'ied human T-lymphotropic'retro» be from states ether than viruses (I-nVs). it, late 1983 and early 198 l.uc nia, As the epidemic' be ins oiritxri y of will ti1ontagnier and colleagues at the Pasteur, in Liao ill", 1�trrlt and tv�liCor- tetL Ire Maris and Robert Gallo at the National In- parts of the count g tt7 it tend to other stitutes of Health in the United States inde en- are`ts' i'amillarity wit what: � iyi�known ftn �frabouh-rislt dently reported the Isolation of what Is now pbe 4�ansmission and preventic�tl l Gl°CitSteS more and lieved to be the carne tortes from patients with more eesentla.l AIDS on AIDS-related disease, Montagnter named disease in the major U.S, risk r� � ,.. The epiderx1to!C;W� of trans111188lon and risk of 1 P thy -associated uletic {l-�1V1, Gallo cadona Cor the general ,tdup,,, with rpp(I (HTL t P P P type g p�Pulatlotl as well, will be It ym hadeno a c.allcd �r. human T�1 m hots is .virus t e III df� i�. il 1tu y ail. An eYarninatlon orAiGS out - HTLV -111 by the time HTLV -111 teas de i' �, ,�atod in detail. h' reds of thousatlt(s al' pea le fn the ex O, t Unit SStarticle in�till afSeries ader is're- bCribed, Und rn United State s had already been exposed, Indeed, eussian of ,the basic sfor a d a the current epidemic: of AIDS was preceded by an: c,pJderrllgingwv and dekn� Shown' remarkab p` rapid peon; the virus has Un Sehlyll . ,t t IdCm(c of HTLV -111 Infecti 1 'netrance Into risk sslsrrrnti'rr��casurr,/"rr/eyrtrralall}�uyrr,!ucrrt groups since Its Probable y rtcrl2itrc; .iltitrt G�,src7',r lt�tta a ej lledichse. rind "iledi al P t.ntty Irx 19?3, Tp'dtay tar+'taG�nl, !i 1, , more than 5Qv, oCrisk group members in certain cutGurtc�r; tinrn�1.} hr)at#1W1t Nr� 5rttril, ,il�arrtE!jinm Xeelf. }funrrrtarPractia� �icin�r.S,;I:£Jtt,S k�� 111111411 lig i 9,"tijcd gtat� . ares. of AIDS in tlle gad. bathh.aus llied taec, an ether be- )it, infected with }I"1'1,i1«lll. iav:grs with the Gl!rnman; fes - Risk of dlsr1,trY of Pare a ppear(+t{ mucous be relatt;tl to baseline ciinle.al 1'c1G' i lig r qtr NY,17disk rllernh�a'e' exIPOSU e to infectedstatus, lt�x tl�d;;e= subic�els whor"rl t )s blond r, ernen.Anal Intercourse presetitcd h'tititttl titr h is postuiifted to be high risk be- tent 1 l ;: persis- Gay and bisexual nen, NLt- caus;, of the susceptibility of the tional�s n p;�ttp� % and lhematolot icy^ mcroUS ease -control and cohort tit Jn-% a.I}efi rectal. miawca� to frau � studies have e�:atninecl risk Cac- rna during sex and the, co7zse- often dGt� ltrj�cCllctt � �tle AIDS a tort I'Or exposure and the natu- que:nt intimate contact of blood a year or r ► histone of 1ITbV ,III ,infcctioel ani y � i t titer" In healthy sera- IrI gay men, who account for iaxtph�� d the use 017 raiipr}l'es subs�evu in4tt'iy tlyt� Iric Ide:tre. Of �Gnt alt Was sghifi- 65% of all AIDS cases In tile. containing sexual st�lrriu/ants cantly )'o�vc.�r, lti sairLe rtt�tar'lces i UnitedStates les.cluding tlhe 8;'t t' Poppt rs") and the coexistent e less than n��y who are a so intravenous drugk � Cit tra11,11,tcrst pro, Of seat lly ti •pitted-�dlsea-8es sp�iGtive.,„sttldltl5 htivEr cst'iraaated atrustrsl l iCferenr. studies have asAlbS ','risk '+'” Subsegai.r, t Ase risk oC A110 to be bima etdt bvrislse ntiy Identified the nutRt, arr, fyse�� have Indicated that 5% all 2C)"� tircrgr Setrtral ears br'i of �!'�11al partners and the ti>rtr ireq,uenc, of 4erta n sexual be u,se pAooW y only: r 11r=rts aizrr,ag ca)7ktrts Of'gay Mali ex. hitt revels oft sexualr. activity, po'to tlttw Il'I"LV-Ill virus, 110:00r$ as key rlsk,factOM High-, Ne'verthgless, ,a possible 'assAcia- risk sexual practice,11iclude re. teptlue aryal intercourse, recep� dein bptriie its use arad the A reeent'1 ` fltlrt by J, �l. Coo{ ert elo een of Ilia live "ristin pasi sarcoma drtet eerllc�tgrpc s trar,I the Nat.iatl- " (ir<tner'sn ct the s 1s reccntl}r repbrced, and viral al Cancer' It7btlttite shctvrcd that hrxrid Into tlt partners rt ett.tm),' ar. Aher co"lrtffectlons may pro- amort r r 4 inic�tl disease a.aon a a,K,rtt,}p;a or gay men styd Cit^ 'Lunt sexual encrauraters ira cart}t GI ,, p ry ler In n; r�' 'ark, 13:tit 44 pa- tlem,s Ithown to btl, se'ropoultive bcXor•c ScptGmber ) 982 had AJD;� by tilt ell Ora threeyaar fo11Ow� up per;ttci That high incidence w did not Fs:l7pear to be fully ex-plained } +! baseline ell nical ata- l tus but. Was a l � )' Grhtips rela.+�d to t�ta the length at• Ong e `�—`--�--�t !tat . e s'exroCa 2410 version, ,tri i11ti Esme llgh(; a group Ill Dcnri1arlt recently noted that close tta s,)2% al- ;sty trit"I i trig tx known to bo r t�t!'i"raposltivc Jpr -� 180 lo,p�ger than 20 Months were a a �1 found to have Invt rtad "N-( ra- t tins, I`Iaose rtllorts underscore the signitica.n": 01, the long ld- i .e tency period 1i,c1i19 infection to 120 disease atld s}.iggse 8t that even pl larger numbees' f)1' infected In- dividuals may eVG1htually devel ,t, up AIDS than Arae might Infer ,gyp from more prel}rninaty studies, -, The largesi: and r11105t com,,pre- pensive cohort stt dy to darn has involved Glosc to 7,000 sub - 1978 in Sail Francisco,, t197f�` 19,9 1980 19,I1 1982 1983 '1984 1985 gr')UP Was assembled 1 Thi f t'titiftlly �� Year .en 1978 and 1980 part'° J Antibody to HTLV -I11 =—D—:AIDS of aw sAIDS Cases tUd`r of hepatitis 13 arming r ar'ustrYe^tri H77V"!!1'WWI ctasesof AIDS tate,Gtpltealjor.$�r:Francscoco%prta/ gay inenattemditlgSexuallytmns G,tl S air ruacrr,p'otlou+trl ros a slrace 1978• &ropositia ty rtiisc jrratta 1„5X, to rntttpd citlbettst clinics. lra � 84� p peetlrxst r. , the San i; rancisco health dc. bot otaleda 12 (Marl Augarst .t 8� in a a;tbsa»a,�le (Y, 4); IDS ctAve$j`or ela#inw partibert Ar,d tlje CD + cul�oYt tutalcd 2G� (3 Jlat ryf Bcbenbei b et�al nt 9A►.!R S 3, I�1>i5 'p 1, ' 4 be an a ,It, h, r f p y cast'sh rseve at aars J a,n, d..��.0 Stud4 t� monitor 'l r � a � +tlsurc rPCedcat , � gra lora of signs of X� 128 Hospital pmetice ;Juste 15, Isola 'r � - �111I1l11.9�iF�(�1YrldliYNaa1 �•::.' 4, r'� .. ' H M : � j r infection and disease. A repre- i r >_;entative subset of 474 tnt n has been fallawed. Seropositivity to,--� l�S f-1TL'Ir-III to this subgroup fa- Creased from 4,5% In 1978 to l } 73,1 ro by AL'185, 'The cLt- _ mulotive lncidencL, of Art d5, fbr GFherallz+f �Lymphadeiiopathy the entire r Callan ,as been 3.8%, ylnce 1973, willeh converts to a; very high suMmary rate of 3,825 4 ` COther Suns per 100,,,000, Acrrr3I men It n, rvr1 to he Ong: r i � or �ymntonis inn� 1978 to 198011trod level- two ' ' a Saggescing Al0S' Rodromt3 aped AIDS by 1985, although the small numbers generate'' ' Nleniarolog wide 95% ebnfidence inta Abnormalltie s (U% to 21%), TLe 5.8% figure„ s f although obviausly, quite high, I's lower than the 5% t't? , (oro se"I eras -ycar I range alreaz,jy noted' That: difference V Irttti'fs�r� probably:diae to orae or both of the rollowIn�r factors! 1) subjects it tlrae other II No Symptoms studies were already either sero- Iri sut)sal?010 o,/ 4;,i 's'++r' rrtc�rl /ullvaat%r1 in , tbwv u�u !birds rtti�c� It! / sltIIed 1978 tr ore r p /rcc v,/ra�7»ptrt»is, Positive or rnanireutfnf, ,Clinica. tiros :/> $til bad trE,lvIrilie t e/rartrul signs qJ illness at the time of the. study f�stte"r,�+ lyy lc�ett, lS�s'S. Tosyl v r left , 1.(,), bl, /jl� j. Clt)re ltl %J�l 0�, 00 VCIVY1plo �'it'&I l�aTrlutyl l� Onset; 2) the San Fra.nclseo. fig-(lkalu y/ tlii'!/rtJ.Jt' �'t r11� urC lra in fact a, mfnimtim: esti- .mute, since It may not Include W1 AIDS cases' diagnosed qut-;ay and bisexual drug users)Ing side of* vara Francisco (in tact, They Corm an impor nd t'itait of exposr;re, Needle n , ?3�'n of the tail etcd sample SAtas UAI bridge far the spread of lost to.rollorw-up), 1? 'I"L'J-11I - shat' � 9s tt t'rlativr, iew phe- nomcr7at� #tnang ` InCei <iUn to ' other se+r Front the data to !tit~~ graph an rnents nr the Population, through ntlr'ratics ad. r*t 9east. In Its Widespread Page I,n�B, it mny be seed !stat l7et�r't75exLai g 1 ., and vertical Gal tI"tG rut �i' trans. inrreas�. in:I of missl�in. t arida' lridlscr'irtllnate 'or m in shr�,egtig gralleeies," AIDS T-zest. is also evidence AIDS w,,rs Preceded by a similar that a;,, a rou where ad- diets r too 4tr sh are or resat injec, p, t'tite al' increase to Ii'I l.V-fII ex- AIDS have a more virulent clinb erasure, wikii a !a6 time of two to la p,at`,alalitrnalla. often, the, saline t1c,t Cllrw h cat course t!~n do a men, three years, The median time gay probablyave a from known serrapasitivity tivn used far 1 to 5G 1ril410tiOns until It IS no longer* to diag, oHrer art to ah sac stasis o1',AIDS in 24 members aC p tastable, Shooting galleries are arialpgraus to coma and instead tlae sample for whom data wore snore rapidly lethal unis� gay bathhouses hsettltt mloloof AIDS: appar available tva� 43 months, qy tic infections, Froin New York l: i?4, the combined prevalence iuitV data. batl�In dent e,t �' Provide for effi posrire to Flood median .survival in al',�I,IaS acrd other t1IUS-related 1984 was slightly more than c:andltwns !n the and body Iluids 0i' larger numbers or wren In the sain- two years in AIDS patients re- ple had reached 28.5%, Indicat- senting contacts. The ei or with Kaposi Sar, ma !ng a substantial hUrden of and nine months !n those 1,978, needle. rr se since entay, HTLV-111-associated r, sease but senting , Ith Pneumo h s e re- pre- also demonstrating that more and time spraIn siootlgil leries have n rinit pneumonia, dhan two thirds of a high-risl been linked to seropositivity. Use Population such as this might Unfortunately, limitedneedles remain tree of Illness over sev- have Of stcr-il( and br e in methadone- e been available on the oat- j val years' follow-up, 'ural history r� oC I-iTL'V-lI grams are believed to be pratcc- e eliev >t' to be 0 rotec- Inlec- Lion in IVDAs, despite the pivotal Intravenous drug abusers role or IVDAs In the tine. Interestingly, Joe geUgW r raphy also SeOM,S to 1a y play a part AIDS ept- 111MAs) represent the nekt larg- demic, Setterai cafe-contxpl stud- est AIDSgroup, with 75 o r - among stud,} b S. g IVDAs , A 1984 '�telss ,risk a1' les have .Indicated a relation COW; Oases (Including a g the 8% or between CXtent or needle; k•I and ca Workers ritrripnsfmLed a steady early shag- (iartttlttt L'dOttpayc 1331 Ftdh�rittil t';'tICd1Y� ,)glrtw b"�, t�t'� 1�� AJ D S (J'rou; Frig,, 129) drop-off in seropositivity rate p ty in /`1q l�rliles New Jcr'seyr addicts at inereasa JY19 distances from'downtown Manhattan, The dally pursuit 47 and frequent use of drugs to avoid the symptoms of with- drawal limit mobility in a' way quite different t frrym the life-style of gay and btsexi.ial men. This Nei�rflt ' 7in"+es may account in part for tn,e con•. x Square tinued preponderance of IV- i ctrug•i'elrated A?DS around te`v York, given the assumption that Perth -%5 Miles, the virus was Orst lntrodi4ced Ambrsy„,,,W i (N=204) am0rl IVDAs In th t city. Close Xy to 80% of the U.S. cases In 1 I'i/DAs have been reported from t New Yorlit and New Jersey. only 2% from California. wW Trenton ZN'al ') ''Long examination of stored sertimiw6'G Branch Brom methadone maintenance Camden fir•' �'"""� �M patients In New Y;ar4 City has Indicated a rapid Increase In HTLV -Ili exposure slt,tce 1076. similar to that seenr ina men• D. C, Des Jarlais of t ht New Ygr1t State Division of Substar f AbU ie Services has reported. an increase in sera o. tivlt� from 0 m -100 Miles 10% In 1975 to 'move than 50% (N=55) ' by 1984, He has' also described a 4% Incidence of AIDS In a coo - hart 01Close to 200 seropoliltive IVDAs durtnt; the Ilrst ; 'wIr of i t\dalwtic city lallaw-up—In the: same range as San' of the studle, involving groups ol'gay illein. ,It has been estimated tH,tat there are 200.000 IVDAs in the New York metropolitan arta idone and 750,000 nationwide. flee° current reports of Close tiJ 1f7Lt'lll �'znapraaYlrt ti' irr ,r'c�rr fcysc , lrrtr�Jt'c4tnrl rlrttSr rtlrttstjts tcfitt!Yl in198,1Uy 60% seropositivity anlong�; IVDAS S. /! it'eiss ut u/ r!c'tlirrc�s ttr't/, S,c�a��rG°r�btC rlrstrrncc'Jirital 1r»r�s'x/ttutN—rtl�Ere tlfc' 1xtCpnrr"Ys. !'trrd�rtrs fI<inYra tlae�irrttc}»r of'cru/twYu9Ylt.�uc,'nr/ifJic rlistn'Utttt"A>t of nNew combined ivitli / D,4 r•elufetrl AID. Y, } ruitb lttlt, „/' crtscs ac�it�r7er1 treat» rVr+tt carr atirl /Wntr /r�rsc�, even consen'ative estimatcia of (,`�ritrt/rYatrrhltctcrtlrarrrtlGiarrfen+ttreurr.