A+ grew out of previous CHEST research with a group of 255 HIV-positive gay and bisexual men in the New York City area. These men said that they wanted a program that is nonjudgmental, that recognizes that sex is an important part of HIV-positive men's lives, and that is not focused solely on issues related to HIV. The men also emphasized that they wanted to socialize more with other HIV-positive men, get the latest information on HIV treatments, and hear how other men are dealing with complicated issues such as telling other people about their HIV status. Dr. Jeffrey Parsons, principal investigator for the project and a leading expert in the development of interventions for HIV-positive individuals, said, "Men's sexuality does not just go away when they find out they are HIV positive. Our research found that HIV-positive gay and bisexual men in New York needed more places to go to hear what other men living with HIV were doing about sex, dating, or just keeping themselves healthy.
A+, which is located in the Chelsea area of Manhattan, will focus on decreasing the isolation of HIV-positive men and engaging them in primary prevention of HIV. Participants will attend large group sessions that emphasize social interaction. The sessions will be organized to provide a safe environment where HIV-positive men can meet other men living with HIV and talk openly about sex, dating, and health. "Men told us they wanted a program that provided them with the most up-to-date information on HIV, treatments, STDs, safer sex, but they also wanted a place where they can relax, have fun, and talk to other guys like them about the things they are dealing with. We've worked very hard to develop a program that meets their needs," Parsons said.
The research team hopes to enroll 500 men over the next year. Each participant will be assigned at random to one of two groups. One group will meet weekly for six weeks, while the other will come together for a one-time event. The men in each group will complete surveys at different intervals assessing their attitudes and behaviors around sex, drug use, and health. All participants will be paid for completing the surveys.
The program was developed in consultation with a fifteen-member community advisory board comprised of HIV-positive men in the New York City area. Results of the study will be disseminated to community organizations serving gay and bisexual men. Researchers hope these organizations can apply positive findings from the study to support groups they run for HIV-positive gay and bisexual men.
Individuals who are interested in participating in Absolutely Positive may call (212) 243-4672. Further information about the program is available from Project Director Eric Rodriguez or from Dr. Jeffrey Parsons, Director of CHEST, at (212) 206-7919.
The goal of this research is to discover a pharmaceutically active injectable peptide that will bind to CCR5 and block the ability of HIV to enter macrophages, thus paving the way for a new class of AIDS therapy known as HIV entry inhibitors.
Scientists have determined that individuals who lack a functional CCR5 receptor gene are resistant to infection with HIV. This discovery has indicated that drugs that interfere with the CCR5 receptor could be an effective treatment for AIDS by interfering with HIV entry into the cell. The goal of the current research is to identify a potent peptide for CCR5 that will act as an antagonist for HIV entry using a proprietary, highly degenerate-oriented, peptide library method. Consensus is seeking corporate collaborators to cosponsor its drug discovery effort.
N-9, the only spermicide approved for use in the United States, also has a limited ability to kill some STDs, including HIV. It is found in varying amounts in about three-quarters of the lubricants sold in this country, and, despite the fact that there have been no clinical trials of its safety and effectiveness in the rectum, is widely used by gay men during anal sex.
The current study was conducted on mice, using herpes simplex virus (HSV), which is lethal to mice, to test if the microbicide can kill the HSV before it can infect the mouse.
When used vaginally, N-9 was found to protect mice against HSV infection. All of the mice on whom the N-9 was used rectally, however, died, and they they died faster--four days as opposed to the normal seven to fourteen days--than the untreated mice. Even when the amount of virus was reduced to levels that would infect only 5 percent of normal mice, all of the N-9 mice died.
A second test was performed, this time with the mice receiving a lavage, or douche, after ten minutes. Samples examined under a microscope revealed floating sheets of epithelial cells, the thin line of mucosal tissue lining the rectum. Microscopic examination of mouse rectal tissue showed "places where there was no epithelium at all, just connective tissue," said Phillips. "The N-9 had stripped the epithelial cells off of these animals." After an hour, the mucosal tissue of the mouse rectum, which repairs itself very quickly, appeared normal.
To test N-9's effects in humans, four volunteers tested two commercially available products, Foreplay (1 percent N-9) and K-Y (2 percent N-9), and two nontoxic carrier gels that contained no active ingredient. Each volunteer tried each product on successive days, first applying a normal amount of the lubricant followed fifteen minutes later by lavage, and sent the samples to Phillips.
"We saw striking differences with the N-9, sheets of epithelial cells, hundreds of them in each of the samples," said Phillips. Higher numbers of cells were shed with K-Y Plus, which has a higher concentration of N-9. The rectum seemed to repair itself completely in ten to twelve hours.
Calling for further study of N-9 and other products in the rectum, Phillips said, "We don't think this is a definitive study. It is only four subjects, although it is very striking that we saw the same in all four subjects. It is very troublesome," he stressed, because stripping off the epithelium "could lead to increased HIV transmission."
