Box Turtle Bulletin

Researchers Catch HIV Infection In The Act

The Telegraph reports:

Researchers found that the virus is transferred from infected cells to healthy ones in a previously unknown way. It is hoped that the discovery will help researchers create a vaccine to combat the virus, which has led to the deaths of more than 25 million people.

The study was made possible after experts created a molecular clone of infectious HIV and inserted a protein into its genetic code which glows green when exposed to blue light. This allowed scientists to see the cells on digital video, and capture the way HIV-infected T-cells interact with uninfected ones.

They noted that when an infected cell came into contact with a healthy one, a bridge was created between them, called a virological synapse.Researchers were then able to observe the fluorescent green viral particles moving towards the synapse and into the healthy cell.

The US study has broken new ground by revealing that it is the synapse through which the viral proteins are gathered and moved into uninfected cells.

… [P]revious efforts to create an HIV vaccine have focused on priming the immune system to recognise and attack proteins of free-circulating virus. The new video footage indicates that HIV avoids recognition by being directly transferred between cells. Dr Huser said: “We should be developing vaccines that help the immune system recognise proteins involved in virological synapse formation and antiviral drugs that target the factors required for synapse formation.”

The study’s findings are available in advance of publication ($15) at the website for the journal Science. The journal has made eleven movies available online for free here.

Jamaica’s Anti-Gay Laws Lead to Increased HIV

Jamaica, perhaps the most homophobic spot in the Americas, still retains anti-“buggery” laws. And, unlike some countries who have laws that are more for message than for punishment, Jamaican society enforces these prescriptions by means of mob violence and murder.

Needless to say, fear of exposure is not conducive to steady, monogamous, mutually-supportive relationships. Instead, those societies that threaten the lives and freedoms of gay persons lead to hidden individuals furtively seeking sexual release and then fleeing into the shadows. Many seek to hide behind a public heterosexual front and live a double life.

This is healthy for neither the individuals nor the society. And Jamaica is a prime illustration. According to a 2008 study by the Caribbean HIV & AIDS Alliance (CHAA) (Jamaica Gleaner):

31.8 per cent of gay men in Jamaica are living with HIV. Another 8.5 per cent were found with chlamidia, 2.5 per cent had gonorrhoea and 5.5 per cent had syphilis.

These are shocking rates of infection. And the reason for them does not lie solely in the secret, furtive, shameful nature of the brief liasons. Rather, they are compounded by a society in which seeking medical care in an honest fashion can gat you killed. As a UNICEF worker reported in 2007,

Beaten, stoned, thrown out and even killed are the prices some people face just for being HIV positive in Jamaica.

CHAA lays the blame for the shocking rates of HIV and other infectious disease at the feet of homophobia and mistreatment. Not only are MSM frightened to seek medical care, they are fearful of HIV/AIDS groups that seek to help them. This leaves gay men, in particular, at great risk for transmission of a potentially life threatening disease (MedicalNewsToday).

Devon Cammock, the targeted intervention coordinator at the Jamaica AIDS Support for Life, said that MSM tend to hide their sexuality even from other members of the MSM community, which makes it difficult to conduct programs that are needed in the community.

Should there be among you some so callous as to think that this is just a “gay disease” and that they are just getting what they deserve (an attitude that is not limited to places like Jamaica), you may wish to consider that homophobic laws and culture are a danger to everyone.

In Jamaica, only those who are most brave (or most suicidal) dare identify as gay. So to track health issues they use the term “men who have sex with men (MSM)”. And CHAA has found that MSM are indeed living a double life – and a dangerous one :

Some 27.7 per cent [of MSM] reported having two or more sexual partners in the last four weeks; 25.9 per cent had a new partner in the past four weeks; 28.8 per cent had a female partner in the past four weeks; 15.9 per cent live with a female partner; and 33.8 per cent had two or more female partners in the past 12 months.

But Jamaica’s culture of violence and hatred is not softened by unknowing victims. Rather, their homophobia is so strong it spreads to non-gay persons who have become HIV infected. Take the story of 20 year old Katie.

In the year and a half she has known she’s infected, Katie has struggled through a lot. When she discovered her status, the boyfriend she was living with threw her out along with her daughter, who is currently four and whose father tragically died the same year she was born.

