Box Turtle Bulletin

AIDS Nonsense From the Far Left

We often debunk the junk science emanating from conservatives. Rarely do we mention junk science from the left. It’s not because it doesn’t exist; it’s just rarely anti-gay, so it often escapes our attention.

The Canadian bills itself as “Canada’s new socially progressive and cross-cultural national newspaper.” But from its web site, it’s unclear how often the paper is published, but a scan of its headlines show a strange fascination with conspiracies, especially if they get to use the word “eugenics”:

• Finance Minister Jim Flaherty’s eugenics message on Ontario’s Budget: Cut taxes to the rich, and ignore social justice for the poor and others.
• U.S. journalists suggest Hillary Clinton and Barack Obama are political decoys for the Bush administration’s North American Union agenda
• First Nations Insight: War is caused from the marginalization of the feminine perspectives of women in social and political structures
• Iraq War is a Eugenics orchestrated genocide masquerading as an anti-terrorist operation

For one whose looking for weird stuff to debunk, there’s treasure to be had here. Like this one by AIDS conspiracy theorist Alan Cantwell:

HIV-AIDS was created with the use of Gay men as targets for Eugenic experiments suggests U.S. doctor
There is no doubt that AIDS erupted in the U.S. shortly after government-sponsored hepatitis B vaccine experiments (1978-1981) using gay men as guinea pigs. …

The widely accepted theory is that HIV/AIDS originated in a monkey or chimpanzee virus that “jumped species” in Africa. However, it is clear that the first AIDS cases were recorded in gay men in Manhattan in 1979, a few years before the epidemic was first noticed in Africa in 1982. It is now claimed that the human herpes-8 virus (also called the KS virus), discovered in 1994, also originated when a primate herpes virus jumped species in Africa. How two African species-jumping viruses ended up exclusively in gay men in Manhattan beginning in the late 1970s has never been satisfactorily explained.

Those two paragraphs alone have a lot of whoppers which are easily refuted. Let’s break it down:

The first AIDS cases were recorded in gay men in Manhattan in 1979. Not quite. The first known case of AIDS was found in a 1959 blood sample drawn from an unknown man in Leopoldville, Belgian Congo (today’s Kinshasa, Democratic Republic of Congo, formerly Zaire). This was long before the hepatitis B vaccine experiments that Cantwell is so sure started it all.

The epidemic was first noticed in Africa in 1982. By having this sentence follow the previous one, Cantwell seems to suggest that the African epidemic followed the American one. But just because the African epidemic wasn’t noticed until 1982 doesn’t men that’s when it started. In fact, as early as 1983, researchers had identified an epidemic already well underway. In fact, it was well established in some parts of Zaire in 1976.

How two African species-jumping viruses ended up exclusively in gay men in Manhattan beginning in the late 1970s has never been satisfactorily explained. Here, Cantwell’s referring to the Herpes-8 virus, which we now know causes a form of cancer known as Kaposi’s sarcoma (KS). This disease was a very common opportunistic infection among those whose immune system was compromised. Being a transplant patients has been one historic risk factor due to anti-rejection medications which work by lowering the immune system. KS was also common among many ethnic groups in the Mediterranean, Middle East and Africans living in Africa.

The virus which causes KS may have been discovered in 1994 but the disease was first described in the medical literature by Dr. Moritz Kaposi back in 1872. Because KS has been quite common in Africa, there have been thousands upon thousands of medical reports on the disease throughout the past century. For evidence, all you have to do is go to the National Institutes of Health’s PubMed database, type in “Kaposi’s sarcoma” and press “GO.” As of this writing, you’ll find references for 10,850 articles in professional journals going back to 1948. That’s quite an achievement since PubMed rarely indexes articles published before 1950.

This is pretty elementary stuff that any dermatologist would know. It takes a lot of ignorant — willful ignorance even — for a retired dermatologist like Alan Cantwell to pretend these facts don’t exist. But like all such conspiracy theorists, he has to either ignore fundamental facts or bend them beyond all recognition for his crackpot theories to survive (like some other theorists we know). Cantwell’s theories are so nutty, he had to start his own publishing house just to get his books into print. Nobody else would touch them. But it just goes to show that the practice of abusing science isn’t confined to one end of the political spectrum.  It’s everywhere.

Hat tip: Stefano

HIV Infections Actually Remained Flat Between 2005 and 2006

We’ve already mentioned that the so-called fifty percent “spike” in HIV Infections between 2005 and 2006 was the result of more states reporting HIV infections to the CDC, not because there was an actual increase in infections in one short year. In fact, we’ve reported on the CDC’s new reporting requirements back last November. Once we remove the new states from the CDC’s count of HIV Infections, we find that there truly wasn’t an increase. HIV infections appeared to have remained approximately flat:

The Centers for Disease Control and Prevention’s (CDC) newly published 2006 HIV/AIDS Surveillance Report estimates that there were 52,878 new cases of HIV in 2006. This is a 49 percent increase over the 35,537 cases estimated for 2005, however, the increase is largely due to the fact that the CDC used data from seven additional states in 2006 compared with 2005. If you remove the states not included in the 2005 estimates from the 2006 estimates, the number of HIV cases drops to 34,878, a 2 percent decrease between 2005 and 2006.

I wonder how long it will be before someone ignores all the caveats from the CDC and jumps on the “spike” bandwagon.  Start your stopwatches… now.

Did HIV Infections Really Increase 50% From 2005?

News reports are breaking that the Centers for Disease Control and Prevention’s 2006 HIV/AIDS Surveillance Report (PDF: 2.6 MB/55 pages) shows a whopping 50% increase in the number of those who are infected with the HIV virus from the previous year. (This figure includes those who are infected with HIV, but who are not yet diagnosed with AIDS.) Regular readers of Box Turtle Bulletin may remember that we reported last November that the CDC had changed how they determined this statistic, and that this new methodology is resulting in a higher estimate than before. We reported:

Before the new regulations took effect, the CDC’s methods for estimating the HIV infection rate was based on actual AIDS diagnoses. But HIV infection and AIDS are two different things: HIV is the virus which leads to an AIDS diagnosis some ten years after infection on average. What the CDC used to do to estimate the rate of HIV infections was to take the actual count of AIDS diagnosis and work backwards from there to arrive at an estimate of HIV infections.

But with the average ten year latency period between infection and AIDS, along with the fact that Highly Active Anti-Retroviral Therapy (HAART) has lengthened this latency period for many people with HIV infection, the estimate has become grossly inaccurate. So now that states are required to report HIV infections as well as AIDS diagnosis, the CDC is getting a much better look at the actual rate of HIV infection.

