R. Adamoli, A. Durante, D. Hagl, F. Rossi, V. Giannelli
(Poiesis Centre of Exodus Group)
(Presented at the "10th National AIDS and Related Syndromes Convention", 1996
Abs P. 176

Objective:
To examine the presence of documentation in literature which certifies the use of unconventional therapies (UT) for HIV and AIDS; of references concerning freedom of therapeutical choice of persons who live with HIV and AIDS (PlwHA); of ethics and deontological references concerning the possibility and the need that citizens' choices may guide and influence Health Institutions' (HI) choices. Further, to identify factors limiting an adequate intervention on the UT matter.

Method:
Bibliographic research on literature.

Results:
a) International researches [1,2] document the use of unconventional therapies (otherwise called: alternative, traditional, complementary; terms often used as synonyms [3]).

Some researches [4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15] in particular showed that 34-76% (according to studies and nations where they have been conducted) of PlwHA use unconventional therapies. The XI International Conference on AIDS which is only just ended in Vancouver underscored the phenomenon's relevance [16] and the Community Forum which took place at the same time has expressly turned an invocation [17] for a greater commitment also with respect to UT experimentation and availability.

b) In Italy, despite the great delay to give attention to this phenomenon, first pilot researches indicate that 26-52% (according to different studies [18, 19, 20, 21]) of PlwHA use UT for HIV and AIDS.

c) Our constitutional doctrine has evolved from a generic affirmation of health as an event protected by the State, to a positive recognition of health as a citizen's right to make personal choices [22, 23]. National [24] and International [25, 26] medical deontological and ethical codes on biomedical research [27, 28, 29] forecast and protect the therapeutic freedom of choice. The Ottawa Chart [30] underscores the interactive and bidirectional relationship between Health Institution and citizen, recognizing them the right to steer health services and to participate in the choice of priorities. In the Paris Declaration [31, 42] delegates of as many countries are committed to "start national policies with the purpose of fully involving community based and non governmental organizations, as well as persons who live with HIV and AIDS, in the formulation and implementation of public policies".

d) From epidemiological researches on UT an interest and a request for intervention towards institutions and Health Authorities [32] arise clearly. Some studies [33] show a higher education level of persons who use UT; this circumstance is due to the fact that the choice to use UT is not based on a particular irrational thrust or a greater trick facility. Persons who use UT declare [34] to gain benefits from these treatments. HIV infection is a specific factor [35] which causes the use of UT and, as such, it should be properly analyzed.

e) Some researches [36] showed the enormous costs (sometimes prohibitive) PlwHA who use UT have to support; the entity of costs sometimes appears incomprehensible. Here a double control of quality, quality and prices problem emerges as well as the need of intervention with the purpose to support costs by the National Health System.

f) According to some studies, 30-80% of persons who use those therapies don't inform their practitioner [37] about this choice. A research [38] presented at the XI ICA based on the results obtained assumes a relation between lack of communication with practitioner and practitioner's availability to confrontation. Only a minority of patients gets information about these therapies from the practitioner, while the majority (over 50% according to all studies) get it through publications, friends and other seropositive persons [39]. Also, from some researches [40] an insufficiency of information on UT emerges.

Besides representing a risk for persons, this circumstances end up compromising the practitioner-patient relation also as well as the compliance and therapeutic alliance needed which is of main importance for every cure's relation.

g) There is a problem of training and professional updating [41] among UT practitioners and it is urgent and important to intervene as soon as possible in order to qualify competencies and to formalize paths (provided professional registers or else).

h) Another problem is represented by prison. Internationally [42] same rights are recognized to PlwHA in prison and those who are not; but difficulties to access UT for PlwHA in prison are greater compared with others [43, 44, 45, 46].

i) For some UT there are in vitro data available [47, 48, 49] which underscore preliminary activity against HIV. For some of these UT, in vitro results are backed up by clinical studies [50] on PlwHA.

j) Persons use UT against opportunistic infections (OI) and to improve their own quality of life also. Some UT have shown to be useful against OI [51, 52, 53, 54] or to improve quality of life.

k) Several reasons make complicate or obstacle a more spread clinical research on UT. Among those, little funds designated to research; the gap between business entity and clinical research costs; lack of interests by official medicine. Further, we have to add objective difficulties in working for example with phytocomplexes (rather than with single molecules) and to match with synergistic effects, etc…[55]. In consideration of the current use of many traditional medicines (which, according to WHO, in case they would have shown acute and chronic toxicity, would have been discontinued) and thus of the already available data on persons Who [56] suggests to operate according to adequate and less onerous experimentation paths with respect to pre-clinical dossier.

