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Posts for December, 2010

Another Reason For FRC To Oppose Stem Cell Research

Jim Burroway

December 14th, 2010

It may hold some promise for curing HIV. An American  patient in Berlin received a stem cell transplant in 2007 in an attempt to cure his leukemia. That transplant, to the surprise of his doctors, also ended up curing him of his HIV infection:

But these were no ordinary stem cells – a mutation found in just one percent of Caucasians in northern and western Europe causes CD4 cells to lack the CCR5 receptor, a receptor necessary for early-stage HIV to infect CD4 immune system cells. People with this mutation are more or less immune to HIV infection.

Those anti-HIV stem cells took root in the Berlin patient and repopulated there. At the same time, the host CD4 cells that hadn’t been destroyed in chemotherapy and radiation completely disappeared. After 38 months, doctors still couldn’t find HIV infection in the Berlin patient – in other words, it seems by all measures that his HIV has been cured.

This is still a very unlikely path toward curing AIDS, but it does give scientists several avenues for further investigation. This article explains the patient’s gruelling recovery:

The `Berlin patient`, Timothy Ray Brown, a US citizen who lives in Berlin, was interviewed this week by German news magazine Stern.

His course of treatment for leukaemia was gruelling and lengthy. Brown suffered two relapses and underwent two stem cell transplants, as well as a serious neurological disorder that flared up when he seemed to be on the road to recovery.

The neurological problem led to temporary blindness and memory problems. Brown is still undergoing physiotherapy to help restore his coordination and gait, as well as speech therapy.

Friends have noticed a personality change too: he is much more blunt, possibly a disinhibition that is related to the neurological problems.

On being asked if it would have been better to live with HIV than to have beaten it in this way he says “Perhaps. Perhaps it would have been better, but I don’t ask those sorts of questions anymore.”

Scientists are now discussing ways to identify stem cells with the built-in immunity for further research. A group of U.S. scientists have announced that they have received funding to to explore techniques for engineering and introducing CCR5-deficient stem cells.

Another ill-contrived circumcision study

Timothy Kincaid

December 8th, 2010

Should there be any researchers reading, let me give you a bit of advice: gay sex and straight sex are not identical. While most heterosexual men do not have penises inserted into their anuses with regularity, this is not an uncommon part of the sexual practices of many gay men.

And further, the easiest way that a gay guy can become infected with HIV is through anally receptive unprotected sex. That isn’t new, surprising, or even contested.

Yep, HIV transmission among gay men in the US is primarily due to taking it bare up the butt. And any research which seeks to understand factors contributing to HIV transmission which does not consider that simple fact is a complete waste of money and time.

And today we get word of yet another Wasted Money Study on whether circumcision impacts HIV transmission between gay men. Reuters:

In a study of more than 1,800 men from the U.S. and Peru, researchers found that overall, the risk of contracting HIV over 18 months did not significantly differ between circumcised and uncircumcised men.

Over the study period, 5 percent of the 1,365 uncircumcised men became HIV-positive, as did 4 percent of the 457 circumcised men, according to findings published in the journal AIDS.

Well, gee, that information would be useful to know… if the study wasn’t conducted in a mind-numbingly stupid way.

Because, you see, that study doesn’t take into consideration whether the men were engaging in receptive or penetrative anal sex. I just assumes that gay men pass HIV to other gay men in some unknown and mysterious manner. Maybe by osmosis.

Well guess what? It really doesn’t matter one iota whether a bottom’s penis is circumcised, pierced, tattooed, or wearing a funny hat if he has semen up his butt. And any study that focuses only on whether a penis is circumcised – but not what you’re doing with it – is going to provide useless information.

I will give this study partial credit for even wondering, as a side note, whether circumcision impacts the transmission of guys who are using their penises in penetrative anal sex. And while they couldn’t bother to craft a study that looked at that issue, they did at least ask. Kinda.

And guess what?

The researchers did find some hints that circumcision could be protective among men who primarily had insertive sex with other men. Among men who said they’d had insertive sex with their last three male partners at least 60 percent of the time, circumcision was linked to a 69 percent lower HIV risk.

That difference, however, was not statistically significant, which means the finding could be due to chance.