After being thrown out by a boyfriend she went to live with her father, where the situation got worse. There, her step-mum spread rumours that she had AIDS and would point her out on the streets, a very dangerous act considering the destructive discrimination she could face.

Although it’s still a mystery how she got infected, it’s one Katie is in no hurry to solve, “it really doesn’t matter to me anymore because I have my daughter and it would really hurt me and her if I started searching for who I got infected by”.

Katie gets little sympathy in Jamaica. Those persons who are gay and invested with HIV get none.

Unless the Jamaican leaders – be they civil, religious, cultural, or community – become willing to let go of their own fear and hatred and say, “enough is enough”, this nation will continue to wallow in crime and disease, clinging only to its animus and self-righteousness, until the freedom-loving nations of the world want nothing to do with her.

HIV Gene Therapy Trials Begin

Human trials are about to begin on a form of gene therapy that could immunize people against the most common type of HIV. Recruiting for the human trials began yesterday.

According to Wired.com:

Since the discovery that a small portion of people who are exposed to HIV do not get infected, scientists have been working to discover the secret to those people’s resistance and how to make others resistant as well.

It turns out that most people have a gene called CCR5, which makes them vulnerable to HIV infections. The naturally resistant people have mutant CCR5 genes that inhibit HIV.

Previously, scientists found that by cutting the CCR5 gene out of white blood cells involved in the immune response known as T-cells, they could protect a tube full of human cells from the virus. The gene editing technique relies on proteins called zinc finger nucleases that can delete any gene from a living cell.

Zinc finger nucleases are compounds that can slice open molecules. This one is is designed to go after the CCR5 gene. The treatment calls for removing CD4 T-cells,the immune cells affected by HIV, treating them with the drug, and re-infusing them into the patient. The hope is that these damaged cells will multiply and give the patient an immune system which is resistant to HIV.

The human trials are being conducted by Sangamo BioSciences, Inc., a California biotech company. The first phase is meant to look at safety and tolerably of a single infusion. The first people to receive the new treatment will be six patients who have developed drug-resistance to HIV and six other patients who are currently responsive to their existing drug regimen.

Saddleback’s New Definition, Courtesy Of Dan Savage

Gay sex advice columnist and author Dan Savage isn’t known for holding back against people he views as enemies of the LGBT community. Angered by anti-gay comments made by former Senator Rick Santorum, Savage named a rather disgusting and previously un-named phenomenon relating to anal-sex after him. Performing a Google search on “Santorum” turns up Savage’s definition as the top item.

And now we get to Savage’s recent anger with Rick Warren of Saddleback Church. What is a “Saddleback” exactly? Savage wasn’t sure it had any definition so he took it upon himself to create one. After polling his readers Savage has announced his new definition of Saddleback / Saddlebacking:

From the new website Saddlebacking.com

Savage finds this new definition apropos because of Warren’s ideological promotion of abstinence-only programs which not only don’t work, but result in teens substituting anal-sex and oral-sex believing they aren’t “real” sex.

CDC Reports Significant Declines In HIV Infection Rates

According to the Centers for Disease Control and Prevention, the number of people living with HIV and AIDS continues to rise as antiretroviral medication continues to prolong lives. In fact, we reported on a study last summer which showed that life-expectancy for those infected with HIV is now approaching normal. While nobody likes to see the number of people living with HIV/AIDS continue to increase, we also noted another CDC study which showed that the number of new HIV infections has remained relatively flat over the past ten years, a finding that is consistent with the fact that new AIDS cases has actually been declining slightly over the same period.

Now the CDC reports some more good news which sheds some light into how the number of HIV infections have remained so flat: The infection rate has been steadily declining since the 1980’s:

Researchers found that the HIV transmission rate has declined dramatically since the early days of the epidemic. In 1980, for example, when the disease was still undetected, the transmission rate was 92 percent, meaning there were 92 transmissions per 100 persons living with HIV at the time. After the identification of AIDS, and later HIV, and the implementation of HIV testing and other prevention efforts, transmission rates began to decline.