…

So far, the CDC doesn’t believe these new numbers represent a significant increase in actual HIV infections.

Page 9 of the 2006 report shows that 52,878 people are reported to have HIV (not AIDS) in 2006. The 2005 report pegged that number at 35,537. However, several large states (California and Illinois, for example) are participating in the names-based reporting system for HIV (not AIDS) diagnoses for the first time. The CDC acknowledges that much of the increase is due to the dramatic rise in the number of states participating in the surveillance program:

CDC officials were emphatic that the higher number of HIV cases reported “do not represent an increase in the epidemic.”

“Instead, it’s more about our surveillance system than any increase,” CDC spokesperson Jennifer Ruth said Friday.

The CDC only recently tied HIV reporting to the amount of money states receive to fight HIV, meaning new numbers are beginning to come in as more states report HIV cases in compliance with CDC standards. In 2005, the CDC’s HIV/AIDS surveillance report included data from 38 states and territories, compared to the 50 states and areas that contributed data to the 2006 surveillance report.

Georgia, which was one of the last states to conform to CDC’s confidential name-based system for reporting HIV cases, ranked eighth in the number of HIV cases reported in 2006, according to the surveillance report.

Data from these new states were not included in the 2005 report.

Other data, specifically the number of actual AIDS diagnoses by year, seems to suggest that the actual prevalence of HIV is not rising nearly so dramatically, if at all. The number AIDS diagnoses has held relatively steady or even slightly downward for the past eight years even as the overall population continues to grow.

There are two ways to interpret this. First, more effective HIV medication may be forestalling the progression of HIV infection to full blown AIDS. But it also suggests that the number of HIV infections leading to those diagnoses may have been fairly stable through the 1990’s. If the number of yearly AIDS diagnoses continues to hold relatively steady over the next several years, then that should validate the belief that there has not been an actual spike in HIV infections.

See also:
HIV Infections Actually Remained Flat Between 2005 and 2006

Today in History: AIDS in Black Africans

As we’ve mentioned before, by the time 1983 came around the panic surrounding the emerging HIV/AIDS crisis had already reached epic proportions, with anti-gay groups and individuals pinning everlasting blame on the gay community. When they had bothered to notice, some would acknowledge that Haitians, drug addicts and hemophiliacs were also at risk for AIDS. But it was the gay community which bore the brunt of the responsibility for the new “plague.” In 1983, Pat Buchanan would thunder:

The poor homosexuals — they have declared war upon nature, and now nature is exacting an awful retribution.

Ignorance among many Americans was running a fevered pitch, but things were very different in Europe. Belgian and French doctors had noticing something for quite some time: they had been treating wealthy African immigrants from their former colonies who were suffering from diseases which were remarkably similar to those reported by AIDS patients in America. Finally, twenty-five years ago today, on March 19, 1983, the rest of the world would learn what they have been noticing with the publication of this brief letter in the respected journal The Lancet:

Acquired Immune Deficiency Syndrome in Black Africans

SIR,-Acquired immune deficiency syndrome (AIDS) has been described in homosexual or bisexual men, in drug addicts, in haemophiliacs, and in Haitian immigrants. To our knowledge there is no report of AIDS and opportunistic infections in previously healthy Black Africans with no history of homosexuality or drug abuse.

Tables I and II show the clinical and immunological data on five Black patients seen in Brussels and who were from Central Africa (Zaire and Chad). Three of them had been living in Belgium, for between 8 months and 3 years. All were of good socioeconomic status. They presented with prodromes of fever, weight loss, and generalised lymphadenopathy, and extensive investigations did not reveal any neoplasia. Patients A and E died; the three survivors are still ill.

These patients fulfilled all the criteria of AIDS. …

This preliminary report suggests that Black Africans, immigrants or not, may be another group predisposed to AIDS.

Indeed, the world would soon learn the horror that had been stalking the Congo river region for decades. This small letter to the editor would later prove to be the canary in the coalmine. It is the first published indication of a pandemic which had already taken countless lives in Zaire and Chad, and would very soon engulf much of an entire continent.

Source:Clumeck, N.; Mascart-Lemone, F.; de Maubeuge, J.; Brenez, D.; Marcelis, L. Letter to the editor: “Acquired Immune Deficiency Syndrome in Black Africans.” Lancet 1, no. 8325 (March 19, 1983): 624.

See also:
Opportunistic Infections

Today in History: A Fog Begins to Lift

Ten years ago, the February 5, 1998 edition of the journal Nature published a short report by a team led by Tuofu Zhu of Rockefeller University. That team examined the genome of an HIV-positive blood sample taken in 1959 from an unidentified man in Leopoldville in the Belgian Congo (today’s Kinshasa, Democratic Republic of Congo, formerly Zaire). By looking at how the virus has mutated over the past 40 years, and by projecting the mutation of that particular virus (dubbed ZR59) back further, they were able to estimate when the various HIV virus groups evolved from a common ancestor. Zhu and colleagues concluded:

Our results … indicate that the major-group viruses that dominate the global AIDS pandemic at present shared a common ancestor in the 1940s or the early 1950s. Given their ‘starburst’ phylogeny, HIV-1 was probably introduced into humans shortly before that time frame, about a decade or two earlier than previously estimated. …The factors that propelled the initial spread of HIV-1 in central Africa remain unknown: the role of large-scale vaccination campaigns, perhaps with multiple uses of non-sterilized needles, should be carefully examined, although social changes such as easier access to transportation, increasing population density and more frequent sexual contacts may have been more important.

That single serendipidous 1959 blood sample from a man whose name and fate is lost to history provided an important part of our understanding of where the virus came from. Simon Wain-Hobson wrote a commentary in the same issue of Nature explaining its implicaitons:

What else is the position of ZR59 among HIVs telling us? First, it probably means that the global epidemic was indeed founded by a single HIV although, in this respect, it is no different from the annual ‘flu strain. Second, the centre of the radiation and ZR59 are a considerable stretch from any simian counterpart, suggesting that HIV had a human history before it went global. Third, the Big Bang seems to have occurred around, or just after, the Second World War. Emerging microbial infections often result from adaptation to changing ecological niches and habits. And, of course, the post-war era saw the collapse of European colonialism and attendant changes in urban and technological traits. As usual, when data are limited we’re in the realm of speculation, meaning that the story is not over. …

In 1959, the Nobel prize for physiology or medicine was awarded to Severo Ochoa and Arthur Kornberg for their work on nucleicacid polymerases, while the world rocked around to Elvis and Chuck Berry. There was fog in the English Channel.