But the truly stupid aspects of this Wasted Money Study isn’t limited to having no concept whatsoever about how HIV is transmitted. It also made these glaring errors:

Male circumcision is far more common in the U.S. than in most other countries, and 82 percent of the 462 American men in the study were circumcised, compared with just 6 percent of the 1,360 Peruvian men.

D’ya think that this may be a material difference in populations? That perhaps there are differences between the cultures, practices, or even extent of HIV exposure between the two countries?

All of the men in the study reported having sex with other men and were considered to be at increased risk of HIV infection because they were already infected with the genital herpes virus (herpes simplex type 2), which can make people more susceptible to HIV.

So we’re talking about men who potentially have open sores… which are known to be ways in which HIV enters the body… but all that can be ignored to discuss the results of circumcision.

None of which discouraged declarations based on the results of the “study”

Taken together, the results “indicate no overall protective benefit from male circumcision” when it comes to male-to-male HIV transmission, write the researchers, led by Dr. Jorge Sanchez of the research organization Impacta Peru, in Lima.

No, Dr. Sanchez, taken together the results indicate an incredibly stupid study which tells us absolutely nothing whatsoever about circumcision and HIV transmission and was a complete waste of time and money. I really hope that my tax dollars did not fund your folly.

We don’t really need studies that inform us that anally receptive men don’t reduce their HIV risk by becoming circumcised. They also aren’t benefited by having flocked wall-paper or a charming haircut.

But I, for one, would be interested in a study that looked at whether HIV transmission could be reduced by means of circumcision among anally penetrative men. That question has not been answered (this Wasted Money Study, notwithstanding) and it would be beneficial to know whether circumcision is a risk mitigator among this subset of gay men, and to what extent.

And, I guess they did add that recommendation to their nonsensical reporting of their results.

They add that studies should continue to look at whether circumcision affects HIV risk from insertive sex and do so in larger, more diverse study groups.

Yeah. Ya think?

Washington Post gets the HIV prevalence story wrong

Timothy Kincaid

September 24th, 2010

Darryl Fears of the Washington Post starts off with

Study puts HIV rate among gay men at 1 in 5

One in five gay men in the United States has HIV, and almost half of those who carry the virus are unaware that they are infected, according to a new Centers for Disease Control and Prevention study.

The problem? That’s just flat false.

As we reported, the CDC study was of men in urban settings and not reflective of gay men on the whole. It was not even representative of gay urban men, just those who are living it up at the bars.

And there is a material difference.

As we have stated in the past, only about 12% of gay men are infected with HIV. But Fears doesn’t have to take our word for it, it’s right there in the study which he was reporting. And the CDC made a point of warning against reporting their study in a sensational way:

Finally, these findings are limited to men who frequented MSM-identified venues (most of which were bars [45%] and dance clubs [22%]) during the survey period in 21 [metropolitan statistical areas] with high AIDS prevalence; the results are not representative of all MSM. A lower HIV prevalence (11.8%) has been reported among MSM in the general U.S. population. [emphasis mine]

While it may take an extra few minutes to read the whole report, it can make the difference between providing news and spouting nonsense.

Of course the Post was not alone is their sloppy reporting. The AP was actually worse

One in five sexually active gay and bisexual men has the AIDS virus, and nearly half of those don’t know they are infected, a federal study of 21 U.S. cities shows.

“We don’t have a generalized epidemic in the United States. We have a concentrated epidemic among certain populations.”

Even gay magazine, Bay Windows, got in on the act with the headline, “CDC: One in five gay, bi men is HIV-positive”.

HIV prevalence in urban gay/bi men

Timothy Kincaid

September 23rd, 2010

The Centers for Disease Control has conducted a study of 8,153 men who have sex with men in 21 U.S. cities and has made some observations about the HIV infection rate of gay/bi urban men. (Reuters)

Overall, they found that 19 percent of gay men are infected with HIV.

The study found that 28 percent of gay black men infected with HIV, compared with 18 percent of Hispanic men and 16 percent of white men.

Black men in the study were also least likely to be aware of their infection, with 59 percent unaware of their infection compared with 46 percent of Hispanic men and 26 percent of white men.

Age also plays a role. Among 18 to 29-year-old men, 63 percent did not know they were infected with HIV, compared with 37 percent of men aged 30 and older, the team reported in the CDC’s weekly report on death and disease.

