An intensive campaign to combat HIV/AIDS with costly antiretroviral drugs in rural South Africa has increased life expectancy by more than 11 years and significantly reduced the risk of infection for healthy individuals, according to new research.
The two studies, published Thursday in the journal Science, come as wealthy Western nations are debating how best to stretch limited AIDS funding at a time of economic stress.
With an annual price tag of $500 to $900 per patient, antiretroviral therapy programs have stirred frequent debate. Critics argue that adherence to the drug regimen is low and social stigma prevents some from seeking care until they are very ill and have infected others. Cheaper remedies, such as condom distribution, male circumcision and behavior modification, deserve more attention and funding, they say.
The new economic analysis of a $10.8-million campaign in KwaZulu-Natal province concluded that the drug scale-up there had been highly cost-effective.
The program was administered by nurses in rural health clinics in an impoverished region of about 100,000 people. Treatment consisted primarily of daily doses of antiretroviral therapy, or ART, drugs, which patients take every day for their entire lives. Patients picked up their medication at a rural clinic once a month.
In 2003, the year before the drugs were available, 29% of all residents were infected with HIV and half of all deaths there were caused by AIDS. Life expectancy in the region was just over 49 years.
By 2011, life expectancy had grown to 60 1/2 years — “the most rapid life expectancy gains observed in the history of public health,” said study senior author Till Barnighausen, a global health professor at the Harvard School of Public Health.
Based on that increase in longevity, researchers determined just how many years of life were effectively “gained” among residents as a result of ART intervention. They used that figure and the total expense of the program to calculate a cost-effectiveness ratio of $1,593 per life-year saved.
The World Health Organization considers medical intervention to be “highly cost-effective” if the cost per year of life saved is less than a nation’s per capita gross domestic product. The program’s ratio was well below South Africa’s 2011 per capita GDP of about $11,000.
“It’s really a slam dunk of an intervention,” said study leader Jacob Bor, a graduate student at Harvard. “These investments are worthwhile.”
The research team noted that the study period coincided with the arrival of electric power and clean water for area residents. But those alone could not explain the dramatic increase in longevity, they said.
“While mortality due to HIV declined precipitously, mortality due to other causes flat-lined,” Bor said. “These changes were almost certainly due to ART scale-up.”
In a second study from the same region, researchers followed nearly 17,000 healthy people from 2004 to 2011 to determine HIV infection rates in areas with active ART intervention programs.
Healthy individuals in those areas were 38% less likely to contract HIV than people in areas where ART drugs were not widely available, researchers found. People in extremely rural areas also fared better than those in more closely populated areas clustered around national roads.
Overall HIV prevalence increased 6% during the seven years of the study, probably because the antiretroviral drugs allowed people with the virus to live longer, according to the report.
It’s not clear how the results of the new study would translate to areas where stable, cohabiting couples were not the norm, said lead author Frank Tanser, an epidemiologist at the University of KwaZulu-Natal.
AIDS researchers who weren’t involved in the studies said they provide strong support for maintaining programs like the President’s Emergency Plan for AIDS Relief, begun by President George W. Bush in 2003.
“These papers present truly remarkable data,” said Dr. Douglas Richman, director of the Center for AIDS Research at UC San Diego.
A HIV positive jobseeker has said he was left humiliated by staff at a Kent job centre.
Jayce Carberry said staff in Maidstone made him declare his condition within earshot of others, and told him he had to see a disability adviser.
He said an adviser also said he would seek legal advice about what contact Mr Carberry could have with other staff. The government said jobseekers were asked if they had a condition which could affect certain jobs.
Former hairdresser Mr Carberry said he went to the job centre a few weeks ago to discuss his options.
‘That stigma’
He said he was not disabled, and the advisor asked if he could write his HIV status in his notes, he said. Mr Carberry said he did not want it mentioned.
“His [the adviser's] reply was I’ll have to speak to my legal team to see if we have to disclose your HIV status to any members of the staff you come into contact with in this building,” Mr Carberry said.
“Obviously I was a bit speechless.
“For somebody to make a comment like that, it just takes you all the way back to the beginning and your self-esteem is shattered, you go back to feeling ashamed.
“You’re subjected to that stigma and it’s really upsetting.”
Equalities Minister Helen Grant has written to the job centre
Equalities Minister Helen Grant, Mr Carberry’s MP, said she had written to the job centre and to Work and Pensions Secretary Iain Duncan Smith to raise her concerns.
Ms Grant, Conservative MP for Maidstone and The Weal, said: “It’s absolutely right that if people like Jayce do what they’ve done – go out, try to get work – that they should be given all the help and support that they need and deserve and at the same time, they must be treated with absolute dignity and respect.”
The Department for Work and Pensions, which speaks for job centres, said people did not officially have to declare medical conditions when applying for Jobseeker’s Allowance.
What are your experiences when seeking work? Have you ever had to disclose your status unwillingly? Does HIV status even matter when seeking work (as opposed to starting work) and do you feel you should disclose to staff at Job Centres.
A special research report by Diana Inegbenebor of African Health Policy Network, and Celia Fisher, of Leicestershire AIDS Support Services
Leicester City has almost the most diverse population for a city in England, with predictions that there will be no ethnic majority by 2012. There are many different African communities in the city, this increases the challenges for HIV awareness, HIV testing and prevention interventions as there are many different aspects and cultural differences to consider. Leicester City has an above average number of people with diagnosed HIV, with a current prevalence of 3.2 per 1000.
This is the 7th highest rate in England. In this context LASS (Leicestershire AIDS Support Service) launched its Rapid HIV testing service in June 2009, supported by a Clinical Governance Group.
The uptake of testing within the African communities was low during the first year of the Rapid HIV testing service compared to the uptake from other communities in Leicester. The Community tester volunteer project was initiated to empower African communities with knowledge about HIV and the skills to deliver Rapid HIV testing as community volunteers in association with LASS. Groups of people from different African communities have taken the Rapid HIV testing training, with a total of 28 of these community volunteers completing the training to 1st September 2011. The benefit of the community tester approach is that each person trained understands their community and can adapt and tailor an approach as necessary.
