Kenyon's blog

From The Defenders Online (the blog of the NAACP Legal Defense Fund).

…28 years into the AIDS epidemic, that silence that once protected us, is now killing us. As we near Black HIV/AIDS Awareness Day on February 7th, all sorts of pronouncements will be made about the devastation HIV/AIDS is having on the community. And though we are disproportionately impacted by the epidemic, concern for black men who have sex with men (MSM) and transgender women will not likely come from most quarters of the community. If black leadership is at all concerned with ending this epidemic, we’re going to have to acknowledge and overcome the homophobia that is driving it in the community.

Even though we've talked over the last year about the new HIV infections rate (incidence) in 2006, I haven't given any thought to the issue of transmission--how many people actually transmit HIV to an HIV negative person every year? And what does the looking at the rate of transmission over the course of the epdemic tell us about what's working or not working with prevention, testing, treamtment or care efforts?

Well that's why we have smarty pants like David Holtgrave, PhD at the Bloomberg School of Public Health at the John Hopkins University. His study, which JAIDS released online ahead of the publication date, looks precisely at HIV transmission rates over the course of the epidemic. They conclude that the highest rates of transmission occurred in the early years of the epidemic--in the early/mid 80s, and then began to drop off at several different points, particularly from 1985-1986 (31.4-17.4), and 1990-1991 (11.7-6.6). By 2006, the transmission rate declined to 5.0.

In other words, 95% of all people with HIV did not transmit the virus to people who are HIV negative.The study goes on to explain the possible causes for this drop in transmissions:

The general decline in HIV transmission rates over time could be considered a rough measure of prevention success, in that even as prevalence grew over time incidence did not grow proportionately. HIV diagnosis is known to significantly reduce HIV risk behavior, and in the past decade, there has been an increasing emphasis on prevention programs for persons living with HIV that further reduce HIV risk behavior and 2006.

Another interesting thing Holtgrave and co-authors note is that AIDS drugs (anti-retrovirals) didn't have a grand impact on transmission rates, as transmission was declining long before ARVs were on the market. Could it be that marginalised communities with no access to treatment is where those transmission rates did not decrease? Could it be that the prison boom and/or Welfare Reform Act of 1996 (when prison construction peaked and we hit the 2 million prisoner mark for the first time) disrupt or change sexual networks enough to create new HIV transmissions in social networks where they had been stable? Holdgrave doesn't ask these questions, but notes that further research needs to happen to explain why ARVs do not seem to have significantly decreased transmission of HIV. But in a Q & A on Johns Hopkins' website, he addresses the impact of housing stability on HIV risk, and also says what he would do if he was AIDS Czar in the Obama Administration:

I think it is critical to address unmet HIV prevention needs in the U.S. As I testified recently before Congress, my wish for a five-year plan would be for $1.3 billion in prevention funding per year. I might front-load that a bit, so maybe it’s $1.6 billion in the first year, and so on. Over that five-year period, I estimate that as a nation we could reduce transmission by half—but we’d need that substantial investment. And if we really saw a drop in new infections, that higher level of funding might sunset in several years, so we wouldn’t necessarily have to continue to fund it at $1.3 billion per year.

Let's hope we're as lucky to have this come to fruition.

UPDATE: The CDC has published a factsheet and podast on HIV Transmission Rates in the US, based on the release of this data.

World AIDS Day: We’re still living with AIDS

By Kenyon Farrow

(originally written for the NGLTF Policy Institute)

December 1, 2008

Today, many of us will dust off those red ribbons, and “remember” to remember the people who we’ve lost, and who are currently living with HIV/AIDS.

Some of us may even donate money to an AIDS charity doing work in some far flung place. But red ribbons and prayer services that commemorate only hide the reality that here in America, we are still living with AIDS.  read more »

Today the New York Times published a batch of letters responding to their editorial on rising HIV rates in young gay men. Since they didn't publish CHAMP's letter, I thought i'd do it here (This is why we love the Internet!)

The January 14th editorial, “HIV Rises in Young Gay Men,” spent a lot of energy blaming 19-year olds, and ignored core issues that hamper effective prevention efforts.

A recent Journal of Adolescent Health study counted youth homelessness as a major factor in HIV risk. The New York City Council commissioned a 2007 report showing that one-third of all homeless youth in NYC were gay.

Congress continues to bankroll abstinence-only education programs in spite of the proven increase risk behavior they cause. Though the HIV epidemic grows worse in black and Latino communities, the Centers for Disease Control & Prevention (CDC) budget has remained stagnant for a decade.

We still have no national HIV prevention plan, 27 years into the epidemic.