I am beginning to consider that a comprehensive campaign needs to be planned to test every man who has sex with men. I would not write off a socially-coercive campaign based on “everyone will get tested on such-or-other week” or be the recipient of scorn and rejection. I’m just “thinking out loud” here, but it seems to me that the key to reducing HIV transmission is in reducing those who do not know and perhaps drastic measures may be required.

The logical (dangerous, nonsensical) conclusion of careless reporting on HIV

Timothy Kincaid

September 10th, 2010

As I noted earlier this week, the story of an HIV study out of Ghent, Belgium, has been reported in a very irresponsible manner. Now the conservative Christian zealots in the UK have latched onto the story and repeated it in a way that is so far from the original as to be laughable (if it wasn’t disgusting and dangerous).

Running the headline Young homosexual men are fuelling HIV in Europe, the Christian Institute has declared the following:

Men who have sex with other men are fuelling HIV infections in Europe, according to a new report supported by the UK’s largest sexual health charity.

The study noted that “unprotected sex between men” is often reported as the main transmission route for the virus. However, the study itself examined all homosexual contact and did not distinguish between protected or unprotected sex.

Medical experts note that anal intercourse is, by its nature, the most risky form of sexual activity.

This deliberate attempt to distort the science to suggest that there is no risk difference between safer-sex and unprotected sex is immoral and reprehensible. This is the exact opposite of the intention of the research and efforts to stop the spread of the virus.

I don’t know how “Christian” these monsters are (they certainly seem to be outside the mainstream in the UK) but I’m sure their god has a very special place for them in the afterlife (and perhaps they should invest in asbestos jumpsuits).

Getting the story wrong on HIV

Timothy Kincaid

September 8th, 2010

When I was a kid, we would sometimes play a game called “telephone” that went like this:

…the first player whispers a phrase or sentence to the next player. Each player successively whispers what that player believes he or she heard to the next. The last player announces the statement to the entire group. Errors typically accumulate in the retellings, so the statement announced by the last player differs significantly, and often amusingly, from the one uttered by the first.

Well it seems to me that there is a game of telephone going on in the mainstream (and other) media in which each retelling of the story gets further and further from the truth. The headlines are the most glaringly obvious:

  • The Guardian – September 6: Young gay men fuelling HIV epidemic, study warns
  • Daily News & Analysis – ‎September 7: White homosexual men ‘still taking too many HIV risks’
  • Pink News – September 7: ‘Young, white gay men’ are ‘contributing’ to spread of HIV infections in Europe says report
  • UPI – September 8: White gay men take greater HIV risk

The UPI article, the most recent, tells us about a study at Ghent University

A significant number of new HIV infections occur through high-risk behavior between young white homosexual men, researchers in Belgium say.

It follows the rather breathless report from Pink News:

According to new research published today, reckless sexual behaviour among a subset of young gay men is fuelling the HIV epidemic in Europe and the UK.

According to open access journal BioMed Central (BMC) Infectious Diseases, a considerable number of new HIV infections in Belgium, where the study was conducted, were occurring as a result of high-risk sexual contact between young, white gay men.

Well there is a story that comes out of the Ghent University study, and it does discuss gay white youth. But the story coming from the study is hardly what you’d think reading the later reports. Here’s what happened:

Researchers at Ghent University in Belgium looked at regional HIV infection to see if they could identify trends. They looked at 506 patients who seroconverted in Belgium between January 2001 and March 2009 and analyzed them by race, sex, transmission cause, and HIV strain.

Sixty percent of those who seroconverted had HIV-1 subtype B and were mostly young gay Belgian men. In addition, this group also had statistically high levels of other STIs, including syphilis and chlamydia.

The other forty percent had other strains of HIV (18 variations identified) and were 60% African and 33% Caucasian. These transmissions were predominantly through heterosexual sex or intravenous drug use.

They also looked at the specific genetic attributes of various infections and found “clusters”, individuals with virtually the same virus. Among gay men (subtype B), clusters were small (3 to 10), but one cluster of 57 patients was found. Fewer clusters were found among non-B strains.