•tfU.S'lrrritlr/tt1u, projected AIDS Incidence amon� .) h4cropositives, constitute aii om, mous prediction of many thou- the past century, has shown artOSureo In - sands of view ("Uses ai,rong tllis Upturn since 19s0, The largest crease in moirtallty arfromi prrieu- c p Over the cor'ning years, increase .in naw cases has been monia (even excluding p, cctrl; In addition to AiDS Itself the !.iocumented In black and Hiss- nit) has i)een sesen In M.As In lour clen of othier ilh .ess related I)anir, rt'tales between 25 and 44, New Yor+lt since 1,S180, Mortality to HTLV -111 Int'ection in this Preliminary data suggest that froiyr QaJl7er common causes in group may be of Increasing Irn- this increase may also be con- I�pAs�- �, cirrhosis, lynt'tance, The incidence nl`tuber entratcd in IV drug; users, per Wide, sl cidc +hasr=alned Culgsis in New York City, which hy�s accelerated'I�v the imnnur;,i ess: rit,ially t.tnckYair ;ed (aver the Ilad been declining; Ste aYllly':,trtcc dys1,,nctlon due to Ii'I'l.i-ill ex, satnc: pt��'lod, This findingun- Ftraapitr t°Itkgdcq ,IAM' Iii, 19815 ,ILL derscores the potential impact hemophiliacs, the �f of HTLZ-r=III intectxarl on vari911$ HTLV-III serncanver�atnrp�avef tioraof` �aklert(sftr� r risk groups The long-term hrtwl shown striking similarities to r a l mild ot» global elffe Ls of widLspread those among g men a' rp W klI rtttld ar q�tl�ttykc ltiemciptailta A txi � or o I immune dysfunction may ext&,rs, ay and IV, aark wMebrarid's disease, far beyond those identified with siudie Se nti ducteed JnSeveral r dill rt1Ve `l"ll#, clinical martife8t,,1t:iorI,, of, AIDS arAIDS-related conditions, regiens of the `United States, In-, la�8t�q Ujjos�aomholnacgtlt�"s1m» dicated a rise In seroprevalence g tlsiC Hemopirrliacs. he first report Pram 5% to 1,5% in '1980 ta' 74 Survival, although the kf1'rlG� taf• of AIDS, in a hemophiliac, in to 85% 1n 1984 amongNemo- etarvlvt�l t l'ter diagnosis witty be ones f 198n• strengthened the- pallia A patlentsl' For requent Other,verl I o ter Ciei ks than thpt 1±✓xtstir7,f, er1aL t Hires eta transmissible agent in users of factor VIII, current rero» the etiology Of the disuse. prevalence may i o have ,led to sorra estimates on; Through their expgsure to 1�u- y" pproach 1p0 /,• tile; development of disease in c � p Rapid serOc nveriion appears to this''how man plasma products,' herrao kill- p have occurred 'arQuad 1982,, yc�tposedrfslr. fatif�, sacs had long been known to be As of IN, 9, 1986, 169 casos. til' at risk, The prolYn of doctor plasma Ail in 'U,S, hemophiliacs heel iqr the transmission of and thewidespreaddtstributlon beton In UWted m bean d specific vir�il agents, e,g,. he of factor VIII concentrates a it4g. Lids B virus (before serolt>�ic pear to have been a dr+amaticalp nostd through the first tluartLr' screening was available for this bfficient way to disseminate or; 1080, It � ses anidcla eta She agent), tytoniega,lovirus, and, the HTLV -111 infection• Hemophiliac ai LIIQ pe case c Cases. Thes.r Agent non-A. non-B lie antis, e p AIDS cases show nn geographic larrr'(kohtageS have re-mained essen plasma i Caduebyri s oCati ilab.le restriction in'tlnt United States, r The maid c rite so products a;re cryoprecip- Further, export of LIZ, colleen- Udll� constaht since hernophlll. hate, t'resh frozen plasmin, and Crates to Europe has been impli- rl' It ,roW p('s WOMitt fslestimat d that plasrrra laeCorconccntrates, Fac- %sated in the observed high prey, Irl tilt t ,f?q0' to 17;000 hema• ' for Vill anri factor LX concen- alence of 1-1TY,V-YYY ex exposure Lra.tes are obtained from the amort y p phlllaus In the United Stores, Pooled play )�a products of' sev» �, urolaedn hemaphillacst the Ineidenct, of'Ali.�;�, is 16 per sral thn0i F»+ donors and are Austri78%19$3, tB M 1.O(iC�lletn,ophilli.A.paUentsand 62% in aenmark and 78'� In Great Brit- OJ3 pt„r 1,600 l'temaphtlta 13 pa- used ibT „ asfg hemophilia. �A airs In 1984. and the � P,,nmon hema hil- Icports oti nts, H'1'LV.iii'sara o;; - , ., is 1 rest,; ,tively. Gornmerci'al tl4!ity are much reduced amotlir c Both Iletcl`OseXual and verb• factor concentrates are widely p g a tr•rAnSmission Ill this group distributed Cot` use throughout those withmildase kind Parallels that seen among IV the United State and Europe; drug U8Crs,: al celve only cryoprecipitate ar IrI rx rc:tro�pe Id Clveleir cotnstud,9 cryoprecipitates and fresh fro• fresh frozen plasma, This has UI' $z Patlontscrppbyrtkve liemophi)ia len plasma tend to be produced been variously attributed to the and used an a more local level. smaller number of honors used wotitt;r;��$iaund ar�overallnd ca� An average patient with hema- for Preparation of fresh frozen irletritars f of �� to � AIDS philia A may rewire 70,000_ plasma and cryoprecipitate, to era] years of i'ollow-up over s n, Units of!actor Vill s year fa unit the posslb,ly different effects of lllGe Citic datkt in the ,�Jart Fran• p not ;ani Is defined as Cha amount or fac- the preparation of factor Vlll cisco Collart. of tnr' Vilt equivalent to what is and factor LX concentrates on cent, Britishcohort study men, A re- present lasma).-Bl din al, infresh mil I'sc `;en' the viability of HTLV-III, or per- similar y ar �ived at a Plasma), g ri oases Daps to other confounding differ- hemophiliacs followed cohort h may sometimes be controlled by ences in tho clinical aspects and tniti 1911h, g the use Orel, uprecipitaLes alone, epidemiology More orylinously, how - Given the s —itematic exposure reditar { g} of its different Never - Jr ever, Eysfrwrs group found a high factor concentrate recipients theless onats ud+: I'rorn� the CDC prevalence ofgcnerallzed lymp,h- to the plasma products or large indicated that by 1983, 39% of adenopathy f?O��j and lympho - numbers of donors, it is not group aC hemophilia I3 patients known to 0%)' in the subgroup Surprising that a bloodborne s e been seroposi- had developed antibodies to live for three years or longer. `gp HTLV -111, and several reports That Observation, similar ltatyc entered and spread oidl� HT1; implicated the Chronic use ,., to p S havt tlxo,e In lon r_ a r Introduced this population after be ,tetra studies <ol' among this of cryoprecipitates in several r y Ing ced throuc;h plasma cases of seroconversion, Indeed, gay burden . suggests oft t nat til Il ong. dariatian from members ol`other whereas earlier reported cases In this anti other'srou s may AIDS i-lsit groups, indeed, ;since Involved predominant severe r 6 p be the first reports of AIDS among Irl mr�phtlia A, more recent Cases greater than c urrcrttly sizppasrd, fcUruthwid doatge 1ag1. 134 ttaspj.tw prauticc Juri� IG, 19Hb � r a � ap 1 A f D S (/•rim page 1341 Additional natural historystud- les among hemophiliacs are 120 -- needed to ,help determine the risks and cofactors for disease 1000------- P Pd the possibility exists infected, .a Son those ahead inf that Y a 800 some of the Omdbod «- y Positivity o among hemophiliacs may, reflect,not the X00 ---- --� Presena. Of live a but perhaps exposure gyral . Particles attenuatedor disrupt- 400 u Vic` k 1 ed through plasmas ro- xh a for p e r ` CC$s+rrg. For this reason, Some invr'sl,igatars 'are studying .yln6 sero- ?.Q0 , pasltive hemophiliacs for possi ble Insight into the prospects 0 for vaccine development, 19$0 - Begimn4ing in 1983; the public Year ' 1904 rlr�ll.h Service recd:alznendec} Year that all members of AIDS rislt AIDS ( pneumonia GOasis t3Pugs Ctther; r,�ups r 1rt11n, rrom donating A�""�"C$4x0lrtt0rl deaths in .vLr1, k'ork iitlrty , 'blood or blood products. Since 199.4 ,Asan ttumtl�er tirrrrrr,c�rrftrt)n 55d to �`ti�t�t/�fJI.� yt�' 1�fllJ, 19192, mul the spring fiu2laen; 00tUbS fitnit /aruwYt;tell + ,� t 1," It1! IJ t dc'tt!!5s lNCreas'ert still aC I�J85, all donated tlerttltsltono :11115'«tul ? t)jzsa «sir°ter att+t',v ltttrx'ttatrtl uttlll sllgfrt[� ttlJltc�, lalobtl izl the United Stales has t:�rltrrlct Ujose f lm f�munutel is L%riniil(ttittr»',1lt t!l}', l�tt'tntrt»tltt clettbs (tt,lticb' been tested for the presence of utt i»rt t«Jte s' n,/ trJ ImIkid of 117Z�111li ertion ' TlTLV-1I1 antibodies,'Those mea,. riven �ithealiccvtruvf� �t�r�rdrrl�;t,Ur+t«1jAlrt llrtittt�j�tryrrrnl/sth� �ur/x,SAc,rs sures have certainly contributed to the reduction of risk among hemophiliacs not yet exposed. as have the 1984 recommend a• through cOntarnlnated blood of`Int'onts"ln mune ste s tions of the Navional Hemophilia products (including red y m , the roundation (o r'-duce the urs. platelets, plasma, .one! tvhlls,ole larll grat� ro I i,Ional,dosc of,virus �Jt.'cess,"'Y use al' lrrclor concen- }.�loo6), In tiddition to the cases boll z ''tdblrra+{ relative to trate:s, Additionally, It tuns dem- described among y tt�t' Ind,'the 0--p •tcr' inc:u- czrrstrated in 1984 that a nety As a percentage p etot l clases, undarri�j�kre!s�mtatiI inlants, The method of hcsxi, treatment in the transfusion -rases doubled from patlen,(,s, sirs' tatlon f' elderly hand production OC concentrates el' 1% to 2;"a between 1985 end may � s te'i titcly` inactivates ItTLV-III. 1JSEi, Z'htrtJ» y Indicate that they tend not S c fight percent it to survive 4141r acute or under- This fed to the. recommendation such patients received Cliefr 1 in x A andwidespread ImPlementatlon transfusions in either gest+York de119 Illnesses long enough to of 1111s proced!,,re for plasma or Calllbrriia, Investigations by ed latencylDS during the xpec t- r p,•epara'.lon. (Recently, the; CDC have identified donors period. IOLo some researchers have claimed in AIDS risk groups to the ma- e Icnow that this method may not be jority of cases �vh^.re investixa- ire rlisf tsiar�-associated scases ' dil()rro effcctite; further mod}fi, tons are complete, The age d s- etltfrrns may be neeessa A g makes it Possible ko estimate Complete p n to en- kt`fout}ori o!' rases has ranged Che incubation period for AIDS, Sure the mom lets inactiva�<Ion from newborn to 82 yyears, The Mean I11t~ubatloll for children i of H T LV•I11) Obviously, the vela- p ittern dil'lbrs from the overall 21 months (with a tiieditxa o' s th'e safety of currently available age range or blood transfusion 21 mot for adults e , months Plasma products will not reduce r'CIPI nes to the s'ianifica t the likelihood of future disease overrepresentatlan alb Inl'an s (medifigurea . �0underestimate t). 'T'hose P an a o�' r p the amc,ng these tvtio received l€tr- and an underrepresentation pl` .true Incubation period, hotvev- mentation oftheseare the im 1¢� p e 7rn Infants account er, because they relleot only the Transfusio �„ practices, for 10' of lransf'usibn-assoclat- ca � c:oncen tra� s t7e cases sig far reported In whaf( Is �O of March in. ed ArDS Patients but represent an an ot-l� r rJiit�, 816 cases of AIDS in the less thane , Of total blood trans- i;ar cases ltrllteci to trarisl►a United States had been linked t'usions, or ex ylFsnatlons i, e � 11 epidemic., to (rc* indeed, to the tran5missi,tirl of I T'LV ►li Increased ; slams include Increased susoepttb'ilfty 1 f9i9,';thr ni'van Incu- t 1, : err in teutlttttutti ctrapat�tA l�d;l1 Hn3p#krttkrJ'�Ctic� +1ltrre Ito, I:)ktz 13i} i L , � r FORTAZQIX0 Cel t1T1�'ibFtTlifaCT10(1 Formtrayenau3brmtramuscularbse Bri+lcurpmatr B+Inreprdssrinin0,con+ullcompfdtaprdar.;,,,,,-y)nrot,;Fiiyrz,-I INDICA]'ION5ANDUSAGE r 2v w t A'� �� Vrbm pave 1$9) fGRgTAZ'rslndipfedPorihatrenfmanto(WitentsrwlhillteMan srausedbysuscapilbleSion heofthe dart natedo anismsmthddseasesrw etlhefuvr 1.lnkerRasphatgryhadrre � ( (3CiE7Ci has I3GlE.',rt 5 Psrudamanassp4raes;Nad rusillwentneindudragamdzrlltnYrdsl9�¢t tnsns "a and other 10t � t Irak those e pOsed InEnkmbactrrspenas;prutgtrmrrablks,fsrlrerrcJuaaaSrntssPenes �4AK, w�4 a'ggtgdetsbSllaspaces; Skin a" Skin Atruc4im Israel sadufdphusedtGasaurrns (mOtMCdbn SUaceptlbla slraulPSrro �lttiircludin pmiaDlt3ndtodalt.posltreFlarwSo� Ygr feSPoCIM M' 'ssvpi kt' 1jj(�r1ti7S. �v `'pt1.1(�,,�il;8 Of high-Ir dDnt)F$ methraflm suscephbles pa0q c; trainsl;and5pyslBands(grauoA.heta•hemalYhdslredfocgcc+) 3. Y 5p4C1aF:Prd1a055 c1VC sJ�}IIeVBR�tnIn tl7elyde» A CpegbClttCamphCGtedandUnCOMpfIC0letl,pUggghyp g111ceEnterWjtGt"G,. 4, vactorlal99Sgplteemta,�Uincluding pmUabfksand indeldptlsrbYdPralepr2ft9)f/Os3,*6 erlibud,.cvb Closed by Pderogrnoxr;l(IebsrNWspacNs:Kmfwdittaa;Ecntri$cvratrasppuet:S COnoanduelznnSaureus(Mgthrcdhnsuscephblesrralrsl. 5,OagoandJoint lnlacboat,wuSodbyP,aeorgroNsa;toehsnYlrspeaeS;Ent�Jotactuspdctes,atcd �1 SCZ'�2 t�( It, 47� .a Chronic Carrier Slak( t�ji{j ]g (nlnlhltlllm•5U5CCPIInle5l,t.nSj. surras S.tract. bynteCtlOnk,IrtdaorngendtlmgtNhS.pCIVtGGNTUhlzsanddthartlirectfonsOfthefomald�amga marked j�Oti2 ry 1 b pCsriisto1lt viremla and caused aused trans cau edhyt cavi Y.(MolhBbdaMlu+IlnoWit nt.IT tUan9penlanrllsausr Oy6mk:AkbSrulaspecies:Saueu (mglhtedhnaustephhlgstrainj.andpolymlc(dbrailnfeclronsausNbyxarnbrcaitdgnaerobicargamims, q y' , C 'r�`1C�C�"nt progj,4,8,f111�11 to AILS or AIDS-re- iatetl andttacferinoul dyecrgsrmanysthmsofd/rdgl(rsnidresi4lanr). G mam q'r1idis FURTAZhas131shtlganain t ntttllk'Ipi7Sr Studies by the r^r t CD'"`' usgdstu iessl IlyltInalimtltdbnumCgrgUenip`se�olmen` nytlsduetoA, aerUlaronsfatbSppria[ < F�i(wi t ti ktienttfied 17it7-risk donf l;� Iii �'% transAlston»asso- Cxn5ulrvonrgartl5msAnd toddtamae'halihildfSu5bclPtlhll AillaoO and ideal tosuit g 0l suscalaoiIIllty Studios and knOvrn; ho*ceaL ollty' 05etalotoofts f,Thare aVa1aybe:,lpaitute bee 6epore treatmentnTAZshould bdad(usfedaCgardmglg /. �y j ei 9'i6 axim�; 4; Of 46 donnr`S' �Y^7e m cI of w IhiJt as 4mPtnclherapy'tn uses wY MeyanuU4 caubm lit thFO pros Wt h otherari:bro1 rstixveY bganused, use 3 UblSbeth itblood Werk 4it1i( ii�l rtrFa�i r1t i1�,rs O� dc1i aw on, 40 were Sind myein.it, also ea ttdtviire2tm�lvtne jo lgoya dbhthe mmlrrncomppsoiny%egpatent cOOmyr.tgit d ConctionlaM lfeatrrrtnt tS npPrOpr1'it,`.PresChninp rnl0rmallon in the ilbcooto Of lhegiher DoorsWhen r011cs ShOpld beldllOwadr The dose tlgpedusaniiaseventyul Ina rdleeitgnAnd subse, quC111d U y` t�iy rteQ kJ "eroposikive; lOr t� { ��i�' vYJten evil j the patIenl'scatrdthon CON'tBA1HDtCATiONS 'k - FtTF1TAZ•rscnnlrarnCtwtedurpalrenlswnghavgsnOwnAypersensthaltyloc4bavdrmgqrlAetephalOspan ti c{ked to t7 tYlOn(11S after ddriatioly, I(j WARNWas , WANNt had d civoXt Ped AIDS, and 27 re. THERAPY "ENTHAS A2 AM()IT�l7HEYD,CAAEFULtftQUTA/SHCULI BEMADCToOETENMINE sy I� IIS StILf4 altl7pU 1III gAiAHLOSPORINS,PENICIL INS OROTHEf10RU S.ANTIp�CS5A0 LLD BE AOMINiSTEflEOVVITN CAUI'rpNTOANYPATIENTWHOHASCEAIONSTRATEDSDMEFDRMOFAL'CEAGYPAB11CIpLAflLYTOORUGSr n7O5t 17l kk CQntlnued to be THIS EACHOOUCTSHOULD BE FWCILINn, EHWAH� uRONTOgATIENSWITHTYPBT'HYPERSENSITIVITY AEAGTIONSTDPENIL'ILLINIFANALLERGICAEi4CTIpNTOFORTAZi=FJS;pi5CONTiNUETREAi�iENT t,�rr1 Cernir" 4J2tl5e figures'iI1(jIt„at' WflHTHEOAUD SEAlOUSACUTEHYPER5ENSIAVAYREACTTONSMAYREOUI8HEPINEPHRINEANOOTHEA EMF.AGEtJCY MEASURES biakil' hitt yid Cumulative .rate Of Ps¢udomgmnranopicalldxhut been ropeftadWith Ydautauynaph+Vlsperint(aadalharhtaadrhp+tlnrm( anllhlolfal;thgr+idrd,bLlmpartaniloconsldttl(axgn0 tfgp+gcnitwhqQ4vqfapdUttAd+ln uTreatmenwithbloadllcvaa Treatment disease t 22tl amE�n this sub. group Wig people known dlGad10 ap1ann drddti CCdtbyCl XUkH p�tO n�m� f p fantlr0011C agA0d ]ICd�t0111Ygt tAddca3esnlcoldlsmaymsoandladrupmsMnhnudnClarOnu.