Alex Blaze

We don't have good sex ed or condom distribution, but we want more ideas?

Filed By Alex Blaze | December 30, 2010 12:00 PM | comments

Filed in: Living
Tags: global AIDS, HIV/AIDS, Michael Weinstein, prep, solutions, technology

Michael Weinstein has an interesting column up about the potential of PrEP, the pre-exposure medication regimen that recently showed some potential to slow the spread of HIV:

HIV ParticleThe potential use of this drug is based on the premise that we cannot succeed in getting gay men to use condoms. Have we really made a wholehearted effort to do this? Are condoms readily available in bars, bathhouses and other meeting spots? Are they advertised on TV? Do our political, religious and community leaders speak out for protecting gay men from HIV? The answer in each case is no.

The rates of HIV infection in tolerant places in the world, like Holland, are one-sixth what they are in the U.S. Partner reduction, delay of sexual debut, faithfulness and condom use, combined with political will, have brought HIV rates down in such diverse places as Cambodia, Brazil, Northern Europe and Senegal.

Another question: Who will pay for this pre-exposure treatment? Today, almost 5,000 Americans who are already HIV-positive are on waiting lists for lifesaving medications. The minimum these new drugs will cost in the U.S. market is $10,000 per person per year. Will insurance companies cover them for preventive use? Will they cover HIV medications when the preventive drug fails?

It's a strange outgrowth of America's and the West's growing income inequality: instead of looking for ways to use solutions that already exist, we focus on technology to expand the number of solutions already available. And no where does this come off as more ridiculous than with communicable diseases.


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I find the message advanced by Michael Weinstein, the President of AHF, to be irresponsible and far removed from the realities faced by those living with HIV/AIDS and the scientists diligently working to find a cure or better treatment alternatives.

The HIV virus does not selectively infect gay men and any advances within treatment protocols must consider all persons infected with HIV.

Fact: the vast majority of new infections occur within the heterosexual populations of the world residing in low-income nations. As documented by the UNAIDS (2010) 'UNAIDS report on the global AIDS epidemic, .. "an estimated 1.9 million people in sub-Saharan Africa became newly infected in 2009. This means that there are now an estimated 22.5 million Africans living with HIV/AIDS. In this part of the world, particularly, women are disproportionately at risk. As the rate of HIV infection in the general population rises, the same patterns of sexual risk result in more new infections simply because the chances of encountering an infected partner become higher."

The increase of HIV transmission among the heterosexual population is not limited to low-income nations. “In the United States, a quarter of people diagnosed with AIDS in 2008 were female, and three quarters of these women were infected as a result of heterosexual sex.”[1] In several countries in Western Europe, including the United Kingdom, heterosexual contact is the most frequent cause of newly diagnosed infections.[2]

Mr. Weinstein does not provide a citation for verification of the information presented within his letter indicating, in part, ..” an average man taking the medication was 44 percent less likely to become infected than a control group taking a placebo.”

The following information is provided by The Tartan, “In addition to previous clinical trials, a mathematical model study gave weight to the optimistic prospects of PrEP. A study led by David Paltiel in the Yale School of Public Health revealed that if PrEP were introduced, it would dramatically cut the lifetime infection rate for men who have sex with men from 44 percent to 25 percent. This mathematical model was based on an already existing data set of a sample of men who have sex with men from a vaccine trial study, with the mean age of 34. The model was designed to take into account various lifestyles including multiple partners and irregular condom use among the sample.”

In other words, rather than 44 men in 100 becoming infected with HIV during a lifetime, the rate would be reduced to 25 men. This translates into 19 fewer men in 100 acquiring HIV in a lifetime. Based on an estimated population of 138 million men (US only)[3], of which 25 percent are gay (34,500,000), more than 6,555,000 men would not contract HIV through the use of PrEP in a lifetime (44% = 15, 180,000; 25% = 8,625,000, difference is 6,555,000). This information only considers gay men in the US. The number of new HIV infection which could be averted globally would be significantly greater.

PrEP is not a new concept or “baby steps ..interpreted as huge leaps in scientific knowledge”.[4]

PrEP is short for Pre-Exposure Prophylaxis. Prophylaxis treatment is a form of disease prevention that involves taking medicine before exposure to the disease. Examples of Prep include taking malaria medications before traveling to malaria-affected countries or as simple as applying sunscreen before exposure to the sun to prevent sunburn.