Since the peak level of new infections in the mid-1980s, just prior to the introduction of HIV testing, the transmission rate has declined by approximately 89 percent (from 44 transmissions per 100 persons living with HIV in 1984 to five transmissions per 100 persons living with HIV in 2006). Over the last decade, as prevention efforts have been expanded and improved treatments for HIV became available, the transmission rate has declined by 33 percent (from an estimated eight transmissions per 100 persons living with HIV in 1997 to five in 2006). Five transmissions per 100 persons living with HIV in 2006 means more than 95 percent of persons living with HIV did not transmit the infection that year.

The large fluctuations in the graph prior to 1980 are due to the relatively small numbers of persons living with HIV at that time and the limited surveillance structures that were in place.

The analysis, conducted by Drs. David R Holtgrave, H. Irene Hall, Philip H. Rhodes, and Richard J. Wolitski, will be published in an upcoming edition of the Journal of Acquired Immune Deficiency Syndrome.

[Hat tip: Michael Petrelis]

Dallas County Overturns Condom Distribution Ban

Dallas County, Texas — yes, that famously conservative Dallas — has voted to overturn a 14-year-old ban on county health care workers distributing free condoms. Republican Maurine Dickey joining Democrats Jim Foster and John Wiley Price, to overturn the ban on a 3-2 Tuesday morning.

Republican Commissioners Kenneth Mayfield and Mike Cantrell, both of whom supported the ban in 1995, voted against overturning it, saying they feared it could lead to condoms being distributed in schools. But Dickey, who wasn’t on the court in 1995, said she was more concerned about the high cost of treating people with HIV/AIDS.

According to a report prepared by the county’s Health and Human Services Department, which recommended overturning the ban, the lifetime cost to treat someone with HIV is more than $600,000. “I think we need to put the taxpayers first,” [Commissioner Maurine] Dickey said. “If we prevent two people from getting AIDS in Dallas County, we will have saved over $1 million of the taxpayers money.

Warren’s Counterproductive AIDS Efforts in Africa

Last month, I commented on how Rev. Rick Warren’s efforts to fight AIDS in Africa seemed to be more of a means by which to influence religious doctrine and public policy in several African nations than a charitable effort. My analysis seems confirmed by an article for the Daily Beast by Max Blumenthal, in which he investigates Warren’s AIDS efforts and finds them closely tied to anti-gay political activists and driven by dogmatic ideology.

In addition to the Anglican Bishops that are seeking to destroy the Church of England and remold it under their personal control, Warren has aligned himself with an evangelical pastor in Uganda, Martin Ssempa. This pastor quickly became interested in AIDS prevention after the US allocated 15 billion dollars (the PEPFAR program). While taking a salary from US taxpayers, he implemented efforts to remove condom use from Uganda’s successful ABC (abstinence, be faithful, condoms) anti-AIDS efforts.

By 2005, billboards promoting condom use disappeared from the streets of Kampala, replaced by billboards promoting virginity. “Until recently, all HIV-related billboards were about condoms. Those of us calling for abstinence and faithfulness need billboards too,” Ssempa told the BBC at the time. A 2005 report by Human Rights Watch documented that educational material in Uganda’s secondary schools falsely claiming condoms had microscopic pores that could be penetrated by the HIV virus and noted the sudden nationwide shortage of condoms due to new restrictions imposed by on condom imports.

Due in part to these efforts by Ssempa, HIV began to increase in the country.

AIDS activists arrived at the 16th International AIDS Conference in Toronto in 2006 with disturbing news from Uganda. Due at least in part to the chronic condom shortage, HIV infections were on the rise again. The disease rate had spiked to 6.5 percent among rural men, and 8.8 percent among women—a rise of nearly two points in the case of women. “The ‘C’ part [of ABC] is now mainly silent,” said Ugandan AIDS activist Beatrice Ware. As a result, she said, “the success story is unraveling.”

This should have given concern to those most familiar with AIDS in Africa. However, Rick Warren did not seek to return to the success of ABC. Rather, he took personal action to continue the program that had been shown to increase HIV infection – abstinence only.

In February 2008, Rep. Tom Lantos sought to reform PEPFAR to lift the abstinence-only earmarks.

His maneuver infuriated Warren, who immediately boarded a plane for Washington to join Christian right leaders including born-again former Watergate felon Chuck Colson for an emergency press conference on the Capitol lawn. In his speech, Warren claimed that Lantos’ bill would spawn an increase in the sex trafficking of young women. The bill died and PEPFAR was reauthorized in its flawed form.

