Surviving HIV, facing Hepatitis C

As liver disease surpasses virus that causes AIDS as a killer, it should be a wake-up call for LGBT people to get tested, educated about risks

Webb-DavidAfter the emergence of HIV/AIDS and the devastation it caused in the 1980s, the identification of yet another deadly virus about the same time went virtually unnoticed by the general public.

News and concern about Hepatitis C understandably took a back seat to HIV, and so the liver disease apparently grew exponentially because it was a slower killer and asymptomatic.

Spread mostly by blood-to-blood contact, HCV is now thought to infect as many as 170 million people worldwide, many or most of whom are unaware of their status because of the absence of any symptoms they are ill.

Often people do not become aware of their infection until significant damage is done to their liver, and cirrhosis or cancer develops and a transplant is necessary.

Now, more people die from HCV-related illnesses than those associated with HIV, according to a study from the U.S. Centers for Disease Control that was unveiled this week.

CDC officials warn that Baby Boomers, anyone born between 1945 and 1965, should get a test to determine whether they are infected with HCV.

Federal health officials estimate that two-thirds of the people infected with HVC are in this age group, and that half are unaware of it.

Medical researchers and practitioners theorized since the 1970s that another hepatitis virus existed in addition to Hepatitis B because some patients who no longer exhibited traces of HBV in their blood continued to show similar signs of liver malfunction.

Finally, in 1989 Hepatitis C was proven to exist, and widespread testing of blood for the virus since 1997 has revealed its frightening spread.

Many people in the LGBT community were unaware of the existence of HCV and only learned about it if someone they knew was diagnosed with it or, God forbid, learned they themselves had contracted it.

After dodging the HIV bullet and vowing not to place themselves at risk of contracting it, many people no doubt were shocked to learn there was yet another virus they could have contracted through blood transfusions, shared intravenous drug use and sexual activity.

What’s worse, there are concerns that the transmission of HCV might occur more easily than HIV through unsterilized medical and dental equipment, body piercings, shared personal items such as razors, toothbrushes and manicure tools — and no telling what else.

In contrast, HIV is thought to be less easily transmitted.

The possible presence of HCV was sometimes detected in the early 1990s among patients who got annual physicals because routine blood tests revealed irregularities in liver enzymes.

Further testing to identify the cause could reveal the presence of HCV when patients were in the care of doctors who stayed abreast of the medical developments.

It became clear HCV would become a chronic infection for most people who contracted it, and that it would eventually lead to severe health problems or death.

Only a few people would contract the virus and overcome it through the body’s natural processes, as is thought to be the case with some people who are exposed to HIV.

Two people of whom I have known and were HCV-positive illustrate just how widespread the virus could ultimately be.
One individual was a gay man who was a former heavy intravenous drug-user and HIV-negative, but nonetheless a member of a high-risk group.

The other was an older married female who didn’t even drink, let alone do drugs or engage in sex with multiple partners. She would surely be considered a member of a low-risk group, and I suspect she contracted the virus in a hospital setting long before its existence was known.

There are treatments available for HCV, but they unfortunately have different levels of effectiveness among patients, are expensive and can be intolerable to some people. Both of the people I knew were unable to tolerate the treatments. The heterosexual female has died, and I have lost contact with the gay man I knew who was HCV-positive. The last time I talked to him he had been declared disabled because of his HCV infection and the damage it had done to his liver.

In both cases, the months-long treatments that included injections and oral drugs caused flu-like symptoms and severe depression. They both abandoned the treatments.
Fortunately, other people managed to survive the treatments and the combination of drugs apparently eliminated HCV from their blood.

The very fortunate discovered the infections and received the treatments before irreversible damage was done to their livers as was indicated by biopsies.

At the time the two people I knew tried the available treatments, only a combination of pegylated interferon and ribavirin was available.

Those treatments initially were prohibitively expensive, but they are considered less costly now.

Today, there are new protease inhibitors available for treatment showing promise, but the cost is astronomical.

The new drugs, Victrelis at $1,100 per week, and Incivek at $4,100 per week, must be taken for months, and they also can cause hideous side effects.