l) Criteria and modes of fund allocation for AIDS research in Italy are currently under discussion, as it is evident that only some AIDS organizations have the chance to be represented in various National Commissions [57]. It is important to examine the UT area also in this debate, with respect to which the difficult (if not impossible) intelligibility of selection criteria adopted with the purpose to decide funds [58], as well as difficulties in participating to the problem definition and to the research of solutions are particularly evident.[59]

m) The public calls for the presentation of projects within the 1st and 2nd "Research Project on Psychosocial Effects of AIDS" provide the possibility to present researches and intervention projects on UT also (usually defined Complementary Therapies) but, as our direct experience, we can affirm that this type of proposals meet much resistance and that arguments brought to sustain the rejection of such projects sometimes are contradictory and not comprehensible.

Moreover, the Superior Institute of Health (I.S.S.), after having analyzed the projects, makes public [62, 63] only data concerning approved projects, just indicating name of the scientific responsible, entity of title and funds; making it impossible to understand the reasons of the choices made and the overall criteria pursued; also precluding the possibility to formulate considerations with respect to choices by the judicatory commission.

n) Modern knowledge of immunology and the confirmation [64, 65, 66, 67] of the predictive value of new tests on viral load (qPCR, bDNA, NASBA) enable today a first evaluation of in vivo activity of a therapy also through small, limited and more economic clinical studies; disclosing a new possibility for unconventional therapies also [68].

o) PlwHA combine conventional therapies and unconventional ones [69, 70] and this introduces - among other things - on one hand, a bias problem (in this case an information flaw and else) concerning clinical experimentation and on the other, the need to evaluate pharmacological interactions concerning clinical treatment. The use of UT may be a very important element in PlwHA's clinical history [71].

p) Some national health authorities considered it important to activate very real offices and services dealing with UT. An example is given by the Office of Alternative Medicine (OAM) established by an order of the American Congress at the US National Institutes of Health [72, 73, 74].

q) OAM has activated, at some American universities research centers on UT; at the Bastyr University the AIDS Research Center [75], which is attending UT for HIV and AIDS and where an epidemiological longitudinal study [76] on the use of UT by PlwHA has already started.

The European Parliament itself is dealing with UT in general [77].

Some of the most important world's HIV and AIDS researchers clearly expressed the need to look for natural therapies to fight HIV and AIDS [78, 79].

r) Many years ago persons with HIV and AIDS, AIDS organizations and PlwHA started requesting the Italian national authority for an active and positive interest on UT [80, 81, 82, 83, 84].

s) A group of Italian AIDS organizations, just to give substance; continuity and rigor to a commitment on UT for PlwHA, has set up the Italian Network of NATC Caucus Europe [85]. It would be important for Italian Health Authorities to favour these efforts and build a prolific interaction with these initiatives. In other countries the contribution by AIDS organizations on this topic, is recognized and enhanced [86] and it would be important that this happened in Italy also.

t) The current cost for combination therapies reaches unsustainable amounts for most of PlwHA. Health expenditure each, of some African countries is equal to the daily cost for AZT mono-therapy. It is necessary that access to these drugs be warranted. But in a short time, many UT which have been shown (even though in vitro and in pilot studies only) useful to fight HIV infection and to boost immune defenses might be locally available (phytopreparations) [87, 88, 89]

Conclusions
Needs

a) PlwHA who use UT, uphold to get benefits without side or adverse effects. Therefore it is about therapies on which it wouldn't be ethic to intervene in censorious and prohibitory terms. A serious and efficient possibility to modulate the use of these therapies may be determined by an authoritative, correct, without preconceptions information on the real effectiveness, safety or less, of these therapies.

It is therefore necessary to promote a critical knowledge by PlwHA with respect to UT.

b) In order to inform it is necessary to be informed. In this sense, the primary and basic need in this field is represented by a database collecting all the knowledge about these therapies. In these years we have extensively verified a substantial not knowledge by practitioners and Italian researchers also on the most rigorous available foreign literature on this topic.

c) Pharmacological research needs a great financial investment ability and currently an interest and an investment of big capitals on UT research is not conceivable. This also in light of the difficulties to patent the findings in order to recover the high research and registration expenses, due to production and marketing rights.