This research report is focused on the effects of the LASS Community Rapid Testing training with different African communities in Leicester and the influence of trained community testing volunteers on the uptake of HIV testing. Key objectives are:
To compare the uptake of POCT HIV testing in the different African communities before and after the LASS community HIV tester project was initiated.
To determine the cost benefits and savings of using Rapid HIV tests delivered in the communities in non-clinical settings and by non-clinical volunteers.
To find out the motivation for people volunteering to become testers, keeping in mind the training includes an HIV test for each person.
To provide recommendations about using and evolving the community tester model in what will become a resource limited environment.
A literature review was undertaken to determine what information is available about Community HIV Testing models. The review summarises evidence sourced 3 from Medline/Pub med, Global Health/Global Health Archive, Cochrane, and Google scholar. Review of material about Rapid HIV Testing reiterates the effectiveness of HIV rapid test kits in early detection of HIV especially for use in the community. There are models of practice for using volunteers in HIV prevention and care work. A study in Zambia looked at the role of community volunteers in voluntary counselling and testing. They concluded that community volunteers, with approved training and on-going supervision can play a major role to provide counselling and testing services of quality. Research into “training to test” shows that volunteer testing programmes have been tried and proved successful in other countries.
Analysis of the uptake of Rapid HIV testing by people from African communities is compared between 2 periods – before and after the community tester project was started. The analysis clearly shows the effectiveness of focused interventions with 100% increase in uptake over similar periods of time. The benefits of focused interventions alongside accessible HIV testing are evident – in particular taking HIV testing out to the community, with significant numbers of people getting tested at these events. The trained community testing volunteers understand the benefits of being tested and have a significant effect on the acceptability of testing in the communities. There are more tests carried out in the office based setting after these interventions, with 3 new diagnoses in one period due to these influences.
The experience with the different communities highlights that it is important for HIV to be openly discussed to enable people to have the confidence to get tested. When communities are openly talking about HIV and the benefits of testing more people will get tested. The community testing volunteer approach gives an ideal opportunity for people to practice sharing strong messages about HIV and HIV testing.
Results from the qualitative research show that people who have been trained to test were generally very satisfied with the knowledge they had accrued from the training course, and were willing to take what they had learned to their communities, to educate and empower others. People are motivated by doing things for their community. In this model the testing is encapsulated in a ‘bigger’ outcome for the individual.
The effect of the community tester model increases the confidence within the community generally as they have access to new skills and knowledge. The majority of people in each African community here in Leicester have direct experience of people living with HIV, whether locally or back home. LASS have anecdotal reports of people using their up to date HIV knowledge globally: being able to provide clarity and facts for a person who knows mainly myths. Others are planning to use these skills when they return to their country – as they can now deliver with confidence.
The community testing model using volunteers is cost effective. Comparison of the cited potential cost savings to those of the Community testing model delivered by LASS, immediately highlight the benefits of using this model:
Potential cost savings for 8 new diagnoses are between £2.24 million and £2.88 million with between £7,840 and £14,000 spent to achieve this delivering 556 tests.
Recommendations from the research are as follows;
Take the model into different communities and continue to evaluate the benefits.
Deliver HIV testing in different community settings on a regular basis to increase accessibility and acceptability, in particular using the outreach van.
Research to consider and evaluate the benefits of community HIV testing volunteer training in local communities and with their global connections.
Initiate research into how community testing and involvement of people in seeing their blood make the positive result affects acceptance of diagnosis and onward management of HIV. This recommendation is based on observations during the research for already diagnosed HIV positive people.
Develop the community volunteer tester model to include testing for other health conditions, for example Hepatitis.
The authors would like to acknowledge the involvement of community testing volunteers and all those involved in organising and delivering the interventions.
We often talk about prejudice and stigma relating to HIV / AIDS, and in everything we do, attempt to combat this stigma. Not enough people stand out, and sometimes those that do, speak about stigma on a grand scale. Coming up, Rich Juzwiak, an editor at Gawker has posted a wonderful, honest and frank article about understanding the nature of HIV in the context of sex between men from a presumed HIV negative viewpoint.
What is particularly noteworthy is Rich’s unbiased honesty and openness throughout his article. By asking the right questions to people he is meeting for sex (or not) he’s gained a much improved understanding of viral load, and the risk factors involved when meeting people for sex. Sharing his experiences not only provides an education and insight to HIV negative people, but also informs HIV positive people just how little knowledge there is on viral load and transmission.
In addition to the work of organisations like LASS, the Terrence Higgins Trust, the National AIDS Trust and many, many more, the real advocates are the people (regardless of HIV status) who ask questions, understand what’s going on and share their knowledge to the wider public so we can all know our HIV status and enjoy shared companionship whether that intimacy is based on sex, or conversation.
Article follows…
(Would you like to listen to this article instead? Click the play button below…)
The first guy I ever turned down on Grindr for having HIV, my patient zero if you will, is all kinds of hot: hot in the face, hot in the body and hotheaded. In May, he asked me to come over and make out. We chatted a little bit more, he told me about his status and I slipped out of the conversation, just like that. Randomly in July, I noticed him at a movie theater: On Grindr and online, people lie with pictures all the time, choosing ones that distort their appearance in a captured second, but I was able to pick Miguel right out of a crowd. His picture is a symbol of habitual honesty, maybe, but also because he’s so attractive, he has no reason to lie.
“This always happens: someone will feel bad and then they’ll see me out and they’ll be like, ‘Oh my god, you’re so fucking hot,’” Miguel told me while we waited for our table outside of a Chelsea brunch spot one Saturday in early July after I reconnected and asked him to talk to me.
Miguel told me that being turned down for sex because he’s HIV-positive is something that happens “all the time,” and that “almost every time, the minute someone gets to know me, their mind changes.” Exposure to a gay friend often converts homophobes swiftly; the same can be said of an HIV-positive guy meeting others who are fearful. It’s somewhat reassuring that that’s all it takes in many cases, but it also underlines the exponential burden put upon positive guys. They are either in a constant state of proving themselves socially or they are sitting on a secret.