�ndatafelpdmre:atadas3hbuldbe m+ndgl'dwtmAldd;hleclrolylO. to have tmilismit f tLE� live vIt-tls and tile. and pmlonsnddlemenhllonIsIndiatedWhen lhOCOh11515ri+ifNrnYedtiy - drtgtllsennhnuancetlrwhgnifrsaeYqrC,nhlvantdmycrnlslhaltgalmgntofcnacolaanllblutfca3snclaldd ps¢utlom¢mnranyp3euUlt produt4dhyPdrnkrtdOlhereaINpItAlmortsncWdatfobedanstdaetl, peC$I kene�' CtI� vi.rt mia In the ' Cna o'it i Y Of: dsymptomatjc rORIAZUi1DH5 •1 Sero- Positives, cortCetYfNlnonspduecuhItemlusualocte nPn�Ilopiswllhlyd3us 0114 anliflonatudserum such0111:11a81ts( renal ooDOScenc�thefnl41113111dagagashouldbofeduftwngncUlindrmgisadministeredto suchgahghls (sca DOSAGE AHD AOMINISTRATiONI o uuifoolle, pul Conhmlad dgsage shdu;U bg gglarmtnqtl by dcgraq ol. tanJlrrnpaln,Unt sgvghtyOingecponaddsp3CrphbdtlynlfhdcausattrQotqanls,As POfaminduse ofroRTAZmarresult .thoviourcwthofhonsuscgptiblOdrgaasmi„ Of In RtdpdiedawluahaugllhapandntTGpndlhunlse3,tduhal,ilsupdrtnlaClmaa L� ,Y 1, 'aa »�" rMA��t�1� i pPG" La�'�d%jf r_ndubn Ihut 111941 ltl shOufd be taken c(`Nt q abyddpraphyrH " t toATATt should beMallipbIOwith caution 11,mdMdulsvnlhahlsloryolOfltlomlnar11NIAlrYdadls aslmaldlssase, , AT Since earlyOnly 1985, several sero M14ominogfKot..NgdhmlozlcgyhasheonraporlMiptlumnaGn+comitant,d,TTlmslraIOnOlCann41050onns' '. wlln dmrnOgiyCoG'ja anhblcllds nt dptehlawrdtlgt.such os lwbsalstrdn. Regal lunchpq shaultlggcarctully geSbl lha am,pd;'Ycasidaa Il hlphtln5anaphrnloslntY5npulaloklCuyyuUarnuaqvso3idlGanUAiahcs, 109IC t�'s(S have been available to l,ietCCt Y Y t ppmuminrpl,esaacraq rglpn ed', bCpU504 1h4 p01Cnhal art to be admnislergd evil tnetipy 15 aone m epmtai iml5 alone in coolrtPdnal.4 Xlcft were, notnOlgl when PORTAZ•(ccltatidlmd tot injection, olazol Was gryen Carelno,lrarlfs,MulAyanes)s,tmpahm¢n(aVFgrllflryLangrtetmsfugresmantmdl5havehotbeenparinmletl l�I•l�l.ry"Iii n,`L�1'j-tibody :and g, -}'1aVe forrrlt,'tl t lf! basis Oi a...I7atipn- In evaluate cacnoggmtpatCnhaLNOhtvalimauteMtcronucleu314stAManArpeslestWerebofhnegalot, Usage(agemeendets, (h+gelnPrgnanry;/MegnahcyfatapdryU Ide1+CY1'n i'br screerzln Cipnc7t� 1 �i d blorjd tlOse5tIp104q hrtlea the RgpmdunlOnsludleshavabeenperlarmedrnmlcaandtatsxp human rotor and have lCYrdlMl no studies have to iQproouttan5lure Of beenadtertdl a I harm to the is al a ISrodUree for evi- denpe'o('11 - IiCt ibn wt l7 thevinas. malt dr4bwaWot fadequaledrrei�hUrnarnrfxoplludoisir2nNgSho IWomen Nuf1j" cry It Clearlyflooded.b useOdunnq qqSt Hursln ATAZisadmrlst m commonly l available Y fed 0anuringWo mannnikmlaWGOnp4ntnirunsCa,thgnshGt neeaaresed arrdloinursingSVOmap l5 tt11e e end 117 , c-linked im- yy�l MUM- ADV�oaERSE A ATAZI, flEACTIONS REACTIONS FFOR AZnaglowinlCiawlldolltlaUlnemosttHIC1ommSlwPtelaCalln2lEhonstoOvomngrn III,st •ngrglpafvas;Irpnitrshnallraclrang,nlheradMonWdacUonswrrennso s 50rtlenk c1�5u ELISA technique. i WhICh ivCs 0owi gInlravillo sIo tJire oeo 0 N d14UlhJmhMeredcbpnswilfarnpolfilthe IOIIgwingadhfSOenacts from Chnical11141s1Vereconsidelenth s;vnnarralaledlpccltuldlmelhrradyurWileOlbncellamtoolagy Spec t'rophotomet-. i rle reading Of the amoun.c or t Lac 6903 entsiOrtedmiesS'^ant%ofpNmnls, WattnhfabglsandmAJmrodhchaltonsilsa,IAlCChan lun 59 pat,entsf antlt)Oti 7 a binding to HTLV-11,I Uypq snn3tllntyHaAdtonq,rapartrdrn2%nlpaNenls,weranrunlus,rash.andtgve4lmrnndlate Gallocin5,1If a, aaab in36Gcuffedmtln'�a, PdIIEMS', G in Srrmpl $I legorted antigens 7 r1�om virus'l rO7W��n In Q leukemic on II'd II in loss than 2% Of patients. "rediarmea II In 781,nausea (I in 1551. a vumrlingllmSpOl.JnuaWlaminalpam(1m4151 luralFmquenlAda EYadltoissthanfroWaretandldiassandyagmd,;CdntrginarwussystemdRnts whlM mcluden cel! IIt7e called 4'19. The E:L1SE`z test iS available 3 headacheaNNnoss, and pareslhesw, l3 Craft; est Ch annasnorddduringFORTAZrhmallnalswemltansrentandtnctuded aa,.dophdlaftln 131 pdsrhvd''.:.0InaStoSCwlfhpUlltamalyslsItin291.InrolgvftmUsf51f Wrmra 117'SCVeic1l commercially prodtl' 1L1tS in 4XeAlan intudepd.2eleydtlanSmlln dtrhe nepah0entymas SGOT(IlnlStr SGPTIl+n151r LU H(11n18LGDTflln i9tprdalkahhq one '. pnnsaAalaselitn231.A5wrin5amenlhnrdephalnsptlahs,Iransldntae4appnsolOtdgqloan, levablood orsin nurogenandarsnrumcreahangwrrrabsgryedOcaslenillYTranSIOnttdukppen%neulropgma, under llCensc from the FDA, The ' different Lr'1'I"�•J/�. Iprmm�ntyitoIIIanglympnaGlZ wartsggnvetytately DOSAGEANOADMIHISiflAY'IDN ImpalredRdnatFUncPgmL•altaJldlma,Sa3ClefedhyIAatiWneys,dlmastrztlUSnrrYtygldmCfUlarNltrahpn iilt5-}lave been ;) eStlmat 4-C i tohave a tPitaltome"aatlgnlsvuthimpanedremaffudcr,OultTFA<SpmUrdmLtllsr±rammendedthat the dotapeal 'srllantlfinevieMducefIgCompenlot lastssldwefekUChcnStlacnrap101eFneScnitingInlOrmatnlnlpr 00lagemdahenis wtlhtoniI ImbaItat Al. sensitivity `eI 034% t0 n ib ' and a SpeCI- L1CIt1 Ot'.99,2% NuwsuPlated SfJOr FC1RTAe nines!yFORTAhputdhewnIatataohlmlladrpomlehlpdraltyeIStO300159'100611,anIf e� to 99,8%. �ek7sl- tivtt� Is defined as the ratio of true-pOSitiveS/true- NOGOf73037.hIFOR1mgsalsywndOfbdn•Wnllapamkr5upphrdlhwdl3andmruSlpnpank5n51nIk:rYs Nncotl3D3t"al 500MgVlalst8a rDc DIa3 Gat 35 Igvffg(rinypl hnc 0113 0379,14 z gVifuofn Of 90 9> nlf0 IT, li I'Ves+ p Slt Cake-vie atives,`and spcolficity`as NOG 0170 0380,ry2 igrnruslnn,ck 'IpC 0173 D351 J2 1" nfusronPack(�iyn1101 true•ne rltivG5% Itle» t a 1tL ctRlueS r NUG Ot703023tldgbgharmxp0ulkpackaaa(TAyn(51 n ��/��rq x Y 'ra,kvxtfat tna hytlmpsnaRa{id,me _. tk�I�dA.�$A" GlSznidh 1165darCATnaAylePLk,NC37i"59 i105p11Ci11 "+L'Y 1083 c CaoYhghl 1985'. Glaza InC ARtIghN2Clafk+d. '. Ps'taCdcd Ju21G 15, 1980 1.413 TPR 100 Septembtq 1985 r, J false- ositive . p s 'lnd spi considered 51,ta r blood donors In tile At. eraanple;,t to assess the tlltt )this hfghiystnsitiveand sFaecitic,ELISA tanto region over the same per a � , itt.l tests f rscoa-e the imperlec- ad shoved a similar percentage and `i p and .r1,�nlfiaance 'of e�;p�tytytiiyt; tan aCa11 diagnostic testing: of repeatet'iy reactive tests g t, law,rtr3k blood dtiktrsrtr any test that is less Than lUt)% a . W110111Dy have false-posltlV� (calf sensitive and specffic (virtuallycateg °)' S2�+ of these tests were res411is, The predictive '�cglUp ty f categorized as strongly re4 Ctive , all tests) Willl necessarily genet_ (with a,high cutoff value), These any yet st' whlc h slgniflt's the ate both false-negatiVes and tests correlated highly with' os_ l� rOdilt of true-po: itfves altl�a'tlg false -positives. T1iis is an especial (five Western blot (94°6) and tats( lyosltives, depends city the~ ly Important consideration in viral culture (56%)., A roSan Fra u. of prevalt'nt"G of the co,nditfoll ttg9:. the context of l-ITLV ►li, where a g p ed hi, the subject populatlpty, extensive, debate has already shalved similar res Yes in which neisco X'Jiktt the senSltfvi taken place on the issue of stig- 60°o of those with s, i whit to and sect~ matization and, "labeling"of i ` lIly, remain conslartYa e4ctive tests were ci. turp- osi- tile fa tisltiVe predictive value« lei. asymptorrratic Individuals with five. Equivocal' ar weak) retie- t't'y'008 with the Increasing preV Positive tests. y alt�,VC Orldist ase. Intuitively, ryn The sensitivity+ and specificity to correlateshuiih ave ooslkivet been sWest- hown etttl re$,son that the rriore liltr ly; oC erre ELI SA may be adjusted by errs blot or ��iraipcul,tIv e, and a tllaWlsc Is to be present, the the spectrophotometric cutoff such donors have rarely been bt~ , more Illtely is a ,pasltive test: to Point chosen, to indicate a poSi- found to ba re risk factors ,'fot a tthe"pOsfttVe, Estimates ttyc test: the .higher, the cut HTLV -I11 exposure, � haVc tyteit made of the positive, point, the,more specific; the prt'0101;Nq value of the three camp fir. low- er the cut point, the more send- Public health and tnedical au- at t>tr«r lolly available ELISA lilts ' Live, A positive ELISA Will gen- thortties have been pleased with itlrlCeif FIs of LV-IiIt al art vow erally be .repeated automatically the implernrentatton and eaa•1 , expasurw , ih most centers, with only cion- results of the blood sereenin f , y At a trttsl populatlaxtprevalenac sistendy reartive results con- Program and have made tsitprts t �aelp til, 61%, tiae numbei* of sidered positive, False -positive to reasstxty the Public that the patlltlVes asa, percentage of ELISA tests have been most blood s4rpply is sale. That teas• fiat) pt)5lttves wouCd be ant t.'ommonly found in multiparous surance fs justil'led, though with I;f % to 82%, Ata higher preva- women, blood tmnsrilslon ,reci g lence lovel of` t%, the true -post - tents, and tri the ; � s.` a caution: h noted, any test tivity t°tttt; would increase, to be. Setting of cross that is less than 100% sensitive t1v4t;t1 06% and 83% (As noted, rcactl4ty wits certain 14LA anti- will ,generate a finite number of tllc� � r , gens present In the 149 cell c1:11 +,`aIle negatives (an important o- a pt't'wdenee rate In the first titre line, tential consideration in the set edwat) tt U , blood donors test - The Western blot test is gent- ting of more than to million erally considered to be more units of blood and f"ytinitAtt's suint as these have specific than the .ELISA and Is nated In the United States each both oi't�jlr tit � LSA andtilo tWn tern often used as a confirmatory year). In addition, several case blot tacsitf'Irt ELI n be obtained test, (Another confirmatory test, reports have descrf ed viremic beton, (IIN Ill are notified the tmmunot'Iuorescence assa, n doanw y yet seronegative persons persis- tibody ptl,,itiVity, The signif cant has had less widespread use;) tently Infected with HTLV 111, false-ptstyftive rate among The Western blot tech - mong lowµ r ce use"> Screening oi' blood products risk popu)ations also highlights an electrophoretic process to must' be accompanied by efforts file dubious value cif such test - separate viral antigens and mea- to discourage members at* sure reaction of serum andbod- groups from onating blood,risk Ing as t1 screening tool among les with specific viral protein In discussing the various those e<not at risk for disease, of bands. The tv,o principal pro 1�ITLV-Cil antibody, tests in use crisictical IMp`�rtance to the phy- Lein bands in the HTLV tIf assay for screening the blood supply, she: should �ntcrpret a urse, Is how fie are denoted P24 (the core poly- it is important to remember she,finding peptide) and P41 (the envelope that tL'Is is in fact their rima Itidtcattng 1i l'I i7 -C11 C^c- glvcoprotelnl, primary posure, This question, along 51nc�e Marth 1955, purposes to identf y and discard with other relating blood potentially infected blood prod- In g to counsel- banks across' the country, have ucts-and not to be used as a With later in this serllls he dealt been le$ting donated specimens clinical screening tool t'orvolun-- C, Cor HTLV,Ill antibody. Ql'the 1.1 teeIr blood donors who are felt to contacts between rrial(41a Count m11110h units collected from be at low risk forAIDS, One can March through ,lune 1985. for �5� at" adult A,'IDS'cages ln' 2,(331 ff1.25 ) a,ere rep( uctst with even equ a alI CLISA t pntat td- the lthasw been `I h licca e t hetcro;15exual pro P ositive to ELiSA, Dat, oh readings, it Is decidedly more 1<,� ol`Ceporttrd cases, Ca chin re 144 nospital Practice June 15, i o86 Ij classified as heterosexual con- ------- tarts if there are no known ex-- "" " """"`""�'� 'Clinical posures other than heterosexu- UsefuInt=ss osf �1" 9r�Ill Awys " ' # al contact with someone at risk'. ,TT •�k la �k' +' • � � ° forAID,S. The heterosexual con- ,z � ,.;;,, f1TlV-Of VI ". ! slfti` 00' a tact group as of March 10, 1986, � I consisted of 242 persons. The ¢ majority of those patients re- i ported sexual contacts IV �{-' A True- " b -False with drug rug abusers, Among the adult Positive �h Iteve patients born In the 'United °°°"�i7,L� DU , : , A,redbod �� +,'t'� i States and having no known risk factors, a sianiticant ISA Test percent- f age of males have tx,Icated his- r G False C=True- tories of sexual ctsnta,ct with t ,= YmlVegative r Negative prostitutes (34% of a recently ` Interviewed sample)heterosex- ual transmission may br !>npli_ Gated to there eases as wr lt. Studies of heterosexual a'aealar" .�'_ nsahve tY=A/A�+C=Likelihood of pe9p►e %vith the catYd itian haw �k; liretest p6rt- ners at' AIDS patients or, risk group �';'� x t o<i Spee:efk4 D)B+D;Lekelihoad "ofp ro"le � • a wltftout th e o ndlifon h members have suggested en b ° �, r „ u,,lsegarfve test fi v ga virus transmission rates of 10 asative , ;, ` , _ F ;ae„” F. ,; �� to 70%, as indicated b� HTLV -(If predictive f Valae �itlre BoLulatioh seropositivity or clinical disease be(nikelihood tasultbeing a true. -positive p p s udietrf a to, in the seX partners. T%vo of* 2i wives of hemophiitacs seroposi- tive i'or HTLV -111 were found to have , Unlike sensitivity and siiece(tcity, positive predktlVej antibody. In a small study valtte well vary with the , vary w t Prevalence of exposure in a population (A+C vo,ti+41 in low at Walter Reed Army Medical Center, five a Population with prevalence of expasure� paiitive predictive YA10 wlll' be lower, than in a group at known risk. For a low-risk o1' sex en wives cs of AIDS patients were found to be o" uldti _p p on - ,, f�lors EL 5 (Ii blood ELISA test Is more likely to 6e a false»posIttv6 than For seropositive. In a larger study; at a true -positive the three HTL`r•lil antibody test kits most corrimohlPredictive Use, Y In use, p value is chiefly applicable For screening and discarding , P Mnrltel'lore Medical Center in � dtitd , the Bronx, New York. C, A. Har- ris and PasfflVo Predictive,Valtte co-workers reported finding HTLV -111 antibodies In (or Sensitivity Specificity Pry dl tree of Exposure 20 of 42 regular heterosexual--__- % partners of AIDS patients, an AbbottLabotatories 93,4% �y4 32%{yf-fr =-rte apparent transmission rate= of ----------- -. Electro-Nucleonicssg,E� y0,2yt 48°6 to sexual partners with no 11;`G �—'— - 56% Other k'10 �"n rislrfactors, Hetero- sexual . tMOSMasion has been docutnente„a in the absence of anal intercourse; itis unclear at and immune dysfunction in a lower than, present whether expevtcd or that certain prat- hemophiliac's wife who was In!