For this reason it is necessary to promote public research and to define experimental paths, which, taking into consideration the current use made of many of those therapies and their relative absence of toxicity, reduce the entity of experimentation necessary investments (for example redefining and aiming what is requested for the pre-clinical dossier, the toxicity proves, insurance, etc.). In such sense we think that a good starting point to could be "The Reasonable Safety Doctrine" postulated by special WHO commission (in document WHO/TRM/GPA/90.2 cited in note no. 47) and that other suggestions might also come from the consideration of some legislative aspects from other European countries.

d) The availability of still a large number of unconventional drugs, active on different phases of viral replication (up to now transcriptase and protease inhibitors) and the awareness of the strong variety of individual clinical outlines, both imposes and enables, the passage from a standard treatment strategy to a personalized one, where targeted drug combinations be administered, evaluated, integrated and if possible, changed. To make this possible it is necessary that the most reliable biological markers for the state of infection, for disease progression as for effectiveness or less of a treatment, be widely and regularly available. Actually, one of most effective tests is the viral load quantification (VQ) which however it is not done in all hospitals and is used mainly in experimental studies. A basic condition to switch to a personalized treatment is the full availability of the VQ test.

A widely spread availability of the VQ test would facilitate the screening of UT administration.

e) For UT, as for other issues, the lack of collaboration and interaction between the AIDS organizations is not a secondary aspect. It often happens to operate separately without sharing with others resources and responsibilities. This behavior is strongly restrictive in the case of UT also. Activists, operators and AIDS organization physicians present in Institutional commissions at national or local level, should operate in a spirit of collectivity and service spirit without using such presence to reach power positions in order to facilitate their own organization. They should have the habit to make a periodical report about their work, promptly inform all organizations about opportunities and newly disclosed project paths; they should make use of the contribution from all to proceed with their work. The re-election (of AIDS organization delegates or practitioners) in these commissions would be in some way related to the presentation of a relation on what the outgoing members, before the possible renovation of the charge, have made for the community (of persons and organizations on one hand; scientific on the other) to participate and to inform about works and deliberations of the commissions themselves.

f) With respect to projects concerning the Psychosocial Plans by I.S.S. it is important that also data related to rejected projects be published and that for these, as for the approved ones, the summary, the referees' and judicatory Commission evaluation and the funds requested be published.

g) Further, the possibility should be provided to present projects on UT within the area of AIDS Research Projects also.

Proposals
a) It is necessary to create, as already made in other countries, at the Superior Institute of Health or another expressly determined Institutional reality (University, clinical center), an agency or an office gathering all available documentation on UT and AIDS (but it might be about other diseases also, as tumors), evaluating it and putting it at disposal for researchers, practitioners, organizations and PlwHA. This work would be conducted in collaboration with NGOs and with PlwHA in order to obtain the widest legitimization.

It is necessary to create databases on UT, to computerize the access to these archives restoring it available on-line free of charge to practitioners, researchers, organizations and PlwHA.

b) It is necessary to activate a systematic program of follow-up and monitoring, on use, safety and effectiveness of UT through provided questionnaires and survey cards adequate for different needs. These questionnaires would be equal throughout the country and distributed in hospitals, organizations and other facilities to be then memorized in a database which furnishes a wide and constantly updated, picture of the Italian situation.

c) PlwHA who use UT have the need to access viral load tests in order to understand if what they are taking may give a benefit or not. The viral load tests (q-PCR, bDNA and NASBA) should be regularly carried out in hospitals also to monitor the consumption of unconventional therapies.

d) The use of UT is yet too conditioned by anecdotal, incomplete and contradictory knowledge. It is necessary to start clinical studies about the efficiency of UT for HIV and AIDS. Small pilot studies with the use of viral load as main marker might be easily accomplished.

e) It is necessary for a higher number of UT research projects and interventions to be supported, also within the Psychosocial Aspects Research Project, and finally also in the Research Project.

f) It is necessary to approach conventional and unconventional practitioners, promoting the most reciprocal collaboration possible, in presence of parallel followed patients. In order to do this the Institutional work and project moments should also involve UT practitioners. Further, confrontation and common work should be promoted on the territory (hospitals, USSL, other institutions and services).

g) Inside the National AIDS Commission, Technical scientific committees, Commission of studies, projects evaluation Commissions, National Consultation and in other ambits about AIDS and HIV UT practitioners should be present. In this way it would be possible to obtain a double result of having discussions and resolutions which embrace their needs also and contemporaneously to obtain a greater sensitization of UT practitioners on the importance of monitoring and validation. These practitioners should be selected (as it should be for their conventional medicine mates also) on the basis of competence, publications and representativeness.

h) It is necessary to favour the professional training of UT practitioners promoting the realization of professional refresher seminaries on the state of knowledge and on experimentation with respect to different disciplines (phytopharmacology, traditional Chinese medicine, homeopathy, etc…). Thus it will be possible to improve the quality of the medical intervention, obtaining a positive relapse for PlwHA.

