Washington Post gets the HIV prevalence story wrong
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”.
More sensationalistic HIV headlines
September 8th, 2010
Here’s a Reuters headline from France:
HIV spread “out of control” among French gay men
And here’s the meat of the story:
Thursday’s study, published in The Lancet Infectious Diseases journal, found that HIV in France fell significantly from 8,930 new infections in 2003 to 6,940 in 2008.
But the number of new infections among gay men was stable despite a decline in other groups, and accounted for 48 percent of new cases in France in 2008.
To Reuters “stable” = “out of control”
Yes, France has unacceptably high HIV infection rates – nearly 10% of gay men. Yes, we need to address the increase in young gay men who seem to be receiving ineffective messaging. Absolutely.
More talk about cancer drugs to cure HIV
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.
Aid For AIDS Nevada FINALLY dumps Canyon Ridge Christian Church
August 25th, 2010
Although no one at Aid For AIDS Nevada has responded to (or even acknowledged receiving) my letter, they have finally responded to Dr. Warren Throckmorton in regards to their chumminess with Canyon Ridge Christian Church:
After evaluating Canyon Ridge Christian Church’s backing of Pastor Ssempa of Uganda and his support of the Anti-Homosexuality Bill, we feel that it is in the best interest of our clients, supporters and staff to dissolve our relationship with the church immediately. Unfortunately, we will be unable to continue to work with the church, as long as they are associated with Pastor Ssempa. Since what he and the Anti-Homosexuality Bill represent violates the basic human rights that should be afforded to all Ugandans. Our mission is to provide client service programs that assist in enhancing the physical health and psychosocial wellness of the individuals living with and affected by HIV/AIDS in southern Nevada, while promoting dignity and improving the quality of their lives. We will further this mission without the support of Canyon Ridge Christian Church.
AFAN arrogantly dismisses concerns about CRCC
August 24th, 2010
There is nothing like public criticism to encourage a response. And after Change.org and the Red Ribbon Army and a number of others began to increase a call for explanation, Aid For AIDS Nevada has finally given the weakest of responses to Dr. Throckmorton for why they have not severed ties with Canyon Ridge Christian Church.
We do not partner with Canyon Ridge. In fact, we are simply a recipient of their donations in support of our lifesaving, essential programming for individuals surviving HIV/AIDS…we are not able to cease a partnership that does not exist.
Which still does not answer my questions: “please let me know whether you will continue to allow CRCC to participate in your organization and to display their organization’s name” and just why have you not responded to expressed concerns. And, especially, why have you deleted comments on your Facebook page from now half a dozen or so different activists who simply want answers.
The Red Ribbon Army is wondering something even more basic: “why Aid for AIDS of Nevada is unwilling to condemn Uganda’s Anti-Homosexuality Bill.” You’d think that would be a no-brainer.
But maybe AFAN doesn’t really care what you think; they don’t really need to. Two-thirds of their funding is from governmental sources and only about 17% of their annual budget comes from the AIDS Walk – and the majority of that is from corporate sponsors.
Ottawa Police disclosed that gay man transmitted “infectious disease”
This commentary is the opinion of the author and may not necessarily reflect that of other authors at Box Turtle Bulletin.
August 24th, 2010
Gay groups in Ottawa are furious with the police for releasing information about a gay man’s sexual health, so furious in fact that they are refusing funds from a police fundraiser. (Citizen)
Several groups in Ottawa’s gay community will refuse funds to be raised by police at a pancake breakfast Monday, in protest over how officers publicly identified an HIV-positive man.
In an unusual move that infuriated the gay community, police publicly released a photo of Steven Paul Boone, 29, charged in May with aggravated sexual assault. Police say he failed to disclose his HIV status to another Ottawa man who contracted the disease after the two had unprotected sex several times.
The story began in May when Boone was arrested. (CBC)
Steven Paul Boone, 29, remained in custody Friday after being charged with nine counts of aggravated sexual assault, said an Ottawa police news release.
The charges were laid after another man alleged in April that he contracted an infectious disease after sexual contact with Boone in late January and early February. Police said they could not disclose the nature of the disease, including whether it was HIV, the virus that causes AIDS.
Although the police did not specifically state that the infectious disease was HIV, advocates felt that releasing the man’s photo was inappropriate.
By releasing the photo, [Brent Bauer, of the Ottawa Gay Men's Wellness Initiative] said, police invaded Boone’s privacy, and spread fear among gays, who might now hesitate to get tested for AIDS.
Okay, to see if I have Bauer’s logic correct, he thinks that because a man who failed to disclose his HIV-positive to sexual partners was exposed by the police, therefore people will not want to get tested.
