The most insidious virus: Stigma

Stigma did not create AIDS. Yet it prepared the way and speeded its ravaging course through America and the world. First stigma delayed understanding of the disease: it’s a gay cancer, it’s a punishment from God, they brought it on themselves, so who cares? Then stigma delayed government action, research, and assistance for the sick and dying. Stigma made people afraid to get tested for HIV and treated. Stigma made people ashamed, isolating and alienating them from friends and family. Stigma cost people jobs, professional standing, housing, a seat on an airplane or in a dentist’s chair. Stigma made many afraid to live, and want to die. But then it began to make some brave people very angry and AIDS activism was born. The activists quickly realized that to end AIDS we must end stigma.

ACT UP protest at the White House on April 23, 1991

AIDS activism did more to fight the stigma on being gay or having AIDS than any other social force. In this way, AIDS activism, like the civil rights movement, became a great moral movement of our time, defending the innocent, restoring dignity to the violated, giving hope to the desperate, and reviving faith in the disillusioned. AIDS activism gave LGBT people courage, dignity, and power they had never held before.  It inspired many to stand up and proudly proclaim who they are and who they love. Twenty-six of the world’s most advanced countries now recognize gay marriage and today a gay man openly married to another man is a prominent candidate for President of the United States.

Read the full article.

Scientists detect new strain of HIV

From CNN

For the first time in 19 years, a team of scientists has detected a new strain of HIV.

The strain is a part of the Group M version of HIV-1, the same family of virus subtypes to blame for the global HIV pandemic, according to Abbott Laboratories, which conducted the research along with the University of Missouri, Kansas City. The findings were published Wednesday in the Journal of Acquired Immune Deficiency Syndromes.

HIV/AIDS Fast Facts

HIV has several different subtypes or strains, and like other viruses, it has the ability to change and mutate over time. This is the first new Group M HIV strain identified since guidelines for classifying subtypes were established in 2000. It is important to know what strains of the virus are circulating to ensure that tests used to detect the disease are effective.

“It can be a real challenge for diagnostic tests,” Mary Rodgers, a co-author of the report and a principal scientist at Abbott, said. Her company tests more than 60% of the world’s blood supply, she said, and they have to look for new strains and track those in circulation so “we can accurately detect it, no matter where it happens to be in the world.”

Health Alert: New drug-resistant STI spreading among men who have sex with men

From Out Magazine

Researchers at the University of Washington have identified a worrisome new bacterial cluster that’s growing in prevalence among men who have sex with men and is resistant to antibiotics.

The drug-resistant strains were identified in Seattle and Montreal, although researchers believe they’re common worldwide. Known as Campylobacter coli, the bacteria cause severe abdominal pain, bloody diarrhea, and fever and are estimated to affect about 1.3 million people in the United States annually. The journal Clinical Infectious Disease published the finding this month.

While the infection usually passes after a few days, it can pose a more serious threat to those with compromised immune systems.

Men who have sex with men are more prone to infection due to sexual practices like anal sex and rimming, according to the researchers. Transmission occurs when fecal matter enters another person’s body, and while it isn’t limited to any one population, gay men are more likely to experience drug-resistant infections because they’re more likely to have recieved antibiotics for similar infections in the past.

“The international spread of related isolates among MSM populations has been shown before for Shigella [another enteric pathogen], so it makes sense to see it in Campylobacter as well,” wrote the study’s lead author, Dr. Alex Greninger. “The global emergence of multidrug-resistant enteric pathogens in MSM poses an urgent public health challenge that may require new approaches for surveillance and prevention.”

Read more on Out Magazine online.

 

More evidence in support of needle exchange programs

In his State of the Union Address earlier this year, President Trump announced the laudable goal of eliminating HIV transmission by the year 2030. Needle exchange programs (also called Syringe Exchange Programs or SEPs) are a public health approach in use since the 1980s with a proven record of reducing the spread of HIV, hepatitis, and other blood-borne infectious diseases. I have presented much of the data supporting needle exchange programs here and, more recently, here. Now, new research reported in the Journal of Acquired Immune Deficiency Syndrome adds even more strength to the argument in favor of needle exchange programs.

Jeffrey A. Singer is a Senior Fellow at the Cato Institute and works in the the Department of Health Policy Studies

Because most of the averted cases would have received publicly funded health care, the study’s authors then translated averted cases into cost savings for the two cities.Using surveillance data of HIV diagnoses associated with intravenous drug use from Philadelphia and Baltimore, cities where needle exchange programs had been permitted since the early 1990s, their analysis concluded that more than 10,000 cases of HIV were averted in Philadelphia from the years 1993 to 2002, and nearly 1,900 cases were averted in Baltimore from 1995 to 2004.

