Two interesting research papers came across my desk this week. The first, Characteristics of HIV epidemics driven by men who have sex with men and people who inject drugs (Wilson et al) used innovative mathematical modeling techniques to evaluate various strategies for reducing the number of new HIV infections in adversely affected subpopulations. Since the first signs of the virus in the early eighties, we’ve learned to identify and test for HIV, determine the body fluids and behaviors that contribute to a higher probability for transmission, and then develop behavioral interventions that would reduce risk. In the early years—before it was even possible to test for HIV—the mantra was, “Since we don’t know who’s infected, assume all your partners are positive, or that you may be positive yourself.” The underlying morality of this model was showing care and respect for ourselves along with showing care and respect for the consenting adults we had sex with.
Over the years, educational programs, counseling and testing, outreach, safer-sex workshops and the like have met with varying degrees of success. Just having a gander at our fellow residents struggling with obesity, addiction, and other preventable health problems should make it evident that changing behavior isn’t simple or easy. With the advent of effective therapies for HIV in the mid-nineties, and the resulting reduction in viral load and transmissibility of the virus, another model for reducing new cases of HIV emerged. Currently known as Test and Treat, the underpinning idea is to identify those who are infected through easy access to regular testing, and then get those who test positive on medication. By reducing the community’s viral load, less transmission will occur, and the number of new cases will go down.
In the Wilson paper they look at serosorting, which is based on the idea of choosing a partner with the same HIV status. The logic behind this is that if two HIV-negative persons have sex, there is no HIV to transmit, and if two HIV-positive partners have sex, no new cases of HIV will occur. One issue noted with this practice is that it can create a type of “viral apartheid,” and labels like “disease-free, you be too,” can exacerbate stigma for those who are living with the virus. The other fly in the ointment becomes those individuals who have never tested and those who have had a previous negative test, but later became infected. Since they see themselves as still being a part of the negative camp, limiting oneself to other “negative” partners can be fraught with peril. Wilson modeled the acquisition of HIV associated with serosorting and found that,
“… (It) is only beneficial when the percentage of undiagnosed HIV-infected MSM is below 20%. These modeling studies are consistent in their findings and have assessed sero-sorting to be effective at the population level in developed setting with high testing rates such that there are a minority of HIV infections which are undiagnosed. However, in most parts of the world serosorting with casual partners is likely to increase risk of HIV acquisition.”
The other paper, Predictors of Unrecognized HIV Infection among Poor and Ethnic Men Who Have Sex with Men in Los Angeles (Young et al) notes that approximately 25 – 48% of HIV+ people may be unaware that they are positive. The percentage of persons unaware of there HIV positive status is much higher in younger age cohorts than persons over 35. Here in Long Beach, County epidemiologists estimate that one out of four infected people don’t know they’re positive. Young’s paper also notes that when subjects were assessed for homonegativity (that means negative perceptions and feelings about homosexuality) higher negative feelings were associated with not being aware of one’s HIV-positive serostatus.
In places like San Francisco where Community Viral Load is monitored, and the Test and Treat model is aggressively promoted by public health officials, the number of new HIV infections has fallen by half, while the rates of other STD continued to climb.
Taken together, these two papers point out the need for more HIV testing, and regular testing for those most at risk. Choosing a partner because of their perceived or posted negative status may actually increase one’s risk of acquiring HIV.
Here at the CARE Program, we offer free confidential testing for HIV, with results in twenty minutes. Call for an appointment at (562) 624-4900. We test Monday though Friday from 9:00 to 11:30 and 1:15 to 4:00. If you test positive, CARE offers comprehensive medical, dental, mental health, and social services. We can also help you enroll in benefit programs to help pay for your care.
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