Oddly enough, that theory was put to the practical test. And failed spectacularly. What Bauer is not acknowledging is that between the photo being released and the pancake breakfast something else happened: five additional victims came forward. (Citizen)
A 29-year-old man accused of failing to disclose his HIV-positive to sexual partners has had his charges upgraded to include attempted murder.
The four counts of attempted murder were laid against Steven Paul Boone in relation to four of his alleged victims. Boone has also been charged with four counts of administering a noxious substance — HIV — to the four men.
Here we have a guy with at least six victims, four of which seroconverted. And Boone did not disclose his status to any of them even though, as it turns out, he had known of his HIV status for at least a year. And it is at least a reasonable assumption that three of them would not have known to get tested if the police had not released this guy’s picture.
Studies regularly confirm that – because most people are not despicable vermin like Boone – the biggest contributor to the continued spread of HIV is ignorance of one’s status. Not only are most HIV+ people responsible, but medications can reduce viral loads to the point where it might not be possible to pass on the virus.
But if these men had not seen Boone’s picture, they may not have gotten tested before endangering others.
I can appreciate that the community in Ottawa is offended in that they believe the police are not considering their complaint about the privacy rights of those who are HIV positive. And I appreciate the value of clear guidelines that protect the privacy of the innocent. But I find the defense of Boone to be difficult to fathom.
I have long been an advocate for those impacted by HIV/AIDS. I was privy to the early debates over confidential v. anonymous testing and I am still not convinced that names-based reporting is the most effective policy (or at least not as it is currently administered).
But I believe we should be doing everything in our power to stop the continued spread of HIV within our community. That should drive our policies and our sympathies and if that means that we put the interests of the uninfected – even the irresponsible uninfected – ahead of those who are deliberately endangering others, I have no problem with that.
I don’t wish to threaten the privacy of the vast majority of responsible HIV positive people who would never dream of doing anything that would pass on this virus. But people like Boone are a danger and a threat to the members of our community and we are fools if we put their interests before our own.
Cancer medication may be effective against HIV
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.
Major Gay Porn Actor Discloses He Is HIV+
This commentary is the opinion of the author and may not necessarily reflect that of other authors at Box Turtle Bulletin.
August 24th, 2010
Due to the subject matter of this post assume all outgoing links are not work-safe unless noted otherwise.
Mason Wyler is one of the more prolific gay porn actors currently producing material; in addition to having a considerable formal filmography (IMDB) he maintains personal and commercial websites. Last Thursday on his personal blog Wyler disclosed that he is HIV+. His brief post in it’s entirety:
I have something to say. I spent the last few months waiting for the right time to tell you but it turns out that there is no right time… I wish I could put this off for a little while longer but information like this usually finds a way of coming out sooner than later. In fact, people have already begun to talk so I might as well just tell you now. I tested positive. I have only myself to blame. I have HIV and it kind of sucks.
Porn news site TheSword.com reports Great Atlantic Media’s (a porn conglomerate) webmaster Mark Wilson originally outed Mason with a trashy post on GayPornGossip.com. Wyler’s admission on his own site appears to have been posted later that same day.
Sometimes it boggles the mind the number of people who think it’s acceptable to disclose someone else’s status, including as I’d previously posted Michael Alvear, Manhunt.net’s in-house advise columnist (Safe for work).
I admit I’m fond of Mason’s work and part of the purpose of this post is to speculate on how this might affect his career. In the mainstream (condom-less) straight porn industry contracting HIV is a career ender (gee talk about stigmatizing).
Contrast this to the gay porn industry where an anonymous survey conducted by TheSword.com revealed a full 30% of actors were either poz or unsure of their status and 52% of survey respondents either never or rarely discussed their status with scene partners.
But my question is, how many of those people are public with their status and how does that affect their cast-ability in films?
Off the top of my head I couldn’t think of any mainstream (non-bareback) openly poz gay pornstars. If you happen to know of any please post a comment below and include a source link.
Fortunately TheSword.com is already reporting the Raging Stallion network of porn sites has issued a common sense statement:
Raging Stallion practices safe sex on all of its video shoots–indeed we enjoy filming hot safe sex and showing other gay men how to have hot safe sex. HIV status should not be an issue when shooting porn if the actors are using condoms and using common sense. Raging Stallion would love to shoot Mason Wyler in an upcoming movie. He is a great actor and I have always wanted to work with him. Nothing has changed from my perspective.
God now if only the rest of the porn industry would adopt such a rational view.