i) In consideration of the growing use of UT (not only by PlwHA) it is important that the teaching of theoretical bases and of the main medical subjects different from the official one, be integrated into University courses.

j) It is important that an equal opportunity to access UT for both PlwHA and PlwHA in prison, be realized.

k) Also in consideration of currently prohibitive costs for conventional medicines in many countries and the local availability of UT, it is necessary to rethink the International cooperation by activating projects which enable countries holding raw materials to produce UT to make a better use of their resources. Integrated projects among universities, research Institutes and of public health (in industrialized and developing countries) and local communities might allow the realization of a rigorous scientific research finalized to the optimization of potential effects by these remedies on persons.

l) It is complicate to deal with issues of UT costs but from the accomplishment of the above exposed points (attention paths, experimentation, verification etc…) an exact knowledge and a sector's regulation would be derived.

For a community development
a) It is important to renew the relation between citizens, Health Institutions and services, thinking about citizens as protagonists of their own health and depositary of the authentic right of freedom of therapeutic choice. Active and responsible subjects, a resource for the community and for its growth also concerning health protection and promotion. The activity of Health services should be characterized by receptivity, hearing, confrontation, answering and community co-planning.

b) It is necessary to favour the participation of PlwHA at all intervention and planning levels of experimental studies and of health policies on HIV and AIDS.

c) In all Ethic Committees activated within studies on pharmacological trials, PlwHA and activists should be involved.

d) It is not objectively possible that all AIDS fighting organizations be represented at the AIDS Commission (Council, Commission, Technical-Scientific Committee , ethical Committee of the I.S.S., Regional AIDS Committee and citizen, etc…) but it is ethically and constructively useful that inside of all these movements there be delegates of those organizations. It is therefore necessary to establish exact and testable paths of investiture for these roles. The association's persons concerned with these instances would "work for the community" and not according to a lobby or cartel-policy or only for their own association. Verification systems on this kind of behavior should be activated. Investiture systems can be several and of different nature.

e) The most information possible should be made on competition announcements and on opportunities of research support, on activities and interventions on AIDS and HIV in general.

It is not reasonable and correct that who is directly represented in national and local seats, where decisions are made on these projects (or in the advisory seats), knows about opportunities some months in advance, while others do so just before the deadline for project presentation and still, others never get to know about it.

Further, it is not reasonable and correct that who has own representatives in decision-making seats (or advisory), - beyond deliberated actions - (knowing and attending the members of the Evaluating Commission) has more possibilities to support his own project, to illustrate it and thus to actually promote it.

It is an irresolvable situation speaking of rules (which may always be bypassed and eluded), which may find a modulation and a moderation only thanks to a deep ethic and motivational revisiting. A re-examination allowing to increase a community intervention culture and the value of investing in the collectivity, promoting the empowerment of weak people, not the exaltation the stronger, distributing competence and decisional possibilities instead of further concentrating them, knowing that there is no need for new "monarchs" but for a greater, fully developed and authentic participation.

Further, decisions taken concerning project selection should always be given notice about and published in the more complete and clear way. Still, results and analytic balances of different plans and projects approved and realized shouldn't be only published and collected but a copy should be sent to all NGOs, wards of infectious diseases, local health units (USSL), etc…, in order to optimize the benefit derived from these studies and to make possible a capillary subsequent evaluation on the validity and on results of the projects themselves and of selection/planning carried out.

Still, we believe the objective conflict of interests in being in some cases both, members of a Commission of evaluation and research proponents can't be resolved with the a simple person replacement. The replacement (without changing the system, habits and customs) would actually only be a tool to "remix cards" , placing - from time to time - in decisional conditions persons close to particular interests and orientations. A way that could lead, at most, to the re-definition of the force relations for those thinking not to be enough represented as concerns power. A logic that doesn' t bring anything new or positive for persons with HIV and AIDS.

It's only through coherent demonstration, clear and effective availability towards the involvement of all and valorization of anyone's resources that competence may be activated and resources de-localized and re-allocated.

It is thanks the promotion of a service and cooperation culture among persons that it is possible to promote a web of relations and feedback able to evolve the overall resource, people and synergy system.

Only through the clearness (making public decisional paths, decisions themselves and results) it is possible to acquaint community with its own decisions and pose one's own work for evaluation.

It concerns of a deep cultural and ethical issue involving all.