The successful use of ARV drugs to reduce the rate of infection ( Prep) is well documented within the medical community. “The CDC cites studies where mothers during labor and newborns after birth were given antiretroviral drugs, which show that the risk of infection for the newborns from their mothers was reduced by about 50 percent. Second, when health care workers took antiretroviral drugs promptly after accidental exposures and continuously for several weeks, there was a significant reduction in the risk of infection.”[5]

Mr. Weinstein states in his opinion, “The potential use of this drug is based on the premise that we cannot succeed in getting gay men to use condoms. Have we really made a wholehearted effort to do this? Are condoms readily available in bars, bathhouses and other meeting spots? Are they advertised on TV? Do our political, religious and community leaders speak out for protecting gay men from HIV? The answer in each case is no.”

The truthful answer to every question he proposes is actually, yes. Mr. Weinstein statements indicate his ignorance with the commendable efforts made by local AIDS Service Organizations across the US, and around the world. These organizations provide and encourage the use of condoms and safer sex practices. None have ever advanced PrEP as an alternative to condom usage.

Further, not a single published study to date has ever concluded Prep as a substitute for condom usage. In fact, the CDC said in its statement, ““Because PrEP is unlikely to be 100 percent effective, it will need to be used in combination with other proven HIV prevention approaches.” The CDC stated that PrEP would be a valuable additional safety net to those who are at a high risk of HIV infection.

I do concur with one statement made by Mr. Weinstein, “How very sad that we have come to this point.” The president of a nationally recognized HIV/AIDS organization openly dispensing misinformation and reprehensible generalizations in the form of an opinion editorial published in the San Jose Mercury News. His letter is a disservice to AHF and the HIV/AIDS service organizations around the world.

I challenge Mr. Weinstein to consider the following questions:

* What message would you deliver to the gay community to encourage condom usage which has not already been advanced by numerous AIDS service organizations? Provide the solution, not the problem.
* How is researching a novel approach to reducing infection rates a misguided experiment? Evidence indicates millions of lives would potentially be saved through the incorporation of PrEP into the existing harm reduction model.
* What purpose (good) does your statement (in part), “Given that a large percentage of patients infected with HIV do not take their medications..”, serve? AHF provides many persons within the HIV community their medications. If your statement is fact, why does AHF continue this effort?
* Additionally, ADAP and other programs which provide ARV medications are, according to your statement, a waste of economic resources. Given the current economic state of many city, county and state budgets, would non-compliance by those infected with HIV be justification for the discontinuation of ARV drug programs?

In my opinion, the medical community has a duty to humanity to explore all efforts which can result in a reduction to the rate of new HIV infections. Our leaders have a duty to become fully educated on these advances and present them to the community in an unbiased and informative manner.

To this conclusion, I respectfully ask Mr. Weinstein to retract the comments made within his opinion editorial and offer an apology to the medical professionals around the world who work tirelessly to find solutions to deal effectively with the HIV pandemic and reduce the number of new infections.

_______________________________________________
[1] Centers for Disease Control and Prevention (2010) 'Diagnoses of HIV infection and AIDS in the United States and Dependent Areas, 2008', Volume 20

[2] http://www.avert.org/aroundworld.htm (last visited 12/31/2010)

[3] http://www.census.gov/prod/2003pubs/p20-544.pdf (last visited 12/31/2010)

[4] AHF President Michael Weinstein, Opinion Editorial Published 12/30/2010 in
San Jose Mercury News Opinion: Advance on AIDS or Give Up on Gay Men?

[5] http://thetartan.org/2010/4/12/scitech/hivprep (last visited on 12/31/2010)

The medical community has a duty...
Our leaders have a duty...

"The rates of HIV infection in tolerant places in the world, like Holland, are one-sixth what they are in the U.S. Partner reduction, delay of sexual debut, faithfulness and condom use, combined with political will, have brought HIV rates down in such diverse places as Cambodia, Brazil, Northern Europe and Senegal."

Thank you, Alex, for calling attention to Mr. Weinstein's article! My hope is that at least some people will take it seriously, and not brush it aside with voodoo statistics, like J. Cooper.

While many look to technological advances to solve the "problem" of condom use, and many others find themselves in a subculture where HIV infection is considered almost inevitable, we continue to try to reach the reachable, and work toward a vaccine and a cure.