And in 1959, a blood sample was drawn from an unknown HIV-positive man in the Belgian Congo. What he must have gone through afterwards…

Sources: Zhu, Tuofu; Korber, Bette E.; Mahmias, Andre J.; Hooper, Edward; Sharp, Paul M.; Ho, David D. ” An African HIV-1 sequence from 1959 and implications for the origin of the epidemic.” Nature 391, no. 6667 (February 5, 1998): 594-597. Abstract available here.

Wain-Hobson, Simon. “Immunodeficiency viruses, 1959 and all that.” Nature 391, no. 6667 (February 5, 1998): 531-532.

Today in History: AIDS in Africa

In early 1988, the AIDS hysteria was in full swing. The air was filled with the rhetoric of the innocent “general population” besieged by disease-ridden homosexual men. Just two months earlier, Pat Buchannan wrote an op-ed in the New York Post saying,

There is one, only one, cause of the AIDS crisis — the willful refusal of homosexuals to cease indulging in the immoral, unnatural, unsanitary, unhealthy, and suicidal practice of anal intercourse, which is the primary means by which the AIDS virus is being spread throughout the “gay” community, and, thence, into the needles of IV drug abusers, the transfusions of hemophiliacs, and the bloodstreams of unsuspecting health workers, prostitutes, lovers, wives and children.

The scientific community however wasn’t seeing it that way. For more than five years, several articles had been appearing in medical journals pointing to central Africa as the source for the new disease. Another similar article appeared in the February 4, 1988 edition of the New England Journal of Medicine by lead author Dr. Nzila Nzilambi of Mama Yemo Hospital in Kinshasa, Zaire.

Mama Yemo Hospital saw a large number deaths in the middle 1970’s due to baffling diseases which strongly resembled what would later become known as AIDS. Dr. Nzilambi’s early personal interest in AIDS led him and a group of American and European researchers to investigate the possible origins of AIDS:

The Equateur province of Zaire occupies the northwestern part of the country and has a population of approximately four million people. The river Zaire is an important geographic landmark and provides a major trade route between the cities of Kinshasa and Kisingani.

In 1976, there was an epidemic of Ebola hemorrhagic fever in a remote part of the Equateur province, centered at the mission hospital of Yambuku, near the village of Yandongi. In the course of epidemiologic investigations of this epidemic, many hundreds of serum samples were collected from residents of the surrounding area. This same are was selected for the present study to allow follow-up of persons examined in 1976. There has been no evidence of Ebola virus activity in this region since the 1976 epidemic.

… Five of the 659 serum samples collected in 1976 had antibody to HIV according to both enzyme-linked immunosorbent assay and Western blot analysis. One of the positive samples yielded HIV on culture. At follow-up in 1985, two of the persons who had tested positive for anti-HIV in 1976 were still alive and healthy: Subject 1, a 59-year-old woman, and Subject 2, a 57-year-old-man. Both had remained positive for anti-HIV. The ratio of helper to suppressor T cells was normal in Subject 1 but abnormally low in Subject 2.

A ten years span after infection with the HIV virus and the appearance of AIDS symptoms is quite common. It appears that Subject 1 follows this pattern and may have been very recently infected in 1976. Subject 2 however is beginning to exhibit damage to his immune system ten years after his blood was drawn. The authors continue:

Subject 3, was was 36 years old when blood was collected in 1976, died in 1978 after a prolonged illness characterized by weight loss, fever, cough, and diarrhea. She had lived in Kinshasa from 1972 to 1976, where she was unmarried and was considered a “free woman.” … Subject 4, who was the wife of Subject 2, was 43 years old when sampled for blood in 1976; she died in 1981 after a long illness associated with fever, weight loss, skin rash, and oral lesions. Subject 5, who was 7 years old in 1976, died of pneumonia and weight loss at the age of 16. With the exception of Subject 3, none of these seropositive persons had traveled outside the region of their respective home villages.

…

The results of our study showed that HIV infection was already present in an isolated area of the Equateur province of Zaire in 1976…

… The clinical descriptions of the modes of death in the three fatal seropositive cases were compatible with a diagnosis of AIDS. These findings illustrate that HIV infection and AIDS could have existed and remained stable in a rural area of Africa for a long period.

Researchers had been writing about AIDS in Africa for several years when this study came out. For example, one study two years earlier found an isolated case of HIV infection from a lone stored blood sample from Leopoldville (Kinshasa’s colonial name) taken in 1959. But none of these studies were able to prove where AIDS came from. That would have to wait until later.

But this one did provide solid evidence that HIV was already present in an isolated region of Zaire in 1976, long before it was noticed in America or Europe. And if the 7-year-old boy was infected from his mother at birth, then that would push the date in this community even further back into the late 1960’s.

Source: Nzilambi, Nzila; De Cock, Kevin M.; Forthal, Donald N.; et al. “The prevalence of infection with human immunodeficiency virus over a 10-year period in rural Zaire.” New England Journal of Medicine 318, no. 5 (February 4, 1988): 276-279. Abstract available here.

HIV and Friends, Part 3 — Where Ignorance Rules

It’s strange how sometimes we see a convergence of related topics coming within a few days of each other. In our discussion of the ethics of revealing someone’s HIV status, I wrote at length on the pernicious effects that AIDS-related stigma continues to have within the LGBT community as well as the larger society. Of course, that larger stigma has had more than twenty-five years to fester.

But then yesterday, we had a mainstream news report from Switzerland, in which health experts suggested that people with HIV/AIDS with an undetectable viral load may not be contagious. (While their hypothesis makes a lot of sense logically, I’m not aware of any research to support it just yet.)

But now, we have shocking news out of Canada — you know, that country that is so much in the grip of the “homosexual agenda” — that a judge believes that HIV/AIDS is so contagious, one can be infected just by sharing the same courtroom with someone. According to the Toronto Star:

An Ontario judge is at the centre of a misconduct investigation after insisting a witness who is HIV-positive and has Hepatitis C don a mask while testifying in his courtroom.

Three groups have complained to the Ontario Judicial Council about the conduct of Barrie judge Justice Jon-Jo Douglas, who later moved the case to a bigger courtroom in order to create more distance between the witness and the bench.