It’s an agonizing situation, but most people are willing to spend whatever it costs if they can and endure whatever pain comes along in an effort to survive. That’s why it’s so important to get tested for HCV and to determine whether treatment is needed before it’s too late.
For others who are uninfected, don’t go there in the first place. Know how HCV is spread and avoid any possibility that it can imperil your life.

David Webb is a veteran journalist who has covered LGBT issues for the mainstream and alternative media for three decades. Contact him at davidwaynewebb@hotmail.com.

This article appeared in the Dallas Voice print edition February 24, 2012.

—  Kevin Thomas

New HIV stats from CDC indicate more young people continue to become infected

According to a new report released this month by the Centers for Disease Control and Prevention, 39 percent of all new HIV infections are among young people aged 13-29. Persons aged 15-29 make up only 21 percent of the population.

HIV disproportionately affects young gay and bisexual men and young Hispanics and African-Americans. Infections among young black men increased 48 percent.

In 2009, the last year for which statistics are available, 8,294 young people were diagnosed with HIV and 75 percent of those were aged 20-24.

In a National Youth Risk Behavior Study, more adolescents are having sex at a younger age — 46 percent of high school students have had sex and 5.9 percent reported their first sexual intercourse at age 13 or younger.

The report faults homophobic educational programs for part of the problem:

“Young MSM [men who have sex with men] may be at risk because they have not always been reached by effective HIV interventions or prevention education — especially because some sex education programs exclude information about sexual orientation.”

—  David Taffet

Knowing the stats, finding help

Despite the perception, suicide rate is usually down during the holidays. But the statistics are still alarming

One of the biggest myths about suicide apparently is that people are more likely to kill themselves during the Christmas holidays. That’s what I had always thought. But now I know I was misinformed about that and much more related to suicide.

It turns out the month of December actually has the lowest number of suicides during the year, and spring and fall months have the highest incidence, according to the Centers for Disease Control and Prevention. It is speculated that people who might be suicidal think less about killing themselves during the holidays because increased social activity distracts them from their thoughts.

The federal agency recently released the results of its study of suicidal thoughts and behavior in adults for the years 2008-09. The report, which reveals that someone kills him or herself every 15 minutes in the U.S., provides some interesting statistics about suicidal thought. It is the first report to present such data state by state.

One of the more interesting findings of the study is that suicidal thought and behavior vary widely from state to state. About 2.2 million adults — representing 1 percent of the nation’s adult population — acknowledged making plans in the study year to commit suicide, ranging from 0.01 percent of that number living in Georgia to 2.8 percent in Rhode Island.

David-Webb

David Webb The Rare Reporter

About 1 million adults reported attempting suicide, ranging from 0.01 percent in Delaware and Georgia to 1.5 percent in Rhode Island.

The report’s researchers concluded that adults in the Midwest and West were more likely to think about suicide than those in the Northeast and South. Adults in the Midwest were more likely to make plans to commit suicide than those in the South, but suicide attempts did not vary by the four regions.

The variance among the states’ statistics is peculiar, but suicide statistics in general seem to be perplexing. As in the case of loved ones who are often left wondering why victims killed themselves, researchers must try to make sense of the data the victims’ deaths leave behind.

The American Foundation for Suicide Prevention reports that four men commit suicide for every woman who kills herself, as was reflected in the 2008 statistics when 28,450 men succeeded in killing themselves compared to 7,585 women.

Yet women reportedly attempt suicide three times as often as men.

By age, suicide is the sixth leading cause of death for children 5-to-14 years old, and it is the third leading cause of death for people 15-to-24 years old. Rates of suicide among adult men rise with advancing age, and men 65 and older are seven times more likely than women to commit suicide.
Women are most likely to commit suicide between the ages of 45 and 54, and then again after age 75.

By ethnic groups and race, the highest rates are seen among Native Americans, Alaskan-Americans and Anglos. The lowest rates are seen among Latinos and African-Americans who commit suicide at rates of less than half of what is seen in the other groups.

People diagnosed with AIDS are 20 times more likely to commit suicide, according to the foundation.