Cross posted on The Denver ELEMENT
HIV considered “dangerous weapon”
August 20th, 2010
Back in October, a fellow by the name of Christopher Everett proved that the gay community is not exempt from including absolutely disgustingly foul creatures. From the arrest affidavit:
On October 20th, 2009 XXXX was interviewed at the Children’s Advocacy Center in Belton, Texas by Forensic Interviewer, Susan Schanne-Knobloch. During the interview XXXX advised that Christopher Everett invited him to “hang out” at Christopher’s home on the evening of October 16th, 2009. They arranged to meet by using their cell phones. XXXX left his home without his parent’s knowledge and Christopher Everett picked him and they arrived in Copperas Cove shortly after midnight.
Once they arrived at Christopher Everett’s home Christopher began kissing and touching him. XXX then explained that before Christopher Everett took XXXX back home Christopher Everett had penetrated XXXX anally (without the protection of a condom). XXXX also added that Christopher Everett knew his age which XXXX divulged when they first began to communicate through an internet social site called “grinder”. XXXX added that after the incident occurred he learned (through a friend who had also communicated with Christopher Everett through “Grinder”) that Christopher Everett claims that he is HIV Positive.
Everett is 26, XXXX is 16. There is no report on XXXX’s seroimmunity status but I hope that he did not become infected.
Everett was in the Coryell County jail Tuesday in lieu of a $50,000 bond. He is charged with aggravated sexual assault with deadly weapon, an offense punishable by five to 99 years or even life in prison.
Now is one of those times when I’m glad that Texas is not lenient on criminals. I’ve seen too many kids who trusted a foul creature like Everett before they were old enough or wise enough to know better.
Reader PR brought a follow-up story to our attention which adds additional detail (kxxv):
During an interview with investigators, Everett admitted he was infected with HIV and did not inform the teen.
He pleaded guilty to Aggravated Assault with A Deadly Weapon in June, with the deadly weapon being the virus.
Everett’s attorney argued for parole, because the victim’s blood tests haven’t tested positive for HIV. State prosecutors said the act was like “pointing a loaded gun at someone, and then it not going off.”
Everett was sentenced in the 52nd District Court to 15 years in prison and must pay a $3,000 fine.
Where Does San Francisco’s AIDSWalk Money Go?
July 16th, 2010
You’d probably guess San Fransisco, with some maybe to other bay-area communities like Oakland or Daly City. How about Ukraine?
This Sunday, San Francisco will host its annual AIDSWalk in Golden Gate Park. As with AIDSWalks that take place around the country, I would imagine that every one of those 25,000 participants are volunteering for this important charity event to raise money for AIDS charities in the local community. But according to the New York Times, the bulk of the money raised by the San Francisco AIDS Foundation will actually go to Cambodia, China, Ukraine, and five countries in Africa. In 2008, the San Francisco AIDS Foundation awarded 57% of its grant money to the Pangea Global AIDS Foundation, a separate international charity founded by the San Francisco AIDS Foundation in 2001 and with which it shares office space and employees. (Update: Michael Petrelis notes that Pangea was headed by Dr. Eric Goosby in 2001. He is now the United States Global AIDS Coordinator.) In 2009, 73% of the Foundation’s grants went to Pangea.
Ms. Kimport [Barbara Kimport, the Foundation's interim Chief Executive] said that in recent years the foundation’s support of Pangaea had come from other sources of money, not AIDS Walk donations. The walk last July raised $3.5 million. Foundation records show only $246,000 in grants to local groups in the 2009 calendar year. During the same period, the records show, Pangaea received $500,000.
Reactions were mixed. One participant in the Foundation’s cycling fundraisers said, “I recognize that the epidemic is universal.” But others feel deceived:
“I have friends who are positive,” [Jamie] McPherson said, believing that the money would go to support them. “Does it bother me?” he said. “Yeah, it does. You’ve got to take care of home first.”
Local AIDS charities report financial strains due to the financial crisis:
Mike Smith, president of San Francisco’s H.I.V./AIDS Providers Network, which represents 40 nonprofit groups, said the recession had strained budgets and fund-raising. “We have the highest density of people living with H.I.V. in the nation,” Mr. Smith said — 35,000 people infected in a city with a population of less than 800,000. “It’s staggering.”
Human Stem Cells Successfully Fight HIV in Mice
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.
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.