Bibliography:
[1] Fisher P, Ward A. Complementary medicine in Europe. BMJ 1994 V. 309 pp 107-10

[2] David M Eisemberg et altri. Unconventional medicine in the United States. N Engl J Med 1993 V. 328-n°4: 246-52

[3] Joyce C. R. B. Placebo and complementary medicine. The Lancet 1994 Vol. 344 pp 1279-81

[4] Anderson at al. Patient use and assessmen of conventional and alternative therapies for HIV infection and AIDS. AIDS 1993; 7:561-5

[5] Cohen C.J. et al Prevalence of non conventional medical treatments in HIV-infected patients: implications for primary care. Clinical Research 1990; 38:692A abstract.

[6] Arochne J. Complementary therapies. The frustrated promise. National Aids Bulletin, n°20-1995: 20-21 etc.)

[7] Sandmann M. et al. Complementary Therapies in HIV-infectec patients - a multicenter study. XI Int Conf on AIDS. Vancouver 1996. Abstract: Th.B 4099

[8] Ostrow M. et al. Patterns of complementary therapy use in a provincewide HIV/AIDS drug distribution program. . XI Int Conf on AIDS. Vancouver 1996. Abstract: Th.B 4095

[9] Bhatia R. et al. Evolving strategic planning complementary therapies: a national care, treatment 6 support approach. XI Int Conf on AIDS. Vancouver 1996. Abstract. Mo.B 184

[10] Meneilly G. Alternative therapy use in HIV positive women.XI Int Conf on AIDS 1996. Abstract: Mo.B 301

[11] Collins et al. Use of alternative treatments for hiv: patterns and correlates. XI Int Conf on AIDS. Vancouver 1996. Abstract: Mo.B 183

[12] Sabo et al. Standardized clinical assessmant tool on the use of alternative therapies by positive individuals. XI Int Conf on AIDS. Vancouver 1996. Abstract: Mo.B 182

[13] Berrier et al. Use of complementary/alternative therapies (C/A Rx) by HIV+ women (WM): the wome's interagency HIV study (WIHS). XI Int Conf on AIDS. Vancouver 1996. Abstract: Th.D 5120

[14] Lubeck D. et al. Use of non-traditional treatments by person with hiv-infection who also receive "traditional" care from primary care physicians. XI Int Conf on AIDS. Vancouver 1996. Abstract: Th.D5119

[15] Malafronte B. et al. Use of unconventional medicine among hiv positive patients. A survey of 3 care-providing center. XI Int Conf on AIDS. Vancouver 1996. Abstract: Th.D5183

[16] Adamoli R. Durante A. Undicesima Conferenza Internazionale AIDS e Terapie NonConvenzionali. in Medicina Naturale N. 5 Settembre/Ottobre 1996a pp 96-103

[17] Non è ancora disponibile il testo ufficiale delle conclusioni del Community Forum ma è possibile chiedere al Centro Poiesis copia di una propria sbobinatura e traduzione.

[18] De Francesco A. et al. Aids and alternative medicine. XI Int Conf on AIDS. Vancouver 1996. Abstract: Th.D.5124

[19] Adamoli R. et al. Ricerca su utilizzo e sperimentabilità delle medicina tradizionali in Italia.
3° Colloquio Europeo di Etnofarmacologia. Genova 29 maggio - 2 giugno 1996b. Abstract book pag. 180

[20] Hollander L. et al. Evaluation of the use of CT among PLwHA in Italy. XI Int Conf on AIDS. Vancouver 1996. Abstract: Th.B.4102

[21] Adamoli R., Mioli MC, Poletto M, Caggese L. Giannelli F., Durante A., Hagl D., Rossi F., Breglia M., Cremonesi F. Ricerca Pilota sull'utilizzo di terapie complementari da parte di 223 persone con hiv afferenti ad un ambulatorio di Malattie Infettive. X^ Conferenza Nazionale AIDS e sindromi correlate. 21-23 Novembre 1996c. Abs O.70.

