A Bit More Detail

Assorted Personal Notations, Essays, and Other Jottings

Posts Tagged ‘hiv/aids

[LINK] “With a little pill, could one city’s AIDS epidemic be ending?”

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Ariana Eunjung Cha’s Washington Post article suggests–plausibly–that the mass uptake of PrEP in San Francisco may mean that future HIV transmissions will stop in that city. There’s something fitting to this, inasmuch as AIDS was first identified in this centre.

On online dating sites, Matthew Sachs identifies himself as a 5-foot-8, 130-pound grad student who likes hiking, performance art and community service. He says he’s interested in meeting a broad range of guys, from jocks to geeks, and notes that — oh, by the way — he’s “On PrEP.”

Those four letters stand for a daily medical regimen in which healthy individuals take a blue oval pill to lower their risk of becoming infected with HIV. The treatment, known as pre-exposure prophylaxis, has become so common in the Bay Area’s gay community that it’s frequently mentioned in social media profiles from Facebook to Scruff.

Since the first breakthrough research was published in the New England Journal of Medicine in 2010, the once-a-day dose of Truvada has consistently been shown to reduce the risk of HIV infection by as much as 90 percent. The results of the most recent study, which was published in September, were even more encouraging: Not one of the 600 people taking the drug became infected over two years.

As many as 10,000 San Franciscans could now be on PrEP, according to one city official’s estimate. The treatment has been transformative here, not just in medical terms but in how it has changed the nature of dating, love and relationships between those who are HIV-positive and those who aren’t. And it has prompted some AIDS experts to consider something that would have been unfathomable during the dark days of the 1980s: Could the nation’s onetime epicenter of HIV/AIDS be the place where the epidemic that has so haunted Americans begins to come to an end?

Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases, is one of the believers. It’s “very realistic,” he said, that San Francisco might see new HIV infections cease in several years. But the rest of the country will be more challenging, he said.

Written by Randy McDonald

January 28, 2016 at 5:00 pm

[DM] “A note on public health, or, how you get what you pay for”

At Demography Matters, I note the revolutions in public health concerning HIV/AIDS, PrEP and TaSP, and note the continuing survival of the pandemic shows that we get what we want to pay for.

Written by Randy McDonald

January 4, 2016 at 11:57 pm

[LINK] “Atlanta’s alarming HIV/AIDS epidemic reminiscent of New York in the ’80s”

Al Jazeera’s report on the rampant HIV epidemic in Atlanta, particularly concentrated among blacks, is alarming. At a time when such progress is being made in preventing and controlling the epidemic, this is shameful.

“Atlanta is like New York was in the ’80s in the need to develop a public health response to a serious [HIV] epidemic,” said Devin-Barrington Ward, an advocate based in Washington, D.C., who helped organize the Georgia symposium.

The issue is particularly acute for young gay and bisexual black men. One Emory University study followed a group of Atlanta-area men ages 18 to 39 who had sex with men during 24 months and found that 12.1 percent of the black men under 25 contracted HIV, compared with only 1.0 percent of the white men under 25 — “one of the highest figures for HIV incidence ever recorded in a population in the resource-rich world,” according to the National AIDS Manual. What’s more, AIDS is the leading cause of death among black people in Georgia ages 35 to 44, according to the state Department of Public Health.

Grady Memorial, one of the nation’s largest public health hospitals, also found alarming numbers, through a grant-funded project that allowed its staff to offer opt-out HIV screening to all patients entering its emergency room: About half the patients diagnosed with HIV already had clinical AIDS. This means they had the virus for years and not received the sort of treatment that would prevent further deterioration of their immune systems.

“None of my colleagues [nationally] are seeing those numbers,” said Dr. Wendy Armstrong, a researcher at Emory University’s Center for AIDS Research. “It’s appalling.”

Written by Randy McDonald

December 31, 2015 at 12:28 pm

[BRIEF NOTE] On PrEP, and TaSP, and the imminent end of HIV/AIDS

The Thursday before last, I was interviewed as a subject in an ongoing research project, led by the University of Toronto’s Peter A. Newman and Carleton University’s Adrian Guta, examining the PrEP front in the ongoing fight against HIV/AIDS.

The PrEP choice project: Exploring PrEP users, non-users, and provider perspectives

Are you a man who has sex with other men, living in Toronto, and over the age of 18? We would like to talk to you if you:

1. You are currently using Pre-Exposure Prophylaxis (PrEP) and would like to share your experience and you are not currently enrolled in a clinical trial about PrEP.