U.S. Starts To Mimic Third World Conditions For Access to AIDS Meds
July 1st, 2010
The economy is wiping out state and federal budgets for life-preserving AIDS meds, and the political will to solve the problem appears to be lacking. Nearly 1,800 people are now on waiting lists, a number that three years ago stood at zero. For some, things are getting hopeless:
Louisiana capped enrollment on June 1 but decided against keeping a waiting list. “It implies you’re actually waiting on something,” said DeAnn Gruber, the interim director of the state’s H.I.V./AIDS program. “We don’t want to give anyone false hope.”
…Scott Miller, 42, a northeast Florida truck driver who lost his health insurance in May along with his job, said he had never before sought assistance during five years with H.I.V. When his caseworker told him there was a waiting list, he asked what he was supposed to do.
“She just shrugged her shoulders and said, ‘I don’t know what to tell you,’ ” Mr. Miller said.
The ramifications are three-fold. First, obviously, is for the health of the person living with HIV. Secondly, without anti-retroviral medication holding HIV at bay, the virus may mutate into a form that is resistant to medications. This leaves the individual vulnerable to even more costly and less effective treatment down the road. And third, without anti-retroviral medicines keeping the individual’s viral load down — often to undetectable levels in the bloodstream — that person is now more infectious and more likely to pass the virus on to others.
Atlanta mayor promotes HIV testing
June 24th, 2010
“This is a disease that impacts all of the city,” Reed had said at a press conference earlier to urge widespread testing. “That is why I am going to participate and be tested as well.”
After a battery of medical questions, the technician handed the mayor an oral swab and instructed him on how to conduct the test – basically gathering saliva.
“Oh,” Reed said. “It is like brushing my teeth.”
And with that, it was over.
Twenty minutes later, the mayor would learn his status.
I appreciate Mayor Reed’s decision to heighten awareness about the ease and availability of testing for HIV. Most new infections are tied to a lack of knowledge about the HIV infected partner’s status and studies show that those who detect the virus early and seek treatment live longer healthier lives.
Those who are not absolutely certain about their status should follow Reed’s example.
S. Nevada Health reconsidering connections to Ssempa-supporting church
June 23rd, 2010
Several of us contacted the South Nevada Health District or signed a petition to express our concern about their partnering with Canyon Ridge Christian Church. This church has a global partnership with Martin Ssempa, the primary religious supporter of Uganda’s Anti-Homosexuality Bill of 2009, a legislative effort to execute HIV positive gay people and to incarcerate HIV negative gay people for life.
Michael Bussee, onetime founder of Exodus International and friend of Box Turtle Bulletin, has received a response.
Dear Mr. Bussee:
Thank you for bringing this matter to the attention of the Southern Nevada Health District. We were completely unaware of Canyon Ridge Christian Church’s partnership with Pastor Martin Ssempa or his stance on criminalizing homosexuality. The health district is absolutely opposed to the stated efforts of Pastor Ssempa and plans to evaluate and strongly consider any future partnership with Canyon Ridge based on this new information.
However, due to the timing of the testing event, and the outreach efforts that have already occurred related to this testing site, we do not feel we can cancel this venue for next week’s event. We do not condone the church’s continued partnership with Pastor Ssempa; however, we feel the immediate risk of canceling this venue just days before the scheduled event takes precedent at this time. If just one person shows up at a canceled event and decides to delay getting tested, that will be one person too many.
We share your concerns regarding this issue and remain committed to promoting testing in an environment that is comfortable for our clients. Thank you again for your input and for bringing this important issue to our attention.
Southern Nevada Health District
This appears to me to be a reasonable and responsible approach. Thanks to all of you who helped raise this issue with the SNHD.
FDA Approves More Reliable HIV Test
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.
Exodus Co-Founder: I Regret Teaching If You Had Enough Faith You Would Be Changed
A multi-part video interview series with Michael Bussee, co-founder of Exodus International turned critic.
May 17th, 2010
My question to Michael, is there anything specific you regret teaching, produced an answer with two separate and distinct parts. (We’ll have a video up tomorrow of the other half of his answer.)
First we look at the idea that if you worked hard enough in an ex-gay program you would be changed. Michael now believes the only thing being a loyal Christian guarantees in life is sharing in Christ’s sufferings. To teach otherwise Michael says is heresy.
Yes, heresy, you don’t hear that word thrown around on this blog very often.
(transcript below jump)
Looking at HIV with a consideration towards racial and genetic heritage
This commentary is the opinion of the author and may not necessarily reflect that of other authors at Box Turtle Bulletin
March 31st, 2010
It has long been known that HIV and AIDS in the United States is not experienced proportionately across racial demographics. About 42% of all cumulative AIDS cases, and over 50% of new HIV infections are in African Americans, even though they only comprises about 14% of the population.