[22] Santosuosso A. Gli sviluppi del diritto alla salute in Italia. in L'Arco di Giano. N° 4, 1994 pp 53-73

[23] Santosuosso A. Libertà decisionale del malato e richiesta di sospensione di cura: una prospettiva giuridica. in Aids e bioetica. Istituto Scientifico H San Raffaele. Europa Scienze Umane Editrice 1992, p 106

[24] Codice Deontologico dell'Ordine dei medici italiani. 1995

[25] Guida europea di etica e di comportamento professionale dei medici. 1982. in Documenti di deontologia e etica medica. Edizioni Paoline 1985. pp 62-72

[26] American Hospital Association. carta dei diritti del paziente. Approvata 1973. in Documenti di deontologia e etica medica. Edizioni Paoline 1985. pp 114-16

[27] Associazione Medica Mondiale. Dichiarazione sulle ricerche biomediche. 1962 con successive integrazioni Helsinki 1964 e Tokyo 1975. in Documenti di deontologia e etica medica. Edizioni Paoline 1985. pp 39-45

[28] Consiglio delle Organizzazioni Internazionali delle Scienze mediche, Direttive etiche internazionali per la ricerca biomedica condotta su soggetti umani. Ginevra 1993, in supplemento al n° 4 1994 di "Aggiornamenti Sociali".

[29] Building a New Consensus: Ethical Principles and Policies for Clinical Research on HIV/AIDS, IRB: A review of Human Subjects Research 1991, 13 (1-2): 1-17. Tradotto in "Dichiarazioni consensuali sui diritti etici e le strategie per la ricerca sull'AIDS", traduzione a cura di R. Mordacci in Aids e Bioetica, Istituto Scientifico H San Raffaele, Europa Scienze Umane Editrice, 1992, pp.275-281
Queste dichiarazioni consensuali sono state elaborate da un gruppo interdisciplinare di ricercatori, clinici, eticisti e rappresentanti dei pazienti. Il testo, corredato di un ampio commento, è stato pubblicato a cura di C. Levine, N. Neveloff Dubler, R.J. Levin.

[30] Ottawa charter for health promotion. An International Conference on Health Promotion. 1986 Ottawa, Canada.

[31] Dichiarazione di Parigi del 1° Dicembre 1994 firmata da 42 rappresentanti di altrettanti governi.

[32] Vedi Sandmann 1996

[33] Vedi Ostrow 1996; Berrier 1996 e altro

[34] Vedi Arochne 1995

[35] Vedi Sabo 1996

[36] Ad es. Hollander et al (costo annuo: 15.7% meno di 500.000; 18.7% fra 500.000 e 1 milione; 21.6% fra 1 milione e 1.600.000; 16.4% più di 1.600.000) ma anche Meneilly 1996

[37] Vedi David M 1993, Ostrow M. 1996, Collins 1996, Sandmann 1996, De Francesco 1996, Adamoli 1996c

[38] Vedi Malafronte B. et al 1996

[39] Vedi Sandmann 1996, Meneilly 1996.

[40] Vedi Meneilly 1996, De Francesco 1996

[41] Mozione finale Seminario "Per una dottrina della sicurezza ragionevole: ipotesi di lavoro per l'uso e la sperimentazione delle terapie complementari per hiv e aids. Bocca di Magra 12-14 Maggio 1995

[42] Organisation Mondiale de la Santè. Programme Mondial de lutte contre le SIDA. Directives de l'OMS sur l'infection a VIH et le sida dans les prisones. Geneve Mars 1993. WHO/GPA/DIR/93.3. Traduzione in italiano disponibile c/o Centro Poiesis.

[43] Balderi M. Intervento di apertura per i detenuti e per le detenute al Convegno "Progetto Ekotonos. Milano 1994.

[44] Durante A. Carcere e libertà di scelta terapeutica. Atti Seminario "Carcere e HIV" Torre Pellice - Torino 1994

[45] Coordinamento Cittadino del Volontariato e del Privato Sociale. Problematiche giudiziarie e sociali per persone con hiv/aids. Quaderno di documentazion Centro Operativo Aids Comune di Milano. Ottobre 1995

[46] Centro Poiesis del Gruppo Exodus. Alcune considerazioni su hiv e detenzione in Italia. Relazione presentata al Meeting European action "Terminally ill prisoners: change the law". Giugno 1996 Aix en Provence. Francia

[47] Ad esempio sono numerosi i dati in vitro su principi attivi di piante. Citiamo a titolo indicativo "Report of a WHO Consultation on Traditional Medicine and AIDS: Clinical Evalutation of Traditional Medicines and Natural Products". WORLD HEALTH ORGANIZATION. WHO/TRM/GPA/90.2 in cui vengono indicate 33 sostanze fitochimiche attive in vitro contro HIV.