The conclusions from this study were that there are two distinct methods of HIV transmission in Belgium and that these two populations have little overcross. Young gay men who become infected get the virus from other local young gay men while Africans and other non-gay patients came to be infected through travel or migrated to Belgium with the virus.

  • * What this study did not find was that “white gay men take greater HIV risk”. The study told us almost nothing whatsoever about whether “white gay men” or “gay men of color” take greater risk, because the study had few gay men of color. Belgium is not known for its racial diversity (racism in Belgium is defined in terms of Dutch v. French speaking people). Nearly all of Belgium is white, so nearly all gay Belgians who seroconvert were also white.
  • Nor did it find a rampant disregard for safer sex among gay Belgians. A rough calculation suggests that only about 4% of gay Belgian men are living with HIV, a rate a third that of the US. In fact, it would appear that a small subset of young gay Belgians were behaving irresponsibly (perhaps specific social circles) and were consequently infected with a number of sexually transmitted diseases, including HIV.
  • Nor does the research of transmission rates and methods in Belgium tell us much about rates and methods in the rest of Europe and especially the rest of the West. This was a local study involving one Belgian city, not “Europe and the UK” or anywhere else for that matter.

Accurate reporting on such issues is important. Headlines declaring that “white gay men” are fueling an HIV epidemic only serves to further stereotypes about gay men in general. But more importantly, they distract from populations that could believe themselves to be outside that demographic and can impact the allocation of resources where they are most needed.

In Belgium, high-risk taking MSM (specific young white gay men) constitute the most important source of local onward HIV transmission in their region, and this is where prevention efforts should be focused. This study even argues for “a debate on the appropriateness of systematic treatment of MSM meeting some of the characteristics associated with a higher chance of being a transmitter.”

But in the United States, the subpopulation most highly impacted by local onward HIV transmission are African Americans – mostly gay but also heterosexual. There are various reasons why blacks are disproportionately impacted; but one big contributor was the flawed focus of early prevention efforts. By narrowing resources and prevention messages to white gay men and virtually ignoring minority populations, there was a false impression created that HIV/AIDS were a white gay mans disease.

We must be diligent to both provide the resources necessary for care and targeted prevention messages in the black community (and all communities impacted) and to derail any confusing and contradictory messages – like this one – that could be counter-productive.

More talk about cancer drugs to cure HIV

Timothy Kincaid

September 3rd, 2010

The pharmaceutical world has become quite skilled at treating HIV. For most HIV infected patients, a daily drug can reduce the virus in the body to the point where it has virtually no impact; the immune system is not effected by the virus and it is even theorized that such persons are no longer infectious.

But “virtually” is the important word. While the virus may seem gone, it is not. Rather it is lurking in cells that the drug regimen cannot reach and should the patience cease their treatment the virus will return even fiercer than before.

And it is this lurking that has proven to be the attribute that has stopped researchers from finding a cure.

But, as we discussed last month, some are starting to think outside the box and are utilizing existing cancer drugs to break through this last threshold and actually prepare a cure for those infected with HIV. Now a similar effort is being reported for a Merck cancer drug, but using a different theory. (Bloomberg)

Researchers at the University of North Carolina in Chapel Hill plan to test Merck’s drug, Zolinza, next year in about 20 people infected with HIV, the AIDS virus. The goal is to determine if Zolinza, or a medicine like it, can force HIV out of cells where it can reside, concealed from attack by potent antiviral treatments, said David Margolis, a professor of medicine who’s leading the research.

While AIDS drug cocktails can eliminate more than 99 percent of virus from an infected person, the treatment isn’t a cure because a remnant of the virus remains hidden in certain cells. For years, scientists have sought a simple way to drive the remaining virus into the bloodstream where the drugs can clear them from the body. Zolinza, approved in 2006 for use against a rare type of blood cancer, may work by blocking an enzyme that helps the virus avoid detection.

This is not a certainty, of course, but previous testing has shown promise.

In a laboratory test published last year, Margolis used the medicine to coax HIV out of hiding in cells taken from infected patients.

It may prove that the optimism for a cure is as hasty as was the optimism for a vaccine which was in the air a few years ago. But, nevertheless, I do think that for many HIV infected persons, there is a reasonable hope that within their lifetime they will again be free of this virus.