Dr. Kenneth Mayer, a clinical researcher in HIV at Brown University and a member of the Gay and Lesbian Medical Association said, "I think that there are enough concerns raised by the work, and anecdotal reports of irritation" from N-9 products used during anal sex "that we can't assume that N-9 is good." He urged that N-9 lubricants be used as a complement to condoms rather than as a substitute for them.
The Sixth Circuit Court of Appeals found that Louis Holiday "was entitled to be evaluated based on his actual abilities and relevant medical evidence, and to be protected from discrimination founded on fear, ignorance and misconceptions." In a strongly worded, precedent-setting decision, the court ruled that the city may have violated the Americans with Disabilities Act by refusing to hire Holiday because he has HIV.
"This ruling makes it clear that medically related employment decisions, whether they are about HIV or any other disability, must be based on facts and the individual, not based solely on opinion--even a doctor's opinion," said Matthew Coles, Director of the American Civil Liberties Union's AIDS Project. "The court has sent a strong message to employers. You cannot discriminate against employees or an applicant just because they have HIV."
In the ruling, in Louis Holiday v. City of Chattanooga, the court explicitly said that the ADA mandates an "individualized inquiry" in determining whether an employee can be disqualified from a particular position. The court found that the city did not consider documentation and physical tests that strongly suggest Holiday was capable of performing the job. Today, Holiday is a police officer with the Tennessee Capitol Police.
Coles noted that employers have claimed that the threat of HIV transmission on the job disqualified applicants from employment for the last fifteen years. "We're seeing progress, which this case illustrates," said Coles. "The city initially claimed that hiring Mr. Holiday would be a risk because he might transmit HIV on the job, but later dropped that claim. But some employers still claim that employees with HIV pose a health threat--particularly in police, firefighting and medicine."
For example, a trial will begin in May in John Doe v. Oregon Resort, an ACLU case against an Oregon ski resort that demoted a man because he refused to take an HIV test after the resort learned that his wife has the virus. The man was a ski patroller--which would require him to administer first aid in emergencies--but after he refused the HIV test the resort transferred him to a job removing snow from the parking lot during the night shift.
The sixteen-member advisory council has no formal authority but is influential in helping to keep AIDS on the White House agenda. Dellums said, "I'm not an expert on AIDS. I've never run an agency on AIDS. I am just a loudmouthed political activist. But perhaps that is what this issue needs at this critical moment."
"We cannot wait any longer," said Donald I. Abrams, M.D., President of the 2,000-member organization of physicians and medical students. "We are seeing a severe increase in the abuse of methamphetamine, ecstasy, ketamine, gamma-hydroxbutyrate (GHB), and nitrates (poppers). We are seeing the devastating results in our emergency rooms.
"Unfortunately, that's not the end of it," Abrams added. "There is potential for even greater harm because we are not clear about the long-term effects."
Abrams, an HIV specialist and leading researcher in the study of medical marijuana, said that GLMA has sounded the club-drug alarm because the message isn't getting to the research community or to the people using the drugs who "need to know what kind of dangers they face."
Indiscriminate use of club drugs appears to be highest among gay and bisexual males in the LGBT population, based on the increase of acute episodes in emergency rooms, Abrams indicated. Because of the lack of research data, however, even less is known about club-drug misuse among lesbian and transgender populations.
Such club drugs as methamphetamine are being abused outside the party and rave circuits as well. Meth use, particularly in the northwestern United States, is rising at an alarming rate.
GLMA policy calls for the National Institute on Drug Abuse, Substance Abuse and Mental Health Administration, Centers for Disease Control and Prevention, Center for Substance Abuse Treatment, National Institutes of Health, other government agencies, as well as corporate and private foundations, to step up efforts and funding allocations for community-based research and educational programs.
"In addition to the immediate dangers of these drugs," Abrams said, "the potential for drug interaction with prescriptions, including antiretroviral drugs, is death. It is also clear that there could be permanent depletion or destruction of neurotransmitters such as serotonin that could lead to depressions that are not responsive to currently available antidepressants.
"We need to have some answers to some very serious questions before the club-drug phenomenon becomes a full-blown epidemic," Abrams went on, "and we lose another talented generation of LGBT people."
Schoofs, a Voice staff writer and columnist who specializes in reporting on science and medicine, said, "Even though I have covered AIDS for thirteen years, nothing prepared me for the devastation the disease has caused in Africa. It's the worst catastrophe since slavery." Schoofs went on to say that what affected him most from his months of reporting this award-winning series was the devastation brought on the elderly grandparents, who, while themselves feeble, had to care for their many grandchildren after losing their own children to AIDS. He said that he will donate half of the $5,000 Pulitzer Prize award money to AIDS organizations based in Africa.