[48] A titolo d'esempio citiamo anche quest'ultimo lavoro: Chang R. et al. Meta-survey of plant and herb material as a treatment for hiv. XI Int Conf on AIDS. Vancouver 1996. Abstract: Mo.B 303

[49] Yamasaki Anti-HIV-1 activity of labiatae plants, especially aromatic plants. XI Int Conf on AIDS. Vancouver 1996. Abstract: Mo.A.1062

[50] Sono diversi gli studi clinici sull'efficacia di fitopreparati nell'infezione da HIV, in particolare su piante o principi attivi delle stesse come l'Ipericina, la Curcumina, il Pao Pereira, il Bosso, la Glycyrrhizina, l'Uncaria Tomentosa, l'Aloe Vera etc.. Citiamo per tutti lo studio multicentrico sul Bosso presentato all'ultima conferenza di Vancouver.
Durant J et al. A multicenter, randomized, double-blind, placebo-controlled trial of SPV efficacy and safety in HIV-infected asymptomatic patients. XI International Conference on AIDS. 7-12 luglio 1996. Abstract.

[51] Solo per citare alcuni lavori a titolo d'esempio, vedi le 2 note seguenti realtivi a lavori presentati XI^ ICA.

[52] Vazquez J. A. et al Use of an over-the- counter, breathaway (Melaleuca oral solution) as an alternative agents for refractory oropharyngeal candidiasis in aids patients. XI Int Conf on AIDS. Vancouver 1996. Abstract: We.B 3305

[53] Fareed G. et al The use of a high-dose Garlic preparation for the treatment of Cryptosporidium Parvum diarrhea. XI Int Conf on AIDS. Vancouver 1996. Abstract: Th.B 4215

[54] Homsy J. Traditional medicine is a valid local alternative for the treatment of chronic diarrhea and Herpes Zoster in Aids Patients in Kampala, Uganda. XI Int Conf on AIDS. Vancouver 1996. Abstract: Mo.B 300

[55] Wolfstädter H. D. Überlegunger zu einem modern Konzept komplementäree Therapies bei HIV: Jäger H (Hrsg) HIV Medizin, Möglichkeiten einer individualisierten Therapie. ECOMED Verl. 1994, 259-67. Traduzione in italiano disponibile in " Relazioni, interventi, sommari e comunicazioni" Seminario "Per una dottrina della sicurezza ragionevole" Bocca di Magra 1995, pp13-24.

[56] Vedi WHO/TRM/GPA/90.2 alla nota 47

[57] Chiara Amigoni. Qui si gioca sulla pelle del malato. in Vita Anno 3 n. 27. 6 Luglio 1996. pp. 4-8

[58] Esperienza condivisa da alcune associazioni ( espressa in occasione di convegni pubblici come "Per una dottrina della Sicurezza ragionevole" Bocca di Magra Maggio 1995 e Tavola Rotonda "Verso la costituzione dell'Osservatorio Nazionale sulle Terapie Complementari nella cura dell'Aids. Protocolli sperimentali e parametri di validazione scientifica delle medicine non convenzionali" in Medicina Naturale a Convegno. Milano Ottobre 1995). Vedi ad esempio pareri dei Referees e della Commissione rispetto progetti presentati dal Centro Poiesis nell'ambito del 1° e 2° Progetto Psicosociale. Alcuni dei pareri dei referees sono elementari riassunti dei progetti stessi, privi di un giudizio analitico. Pareri visionabili presso il Centro Poiesis del Gruppo Exodus..

[59] Esperienza diretta del Centro Poiesis meglio esplicitata nelle conclusioni.

[60] "Primo progetto di ricerca sugli aspetti etici, psico-sociali, giuridici, comportamentali, assistenziali e delle prevenzione nel campo dell'AIDS (1994)" in Notiziario dell'Istituto Superiore di Sanità. Vol 6. N. 10 Ottobre 1993.

[61] "Secondo progetto di ricerca sugli aspetti etici, psico-sociali, giuridici, comportamentali, assistenziali e delle prevenzione nel campo dell'AIDS (1996)" in Notiziario dell'Istituto Superiore di Sanità. Vol 8. N. 8 Agosto 1995.

[62] Piano esecutivo "Primo progetto di ricerca sugli aspetti etici, psico-sociali, giuridici, comportamentali, assistenziali e delle prevenzione nel campo dell'AIDS" Ministero della Sanità, Istituto Superiore di Sanità. Rapporti ISTISAN 95/7

[63] Piano esecutivo (anno 1996) "Secondo progetto di ricerca sugli aspetti etici, psico-sociali, giuridici, comportamentali, assistenziali e delle prevenzione nel campo dell'AIDS". Istituto Superiore di Sanità. Rapporti ISTISAN 96/21

[64] Bakerr R. HIV Viral Load Supercedes CD4 Count as Best Marker for Predicting Risk of AIDS and Death.Bullettin of Experimental Treatments for AIDS Jule 1996. pp 9-11

