Rare and Aggressive H.I.V. Reported in New York
"A rare strain of H.I.V. that is highly resistant to virtually all anti-retroviral drugs and appears to lead to the rapid onset of AIDS was detected in a New York City man last week, city health officials announced on Friday.
It was the first time a strain of H.I.V. had been found that both showed resistance to multiple drugs and led to AIDS so quickly, the officials said. While the extent of the disease's spread is unknown, officials called a news conference to say that the situation is alarming.
"We consider this a major potential problem," said Dr. Thomas R. Frieden, the commissioner of the New York City Department of Health and Mental Hygiene. The department issued an alert to all hospitals and doctors in the city to test all newly detected H.I.V. cases for evidence of the rare strain.
The virus was found in a New York City man in his mid-40's who engaged in unprotected anal sex with other men on multiple occasions while he was using crystal methamphetamine. Health officials have long said that the drug's stimulating effect and erasure of inhibitions contributes to sex marathons that have increased the spread of H.I.V....
"This case is a wake-up call," Dr. Frieden said. "First, it's a wake-up call to men who have sex with men, particularly those who may use crystal methamphetamine. Not only are we seeing syphilis and a rare sexually transmitted disease - lymphogranuloma venereum - among these men. "Now we've identified this strain of H.I.V. that is difficult or impossible to treat and which appears to progress rapidly to AIDS."
The man, whose name was not released to protect his privacy, is believed to have had unprotected sex with hundreds of partners, according to one person briefed on the case who insisted on anonymity because the investigation is continuing...
From the moment the Health Department learned about this case on Jan. 22, its scientists have been studying complex laboratory tests to decipher the patterns of resistance, and epidemiologists have tried to trace the man's sexual partners and notify them of the potential risk.
In May 2003, the man tested negative for H.I.V., health officials said. Investigators believe he contracted H.I.V. in October 2004, when he engaged in unprotected anal sex with multiple partners while using crystal methamphetamine. The man found some of his partners on an Internet Web site, officials said, though they would not identify the site. Health officials said they were working with those who used the Web site to reach as many people as possible who might have been infected or are worried that they could have been...
Health officials have been worried for some time that city residents, particularly gay men, are growing lax in their attitudes about sex practices, lulled into complacency by the success of antiviral drugs. In the past four years, the number of new syphilis cases in the city has slowly increased, with gay men accounting for most of them. Only 45 percent of gay men surveyed by the Health Department in 2003 said they used a condom during sex..."
"This story is the homosexual lobby's worst nightmare. When it agitates for marriage, adoption and other extraordinary rights, it finds homosexuals who have been in committed relationships for long periods to speak to legislators, judges or journalists. But as extensive sociological research has shown, the New York City case is more typical of the promiscuous lifestyle of homosexuals...
As much as homosexual agitators contend HIV threatens everyone, the U.S. Centers for Disease Control and Prevention says 82 percent of America's 920,000 AIDS cases in 2003 began with homosexual sex, the sharing of drug needles or both. Heterosexual contact accounted for less than 15 percent, but the rate among monogamous couples and abstinent singles was 0 percent. These numbers illustrate best why the life expectancy of homosexuals is at least 30 years shorter than that of the average heterosexual.
At a time when the cost of health insurance is soaring and millions have lost or are at risk of losing their health coverage, why should taxpayers through Medicaid and insurers through higher premiums have to pay so that more than 200 million people may undergo unnecessary testing when the people most responsible for transmitting HIV won't submit to tests or take precautions to prevent the spread of the disease?
S.D. man could have aggressive HIV strain
"An unidentified San Diego resident may be infected with the same rare, aggressive and highly drug-resistant strain of HIV found last week in a New York City man who has rapidly become ill with AIDS, health officials said yesterday.
"(The local person's) HIV has a similar molecular makeup as the patient in New York City," said Dr. Nancy Bowen, the San Diego County public health officer who held a press conference about the finding yesterday afternoon in San Diego.
It's important to notify the public about a new and possibly supervigorous strain of HIV so people can take extra precautions, Bowen said. But "I don't think it will do anybody any good to get panicked about this," she said, emphasizing that many details are still being sorted out..."
