C.A.R.E. Knowledge Blog

The Potential to Reduce HIV Transmission

Science and Nature are the two biggest peer reviewed journals around. For an article to make these magazines, they have to be a significant scientific breaktrhough. So (according to Science Magazine) what was the biggest scientific breakthrough of 2011? It wasn't the discovery of habitable earth-like planets orbiting other suns, or evidence of Higgs boson by the Large Hadron Collider; it was in the field of HIV and public health, or more specifically, using HIV treatment as prevention. From MedPage Today:

In the history of our time, 2011 could be remembered as the year the tide began to turn against the HIV/AIDS pandemic.

Equally, it could be remembered as the year we fumbled the opportunity to end one of our greatest scourges.

The key event was the release in May of data from a single randomized clinical trial — the 052 study by the HIV Prevention Trials Network (HPTN) — that showed that treating people with HIV reduced the risk of transmission by some 96 percent.

The study has been "catalytic," according to principal investigator Myron Cohen, MD, of the University of North Carolina in Chapel Hill, N.C.

Considering that condoms are about 85% effective at preventing HIV trasmission, you would think the government would be all for something that reduces HIV transmission by 96%,  but that might be seen by some as giving tacit approval for folks to have sex. Up in San Francisco, public health has already adopted "Test and Treat" as their policy, promoting testing and offering therapy to everyone no matter what their CD4 count. As a result, the number of new positives has dropped while STD rates have remained steady, a good indication that it's working. 

Other studies coming from places as diverse as Taiwan and Brittish Columbia show that increased testing and earlier treatment is reducing new infections. 

Here in LA, they're looking to combine HIV prevention and treatment planning bodies, so the main object of prevention will eventually be promotion of HIV testing and getting people into care. Unfortunately bureaucracies change slowly, and the sex police will be digging in their heels. I'm reminded of the H. L. Mencken definition of Puritanism: the haunting fear that someone, somewhere is having a good time. 

Here in Long Beach, those undiagnosed with HIV are the main drivers of the epidemic. Consider the hypothetical person who tested six months ago and has had a few partners since then. It's these folks who think they're negative (because that was the indication on their last test) who are recently infected that have the high viral load that makes the virus easier to transmit. Public health estimates that there are 6,000 people living with HIV in Long Beach. If 1,500 of them don't know they're infected, that can mean there are easily over a thousand gay men typing "I'm negative, UB2" in their on-line profile, when in fact they're carrying the virus. 

In the early days of the epidemic--before HIV testing--the gay community rallied together and reduced transmission by assuming all  partners were positive--or they might be positive themselves (and took appropriate precautions). Perhaps we can set aside the viral apartheid contained in terms like "clean" or "disease free" and start thinking about the well being of the community. "Test and Treat" shows you care about yourself and you care about others. Getting tested for HIV every six months if you're sexually active is the first step; if you do test positive, seeking treatment is the best thing you can do for yourself and for the community.

 

HIV Testing in Long Beach, CA

Here at the CARE Program at St. Mary Medical Center in Long Beach we offer free Ora-Quick testing for HIV. The test uses an oral swab--no needles, and if you test confidentially, you'll get your results in twenty minutes. Also, when you test confidentially, you can get a copy of your result if you need to show the courts or your partner.

We're located at 411 East 10th Street in suite 107. We're in the two-story building next to the parking entrance to St. Mary Medical Center campus. There's plenty of free parking in the neighborhood if you don't want to pay. We offer testing Monday through Friday from 8:30 to 4:30, and we're closed for lunch. If you call first, we can probably see you without waiting. You can call our HIV testing line at 562-624-4900. 

The campaign theme for World AIDS Day this year was "Getting to Zero" which comes out of recent studys that have reduced transmission by promoting testing, and making HIV medications available to those who test positive. 

Locally, the biggest driver of the AIDS pandemic are those people who think they are negative, because they had a negative test in the past. But because they tested in the "window peroiod" (now considered to be three months after exposure, before HIV antibodies are produced) or because they were exposed after their previous negative test, they may be exposing others to HIV. Once someone goes on an effective combination of antiviral medication and remains undetectable for more than six months, the chances of them passing on the virus is greatly diminished. So tesing on a regular basis--and seeking medical care if you test positive--is probably the best thing you can do to get Long Beach to zero.

Remembering on World AIDS Day

General Idea: One Year of AZT, One Day of AZT, 1991

Back before I started blogging here at the CARE Program, I wrote mostly on contemporary art at my blog Leap Into the Void. Back in 2008 I bemoaned the fact that World AIDS Day and A Day Without Art had seemed to have fallen by the wayside. My attempt at the time was to remember a specific artist, someone who I had gone to school with, who died of AIDS. Other bloggers followed suit, and their posts can be seen here, here, and here. Part of my thinking was that the era of effective combination therapy came along at the same time as the internet, which means there's little or no record in cyberspace of those who died of AIDS for the most devastating years of the epidemic. Perhaps that's one of the reasons we see so much complacency around HIV prevention and treatment today. 

With that in mind, there's someone I'd like to remember here today. In 2001 I attended the GNP+ conference in Port of Spain, Trinidad. GNP+ is the Global Network of People Living with HIV/AIDS, and they hold an international conference on the off years, in-between the International AIDS Conferences. 

It was in Port of Spain that I met Kenroy Nicholson, a young man in his twenties from Trinidad who was living with the virus. After meeting at the conference we hung out for a few days before I flew back to the United States. At the time he was working at Royal Castle, a local fast food chain. He lived in a township outside the city, an area with dirt roads, and maybe a water pipe that came to each block. His place had no phone or electricity, and was made of tin sheeting and cement blocks. He lived there with his two siblings, their partners and children in a one bedroom home. Of the five adults in the house, he was the only one who was working, and he did it without shoes, and without HIV meds. He never asked me for anything except friendship and understanding. We stayed in touch by mail, and he invited me to return for Carnival the next year. I couldn't return until the following Summer, and by the time I got there he had died.

So I'm dedicating this World AIDS Day post to Kenroy, one of the five thousand people who die each day from AIDS, people who do their best despite the lack of the most basic medical attention.  

If there's someone you'd like to remember, feel free to post in the comments section.