But Ssempa was not content to put his anti-sex agenda ahead of the AIDS-prevention efforts of his nation. He also used his political connections and US backing to advance a harshly homophobic political atmosphere in their nation.

August 2007, Ssempa led hundreds of his followers through the streets of Kampala to demand that the government mete out harsh punishments against gays. “Arrest all homos,” read placards. And: “A man cannot marry a man.” Ssempa continued his crusade online, publishing the names of Ugandan gay rights activists on a website he created, along with photos and home addresses. “Homosexual promoters,” he called them, suggesting they intended to seduce Uganda’s children into their lifestyle. Soon afterwards, two of President Yoweri Museveni’s top officials demanded the arrest of the gay activists named by Ssempa. Terrified, the activists immediately into hiding.

The more I learn about Rick Warren’s AIDS efforts in Africa, the less I respect him. He has endorsed policies that he knows are not the most effective and he has befriended and supported some of the most homophobic religious leaders in Christendom in their anti-gay political actions.

It is commendable that Rick Warren feels compassion for those suffering from AIDS in Africa. It is not commendable that he has used this suffering as a way to get a political and religious foothold in the region or that he capitalized on – and encouraged – hatred against gay people in the process.

AIDS Skeptic Dies

Christine Maggiore, a Van Nuys woman who was an outspoken skeptic of the science behind the Human Immunodeficiency Virus (HIV) as the cause of AIDS, has died of AIDS.

Maggiore, 52, was founder of Alive & Well AIDS Alternatives to challenge the “common assumptions” about AIDS. Her group advocated shunning AIDS medications for expectant HIV-positive mothers. She wrote the book, “What if Everything You Thought You Knew About AIDS Was Wrong?”

Maggiore had said that she did not take antiviral medications during her pregnancy and that she did not have her daughter, Eliza Jane Scovill, tested after birth. Eliza died in 2005 of AIDS-related pneumonia after Maggiore and her husband, Robin Scovill,  refused AIDS treatment. In 2006, the Los Angeles County district attorney’s office decided not to file criminal charges against Maggiore.

World AIDS Day 2008

Today is World AIDS Day and while you may have few options for changing the global situation, here are a few suggestions of things you may want to do locally to commemorate the international event:

• Get tested. Make it an annual event whether you need to or not.
• If you are positive, this might be a good time to review your meds, make an appointment, read up on new treatments, join a gym, or dedicate some time to thinking about and planning your health.
• Contact a local AIDS service group and find out whether you can volunteer some time. While due to advances in medical care many HIV positive people live very normal lives, for some 2008 is no better than 1998. Food still needs cooking and delivering, dogs need walked, and sick people need a caring ear.
• Write a check.
• Tell the truth. Many people – gay and straight – are misinformed about this disease and its impact on our community. Today is a good day to help eliminate myths. Yes, most HIV patients can manage the virus through a strict regimine of medicines, but not all can: so play safe. And no, not all gay people have -or will get – HIV; only about 12% of gay men and virtually no gay women have the virus.
• Think about whether you have a unique talent that could be put to good use. If you are a member of an ethnic minority, you may have access to the hardest hit communities in ways that no ‘white guy in a suit’ could ever reach. We each have our own skills and advantages; find yours.
• Pray. If you are a member of a faith-based group, ask others to join you in your appeal to the divine.
• Take a moment to remember those whom we have lost to this horrible disease and honor their memory.

Predictions of The Demise of AIDS

Don’t get your hopes up, but the Associated Press is reporting on a study published online Tuesday in the respected journal The Lancet, which, using complex mathematical models, predicts that HIV could theoretically disappear within a decade if everyone living in countries with high infection rates are regularly tested and treated.

Caution is always wise when reading about research like this. Mathematical models on HIV/AIDS regularly come and go. I’m not aware of very many which have proven to be accurate as a predictive tool, and I doubt this one will be either since it’s is loaded with assumptions which simply aren’t realistic. I don’t have the full-text article, but the short abstract alone doesn’t give much reason for optimism.