… “The HIV virus will live in a dried state for year after year after year and only needs moisture to reactivate itself,” Douglas insisted, according to a transcript of the Nov. 23 trial proceedings.

At one point, court employees donned rubber gloves and placed documents touched by the witness into plastic bags.

Judge Douglas’ ignorance is downright appalling. I have no idea where he gets his medical information. Maybe from the same source as Mike Huckabee. You may recall, he recently defendd his call to quarantine everyone who’s HIV-positive (while saying it wouldn’t be called a “quarantine”). Instead, Judge Douglas should probably acquaint himself with what the experts at Health Canada has to say:

HIV cannot be transmitted through:

— Casual, everyday contact;
— Shaking hands, hugging, kissing;
— Coughs, sneezes;
— Giving blood;
— Swimming pools, toilet seats;
— Sharing eating utensils, water fountains; or
— Mosquitoes, other insects, or animals.

Meanwhile, complaints have been filed against Judge Douglas:

Ontario’s Criminal Lawyers Association has also lodged a complaint with the judicial council. The lawyers’ group contends Douglas did not bring a judicial temperament to trial proceedings and treated a witness differently on the basis of irrelevant personal characteristics. … The complaints are being investigated by a judicial council subcommittee, which will determine if a public inquiry into Douglas’s fitness to remain on the bench is warranted.

Judge Douglas however remains obstinate:

Douglas refused the Crown’s request to grant a mistrial, declined to recuse himself from the case and refused to consider granting bail to the accused, Lee Wilde, when it became clear the trial would have to be adjourned until the judge’s concerns were addressed.

A new trial will begin Feb. 14.

See also:
HIV and Friends, where we discuss the ethics of revealing someone’s HIV status and the pernicious role stigma plays in the assumptions surrounding those living with HIV/AIDS.
HIV and Friends, Part 2 — Is an Undetectable Viral Load Safe?, where we examine the hypothesis of Swiss health officials who suggest that an undetectable viral load renders one virtually non-contagious.

HIV and Friends, Part 2 — Is an Undetectable Viral Load Safe?

The Swiss seem to think so:

The Swiss National AIDS Commission said patients who meet strict conditions, including successful antiretroviral treatment to suppress the virus and who do not have any other sexually transmitted diseases, do not pose a danger to others. …

The Swiss scientists took as their starting point a 1999 study by the U.S. Centers for Disease Control and Prevention, which showed that transmission depends strongly on the viral load in the blood. The Swiss said other studies had also found that patients on regular anti-AIDS treatment did not pass on the virus, and that HIV could not be detected in their genital fluids.

“The most compelling evidence is the absence of any documented transmission from a patient on antiretroviral therapy,” said Pietro Vernazza, head of infectious diseases at the cantonal hospital of St.Gallen in eastern Switzerland and one of the authors of the report.

I have seen a few references to this hypothesis in medical journals — I call it a hypothesis because I haven’t ever heard of a study to test the hypothesis — but I’ve never before seen anyone go out on a limb to say that unprotected sex with someone with an undetectable viral load is safe. And I won’t. As I understand it viral loads can fluctuate for a variety of reasons, including if the person has the cold or flu or any other temporary illness.

I normally wouldn’t even comment on this hypothesis except it has now appeared in the mainstream media. If I were you, I’d demand a whole lot more proof before changing any behaviors. My advice here still stands.

Update: The CDC has responded to the Swiss actions by reiterating their previous recommendations.

See also:
HIV and Friends, where we discuss the ethics of revealing someone’s HIV status and the pernicious role stigma plays in the assumptions surrounding those living with HIV/AIDS.
HIV and Friends, Part 3 — Where Ignorance Rules. If the Swiss believe that HIV isn’t contagious under certain conditions, a Judge in Ontario believes HIV is so dangerous it can be transmitted simply by sharing the same courtroom with someone.

HIV and Friends

This commentary reflects the opinions of the author, and is not necessarily those of the other contributors of Box Turtle Bulletin.

Last Friday, BTB contributing author Daniel Gonzales wrote a controversial post objecting to some advice given on the gay male hookup site “Manhunt.” (By the way, I think that post marks the first time an author on this humble site has ever linked there, but that’s beside the point.) The advice was in response to this question:

So, my friend “Dave” has HIV and when he met my other friend “Steve” sparks flew. I debated if I should tell Steve that Dave was positive but decided not to. Later that night Dave and Steve went home together and when Dave told Steve he was positive things came to an abrupt halt and now Steve is no longer speaking to me because he thinks I should have said something. Was I right to keep my trap shut?

Manhunt’s sex-advice columnist Michael Alvear’s responded:

I would have told “Steve” that “Dave” was HIV+. Why? When philosophy meets reality, logic flies out the window. If I’m asked to choose between an abstraction like personal responsibility and the well being of a close friend, I would rather be intellectually inconsistent than emotionally tortured. I’m not passing judgment on you because there are good arguments on both sides. The only person who needs a wake-up call is negative Steve. He gave up a night or maybe a life with an awesome guy just because he’s HIV+? What a schmuck.

Daniel called that advice “bogus”:

Remind me never to make friends with Alvear if I contract HIV.

A person’s HIV status is their own business and their own business only. I’ve been in situations similar to this and never for a second considered disclosing someone else’s status.

The response in the comments was quite varied. And privately, I’ve gotten a few e-mails from readers who are very puzzled by Daniel’s reaction. One asked if we’ve lost our collective minds. Well, yes and no. The topic of HIV/AIDS tends to do that. Since some have questioned our credibility because of that post, I want to take some time to address this question in detail and throw my two cents worth in.

This particular situation calls for everyone to examine this from three sides: Steve’s responsibility, Dave’s responsibility and Bob’s responsibility. Who’s Bob? Well, the letter writer doesn’t have a name, so I’ve named him Bob.

Steve’s Responsibility

Let’s recap. In a nutshell Steve is Bob’s friend, but he’s mad at Bob because Bob didn’t tell him that his other friend Dave was “poz,” or HIV-positive. Steve’s furious that because Bob didn’t warning him ahead of time, Steve didn’t know until Dave was “poz” until Dave told him, bringing everything to an “abrupt halt.”

I think we can all agree with Michael Alvear on one point at least: Steve is a schmuck, but for a more serious reason that Alvear cites. Steve’s a schmuck because he’s denying his own irresponsible behavior while trying to make Bob the scapegoat.