And results released last week about a survey of gay men in Washington, D.C. confirm the pattern. While the study found that 14% of the sample of gay men are HIV positive, this was not uniformly distributed.
Men of color who were 30 years or older had the highest rate, more than twice the overall HIV positivity rate. By race and all ages, over a quarter (25%) of black men who participated in the study were HIV positive, more than any other racial group. Over 10% of men who identified as multirace (11%) and other (10%) were HIV positive and 8% of white males who participated in the study were HIV positive.
In fact, this difference was most notable in participants under 30. While 12.2% of young men of color were HIV infected, “of the nearly 100 white men younger than 30, none were HIV-positive.”
This disparity is usually discussed, when it is discussed at all, in terms of social or cultural difference (especially by those who are not African-American). Non-equivalent infection rates are “part of the down-low” or “the result of homophobia in the black community” or “resultant from a lack of self-worth” or some other culture based phenomenon that hints at irresponsible behavior or an inadequate appreciation for safer sex rules.
I do not doubt that there are some social factors (discrimination, economic inequalities, social position, or even media representation) that do contribute to the prevalence of HIV in Black America. But something in this study caught my attention.
Over 40% of men did not use a condom at last sex, though men of color used condoms nearly twice as much as white men.
Younger men who have receptive anal sex (“bottoms”) and older men who have insertive anal sex (“tops”) were less likely to use condoms.
But if black men were twice as likely to use a condom, then how exactly is it that they were more likely to seroconvert?
One explanation that has been bandied about is that because the pool of black men who sleep with black men is already disproportionately infected. Therefore, because there is an increased risk of contact with infected sex partners it raises the likelihood of higher infection rates.
But that doesn’t seem to be evidenced by the results of this study.
The research allows us to compare those who were already aware of their HIV status to those who were newly infected, by race. Assuming that black men were adhering more closely to safe-sex guidelines, this should have been reflected in the ratios. But newly infected men were even more disproportionately men of color than were those already detected.
This seems contradictory to the notion that black men use condoms at higher rates than whites. So perhaps something else is going on. Perhaps there is something other than behavior that is contributing to the disparity.
We know that some communities inherently carry higher risk of certain diseases while others are fairly immune. Tay-Sacks is more commonly found in Ashkenazi Jews, sickle cell anemia is associated with people with recent ancestry from parts of Africa, the Mediterranean, India and the Middle East, and some Scottish islands have higher incidences of color blindness. These are all the results of inherited genes.
So it should not surprise us that various communities may have inherited genetic susceptibilities or immunities that greatly impact the extent to which any individual in that community is at risk for HIV transmission. And, indeed, research does seem to suggest that not all ancestor-location based gene pools respond to potential infection in the same way.
Some people seem to have inherited a resistance to HIV, effectively leaving them immune from infection.
Genetic resistance to AIDS works in different ways and appears in different ethnic groups. The most powerful form of resistance, caused by a genetic defect, is limited to people with European or Central Asian heritage. An estimated 1 percent of people descended from Northern Europeans are virtually immune to AIDS infection, with Swedes the most likely to be protected. One theory suggests that the mutation developed in Scandinavia and moved southward with Viking raiders.
Similarly, it appears that some communities have inherited ahigher susceptibility to HIV infection.
New research shows Africans and people of African descent could be up to 40 percent more likely to get HIV, the virus that causes AIDS, than people of other races.
This appears to be related to the Duffy antigen, a protein on the surface of red blood cells, which plays are role in defense against malaria. This trait appears to be present in over 90% of black Africans and about 70% of African Americans.
Indeed, as I looked for further discussion on the subject of gene-linked susceptibility, it seems that the community of scientists looking for transmission patterns, infection factors, and treatment possibilities share an assumption that genes play a significant role, and one we do not yet fully understand. And even within specific racial groups, some genetic families may be far more susceptible than others.
But this contributing factor seems to be, to a great extent, outside of common knowledge. Even most gay men – including those I know of African descent – seem not be be aware of genetic factors that contribute to increased or decreased infection risk.
And this troubles me. I believe that this is of such significance that it should be emphasized, particularly among those who may have inherited a higher possibility of infection.
As I see it, there are several reasons why an increased understanding of possible racial group or family genetic traits should be part of our consciousness.
First, if African-Americans are not aware of increased risk, they cannot be prepared. And as we learn more about subgroups or families, individuals of all races can take steps to define “safe sex” in more specialized ways. As unfair as such knowledge may seem, knowing that you can’t live by the same standards as everyone else may have life impacting importance for some individuals.