- heterosexually exposed females tied$ amoi:,g heterose ',ials pro- tially exposed through sexual may lack sa'trtes additional infect- transmission More diel"• contact and theca 'reverted to ien cfently than others. ural nor- tions or other r,ofactor. immune fLtn.ctton and anti- Data tan the risk of AIDS body-negative Debatecontinued over the statusafterafter dis- poss bil t1 ss of tbmalr tomale among lteteracexually infected continuing exposure to the hu,;- persons are also variable. Cer- band's tarn versus semen. Epidemiologists Catib- researchers have suggested In that in the absence of other in- $ion, to Africarand the New York have also noted bean, bidirectional hrtc"roseXual that the incidence of AIDS in transi'e:r appears to i e cs�tntrtt)n l'ecdons or cofactors, such per- female IVDAs is hurts may In fact- have a lower Nigher , considerably and the ratio Or male tea ramal, ale andAID than that calculated a ,40 lar cases vitt Laird risk of disease', than other risk- the estimated popul ttfun of fe- :1 group members, 01' interest in male sexual oppc —ed to 1-3.3: i In the Uni Led this re and was the findirt t this of malt" States. In fix,' g of' IVDAs, "1'tiey Ursited $tates , as Irtfer el that a whale:, ramal-to-maie trans - transient HTLV -111 antibodiesviral transmission vital ra tes are cnisslnn has, not been dpcu- ttoapit t PrAcwc ,luny t,G. IS1sB 145 l; mented on a targe scaler am y Prostitutes In fact roc- H y. man about 10 of the heterosexual tJCe ',safe sex" techniques, Acac- p corat�ts vgltu-,tCZ lova-rlsl� Cntttataaers contact cases' have occurred in al vaginal Interco Iu' ezaa be rnzxle partners ,;tho 3tl�ii males. However,, several Inde- uncommon, Y I�l�t� orad clevelu ', wlt 1s� with ; he ttse of P �d AlDS: wraulc f ones the rv,10' oral- sei o11 be, outegarJzed as,, IVD��i't'lattzGl, laexaden,t st:udles have indicated �wond that bidirectional transmission contact, manual sti�5ulataQn, �r casts. does occur in this country. For certain fnrrn �. g at1r� Kipt he"terost'xuai4GcatatztCt example. k R Redfield and co- u of .,zmc„ated sex- Spine observers heave the(W workers at Waiter Reed re- al activity appear tp be,stan- that the under °- iced ported that li) al 15 heterosex- �ard reducedall vb1chrlsl: could account, cro t 11 nt as' -,S4111 pd'om t , ll)r cast evolve from llyt ctilr- ua: contact cases occurred in male tra.nsferofwdrus. r�rit .raaale preponderance tituzartl' males w4 triad contact, wtth Recent reports have dncu- , ta, distribution ctnsex to ila4 Al't`s- prnstitutes or multiple 1'etnale rnented the, isolation pf ;live , ,+� r toil at oder as more fema)es be, Partners, antl live occurred in HTI..V 111 front vr�lnal or t vicar t o'.`e lh' cted with the vial , risk �maiTe sexual T contact pl hi,rh- s Ina _$boils remain t secretions or` antibnd - asitIvQ , 'Portant;rte tae investigators females. A Boston group isolat- bc' tan$Wered c: discounted the possible under- ed V' h-Lts from %tour of 1 tv�p en bt1d, Al n is � tie eCCit,it loll reporting of homosexual con- znd investigators of 14 batt Hifi ince of txansgils:;3t5i1 toots draanra mutt xe sexes. Consensu��s g Military; personnel, cisco found virus In four of rM,ars e ctst, however, on the pe;_ on the basis Of corroborative in- eight Women. Most pf the wvprtien , g p tc►aiital Cit. helerose:�ua! spretyd tewrviews with ramify inembers i:n bpth rpet s wverc' either IV of the dfs`�ase, .and caution, labs orad the' absence In thew' pa- drug abusers,or the sext,ral ea al't n 'adv)j ed with respect to tients or sexually tm smittod tacks nl' TVDAs Further studies �l otce' Of pari' di.sc,ases commonly seen In 94Y will heip,asses5 alae potcntltrl iia- lea Malo � Hers and the use: maks,) In addition, a recent case Cr clivitY;,of such secretions der- of llbdtdora3s artri other method report from Ohio decrrbed a int et thl4,�xchange pt lndy (duster at' three cases 1tTapilcat- possible Imposexual rtance of �^aexis , 1lztldstiUrtng�exuai �anlaet, activity, as well firs tine Int; bidirectional trtansrnis,sion Ing cerlleltis or other Intlam. ,�"t;rilatrics, The first case's'su�+, through a chain of hctterosce cual rnato c gt adve Oran A1D541ke tllbess Ir!, cmitae,,s. onditlons in Wther , partner•, which Might affects- Gltlldrt ti were reported by the l.itnttzd studies tataa t 0 prasti- ther the number of,inft.ctcd f m- CDC In ,IOd2, %vith retrospective tu,tcs in the United Staters have pfaocytcsin the vagina �arI the , Y lcir,nt111r.atlon ryf probable cases itaciicatcd laiC;h PITLV--iii Sero-IntegrityEos stat' back au poyitt�itti raze;; in cerialn rcglorf;, tpous al of genital mu- , , y1 80, Since then,, thz,te 114Ve been X56 cases of nl' tlnc Gou,nttw, often linked toa AIDS Ira'Patients under 1,3.years roexisttn r Regardless of' actual effi- of' age, trncl 59°Y� have died, More taistot� of IV dru r �, c i .Hcy of' lemale-W-male versos than 75%, ofsuch cases have. In. abuse, In Miami. 10 of, z5 pros- male-to-Ilernafe transfer; certain vplvtttl ch lid' with one ti lodes attending' n AIDS screen- a iderniolo f' or both ine P rtcaspectso!'thepat- part�tlty at risk CorAIDS;t1ze L c 13raic were found to be tern of HTLV -Ill exposure in the r , seropnstlive (eight of the 10 had United Statc$ may help explain have bt t,ra IV drug ab he ' gr(sat majority ol• those parents histories 0r IV drug; , New Yprl- City, where �tI ecstt- t spread FI predominantly l unidhection- users Be - mated 40 a of prostitutes are rapid penetration of aauyt. mast Grin till' eases ls- g early salt li•om perinatal transmis- IVDAs, 500 ol` a group sampled thn toile etratiexutu ands, int' ptota, the geographic, In 10S�1 were scrnppSltive. racial, and ual populattun, the reservoir of seen l In adult Iern parallels 1DS that In%'eWtg•,,ztnrs have wondered, infected persons contains more sen I �.I grit � n p howvever, given the probable reg.' males than terriales. That alone He ts' rc'tagls have cnt of pedlat, en,oir of inflected prostitutes, would reduce the refat3ve Ilkeli been black or why there have not been more hdod of female -to -male Hispanic, and '7,5% have been cased of' prostitution -related' Ston on a �5imple probability ba- reporters from New Park. New AIDS. Some conclude that f'e- sis, Second, the predominance Y �ie�rsey, FI c,lda, acid Calil`�arntv,. male -to -male transmission oc of males annan 7 tri order In exclude tlae H�mer- curs only at a low rate; others populaliort of' IVD�,�s (70% tnrnale ous congenital causes oi` im- have qucsllnned the actual risk to 30% 1'emalel would enhance lhespta �i1`ic3ty of� AIDS olio �npse mune deficiency and to eaahance Inc pry ilu d from practices i.nt'olved that W'f'cct. Further, evidentte exw L s related st~%, Des fists _ghat lcrnale IVDAs may , irr cttlldrett, the CDC has adopt- Jarlais and co -Workers have more likely than their malty cour- nlltion, This a strict = deft nttion wilovisional l tend conducted extetisite Iraten•iews terparts to have drug -using street , 1, using sexual to class rnokt as AIM only the. prostitutes in New contact$, which would reduce York and havc concluded thry! UlCir number ot'potendal sexual as -e and a illenot cos rat e wvid' 1,16 Ftuspitai Pmcttce June 15.1986 ,i i. - wvA�l'�.w.rr.�•..-�w.rypll5�T7 j �range of AADS -related illnesses alar infections as are ,children Public ,1`lealLh,dispels hysteria, that maybe occurring In children, " born with congenital, agamma- and wxfegUx .irds Individuals Some researchers have proposed globullnenila, Some researchers against U11(,JUe stigmatization is a broader case lefiniLion, argu- advocate regular parenteral in- criCictllk,�` ilet:de& The recent CDC Ing that .the occurrence of op- jectlons: of gamma globulin In recot71k1' 0110atibris on eaucatioil portunisticr infections in (child- AIDS Infants, with some claim and foster care of children with ren is necessarily a late finding, of bett.eficial effects,, :AID$ will be presented in a since infantss often lack prior Increasing:,evidence suggests fort'hc;cii"r'iirlg article. exposure to those organisms, that there are often serious;cen- Alternative classifications have tral nervous system corse. Paeptliti,tltay,'The mechanisms proposed using epidemiologic quences of HTLV-III Inrection In Of Vttt''G ORI transmission of risk -factor data, in vitro Immu- adults, reflecting the direct nein HTLY411 lire 'not Tully under- nologic studies, and I-1TLV 111 rotropic effects of the virus and stood, tHAL More studies suggest antibody .assaNts as sufficient persistent Infectton of brain that tk�titl;ltitCllssi�on occurs trans - diagnostic criteria for pediatric tissue. Dementia and subacute plaIceniiidly or at birth; HTLV III AIDS, after excluding other rec- en.cepf�alopathy have ' been in- has l)tltifl isolated from the or- ognized immune deficiency syn- creasingly reported, not only to gars otic M -Week-old fetus after dromes. AIDS patients but also .in Iother- electiV0, ttbOrtion by'A scroposi- Tile medlar age at onset of wise asymptomatic risk -group Live W rix"Liguser, Viral a¢rtigens Symptoms in, oases linked to members. Parallel effects have were d(,tt:ct,ed;,at necropsy, In high-risk pa rits I's between been noted In pediatric cases. In thymiijg1fidsue' of an Infant born, fbUr and six months, icor I'ri- a prospective study, of 10 1n- byr CcsiltPtltty sec tion at: Weeks` ffin tlop S r sot� ants with AIDS r AIDS-related gesttti ILII to a Mother with AIDS. stilt blood xamsftrls onsath complex followed at Albert Gin- ane„ rclpfart has ,suggestod post- median Incubation period Is es- stein College ol'Medlcine, 4 13611- natal 1,11arlsmisaion, possibly Uinated to be eight months, sig- man and co-workers found pro- througli breast milk, in the case nificantly shorter than that for found CNE( deficits In virtually of an Ntxiat ( whose mother had ;adult transfusion cases. The all, They estimated a 90% preva- acqu,frad the virus ,from a„post- median _incubatlon period I'orall fence of symptomatic CNS in- partum blood transfusion,Addl- transfusion-associated ped,iatric volvement, with common clinical 1:icnal t4tUdi0s have Isolated cases Is calculated ;to be 14 findings ofdevelopmental delay, 1.1TLV-lklProm-' cell -free' breast manths. Compared with 30 loss of milestones, acquired milk cif'1�.�� healthy seropositive months l'oraduiltcases. Aside from microcephaly, cognitive defects, wa mo,n, uUt the t;liniral (mplIca� any documented major oppor- encephalopathy, and local motor tions 1100 not bi„en rally de- tunistic infractions, the clinical deficits, terrnlrlittf, course or infants with AIDS or Unfortunately, the natural' cis- The f'Mc of perinatal trans - related conditions Is marked by Leary at' I-ITLV•Ill infection In misslatll ilia appeared to be trarl- failure to thrive, persistent children remains to be defer- able, Wl(h dra'rnatic differences lymphadenopathy, chronic or mined, and, it is possible thak rcparLcd tixnbnt; studies; addl- ' recurrent oral c,Mandidlasis, per- more widespread yot subtle def doral ' I)rospective studies of ilstenL diarrhea, hepatospleno- lrits (such as development.W, 11(911.00k pregnant women are irmegaly, and chronic Interstitia( delay, forms of mental relarda- needed ttl define the_ri'k rxkore pneumonitis on chest x --ray, Sao- tion, behavioral abnorinallLies) clearly, I'lle rates of viral is-ans- Ler.isl Infections are common, may become evident In the long- mission from, mothers to Infants occasionally severe and life term follow-up of congenitally have rangedfrom zero to 100% threatening. In fact, grain-nega- Infected infants who may be in studies involving srnall num- Live bacterial sepsis %vas the clinically free ofAIDS Consider- hors of patients, A report from leading cause of death In one able controversy has existed Australla describes thrice Infants series of `affected Infants In about the social implications at' whose mothers were infecteO Florida. Palyclonal hypergamma- pediatric AIDS, with questions with I-IVIN—III through artificial globulinemia and depressed cell- raised about education, to ter insernination from an infected mediated immunity and T-cell care, and fear of transmission donor all Infants were healthy function are frequently encoun- in those medical settings;, The and scrnnegative more than a Lered. Chronic parotid swelling, Issue Is all the more important year after birth, in another re- Ito ,also been reported, to address, and the meed for ra- port, three Mr -siblings born In The inability to respond ap- tional discussi,yn all the more San Francisco to a mother who propriately to netivantigens, due urgent, given the possibility of was a prostitute and an IVDA to the lc,,ss of T-cell regulation of already widespread Inicction developed clinical AIDS two