Among LGBT people the reports of suicide attempts are significantly higher in comparison to straight people in similar socio-economic and age groups, according to the report “Talking About Suicide and LGBT Populations.” The report published by the 2011 Movement Advancement Project notes that statistical information about suicides among LGBT people is scarce.

Indeed, most of the statistics about suicidal behavior and suicide seem to create more questions than they facilitate understanding, but researchers have identified certain constants.

People who kill themselves are most likely to use a firearm in the process; their deaths are likely to occur after they have made an average of 11 previous suicide attempts; they might suffer from major depression; they may abuse alcohol and other drugs, and they could be victims of bullying, physical abuse or sexual abuse.

There are preventive measures that can be taken if someone is in crisis and at risk of suicide, and it is a good idea to be prepared for such an event. The strongest indicator of a suicide risk is a previous attempt or ongoing expressions of intense distress and despair. Those people must never be left alone, and they should immediately be afforded mental health treatment.

Psychotherapy has helped people who are at risk of suicide survive, and alcohol and drug abuse treatment can succeed in saving lives that seemed destined for destruction.

And even though it turns out the holidays are not a time when people are most at risk for planning or attempting suicide, the myth has created an opportunity to raise awareness about a preventable tragedy for both the potential victims and their loved ones.

After all, there often are no second chances when it comes to a risk of suicide.

David Webb is a veteran journalist who has covered LGBT issues for the mainstream and alternative media for three decades. Contact him at davidwaynewebb@yahoo.com or at http://facebook.com/TheRareReporter.

This article appeared in the Dallas Voice print edition December 9, 2011.

—  Kevin Thomas

On World AIDS Day: some HIV statistics

For World AIDS Day, here are some statistics gathered from the Centers for Disease Control and the Dallas County Department of Health about HIV/AIDS:

• Someone becomes infected with HIV every 9½ minutes.

• One in five people infected with HIV is unaware of it.

• Since 1981, more than 30 million people worldwide have died from the disease.

• Since 1981, more than 600,000 in the United States have died from the disease.

• 61,595 people in Texas are infected with HIV.

• Today, 34 million people worldwide have HIV/AIDS.

• Although African-Americans make up only about 12 percent of the U.S. population, they make up nearly half the people in the country who are living with HIV.

• Nearly 3 out of 4 Americans living with HIV do not have their infection under control.

• About 1.2 million people in the United States are living with HIV.

• Only 28 percent of those have a suppressed viral load.

• Of those living with HIV who are in ongoing care and on anti-retroviral treatment, 77 percent have suppressed levels of the virus.

• Only 51 percent of those with HIV in the United States receive ongoing medical care and treatment.

On Dec. 1, AIDS organizations from across Dallas County will gather at Main Street Garden at 7:30 p.m. for an AIDS remembrance.

—  David Taffet

Big changes ahead for ASOs

AIDS agencies have to look for ways to branch out if they want to survive and thrive under health care reform

Tammye Nash  |  Senior Editor
nash@dallasvoice.com

An estimated 1.2 million people in the United States are living with HIV infection, and 20 percent of them are not even aware of it, according to the Centers for Disease Control. And a CDC report released in early August suggests that there are about 50,000 new HIV infections each year.

And yet, federal funding for HIV/AIDS services have remained flat for the last five years — from funding for medical services to research dollars to money for support services — according to Raeline Nobles, executive director of AIDS Arms Inc.

And that means, Nobles and Resource Center Dallas Executive Director and CEO Cece Cox agreed this week, that the nonprofit, community-based organizations that have been the backbone have to look ahead and keep their options open to remain viable.

Changes in the way that federal funds through the Ryan White CARE Act are distributed — requiring that 75 cents of every Ryan White dollar be used for core medical services — give an edge to nonprofits that operate clinics. And that means that AIDS Arms, which just opened its second clinic last month — is “more competitive at the national, state and local levels,” Nobles said. “With the number of people who are uninsured and living at poverty levels, access to any kind of medical care is a priority. So if you are providing those kinds of services, it does give you an edge.”

Agencies that don’t provide those kinds of services, she added, can get in on that competitive edge by collaborating with those that do.