Cancer medication may be effective against HIV

Timothy Kincaid

August 24th, 2010

Angina medicine made Pfizer a fortune when it was discovered to cause erections and Merck was delighted when they discovered that their prostate drug could regrow hair. So it would not surprise me if a cure for HIV were to be found to exist already posing with as having an entirely different purpose altogether.

And early testing suggests that possibly two cancer drugs may well be such a find. Louis Mansky, Ph.D., and Christine Clouser, Ph.D., of the Institute for Molecular Virology and School of Dentistry, along with medicinal chemist Steven Patterson, Ph.D., from the Center for Drug Design, decided to think outside the box. Instead of fighting the mutation of the HIV virus in the body, they decided to do the opposite. (Science Daily)

The two drugs, decitabine and gemcitabine — both FDA approved and currently used in pre-cancer and cancer therapy — were found to eliminate HIV infection in the mouse model by causing the virus to mutate itself to death — an outcome researchers dubbed “lethal mutagenesis.”

This is a landmark finding in HIV research because it is the first time this novel approach has been used to attack the deadly virus without causing toxic side effects.

Let’s hope for continued success.

Human Stem Cells Successfully Fight HIV in Mice

Jim Burroway

July 5th, 2010

A new study released online in the journal Nature Biotechnology reports that scientists may be able to combat the HIV using human stem cells which were grown in mice which were modified to have a human immune system. The experiments still need to be conducted on humans to see if the approach will work on people, but scientists are hopeful.

According to HealthDay:

In the new study, researchers engineered human stem cells — cells that create other cells — to lock a kind of “door” that allows HIV to enter. The door, a “receptor” on immune cells linked to a gene known as CCR5, is disabled in a very small percentage of people, and those people appear to be virtually immune to HIV.

“That’s like nature telling us how to cure AIDS,” Cannon reasoned. The idea of the experimental treatment is “to engineer a patient’s own cells so they’d be resistant to HIV” in much the same way.

The researchers did this by “cutting” a gene in the stem cells. These genetically manipulated cells did try and repair the injury, Cannon noted, but they didn’t do a good job and HIV’s way in was essentially disabled. The researchers inserted these tweaked stem cells into the humanized mice and other mice, then tried to infect them with HIV. According to the scientists, the genetically engineered stem cells went on to create mature immune system cells, such as T-cells, in the humanized mice. After a couple of weeks, these new immune cells appeared to provide protection against HIV. The cells grew greatly in number, offering fewer targets for the virus to attack.

If this proves successful in humans, it would amount to a “one-shot treatment” costing an estimated $100,000. With current treatment for HIV/AIDS costing $10,000 to $25,000 per year, this could be a very cost effective treatment.

FDA Approves More Reliable HIV Test

Jim Burroway

June 23rd, 2010

HIV is a very deceptive virus. One way in which it is so insidious is that once it enters a human body, it can take the body several weeks to develop enough antibodies for the infection to show up on most existing HIV tests today. That also just happens to coincide with one of the periods in the virus’ life cycle in which the newly infected person is most infectious and capable of passing it on to others through unsafe sex. Once the body produces enough anti-bodies to show up on a typical HIV test, it also has, ironically, begun to fight off the virus enough so that the individual is somewhat less capable of passing it on to others — although even then that risk is still very far from zero. What that means is that between the time of initial infection and the buildup of antibodies, that person is at one of his most infectious stages in the disease and if he is tested, his test result would likely still be negative during that early period.

There are tests known as nucleic acid testing (NAT) which can detect the presence of the virus itself, but they aren’t routinely used because of their high false-positive rate. But a study published in the June 15 issue of the Annals of Internal Medicine found that adding NAT testing to the current antibody-based rapid HIV testing that is commonly in use can increase detection of HIV by 23%.  Yesterday, the Food and Drug Administration announced the approval of the first HIV test to detect both the antibodies and the HIV virus itself. According to a statement from the FDA:

“The approval of this assay represents an advancement in our ability to better diagnose HIV infection in diagnostic settings where nucleic acid testing to detect the virus itself is not routinely used,” said Karen Midthun, M.D., acting director of FDA’s Center for Biologics Evaluation and Research. “It provides for more sensitive detection of recent HIV infections compared with antibody tests alone.”