to B.cell function, leaves lol'ants among Congenitally Infected In. ` W months after birth (one in - with AIDS as vulnerable1o, slin- fan (s, A police that protects rant received multiple transfu- ti ar,ptktxi t t clic �Xil�Ifi 15a ta8cl 1;49 sfons in the neonatal period), developed AIDS-related complex `introduced a,selec The mast complete prospective' over a 1t7IIow-ug period avera - tion bial;l that study to datE 'introNO,s a group of ing ti0 rrrgnths after the firth of distorted the risk' of , women in Miami, each ol'wham the first affected child 'That d-ttat,a, fix was followed through subse- finding has :led some obs' bath' mothers and infant &, quent'pregnancies after having to warn, that observers' In 444 study from Italy lrtlllCit"fed already giver, birth to a child Pregnancy itself in as Idtter to Lancet), ll taI" 1 Indy; have adverse effects on la- infants barn to sero a tubo developed A1DS. G, g, Scott tent HTLV-III infec'tlon,Perhaps, lid"aitlVe and co-workers reported that 13 vrriothwrs wdre themselves t'out'zd of 20 infants subsequently through the known sxzPpressive r Uenti ba to be q born a to triose mothers we'resera-effects of Pregnancy on cell -,me- H'1'1V-In wi ho ven of the I11' g. has immunity, This lrnding hulzy r �, Pas!tive or, had clinical tindin s of been replicated else- AIDS Or AIDa r�,,Jated of HTLV--II1 infection several where. however. and Indeed the cotnlalLY' These results axe 1'\>�`n months aFaer birth, Additionally, special; characteristics of this MOW' 0Xtrerne than,y of 15 mothers who were well ti�oht', tai patient group, in'which all S�tattl`liotvever, tl. PnPultttltin When theindek eliilc was born, members had alreadyazid the methods are not; de. five developed AlDS and seven Produced set"Ibt d in detail, and one hope$ an infant will! AIDS, may have thrat Llrlboratton at this l]tlton• ' -----�"_ Much speculation has centered: on the origin, ` , Virus AV. When and where' did the it)`Yo oC gl��dltltlon groups sampled in pjjVCbi of s first appear'? Is It an entirety Hary entlt Rwanda ICCItyyE14 and remote areas of ea;tt or aloes It represent a recent lethal new ti ty, etre. H'l'I,,1�/,lil antibody 01-r1 Of a; preexisting virus'?' is It the result of ,an khth s y' � , i y Positivity izL sorrlt� i�f intersPecies transfer tai' an Infectious agent with any' � `�mCalcs has not been assoCftltGcl y c1lliliotal or laboratory evidenot> Cif' h animal to human'1 osul�lyrtsGion, unlike the card anlr>t71, !`ro n1 T efirstrnemberoCtheHTLV'1'arrtily,HTLV-I, risk grattpra !rt the Unftvd States. This eit,llYlr Is believed to be endemic to varying do frees nilly, su�;gc,9t a dlverger t natural history of"11,1. ` g 6 rection with,:the 14AMe virus cin perhaps it'ttl1. In arts of Africa, , p the Caribbean, the. South.'ca,tcls enderne (ri!'ttctlon In �11'rica vlrith a elr�yc+l eastern United States, South America, and related rionp'4thogcnicstraln,';. Japan, HTLV-1,whish in 1078 was implicated T},c ` air, y In T' -cell malignancies In humans, has ser"n rn bone(, of AIDS as a:,clinical entity found to he closely related to a retrovirus in c,enlral.A1'riCa, Slighily before oral the yaU�1'1.! called simian 'T-iymPhotropic virus type I time as t,n the Utllted States, sUI ISTLV-Il, which Is lound In certain Ofd World the view that In'A/rico, as elsewhere, a pat11171 monkeys in Africa, investigators genic form of I1lLV�IIi was only recently i11« either b postulate troduced, trepresents the Sim anvirus or that both viruses em In of In parallel with observations made e d the relatedness Or NTGV-1 and STLV-1. l aSim. !torn a common ancestor In Africa, and that HTLV-1 ryas disseminated throu rh comnrer- tan virus similar to C-l`1'1,W1I1 has 11een !dentia cial and slave tl adln r fled and named S`I"I,V-111; This virus has been 1, routes dating as !'ar roared to captive macaques in the United 'back as th�� sixteenth century, States, where t1 IS assr�elated with " r rhe to art of an AID&like Illness In centra! a >Ilnf4al P immune deficlency syndrome. and in healthy Africa and the I'Inding that stored Nl'rtr-an sera dating back to the early 19706 contained ty orc ertaA Ai'rican green monkeys, Cdi active- antibodfes to HTLV -111 ltd to similar h oth- ty of ccrlatrl West l�I'rtcarl human sera With eses about an African a ' elements Of'STLV-ill rals+ �. origin �d However, several researchers have Ire reported infection with the possibility at' a shared or very similar virus, P l+ecently, M, Essex and associates at Harvard high false positivity rates among Africans Identified What they )7elieve Is a new HTLV, tested far technique antibody, especially by the called I-fT1 V -IV, In 'blood samples of healthy ELISA terhnique !perhaps due to the coexis- tenoe ofpar•tsitie or other inl`ecdous diseases). Senegalese prostitutes, Serologic evidence sub Nevertheless, HTLV,I11 antibody confirmed b gests'that It may be'closer to STLV ill than to J' HTLV-ItI, 11 terestlrl;Iy, this virus does not. `. Western blot has been reported in more than derrYanstl•ate the characteristic cytolytic '` f+rap. , fa Pt) H ospaw Ptactace Juty: 15, 1986, ,._ Its►. tlr orcin taut finding will be There are 1,500 knrawn girths - forthcamsn ICAs, g' each year to women eon births, .in ) As mentiorlt (t stYro= Important questions remain, meithadone maintenance, pro- 1 1t1r<tiltalogla data soggest that therefore, ata the risk and sj,g,nift AS In New Yt�t'lc C<tor«Ilea ,art canoe of HTLV Ill transmission Scram, rrr New York, Orad try can-, HTI,V� k ri'ati�e estimate, 5,000 iinfants level'' ,ll at antibody prevalence In pregnancy and the perinatal may o ajose to 50% Its the earI period, A ;review, of eptdemiok ed women notintreatment . >,�tll'�a :with greater plevalence logic asl5ects of pedl AII)S.' In 801110, hlgh�risk s,ubgraups, In New York City raises furtherThose questions, As of Apr'ii � 1, 19t#5, that there may frs,wo 2 d su est 1av4�Ylriltl Intentionally 117 felt yt I IN'e.valence rate o°v a total 017,122 oases of Pediatric. en 20,000 ro P to 30«000 births to hi h-rsi isk t t3 IVDA8 Would still Imply AIDS had beefs reported In New g ro ul4+lily �'C),OUb dt-rlsk,pregnan.. York City. Meanwhile, there are the•,' firstnX edictkAa1ISe rnceies gigs, , an estimated 60,000 to 80,000 were Identified in, 1AID (These `AIS tllcatiort Of the trams- fenral;e IV drug users in the Near nalsrlgt► rates reported Irl the fork area, with the naa'ari of numbers do not include the ° sion� lsting vertical transmis- reproi3uctive age iltUdies would lead to an J tY additional high-risk population estltlttiLer t 6,000 Or more cases g (. I5 to' 4 j, of il'male sexual partners of mr�lc� (continged on Page 155) DLJ rus? erties of HTLV-III in vitro, and the patients stu.lied had no evidence of any AIDS -like dis- tr nsfcr of a Ientivirtls-like a Ont, as , These findings lend new support Indee.t be ominous. The fact i rUlls would �trrie that HTLt' III emerged to pp to the- STL`d-111'share cOmrnon elegy jj 141 t t. IlCLQ III and genetic oar TLVm aeon g Africa through that such, passage. if it occurr( Indicates i�app otic! g preexisting entitie9. relatively' recently, which su r r J 'T'he elucidation of both shared and divergent full trnpllcatians of such an: « sequences between HTLV•lII and thea events that the endy nonpathogenic HTLV -IV is nci�v under Only begun to be a t v10 editorial have 1v{�, ppierlated, A 16b cditarial This may help In the development of an by d' Seale in the Journal' aj'the lr yaj Sactc'. cine, ty Obledicind speculated effiective p: ed an san`Iq ctl" the pas. Theories suggesting cordes ai' intersl?e transfer aC.FITLV-TII ora ro � sable Implication een Inconclusive, The Precedent for the occurrence of such events is established and alarming, A hS vi sli nlflrant r�onsideration le t1lat the however. Viruses that are able to cross species AIDS virus Is spreading as a vir i , barriers are often quite virulent to the ne%v I� nLtrrlit opt• p demle throughout mankind dI'tt;r ct'nssing species while remaining harmless to the ori the siaecies barrier, probably tram tt green Inas hest. There is molecular blolo to the or monkey,, New1V 'recognized animal vll`uses that HTI•VIII may he more closely related to which have crossed to man In t years the lentivirus, or slow virus, subgroup of the and are bloodborne have caused only ihtn, retrovirus family than to ited HTLV-1 and 11, which bpiGicmtcs. The viruses of i.assa fever. &jar. are classified in the oncovirus subgroup, Len- urg disease, and fibula hernorrliap, levo* titi«iruses are known to causeprogressive,,, ��urmals}t infect rodents or monkeys Ill WIllch hilitating disecse In hoofed mammalsA na they« are quite harmless They kill (11 reeled the lentitNruses, H M�`.lit a � men so quickly, and the immune rt~spnrt r of appears to share the most, common sequences with visna virus. those who survive kills tine virus so MpIdly Which like HTLV-tll Is tropic far the CNS and atter a transient viremia, that they are in. causes a persistent, incurable, and Ultimatel capable ofsustalningan tpddemtc in man,fatal disease Y progressive of sheep marked b However, a new ,virus which produces a :ve persistent virus is known Arernia Cor life, and causes a slow neurologic deterioration. Visna. to persist Indefinitely in the blood of toll cted vinic encephalopathy after a mean incubation anlrnals, escaping immune surveillance period of mon years, would produce a sell Y through antigenic drift --not unlike ono or the sustainingapidemlc. Indeed, would produce It Mecilanisms postulated for HTLV.III, a lethal pandemic,," ora magnitude unparal. !ecles leleo In human history, Tills is what: theAID8 Ir HTt;V III to fact represents an 1'nters p virus Is now doing, . _.._ Hospital pfttire ,irine t5. It►se 151 ,AID(Prom �iaye 1t 5r) woman who continues to be 'at of AIDS or AIDb5-related complex the f oten taction, Irievertheiess, I i5,1<r (� " risk x�`ti7yl"7zSsio�a among children born to tiro p al Ask for both abusing m0thOrs o Nei g- mother and infant demands tli t StTilsa ' tit; beginning lot* tlge iv Yarlc rho t AIDS lti)1t1K3t�llc, t.ottct rtls 11ty se issues be" acldressed. In been ,t't#ihiiltl ixbcittt the pasil.ltlt* Icily noted, only 12 cases the absrnce cif an have been reported to date. Sev scree tests,. HTLV TItb tier Ly 01 dinotis4 trh,nsmission Ol'it. eral possible CactOrs may account body testing moat be part of Che ; sldc tl��+ i°ecogrtl✓Gra risk groups, ft" this apparent, discrepancy., a��z�ll clinical a Nepal t.j of, dlbr;rimtnatiat"1 ' in IS dedlatric AID' a cases may be Ideal l pprOach houSl#I(1,' t'knplvraent, and ac uncierrwpol'Cr:d; ;�) I-TTi✓V IIT- should h � t unseled bc,f Women the atiss t, tnrected women May bete fere. tl(rrvlc,$ against persons become pregnant. Th y witlx I'�C atte tG to the OrWil ti,le or ex erl,ence more fetal chtlose to avoidPregnancyey may vYIGIri;Tpreijd fears about CgxxCtlxi losses than do uninfected' they-dsi�s oft transmission are 101`1 , women,; 3) HTLV-III-IxlCeeted in- ttlarl casual ual con. All tMlal� Cants May die in `earl int' further defined or more send delnit ltaC'i'ry Kind Physiologic, t l deny, ltoWrlver,� 'SU floral before they can develop clinical g are available. the tt' AIDS:v ¢ � y ttve antigen, tests (' t-ITLVIII 1 p skht yston c TiTT_V�III-Infr~cted tti'i Infants may In fact exist in larger numbers 'Arith a range or clinical presentations, With011t being identified ascases `AIDS Ivtalp �*i y, da�+4 e pts ca6api 9rd1 dl i i cases crate- bj^ Ho;no exuai v or Bisexual }' erttcfal�tr.ansriiIsston'dai".5 S', r rtiat Wcur in'thls populatioi7 at'h as high a rate as that reported II In the literature. ,5amz or all of those tactors S i11(rawenouS y ma I be Involved. Drug Abuser ° however, preli�Minaty data �sug- <� ,+ i gest that at least factors 2 and 3 are not significant. l v e L t U1(y Whatever the risks and cot, I'ier'nophili 6 , tors for perinatal transmission Patient care 11nally determinedto be for Offierentgroups, atient p it is clear that the transmission at' Transtrssfdn H'T'I.V-ll.I in pregnancy may be Recipient (with effectively reduced through "eclu- out other �� cation. counseling+ and at least risk factors).r 4, ,. tcrrlporary postponement of pregnancy by high-risk women, .. Setore the CDC's recent rc(. rOm- Male Homosexual rndatibnsto ofrer IrrI,V-III or iliaeruaiand- " a antibody testing, to all risk -group IVDA, members. high"risk Women can templating pregnancy were one - I of the few groups 11rr which anti- � �- body testing %vas advised. No known ! As always, the meaning el'the Risk Factors 14TLV-111 antibody test needs to ----------- be interpreted in the context of the patient's risk I"actors and'p g ; clinical presentation, and the 10 20 30 40 50 60 70 60 00 100 psychosocial and medical issues A105 Cases raised by a positive l-ITLV-III an- European Caribbean tibody test in a fir$ {(scar. tliJ�Srusea ait, brYyketr riartrr l)African healthy preg- frit JJt) rrt es rte a ,l rtsk�,rnu/y rtecorrlltJ! J1J �ecr nant Woman are complex, alm- tX rrOrl lbriugh hlrrrcl! !r �{ S riyJ/i!nEar{Sin palfents trc t1` , , . b 1f15;-�blrrrr� rl Jt(l,y, t� orrtti,#�+ Grtrrr/xtrrr ilarly, a negative test needs to be � aunts, uul iruJJas, cr�nr rrt�+r/ rcq'r!