AIDS Fighters Face a Resistant Form of Apathy
Where have all the condoms gone?
Don't try looking at the Monster, the Hangar, Starlight or Barracuda. On a recent evening, these and more than a dozen other Manhattan gay bars were well stocked with free going-out guides, but not a scrap of literature about H.I.V. prevention or the perils of crystal meth. As for condoms, the frontline defense against sexually transmitted diseases, only one establishment stocked them - behind the bar.
As part of his graduate course work at New York University, Michael Marino set out last winter to compare the AIDS prevention efforts of New York and London. He was troubled by what he found. At most New York bars, and even at some bedrock gay and AIDS service institutions, educational pamphlets and free condoms were hard to find, if not impossible. In London, Mr. Marino found them easily.
"No wonder things are getting so out of control here," he said.
Condoms, which still can be found in vending machines at a handful of places, were once given away by the bucketful. While no one believes free condoms will completely halt the spread of H.I.V., their disappearance from bars, the equivalent of a town hall for some gay men, is a telling indicator of how much steam has been lost in the fight against AIDS.
Although the city health department's recent warning about a rare, possibly more virulent strain of H.I.V. has caused a stir among gay men, many AIDS activists hold out little hope the news will prompt substantial or lasting changes in behavior. They point to the continued popularity of methamphetamine, which has contributed to a rise in condomless intercourse, known as barebacking, and the widespread apathy in which H.I.V. is seen as a nuisance, not a potential killer.
Compounding this laissez-faire attitude, they complain, are drug company advertisements that gloss over the disease's effects by portraying patients as the picture of perfect health.
Locally, at least, the statistics paint a mixed picture. The number of new H.I.V. infections among men who have sex with men declined slightly from 2001 to 2003, according to the most recent figures available, although in much of the country that number has been rising. But AIDS service providers, pointing to a recent spike in syphilis cases and the rise of methamphetamine abuse among gay men, fear it is only a matter of time before New York faces a new surge in infections.
The challenge is far more complicated than handing bar patrons informational brochures and telling them to be good, prevention specialists say.
"Just because folks are well informed doesn't mean they'll necessarily make the wisest choices in terms of their health," said Dr. Ronald O. Valdiserri, who oversees AIDS prevention at the Centers for Disease Control and Prevention. "This is true of all humanity, not just gay men."
The reality that gay men continue to have unprotected sex has been vexing health experts for 20 years, although the struggle became even more daunting in the mid-1990's, when a new class of medications sharply reduced death rates and fed the misconception that AIDS is only about as troublesome as the flu.
And then there are those who disdain condoms. With the specter of imminent death gone, the idea of using condoms has become an annoyance for many. "Let's face it, sex with a condom is not as good," said Dr. Robert L. Klitzman, a psychiatrist and professor at Columbia University. "Sex is supposed to be an incredibly intimate moment, and it's not as intimate when there's a piece of plastic between you and your partner."
There is a growing sense that the traditional sloganeering about condoms and club drugs is about as effective as birth-control campaigns that rely on abstinence. The only hope for changing behavior, public health experts and psychologists say, is to recognize and address the underlying factors that propel men into risky situations. Loneliness, alienation and self-hatred, they say, are the real culprits that need to be addressed.
But others, describing such talk as naïve, say it makes more sense to stress personal responsibility. Demonize crystal meth, stigmatize unprotected sex and remind people that living with H.I.V. can be grueling, or worse. An important first step, they say, would be to stop running pharmaceutical ads that portray people with AIDS as carefree and virile.
Other ideas include following the lead of the San Francisco health department, which is seeking strict limitations on the availability of erectile dysfunction drugs that counteract the impotence induced by crystal meth and encourage the spread of sexually transmitted diseases.
Many AIDS activists in New York, describing current public service campaigns as toothless and ineffective, say bus ads and billboards should remind people that AIDS is a devastating and entirely avoidable illness.
Many prevention advocates agree that only a creative, ever-changing arsenal of tactics can reduce the number of new H.I.V. infections. They point out that it has taken years and millions of dollars to change public attitudes about tobacco and seat belts, and even now reasonable people lapse into old ways.