The test was developed by Abbott Laboratories. The separate study published in the Annals of Internal Medicine, which appears to be unrelated to the FDA announcement, was funded by the National Institutes of Health, University of California at San Diego, and the California HIV/AIDS Research Program.

Fact Checking the Family “Research” Council Straw Man Argument

Jason Cianciotto

March 13th, 2010

In response to a Washington Post article about the economic benefits of same-sex marriage in DC, the Family Research Council (FRC) provides a classic example of how right-wing organizations manipulate data and statistics to suit their anti-LGBT positions.

Here’s the quote:

When same-sex weddings kicked off in D.C. yesterday, the city wasn’t seeing anything but dollar signs. In an absurd article in today’s Washington Post, reporters tried to argue that counterfeit marriage could be the economic salvation of the city’s economy. In a region with 12% unemployment, local officials claim that redefining marriage “will create 700 jobs and contribute $52.2 million over three years to the local economy.”

Not so fast, says FRC. The last census counted 3,678 same-sex partner homes in D.C. Assuming that number has stayed roughly the same, then the 150 who applied for marriage licenses yesterday would amount to a whopping four percent of the local homosexual population–hardly the stuff of economic recovery. For the Post’s $52.2 million projection to come true, all 3,678 of those D.C. couples would have to get married and spend over $14,000 per wedding. (I don’t know about you, but my wife and I spent a LOT less!) These “marriages” (which have yet to meet financial expectations in other states) may make a fast buck in the short term, but they will do nothing but drain the economy down the road. Consider the massive health care expenses incurred by taxpayers every year to cope with the diseases spread by homosexual behavior. According to the Kaiser Foundation, federal funding grew to more than $18 billion in 2004 to deal with the HIV/AIDS epidemic. Over half of all U.S. infections are in men having sex with men! That means taxpayers spend roughly $10 billion a year treating the diseases caused by a behavior celebrated in same-sex “marriage.” So much for economic development!

Not so fast FRC.

Yes, according to the Washington, DC Census Snapshot published by the Williams Institute, there are an estimated 3,678 same-sex couple households in the district, and the Associate Press did report that 150 same-sex couples applied for licenses on the first day same-sex marriage became legal there. This is about all that is factually correct in FRC’s statement.

FRC’s claim that the 150 couples represent “four percent of the local homosexual population” is a classic manipulation used by the religious right and discredited “researchers” like Paul Cameron. They take an estimate of one portion of a minority population and pretend that it is generalizeable to the population as a whole. In this case, the number of same-sex couple households willing to self-identify in the Census is not equivalent to the total population of lesbian, gay, or bisexual DC residents, which according to the Williams Institute is approximately 33,000.

Even more importantly, it is laughable for FRC to base its argument on the number of couples who applied for licenses on the first day. The Washington Post article references another Williams Institute report, which estimates that 2,000 same-sex couple in DC would marry over the next three years. In addition, another 12,500 couples are expected to come from out of state to get married. This is a more complete picture of the estimates used to create the projection of 700 new jobs and $52.2 million in revenue, but FRC simply ignores this information.

Where to begin with FRC’s last argument about same-sex marriage being a long-term drain on the economy because of “diseases spread by homosexual behavior?”

We could cite CDC data on transmission rates caused by “heterosexual behavior.” We could also estimate federal funding spent on prevention efforts that address the damage caused by social, and familial environments created by FRC. As they say, so much for economic development!

However, it would be a waste of time to feed into FRC’s “straw man” arguments.

They have no interest in examining real facts. Nor do they see the folly in their position against allowing same-sex couples access to an institution that fosters monogamy as well as mutual caring and support. As so many articles and special reports on Box Turtle Bulletin have illustrated, there is no place for scientifically supported facts in the anti-gay playbook.

People With HIV Can Have Near Normal Life Expectancies

Jim Burroway

February 26th, 2010

That’s according to two new studies presented at the 17th Conference on Retroviruses and Opportunistic Infections (CROI) being held in San Francisco.