“There’s really no new money to sustain new agencies,” Nobles said. “AIDS is definitely off the docket in terms of diseases people seem to be concerned about. In fact, any HIV provider across the country who is not considering all their options is in a great deal of denial, and that may well come back to bite them rather severely.”

There’s also health care reform to consider, with several parts of the law passed in late 2010 still to be implemented. That reform, said Cox, is changing the face of community health clinics, like RCD’s Nelson-Tebedo Clinic, and HIV/AIDS service programs.

“Our nutrition program is a good example,” Cox said. “It has really been hammered in terms of federal funds, so we have focused on supporting the program through the community, foundations and corporations. … It is an amazing puzzle we have pieced together, even with cuts in traditional funding streams. But we have managed. We have done the things we felt we had to do.”

And there are more changes coming. Nobles said that if the Ryan White funds survive beyond 2013 when more health care reform measures go into effect, “it likely won’t include any money for outpatient services like we offer” at the Peabody Clinic and the new Trinity Clinic.

“So we have to take a look at what we do best, and we can use our model and globalize it into different areas. We have to become even more sustainable. Diversification of business is key to survival,” Nobles said. “It can’t just be about HIV and AIDS any more.”

Nobles said “serious discussion has been going on at AIDS Arms for at least two years, at the board and staff levels” about how the agency can expand its focus beyond HIV/AIDS and remain viable.

“We have to diversify our business plan. The situation has been serious for awhile and it is becoming even more serious for our board,” Nobles said. “We hope to have, by early 2012, a final business plan in place to move into the future.

“Health care reform is a great thing for a lot of people, but it poses real challenges for the nonprofit sector. You have to stay ahead of the curve, or health care reform will run right over you. We definitely want to stay ahead of that curve,” she continued. “The HIV nonprofit community has the best model of care and support the U.S. has ever seen. That model can be globalized to include care for other disease — heart disease, cancer, diabetes.”

Cox said that staff and board members at Resource Center Dallas also began planning for the changing future some time ago, and its current capital campaign to build a new facility is part of the plan.

“Nobody seems to have all the answers right now. The feds won’t say what they will and what they won’t fund. So savvy business people are already thinking, ‘If this funding goes away, what can we do instead?’” Cox said.

“Everybody feels like the challenge working in the nonprofit sector is that you are always aware there is so much more that needs to be done,” she added. “But doing more requires more space, more staff, more resources. And to have that, you have to build the business in a way that is sustainable. And you have to remember, nobody can do everything.”

Both Cox and Nobles are quick to remind that even though their agencies are “nonprofits,” they are businesses nonetheless, and have to be operated with an eye toward success.

“There has been, and probably still is, the mindset about nonprofits. People expect the nonprofits to be there to provide all these services without caring about costs,” Cox said. “But the fact is, nonprofit or not, these agencies have to be run like a business. You have to anticipate, plan ahead. You have to put the structures in place and you have to invest. We make large investments in our staff and in technology. For-profit business sell stock and they answer to their stockholders. We get our money from our donors, and we have an obligation to let our donors know what we do with their money and to let them know we use it responsibly.”

This article appeared in the Dallas Voice print edition November 11, 2011.

—  Kevin Thomas

Abounding Prosperity receives $1.7 million grant

South Dallas prevention organization targets population hardest hit by new HIV infections

FUTURE MOVE? | Kirk Myers, CEO of Abounding Prosperity, says that his agency, now located in South Dallas across the street from the Peabody Health Center, will have to move to a bigger space to adequately house the extra staff he needs to operate the grant the agency just received from the CDC. (David Taffet/DallasVoice.

DAVID TAFFET  |  Staff Writer
taffet@dallasvoice.com

Abounding Prosperity, a South Dallas-based AIDS education organization, has been awarded a grant from the Centers for Disease Control, and is the only agency in the Dallas-Fort Worth area to be included in this round of CDC funding.

The money will be used to expand HIV prevention services for young gay and bisexual men of color, transgender youth of color and their partners, according to Kirk Myers, CEO of Abounding Prosperity.

Myers said that his organization was one of the few nationally that got fully funded. The five-year grant totals $1.7 million.

The CDC awarded prevention grants to 34 agencies around the country. This expands on an earlier program to reach the targeted populations with an increase of $10 million to $55 million nationally over five years, funding a larger number of community organizations.