"Everyone knows smoking is bad for you, but we still print those health warnings on cigarette packs," said Kwame M. Banks, a consultant specializing in prevention work. "People need to hear these messages 100 times a day. That's the way these things work."
Still, when it comes to H.I.V. and AIDS, some wonder whether it is time for a new strategy. Perry Halkitis, a psychologist at New York University who studies the relationship between drug use and sex, believes that many gay men who engage in risky behavior are grappling with profound mental health issues.
"People are not taking risks because they're stupid, or because they wake up one day and say, 'I'm going to take a risk today,' " Dr. Halkitis said. "They do it because the sexual risk fulfills a need, or somehow makes them feel better about themselves."
He and others say any successful fight against H.I.V. must deal with depression, substance abuse and low self-esteem, problems that studies have shown affect gay men at disproportionately higher rates.
"Many people might argue that as a community, we suffer from post-traumatic stress disorder because we're so ostracized by society," Dr. Halkitis said. "Being rejected by family, by our churches, and these days by our government most certainly has an impact."
That emotional fragility has been compounded by the trauma of the 1980's and early 90's, when sickness and death permeated the lives of so many. Peter Staley, a veteran AIDS activist, said it was no coincidence that some of the first people in New York to pick up crystal meth habits have been men 35 to 45 years old.
"We are the long-term survivors who watched friends die, who never thought we'd live to have a midlife crisis," said Mr. Staley, who is H.I.V.-positive and himself a recovering meth addict. "Then the new medications came along, and suddenly everyone returned to their old lives and people moved on to other issues, like gays in the military and gay marriage. Where was the communal processing of the emotional hell we had just gone through? I think as a result we're a deeply scarred group."
While such scars can lead to substance abuse, psychologists say the internalized homophobia and deep-seated feelings of low self-worth are just as powerful. That is where the allure of crystal meth kicks in. Those who have used the drug say it tends to blot out feelings of vulnerability, boosts self-confidence and imbues them with a false sense of connection to strangers.
Then there are the "bug chasers," H.I.V.-negative men who actively seek infection. Although such men are thought to be few in number, mental health experts say the phenomenon reflects the intense alienation that many gay men feel. Louis Pansulla, a psychoanalyst who runs gay therapy groups in New York, said younger men, in the generation that missed the darkest days of the AIDS crisis, believe that infection will win them membership into a clique, albeit one coping with a dreaded disease.
"It's almost a longing to belong, even though it's a completely unconscious thing," he said.
Michelangelo Signorile, the host of a gay-themed talk show on Sirius Satellite Radio, takes a less nuanced view: "If everyone in your group is beautiful, taking steroids, barebacking and H.I.V. positive, having the virus doesn't seem like such a bad thing."
It is for that reason that Michael Weinstein, president of the AIDS Healthcare Foundation, believes the disease is due for an image makeover. He cites a hard-to-miss ad in last month's Out magazine that is embedded with a tiny audio chip and features two robust men on a beach. Opening the magazine sets off the trill of a ringing phone and a man's voice essentially saying he is having too much fun to worry about his chronic illness. Mr. Weinstein has asked the ad's sponsor, Bristol-Myers Squibb, to stop using the ad for the drug, Reyataz. A spokeswoman said the company was re-examining its advertising campaigns.
"People are in such denial about how serious H.I.V. is," Mr. Weinstein said. "Unfortunately, the best prevention is seeing people die."
Of course, frontline prevention workers hope to avoid a new wave of deaths. At Gay Men's Health Crisis, prevention workers are planning a series of events that seek to promote "connectedness and community."
Others are creating antidrug messages that masquerade as packets of meth that can be dropped on dance floors. A series of subway ads unveiled by the state for the first time shifts responsibility to those who are already infected.
And then there are people like Daniel Carlson, a former marketing executive who became so disgusted by the number of men soliciting unprotected sex online that he and a friend started a group to combat the prevailing ethos about sex and drugs. In the past two years, the group, H.I.V. Forum, has organized a half-dozen town hall meetings on crystal meth and unprotected sex that have drawn packed houses.
"I know it sounds touchy-feely, but if we could just emphasize a little bit more community and brotherhood," Mr. Carlson said. "We have to decide whether we're going to be selfish or whether we're going to care about one another."
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