Look at what happened. Steve was about to have sex with a someone he had just met that night, and he was going to do so without having “the conversation.” And it appears that Steve decided to call everything to “an abrupt halt” only because he got the “wrong” answer from Dave when Dave brought it up. Ironically, the “wrong” answer just happened to be the honest-to-God truth about Dave’s HIV status.

If there ever was a case of playing with fire, this is it. What if instead of honest Dave, Steve had found another really hot guy that he decided to go home with, someone who Bob didn’t know. And what if no conversation took place? I have a sneaking suspicion that nothing would have come to “an abrupt halt.”

But let’s say that Steve is only slightly less than a schmuch and initiated the “the conversation,” and in that conversation Steve got the “right” answer because this hot guy lied about his status? Would Steve have brought everything to an abrupt halt then?

Or what if that hot guy just assumed that he’s negative because he’s never been sick and never been tested? According to the CDC, nearly one million Americans are infected with HIV, but about a quarter of them don’t know it.

Or what if that hot guy was honest and thought he was really HIV-negative because he just got a negative test result last week? That negative result may not mean he’s actually HIV-free. The truth is, it can take from a few weeks to several months before an infection leads to seroconversion in some people, and it’s that seroconversion which produces a positive result.

All we know is that Steve changed his behavior because Dave gave him the “wrong” (but honest) answer. But given all the possibilities in this situation, Steve is playing a dangerous game no matter what anyone else might say or do. Before anyone casts any stones towards anyone else, we really need to place the responsibility for Steve’s health squarely where it rests: with Steve.

Dave’s Responsibility

But just because the primary responsibility rests with Steve, it doesn’t mean he’s the only one who should be concerned. And in this story, it turns out that Dave is the hero in the story. He made sure “the conversation” took place and gave Steve the information he should have asked for. At least we know that there’s one responsible person in this whole scenario. He deserves a heaping helping of recognition, and everyone who is in this situation needs to follow Dave’s example. It’s tough though for a lot of reasons, so I have a whole lot more to say about Dave. So stick around, because I’ll come back to Dave after I deal with Bob, since he’s the focal point of the whole controversey.

Bob’s Responsibility

So now we come to Bob. The guy caught between his two friends, Dave and Steve.

I wish Bob had explained why he decided not to tell Steve about Dave’s HIV status. I’ve thought about it, and can only come up with three possible legitimate reasons: 1) that he was confident that Dave was a stand-up guy and would do the right thing, or 2) that he thought that Steve was a stand-up guy and would do the right thing, or 3) that it wasn’t any of his business.

On the first point, Bob was right. Dave is a man of integrity who did the right thing. Maybe that’s why Bob and Dave are friends.

But on the second point, Bob was seriously wrong. Steve was a complete idiot. Does that mean Bob should have spoken up? Maybe so, and he can do it without disclosing Dave’s HIV status. But given Steve’s reckelessness, Bob might be taking on more responsibility that he can reasonably handle, since he’d probably feel obligated to speak up regardless of who Steve is about to go to bed with. With Steve’s dangerous calculation, how on earth is Bob going to keep him out of trouble?

So what about the third point? Is it any of Bob’s business?

My view aligns somewhat with Daniel, that it is none of Bob’s business — generally.

We all know that matters of health are very sensitive, so much so that we demand confidentiality between the patient and his or her doctor. I think we can all instinctively understand that this confidentiality is important. And so as a general rule, I think we can understand that maintaining confidence about someone’s health status is generally wise.

It’s the party line in the poz community that one must never ever ever never reveal someone else’s health status. But that’s the thing about party lines. Party lines which leave no exceptions, generally speaking, aren’t always wise. There needs to be room for exceptions.

The question has been asked, does privacy trump safety? I think the question sets up a false dichotomy. If I were Bob and I believed that my friend Dave would actually lie about his status, and I believed that my other friend Steve was too much of an idiot to take care of himself no matter what Dave might or might not say — then yes, I would probably feel obligated to say something. But that doesn’t mean I have to reveal Dave’s HIV status.

But if Steve were such a complete idiot there was no other way of getting through his thick skull, then yes, if pressed, then I might. But remember, in this very limited scenario, I believe that my friend Dave would lie about his status (and why would I protect that behavior?) and that Steve is stupid and utterly irresponsible. Which means that I’d also have to dump both friends and look for a much better class of friends.

I know that’s crossing a party line, but sometimes party lines beg to be crossed. But in the end, I’m no more capable of protecting Steve than anyone else. Ultimately, it has to be up to him.

But there’s another point to be made here. The issue has been raised that Bob had no business discussing Dave’s health status. But I’d also point out that Bob had no business assuming that serodiscordance between Dave and Steve should be a deal breaker.

Serodiscordance in couples — where one partner is HIV-positive and the other is negative — is not terribly uncommon. There thousands of couples all across the country, both casual and serious, who are “poz/neg” (I hate the term “serodiscordant”; it sounds too, well, discordant). The fact that Dave and Steve are of a mixed serostatus doesn’t mean sex is inherrently dangerous for Steve. It just means that they need to take measures to keep from passing HIV on. This isn’t always easy, but thousands of couples somehow manage. Besides, the fact of this particular couple’s being poz/neg shouldn’t trigger any change in behavior on Steve’s part anyway, since Steve needs to protect himself no matter what anybody says or doesn’t say.

But if Steve considers serodiscordance unacceptable — and he has every right to establish whatever boundaries he chooses (again, I’m treading on another party line) — then that just means he has a special obligation to raise “the conversation” as early as possible. After all, doesn’t Dave have a right to know he’s about to waste an evening with someone who considers it a deal-breaker? If Bob knew that serodiscordance was a problem with Steve, then if anything he probably should have pulled Dave aside and told him, “hey, Steve’s not going to go for this.” But I don’t see anyone making that argument for some reason.

I think Bob did the right thing in this particular scenario. With a different scenario, maybe Bob might feel compelled speak up. Since this is something of a judgment call, I wouldn’t come down too harshly on Bob if he had said something — although I’d be very critical if he unnecessarily disclosed Dave’s HIV status. But I strongly disagree with the notion that Bob bore a moral responsibility to do so.

So to those who say “I would want to be told”: if you really want to be told, then ask — and take the answer with the appropriate grains of salt. That’s the only way to protect your health. No one else can protect it like you can. Even if Bob were inclined to freely blab about who’s poz or not, he won’t always be around.