Me
As a gay man in New York with an active, multiple-partner sex life, the chances are that I have hooked up with an HIV-positive guy or five and didn’t know it. Maybe I didn’t know it because he didn’t know it. Maybe I didn’t know it because he was a liar. Maybe I didn’t ask.
Granted, I generally play it safe, keeping fluid exchange at a minimum, using condoms, opting for oral over anal almost every time, and especially with strangers. (Although, as we are coming to realize, oral sex maybe isn’t as safe as we’d like it to be). Even with that in mind, getting tested is never less than horrifying, no matter how regularly I do it. There have been times, especially after suffering from a weird flu-like bug that no one else around me seemed to contract, that I have been sure that I would test positive.
I haven’t yet. I think I’m HIV negative, but since the virus can take three months to show up in blood, I can’t really be sure. In fact, none of us who are sexually active can be sure – except for those who are HIV positive.
Therein lies the hypocrisy in turning down a potential hookup who a) knows his status, and b) is honest about it in favor of one who doesn’t or is lying about it. That kind of discrimination is motivated by fear of the known while taking an agnostic approach to the unknown. It’s especially foolhardy considering that guys who know they are HIV-positive tend to be healthier and with lower viral loads than guys who don’t know they have it and are going untreated. The kind of optimism that assumes someone’s word is as good as a hard copy of a test result is potentially life-altering.
And yet, I’ve turned down guys who are open about their positive status. I watched the onset of AIDS in the ‘80s through the confused eyes of a child. I had it drilled into me that this was a disease to stay far, far away from. I also know better than to sleep with someone who announces himself as HIV positive. Or knew. Now I’m not exactly sure what to think. I feel guilty and scared, but not necessarily in that order.
Giovanni
I forgot to ask Giovanni* his status on Grindr before he came over. I remembered once he was inside of my apartment, discovered that he was HIV positive and asked if he’d like to be interviewed instead of hooking up. He agreed.
One of the first things we talked about was what complicates the situation the most: The widely held idea (at least among the HIV-positive guys I talked to for this story) that antiretroviral medication, which reduces the amount of HIV in a person’s blood to undetectable levels, is a contagion cure-all. That is to say that many people believe that it is virtually impossible for guys who identify as “poz but undetectable” to transmit HIV to a sex partner.
“I feel a little bit discriminated against just because if someone is taking care of themselves, there’s no risk on it, unless you have cuts or you’re bleeding,” Giovanni said. “But even then, you have to have a high viral load. If your status is undetectable, it’s very rare that someone else can catch from sucking.”
Giovanni contracted HIV about three years ago from his boyfriend who lied to him about his status: His partner said he was negative, they repeatedly had bareback sex, it turned out his partner was positive and it destroyed their relationship. “I blame myself,” he told me. His regard of personal responsibility is also present in his current philosophy regarding disclosure. If he’s not asked directly, he doesn’t open up about his HIV status.
“There are people that never ask me about my status, so I just go and assume that they have it,” he told me. “If you don’t ask me, I assume something’s wrong with you.”
I found this point of view disturbing, but most of what else Giovanni said was endearing. He told me that he empathizes with the people who are too scared to hook up with him and who turn him down: “I was there before it happened to me…I know how a person feels. When someone says you’re positive, your world changes.”
And so does the world of the person who has it. “It’s not hard to find somebody that accepts me the way that I am, but I don’t know…” he trailed off.
Before he left, I gave Giovanni a big hug. We were intimate and raw and we never took our clothes off. We talked about staying in touch and getting together again soon but it never ended up happening.
Chad
In early June, I lost interest in Chad when he told me he was “poz/undetectable” on Grindr. I didn’t respond to something he said, and 10 minutes later we shared this exchange:
Chad: Haha is that a no? I can take it Me: It’s so weird, the situation. I don’t want to seem like a dick or discriminate. You know? Chad: People discriminate all the time. But if u think I would put you at risk, I disagree. And guys think honesty makes things more dangerous. Me: Tell me more about how it wouldn’t put me at risk. Chad: Safe sex with an undetectable guy has no real risk, never been a documented case of transmission. But if you’re feeling spooked it’s no fun for either person . Xx. Me: I need to do more research. I didn’t know that. Chad: Take care.
I attempted to engage Chad again and he didn’t respond, not that I blamed him. In July, though, we met face-to-face through a mutual friend. I already knew who he was the second I set eyes on him from afar. From there we resumed communication and I’m glad: he’s attractive with intellect balanced out by an easygoing attitude. He’s exactly the kind of guy I want to be around. He’s also an AIDS activist, and thus particularly informed on the matter at hand.
“Lack of communication and lack of conversation around HIV is a big issue,” he said when I asked him about anti-HIV discrimination. “You have this turning point where the drugs start working well enough so that people won’t be outed by their physical appearance and then talking about HIV becomes a choice. Gay people were very tired of being associated with HIV and AIDS and it just kind of went underground. That’s the birthplace of the stigma. As soon as it became something you could disguise or put away, then it became a question of character.”
Chad’s activism doesn’t turn off when he logs onto Grindr. He says he regularly schools people on the app, as he did with me. He makes education sound like foreplay: he says the type of guys he’d be attracted to anyway are those who are knowledgeable on the subject or willing to learn. He told me that based on the information at hand, he can do “basically everything” in bed, just as long as he’s safe about it.
We talked a little bit about the rejection he’s faced from others like me, which sounds more patience-testing than soul-crushing. He bemoaned guys who “just go totally cold” and make things awkward when he reveals his status in person when he picks them up IRL (he says he always tells people in advance of meeting them if they initially connect online). “If you’re uncomfortable, fine. But communicate. It’s not the end of the world and you’re certainly not going to hurt my feelings. But it’s annoying to go through this beat-around-the-bush rejection process,” he told me.
I wondered about the other extreme: guys unafraid of having unsafe sex with him. He says he’s only experienced a “handful” of these, most of them “dedicated pigs who value raw butt sex.” Whether he would appease them depends on the dude.
Toward the end of our conversation, I apologized to Chad for brushing him off. He told me it was nothing, a blip in his life.
“If the situation presented itself again, you think the guy’s attractive and you’re still not comfortable, what do you say?” he asked, testing my apology.