� rYj1Jgl4j, 11JA; raf trllJheurt tJrtd i Interpreted caiutiousl tf�rur�hrayn ��uric�rats, Jt1 frrx"t, H;f;rt/'tfae r,trinht{rrrfierirrs,firlrl trrt kunrurla�+ y In a frratarx. (alta Of trIM) C:r�J0irirrwiw Y.'erltrti klAtltlt l.gw1`,+�, 1knot lnaptt d t�trlctrCt ,June ta,1086155 e in fact quite' difficult. No cases tentially Infectious: wastes of �Ln 11g)I"plIkt,Iy than for 14TLV-111, of AIDS have been reported AIDS patient; such pr�;cautions ` �t1W the'. similarity in modes among household contacts of are effective and easily adopted Of 't11' 1118Mlsslon 'between f4TLV-� t he close to 20,000 cases report in a household setting, 11I IMd hopatitis.JB, similar reo- ed to date (excludin g 'house=hold Health care woricers haves not tailli'1'iCltldallans hl4ve been deyel- contacts who fall into known emerged as a group'at increased tapofl,1tlt, protectI'n against expo- risk groups). risk of AIDS, although concerns stlTti Ili (ho workplace, Socause C, R. Friedland and associates have been Consistently raised . Of I316. 1t riser Infectivity of i-Ii'LV- at Montefiore recently examined about the possibility of work III, tDtlt+„h rt 4ornmendations have 101 household contacts of .39 place transmission, A number, neral t,/jIutight to provide a wide” AIDS patients to determine the of studies have investigated this ' iTt1?rg r bi' safety against � trans- rans risk of horizontal transmission risk issue. By late 1985, close to it'lis ltoit tar this virus, Recom� of virus in a household setting. 1,500 health care workers Kaci n)0ltrtllitltans center on the safe All contacts ,had lived in the been tested for HTLV -111 anti- 11MR11114f of blood and other° household with the Inde.,c pa- body." of whom 666 had; known ` hotly (11.46, avoidance' of skin: derit for at least three months. parenteral or mucou'smembrane , tr,tl'tt,111ue a.us membrane injuries; with a, median of 22 months of e,,vposure to patients with AMS and') reaper Idisinfection:' or con- close personal contact during or HTLV-III infection. Of a.11 the taxt7llitttod'equiprrtentr HTLV -111 Lie period from 18 months be- liealth care workers tested, 26 erialMtlilill sten from health care` fore the onset,of the patient's (1.1%) were seroposittve, but 28 wot^ltdr to patient has not been. symptoms until the time of of those belonged to, AIDS ,risk dootallontc d-, In this context; s,q', screening, The families were pre- .' ,groups, Epidemidogic data for well, the accepted precautiona dominantly low' income,, often tivo or the remaining three sero- fOl' 1.10tiatills B ,1have been ap., living In crowded ,'conditions- positives suggest that other risk ;, pi)'Gd, Ii:i the absence of Immune j More than 90% cif' contacts re- factors were not present. How- syNIC`I11 t,ttrnprotnise, asymptom• ported sharing; bathroom or ever, heterosexual transmission radii l� TIN -11i ini'e tion laas.,not' kitchen facilities with the judex cannot be,excluded in at least boon l'i`lt to Indicate that a patient: 80`;x, reported hugging one''of the two cases, nor are any beth()'1 t,atre worker 'should ' or kissing; on tl ., cheek: close to preexposure sera available to change employment, P� summary 50% Indicated sharing; cal' drink- help document scroeonversion. bl' the, recant. CDC rec:ommend,,1- ing; glasses: and a small number' Those cases have been desig- 00110 oh the prevention of,woeky reported shared use of personal nated as only "probable" occu- wlilt'r tr4`titsiltission will appear• hygiene items such as tooth- pational exposures, In it f00he:aming Installment. brushes, combs, and razors. There Is one documented cast - None of the household contacts of 1-ITLV4II transmissfun by 1"Weltao-dolracu outsltle developed AIDS, and only one of needle stick involving a nurse in V 00' t�rrri�'tlS�tttG�s 101 was seropositive for H.TL\r- Africa: pre- and postexposure : Ili on repeated testing, The one sera showed seroconversion ac- 01,itr31de (he United States, seropositive contact was a live- eomparrled by an acute febrile' Ail7;� t!twcr, have been reported year-old child whose mother had, illness with lymphadenopathy frorit More than 40 countries on, AIDS and who was thought ^� four to six weeks after the nce- flvtt 0011tinents. but differences have been infected perinatally dle-stick Injury. Vlore recently, a In 1`01orting; and surveillance Mince the child had shown signs letter to The New Cngtand erilffla pease problems for conn- ' of 1-ITLV-.111 in1'cctior since in- Jourrial of',Medtcme describes a parkin ol'the epid'emic's Course fancy, The authors conclu4 documented case orseroconver- In (111101-ent parts of the world. that >nonsexual household con- cion involving a temale Health Tht# 1110.4t t omprehensit,e data facts of persons with AIDS are worker who sustained a'needle- are avralluble for Europe, where nimum or no risk for horiy at nmf' stick in u Burin the resuscr- Injury during 17 ' countries have been cooperRat- rontaltransmission ol"inCeetian, `tationofanAIDS 'patient, Ing, with the World Health Or - Those important findings not- However, even If the '"prob_ ganizttittln Collaborating Centre withstanding~, a recant report able" cases are Included. the: on AIDS to provide uniform re. described a mother who became risk of transmission from a ports taiAICDS activity, rising the Inl`ected with 1-iTLV-111 from close needle stick or mucous mem- standard CDC c, tie degitaitlon. contact with blood and secre- brave exposure Ili health care 01' I,he: 1.220 European cases lions of her Infant child, who workers would be significantiV reported through, June t905 had contracted the virus less than 1%. Sy contrast, the 72;'[ were from France, West through a blood transfusion, risk of helmUtis D infection from Germany, the United [kingdom, 'Chat unusual occurrence under- a needle stick has been esti- and 0elg;luin, 'rho highest cu - scores the need for proper pre- mated at 6% to 30`x, or any- mulative"rates per million popu• cautions In dealing with tete po- wheri from 20 to 100 times latlbn c;aine front 'Switzerland,,` 1$6 ttoepliei Pmatice Jane 16, 086 to --mom, 7 & ok n r K#;i d da y, a n a � a hai'i i+lfl r IY x, -f r d 51114 �1'.rx"S. tk t x a 1 x Y4hdrf. Y, t mt 1 qn tltifYll F1�' 1 �.Ik�4r J+11 6RItJ tt aN'� 1 Y „ ii Senegal Dakar RN M r ziir "� i r m ,• m ,~ R , ,� "b„ ,fv[ ��'"� �, d !^€t 8gl r ' I�Y �+� 71 ,4f a jilh .A'�' v.v ,Wt`^ +I �,y'�'f J4�'✓ce ! ""i" ^I t (i' d1�W e c"�"'1T}If" f. N� Qs�Pay tatrcPri b ° yti1ra ha€"��d4veL xqM� " Rwanda asa h 1Ctwhak�k+th b "` -^ Burundi Y'" il�.� k ,y h t i�.drlii?Fc7 d �`i 1 Confirmed or SusPeCtcrf AIDS €� �-�-� Reported Seropositivity to HTLV -111 i HTLV -(Lr reported _ ,! be+,ry(t r to ry)/x�i)l . -oral 4,/rrrrl trr1 rrbrrut tite� rrrnre, ape tts Yt arra boil{Sr lrrcrr,€lttzer! etccar'hert�, !ltrrrr�5ilt , hresu7tln- ratlike clialrcctt t s t►t YclrrjNysr'tlrfe rlteinbc lualrlyen ,a/ cases lJur�j buea nR0j,lttulur R /Ntr7e ill S e:1%NritMe !Nair Iver rcyNlrterl /crtrcR, Lcrntbtrt, altd /trt•ultcla, ill. trrlcrrtirtll l()rf.centt re) its rt6 c'ylt,.r!!Y krl � ' S!J let�ils ru /xrrts of h"t�ttl•rr, tbrtr��b rtrt trrsc:ti r1 .1/l)S•rt�lutcrrl tllltess fl`rtln C�*lltrlil Wid srtspertrxrl cases rtj tlliS' xtt� )'r't been tdettttper! i'll that crttittt ^ to ''Mnzcatia anel !ltaYdlt[l!, .Semt�tt}rwlettc'e S'frrrffcs ittrli. , Nr�ttxjq.tlNtt;ettrc re�tivortra; rrrtttte�d Irl7l.b. ✓ � ri lrctr crtia cRtrtlrrr>tic !l!/G'Ltlu/7 147lb 117ZI=/// at scterct! a ,these ctsrttJt/J/c rr/`lierrllhl'.5'euesRrd�tse strb R: �, !{ ttiJs detected ill t'atllill7e'S, _h1joub'b (.(/tt`lt ill lb�e SN1tGe rtf• tatlltttllttstt)f. rte , /tit , tt auto'/Jh47idrle lte'tt' e7uea it) the ithyR!!r rJ/'!l7ZV//! taut ltirill/Jrrtt10 1t 0d in tbe� 1 r t/uptttetrl ufear c�jrcrfrva t'rtcGit,e, Dentnarlt, France, and Belgium tam�ared with More than 40 ca IGtltl�cru)ah in 13el�ium, close s n� to ger ' es hall i million � n 1 tan tile 75% of cases have ocCurred in in the United States, brUI(Ct, and the aver ll asp; a� Patients Of central jU'rican ort. he prctfllt: of the e�ltlsmie In tlity rate 1� 51; 4 gin). In all of diose Europe shatiVs strong simtlari� born y', Curopean. �e t eclntries, ties to that in the United Sttxt�s, patients tend to distribute the rates ware under 10 tar• mils p albeit on a redticeci sc lc. iVates, Into the ntnjorw risk groups ree• 11011 populatiorl at that Lillie, as �rGtrtttt7t i'or i� 10,6 old scat tai a% r�r. tiroiigh tile United Velativy States. pond- FiapitN r*tuntla €lung lu, lcJNG 1 ,97 I X era.nce of male.hamosexuals and much attention was+ bis much uaIs and a smaller pxopor- during the earl focused lest { same: Of the friclr{cnke ` b the y pert I o1 of tion of LDAs g p, F1I?.y,S among X�altlat`i ltirtil� ' Csee graPb on .epidemic, the.. case rate in 1984 i ti t page 15). By contrast, 8IN its European tilt a comznori lyit'i,1ge of was estirnateci at 59,7 per' mil - European cases occurring in tion �populatiora. "fixe first cases Nalti f'or, 1pCni�ons to t'tir C�lvt patients born in Africa or the of AIDS in ,Haiti were noted in 1i'tti'aixauscular fnj+wctlan.r qi' VI Caribbean have no known risk 1979, and antlbloticis fnf and review, of hospital 30-111t1s Cyn factor; that parallels whal.- is charts and a,ratopsy Arid biopsy t�pe(Ilflo Symptoms Tizesc ii'{jLe� Icnucvn about AIDS in Africa, records failed tea shote any cases es tit lit r11�t elkl'it r medical l�srhlClzi� which will be discussed in more occurring before 1878, That y .,piglArw s,' air o(Iti.n dleitfi.f epidemfologicstudies parallels the, findin ' In ;the lulf� In Stercd with ,'oristez°Ili, have confirmed the significant United +iet'�'NN rid syringes.) ' gretros State, where pec- entry of HTLV:IZI infection Erika five chart revletvr In IVeW York 1 1,f( an risk factors ilCitW Euro earl risk groups in a sim- City has wlthstanding, seroj�revaleni;a been' simflart unable tlar though delayed pattern corn- to dernonstt~atie an a cases occur-1(GV�lli kii" infection amortgr' lxfill- pared with that In the, United ring before 1 7$.y' he stalltin tlan.,4 In the United States 1,jau Slates. Seroprevalence 13t.k1 among Increase in. "AIDS incidence groups of gay men In Landon among Haitians fC°pnrtad as high as fry�,� Wf'Flc(i (though lower than who entered :the rose from 4 % to 5% in the 1980 United' States after 1979, d th to 195 period to 21 m to 34� In with tllitf, SC,i"h In other risk -group meal. berg) Is an order of rnagnitudt, pared those%'110 frr�tni rat- 1984, more rapid increases have ed earller, also suggests that the been noted among groups of HTLV -ill in rata. rltakll blood donarsher than tile � Fcrsthls gay' agent, tilos Introduced men in Denmark. Up to 80ti of into the two countries at about hernophill l'e µ Publica acs in different Euro- the same time. peon centers are ,reported to llnt;at omrnfic�nd thatserviHaitian t:ritt�'J s to the United Staten have been eXpased. Among The Initial desi s' �nation al'Iii�t- lV15As $S ti iverc reported sero, Barrs cont)'ntlt; to rel'rain from donat- Ing blood or I�Ipo�l. prtaducts as a separate ,F1,1DS� risft Positive ill Zurich In 1984. and group r g P wa, dropped In 1'J85 after a rapid increase from and that naltlan irrrmigrant cvarnOn be ecllizlsplcd 15% in increasing y g evidence suggested 191)7 to 75 in 1985 was Hated that known routes or trartsmfs- In ai�Qut the risk of JITLV•IlI tlanszrttsslon in riskof se:rfall surveys in Bart, Italy, Sian playa role In the spread 'of' Decent data, indicate that a disease t,i111t y, t'►1a Africa, pe- In this o tilton, rind nt rapid Intrreast, to in!'ec- review ol`cases s p p Port- p - seen in A st.ii trsls, that the AIDS at the7f; DS fj tion arnorr 'IVDAs may have oc - Prince In 191 8 and 19$4 Idents- carred tl�ldt rzilt,m�has Y y p attained . major ria Edinburgh as well, fled known risk factors In p� So►rte or these reports suggest 17rofaC)t'iluns (rt'taarts t�f central �!'rIC `I" �1l`tlrYuldes ex�Ist In proximately 401 (cases. Thir In the escalation tai`HTLV- siv percent of 'male the and surveil - itill'1 udata Ill patic s 111 InlecllorY amohg risk groups, admitted to biseualartivik r in achievement Ora critical density a�wteiarea (poetIng'. epiderm Ityrl .. art Iplt,lkhav but a society with a strong Cultural of infection permits rapid and bias against homose uaflt In Increasing a number e- prove file Cent . spread among the another Haition study, n y Population at risk. 11' than is the transmitted were et% e, or wl Cent t.zitttgazt alp t+�idespread ad HTI.,V"Ill Inibcdon d1seases dully ttase, educational and other eG nosed in 71% or SeL forks residence and disease. By the Carly 19806, clfnlcfans in to prevent transmission In an urban area kny,rvn for Els should perhaps be Intensified high amount orprostfiution EurolacGln capfk�ls began to see intra, f , numbersof' was In those areas where the rapid ;ilstisignll'icantlyas5ociated With acceleration, acceleration, has A1'creti'iilIg 7mb rel fe.rted iWr not yet ac- AIDS cases, Thus, , red—a strategy seal ttctivl» gy that has im- ty may account for a substantial investigation of an unez,plained immune dGfluiency portant implications far parts of proportion of Haltian cases, In the United States where current addition, blood transfusion has syttdromo resemblin r thp. report - cd cores OrAIDS tri he tirilted P prevalence remains law, been im ltcated fn a to 7 p 0� In North and South America. cases Skates, The Specific trppcyrkunts- , fic'Inii'actions differed of documented apportu, llle largest nurbers of cases ixisl:le inl'eCifons there. somewhat, gh Immunologic Studies outside the United States have More recent analysis Hal- been �s111ljasiin of .reported in Canada, i3raziL flan cases in the* (United States and Hal If. The epidemic in Cala- Cal coh rstrapidly, r�(il bath groups, Mrican-born has indicated that heterosexual ada has features similar to the contact, as well as possible atlenls Currentlyaccount for; 12% of ex- Eti,ropean#dia ncsr,d ctises 'ttiC European pattern. Scant epi- pasure to contaminated blood AIDS g demiofogfc data are available through the cultural practice of from 13=1h In Haiti, where injectianisrirt, tayrry explain at,gt, In 19t3ti, a particularly Fi ;rrs� fconlirnrea Oil Page 16aj l58 HasprBial p���� Jllne Lri, 1�J�1C 7 r, AIDS Vront•page;.1581 trify cases through retrospective hospital',records sive' Farm review, of of Xaposi sarcoma, , , I11 a S'R�l3rtttt repot, is have no , in an t�sstaeldtion between central Afr can and Eu predominantly affecting European malarial `tlntibodies and alnti- r,nales, was described Y ti in Zambla, along'wt h the rapid lntcrease n a"zlbn Kaposi sarcoma had ion bNen bode t1g 1n�It 1+ITL1/•,III� � the lirsk diagnosed t die nosed cases +� ti t^LIra1 pvpul&clan recognized strdce the earl A t1 in Africa In an en- 1980x, lends su Baste tl r^t11rt demtc, siowt :pport to than, art on t b , acid file second Pro ressive` form' view, Occurring In older men; a dis-Y The earlier occutrrerece of acuPe KiitY:1tt11UONeither, Patients ala seminal d form had ben mi ease In 'remote . uraV areas tion P P no ed hu lirrrl ah occasionally in ybun might' have. been missed. al- i owed signs of beon, C3tldlttonal. contended Irn�'11lLV ljklhress and ,renal transplants ckplenks. Ch�it�ncr�asins Y� Il'l''1;,,'� ill serapgsltivlty rake The view, � 6ecLra Zambian. cases were bili between rural and a mon Of3% p closer �'�e l "iii have heart reported to tris childhood d ;urban artaoKr R 11R±aikhy al�arigirjal Amar variant, areas would make at less likely' zoxlltlrY h(lattns in ' characterized by aggressive that suclr a disea " spread, multiorgan inp,alvernent, gone ;undetected in urban cera are itis rueas a e wvatrld have region 1�r1ir'wkc: ain r and a' fatal outcome, In nei h- Parasitic tic tllseases g tors t 1100rt jc, for a sigpifIcant timer k�oritag Rttranda the Incidence of The hypothesis of an African esophageal Purther study IS, t! It7 determtnfa whether thoac; candidiasis In the origin; of 14TLV ili leas litidings Y'e,Presettt the capital � city of Kigali Increased source of ongoing debate Sero- settitlfaIse.