Young gay men are not to blame for the profound failure of government to provide comprehensive HIV prevention—nor for the media’s continued ignorance of the root causes of HIV.
 read more »

Published yesterday in Public Library of Science (PLoS), a new study done in mice with human immune systems show that mice given Pre-exposure prophylaxis (PrEP) did not contract HIV vaginally.

Though the study has not been tried in humans, it offers some hope for what may be possible to prevent women from contracting HIV vaginally--especially since the use of PrEP may be done without the consent or knowledge of a (consentual) sex partner. If this proves effective in women, the political hurdles to getting ARVs in the hands of women is going to be a huge battle.

I love the Public Library of Science for providing free access to peer-reviewed studies for people, and providing great summaries for thos of us not scientifically trained or inlcined. Here's what they said:

Editors' Summary

Background.

"Since the first cases of acquired immunodeficiency syndrome (AIDS) in 1981, the AIDS epidemic has spread rapidly. About 33 million people are now infected with the human immunodeficiency virus (HIV), the cause of AIDS. More than half of newly acquired infections now occur in women, mostly through unprotected vaginal sex with an infected male partner. Women are biologically more susceptible than men to HIV infection during vaginal intercourse and often cannot persuade their partner to use a condom. Consequently, alternative strategies that prevent intravaginal transmission of HIV (infection through the vagina) are urgently needed, particularly strategies that women can use without their partner's agreement. A vaccine would be ideal but it could be many years before an effective HIV vaccine is available so researchers are investigating other preventative strategies such as the use of microbicides—compounds that protect against HIV when applied inside the vagina—and pre-exposure treatment (prophylaxis) with antiretroviral drugs.

Why Was This Study Done?

Before any new strategy to prevent intravaginal HIV transmission is tried by women, it has to be tested in animals. Currently, this can only be done in macaques, an expensive option. In this study, the researchers have investigated whether “humanized BLT” mice could be used instead. When HIV enters the human body during vaginal intercourse, it sticks to dendritic cells (a type of immune system cell) in the vaginal lining. These cells carry the virus to the body's lymphoid tissues (collections of immune cells), where it infects and kills CD4⁺ T cells (another type of immune cell). Dendritic cells and CD4⁺ T cells have molecules on their surface that HIV recognizes. Mice are not normally susceptible to infection with HIV because their immune system cells lack these molecules. Humanized BLT mice have a nearly human immune system—BLT stands for bone marrow, liver, thymus. They are produced by implanting pieces of human fetal liver and thymus (the organ where T cells learn to recognize foreign invaders) under the kidney capsule of immunodeficient mice (animals born without an immune system) and then transplanting human hematopoietic stem cells (the source of the major immune system cells) into the mice.

What Did the Researchers Do and Find?

When the researchers examined the female reproductive tract of humanized BLT mice for human immune system cells, they found CD4⁺ T cells, dendritic cells and macrophages, all of which are involved in HIV infection. Furthermore, half of the blood cells of the BLT mice were human. Most of the BLT mice, the researchers report, were susceptible to intravaginal HIV infection as shown, for example, by a rapid loss of human CD4⁺ T cells from their blood. However, BLT mice pretreated with antiretroviral drugs (a mixture of emtricitabine and tenofovir disoproxil fumarate) were resistant to intravaginal HIV infection. As in human HIV infections, CD4⁺ T cells were also depleted in several other organs of the BLT mice after intravaginal HIV infection. Again, this depletion was prevented by antiretroviral pre-exposure prophylaxis. Finally, human CD4⁺ T cells also disappeared from the gut-associated lymphoid tissue (an important site for HIV replication and CD4⁺ T cell depletion during human HIV disease) of the BLT mice after infection with HIV.  read more »

What Do These Findings Mean?

These findings show that humanized BLT mice are susceptible to intravaginal infection with HIV and that many aspects of HIV infection in these mice closely mimic infection in people. In addition, by showing that pre-exposure prophylaxis with antiretroviral drugs prevents HIV infection, these results suggest that humanized BLT mice could be used to test new strategies designed to prevent intravaginal infection. As with all animal models, any approach that works in humanized BLT mice will still have to be tested in people. Nevertheless, these findings provide preclinical evidence that pre-exposure prophylaxis with antiretroviral drugs may be an effective way to prevent intravaginal transmission of HIV and, therefore, provide valuable support for clinical trials of this approach."

How many times will the messages of Prevention Justice be confirmed by science?