Let’s Talk About Dave Some More

Remember Dave? In the responses to Daniel’s post, both public and private, few seemed to notice that it was Dave — the poz guy who posed such a terrible threat to poor unsuspecting Steve — who showed responsibility by forcing “the conversation.” For some, it’s almost as if the poz guy is virtually guaranteed not do the right thing. That because he “did something wrong” to get infected, then he’s going to keep doing something wrong to pass it on.

Ever since five gay men died in Los Angeles in 1981, people with HIV/AIDS have been a frightening abstraction. AIDS is certainly frightening. It’s commonly believed to be a fatal condition, but that’s no longer true. Thanks to modern medicine, AIDS has moved from being a fatal disease to a chronic one, much like diabetes. It is still a very serious, complicated and life-changing condition (like diabetes), it still causes a lot of health problems in virtually every organ of the body (like diabetes), it still ultimately results to a lot of deaths for too many people (like diabetes), and it remains incurable (you get the picture). And like modern-day diabetes, AIDS is often acquired due to poor choices that one makes in life — but also like diabetes that’s not always the case.

AIDS differs from diabetes in two distinct ways. First, AIDS is communicable and diabetes is not. And secondly, unlike diabetes, AIDS carries a very special stigma more than twenty-five years in the making.

Well there’s a dirty secret we’re not supposed to talk about, so I’ll cross yet another party line. It’s the stigma that surrounds HIV/AIDS within the LGBT community. In February 2006, Cari Courtenay–Quirk and colleagues published a study in the journal AID Education and Prevention titled, “Is HIV/AIDS Stigma Dividing the Gay Community?” In short, the answer is yes. One poz participant talked about the taboo that has developed among some:

I think people support you to a certain extent, and then they kind of back off from you. It’s like taboo to them. So on the one hand, they’re always there to help and they’re concerned, but when it comes down to getting to know you, if they’re not HIV–positive, then it’s different. There’s some sort of block there.

The stigma surround HIV/AIDS often keeps HIV-negative men from talking about it, much like Steve in our story. Another study participant noted:

They are afraid of being involved with somebody who has it or being attracted to somebody who has it and then risking getting it themselves. And it’s a lot of just not wanting to think about it, and so please, don’t bring it to my attention. Let’s not talk about it, and, you know, we’ll be fine.

That very same stigma can reach everyone regardless of HIV status. Several years ago, I decided it was time to shed a lot of excess weight. When I did, I experienced reactions similar to this one:

Nobody knew his status. And he chose not to tell anyone. And I would hear like a lot of little remarks because he started losing weight, you know. And it wasn’t in a sort of nice way. I don’t know, but catty gossip, you know? Like, so yeah. I think that sometimes you can find prejudice among your own people.

There is considerable stigma surrounding HIV/AIDS, and it’s not just heterosexuals who are responsible for it. The difficult truth is that it is alive and well within the LGBT community. And because of this stigma, many people with HIV/AIDS remain in a second closet, fearful that if their secret gets out they will lose friends and family and even their homes and jobs. The stigma also affects people who are not living with HIV/AIDS, including even AIDS volunteers and health care workers. People living with HIV/AIDS who have experienced this stigma are more likely to be non-compliant in mantaining their health regimens, and they are less likely to reveal their serostatus to their prospective partners and friends. Stigma has even been cited as a critical factor in why some people put off getting tested or treated.

I’ve personally seen the HIV/AIDS closet in action. In cities where there is less stigma attached to HIV/AIDS, people talk more freely and openly about themselves and their health. They have come out of that second closet. But in other places, having HIV/AIDS is treated as a deep dark secret which can be disclosed to no one. Not even to their close friends like Bob.

As long as HIV and AIDS are the topics for gossip, intrigue and condemnation, there will always be those who would just rather hide than make themselves known. That’s human nature, and as gay men you’d think we’d be more sensitive to this dynamic that we’re creating. All of us, positive and negative, have been there with regard to our sexuality. Yet we are setting up the same forces with HIV/AIDS.

No matter how responsibly Dave carries himself for the rest of his life, it appears he will still judged by his HIV status. He is often looked upon as a dangerous predator out to infect the poor innocent Steves of the world. This notion that Bob needs to go around warning all the Steves of the world about Dave just provides more fuel to that attitude. It’s time for Steve to finally grow up and be a man.

So Steve, leave Bob alone. He can’t keep you safe. Only you can do that.

Schmuck.

See also:
HIV and Friends, Part 2 — Is an Undetectable Viral Load Safe?, where we examine the hypothesis of Swiss health officials who suggest that an undetectable viral load renders one virtually non-contagious.
HIV and Friends, Part 3 — Where Ignorance Rules. If the Swiss believe that HIV isn’t contagious under certain conditions, a Judge in Ontario believes HIV is so dangerous it can be transmitted simply by sharing the same courtroom with someone.

Michael Alvear & Manhunt – Remind Me Never To Be Your Friend If I Contract HIV

The gay hookup site Manhunt.net has an in-house sex advice columnist, Michael Alvear. Here’s my summary of this week’s question:

So, my friend “Dave” has HIV and when he met my other friend “Steve” sparks flew. I debated if I should tell Steve that Dave was positive but decided not to. Later that night Dave and Steve went home together and when Dave told Steve he was positive things came to an abrupt halt and now Steve is no longer speaking to me because he thinks I should have said something. Was I right to keep my trap shut?

Columnist Alvear replies by quoting an exchange he had with NYC-based psychologist Dr. Brad Thomason in which Thomason takes the position it’s never ok to disclose someone else’s status. Alvear, however ends by stating:

I would have told “Steve” that “Dave” was HIV+. Why? When philosophy meets reality, logic flies out the window. If I’m asked to choose between an abstraction like personal responsibility and the well being of a close friend, I would rather be intellectually inconsistent than emotionally tortured. I’m not passing judgment on you because there are good arguments on both sides. The only person who needs a wake-up call is negative Steve. He gave up a night or maybe a life with an awesome guy just because he’s HIV+? What a schmuck.

Remind me never to make friends with Alvear if I contract HIV.

A person’s HIV status is their own business and their on business only. I’ve been in situations similar to this and never for a second considered disclosing someone else’s status. This bogus “advice” has no place on Manhunt, a site which appears to be concerned with promoting socially responsible sex practices.

For those interested here are some contact emails, support@manhunt.net, cruisedirector@manhunt.net, info@online-buddies.com

And if you’re so inclined, Manhunt’s phone number 866-424-9999, and the phone number for the company that owns Manhunt, “Online Buddies Inc” is 617-225-2727.