2. You know about PrEP but you have decided it is not right for you at this time and you would like to share your experience.

As I explained in my enjoyable sixty-minute interview, I fall in the second category. My reasons for not taking PrEP have nothing to do with skepticism on my part about the science, or about taking medication. Rather, it relates directly to matters of cost: My drug plan at work does not cover PrEP, Truvada not yet having been approved by Health Canada as a drug that very effectively prevents HIV transmission, and I don’t know how I could get the funds to do so. I have very recently heard that some people have been able to access the Trillium Drug Plan, and this is definitely something I’ll be looking into in the New Year. For the time being, I feel as if I’m sitting in an uncomfortable place, looking at a medical revolution occurring outside Ontario–in the United States, in Québec, and most recently in France–and wondering how I’ll last.

It isn’t that I think I’m at especially high risk: I know what I do and who I do things with, I know what the actual risks are, and I think that if, one day, I ended up testing positive for HIV, I’d have legitimate reason to be surprised. The protocols of safer sex with condoms are protocols I have not had any problems following in my personal life. Were I to get PrEP, I don’t think that my sexual practices would change substantially–I certainly would not, as described in the 2005 Los Angeles Times article where I first heard of what might be called proto-PrEP, embark on crystal meth-fueled lost weekends. That sort of sexual behaviour is frankly uninteresting to me, much more of a problem than a source of relief.

In part, it’s a matter of my liking a belt-and-suspenders approach. Condoms work very well, used consistently. PrEP also works very well, used consistently. Why not combine the two to absolutely minimize HIV transmission? Truvada does have costs, financial and perhaps otherwise, but as noted by many even the costs of lifelong Truvada treatment are substantially less than the costs of lifelong HIV treatment. What’s wrong with a simple pill that can ward off a disease that is still life-changing? Or, rather, what’s not right with it? Not taking the drugs can be an issue, but that’s always the case with any medical regimen.

It also relates to deeper shifts in the nature of the epidemic. It’s starting to become a relative non-issue in ways I scarcely imagined when I first came out. At the same time that the PrEP revolution is ongoing, preventing HIV infections among HIV-negative people, the latest anti-retroviral treatments are not only keeping the HIV-positive in good health, they are radically reducing the chances of further infection. One thing widely reported in the media with varying levels of incredulity after Charlie Sheen’s self-outing as HIV-positive, in
Vox and Gawker and MacLean’s and New York Magazine, is that Sheen has undetectable levels of the virus in his system and cannot infect people. This was not just Sheen talking: This is the actual science. Multiple research projects, including the ongoing PARTNER study, have so far concluded that the chances someone HIV-undetectable could transmit HIV on to someone HIV-negative are trivial. The PARTNER study has not yet found a single instance of such a transmission happening, not with tens of thousands of sex acts in hundreds of couples in two years. TaSP, treatment as prevention, also works. The approach of systematic testing and universal treatment of HIV, pioneered in Canada in British Columbia by Dr. Julio Montaner, can break the back of the epidemic. Saving people’s lives also slows down the epidemic.

Take the existence of PrEP, to start. Throw in alongside PrEP TaSP, equally effective in preventing infections. Throw in alongside these two the existence of condoms, a technology that is also quite effective. I do not think that I am wrong to say that, in my particular First World environment, HIV/AIDS is starting to become a trivial threat. It makes my head spin as I think this, so contrary it is to what I learned and what I practiced, but fearing HIV is something that might be falling out of style. This is wonderful, but this is a shock with profound ramifications for me and others. Once, when I read psychotherapist Walt Odets’ In the Shadow of the Epidemic, I was struck by an exchange in which a gay speaker explained to a straight counterpart that, in the context of HIV/AIDS, every instance of sex, every moment of intimacy, was overshadowed by the possibility that something might go wrong, that someone might become infected with a lethal agent or (even worse) infect someone they loved with said. Not living under this fear would be such a relief, I can scarcely imagine what it would be like.

We need many things, here in Ontario at the end of 2015, here on this world, even. PrEP is one of them.

Written by Randy McDonald

December 21, 2015 at 11:59 pm

[BLOG] Some Wednesday links

  • The Broadside Blog’s Caitlin Kelly talks about the importance of people who believe in you.
  • The Dragon’s Tales notes a surge in gun sales after the San Bernardino shooting.
  • Joe. My. God. and Towleroad write about ending PrEP profiteering.
  • Language Hat talks about Mancunianisms.
  • Language Log describes the odd but evocative language used to talk about pollution on Chinese social networks.
  • Lawyers, Guns and Money seems unduly wedded to Venezuela’s Chavismo.
  • Justin Petrone talks about how compact the Baltic States actually are.
  • Transit Toronto talks about the 1995 retirement of the PCC streetcar.
  • Window on Eurasia is not hopeful about the consequences for a breakdown of the Putin consensus and speculates about the future of Russian statehood in the light of Soviet dissolution.