I stammered and then finally: “It would depend on the level of attraction. But I don’t think I’m a firm no.”
“You’re weak now?” he asked, grinning.
Eddie
There is an East vs. West Coast divide on attitudes about HIV positive guys, or so I hear from a new friend, Eddie, who I recently met through other friends. A resident of San Francisco, Eddie told me that uptightness or reluctance on this issue is something he’s only experienced on the East Coast.
“People in San Francisco especially, but on the West Coast [generally], as soon as you say you’re undetectable, it becomes like a free pass,” he explained. “‘Oh, you’re undetectable, and the risk is so minimal, and I’m a top and you’re a bottom, and that’s even less of a risk.’ I’m like, ‘I guess?’ I’m not willing to take that risk.”
He told me that when he was in the gay mecca of Provincetown, Mass., last year, he found himself in a group that was ridiculing someone they knew who was recently diagnosed. That pissed him off, and he told them as much. “On the East Coast, [contracting HIV is considered] your fault, on the West Coast, it’s, ‘That could be me, and so I understand where you’re coming from.’”
Eddie says his experiences with HIV hookups have been “80 percent positive, 20 percent negative.” He was diagnosed in 2003 and says it was “probably the hardest thing I’ve ever dealt with.” It may seem unlikely, but sex ended up being therapeutic for him:
“When I started [dating and hooking up], and it wasn’t a big deal for other people, that really helped me. It really helped me realize that I can incorporate it into my identity.”
Eddie’s own journey to comfort exposes the contradictory cultural status HIV has right now: it’s both no big deal and a huge deal. It’s no big deal because the drugs that make HIV undetectable in blood have largely converted the disease into a manageable inconvenience. For many, it is not the death sentence it was. But for others it is: drugs are expensive and the high cost means that every minute, four people die of AIDS-related illness (as related in David France’s upcoming documentary How to Survive a Plague). The drugs can also have debilitating side effects, diminishing the quality of the life they are also saving. A relaxed, non-stigmatizing attitude is a nice thing for the world but complacency with a plague that continues to rage on is not.
Eddie said he understands his risk of transmission to be incredibly low. “I’ve dated people, and we’ve had unprotected sex, and we haven’t transmitted it. But, that’s in a different context than just hooking up with somebody, because you have that conversation and you make those decisions together,” he told me.
Eddie said he feels more discriminated against than stigmatized and pointed to the number of ways gay men can be socially awful to each other. “I think there are plenty of places where the gay community hurts itself—whether it’s through race, or class, or internalized homophobia. And also with HIV status.”
The Counselor
All of this is great and enlightening and galvanizing, but I still wasn’t sure about the information I was receiving. I know that part of taking care of yourself as an HIV positive individual involves educating yourself, and I have faith that these guys know their shit – much more than I did, at least. But the information that all of them hold true – that hooking up with a guy who is positive but undetectable will almost never or actually never result in the infection of a negative individual – it behooves them to hold true. Because they profess to be ethical people, they wouldn’t have casual sex if they didn’t believe this.
I’m not saying they’re wrong, I’m just saying that they could be biased. They are human, after all.
Through a friend, though, I was able to connect with Bryan Kutner, a counselor who was in South Africa working with an HIV-prevention group when I reached out to him. His is a key populations specialist and a consultant with Columbia University and the Harm Reduction Coalition.
Kutner pointed me to a recent study suggesting that just because HIV is undetectable in blood doesn’t mean it is undetectable in semen. It’s one study of a small sampling of HIV-positive men (81), but it does suggest that being undetectable isn’t the “free pass” that some would like it to be, maybe. The paper raises yet another contradiction: as antiretroviral therapy has become more popular, HIV has experienced a resurgence. At the very least, we shouldn’t rest on our antiretrovirals just yet.
But what does that mean?
“You won’t get a hard answer from me on it, simply because there’s not enough science for us to know exactly the state of affairs for men who are gay or have sex with other men,” Kutner wrote me in an email. “Studies have quantified the lessened risk, but I wouldn’t generalize their findings to the lives of gay men. That said, the consensus is that undetectable viral load is a good thing, all evidence on the subject points toward lessened transmission risk, and there may be more we still don’t know but we’re just gonna recommend that low viral load has some beneficial effect on lessening HIV risk even if we can’t exactly quantify it yet among the gays and other [men who have sex with men].”
But the lack of hard facts does not mean that we must abandon reason. It does not mean that it is impossible to make educated decisions based on the scraps of knowledge that we have. Here is how Kutner broke down the choice faced by Grindr users on the poz/neg divide:
[Say] one profile says nothing about status, another says he’s negative, another says he’s positive and undetectable, etc. As a thought experiment, let’s imagine that what people say online about themselves is always true – which is a stretch to begin with, but let’s go with it for now. The guy whose viral load is undetectable might be the better choice for reducing the chance of transmission; he knows his status, he takes his meds, he has no measurable HIV in his blood. The other guys don’t say their status or they say they’re negative. The unknown status guy could have HIV but not want to say anything about it…Then there’s the negative guy. He’s either truly negative or he just thinks he’s negative; if it’s the latter, then in all likelihood his viral load is more of a transmission risk than the guy who knows his status and has undetectable viral load. Based on counseling NYC men testing for HIV, plenty of “negative” guys fuck without a condom and naively think they and the guy they just fucked is negative – so what they say about being negative is true, but it isn’t accurate since a guy’s HIV status is subject to change before he knows it has changed.
So of those three choices, the guy who’s willing to be out about his status might seem like the easier one to trust. Of course, it’s so much more complicated – who wants to think about HIV during sex when it’s hard enough to contemplate it after sex?
So, right. No firm answers to be had here, except that abstinence is the only way to stay truly safe. And abstinence, as we know, is impossible. How terrifying.
Miguel and Me, Redux
“This always happens: someone will feel bad and then they’ll see me out and they’ll be like, ‘Oh my god, you’re so fucking hot…’”
Miguel is 32 and was 21 when he was diagnosed. A former drug abuser, he told me that when he found out he had HIV, it barely fazed him. It wasn’t until he got clean that he realized the true value of himself – now he says he’s healthier than he’s ever been. He has an insanely cut-up torso to prove it.