Kay Warren’s Fight Against Aids

Kay Warren, wife of the pastor and author Rick Warren, has written a new book, Dangerous Surrender, encouraging conservative Christians to join the fight against the spread of HIV and AIDS.

Like many who have spent the last 25 years hearing how AIDS is God’s judgment against gays, I am cautious in endorsing Warren’s efforts. Part of me feels that if it takes a trip to Africa to see dying heterosexuals in order to stir your compassion, then I am inclined to think your “help” comes with too many strings attached.

Mrs. Warren is aware that conservative involvement is met with skepticism. And I believe her words illustrate both an awareness of the problem as well as a practical solution.

Did Jesus ever ask anybody, “How did you get sick?” We get stuck on the “How did you get sick? How did you become infected?” We look with everybody with HIV and assume they did something wrong and that’s why they’re sick. You will not find Jesus asking, “How did you get sick?” He just said, “What can I do? How can I help you?”

First, we need to get God’s heart on how he feels about people who are sick. Second, we need to model our ministries after the way Jesus treated people. Third, we need to come alongside and build relationships with people that says it doesn’t really matter to me whether you put yourself at risk or you didn’t put yourself at risk. The point is I’m going to care for you. My response is going to be the same.

Warren has also come up with a practical program for reducing or eliminating the spread of the virus:

If you want to S.L.O.W. down the spread of HIV:

S Support the correct use of condoms every sexual encounter.
L Limit the number of partners, because studies have also shown that the greatest risk is in multiple partners.
O This is very controversial. Offer needle exchange. Studies have shown that in some places clean needles can slow down the transmission of HIV.
W Wait for sexual debut. Studies have shown that the younger a person is at their his or her sexual encounter, the more likely it is that he or she will be infected with HIV. So if you can encourage people to wait until they’re older, eighteen, nineteen, twenty, before they have their first sexual encounter you can slow down the spread of HIV.

I have an even higher goal: I don’t want to just manage HIV. My goal is to end HIV. I want the world to be rid of this evil virus.

So to STOP it requires a different strategy.

S Save sex for marriage.
T Teach men and boys to respect and honor women and girls. If men continue to treat women with such disrespect, HIV will be on our planet for a long time to come. So there’s a discipleship element.
O Offer treatment through churches. We think that those things that I told you about, those six things that churches can do, when the church is involved, it can stop the spread of AIDS.
P Partner with one person for life.

While the SLOW approach is pragmatic and relies on tested methods, I find much in the STOP half of this that smacks of heterosexism. Her program is geared solely to address heterosexual contraction of HIV and ignores the existance of gay men and women.

It is of no value whatsoever to tell a young gay man that he is to wait for marriage while simultaneously railing at him that allowing him to marry would destroy the foundations of society. And lessons on how to respect women are not going to give him tools on how to avoid infection.

Yet as the conservative church has been so very reluctant for so very long to provide the slightest care for those with HIV or AIDS, I welcome even this exclusionary approach. I am hopeful that Kay Warren’s STOP program is simply ignorant of the realities of same-sex attraction and are not a continuation of the church’s long history of barring its door to those who find themselves gay.

Perhaps in her new book she better lays out her beliefs. Until then I’ll gladly give her the benefit of the doubt and welcome the vast resources that conservative Christianity can bring to those suffering.

CDC’s HIV Stats Higher Than Previously Thought

We mentioned that UNAIDS revised their estimates downward for the number of people worldwide infected with HIV. The US Centers for Disease Control and Prevention (CDC) is grappling with the opposite problem. The Washington Blade reports that the CDC is trying to figure out how to break the news that the annual number of new HIV infections in America are as much as fifty percent higher than the 40,000 or so per year they had previously estimated:

According to AIDS advocacy groups familiar with the CDC, middle level officials at the disease prevention agency have quietly confided in colleagues in professional and scientific circles that the number of new HIV infections now appears to be as high as 58,000 to 63,000 cases in the most recent 12-month period.

…CDC officials have told leaders of AIDS advocacy groups that the new figures are being withheld while they are subjected to a rigorous peer review process by an unidentified scientific journal, which is expected to publish the findings within the next few months.

Others familiar with the CDC have said CDC would likely publish the new data in its own journal, Morbidity and Mortality Weekly Report.

As of this morning, the CDC’s web site still cites the 40,000 figure for HIV infections. This tracks the actual number of AIDS diagnoses that the CDC counts each year.

Part of what the CDC is trying to grapple with is the political dimension of HIV/AIDS. Headlines screaming about a fifty percent spike in HIV infections are sure to provide a bonanza for anti-gay extremists. With that crowd, this news will be like winning the lottery.

But according to the Blade, the CDC’s experts believe that the dramatic increase doesn’t reflect an actual increase in HIV infections, but are the result of new requirements that states accurately track and report HIV test results. There has been mandatory reporting of AIDS diagnoses since the mid-1980’s, but requirements for mandatory reporting of HIV infections didn’t begin until more recently.

Before the new regulations took effect, the CDC’s methods for estimating the HIV infection rate was based on actual AIDS diagnoses. But HIV infection and AIDS are two different things: HIV is the virus which leads to an AIDS diagnosis some ten years after infection on average. What the CDC used to do to estimate the rate of HIV infections was to take the actual count of AIDS diagnosis and work backwards from there to arrive at an estimate of HIV infections.

But with the average ten year latency period between infection and AIDS, along with the fact that Highly Active Anti-Retroviral Therapy (HAART) has lengthened this latency period for many people with HIV infection, the estimate has become grossly inaccurate. So now that states are required to report HIV infections as well as AIDS diagnosis, the CDC is getting a much better look at the actual rate of HIV infection.

Another factor which may be causing the HIV stats to rise could be the CDC’s latest recommendation that most adults in the US undergo an HIV test during routine doctor exams as well as hospital emergency room visits. This may be catching many people who either avoided HIV testing or who believed they weren’t at a significant risk for infection. So not only is the CDC now actually counting HIV infections instead of merely estimating them, their policies may have resulted in an increase in the number of people getting tested each year.

So far, the CDC doesn’t believe these new numbers represent a significant increase in actual HIV infections. Yearly AIDS diagnoses has held relatively steady for the past eight years, which suggests that the number of HIV infections leading to those diagnoses was probably fairly stable through the 1990’s. If the number of yearly AIDS diagnoses holds steady over the next several years, then that should validate the belief that there is no actual spike in HIV infections.