The predictive model was based on data from South Africa and Malawi using a number of assumptions. The model assumed that people would be voluntarily tested each year and immediately given drugs if they tested positive for HIV, regardless of whether they were sick. That last assumption alone is problematic. Even if drugs were available for everyone, having them take it even when their HIV infection hasn’t progressed to AIDS is fraught with controversy. AIDS medication has several serious side-effects, and the long-term effect of taking these powerful drugs is unknown. The longest that most of these drugs have been available is only about ten years.

The model also assumes that all HIV transmission in South Africa is heterosexual. While HIV is predominantly transmitted heterosexually in South Africa, this assumption  does represent a strange gap in the model.

Another concern not mentioned in the abstract is the assumptions they used concerning the transmissibility of HIV in people who are infected but are on Highly Active Anti-Retroviral Therapy (HAART). We do know that HAART can drive viral loads to undetectable levels in most cases, and thus reduce the risk of transmitting the virus onto others. But that risk of transmission is not zero, and besides that, viral loads can fluctuate — for example, when the patient has a cold or flu.

But if all the model’s assumptions did hold true, this model suggests that HIV could be theoretically eliminated in a decade. The cost test and treat everyone as the study suggests would be staggering, but no more staggering than the way we are doing things now:

“We estimate that in 2032, the yearly cost of the present strategy and the theoretical strategy would both be US$1-7 billion; however, after this time, the cost of the present strategy would continue to increase whereas that of the theoretical strategy would decrease.

I doubt that we will see the demise of AIDS within ten years, but its incidence could be significantly reduced. This model clearly demonstrates the benefits  of universal testing and treatment to society overall, not just to those who are infected today. Sticking with current policies all but guarantees the continued growth of the pandemic worldwide.

Indonesian Province Proposes Chipping People With AIDS

William F. Buckly famously wrote in a 1986 New York Times op-ed that “Everyone detected with AIDS should be tattooed in the upper forearm, to protect common-needle users, and on the buttocks, to prevent the victimization of other homosexuals.” Paul Cameron also proposed a similar solution along with quarantines.

That was more than twenty years ago. Skip ahead to 2008, where the Indonesian province of Papua is considering a 21st-century solution:

Legislators in Indonesia’s remote province of Papua have thrown their support behind a controversial bill requiring some HIV/AIDS patients to be implanted with microchips – part of extreme efforts to monitor the disease.

Health workers and rights activists sharply criticized the plan Monday. But legislator John Manangsang said by implanting small computer chips beneath the skin of “sexually aggressive” patients, authorities would be in a better position to identify, track and ultimately punish those who deliberately infect others with up to six months in jail or a $5,000 US fine.

Of course, no one can say how they intend to define “sexually aggressive.” Indonesia has one of Asia’s fastest growing HIV rates, fuelled mainly by intravenojus drug users and prostitution. Papua has been hardest hit.

Nancy Fee, the UNAIDS coordinator for Indonesia is concerned about the impact the legislation would have on prevention efforts.

“No one should be subject to unlawful or unnecessary interference of privacy,” Fee said, adding that while other countries have been known to be oppressive in trying to tackle AIDS, such policies don’t work. They make people afraid and push the problem further underground, she said.

Local health workers and AIDS activists called the plan “abhorrent.” “People with AIDS aren’t animals; we have to respect their rights,” said Tahi Ganyang Butarbutar, a prominent Papuan activist.

Hope for a Cure

1990’s Longtime Companion ends with an imagined day in which AIDS and the HIV virus is overcome, a day of celebration. Now there is a story that hints that such a day may come.

It has been long known – and seldom discussed – that some persons are immune to most strains of the HIV virus. I’ve wondered whether there couldn’t be a way of using that immunity to kill the virus in those who are infected. Now it seems that a German doctor has done just that. (WSJ)

The breakthrough appears to be that Dr. Hütter, a soft-spoken hematologist who isn’t an AIDS specialist, deliberately replaced the patient’s bone marrow cells with those from a donor who has a naturally occurring genetic mutation that renders his cells immune to almost all strains of HIV, the virus that causes AIDS.