Though he told me he isn’t angry, his words suggest otherwise. He gets visibly riled when we discuss HIV-related ignorance within the gay community.
“I’ve had people tell me, ‘I’ve ever been with anyone with HIV.’” he said. “Are you fucking kidding me? Do you live under a rock? ‘Well no one’s ever told me.’ That’s exactly it, and you never bothered to ask. So now you’re an idiot. And then they get mad and it’s like why are you getting mad at me? You’re the dumbass who’s probably going to get HIV because of your mindlessness.”
He isn’t exaggerating. Probably. Using CDC figures, I’ve calculated that 1 in 14 men who sleep with men in America has HIV. I’ve heard estimates as high as 1 in 5 in New York. The stats get fuzzy when you take into account how many guys have it but don’t know it (though there are stats for that percentage, too). In general, the hard facts are elusive. HIV is everywhere or not so much and maybe you’ll get it from someone who is undetectable or maybe you won’t and then maybe you’ll be fine after taking some meds. Maybe.
Where having HIV is concerned, you’re damned to a life of uncertainty and anxiety if you don’t, condemned to one of shoddy treatment from your gay brothers if you do. Even if I never contract HIV, it will remain a concern of mine for life. I have contracted an issue.
Miguel informs everyone of his status up front, and told me that those who don’t “are the people who create this stigma with us.” He said he has a “pretty damn active sex life,” hooking up with “a couple of guys a week.”
But “hooking up” means different things to different people. “I mainly just do what happened earlier. That’s about it,” he added.
Right. Earlier.
After Miguel and I set up our brunch date earlier that day via text, he casually mentioned that he was jacking off. I thought that was hot. It inspired me to do the same and I told him. He sent me shots of his hard cock and asked me to, as well. I explained to him why I never do that (I write in public)…and then I caved. Part of it was out of obligation – I had already turned him down enough – but the bigger part of it was that it was sexually exciting, a slight risk (what if the pics leak?) to make a hot situation hotter. He sent me his ass pic as well, and we said nasty things to each other. “Shoot ur load,” he eventually directed me. “I’m going to in a bit,” I said back. He sent me video of himself ejaculating and then said, “Show me.” And so I did.
At brunch we talked about how hot that was, and how lovely our conversation was going. “I feel like this is much more intimate than a hookup,” I told him, verbalizing what I had felt back when Giovanni sat on my couch and spilled his story to me. “Me too. I would much rather do this,” said Miguel.
After we wrapped up our interview and brunch, Miguel and I stepped onto the bright Chelsea sidewalk outside of our restaurant and kissed passionately. We walked down the subway together, our arms spilling all over each other and I felt proud in the presence of this beauty and flattered that Miguel shared his knowledge and story with me.
* Except for Miguel and Bryan Kutner, the names that appear in this piece are pseudonyms.
PEP stands for Post Exposure Prophylaxis and is a treatment that may prevent HIV infection after the virus has entered the body.
Post
= After
Exposure
= A situation where HIV has a chance to get into someone’s bloodstream, like unsafe sex.
Prophylaxis
= A treatment to stop an infection happening.
PEP Treatment:
Involves taking anti-HIV drugs for four weeks
Must be started as soon as possible after unsafe sex or a condom not working, straight after exposure or within 24 hours is best and no later than 72 hours (three days)
Has side effects
Is likely to stop HIV but isn’t guaranteed to work
Where do I get PEP?
Sexual Health clinics (GUM clinics) – at Leicester Royal Infirmary or the one in your city / town
Hospital Accident & Emergency department (A&E) – be prepared to ask for PEP as soon as you can after you book in.
Not all of these places in every part of the country will have PEP or be able to prescribe it
PEP – Post Exposure Prophylaxis
How soon?
It is best to start PEP straight after exposure or within 24 hours and no later than 72 hours (three days later). The longer you wait there is less chance it will work, after 72 hours PEP isn’t usually given as it’s unlikely to work by then.
But if HIV is in my body doesn’t this mean I will now be infected?
No. After HIV gets into your bloodstream it takes from a few hours to a few days before it permanently infects you. If you act in that short time you stand a chance of stopping HIV before the infection takes hold.
How does PEP work?
Taking anti-HIV drugs every day for four weeks might stop the HIV before it gets a permanent hold in your body. PEP is not a ‘morning after’ pill that’s taken just once, it’s one month of drug treatment.
So if someone takes PEP they won’t become HIV positive?
Research shows PEP makes infection with HIV a lot less likely. But PEP doesn’t always work, some people who take it still end up with HIV after treatment. PEP can fail because some anti-HIV drugs don’t work against some strains of HIV. It’s more likely to fail if it’s not taken properly or soon enough.
Are the drugs the same as the ones taken by people with HIV?
Yes, you take three drugs which are also used in ‘combination therapy’ taken by HIV positive people.
Is PEP a cure for HIV?
There is no cure for HIV. PEP can only stop the HIV infection if it’s taken very soon after it has entered your body and before the infection takes hold. Once the HIV infection becomes permanent then anti-HIV drugs can’t get rid of the virus. This is because it is not in parts of the body the drugs can’t reach. Once HIV permanently infects someone the drugs can usually control the HIV in their body but can never get rid of it completely.
Does PEP have side effects?
Yes, it can cause diarrhoea, headaches, nausea and vomiting. Because of the side effects, you may need time off work or study and some people have to stop taking it. Side effects go once you stop taking the drugs. One Australian study showed that among people taking PEP, side effects were mild to moderate for two out of three people and severe for one in four.
What are the chances someone will get PEP?
New guidelines have been given to Sexual Health Clinics that help doctors decide if PEP should be given. A doctor will need to ask questions about:
Who you had unsafe sex with, to identify the likelihood of you having HIV.
What kind of sex you had, when it happened, whether it was oral, vaginal or anal sex and whether either of you came inside the other.
Doctors might sometimes give PEP after oral sex, depending on the circumstances.
It’s worth thinking about PEP if you or someone you had anal or vaginal sex with didn’t use a condom or something went wrong with the condom and it’s not later than 72 hours (3 days) since it happened.