AIDS – Poppers Connection

Between the first reporting of a new “cancer” that was appearing in young gay men in 1981 and the discovery of HIV in 1984, there was a lot of speculation about why some men were getting sick and others were not.

One of the popular hypotheses was that the use of poppers (amyl nitrate, an inhalent that gives the user a rush) was the reason. With the discovery of HIV and further research into its methods of transmission, the poppers discussion was dismissed as nonsense.

Now, more than 20 years later, a study seems to confirm that early guesswork:

Researchers found that gay men who inhaled poppers during unprotected anal intercourse had a significantly increased risk of being infected with HIV. The investigators think there are two reasons why poppers are implicated in HIV transmission. Firstly, they facilitate longer and ‘rougher’ sexual intercourse; and secondly, poppers could increase biological susceptibility to infection, either by suppressing immune function or increasing uptake of body fluids.

UNAIDS “Cures” 6.3 Million With HIV

This is something that happens all too often. Say you’re a medical professional trying to understand the spread of a particularly sexually transmitted disease. What better place to go to study it than the local STD clinic? Just run a survey of the people who show up, and if you’re lucky and the findings are interesting — either they confirm something that others have suspected or they show something new and different from what was believed to be true before — you get to write up a research report, publish it in one of literally hundreds of professional journals, and your small contribution adds to the enormous body of knowledge which continues to accumulate about that disease.

If you’re unlucky however, someone else — say, an anti-gay activist — will read your report and they will write another report which says that everyone behaves just like your sample from the local STD clinic. They do this even though your sample is in no way representative of the general population, or even necessarily representative of STD clinics in other cities. But that’s how we get such nonsense as the so-called “Dutch Study.” Anti-gay activists claim that it “proves” that gay relationships last only 18 months on average and that gay men have some eight additional partners each year while in that relationship. Of course, this is not what that “Dutch Study” demonstrated at all. But no matter. They have their shocking statistic which they use quite often.

So what does it say about the state of our knowledge of the worldwide AIDS epidemic when we discover that epidemiologists — those who are tasked with studying the transmission and control of epidemic diseases — do the same thing as these anti-gay activists?

This morning’s New York Times reported that the UN agency UNAIDS issued a report acknowledging that it had been overestimating the size of the worldwide AIDS epidemic (PDF: 144KB/3 pages) by more than 6 million people, and that the epidemic actually peaked in the late 1990’s. And how did this happen? According to the New York Times:

Until recently, most national estimates were made by giving anonymous blood tests to some young women who came into public health clinics because they were pregnant or feared they had a sexually transmitted disease; those results were expanded with statistical models.

But epidemiologists have realized that such a method — usually applied in big urban clinics because it was more efficient — oversampled prostitutes, drug abusers and people with multiple partners, and ignored rural women. Then the statistical extrapolations exaggerated those errors.

Recognizing this elementary flaw — one they should have recognized from the beginning — UNAIDS now estimates that there are currently 33.2 million people infected with HIV, down from its estimate of 39.5 million from a year ago. It’s as if 16% of the world’s HIV-positive population was cured overnight.

Of course, we know that there was no miraculous cure. It’s just faulty math. And unfortunately, epidemiologists — the very people who should know better — are too often prone to making exactly this kind of error.

Some suggest that there may be political motivations involved in inflating the numbers. After all, jurisdictions which can show that they have a severe problem with a given disease can more easily qualify for grants, discounts, loans and other aid to fund research, prevention and treatment programs. If that’s the case, then this implies that one jurisdiction’s exaggeration may draw badly needed funds from other jurisdictions which act professionally and play by the rules.

It’s hard to tell if that’s a major problem with the UNAIDS surveillance program. Several African countries are now implementing more rigorous surveillance programs, while India has switched to a more representative household survey. UNAIDS says that these two developments are largely responsible for their estimate’s dramatic decrease. But there’s no question that HIV/AIDS is heavily politicized the world over.

I’m glad there are now 6 million fewer people with HIV in the world. It should still concern all of us that there are still maybe 33.2 million, more or less, with HIV. That’s the bigger picture we need to focus on.

But at the risk of drawing too much attention away from that more important picture, I’d like to suggest that there’s another lesson to be learned here. People and statistics are two entirely different things. And sometimes, when you really look at where statistics come from, you may discover that they have surprisingly little to do with the people they purportedly represent. Just try to ask those 6.3 million who were “cured.”

AIDS: One, Two, Three (and Four)

ONE: Four Chicago Transplant Recipients Test Positive for HIV
In a development that is likely to set back efforts to life the ban on gay men donating blood, four Chicago area transplant patients have recently tested positive for the HIV virus after receiving their transplants last January. Hospital and organ donation officials believe the virus escaped a rarely encountered flaw in the test procedures, a flaw that more sensitive tests could help fix. This is the first known case of transplant-related HIV transmission since 1985.

TWO: Failed AIDS Vaccine May Leave Recipients More Susceptible to AIDS
In a development that is likely to set back efforts to bring potential AIDS vaccines to trial, top investigators in the failed Merck HIV vaccine study said they are still trying to understand why who received the vaccine had higher rates of HIV infection than those who received the placebo. \

The vaccine is made from a common cold virus with three synthetic HIV genes tucked inside. The vaccine is designed to stimulate the immune system to kill any HIV-infected cells encountered in the future. But the preliminary investigation suggests that this stimulation didn’t take place where patients had a pre-existing immunity to that particular cold virus.

THREE: Cheer Up, And Have A Happy AIDS Day!
The deliciously offensive comedienne Sarah Silverman may or may not have penned this ditty for World AIDS day:

I’m not black
I’m not gay
And Africa is so far away
But what’s one more December holiday?
Happy AIDS Day anyway

I have no idea whether this is genuine or not. But it certainly captures the apathy surrounding AIDS in a very sardonic, ironic, Silvermanesque way. And it reminds me of this episode from the first season where Sarah decides to cheer herself up by getting an AIDS test.

(UPDATE) AND FOUR: Not Everyone’s So Apathetic After All
Someone in Dallas worked up the motivation to shoot out the AIDS Interfaith Network with a high powered rifle. The rifle was powerful enough to go through the wall of the building, tearing up furniture, a printer, a file cabinet and other office supplies. One person was in the building at the time of the overnight shooting, but no one was hurt. Two of the minivans used to take patients to their appointments were put out of service by the overnight shooting. According to the Dallas Morning News, “With much of the rest of the drab, one-story office complex vacant, the cluster of bullet holes doesn’t seem like the mark of random gunfire.”