It’s all fine and good to say “always be safe”, but everyone knows someone who slipped up and ended up okay. But if some individuals have inherited higher risk , they need to know that the answer to “what are the odds” is “much higher for me so I don’t dare risk it… ever.”
Second, a different response in one’s body to the presence of HIV should be reflected in treatment and management. It would be foolish not to test to determine whether some treatment protocols were more or less effective based on inherited factors.
Our nation has a history of medical research that assumes that everyone is a white male, and a fairly interchangeable one at that. But if different protocols are more effective for those of African descent, or for others with specific genetic heritage, it would be immoral not to test for such differences and instead rely on, “this is what works for wealthy white men in West Hollywood”.
Third, vaccines under testing should be studied for whether race or inherited attributes impacts effectiveness. I am troubled by the possibility that some vaccines which were discarded as ineffective in some trials may have been very effective in a different demographic.
But I think we need to approach this with sensitivity. HIV/AIDS has a history of blame and stigma; And any discussion which seeks to assign blame or which seeks to make HIV a “black disease” will do more harm than good.
Additionally, we should remember that individuals are, above all else, individual. We should not make assumptions or assign stereotypes.
Instead, we need to focus research and funding, coordinate outreach and education, and for once talk about the impact of HIV on the African American community without hinting that the phenomenon can be explained in terms of behavior.
And in the meanwhile, let’s find a way to be part of the solution. You can contribute to HIV/AIDS prevention efforts that specifically target the African-American community:
(my appreciation to those who read the draft and provided some insight and suggested revision)
The alarmist and misleading new headlines about HIV transmission
March 12th, 2010
The Centers for Disease Control has issued a “new look at disproportionate impact of HIV and syphilis among U.S. gay and bisexual men”. And this “new look” is quite alarming:
The data, presented at CDC’s 2010 National STD Prevention Conference, finds that the rate of new HIV diagnoses among men who have sex with men (MSM) is more than 44 times that of other men and more than 40 times that of women.
That certainly sounds frightening. And it lends itself easily to anti-gay activist who argue that gay men and women do not deserve equal rights under the law because gay men are crawling with disease. (Iowa Independent)
Homosexual activity is “more dangerous for individuals who engage in it than is smoking,” and because of this, state lawmakers need to pass a constitutional amendment overturning last year’s Iowa Supreme Court decision legalizing same-sex marriage, according to Iowa Family Policy Center President Chuck Hurley.
Naturally, anti-gay activists like Hurley fail to distinguish between “individuals who engage in homosexual activity” and individuals who engage in unsafe sex. And, having only the vaguest of notions about those same-sex couples who marry, he leaps at a conclusion that is out of his reach.’
Unsafe sex significantly increases the odds of seroconverting. And considering that the CDC lumps all men who have sex with men (MSM) together regardless of their relationship status or sexual practices, single gay men who whoop it up sans condom with a stranger tonight have a FAR MORE than 44 times likelihood of becoming HIV positive than does a heterosexual dude that does the same. Which is one reason we should encourage relationships and responsible sex.
But setting aside the lunacy of opposing committed relationships so as to stop promiscuous behavior, let’s look at the numbers themselves. And let’s consider the responsibility of the CDC and those who use their statistics to report them in a way that is meaningful and useful rather than pointlessly frightening.
Yes, “44 times that of other men” is scary. But what does it mean?
For that we have to look at the following paragraphs.
The range was 522-989 cases of new HIV diagnoses per 100,000 MSM vs. 12 per 100,000 other men and 13 per 100,000 women.
The rate of primary and secondary syphilis among MSM is more than 46 times that of other men and more than 71 times that of women, the analysis says. The range was 91-173 cases per 100,000 MSM vs. 2 per 100,000 other men and 1 per 100,000 women.
Unpacking the medical language, this is what we find:
There were about 33,750 new cases of HIV infection in 2007. Assuming that gay/bi men make up about 4% of the population, this number is about three quarters of one percent (0.75%) of all gay/bi men.
For syphilis, the number is about 5,900 cases and an infection rate of about one tenth of one percent (0.13%).
Previous analysis suggests that about 12% of all gay/bi men are currently living with HIV. As syphilis is treatable, the total number of gay men living with syphilis is less easy to determine.
Further, if we wish to be credible, we have to recognize that the gay community is not homogeneous. HIV and syphilis infections impact certain demographics far more than others. Factors such as race, location, education, and self-worth can have almost as much a factor on one’s likelihood to contract HIV as sexual orientation.
Too often we can read alarming headlines and think, “why fight it, it’s inevitable.” This isn’t true. Most gay men don’t have HIV and never will. And while these frightening statistics can remind us to be careful, they should be taken in perspective.