“We will be trying to identify those people who are positive and unaware,” Myers said,“and help those people who are positive and know their status to become responsible for not reinfecting themselves or anyone else.

“We see ourselves as a prevention organization rather than a care organization,” he added.

Although three Dallas AIDS organizations applied for the grant money, Myers said he believes Abounding Prosperity was chosen because it targets African-American men who have sex with men (MSM) between the ages of 17 and 29, the group hardest hit with new infections in Dallas.

That includes many who are unemployed and underemployed.

To encourage testing and behavioral intervention, Myers suggested using incentives such as gift cards that might cover gas costs.

“Even though testing should be done routinely, you’re not worried about testing when you’re worried about your next meal,” Myers said.

In addition to testing, the focus will be on using evidence-based interventions designed to create behavior changes using techniques that have proven successful with gay men.

Myers said he will need to triple the size of his staff to nine and add more office space to operate the grant. He has already looked at two properties on MLK Boulevard near Abounding Prosperity’s current office.

Myers said that he would like to collaborate with Dallas County and other AIDS organizations’ programs to reach the most underserved populations.

He specifically mentioned Resource Center Dallas’ syphilis elimination program as an obvious partner.

“Syphilis is off the charts in Dallas,” Myers said. “And if you’re putting yourself at risk for syphilis, you’re putting yourself at risk for HIV.”

But, Myers said, his ultimate goal is to do the job of education and prevention so well that he can put Abounding Propserity out of business.

“I want to eradicate AIDS,” he said.

Ryan White funds

In addition, the Health Resources and Services Administration of the U.S. Department of Health and Human Services announced $1.89 billion in grants to states for HIV/AIDS care and medications. Texas was awarded $85,856,474 in Ryan White money designated “supplemental part B.”

The state also received $786,424 in AIDS Drug Assistance Program (ADAP) Emergency Relief Awards.

ADAP funding matches money spent by the state. Texas cut its ADAP funding, which may be a reason smaller states are receiving more money. Georgia and Louisiana each were awarded $3 million and Florida almost $7 million in emergency drug assistance money.

Dallas will receive $14,625,082 and Fort Worth $3,864,274 in Ryan White Part A funding. Dallas awards are administered for the region by the county. Other cities in Texas receiving these grants are Houston ($19.7 million), San Antonio and Austin ($4.4 million each).

This article appeared in the Dallas Voice print edition September 30, 2011.

—  Michael Stephens

We are ‘greater than AIDS’

A LOOK BACK | Elton John, right, is joined by Ryan White, left, and Jason Robertson, both suffering from AIDS, as he performs at “For the Love of Children” benefit for children with AIDS and other serious illnesses in 1988. (Alan Greth/Associated Press)

As LGBT community grows more complacent, HIV infections in gay, bisexual men continues to rise

DAVID FURNISH  |  Special Contributor

This year marks 30 years since the discovery of the first case of what was later identified as AIDS. With that news, our lives and relationships as gay men were forever altered.

We witnessed an unthinkable tragedy that has taken the lives of more than a quarter million of our gay and bisexual friends and lovers.

In the face of this devastation, leaders emerged. The crisis helped to shape our community’s political agenda, and it provided a platform around which gay leaders could advocate for rights and equality. We realized that if we informed ourselves and acted on what we learned, we could be greater than the disease.

Thanks to the efforts of gay men and our allies, our community saw a dramatic decline in new infections by the late 1980s. Many of us can look back with immense pride at the collective response in those early years.

The availability of effective combination drug therapies in 1996 fundamentally changed how we thought about HIV. No longer was HIV the death sentence it had once been. We had new hope. For many, HIV was a manageable chronic disease.

Many of us turned our attention to marriage equality, adoption rights, the repeal of “don’t ask, don’t tell” and other pressing issues facing our community. While we broadened our focus, AIDS did not.

When we become complacent, HIV thrives. New HIV infections among gay and bisexual men in the United States are on the rise. Yes, on the rise.

We are the only risk group for whom this is the case. According to a recent study by the Centers for Disease Control, one in five of us — that is, gay and bisexual men — in some of the largest U.S. cities today are living with HIV. And half of those who are positive do not know it.

