Sex, drugs and super-virus
More than just fear it also brought back some archaic views of the gay community that have not been seen since the beginning of the AIDS crisis. Now taking a look back at the situation more carefully we may be able to see the details surrounding this unneeded and unhelpful reaction. As, unfortunately, moral and economical reasons once again have stood in the way of good scientific and prevention approach.
One of the most heated debates of the 80’s, which was brought about by the HIV/AIDS crisis, revolved around saunas and public baths used by gay men in the USA. Let’s take a look back: it was the first years of the epidemic, in the middle of the conservative Reaganist revolution, we were not sure what HIV would come to be but it was already frightening, and without any hopes of a treatment in the near future.
People took sides on the matter. On one, the health authorities and a number of gay activists of the time called for the closing of the saunas because they were places where unprotected sexual acts were taking place. On the other, also gay activists and Human Rights groups opposed the restriction to the rights of privacy and liberty and understood that it would be a counterproductive measure. The latter lost, and many baths were closed in New York, San Francisco and in other cities.
Obviously gay men still desired to have casual sex and so they began to look for alternatives to the closing of the saunas. Which gave to the spreading of "sex parties" in people’s homes, with invitations coming by word of mouth, and more or less hidden sex clubs, and finally in the 90’s, with the Internet boom, the sexual rendezvous through the web. Whoever wanted to have sex, of one type or another, looked for it and found it.
HIV/AIDS prevention activists were disheartened: the prohibition of these areas not only did not stop the epidemic among men who have sex with men but at the same time made these practices go underground, which made it much more difficult for the prevention programs and messages to reach those who were taking part in these activities. The saunas, at least, allowed to know where the sex was happening, and therefore helped them in promoting and increasing safe sex. In the end, it doesn’t matter where or with whom, but how you have sex.
The New York Case
These thoughts come to mind with the huge controversy that has been built up around last February’s announcement by a New York team that they had "discovered" the existence of a super-virus, which was multi-resistant to the current treatments and caused a rapid progression to AIDS. To give an overview of the case: a 46-year old New Yorker claimed he had had hundreds of sexual encounters over the last two years, most of the time casually, and frequently accompanied by the use of the drug known as "crystal meth" or methamphetamine, a strong narcotic causing behavioral desinhibition and sexually stimulating. This man was diagnosed with HIV for the first time in December 2004, and it was said that two months later he had developed full-blown AIDS.
We were up against a very virulent and dangerous strain, insisted the authorities, which justified the call for public alarm and the frantic search for this man’s former sexual partners so as to test for HIV and analyze their strains, to check if they were identical.
Let’s go step by step. This man’s last HIV negative test was in March 2003. This means there was a window of 20 months until December of 2004, which would allow us to question the rapid progression. Yet even if it was true, this is not a really new case: for some time now there have been documented cases of rapid progression, people in which the HIV virus destroys the immune system more efficiently than usual –a similar thing happens in the case of slow progressors, whose progression to AIDS is slower than the average. Although it is open to debate, the majority of scientists believe that rapid progression is due to a combination of various factors, most importantly genetic and biological characteristics of the host, which can facilitate resistance to drugs.
A misleading «genius»
David Ho, the head scientist of the team that discovered the NY case, claimed that the uniqueness of the rapid progression was due to the fact that it appeared in a multiresistant strain, something never seen before. It is a bit shocking that Ho spilled the beans on this issue, since it has already been documented by Julio Montaner, of Vancouver, in two similar cases in the Retrovirus Conference in 2001, and even more so other cases were published after that. Ho pretended he ignored these facts: something that is a little surprising coming from a "genius" in the area of viral investigation.
Also it has come out that the investigators had come to the conclusion that the New Yorker had AIDS based only on the fact that his CD4 count was less than 200 cells/ml (first 80 and later 28), this without the appearance of any opportunistic infection. It is true that this is a level where maybe all the international directives advise starting treatment, but it is slightly absurd to claim that it is a clear-cut case of AIDS. In the first months of HIV infection it is not strange to have large variations in the CD4 cell counts in the peripheral blood, as a result of the interaction of the HIV virus with the immune system. The possibility cannot be thrown away that this individual was in a phase of immune suppression that his system would have overcome in a few weeks. However Ho and his teem insisted that this was not the case.
As for the strain itself, the team never clarified at any time what they meant with the terms "super-virus" or "super-strain". These expressions, which are quite uncommon in the usually sober world of medical literature, evoke ideas that either this virus is more aggressive and destructive than others against the immune system, which as we have stated before is more than questionable, or that it can be transmitted easier from person to person. This point here would be very important to highlight, given that resistant viruses tend to be less transmittable (if this is what is meant by "less aggressive", a phrase that has been repeated to satiety by the media without really understanding what it meant): this is what it is, a multi-resistant virus that is transmitted easier than others. Yet at the moment of writing this article Mr. Ho has not found any other person with the same strain as our man from NY, and this even though there have been abusive man hunting and interrogation techniques used in the search.
