HIV/AIDS Update

A couple of new and interesting things about HIV and AIDS this last week or so...

• A new study, probably considered a big duh to most advocates and prevention works, finds that binge drinking leads to increased HIV risks. Though the study is limited to New York City, I think it's probably generalizable out to most areas; the research was also done primarily in bars, which makes sense for a study of this nature. Some interesting bits of data out of it: 65% of men who have sex with men who use alocohol during receptive anal intercourse were likely to use a condom, versus 86% of those who do not consume alcohol. Meanwhile, 48% of men who have had 20 or more sexual partners in the last year reported being under the influence for their last sexual encouter. We are often asked, in our work, why we question peopel presenting for testing about their drinking behavior... I think it's clear.
• The New York Times recently did a little look into hospitals that offer HIV-testing to clients presenting in the Emergency Department after 3 hospitals in Connecticut were added to the pilot CDC program. Cincinnati, specifically University Hospital, is part of this pilot program and has been met with tremendous success -- nearly 5,000 tests in the 2008 (which makes it the largest HIV-testing site in the city), and a huge portion of that comes from the OraQuik Advance 20-minute HIV screening test. Nothing major really comes out of the report, except that it has been met with some resistance by Emergency Department docs who feel that it may burden an already full system, as Emergency Depts are used these days as the primary health provider for uninsured or low-income persons. In Cincinnati, there is a separate program and separate staff providing the service.
• The FDA has approved a new HIV-test for blood and tissue donors that is more sensitive and detects rarer strains of the virus. Like the current standard, which can detect infection two weeks out, the price tag is too large to provide for public health screening. (Comparisons: OraSure 2-week oral=approx. $3, OraQuik 20-minute oral/blood=approx. $20, Viral Load=approx. $400, etc.) The big problem with quicker detection has never been the technology, as we have been able to test for infection much sooner than the 3-6 months we currently quote patients, but that the price tag of that early of detection is so high.
• Out of West Virginia, more calls for redirecting health money away from HIV/AIDS and into other diseases. Blah blah blah, no news there or even new points... but the comments are funny. -- "Our usually sure-footed conservative editors slipped here. We wouldn’t be in this saving-life “game” if it weren’t for deviant sex games played crudely by homosexual men." Teehee. Silly West Virginians.
• This one is old but it's the first time I've heard about it: in 2007, researchers found that proteins from HIV can be injected into cancer cells to cause them to die. Because HIV is so efficient getting into cells, its proteins can be used to insert hormones into cancer cells that don't respond to the "now die" command in their DNA (the mutation that causes tumors). Once these hormones are inserted, the cancer cells get the message and die off. I'm surprised we've not heard any more about this...
• And a strange bit on CNN where a woman was burned alive after being convicted by a mob of being a witch. Apparently, in Papua New Guinea, it is common for people to blame AIDS on witches... not on a disease. Whoa. 

And, of course...

• South Africa has named Edwin Cameron to its highest court, making him the highest ranking openly gay and openly HIV+ public servant in the world. In fact, he may be the highest ranking openly (and publically) HIV+ person period. He has written extensively on the subject, as well as on the subject of being gay in South Africa. The more I read about him, the more impressive he is. Congratulations, Justice Cameron.

Picture courtesy the Queerty article.

HIV/AIDS: Three news stories

At work, I sometimes surf the web to find interesting news stories about HIV/AIDS to share with my coworkers. It's something I started to relieve a little boredom that can happen at 4am in the Emergency Room; but, mostly, it's to keep myself updated and provide fodder for postings for my blog.

Found three interesting little bits...

1) To start, the biggest duh story of the year (up there with "alocohol and drugs increase HIV risk behavior"): Crack users with HIV engage in unprotected sex. Thanks guys, we know. The numbers:

One-fourth of the group reported having unprotected sex in the last six months,half had not seen an HIV specialist in the last six months, and more than three-fourths were not getting important medical treatments.

*Shrug* I suppose it's a good reminder.

2) From Uganda...

Health officials and campaigners have protested proposals from Uganda to condemn
to death or severely punish people who deliberately infect others with HIV.

Uganda has become the latest in a number of countries which are considering or have enacted laws which punish people who deliberately infect others.

Let me go on record as saying: I do not support laws that criminalize sex for people eith HIV. The laws, I understand, that say it is illegal for HIV+ persons to engage in sex without first notifying their partner of their status are to provide safeguards against the almost mythical (thus, rarely true) predatorial person who is consciously and knowingly infecting people. Rather, the law is being used mainly against prostitutes and people guilty of other sex crimes -- public lewdness, solicitation, importuning, etc. -- and I don't think there has been a case where the law was used genuinely against the people that was used in propaganda to support the bill (think Welfare Queens a la Reagan for a similar example).

There are two people (or more, I suppose) in the room (or car, I suppose, or park) when sex occurs. They both make decisions and they both consent to a series of behaviors that they know may put them at risk for HIV and/or any other STD. To blame just the HIV+ person is marginalizing them, because the (supposed) HIV- person had a say in what was going on. I don't think it's right to prosecute because, as is most cases, the negative person simply did not ask if the person they were having sex with was positive.

In the case of prostitutes, I don't think it's really an issue 99% of the time because that's mainly oral (extremely low risk for HIV transmission).

A friend of mine (HIV+) once said to me a line that was disturbing at first, but I now regard as truer than anything I've heard in my years of work in HIV/AIDS: If they don't ask, they either have it or want it. It's disturbing to hear, but the reality is that most people in the world (especially in my gay world) are keenly aware that HIV exists. Most of them know that they play a part in their own protection, but, for whatever reason, depersonalize the risks and move on. So, in a way, he's right. People know they should ask, and, if they don't, they are consenting to the risks of the behavior as well as the behavior itself. (Consent, ultimately, is an agreement to knowingly accept possible outcomes of a decision -- negative and postive and, sometimes, unknown.)

Do I agree with this death sentence? No. Though my coworker brought up the point: If someone knowingly infected my daughter, I wouldn't wait for the government to do anything. I'd string him up myself.

For the record, I also don't support lynchings or vigilante justice.

3) And a good reminder that the best way to get tested is through a known source and/or provider of HIV testing services... online testing kits are not always the safest, and there are no current FDA approved HIV tests (I don't think... can someone fill me in if I'm wrong) that are "home testing." There have been in the past, but the vast majority have been pulled from the market. Besides, I don't like the idea of home testing simply because it concerns me about someone finding the result at home, alone, with no one to say "alright, this is the next step" or to help bear the emotional brunt of those feelings.