The first study from the Netherlands followed 4612 newly diagnosed patients between 1998 and 2007. The study excluded those who start antiretroviral therapy (ART) less than six months after diagnosis or who already had an AIDS-defining illness in the first six months. The researchers then calculated the mortality rate of 0.67% a year:

This mortality rate enabled the researchers to compute life expectancies. For a patient diagnosed at the age of 25 the life expectancy came out at 52.7 years – in other words they would die, on average, at the age of 77.7. This was scarcely different to the life expectancy for 25 year olds in the general Dutch population – 53.1 years.

…Men and women diagnosed aged 25 could expect to live just five months less than HIV-negative people and men diagnosed at age 55 would live 1.3 years less (women 1.5 years less). For patients diagnosed with HIV (but not AIDS) symptoms the figure was two years shorter for men and women diagnosed at 25, and six and 7.5 years shorter for men and women respectively diagnosed at 55.

The second study was a much larger one of more than 80,000 patients from 30 European countries. This study didn’t just follow the newly-diagnosed, but all patients who had been on anti-retriviral therapy (ART) since 1998. It found that men who were not injecting drug users and who had a current CD4 count over 500 were no more likely to die during the follow-up period than their HIV-negative counterparts.

The key was maintaining a CD4 count of over 500 for at least three years. Over all, when those with lower CD4 counts were included, people with HIV had a 50% higher risk of death. But when injected drug users and people with CD4 counts lower than 500 were excluded, the mortality of people with HIV was virtually identical to those who were HIV-negative.

HIV Vaccine Results Called Into Question

Jim Burroway

October 14th, 2009

Remember that HIV vaccine story we were so excited about? It turns out that it may not be so promising after all. A Wall Street Journal article over the weekend determined that unreleased analysis of the data suggested the trial might have been a statistical fluke:

The second analysis, which is considered a vital component of any vaccine study, shows the results weren’t statistically significant, these scientists said. In other words, it indicates that the results could have been due to chance and that the vaccine may not be effective.

The additional data were available to the researchers on Sept. 24 when they announced the trial results, but they chose not to disclose them, said Jerome Kim, a scientist with the U.S. Army who was involved in the study. News of the second analysis was first reported on the Web site of Science magazine, but the story didn’t provide specific data. Full details of the trial are to be aired at an AIDS meeting in Paris that starts Oct. 19.

A group of 22 scientists who were critical of the study when it began in 2004 wrote that they feared that “one price for repetitive failure could be crucial erosion by the public and politicians in our capability of developing an effective AIDS vaccine collectively.” The WSJ article suggests the Army, the Thai government and the U.S. National Institutes of Health rushed to put a positive spin on the study. The AIDS Healthcare Foundation is calling for an independent review.

Who Are We Without the Wall?

Gabriel Arana

September 25th, 2009

Yesterday, major media outlets reported that for the first time an AIDS vaccine has had partial success in humans. In trials, it was about 31 percent effective. This is a far cry from the 70- to 90-percent effectiveness typically required for a vaccine to be licensed, but it shows that a vaccine is possible and represents the first-ever major breakthrough.

Since the announcement, I’ve allowed myself to consider seriously what a world without AIDS would look like. I was born in 1983 and remember the late ’80s, early ’90s television reports on the devastation wrought by AIDS in the U.S. The reports were terrifying, and it is odd to look at them in retrospect, knowing what they foreshadowed:

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Since then, even as medical advances have made AIDS a chronic illness instead of a death sentence, contracting HIV has been one of my biggest fears, which goes to show that the stigma associated with it remains. I fear hearing, “you’re HIV positive” more than being told I have an inoperable brain tumor, which I know is irrational. I’ve had probably five HIV tests, and for all except the first one, the anxiety of waiting a week for lab results has made me run to the nearest rapid HIV testing site and get an answer in 20 minutes, which is also excruciating.

I grew up understanding that gay = AIDS, an equation that I realize is outdated and perhaps prejudiced. But part of me fears that being infected with HIV would confirm all the dire predictions made for me by reorientation therapists and concerned family members. I’ve often felt the pressure to defy these predictions by leading an exemplary life — which I of course haven’t, and won’t. But the point is that AIDS has been framed as the natural “consequence” of homosexuality.