The forecasts estimated an average of 1,059 HIV diagnoses in Philadelphia and 189 HIV diagnoses in Baltimore averted annually. Multiplying the lifetime costs of HIV treatment per person ($229,800) by the average number of diagnoses averted annually in both cities yields an estimated annual saving of $243.4 million for Philadelphia and $62.4 million for Baltimore. Considering diagnoses averted over the 10-year modeled period, the lifetime cost savings associated with averted HIV diagnoses stemming from policy change to support SEPs may be more than $2.4 billion and $624 million dollars for Philadelphia and Baltimore, respectively. Because SEPs are relatively inexpensive to operate, overall cost savings are substantial even when deducting program operational costs from the total amount.

Needle exchange programs have long been endorsed and encouraged by the Centers for Disease Control and Prevention, the Surgeon General of the United States, the World Health Organization, the American Public Health Association, and the American Medical Association. Nevertheless, needle exchange programs are legally permitted to operate in only 28 states and the District of Columbia. Drug paraphernalia laws make them illegal elsewhere.

Some critics argue that needle exchange programs “enable” or “endorse” intravenous drug use. Such moralizing is not appropriate in this context. Addiction is a behavioral disorder characterized by “compulsive use despite negative consequences.” Preventing organizations from providing an effective means of harm reduction to people with addiction who continue to use drugs is akin to denying insulin to diabetics who continue to make dangerous eating choices.

It is not unrealistic to set a 10-year goal for ending HIV transmission. Needle exchange programs are essential for that to happen.

HIV advisory group for the Department of Health Division of HIV DISEASE seeks new members

The HIV Planning Group (HPG) is now seeking interested candidates to apply for membership! The deadline to apply is November 14th.

The HPG is an important advisory body for the Department of Health’s Division of HIV Disease and is organized by the HIV Prevention and Care Project at the University of Pittsburgh. The group seeks to better inform all levels of the HIV Care Continuum in Pennsylvania (excluding Philadelphia, which is funded separately) through Integrated HIV Planning and oversight, statewide assessment, and advisory responsibilities.  The group is particularly seeking HIV positive applicants and folks who represent minority communities, trans communities, and those at-risk under the age of 39. You can find more information on StopHIV.com.

You can also use this convenient online form to apply.

Summer 2019 newsletter highlights study’s 35th anniversary

Clinic coordinator Bill Buchanan: “None of it would have been possible without the volunteers.”

From the Summer 2019 newsletter

The origin of the study can be traced to 1982, when University of Pittsburgh researcher Dr. Charles Rinaldo met with a young gay medical student named David Lyter to discuss the opportunistic infections that were killing gay and bisexual men. From this came the Pilot Study, which formed the basis for a 1983 National Institutes of Health grant application that created the Pitt Men’s Study, part of the national Multicenter AIDS Cohort Study (MACS) with additional sites in Los Angeles, Chicago and Baltimore.

“The study’s longevity is due to the incredible response from the community to one of the major health crises of our time,” says PMS clinic coordinator William Buchanan. “None of it would have been possible without the volunteers.”

Find out more in the Summer 2019 newsletter.

Implementing rapid ART initiation to successfully manage HIV

As countries across the globe continue the fight against HIV, treatments that are quickly initiated and effective are crucial for getting patients with HIV virally suppressed both to improve their clinical outcomes and to stop the transmission of infection.

Addressing both of these issues, Mary Montgomery, MD, associate physician in the Division of Infectious Diseases at Brigham and Women’s Hospital, and an instructor of medicine at Harvard Medical School, discussed emerging treatment strategies for managing HIV during a session at the National Association of Managed Care Physicians 2019 Fall Managed Care Forum, held October 10-11 in Las Vegas, Nevada.

More and more, clinicians are understanding the benefit of prescribing antiretroviral therapy (ART) to patients the day they are diagnosed with HIV, otherwise known as rapid ART initiation.

The literature has shown that rapid ART initiation is associated with a more favorable mortality profile, as well as quicker viral suppression. In one study,1 the median time to viral suppression was 56 days for those who initiated treatment at diagnosis, compared with 126 days for those who began treatment consistent with prior recommendations for universal ART and 219 days for those who received CD4-guided ART.

Read the full article