[65] Levin J. A Perspective on Viral Load Testing. Bullettin of Experimental Treatments for AIDS. Dec 1995. pp 15-16

[66] Gallyot R. et al. Viral load in low CD4 count HIV-positive patients with and without a preceding AIDS-defining diagnosis. XI Int Conf on AIDS. 7-12 Vancouver 1996. Abstract: We.B 3382

[67] Graham NMH et al. Infectious HIV Viral Load predicts clinical progression and survival among HIV infected adults. XI Int Conf on AIDS. 7-12 luglio 1996. Abstract: Mo.We.B 411

[68] John James ripreso in "Conclusioni del Community Forum" 1996. Sbobinatura e traduzione ottenibili c/o Centro Poiesis dell Gruppo Exodus.

[69] Greenblatt r.M. et al J. Acquir Immune Defic Syndr 1991, Vol 4 (2), pp 136-43.

[70] Vedi anche Collins 1996, Sandmann 1996, Hollander 1996, De Francesco 1996, Ricerca Ospedale Niguarda 1996

[71] Vedi Sabo 1996 e Malafronte 1996

[72] Office of Alternative Medicine of NIH. HIV/AIDS information package. OAM Aprile 1995

[73] Alternative Medicina: Expanding Medical Horizons. Workshop on Alternative Medicine, Chantilly, Virginia. 1992

[74] "Alternative Treatment Research Center Receives NIH Grat, in Aids Treatment News, n. 209, October 21, 1994

[75] Bastyr University AIDS Research Center. First Years-end Report, 9/30/94 -8/14/95

[76] Standish L.J. et al Nationwide longitudinal outcomes study of hiv/aids alternative therapies. XI Int Conf AIDS, Vancouver 1996. Abstract: Mo.B. 181

[77] Vedi Fisher 1994

[78] Robert Gallo. Dichiarazione riportata in Positive Nation. August 1996, Issue 10. Pag 19.

[79] Luc Mantagnier. Aids L'uomo contro il virus. Ed. Giunti 1995.

[80] Centro Poiesis del Gruppo Exodus, Associazione Solidarietà Aids, Associazione Lotta Aids (A.L.A.). Lettera aperta a medici, ricercatori, operatori e istituzioni sanitarie. 1° dicembre 1995. Inviata alle autorità sanitarie italiane.

[81] Mozione finale Convegno "Per una dottrina della sicurezza ragionevole: ipotesi di lavoro per l'uso e la sperimentazione delle terapie complementari per hiv e aids. Bocca di Magra (La Spezia) 12-14 Maggio 1995

[82] Adamoli R. Relazione d'apertura. Convegno "Per una dottrina della sicurezza ragionevole: ipotesi di lavoro per l'uso e la sperimentazione delle terapie complementari per hiv e aids. Bocca di Magra 12-14 Maggio 1995

[83] Centro Poiesis. Proposte avanzate nell'ambito del Community Forum tenutosi parallelamente all'XI Conferenza Internazionale AIDS. Vancouver 1996

[84]Carta Fondativa NATC Caucus Europe -Italian Network ("Natural, Alternative, Traditional, Complementary medicine). Edita a cura di NATC. Ottobre 1996.

[85] Ad NATC Caucus Europe-Italian network aderiscono il Centro Poiesis del Gruppo Exodus (c/o cui ha sede la Segreteria), le associazioni La Sorgente di Venezia (sede del Comitato Etico), Alfaomega di Mantova, A77 di Milano, Arcobaleno di Torino, LILA sede di Bologna, Archè di Milano, Gamma di Sondrio, Jonathan di Pavia, Comunità Nuova di Milano, Iride di Verona, S.O.S. HIV di Varese, Vele Verdi di Roma, Pantagruel di Pistoia, Casa Marcoaldi di Vicenza, Associazione Solidarietà Aids (ASA) di Milano.

[86] Abrams D. L. Alternative Therapies for HIV. in Volberding P.A. et al. The medical management of AIDS - Fifth Edition 1996 pp. 143-158. Edit by W.B. Saunders Company

[87] Lakew G. Potential of Ethiopians Medical Plants in the fight against aids. XI Int Conf on AIDS. Vancouver 1996. Abstract: Th.B 4096

[88] Ssemukasa M. Herbal Medicine: an alternative therapy in poor rural areas. XI Int Conf on AIDS. Vancouver 1996. Abstract: Mo.B 305

[89] Shide L. et al Ninety anti-hiv active chienese medical herbs. XI Int Conf on AIDS. Vancouver 1996. Abstract: Th.B 4104