A new study published in the Journal of Adolescent Health shows that youth who are unstably housed are more likely to engage in risky sexual behavior within the first six months of being homeless. Science Daily reported that "this is the first time that researchers have followed newly homeless youth -- those who have been away from home for a period between one day and six months -- for any length of time to track how their behavior changes. The researchers examined how individual factors, such as sociodemographics, depression and substance abuse, and structural factors, such as living situations, can influence sexual behavior."

What's also interesting is what the study's author, Dr. M. Rosa Solorio, assistant professor of family medicine at the David Geffen School of Medicine at UCLA says about the study:"The reason these findings are so important is that interventions in the past have focused on addressing individual risk behavior and not on addressing structural factors, such as living situations, that might have an impact on their behavior...When we look at homeless youth, we want to consider these structural factors if we want them to reduce their risky behavior and thereby prevent sexually transmitted diseases such as HIV."

   read more »

Gay City News is reporting today that they were leaked a memo from inside the NYC Department of Health and Mental Hygiene (DOHMH) that recommended some changes to the NYC Code regulating sex venues. Whether you're in NYC or not, the document is a fascinating read of public sex policy, and may impact you if you live in another city (they talk at length about what Los Angeles and San Francisco have done).

Sara Markt, spokesperson for DOHMH said to Gay City News that "[T]his document was an internal backgrounder about our current policy, what other cities do, and what the options could be if this policy was ever to be revised," she wrote. "We don't have any plans to change the policy at this point, just wanted to evaluate how NYC and other cities are dealing with the issue... [W]e are not making any moves to change or recommend changes at this point."

But FYI, here are the options they are considering in the full memo, also published by Gay City News:

1. Continue current policy. Allow bathhouses to operate without inspection in private areas; close (or threaten to close) gay bars and other venues in which sex takes place in public.

Comment:This requires the least effort and is unlikely to cause a public outcry. It has resulted in changes in some institutions where warning letters have been sent, and may have a "chilling" effect in keeping other venues from allowing sex on the premises. However, it is likely that HIV transmission will continue to occur from unsafe sex in private areas of bathhouses and at the other venues, including "private sex parties."

Want the good news or bad news first?

I'll give you the bad news.

Sex columnist Dan Savage whose syndicated column Savage Love is read weekly by millions in alternative weeklies around the country, wrote a blog entry for the Seattle news site The Stranger about the NYT story on rising HIV infections among young MSMs. His blog post was his usual snarky self, but horribly misinformed. He writes:

" so long as gay health educators refuse to level with gay men--there's no "moderating" your meth use; you can suck too much cock; anal sex isn't a first-date activity and having anal sex with hordes of anonymous partners, even with condoms, is sure-fire way of contracting HIV--these new campaigns won't have much of an impact. And so we'll be reading this story again in a couple of years, yet another story about HIV infection that makes tragic heroes of guys like Javier Arriola and goes on to suggest that straight talk about HIV infection is part of the problem, not part of the solution."  read more »

In what seems like a space-filler on a slow news day, the New York Times reported yesterday that HIV rates among gay men under the age of 30 are on the rise.

Why do I say it must have been a slow news day? This data was issued in a press release by the NYC Department of Health and Mental Hygiene on September 11, 2007. The NYT story, which was the front page of yesterday's Metro section, appeared nearly three months later. In any case, here's the main info from the Times:

"The number of new H.I.V. infections in men under 30 who have sex with men has increased sharply in New York City in the last five years, particularly among blacks and Hispanics, even as AIDS deaths and overall H.I.V. infection rates in the city have steadily declined.

New figures from the city’s Department of Health and Mental Hygiene show that the annual number of new infections among black and Hispanic men who have sex with men rose 34 percent between 2001 and 2006, and rose for all men under 30 who have sex with men by 32 percent."  read more »

On Wednesday December 5th, members of the Georgia Prevention Justice Alliance went to the Fulton County Commission to testify about the possibility of the county funding syringe exchange programs in the Atlanta Metro area. Here is Jeff Graham of the Georgia Prevention Justice Alliance's testimony to the Commission:

Good morning. My name is Jeff Graham. I stand before you today as a member of the Metro Atlanta HIV Health Services Planning Council, a member of the Fulton County Commission on Disability Affairs, a volunteer with the Georgia Prevention Justice Alliance, and a long-time Fulton County resident.

Over the past week, much has been in the news about the AIDS epidemic. On World AIDS Day we stood in unity with the 33 million people from around the world who are living with this disease. On Monday, we listened and learned as the Centers for Disease Control and Prevention opened the National HIV Prevention Conference here in Atlanta. Today we come before the Fulton County Commission to speak about the future of the HIV epidemic in our own community.  read more »