�rl`iftivtlatafl#rl"l,ilrlarid kir- dramatically in 1083, as did occurrence ofc tyl a parasttcmlaarad cir- the epiderniologiestudles have dem- culrikltl ►kn rypkococcal In onstrated HTLV-111 seropositive= angitis 1.n Kinshasa, I' wilek)it;� ltd dao there iune s lexescausal ,Zaire, begin- ty by ELISA In stared sera from tntertKCtltIII lh 1981, In 1982, a wask(ng as ynd o Car back as the early 1970s, syndrome marked diarrhea The estimak�:rl tl0h`'a tureen malarial In- feut(oY1 kine! 11TL'V tlI or a r la os aarovalence pl' rc c ked and severe weight loss, assOcl- 1ITLV-11I e:pCisure b r etre With lever, rash, aver:S EL1SA testing and oral candidiasis, teas first re Ions Qt+ In rtran Altllt7u� file 'IW po IrsipIons of Car centC recognized In southwest Ugan- centralAlxlca has recognizeded Crot g m er i.l populations of Ceti- kAfrican to b0fr Even with ed fr Western This entity; referred to local! 2% or 0% '• specific clear,�fric countries are un, as slim disease, shares entero Iirmatlon, tkte pathic features with In se- does 80erhI tO have�clipnicalisig cases of lected groups healthy sub AIDS Initially p P- - y 're orted in Zaire jects from ntCicklxlce rXtttOnr tlent4 Wltlt 'K'eCa�' Afrtcatl pa• ticn ltrtl Rwanda and Zaire and more recently in Tanzania, remains between 16%, and l et ospecnve related, Cd , POCOnnized AIDS 0 investigations y 15 have sung Recent! however, the mean- suggested that AIDS 't„, C`tit rther, f-ITLV-111 c*: I I I contact with prostitt�tes. Sero- seven female patients with AIDS, to Prevalence survey to pras� were lJons ,tt•}ig'ht predis ose ttl , UtMtes have shown HILV-111 group rprfo8titu42 1tes, Uwom a� with" p 111C. (�Asikiiit *mites of 54% and 8o% AIDS or AIDS relate + �t111ders, virus between , g tftlslal of $t Vttttl hI Kenyan and .Rwvandese pzns� 4�, �ctereptostituated complex 1 One researchot` iiftki Mutes, res I ctivel � + %Iggcgsted khat heterosexual tlltt�ll 3 }; tested In lr� orcourse might account (0, 1083-84. Additionally, the Ken- Unlike the sel'1'le al' the seeming eCllrnl yatl group showed a 5S� Preva- AIDS ease ratios crf 13 to 1�5 ll el 11(tetasextial trarlsniis(pli ill Ir3ce of genrrral.ized lannphade seen Ln the United States and Ala°llua'l�e geographic piltGerll t- apathy among the seYnpt,sltive Europe, klle African ratio has l�rOStltutes, Compared with 1.U% been de$cYibt~d as rIa ttl" All S In AlYica has been ,�itilkl lliilting 'serongavt s, will, 'sig- to,unity. Based on;limited eri- tt)tilallel ,the traditional laLtt.' ueh eloser ltrl'il 01'female circumcislakl lltltl i3 ,, p r i'311lGantiS rower I}l t fi$ ratios in ods of observation'in 1983 In !anital Mutilation, a tht> eroposiuve g oup, Ina case- Zaire pI'ar G It r, ttt3l°°Itrol stud�r o,f 58 African men Malo case ratios male-to-fe- G1111t often precludes vagi3ltil lliw tad com- 1 9;1 in iCirlshasa re 1,1 1 and tel With and,may be assrit�Jt t- With AIDS or 11DS-rel tial Wlth anal Intercourse i11t311 l It , N. � lautzeek anc1 associate S raspectivel},That would g ll4.l 0rosextta[ partners, Dpi`detlll ' III Orussels sound that African �bidirection. suggest fil I C data Have so far failecj to xtGGlents with AIDS were '8,1 ,would; the data on frequent'llets stil)j3Clrk thathypothesls, 1. tlirlas more likely than controls erose.xual contact among both I't7 slave had regular C, with male and female patients, The I4ltat'e orninousl , prostitutes-with a median nu j- report of two clusters pati of 'cases y ri may ilq Iltltisiblc that the African; ctallt' bel' cri' 3 ver,'is three regular among,a chain of heternsextlal ditArI lutlon merely derrjoll s4ctlal partners peYyear. respec. partners In Kinshasa lends;lilr 4.4VIrLts rapid bidirecticfnal trat'ltfw LiuCWly. Ancttherstudy in Rwanda ther support dt711lslt�tl of"virus in a populatioll Indicated that 76�, of � male a- Pport to this claim, whtae �ini'ectlon has reached tl p The iiaquen coe:tistencc; of ec+1"ttllfi'Grltical point;"in kha prt±4,I� tiarlGr3 reported frequent attd re r. r. ulilr' hckerostwa ural cantaets wll l! At'rtcalnyl nd Flails atdl diseases in c llrttu ryl` potential cofactors thi>l. diJturent partners, lncludllj f espec l'rlay facilitate the s read o1'd13. Prostitutes in 65°G; thtr a al lesionsr lnllammat ry cnndi� 7 p rl, that g Fast.° Inr"e lleteroseual trarls �"------� ----_ _.._ itliKslc111 Is :already 'known Gtr `" '--~-------- pat tir In the United States, we Seleeted Reading Call"Nct that Iriereasing num. dalfc 1W LA ah She ac»quirt d rrnMunadr:ficicnt" 'At bars Of itmales will become In. lrarnosexual, wrote. Ann Intern felt- �". rtdromc In a r ohort of l'ectach ' If ferrlale-to-male tr itysw d tU3:2117, 19fx6 cn14l100H occurs at:all hart (and Lr nint The In(( rrrurtunird"ienr}r .Yndrome in_ perspr7s tvllh ht�mophtha" Ann ;intent &lt tl I U3, 72 3, l t lll'"O Is evidence Ll-I t it (and yn11cd mann et ai: 7"ransltrxion rtssocfated °u ulrrd Immt,� Lhe'ri,? ltl syndrbmt in the United S1,,tas. IAMA 25 }:2913; 1955 ill les t1 be onough in. s q nnderic►enry frtltiwd f"eillales to allow for mart; AhiA Council ora St tent111t :Arlalr'S: Status report oil tits acquired irrtmu„ e lctl;tlVe bidfrcctlonal spread, I nodaiirtencyrSyndrome., Htrlttan r»cell I � �l'ht+ li'nplications of' tills fol' JAL)4A 254.13.12. 1985 } mphotrople "rus type Ili testing, fur th(".1. fleterosaxual grYd vertiw ICrtstal Atl The rmpart ui the 4V(juirrd rmtnunodelicienr.r syndrome nrt Cal'tu�se�IriS10'jfCiin this countl)f Patterns Of prcmaturcdeain ur NOW York L"ily.J�lhigl 255,k3pti, t9 FJ � g ghiig1lI the iictt r aden al trans sot,lat, ul human T lyinphorrople t11-us type illi educational intervcri va ° IJ"mpirsdt:nopathti-allot+raCtd �•inrs. MMtVie ^ _ : � . r Ttec'd foC't;l'I"t,ctiva prevhritiva and J 1 5V1. lass additlonal population groupslbe- Arttmann AJ 1'ht: acqutrcti rrtnnuiiodcllr;lertey syndrome In Infants artd co,ttla c,;,1 children. Ann intern Med 103 734, 19135 used, C? A vigorous and Friedland GIi et ai. track .d transmission of [iTl, :-CIidI.AG' infcct[on to Will have well-1to be devil c effort household>Contacts of PaW rtts with AIDS rtrAIDS related conipley with mlC venL! In a Oral candidiasts,,V Engjj N1tFd 3L14.344, 1986 "I10 that addresses body the Brune( JRAnrelle AA:'I'ht uttornatlonal ocvurrence rel dhr, acquired iht• health munodcrfclentY SYndrornt ;1mt Intcrrt +tiled 1t7�.fi7 , jt,d5 Lull th elisions of a true public emergency and protects 1311 r;trr fiJ: hcA3i�S plrolak Itt to Afrfca. Laifcct I :7f7, 19titi vulr3crable individuals tl i Beetle J; AIDS xtna gainst .� rrylet�ifk,n Prognosis ural transintssloh, J 1 unwarranted dlscritninatia�, +vied 75;613, 1955 2o�rril . Sor 'MIG d1C - arnativas may be either Scott OB et a1: Riarircrs of ninnts with (ltc acquired unntuhoricllcit nt an IrnCl'laClctd epidemic cXtolid svridronie: Evidence for lr ttr ,3,fjjplornatic ;tnrl ats3 tnpirinyaitic carriers, Population ing further" Into tilt= general JAhIA '253:,'363, 1985 p l ulation or art oppresslyq ibrrn of l. ndnt' ul parallt'led In recent medical history, ' i Ci4 Hospital Pr"acdct .;tont• ! 1"}ltrij � I BUTTE Cq�INTS.► PLANNING COMMISSION BARING Notice is hereb "�. hearinggiuen by the Butte Count Planning* s will be held on Wednesday,y t.ommiss;�al1 'i.h�tt pttblia Board of Supervisors' Roam, CountJuly 23, 1986, in the 81.tt'f Drive] Orovillea California y Administration Centers 25 0ounty times: , regardarlg the follaWin fi0Lt#1ty center g items at 'L�tc f�allawing ILT91 ON MRICII A MITIGA'.CED NEGATIVE DEC t�tlfttl'10'I°� EAbITG CNV_ ONMEN'rAL IMPACT LTA§j BEE 1:30 p.m. Barbarz' C.; � 8ioneo a Use Fexmi.t to allow an addit�, )nt l dw ' in as an LT j`U sicrn' of a pre-existing hon-coiai ormi>n zoned C7 ;Uncl,a6sified) lonattd o , 1 S ttsC an p> oper'y Road,' at�pioxinaate the soo.th side t x 1��'►.�'11boldt as AP#60-15J-03 �y miles east of ,Butte Ateadowq, c t txt f c d Butte Meadows. Jobn G. Copeland Use Permit to allow ''tile ex a pre -e, istin9 non --conforming use to allow an asci ! L;�r S9k unit on ,property zoned L` (iJnelas'to all) �.�rnsl dwelling side of Iiuxnboldt Roady located' 0j'1 1te south as AP#60-1,5_0 ' /4 mile West of Jonesville, ,I,�iexytified Butte,'Meadows area. ITEM DN WHICH NEGATIVE REGARDINGECLAFATCN Ol tMNTAL IMPACT CTAS BEEN wr For $ Inuestmants Variance to minimum lot' size: f:Cy fit' 9.99, 9.97 and 9.,95 acre �aow ' y parcels on property ,ones .- (Agricultural, 10 acre parcels), located a :LC feet east of Highway 99 0 PProxihiatol St�0 H ghtaaY, ideretif ed as AP��47 10-420, .Qnnrthsection Cana Rene' Vercruylssen Use Permit to allow a 7 ground gasoline storage tanl�, on P _0'0 000 ga:t•1et� above Industrial) sideeof thened M-2 , located on the `west y za (�-loavy of Brute Creek, identified as of Just north AP#40�-02-141,, Chico'. ITEM DETERMINED TO BE T FRDPI�THE FNVIROMIENTAL_ 1•lEVl: a .rt.W CATEGORICALLYE.XEMP . Carey Hedlsnd Use Permit to allow a mobile home orary second dwellingon y , Mpw property z,anerl A-5 as a; tG 5 sate paraelsj, located on the east side of Turner taltane approximately 2300 feet south of Burdick Road, identified AP#39-24=23, Durham, ed as Vita Quatraro &James Tuttle in a re- Use Permit to allow •the change Office +ase on Pro non -conforming rye from retail sales t property zoned U Unclassified o all northwest .earner of the Esplanade and Lassen Avenue loceaed on the as AP��O6-35-24„ Chico, t 41 Identified, l j: HECt-H-r DIAMGOND & GREENF1,Et,Lb a�kRVY'N L, YNECHT 000-iCR JON OIAMONO A LAW CORPORATION I40NA4G S, OR.EENPIELO 95415 fiUN SET. BOULEVARD , - TELEPHONE: IPA I�Y:PACkFI a 3KtN Al.i$ADE$ CALI4•ORNIA 50272-:g564�. f, 131 4S«t-OQaI ti,.1»I-I L» aTE;q HORN, J,R, 1t.*1 870-4pa(l... rlDNALD k,. SAL.TZMAN TE4EX US-:]9+1 ,ARO wars 10 ANSWCq�FlGIt H03 x+0.1'0 140WIRM aY fiMF 1?[ t CaMPUTER MA14130,, VIAI1'uIRCE W AUl August 7, 1§86 4:?traillQpUr� Bettye .Kircher, Di rector Of Planning 7 County Center Drive OrOviller CA 55965-3397 Vie. Fr-�ntasyland, 282T Esplanade, Chico, CA 00ar Ms- Kircher: I have a copy of yz,UIr ,ful,Y 24, 1986 r letter to Mr. Jarl Posner advisingriim that ths' Planning Commission will meet . 986 to consider h4 reciuest for an extension Pursuant on August 13 l rovisions of Butte County Code Section 24-36x.4 want to the Four letter was not directly respon1986 to You. sive to mit letter of July l5, Mr, Posner will be out of the country on August 13 scheduled to leave on August 11, 19$6. n 1986. He ie until some time after August 27, x986. He will not be available I have reviewed 2436.4 of the Butte Count that it authorizes th Commission to requestoth information believe call You seed: in Your letter of Jul 24 Yr You request tax returns. As' 8pecii« confidential. Their disclosure cannotube compewr tax returns are ordinance does, not authorize the production ok tax records.,he You also mention a CPA audit. CPA auditsare very expensive. Moreover, there is not sufficient tu audit. ne to arrange for such an We,believe that it is self evident that requiringt to shutdown On November 26, 1.986 would cause it to suf he Fantaayland c ial hardship. fer a fna�.7- mage 2 8/7/86 Letter Cont d. To: Ms. B. Kircher Re Fantasyland We also believe that it was improper for the ,Butte County Hoard of 8upervisors by resolution to limit the authority o,i the Planning COMMission to grant extensions for no more than 90�i�vs. The 3 uC:te County Code, ;Section 24-X36.4, does not contaip such a, restriction. If the Board had wanted to impose such restriction, which we 'believe would be unconstatut,tollal an any rventf at a minimum,T the Board would have to adopt an ordinance amending Section 24-36.4. In any event, this is to advise you that we cannot submit the tax rotUrns or the audit requested by yc u. Moreover, Since Mr. Posner will be out of the country, he will not be able to a pear on August 13, 1986. Mr. Posner was prepared to file a federal, civil. ri -#C:a lawsuit against Butte County as I described in my letter of %7uly 15r 1986 to you. He has been successful in other jurisdictions. W-wertheless, Mr. Posner is willing to settle his differences with twine County, If you will gave ixam until the end of January 1987 ' (:Less than 90 days)', he will give up his right to 800k any further extensions and will, agree to shutdown at that time and' never re- turn to Butte County. Please lei: me know whether the Commission,' is willing to grant such an extension. Upon the granting of such an extension to the end of January 1987, Mr. Posner will shutdown the Fantasyland and nover return to Butte County, It would be a financial hardship for him to shutdown .the, Fantasyland on November -26, 1986. Please :let me have your response as soon as possible. Sincerely, HECHT, 'DIAMOND _� GREENFIELD ROGER N DZAMUND O' RJ'n: jb ''Call Jack Posner IIIIIYINII®are-rrr.r�-=--- ,f Iw i Y i HECHT, DIAMOND REENFIELO MEIRVYN L, HECHT„ '. - A LAW. CORPORATION 'ROGCR JON OIAMONp.. 