When we hear “HIV diagnoses… 44 times that of other men” or “2000 times higher than repeat blood donors”, we have to remind ourselves to step back and take a better look at the numbers. We need to recall that the purpose of information of this sort is to fight the virus, not the people who are infected. And we need to understand that we each are individual and not a statistic.
Rethinking the blood donation policies
This commentary is the opinion of the author and does not necessarily reflect that of other authors at Box Turtle Bulletin.
March 8th, 2010
In 1983, the FDA established a policy requiring that blood banks not accept donations from any male who had engaged in sex with any other man at any point since 1977. This was implemented so as to attempt to eliminate blood which was potentially infected with the HIV virus from the pool, and it made sense at that time.
It wasn’t until 1983 that the HIV virus was identified, and a method of testing for the virus wasn’t established for another two years.
In 2006, the AABB, America’s Blood Centers, and American Red Cross jointly asked the FDA to reconsider these rules. They argued that continuing the ban was not justified by scientific advances since the ban was implemented.
AABB, ABC and ARC believe that the current lifetime deferral for men who have had sex with other men is medically and scientifically unwarranted and recommend that deferral criteria be modified and made comparable with criteria for other groups at increased risk for sexual transmission of transfusion-transmitted infections. Presenting blood donors judged to be at risk of exposure via heterosexual routes are deferred for one year while men who have had sex with another man even once since 1977 are permanently deferred.
Current duplicate testing using NAT and serologic methods allow detection of HIV- infected donors between 10 and 21 days after exposure. Beyond this window period, there is no valid scientific reason to differentiate between individuals infected a few months or many years previously. The FDA-sanctioned Uniform Donor History Questionnaire was developed recognizing the importance of stimulating recall of recent events to maximize the identification of donors at risk for incident, that is, recent, infections. From the perspective of eliciting an appropriate risk history for exposure to HIV and other sexually transmitted infections, the critical period is the three weeks immediately preceding donation since false negative NAT and serology reflect these window-period infections, and the length of these window periods provide the scientific basis for the deferral periods imposed for at risk sexual behaviors.
The FDA refused.
They argue that as gay men have a higher concentration of HIV infection than some other demographics, this justifies a blanket ban on all donations by all gay men.
Men who have had sex with men since 1977 have an HIV prevalence (the total number of cases of a disease that are present in a population at a specific point in time) 60 times higher than the general population, 800 times higher than first time blood donors and 8000 times higher than repeat blood donors (American Red Cross). Even taking into account that 75% of HIV infected men who have sex with men already know they are HIV positive and would be unlikely to donate blood, the HIV prevalence in potential donors with history of male sex with males is 200 times higher than first time blood donors and 2000 times higher than repeat blood donors.
This week, Senator John Kerry, along with several other Senators, sent a letter to the FDA requesting that they reconsider their rules.
“Not a single piece of scientific evidence supports the ban,” the Democratic senator said in a statement. “A law that was once considered medically justified is today simply outdated and needs to end, just as last year we ended the travel ban against those with HIV.”
I doubt that this will be effective. If the FDA refuses to listen to those who know the very most about donation, testing, infection, and the blood supply, why would they listen to John Kerry?
But Kerry’s action does allow us as a nation to re-question why the ban is in place. Is it a matter of heath science or a matter of mistrusting (or disliking) gay men?
The FDA argues that any increased risk of tainting the supply is unacceptable. And that allowing gay men to contribute would unquestionably increase that risk.
But is that true? Does the ban effectively increase the safety of our blood supply? Or does it actually do harm?
To answer these questions, I think we need to look closer at the ban and how it functions.
1. The ban is only as effective as it is perceived to be reasonable. Remember, the ban is voluntary; by that, I mean that the only thing which stops donation is a questionnaire and the donor’s decision to answer honestly. If a gay man is determined to donate, he will only be persuaded not to donate if he believes that the criteria of exclusion is based on reason and not on bias.
2. We must assume that only a psychopath would choose to purposefully donate HIV infected blood. And no questionnaire is going to stop a psychopath. Therefore, this purpose of the questions is to eliminate those who are unknowingly infected.
But who donates blood? According to the Red Cross, only 3 out of 100 of Americans donate. And this 3% is not representative of the population as a whole.
Yes, blood donors come from all races, ages, political affiliations, and economic situations. But they have one thing in common, they are motivated by altruism or a belief that it is in the common good that they donate. They donate because it is the “right thing to do”.