They will also talk to you about having an HIV test. Before you are given PEP you must have a test to check you don’t already have HIV. You must also agree to be tested after taking PEP to see if it’s worked. PEP won’t be offered if you refuse to be tested.
What if I can’t get to a place that has PEP within 72 hours?
After 72 hours PEP won’t usually be offered so if it’s not possible to get to a Sexual Health Clinic in time it is advisable to go to a hospital Accident & Emergency department because they never close.
If I take PEP can I become resistant to HIV drugs so they won’t work if I get HIV later?
No, it’s HIV, not your body that can become resistant to the drugs. If PEP works it gets rid of the virus – and the virus can’t become resistant because it’s not there anymore. So if you were to become HIV positive later and needed drugs if wouldn’t make any difference that you took PEP in the past.
But if PEP doesn’t work and you become HIV positive, there may be problems with the HIV in your body being resistant to some drugs, including ones used in PEP.
If I’m taking PEP does that make me immune to HIV while I’m on it or when I’ve stopped taking it?
No. Unsafe sex while taking PEP could let more HIV into your body, making PEP much more likely not to work.
If, after taking PEP you have stayed HIV negative and then you have unsafe sex again, you can become infected just like any other HIV negative person.
Now we have PEP does it matter so much if I don’t use condoms?
PEP doesn’t change the need for condoms, here’s why:
Using a condom is more likely to stop HIV being passed on than PEP is.
Condoms don’t make you ill with side effects, which PEP can.
You need a condom for as long as the sex lasts – but PEP lasts for four weeks.
Condoms are everywhere. PEP can be hard – sometimes impossible – to get.
You control getting hold of condoms but doctors decide if you should get PEP and they may say no.
How many times can I have PEP?
Doctors decide who gets PEP and they’re unlikely to give these expensive and powerful drugs to the same person time after time. So if you keep having unsafe sex you will usually be offered help with having safer sex rather than being given PEP lots of times.
As we prepare to enter our 25th year, we are reflecting on the global HIV events from the last three decades. HIV has swept across the globe touching communities on every continent. Here’s an introduction to some of the key moments in the early global history of HIV. Catch up on the story using the ‘Recent Posts’ link to the right.
We focus on 1993 today. During January, 116 new cases of AIDS were reported in the UK, bringing the cumulative total to 7,045. One in six of these new cases were acquired through heterosexual intercourse.
In March, the House of Representatives in the USA voted overwhelmingly to retain the ban on the entry into the country of HIV positive people.
In early April the Ministers of Health and Finance from 39 countries met in Riga, Latvia, and launched an initiative to contain the spread of HIV in Central and Eastern European countries.
On 7th April all French television networks broadcast ‘Tous contre le Sida’ (All against AIDS) simultaneously, a special 4-hour programme designed to heighten awareness about HIV/AIDS and to raise money. The estimated audience for the programme was 33 million. Some 32,000 cases of AIDS had been recorded in France, with 15 deaths each day, and an estimated 150,000 people were thought to be infected.
In Romania, the number of children infected with HIV had increased. There were an estimated 98,000 infected orphans.
China had reported one thousand cases of HIV infection, mostly in injecting drug users, but it was believed that this greatly understated the scale of the country’s HIV epidemic.
In South Africa, the National Health Department reported that the number of recorded HIV infections had grown by 60 percent in the previous two years and was expected to double in 1993. A survey of women attending health clinics indicated that nationally some 322,000 people were infected.
In mid-1993, it had been realised that HIV was also spreading rapidly in the Asia and Pacific regions, home to more than half the world’s population, where more than 700,000 people were already believed to be infected.
Official statistics for Brazil indicated that some 46,000 cases of AIDS had been recorded, but estimates put the actual number at anywhere between 450,000 and 3 million cases. Two thirds of the known cases were in Sao Paulo state where AIDS was the leading cause of death of women aged 20-35.
Despite the overwhelming evidence and more importantly, the need that safer sex campaigns were needed, in 1994 In the UK, the Department of Health vetoed an AIDS campaign promoting safer sex and condoms which was already developed at a cost of £2m on the grounds that it was too explicit!
The campaign was developed by the Health Education Authority (a government funded body) who later in the year were banned by the Department of Health from distributing the book, ‘Your Pocket Guide to Sex’. It was aimed at 16 to 25 year olds, giving advice on contraception, HIV and safe sex. The media reacted hysterically, saying that it was encouraging young people to have sex, and the government panicked. They pulped the book and threatened to stop all of their AIDS and sexual health education programmes.
However, this author has just researched Amazon and found it’s available to buy online, here’s the link if you’re interested!
The World Bank reviewed its HIV and AIDS activities in Africa, and decided that AIDS should not dominate its agenda on population, health and nutrition issues.
In the UK the radio DJ and comedian Kenny Everett announced that he was HIV positive, as did Holly Johnson, former lead singer with the group Frankie goes to Hollywood.
During the summer, the AIDS Prevention Agency in Brussels, in collaboration with the European Union, launched a campaign whose central image was ‘the flying condom’.
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On World AIDS Day, 1st December, Benetton in collaboration with ACT UP Paris placed a giant condom (22 metres high and 3.5 wide) on the obelisk in Place de la Concorde in Central Paris in an effort to waken the world to the reality of the disease. A symbolic monument to HIV prevention, it appeared on the covers of newspapers worldwide.
At the end of 1993 the estimated number of AIDS cases worldwide was 2.5 million.
But hope was on the horizon, if only for some, a large European study on mother-to-child transmission showed that Caesarean section halved the rate of HIV transmission, something of hope to expectant mothers and demonstrated that progress was being made in the field of HIV research.
Research indicated that Thailand had reduced its rate of HIV transmission. This was largely due to action by the government, which had distributed condoms to brothels and insisted that they were used consistently.
In face of opposition to HIV prevention programs it seemed that hope was near, in Leicester LASS moves to new premises, our current home. The Michael Wood Centre and establishes a ‘company limited by Guarantee’, and gain charitable status.
Following the dissolution of Leicester Body Positive, a peer support development project is set up to develop opportunities for peer support, undertake and develop advocacy, and develop self-sustaining systems for people with HIV to influence the planning and provision of services in Leicestershire.