1541S SUNSET" BOULEVARD TFLEfrHON'tt RONALD S, GREENFMLO :PACIFIC PALISADES, CALiF`ORNIA !3l'�:272-$58+1 'imq) I'1S•F'OS21 IRA D. RISK.IN (P.13) h1'Y47.46.410 H. CHESTER HORN..I.JF1. - 1kLPX' UC1•: 1OJ43f3240 nONALO L, SALTZMAN h4 TA: K, I10011M PAPA'. HOwA RD MESS �`\JMPI<IT!".{4.,Ir1AtLBO.X TEUE REIN riga g.VAC r, OR `rMt- ,EMA4L Nos Co. pla" nri OINM 4 J U L I July 15, "'1sm9il�A ie Bettye Kircher, Director of Planning 7 'County Center DriLve Proviller CA 95955--3397 Re: 'antasland, .41,829sAlanade; Chicon CA Dear M5. Kircher: T trust" you have: already received my letter ofJUTy 9 r l986� regarw: `ng my, in<4biiity to attend the J?lanni n! C1;cssiar: 1et�ing scheduled for July 23, ,1986. As I indicated in rkiy 't.e.ttery � will be in Tor(into oil July 230 With, respect to the request for extensionr it wag my underptaf1di:ng that under Planning 'Commission vm,s no with respect to ordinance h to theamounto.f time it t limited �u1.d grant an applicant. I have just been informed, however, -that the BoArd of Supervisors passed an ordinance or resolution limiting the planningCommis- sion's authority tee 90 clays. My belief is based �► r 11 a recent n�+wspz,per artiF.�l:e. Y w�iuld like you 'to con.firM 'ohis and L-o also send me, a copy of whatever resolution or ordinahap, -the Board of Supervisors adopted dealing with than subject a,f' extensions.` Fant.asyl,and was planning to ask for a longer ext onsion'. Alsoe there is recent decision of the United States District Court for the Western Distri.ait of Missouri in People Tarr x104 v. Jackson County_ JGe i.slature, Nca.�s5-0028-CV--1+1-,9 (June 13; j1986) holding that Cit of Renton v. Playtime Theaters, Inc, Io d6es not ap1 to g As you know,., Mr. Posner 01011ld file a Y exxstin busness�si . federal civil rights lawsuit in the United SLalLss District Court for the Eastern )District of California seeking to enjoin enforce. raent of the Butte County Ordinance4 He has already filed 6 similar lawsuit in the same court against the City ' of Fresno and was successful in obtaining a preliminary injunction restraining a Fresno ordinance, which also purported to require existing adult businesses to relocate. page 2 7/15/8 Letter Co!'d- To: B . jri,'rCshor CA Re: Fantasylandr 2827 Esplanader Chicon We feel that any limitation placed upone Pl iii [J1 at.OMhession by the Board ,of Supervisors st,rengtnens our g ordinance is unconstitutional IS Notwrithstanding ,the 'foregoingr Fantas hand` woi �' .ii e to piav,Snn n yt IP the its differezAces, �g t Fa tasuland onee90fdayltawgl hin ion# Va tasy- Commission would grant Fan y land would, agree to close forever, not reln+atntte Crauntyr and not seek federal court intervention• Butte County s agr 0 (-0 granting Please let me know whether F`antas laz d one 90 day extension in exchange ' I,.LM agreement to shutdown at the end of the 90 day period and exchange for its agro ment- not to relocate and net to seek �:edrOM€� 'A;n tha federal courts. extension to a�rA7i� A financial. hard-- F'antasyland requires a 90 dal tare its . Vogt tent and make a ship. It believes that it can recap reasonable return on its investent if i . tsat l.)',Mt tod tth�;eb�*st during the holiday ,season,, which season for retail businessese bloc in any Please let me have your rsponsekestheo�uly 23s nootYi.ng and WoUld events we Vrill. not be able respectfully request that the matter be postl�, nod dortwtloeast one month. This will also give Butte County an opr?orrbuftity consider this proposal, Thank you for: your courtesy and cooperation si acerb. Y, HECHT, b�,i��t0'i!�F;� � GREENVI914D RCG— ER w7N DIKA0NI) RJL): j b cc: Jack Posner HECHT, D'1AMOhlD & GREC N,FIELto MZAVYN`L. HECHT .. A LAW OORPOF;ATION T'ELMPHONIEE1 R.00--ER JON DIAMOND SUNSET 15GOULEVAR'b I. � i'. ^E I9 ^y,w✓r7.F,�>':i �4�15 RONALD S. (3REENFIEL0 PACIFIC PALISAOMSI CALIFORNIA 90272 i71�I E31'q)»`�'✓��� H'.-CiHESTER. HOFRN, JR....:.. TK ..Y.t U5-VIOS h;3G 940 ,40',VARD. MOSS - A(� 4 St3UACISt HOO IP14 PAPA STEVEN REIN UOMPLITrm mAILPDX ARA D. Fit-WIN VIA �AOUF'::CG 0I4. "N�.LI' MAIL CONALb L. SALTZMAN wis vs.'orll ing Com, JUS 16 Ib June 1.2, 1986 ti . rdswtlrfia7+ R. A. Ki.rchet, Director of Planning 7 County Center Driye oroVille, California 9596,5 Red Pantasyl.and, 2827 Esplanade, Chico, CA. Dear Ms. Kirchfar. on November 28, :1983 you wrote to my clients adViGing them that they had to cease operating their adult entertainment busihe ej ,at 2827 Esplanade because the business did not meet the requirements of Butte County Code Section 24-36.2, You advisod them, that they had to shut down by november 28, 1986. You also indicated in the letter that an additional period of; time could be granted by the Planning Commission pursunt to Code Section 24-36.4. Accordingly, pursuant 'to that Section request is hereby made thzit the Planning Commission extend the time for the Pantasyland business to continue operating as an adult business, An extension is necessary in order to prevent; undue financial hard-ship Please let me know what is necessary for the perfection of this request for an extension. What procedures do you provide? Ts j these a hearing? Do you want evidence? In addition, please let me know .what.- can.. be none to the Eantary- land bookstore and arcade to render it a tion-adult business within file meaning of your code. As you know, there are, a, substant:ia number of video rental outlets in Butte County that apparently are not considered to be adult businesses notwithstanding''the 'fact that they carry a number of adult video tapes. Please let us 1,mow that percentage of merchandise of a non-adult nature can be in' tro- duced to the, location to render it s non-adult business within the meaning of your code. i ,mow r t ' Sec. 24-36.4..Araortizati€ n. All adult entertaiurn t, businesses and/or activities which k�u« come subject to therracrisiotts of this chapter, and, which do tint ` melt, the 'locatinna re zements of this ';chapter, shall oez se y operation Y,�ithixz Chace (3) years t'ollowing receipt of a'written s notice froth t he plasni3ir�9 ctxtnt iissioh to the owner of the { ;prcnlu,� ea, provided that such activities may be alaad to continue tot, - • ..- an, additional aaeriod upon, th ;iratat ng of an exception,'.bY �c I Planning cananttsrr�n upon tlae finding t}arit the activity is oi►ii gated by virtue of a writf6o ?ease entered into Wore the efrentivo dat® of this chapter, .for a period exceeding three �3) years froth such effective date of this chapter, or that the,activi6yl iz>valve itivesttnent ofrno�iey ia„ loasehold or improveinents, of such suti that a longor p xiod is, n.e0l to rt prevent undue fnaucialhardship� tfrd, �o, "92�Y � -, �', �.2�7�82)' Sec. 24-3`7 Nonconforming Uses ar P f §24-37.1 Pur pose and Intent ` ` r «� t. Existing uses, structures and buildings, and fats ar Parcels which do not conformto the regul,atians of the, Zane in which they are located shall be subject to these spur ifi•c r s"egtilatians,. It is the purpose of this Article' to establish procedures to permit the ' continued operation of such uses where such uses are appropriate while elimiri; t tat nonconforminguses through abandonment, � ,obsolescence or destruction. f , r §24-37.2 Types of IJonconforming Uses Defined As used in this chapter, thetermnonconforminguses includes several types of nonconformities. Seeral di , distinct types of nonaonforr�ities can be distinguished from one another. These inciuder (a)'Nonconforming build - g ing, that situation which Occurs When � building nber�usetofesizes B � conform to the :one regulations heghi.locati ono i.als maters Or proximity to other buildings; and I (b) Nonconforming use of a building that situation a which occurs when the I I use of a building or structure does not conform although the building or structure I# { and does; r (c) Nonconforming uses of land that,situatio'n where the use of the land regardless � i Of an buildings arstruCt.txr .does ,�t�ot ca Y es nform and �p, �y,y� ,�yyrr ��qq pp++�� y�gy7��q� p try �p�i}�T 'p�'{;��V�p +04, .tA.YW lI �M✓&1iG 1IIw . Vi rJ1'9 YStxb�.I'`j : R�Igp0�� Atlr���. Gg� nW W1 0.,I .U.�IA1d�A�NJ.R FY Ai�ll PROC See. 24-20. NszQcare azzRd� Puse of, xbazizit (a) This chapter divides thef� Wunt into uniinGq��pQi�lit(fti taxritoz7 of'the 3" �eeraphieal districts 4N ldesig,,tito(itrios. Itestabl g7e nifg di s nsmitilIg t1l # +� ta�ti of land and structures, location, eight and bulli of tlZb t c open i�rttc spaces �ure�, the about buildings and provide utxh other, ia7P.he sorsa as ill ac amplish the purpose �f tl #o s�;9 s1 r` twklt ter. „ (b) This chapter Is adopted to promot-0 iind protect the pUblie health, safety, aIi[1 r b gefzoral w!eliur'.bl� the folowrin snore particularly specified purpbss: `w (1) To assist; in providing a definite li�il't t► �do velapnient for the Coon+` ' fi and, to facilitate, o,ibc�tri� ji �- go, guid6,� obn. trot and rogulate the future g± ,,o�vi;lx' of thi eoiznt3*, (2) To protect the character, socia.,i(i biA of agricultural, residentiatl, coniurz�ti1 iryx { tiustriei1i�rid other areas withixt the county; to taoiltYrti i<bo ustri and beneficial development l of such arois - n1�c1i t tars puartaC tM' lariY', to provide adequate light sin d i�;C:k"l ,TT to $A'void unduo concentration of Population,, to facilitat"a Lite adgqurfe provision for transportation, ' wator facilities, schools, parks and other ' s(eW'ttge' drainaga' d to COilserVE a17�i d8�re10 pl �?� ( E!�y lopYTIents, the Food su 1 p natural rti�tu�(�s; to protobe Pp Ye o cbnserVe . i ropeiir 'V&'siUeq; to con - serve energy; and to promote et'ioib,wit and tirlltan deaf design al. a agement, .and to secure ecoxlA�y�Y :in gov�c11 i; nzenttal expenditures.' f �f I { r ,.. T 1 i l) To obvitxte the raamenace to the public safet from the loaatiora: of buildings, and see of bit ldjj" �iting Of land, adjacent to and streets a:nd hi iaways wialalt Area pant of the an streets d lraghagays element of tl1Rjjr ecieral K' plan of the ,countY, nr other tlroraughfar. , o 6C0 that ' way rtvgall lie faclxtai IFt�raffao cir•culatioan on tlntd high., (t!) it is expressly declared that all of the provlsi ilia of this chapter ah�ail apply to ail p 7operty with fire unlra tern ory uy � Butte, Count Whether o'Wiied v1 �rl`P011ted firma [nr7 cor�raraiinras x kariV6to llerearl or ley, the government of tllr,� � 1 Mates of America, nr° ariy aT its agencies, or I1'ttrted Craiifornl;w or any of its Political subdivisions or of E t by any county inoludin a(3h1t Jed, or ° tite Pal ebzparution or any afz's ax'tlrer`tra eracies town K1r�''rrllXilici- ; farmed under the Iii�FS of alaetate of California, by alarliatr`iet ti pp a (d) Tlae board of supetvisora shall have the autllor�lt t 6; s decide any questinrr invalyln the interpretation or o Y Of any provision n.€ this ebapter. Sold provisiarra oft g1y1� 10ation and the application;a thereof shall lee held to hlfi Outy Met 1 retluix}emen necessary to pronaote the public she l�lixrilr'turn 4� and ,general Welfare, Except as ?� altkl, Mafoty � p Specifically herein it is not intended ?�y� this chapter to repeal, plf�l{ledw ox° it any way to impair or int p ' 1tat0, annul P of late or Ordinance, or any rule, re�ulatin any exist iaag ptsovial4u d n adopted or issued or which rise rr or permit lit,,IoU to law relating to the use of building adopted promises,a81y, d' �t'� to the erection, cor�at •uctfon establishment moving of eiirti r ` g • ' • a, alttl l 4Gf or enlargemen�, of any buxIdrrr xrup� vemenb, not is 3t t z'rtlr tirr �� ea this 'chapter to interfere with or abrogate or tltofld�fl �g ilial twr eesarnerlt, covenant, or nth aween atr p annul or abrnt ate the public imprn ententstemplaced parties or t�u III for b l 3 pr opex ty avrller, pursuant to previously aril Pftlxi_ pans pr`avided • , y adoptedllllty irnpbses a greater re tr'r'ctiaraAupa the erection tf this rxt alt h r»sr, establishment, inovin alteration or cralnz gement o chap or fire use of any such building or r f buildhign i7 dietricta, or any of them, than'ng p errriees in sair tevt►i" i <! axiatin .s imposed car r44ulired b s g provisions bf law or ordinance, or b Y slio ; l y such Vides, o y1y'W ]at' ar• permits, or by such easements ) covenaiA6 or ,3 ments, than in Buell case the provi ions of this ha ter co r anfr nl. (Ord, No. 1754, § 1, F1�3 ." 4� P Ba )oil k Sec. 24.21. Definitions, ,! Vnjess the contest clearly requires to the contr,.ry the doff. nitions of terms provided in thisf tion within Articles 11 and III of section chaptsar govern corxiAM. -1 MEMOa