And let’s be practical here for a moment. The type of person who donates blood is not generally the type of person who is irresponsible. If you are a ‘give blood’ type of gay man, you are probably also a ‘get tested’ type of gay man.
So the only unaware HIV-positive infected gay men who are likely to be prevented from donating are those who have good reason to believe (falsely) that they are HIV-negative. That’s not a very big demographic.
3. The FDA does not exclude other demographics who are infected at higher rates than the population at large. For example, over half of all new HIV infections detected in 2007 were in African Americans. While many of those infected are also MSM (men who have sex with men, a term used by the infectious disease community), many are heterosexual. Over 60% of women with AIDS are black. (AVERT)
The estimated lifetime risk of becoming infected with HIV is 1 in 16 for black males, and 1 in 30 for black females, a far higher risk than for white males (1 in 104) and white females (1 in 588).
There are many reasons for this (and for godsake let’s allocate more resources to stemming this trend) and I’m not trying to make comparisons or demonize anyone. But it does demonstrate that the FDA’s banning policies seem inconsistent.
The screening does seek to eliminate those women who might have had sex with a MSM or intravenous drug user in the recent past, but it does not issue a blanket ban based on race (nor should it). However, the “ever had sex at any time in your friggin’ life” definition effectively serves as a ban based on orientation.
So while the FDA does not say that the President of the United States is banned from blood donation based on his ethnicity, it does prohibit donation by Rep. Barney Frank.
4. Not all gay men are equally at risk. Homosexual activity does not create HIV. It is a virus, not a consequence of specific sexual acts. Only about 12% of gay men are infected with the HIV virus.
Yet the FDA treats my friends, a couple in their 40′s who met in high school and have been together ever since, the same as it does some gay man who is single and has an active and diverse sex life. Ironically (and amusingly) it considers ex-gays like Alan Chambers to be no less of a risk than the man whose fetish is to be the recipient in unprotected anal sex.
The FDA clumps gay men into a single demographic and assumes that all gay men are at a higher risk than all heterosexuals.
While statistics indicate a rising infection rate among young heterosexual women, their overall rate of HIV infection remains much lower than in men who have sex with other men.
But clumping in this manner is a foolish and rash policy. Contamination is more likely to come from a young single heterosexual woman who relies on the pill than it is from a gay man in a committed relationship who uses condoms regularly.
5. While the ban on gay men donating does not – in my opinion, as discussed in the points above – serve to diminish much risk of contaminating the blood supply with the HIV virus, it is quite effective at something else: labeling all gay people as dirty and diseased.
This universal ban says, in effect, that all gay men are suspect, a cause of concern, human rats carrying contagion. It feeds the myth that gay equals AIDS and lends credence to the anti-gay activists who market in fear and animus.
But is lifting the ban the answer?
I would argue that a full lifting of the ban is not a wise decision. That would increase – at least in some tiny measure – the risk of taint to the blood pool. Rather, I would advise to change the policy in a way that not only increases the blood supply and to reduces stigma but which also could serve an additional medical function.
Obviously the screening questions need to eliminate the risk of undetected recent infections. But such risks should be based on actual behavior based risk, not on stereotyping of communities. This may even serve to reduce the risk of accidental taint from gay men who ignore the current policy as being nothing more than bias.
Science-based periods of either long-term monogamy or sexual abstinence would likely be respected as reasonable and appropriate. Few gay men would argue that every gay man, regardless of sexual history or responsibility, should donate blood.
And revising the rules for donation to match the requests of the Red Cross would certainly be better than the current policy. But I recommend a different approach.
I recommend that all persons who have any risk of HIV transmission – be they gay men, single heterosexuals, or anyone else who could be at risk – be required to take an HIV test as a step in the donation process. Those persons who tested negative and who had no sexual contact for the previous six months (or whatever restrictions are reasonable) could be treated as acceptable donors. The oral swab tests are non-intrusive, give a response in 20 minutes, and are more than 99% accurate.
The current controls over the blood supply do an amazing job at detecting and removing infected blood. But implementing a screening method that is based on measurability rather than voluntary deferral would effectively eliminate unknown carriers, gay or otherwise.
And it would also reach a population of potentially at-risk citizens who might otherwise go undetected.
The single largest contributor to the spread of HIV is unknown infection. Granted, as I discussed above, those gay men who are most likely to donate blood are also among those most likely to be tested regularly. But HIV testing at a blood donation site could provide access and a safe friendly environment for non-gay people who might be a bit intimidated or uncomfortable asking their doctor or going to the testing center in the gay part of town.
People With HIV Can Have Near Normal Life Expectancies
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.