Unless we act now, we will see these numbers rise even higher, and quickly.

My partner, Sir Elton John, often talks of his friend Ryan White, a boy whose tremendous courage in the face of AIDS forced our leaders to take action and inspired many of us. Today, Ryan’s story continues to remind us that just as HIV began one person at a time, it will end one person a time.

Elton and I recently had a baby boy. Becoming fathers has given us new perspective on what it means to take care of one another — as parents, as partners and as members of a community.

And, it reminds us that we cannot be complacent in helping to create the kind of society in which we want our son to grow up. In short, we must take responsibility and each do our part to create a future free of HIV, by being informed, using protection, getting tested and treated — and by getting involved.

And so, as we mark 30 years of this disease, Elton and I have recommitted ourselves to being greater than AIDS. As chairman of the Elton John AIDS Foundation, I’m proud of the community organizations with which we are working to fight stigma and prevent the spread of the disease. And I’m proud that leading LGBT companies — like HERE Media, LOGO TV and Dallas Voice — are refocusing attention on this epidemic. And I hope more will join us.

As a community, we once showed that we could be greater than AIDS. Now is our time to do it again. Visit GreaterThan.org/pride to get started.

David Furnish is Chairman of the Elton John AIDS Foundation (EJAF.org). The Elton John AIDS Foundation is a supporting partner of Greater Than AIDS (GreaterThan.org/pride), a national movement organized in response to AIDS in America with a focus on the most affected communities. Columnist photo courtesy Richard Leslie.

This article appeared in the Dallas Voice print edition March 4, 2011.

—  John Wright

Out Youth gets $25K from Sir Elton’s foundation

Out Youth Austin today announced that the organization for LGBT youth has received a $25,000 grant from the Elton John AIDS Foundation for Out Youth’s K.Y.S.S. (Knowing Your Status is Smart) program for HIV prevention, testing and counseling for young people, ages 12-19, in Central Texas.

The group received a $25,000 grant for the same program in March from the London-based Red Hot Organization. The Elton John AIDS Foundation is based in New York.

Out Youth Austin Executive Director Candice Towe called the latest grant “a tremendous Christmas present” for the organization.

Monrovia Van Hoose, Out Youth’s clinical director who oversees K.Y.S.S., said, “It’s critical that GLBTQ youth have regular access to confidential HIV testing and counseling. Staff, clinical interns and volunteers have received intensive training to provide testing and counseling for HIV and other sexually transmitted infections.”

According to a 2009 report from the Centers for Disease Control, 48 percent of Americans ages 13-24 who are infected with HIV are unaware of their HIV status. In 2008, CDC noted that American youth are at “persistent risk” of HIV infection, and that many are “not concerned” about the risks of infection.

—  admin

Truvada breakthrough gets mixed reaction from local docs, advocates

Report that drug could protect HIV-negative men from infection is good news, but concerns remain over long-term effects, some say

David Taffet  |  Staff Writer taffet@dallasvoice.com

REMEMBERING THEIR NAMES | Two unidentified visitors console each other at the NAMES Project AIDS Memorial Quilt display in October 1989 in Washington, D.C. Panels from the Quilt will be on display in the International Peace Chapel at Cathedral of Hope on World AIDS Day 2010, Wednesday, Dec. 1. More coverage of World AIDS Day events in North Texas begins on Page 14. (Doug Mills/Associated Press)

An extensive study released this week indicates that use of the anti-retroviral drug Truvada by HIV-negative men can prevent infection. Use of the drug for prevention is called Pre-Exposure Prophylaxis or PrEP.

Dr. Nick Bellos, a local infectious disease specialist, called the results of the study a step in the right direction. But Bellos also warned that the study only showed 75 percent effectiveness in preventing infection among people who were most compliant. And he said he had concerns about patients developing resistance to the drug and not using other risk-reduction techniques.

Local AIDS activist Bret Camp, associate executive director for health and medical services at Resource Center Dallas, also warned that the side effects and long-term effects of using Truvada can be severe.