There’s no denying the life-extending benefits of antiretroviral therapy. While it has allowed many people living with HIV to plan for their golden years, it has also meant preparing to face age-related health problems. According to the CDC, 25 percent of those living with the virus are over 50 years old. In turn, there’s a growing need for comprehensive care to prevent and manage typical age-related maladies, such as heart disease, cancer, diabetes and osteoporosis—all of which can be complicated by HIV and its treatment.
You can find comprehensive information about treatment options from your GP and the people over at http://www.aidsmeds.com have written an excellent report into HIV & Ageing covering:
What is aging, and why do we become ill as we get older?
How does HIV affect the aging process?
Are people with HIV aging more rapidly?
Is it possible to slow down the aging process?
Are there experimental treatments to slow aging in people with HIV?
The good news is that most HIV-positive people can do quite a lot to slow the aging process and guard against the onset of age-related illness. So why not head over there and understand how aging works in the first place, and what you can do to help yourself..
The first drug licensed to treat HIV was Zidovudine, (AZT). Dr. Robert E. Windom, assistant secretary for health at the Health and Human Services Department, emphasized that AZT, to be sold under the trade name Retrovir, is not a cure for AIDS (sic) but he said the action “means that significant medical relief will be available to thousands of those afflicted with this dreaded disease.”
Windom said that licensing of the drug, “Marks an important step but by no means a final victory in our ongoing war against AIDS.” AZT was expected to be expensive, costing each patient as much as $10,000 a year.
Final approval of AZT, first administered to AIDS patients in human studies begun in July, 1985, came in record time, the result of a decision by the Food and Drug Administration to consider AIDS drugs as a top regulatory priority. Typically, the process takes an average of 8½ years from the earliest studies to licensing, AZT smashed this timeframe and was licenced after just 2 years.
Soon after its introduction, activists establish the AIDS Coalition to Unleash Power (ACT UP) to challenge high drug prices and rally on Wall Street where “17 homosexual-rights protestors” were arrested, charged then released.
The US government closes its country’s borders to HIV-positive immigrants and visitors which eventually lead to many non-profit organisations to boycott the international AIDS conference in San Francisco in 1990. By 1992, the conference moves from Boston to Amsterdam because of America’s border controls.
An advert featuring The Grim Reaper was launched in Australia to warn people about the dangers of HIV was launched by the National Advisory Committee on AIDS (NACAIDS). The advertisement depicted the Grim Reaper in a bowling alley, bowling over various people from men and women to babies and toddlers, knocking over human ‘pins’ which represented people with HIV. The commercial first screened on 5 April 1987 and was highly controversial; one reason is the unfortunate blow to the gay community, which had already taken the lead in AIDS awareness and safe sex practices.
The Grim Reaper became identified with gay men rather than as the Reaper which was unintentional, however viewers believed that the Reaper was people with HIV infection, rather than the Reaper harvesting the dead.
The commercial was widely criticised at the time, but it succeeded in creating widespread discussion about AIDS.
1987 also marked a UK Government Cabinet Committee devoted to combatting the epidemic. £20 million was earmarked for a publicity campaign, £5 million of which was to be spent on television commercials which could be adapted for cinema. The dilemma facing the government and advertising agency was whether to use shock tactics, as recommended by health groups or take heed of moral campaigners like Mary Whitehouse, who called for the promotion of “monogamy, not sexual precautions”. Another contentious issue was whether to overturn the Independent Broadcasting Authority’s restriction on commercials recommending condom use.
The result was a hard-hitting campaign containing apocalyptic images of icebergs, crumbling mountains and falling monoliths crashing on our screens. The aim was to shock people into practising safer sex.
The most remembered of the five advertisements were Tombstone and Iceberg, with their iconic, nightmarish imagery, compounded by John Hurt’s chilling commentary.
The television advertisement campaign was accompanied by educational television and radio programmes on AIDS and related leaflets, bearing the ‘Don’t Die of Ignorance’, slogan were sent to every home in the country. (Click the image above for a copy). Despite widespread apprehension, the campaign was later acknowledged that it had been successful in precipitating more open discussion about AIDS in the media.
Although cases of AIDS in the UK had remained low, due in part to high profile campaigns, it had become a global epidemic, by this time, the World Health Organisation had been notified of nearly 44,000 cases of AIDS in 91 countries including the cases first recorded in the Soviet Union.
At a time with high ignorance and constant struggle in the face of stigma and discrimination, most of the population thought you could get AIDS from touching someone or sharing equipment or facilities. This was the experience of Mike Sisco, a gay man with HIV.
Mike simply took a dip in a local swimming pool. Word spread quickly, and by the next day fear, panic and rumours – including one that claimed Mike had spit on food at a grocery store—had forced the pool to be closed and prompted a front-page banner headline in the local newspaper which also made the national news.
Mike says that when he went swimming at the pool, the lifeguard was the first person to recognise him, but soon the other bathers did as well. “They kind of ran like in those science fiction movies where Godzilla walks into the street.”
This wasn’t the first time the community had reacted negatively to seeing Mike in public. He says he returned home after contracting AIDS (sic) while living in Dallas. He says his illness quickly became known in the community through the whispers of small-town gossip. The Opera Winfrey show examed the case in an hour long special filmed at the town hall.
Watch Mike tell Oprah his story in his own words here and read more about it here.
At a time when panic, fear, prejudice, stigma and discrimination were wide spread, people with HIV were often rejected by friends and family, and ostracised by society, there seemed to be little hope of educating socialy. What was needed was a public figure to openly demonstrate that HIV could not be caught by sharing cups, towels or even air and that support came in the form of Princess Diana.
Diane was drawn to people she felt were not treated fairly and did not receive the support they deserved. She understood that people living with HIV were desperately in need of understanding and support and that is why HIV was a cause she supported so passionately.
She knew that her public profile meant any cause she supported would receive enormous public attention and recognition. For this reason, she chose to support causes which were not considered popular and glamorous – as she knew it was these causes she could make a major difference to.