Perhaps the best-known piece of writing on the social meaning of AIDS was written by Susan Sontag, “AIDS and Its Metaphors,” in which the author talks about the ways in which we imbued a virus — which is inherently indifferent to human feelings, morals, and motivations — with exactly those attributes. AIDS was cited by people like Pat Robertson as divine retribution for sinful sex, an understanding that reversed the natural inclination to view the afflicted person as a victim. People with AIDS were “guilty,” or earned it, or something like that. You “get” AIDS; you don’t “get” a brain tumor. HIV in the blood is a “poison,” AIDS a “plague.” As dehumanizing as terminal disease is, even more dehumanizing — and disempowering — is how moral, religious, and political leaders talk about AIDS and its victims.

On the other hand, the AIDS crisis galvanized the gay rights movement, and many of the advances in equality were made during the late ’80s and early ’90s. The AIDS crisis was the tipping point for social acceptance of homosexuality, a change that is reflected in the language. It’s no longer politic to call gay people “homosexuals” or refer to the homosexual “lifestyle,” but in the ’80s these were standard phrases used by newscasters:

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A lot of the momentum of Act-Up has waned, but AIDS consciousness still permeates gay culture. Gay people will tag “be safe” (code for “use condoms”) to a goodbye at the end of an evening. I’ve been accosted more than once at a New York gay bar by an awkward grad student wanting me to fill out a survey about my sex life, which includes transparent questions about condoms, meth use, and depression (I can save you the work: gays who are reckless with drugs are probably more likely to have sex without condoms, and are probably more likely to be depressed). Public health officials obsess over how to “reach” us and set up condom stands at every LGBT event imaginable. And we’ve been Riding For The Cure forever. What happens when the finish line appears beneath us?

We thought the wall would stand forever,
And now that it’s gone we don’t know who we are anymore.

The Hedwig quote probably implies a nostalgia for AIDS that I do not intend, so let me be clear: the day the AIDS crisis ends — whether it’s a gradual process or an all-at-once medical achievement — will be a great day, the end of suffering for millions around the world. But it will mark the beginning of a shift in the culture. Will condom use plummet? Will the rate of other STDs rise? Will it change the forms our relationships take?

Probably.

The brief window of worry-free (or at least more worry-free) sex ushered in by the discovery of antibiotics, the pill, and abortion would open again — to the chagrin of social conservatives who have made the regulation of  sex, reproduction, and sexuality an essential component of their agendas. It would deflate many of the biological justifications for religious arguments (or maybe we’d just be cheating God?).

Whereas earlier gay rights activists wanted nothing to do with heterosexual marriage, the shift has been toward assimilating and adopting marriage, which some people think is good and other people think is bad (I’m on the fence). Part of this has come from increasing social acceptance and support of gay couples, but it would be silly to deny that the re-medicalization of sex had anything to do with the rise of monogamy in the gay community. Will the end of AIDS reverse this trend? I am not saying that bathhouses will reopen their doors and meth-fueled orgies will mark the scene until the next pandemic comes around, but de-coupling sex and relationships from the fear of death, disease, and social stigma will change the dynamics. In a sense, though, sex will always be fraught with anxieties: the virgin won’t stop wondering whether he or she will be good for their partner, and people will still feel the sting of betrayal when they find out they are being cheated on.

I’ve hesitated to use the word “freedom” or “liberation” in discussing the de-medicalization of sex. There is something mundane about equating this with human freedom. It seems a rather nihilistic, ’60s-’70s understanding of it. I have no idea what it really entails, but I doubt that freedom just means you have nothing left to lose.

This commentary is the sole opinion of the author and does not reflect the opinion of Box Turtle Bulletin’s other contributors.

HIV Vaccine Results Encouraging

Timothy Kincaid

September 24th, 2009

Eventually it had to happen. Eventually one of the promising vaccines trials for HIV had to provide at least some protection.

And it has. Partly. The trial showed that a vaccine was about 31.2% effective. (NY Times)

“I don’t want to use a word like ‘breakthrough,’ but I don’t think there’s any doubt that this is a very important result,” said Dr. Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases, which is one of the trial’s backers.

“For more than 20 years now, vaccine trials have essentially been failures,” he went on. “Now it’s like we were groping down an unlit path, and a door has been opened. We can start asking some very important questions.”

This is not the vaccine that will announce the end of the era of AIDS. But it is the first vaccine that has shown any effectivity at all and it allows researchers an opportunity to build upon this start to find something that will really work.

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