Global HIV Vaccine Enterprise executive director Dr. Alan Bernstein, referring to another recent study using a topical microbicide that appears to prevent HIV infection in women and another study that included the first demonstration of efficacy by an HIV vaccine regimen, said, “The announcement [about Truvada] … is a very important addition to what is the most promising 15 months in the field of HIV prevention research since the epidemic began 27 years ago.”

The Centers for Disease Control said the findings in the Truvada study are a major advance in prevention research and a new tool to reduce the risk of infection among gay men and bisexuals.

Dr. Brady Allen, a Dallas internist, was optimistic, but also had some concerns.

“I think we have a lot of issues to consider with PrEP,” he said. “We will certainly need recommendations from the CDC. In addition, I think it is promising work.”

AIDS Arms Executive Director Raeline Nobles was also optimistic.

“This study shows hope and a new way to battle the HIV epidemic,” Nobles said. “Usually we are a little apprehensive when there is a press release about new drugs or vaccines being tested, as we know there will be years of further study and validation — and often failure over time to come to fruition.”

But, she added, the Truvada study has her excited about the future.

Camp stressed that “The anti-retroviral prophylaxis approach is promising but only a piece of the solution.”

He said that the new drug therapy cannot replace traditional prevention methods, and he pointed out that new infections did occur among men who took the medication.

Among the 2,500 enrolled participants, 36 new infections occurred among individuals who received the drug. Among placebo recipients, there were 64 new infections. Researchers estimated that the use of the preventive medication cut new HIV infections by an estimated 44 percent overall when compared to placebo.

“Adherence to taking the pills is key to success,” Camp said.

The study did show that those who took Truvada daily had a much higher rate of protection than those who took the pills only half of the time.

Camp said that “two participants who seroconverted had resistance after” that would have been built by irregular use of the drug, causing it to be at a lower-than-therapeutic level in the blood at the time of infection.

Dr. Nick Bellos
Dr. Nick Bellos

Bellos said that those patients also may have contracted a strain of the virus that is resistant to Truvada.

But Bellos still called the results promising and said that prophylaxis is a good idea.

“In a perfect world, if we could get everyone treated, we could plateau the epidemic,” he said.

While the CDC called “developing guidance on the safe and effective use of PrEP and determining how to most effectively use PrEP in combination with other prevention strategies to reduce new infections in the U.S.” its most urgent priority, Camp warned of the risks.
While he said that compared to some of the other anti-retrovirals on the market, Truvada is fairly well tolerated, it can still cause headaches, nausea and diarrhea.

“It’s known to cause decreases in renal function,” he said. “We could be setting people up for renal issues and the long-term effects are just now coming to our attention. Cardio-vascular disease, diabetes — we don’t know what the next 10 to 20 years on those drugs will be.”

Bellos noted that metabolic bone disease could also be an issue.

He said that anyone taking the drug as a prophylactic measure would need to be medically monitored on a regular basis, just as someone who is HIV-positive.

Despite his concerns, Camp did say he believes the results are a breakthrough that proved a non-intended use or expected finding. Previous studies have shown a benefit of drugs for medical personnel accidentally exposed to the virus but this was the first time prevention was proven through sexual exposure.

“The value is more in post-exposure, when traditional HIV prevention mechanisms fail,” he said.

Camp said he is more excited about the research into anti-microbial topical gels that have recently also proven effective in preventing infection after exposure.

Bellos agreed.

“My preference is for a vaccine,” Bellos said.

“Then we don’t have to worry about it.”

He said that a study has been done in South Africa among couples where one is HIV-positive and the other is negative, showing that when the positive partner’s viral load is undetectable, the risk to the negative partner is about 6 percent.

“On therapy, 94 percent of the negative partners stayed negative,” he said.

Bellos also warned that the Truvada study showed that even for the most compliant participants in the study showed only 75 percent effectiveness in preventing infection.

He said he is concerned that people will ignore traditional prevention methods that have proven effective and instead rely on the less-effective prophylaxis.

Nobles said it has long been known that strict adherence to anti-retroviral treatment among HIV-positive people leads to less transmission of the virus to others.

But she wondered about some of the ethical implications that need to be studied, including the cost and availability of Truvada.