Princess Diana worked tirelessly both in front of the cameras and behind the scenes to support people living with HIV and to change society’s attitude to HIV – whether visiting HIV positive people in hospital, opening wards, attending conferences and events or supporting fundraising initiatives.
Princess Diana’s commitment and dedication to raising the profile of HIV helped challenge the stigma of the virus. She often publically wore a red ribbon and was the first prominent public figure in the UK to be pictured holding the hand of a person with AIDS in his hospital bed. This iconic image was seen by millions all over the world and had an amazing effect in challenging attitudes towards people living with HIV and breaking down stigma and misconceptions.
In Leicester, an initial meeting brings together around 40 people with an interest in practical action to address the issues related around AIDS and HIV. A general meeting adopts a constitution and elects a management committee which carries on the work of an initial steering group forming links with other agencies pursuing funding and seeking premises. The organisation is called: Leicestershire AIDS Support Services.
HIV, which attacks the body’s natural defences, also damages the brain, three dimensional medical scans have shown.
The MRI images captured by a US team could show why up to 40% of people with HIV have neurological symptoms. Compared with healthy people without the virus, the brains of the HIV positive patients studied were 15% thinner.
HIV experts said more work was needed to check that neuroprotective drugs would be beneficial to HIV positive patients and that these treatments would not be safe to take alongside the powerful anti-HIV drugs such individuals are already on. As drugs improve, people with HIV are living much longer.
However, at least two in five living with HIV will suffer from cognitive impairments, ranging from minor deficits to dementia, studies suggest. While researchers are aware of this, the pattern of damage the virus causes in the brain has not been well understood.
We’d need more solid evidence on how HIV can affect the brain in different individuals before we looked at offering neuroprotective drugs
Compared with 14 healthy controls, the +ve patients had 10-15% thinner brain regions, including areas called the primary sensory, motor and premotor cortices, regardless of whether they were taking anti-HIV drugs or not.
This tissue loss shown up by the brain mapping correlated with the cognitive and motor deficits that the Aids patients displayed on a battery of brain function tests. The brain tissue loss was the opposite of that seen in common dementias such as Alzheimer’s disease and appeared to be related to the individual’s CD4 count – a marker of how far HIV has progressed and how healthy the person’s immune system is.
The researchers said: “With 40 million patients worldwide now living with HIV, detailed biomarkers of [brain] deficits, such as the cortical maps presented here, are increasingly needed to help gauge the success of neuroprotective therapies.
“Here, they reveal how HIV impacts the brain and may also help identify early changes in neurologically asymptomatic patients with HIV who might benefit most from neuroprotective agents.”
Long-term issues
Rod Watson of the Terrence Higgins Trust said: “We do know that some people with HIV could go on to develop Aids-related dementia or other illnesses affecting the brain.
“This study tracking any cognitive decline is interesting but small. We’d need more solid evidence on how HIV can affect the brain in different individuals before we looked at offering neuroprotective drugs.
“In particular, there would have to be detailed research into how useful these drugs would be and how safe in terms of interacting with existing HIV treatments.”
David Simpson, professor of neurology at Mount Sinai Medical Center in New York, told the BBC News website: “This paper is interesting and provocative, and if the value of this technique is validated in other studies, from other centres, this imaging approach may be a valuable surrogate marker of brain function in HIV infection.”
He added: “The increased survival of patients with HIV, due mostly to HAART, has placed greater emphasis on long-term issues affecting quality of life, such as neurological disease.”
Professor Simpson said that, while many neurological complications are more common in advanced Aids, others, including HIV-associated cognitive disorder, may occur in HIV positive people who have relatively high CD4 counts.
Steve Small, deputy chief executive of Mildmay, a HIV charity, specialising in HIV related brain impairment in the UK, said: “This research backs up what most people have known for sometime.
“You have an increased propensity for cognitive decline the more immunosuppressed you are but, whereas before we have thought that this would go away with anti retro virals, this study claims that it will not.”
Every March, Brain Awareness Week (15 – 19 March) unites the efforts of partner organisations worldwide in a celebration of the brain for people of all ages. It is the global campaign to increase public awareness of the progress and benefits of brain research.
In its “Top 10 Medical Breakthroughs” of 2011, Time magazine has listed HIV treatment as prevention at number three, just behind the use of cloning to create stem cells and a first-ever malaria vaccine. The magazine cites recent studies that show that an HIV-positive person who adheres to effective antiretroviral (ARV) treatment has less virus in his or her system, and therefore the likelihood of HIV transmission is reduced by 96 percent.
The “treatment as prevention” banner also includes pre-exposure prophylaxis, or PrEP, which is when an HIV-negative partner takes daily ARVs to reduce the risk of contracting the virus. These two breakthroughs in HIV treatment, experts say, offer more tools in the global battle against HIV. Treatment as prevention demonstrates that getting ARVs to HIV-positive people cannot only save lives but can curb the spread of the virus.
The treatment of HIV has come a long way, thanks to antiretroviral (ARV) drugs that can lower levels of the virus in the body, keeping people healthy and reducing the risk of HIV transmission. Increasingly, though, studies have also shown that the same drugs used to treat existing infections can also help protect HIV-free people from becoming infected.
This year, two ground-breaking trials — the first to involve heterosexual men and women — showed that HIV-free people were significantly less likely to become infected with the virus if they took the antiretroviral drug Truvada (a combination pill that contains the drugs tenofovir and emtricitabine) every day.
In one study led by University of Washington researchers, which involved 4,758 heterosexual couples in which one partner was HIV positive and the other was not, transmission of the virus was reduced by 73% after three years, compared with placebo, when the uninfected partner took the antiretroviral pill. In another study of 1,200 healthy, sexually active men and women, led by the Centers for Disease Control and Prevention, taking Truvada reduced the risk of HIV infection by 63%.
The results add to the evidence that using ARVs could help control the still growing AIDS epidemic in the developing world, where most new infections occur in heterosexual couples. Public health officials face significant obstacles in making ARVs widely available in these regions, but if they can, they might finally be able to curb the epidemic.
Good evening everyone just a quick reminder that we’re closed on Bank Holiday Monday & reopen as usual on Tuesday 7th. Have a good weekend. 2 weeks ago
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