The underlying issues
A few weeks after the announcement that "a gay man who has had many sexual relations with people whose name he did not even know, in a drug use context" had got infected with an unknown and deadly virus, some aspects have come to light that show that the political haste, scientific vanity, hardly hidden homophobia and pure hard-line moral conservatism had more to do with this situation than scientific methods.
First, Ho and his colleague Marty Markowitz, both from the Aaron Diamond Center of New York, admitted that they could not say this man’s viral population was not mixed and be made up of more than one HIV strain. Secondly, this so-called multi-resistant strain is not resistant to the three families of antiretrovirales but only to two (nucleosides and protease inhibitors). For this reason the patient is being treated, apparently successfully, with efavirenz and enfuvirtide (T-20). And thirdly, the strain in question is a dual tropic one, that is to say, it has the ability to use without distinction the chemokine co-receptors CCR5 and CXCR4, which, although many might not know what this means, is by no means a groundbreaking discovery: for years now the four types of viral tropisms have been described –CCR5, CXCR4, dual and mixed. In fact, new antiretroviral compounds currently in development are based on these therapeutic targets.
The discussion on the implication for the general health of this supposed "discovery" ran parallel to its diffusion to the general public’s mind. Thomas Frieden, the Health Commissioner for NY, made a call to gay men with risky sexual practices to come forward for HIV and multiresistance tests, evoking the shadow of the "risk groups", a move supported by our now more than famous David Ho. Curiously, this same day, the only company in the world that performs multi-resistant HIV tests, ViroLogic, sent out a press release praising the virtues of their resistant test, which just happened to include a statement from Mr. Ho. What neither the company or Mr. Ho clarified at any moment is that David Ho is a member of the Scientific Advisory Board of ViroLogic, and that his brother Sydney is the Head of public relations of the same company. Some rival scientists have brought up this connection. Was it for jealousy or a true conflict of interests?
The medias hindering hand
But let’s return to our events. Without a doubt, metamphetamine, such as cocaine and alkyl nitrites ("poppers"), are immune-suppressing drugs. Many studies have suggested that taking them during unprotected sex may facilitate the transmission of HIV. Also they are drugs that cause desinhibition of behavior, and in this context the use of condoms may be taken less seriously or even disregarded. This surely is a serious problem that the gay community in the western world needs to address with frankness and intelligence. But from here to practically linking homosexuality and the use of drugs to the deadly HIV super-infection is a large step, which has been dug by stigmatizing and discriminating attitudes that in no way help preventive actions.
During those events one had to hear newscasters stating that methanphetamines are "the ‘in’ drug among the gay community" or read in respected newspapers that "not all people possibly implicated wished to voluntarily cooperate with the investigation". Did they truly believe that these men would not resist to be only taken as possible transmitters of an illness instead of as human beings with undeniable human rights, with all the consequences this could have on their lives if they decided to cooperate? How could they evoke with such impunity and roughness the most stereotypical and prejudicial views on homosexuality?
The way the medias addressed the New York case, with the help of the scientific and political parties’ complacency, reflected a moralistic and simple-minded approach that refused to look at the larger perspective of what was happening. First of all, hadn’t we been told that unprotected sex practices between heterosexual partners were the ones on the rise and that women represented the most affected population? Then why this alarm on homosexual relations which reminds us of the homophobic hysteria of two decades ago?
It is true that there are data and studies that show a rise in HIV cases among men who have sex with men in industrialized cities, but as highlighted by Martin Delanay, founder of the Project Inform, it would be cynical to blame the U.S. gay community for the spreading of a new HIV super-virus when prevention programs have been suffering from budget cut-backs at state and above all federal levels for so long now in this country, and even more so in 2005 according to the draft budget of the Bush administration. Especially when you add to that the fact that programs have had to adapt to the political ideals that give priority to sexual abstinence and pretend to limit the drug use reduction strategy to the simple "just say no" program that in her moment Nancy Reagan defended so eagerly.
The heart of the matter is to decide whether it is preferable to take on the prevention weariness within the gay community by bringing back messages based on the fear of a lethal virus, even though these have yet to be proven efficient, which would also mean bringing back the stigma on homosexual men as "irresponsible people who deliberately pass the virus on to others". Or, instead try to explore without moral prejudices and from a point of view of risk and harm reduction the reality of the practices of men who have sex with men in an environment that includes illegal substances.
If we choose the alarm and fear option, the most likely result is that people will go even deeper underground with their practices, not for fear of the virus, but of being judged and sentenced by society and their own community, which naturally will make reaching them and forming a constructive dialogue even more difficult. If we choose the option of respect and comprehension, offering tools for them to manage and measure their own risk level during sex and the use of drugs, it may allow us to get closer to these people who possibly use drugs and sex as a way to boost their self-esteem that has been beaten down by a hostile reaction to their sexual identity and lifestyle in regards to being gay men.
Joan Tallada
EATN - European AIDS Treatment News, Volume 13, I – Spring 2005
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