“If we can’t afford to treat all HIV positive people living with the disease today — which we cannot — how will we ever be able to afford paying for preventive medications, too?” Nobles said.

The drug costs about $45 per pill in the United States. Because the manufacturer gave away the patent for production by generic drug makers in other countries, it is available in some countries for under $1.

“One wonders if insurance companies are going to be willing to pay for this,” Allen said.

Bellos said that he has some patients with family members in places like Pakistan and Thailand and they are able to get the drug from overseas.

“We should have two other large PrEP trials reported on in 2011 in other high-risk groups, which will help confirm or refute these results,” said Allen.

President Barack Obama also weighed in on the importance of the study.

“I am encouraged by this announcement of groundbreaking research on HIV prevention,” the president said in a statement released Tuesday, Nov. 23.

“While more work is needed, these kinds of studies could mark the beginning of a new era in HIV prevention,” the president said.

“As this research continues, the importance of using proven HIV prevention methods cannot be overstated.”

……………………..

MORE ON TRUVADA

Truvada is a combination drug therapy known as a nucleoside analog reverse transcriptase inhibitor. Two anti-HIV medications, Emtriva® and Viread®, are combined into one pill that is taken once a day with or without food.

In the United States, the cost of the treatment is more than $1,000 per month.

Manufacturer Gilead has given away the patent for generic manufacturers to produce and sell it in third world countries. There, the cost of the drug averages 45 cents a day or about $15 per month.

Those generic medications are not available in the United States.

Dr. Nick Bellos said that patients of his who have access to the generic medication have family members in those countries that are filling the prescription and sending them the drug.

Truvada has been one of the more successful HIV medications. Fewer people seem to experience side effects on this drug than on some of the others.

Studies show that more people became and stayed undetectable over a three-year period on Truvada than on Combivir or Sustiva, two other popular HIV medications.

Those on Truvada showed a greater increase in the number of CD4 cells than on other medications.

Side effects include nausea, vomiting, unusual muscle pain and/or weakness.

Longterm use could lead to liver damage, renal failure, increased risk of diabetes and metabolic bone disease.

Changes in body fat have been seen in some people taking Truvada.

—David Taffet

This article appeared in the Dallas Voice print edition November 26, 2010.

—  Michael Stephens

Youth First Texas leader Sam Wilkes speaks from experience about the struggles of gay teens

Sam Wilkes speaks during the safe schools rally in Lake Cliff Park on Friday.

Sam Wilkes is development director and the only paid staff member at Youth First Texas.

On Sunday he appeared on Lambda Weekly to talk about bullying and how groups like YFT can help.

Wilkes said an estimated one-third to on- half of teen suicide attempts are by LGBTQ youth.

The Centers for Disease Control lists suicide as the third leading cause of death of people ages 15 to 24, just behind accidents and homicide. More than 4,000 young people commit suicide every year — that’s one every two hours.

According to estimates, 100 to 200 attempts are made for every actual suicide.

On Friday, at a rally in Lake Cliff Park in Oak Cliff to support safe schools, Wilkes spoke about the youth who attend YFT.

“These are youth who are marginalized and have no other place to turn,” he said. “In fact many of them are homeless because they feel they are safer on the streets than they are in their own homes.”

On Lambda Weekly, Wilkes told his own story and talked about why he’s so passionate about helping other young people.

When he was 18, Wilkes’ mother asked him whether he was gay. Although Wilkes knew he was different from the time he was 12, he wasn’t ready to come out. So he gave his mother an answer that was ambiguous and non-committal.

The next day, his mother handed him a letter that said he was no longer welcome in the house.

Wilkes was fortunate because he already had a job working at a restaurant. He had friends who let him crash on their sofa for several months until he could save enough for an apartment. On his own, he managed to finish school. To this day, he said, his relationship with his parents is nonexistent.

But not all youth are even as fortunate as he was, he said. He called his job at Youth First Texas the best opportunity anyone could have.

Wilkes said more than half of youth at YFT have contemplated or attempted suicide before coming to the center. But after they become involved at YFT and meet other LGBTQ youth, depression and risky behavior decreases tremendously.

—  David Taffet