This treatment for leukemia yielded an unexpected result

The patient, a 42-year-old American living in Berlin, is still recovering from his leukemia therapy, but he appears to have won his battle with AIDS. Doctors have not been able to detect the virus in his blood for more than 600 days, despite his having ceased all conventional AIDS medication. Normally when a patient stops taking AIDS drugs, the virus stampedes through the body within weeks, or days.

This case may be a fluke. And this bone marrow procedure is so risky, and has such a high death rate, that this cannot become a method for treating HIV infected persons. And we have seen many promising treatments turn out to be failures later.

Nonetheless it is stories like this one that give us continued hope for a cure. It certainly provided hope to this patient.

Nearly two years later, standard tests haven’t detected virus in his blood, or in the brain and rectal tissues where it often hides.

Circumcision Less Helpful in Reducing HIV in Gay Sex

JAMA is reporting that circumcision, which may eliminate HIV transmission in heterosexual sex by up to 50%, is less helpful in male-male anal sex.

The study’s authors wrote that circumcision appears to provide “not statistically significant” protection from HIV in men who engage in anal sex with other men. The researchers said however that more research may be necessary to quantify the amount of protection — or lack thereof — provided by circumcision.

It seems counter-intuitive that a virus’ ability to infect a man would be impacted by the gender of his partner, assuming penetrative-only sex. Somehow I suspect some relevant questions were not addressed.

New Research: HIV Circulated Among Humans Since 1908

According to a new study to appear in tomorrow’s issue of the journal Nature, the HIV virus which causes AIDS has been circulating among people for about 100 years. This article in Nature describes research findings which were first presented last June.

This latest genetic analysis on the HIV virus pushes the estimated origin of AIDS in humans back to between 1884 aqnd 1924, with a more focused estimate at 1908. This is decades earlier than the previous estimate of 1930.

Researchers took advantage of the fact that HIV mutates rapidly to reach this conclusion:

…[T]wo strains from a common ancestor quickly become less and less alike in their genetic material over time. That allows scientists to “run the clock backward” by calculating how long it would take for various strains to become as different as they are observed to be. That would indicate when they both sprang from their most recent common ancestor.

The new work used genetic data from the two old HIV samples plus more than 100 modern samples to create a family tree going back to these samples’ last common ancestor. Researchers got various answers under various approaches for when that ancestor virus appeared, but the 1884-to-1924 bracket is probably the most reliable, Worobey said.

In addition to the modern samples of HIV used in the analysis, researchers also worked with a 1960 sample taken from a woman in what is now present-day Kinshasa in the Democratic Republic of the Congo. This 1960 sample is the second-oldest known surviving HIV genetic material. The oldest is from a 1959 blood sample taken from an unknown man in Kinshasa.

Michael Worobey of the University of Arizona noted that the new estimate correlates with the rise of cities in Africa, which he described as “ideal for a virus like HIV” because of the greater opportunities for people to pass the virus on to others. Worobey is also optimistic about the virus’ eventual demise:

“I think the picture that has emerged here, where changes the human population experienced may have opened the door to the spread of HIV, is a good reminder that we can make changes now that could help reverse the epidemic. If HIV has one weak spot, it is that it is a relatively poorly transmitted virus. From better testing and prevention, to wider use of the antiretroviral drug therapy, there are a number of ways to reduce transmission and force this virus back into extinction,” he said.

You can learn more about the history of HIV/AIDS in our 2006 report, Opportunistic Infections — a report which still needs to be updated to reflect this latest research.

National HIV/AIDS and Aging Awareness Day

It’s today. I had no idea.  But it’s a great thing. After all, even though infection rates have remained relatively level, people over 50 now make up the fastest-growing segment of those living with HIV. This is mostly attributable to the fact that people with AIDS and HIV are living longer. What was once a death sentence is now a very serious chronic illness. And as people age — part of the aging process is already about losing immunity — managing HIV/AIDS while simultaneously managing the ordinary effects of aging is a delicate balancing act.

Newsweek as a great series of articles online:

• A Lot of Unknowns: Medical advances are helping many HIV patients live into old age. But that blessing presents its own unique set of tribulations.
• ‘Invisible And Overlooked’: A growing population of lesbian and gay senior citizens seeks recognition for their unique needs and challenges.
• Facts About the Aging Lesbian and Gay Community

You can learn more about issues of aging and the LGBT community at SAGE.