[LINK] Elf Sternberg on imagining Obama laughing at white premature mortality

El Sternberg, in his “Imagine if Obama laughed…”, imagined on World AIDS Day what if Obama reacted to premature mortality among whites in the same way that Reagan’s press secretary in the early 1980s reacted to AIDS.

Press Secretary Robert Gibbs:Someone in the back. RollingStone. Matt?

Matt Taibbi:Mr. Gibbs, recently the media has been tracking a rise in deaths among poor, white Americans. They’re the only group that has seen this rise. What, um, what reaction does President Obama have to this issue?

Gibbs:Why, Matt? Do you have a reason to worry?

Taibbi:No, I don’t. But don’t you think it’s frightening that so many poor, white Americans are dying this way?

Gibbs:I’m not poor and white. The president sure isn’t poor or white. [The rest of the press corps laughs.] This isn’t our problem.

Taibbi:Do you think, maybe, the White House could put out a statement encouraging poor, white Americans to get better healthcare?

Gibbs:[Sighs audibly.] Matt, this isn’t really a problem that the rest of America wants to deal with. Let’s move on.

That white Americans are actively resisting health makes it all the more tragic.

Written by Randy McDonald

December 8, 2015 at 5:18 pm

[VIDEO] Scott Calonico on the AIDS humour of the Reagan Administration

Joe. My. God. linked to this Vanity Fair feature.

One of the most prominent stains on the reputation of the much-mythologized Reagan administration was its response, or lack of response, to the AIDS crisis as it began to ravage American cities in the early and mid-1980s. President Reagan famously (though, not famously enough) didn’t himself publicly mention AIDS until 1985, when more than 5,000 people, most of them gay men, had already been killed by the disease. Filmmaker Scott Calonico’s new documentary short, When AIDS Was Funny, exclusively debuting on VF.com, shows how the Reagan administration reacted to the mounting problem in chilling fashion. Not even Reagan’s appointed mouthpiece, notorious press secretary Larry Speakes, had much to say about the crisis beyond derisive laughter.

Using never-before-heard audio tapes from three separate press conferences, in 1982, 1983, and 1984, When AIDS Was Funny illustrates how the reporter Lester Kinsolving, a conservative (and not at all gay-friendly) fixture in the White House press corps, was consistently scoffed at when he posed urgent questions about the AIDS epidemic. With snickering, homophobic jokes and a disturbing air of uninterest, Speakes dismisses Kinsolving’s concerns about the escalating problem. “Lester was known as somewhat of a kook and a crank (many people still feel the same way),” says Calonico. “But, at the time, he was just a journalist asking questions only to be mocked by both the White House and his peers.”

What Calonico has compiled, juxtaposing the deeply troubling audio with images of AIDS patients at Seattle’s Bailey-Boushay House in the 1980s, is an infuriating summation of the Reagan administration’s fatal inaction in confronting a generation-defining tragedy. Watch the concise, damning short above, but be warned: it will make you angry.

I had first read of Larry Speakes‘ exchanges in Randy Shilts’ And the Band Played On. Vox‘s German Lopez did readers the service of sharing a transcript.

Lester Kinsolving: Does the president have any reaction to the announcement by the Centers for Disease Control in Atlanta that AIDS is now an epidemic in over 600 cases?

Larry Speakes: AIDS? I haven’t got anything on it.

Lester Kinsolving: Over a third of them have died. It’s known as “gay plague.” [Press pool laughter.] No, it is. It’s a pretty serious thing. One in every three people that get this have died. And I wonder if the president was aware of this.

Larry Speakes: I don’t have it. [Press pool laughter.] Do you?

Lester Kinsolving: You don’t have it? Well, I’m relieved to hear that, Larry! [Press pool laughter.]

Larry Speakes: Do you?

Lester Kinsolving: No, I don’t.

Larry Speakes: You didn’t answer my question. How do you know? [Press pool laughter.]

Lester Kinsolving: Does the president — in other words, the White House — look on this as a great joke?

Larry Speakes: No, I don’t know anything about it, Lester.

There are no words.

Written by Randy McDonald

December 1, 2015 at 9:43 pm

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