Transition to Hope

Recently, someone named Curtis Cost wrote an article assailing the importance and validity of African Americans knowing their HIV status. Since the first widely reported cases in 1981, HIV has been mired in controversies, ranging from its origin to the possible existence of a cure. Sadly, over thirty years later, we continue to have many of the same conversations. What should NOT be in doubt any longer is that HIV disease is having a devastating impact on the African American community.

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I can imagine that those who try to remain current with new developments in contraception and HIV risk reduction may cringe at discovering that something else might place them at increased risk of HIV infection. This time, that something else may be a popular form of contraception, injectable hormones. Injectable hormones, such as the well-known Depo-Provera, are one of the easiest, most cost effective contraception alternatives because they are long lasting, easily administered and and gives women more control over the timing of their pregnancies. Unfortunately, they do not protect against HIV or other sexually transmitted infection. Now, a recent study published in Lancet on October 3, 2011, raises concern that their role in HIV infection might be even more problematic. Researchers from the University of Washington followed almost 4,000 couples for two years in Botswana, Kenya, Rwanda, South Africa, Tanzania, Uganda and Zambia. In each couple, either the man or the woman was already infected with HIV.

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Some of you may be aware that the annual HIV Prevention Conference has been taking place in Atlanta this week. One of the unique aspects of HIV conferences is that they tend to bring together an eclectic mix of people: consumers, researchers, medical providers, non profits and other assorted advocates. As we, as a society, struggle with finding new and creative ways to reduce the transmission of HIV, it was only natural to consider the impact a medical model might have on this challenge. Perhaps one of the most exciting studies within the last several months demonstrates the benefit of immediate, aggressive HIV treatment in reducing transmission.

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For the two or three of you (lol) who follow my blog, you may have noticed that I haven't blogged in a while. A lot has happened to me over the last several months that I won't get into now. However, I have returned with a renewed sense of purpose and quite a lot to say.

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For so many years, the news about efforts to combat HIV/AIDS has been, in a word, depressing. It seemed that with every positive development would come news of escalating infection rates, or that some promising vaccine or therapy was less promising than we had hoped. But 2010 will be remembered as one of the first years where there seems to be almost universal optimism that real progress is being made in this war.

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One of the most frustrating aspects of working in HIV is addressing the many myths (as well as conspiracy theories) surrounding it-the most persistent of which is that AIDS is a "gay disease." Clearly this myth started early in the history of HIV in the U.S., yet has persisted despite clear evidence of how HIV is transmitted and the growing diversity of those whom become infected. Moreover, it has been convenient for many to affix the label of "gay" to anyone who has had sex with the same gender. However, a startling new report from the Centers for Disease Control (CDC) may add additional fuel to that myth. A CDC study conducted in 21 cities tested over 8,000 gay and bisexual men participating in the 2008 National HIV Behavioral Surveillance System.

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Despite the persistent myth that HIV was a man-made disease, unleashed upon the unsuspecting, disenfranchised of our society (read gays and blacks), now comes more evidence that it may have been present in monkeys and apes for millennia. New research, published in Science magazine last month, report the presence of the ancestor of the simian HIV virus in Africa possibly dating back as far as 78,000 years. This fascinating research, that studied monkey species on a volcanic island off of the coast of West Africa, who developed in isolation, found that four of the six species had been infected with HIV.

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President Obama's new AIDS Strategy calls for a renewed effort to reduce new HIV infections by 25%, increasing the number of people who know their status from 79% to 90%. Crucial to the success of this benchmark is to test more people for HIV. This is consistent with the Center for Disease Control's recent recommendations (in 2006) to encourage HIV testing to become a routine part of medical care. However, one of the more controversial aspects of this push is the distinction between 'opt -in' vs 'opt-out HIV testing. Opt-in testing generally refers to an opportunity for the patient to be asked, by a provider, if s/he would like to be tested for HIV. Opt-out testing means that a patient will be given an HIV test unless s/he chooses not to have one. The CDC has recommended opt-out testing as well as the elimination of written consent (a medical consent form that authorizes HIV testing).

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The conference is starting to wind down. From a personal and environmental perspective, you can feel the air slowly 'leaving the balloon.' The palpable energy level has dropped appreciably. Many of us are just overloaded. There is so much information being disseminated, as well as events, press conferences, and activities, many occurring concurrently, that it is physically impossible to attend but a fraction of it.

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"Charity begins at home." A cliché? Certainly! But with dwindling resources for everything and a raging HIV Epidemic in Black people in the United States, should we concentrate more of our efforts here?

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