[BLOG-LIKE POSTING] HIV and Me
Aug. 5th, 2004 06:55 pm![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
rfmcdonaldThis morning, I delayed going to the Hassle Free Clinic to pick up my HIV test results; in fact, I only left Little Portugal at 1 o'clock. It was natural that I was fairly tense given the occasion for my venture downtown. This tenseness has persisted, even after the counsellor took me into his cramped office and told me that, no, the tests on my blood did not detect antibodies to either HIV-1 or the much rarer and less immediately lethal HIV-2. In one form or another, I think I'll be dealing with this tension for quite a while.
Contrary to its reputation, HIV is actually a difficult virus to pick up. This 1999 study from the American Journal of Epidemiology suggests that even if you completely ignore the principles of safer sex--first enunciated by Michael Callen and Richard Berkowitz in 1983 after their AIDS diagnoses--you've got almost surprisingly good chances of avoiding HIV infection through homosexual intercourse. It's even more difficult to transmit HIV heterosexually. Having unprotected sex with multiple partners is a relatively reliable way to acquire HIV sexually; so is having unprotected sex with a HIV-infected partner repeatedly. So long as you avoid either set of activities, the chances of becoming infected with HIV are remote.
The problem, from my perspective, is that HIV has become an endemic disease in the male GLBTQ community. According to the Ontario Men's Survey, one-tenth of this demographic is already infected with HIV, a rate comparable to that of Rwanda or Cameroon; perhaps one-quarter of these might not know that they're infected. Worse, HIV seroconversion rates aren't falling but rising, and have been for some time. There are various reasons for this: safer-sex fatigue and an increased willingness to task risks in certain contexts; the false belief that modern protease treatments make HIV infection a manageable condition, perhaps like diabetes; continued ignorance of safer sex principles; or, sometimes, disbelief of what's going on. It's a minor irony that last night on the subway, I read a letter to the editor in the most recent issue of Xtra claiming that the various HIV/AIDS organizations in Toronto are exaggerating rates of infections.
Of course, these rates of HIV infection are actually fairly low compared to other countries. Southern Africa's on-going catastrophe is well-known. What's less well-known is the fact that in Russia, Ukraine, and Estonia, proportionally twice as many people are infected as in the United States, while the United States has, in turn, proportionally twice as many infected as Canada, France, or Italy. Things could definitely be much worse.
But still, they're bad enough.
Randy Shilts' 1987 book And the Band Played On is a famed early description of the spread of AIDS. This book describes the confusion and growing horror that people began to feel, as suddenly, healthy young men first began to grow ill with a variety of baffling disease, then to start dying. Back in June of this year,![[livejournal.com profile]](https://www.dreamwidth.org/img/external/lj-userinfo.gif)
sandor_baci wrote about his experience as a gay man in New York City in the early 1980s, at the very beginning of the HIV epidemic in that city. No one knew the cause of the epidemic (was it an infectious disease or not? was it viral or bacterial? was the pathogen already known or was it a new one?), no one could provide effective medical treatment for even the symptoms, no one survived the onset of the disease, and no one had any idea when or if the epidemic would end. All that was present was an ever-growing fear that somehow, one might fall prey.
In March 1983, Larry Kramer wrote the article "1,112 and Counting" for the New York Native. Just over eleven hundred people had been diagnosed with AIDS in the United States at the time that he wrote; 418 had died. The death toll had risen geometrically: 31 deaths by the end of 1980; 234 in 1981; 853 in 1982; 2304 in 1983. Unnoticed, the HIV epidemic began to rapidly spread beyond the relatively few people infected. Retrospective surveys in San Francisco for a hepatitis-B vaccine reveal that the percentage of participants with antibodies for HIV rose from 4.5% in 1978 to almost 67% in 1984. The result of this unchecked spread was the hundred thousand American dead over the 1980s.
The world was lucky in that AIDS appeared at a time when the study of medicine had advanced to the point when HIV could be discovered, after Gallo had already discovered retroviruses and the basic workings of the immune system were known. Interviewers for the National Institute of Health's AIDS oral history project frequently asked their subjects what would have happened had AIDS appeared in 1955; almost uniformly, they responded that it would have been a disaster. As Charlie Stross wrote two years ago in a depressing discussion on the topic,
The discovery of the HIV viruses and the development of testing procedures from 1984 on, assandor_baci wrote, at least gave people a chance to discover whether or not they were infected. The introduction of AZT in 1987 introduced the first drug to deal directly with the HIV virus; the introduction of protease inhibitors from the mid-1990s on gave further hope. A vaccine for HIV is still far off; given the mutability of the HIV virus, it's unlikely that a virus providing complete protection will be engineered for the foreseeable future. Even so, things could have been much worse.
You're not paranoid when they really are out to get you. HIV isn't an entity with a volition of its own, of course, but it is a virus that continues to spread rapidly. It isn't hypochondriacal to worry about becoming infected with AIDS when you belong to a demographic--non-heterosexual men, young southern Africans, users of IV drugs, people who don't engage in protected sex--that's disproportionally at risk of infection. It's only sensible.
And yet, despite two decades of fairly solid and continuous education about HIV and AIDS, the number of infections continue to grow. The epidemic in southern Africa, where more than one-fifth of the population is infected, is well known; I explained the endemic status of HIV infection in male GLBT communities in the First World above. What isn't as well known is that the former Soviet Union has some of the highest growth rates in HIV infections in the world, with more than 1.5 million Russians infected already and the epidemic beginning to spread beyond its core demographic, or that 5.1 million Indians and a million Chinese are infected. The sigmoid curves of infection continue to rise, even as national governments continue to fumble with creating programs to prevent infection, or courses of medical treatment for people already infected. Things seem particularly bad in Russia:
The terrifying thing about HIV, which over the past three decades has emerged from obscurity to become one of the fastest-growing epidemic diseases, is that it's still being contracted. It isn't a moral issue, save inasmuch as governments and other organizations do little to either halt the spread of the infection or to provide effective treatment for those already infected. (Thabo Mbeki, stand up.) It's rather a matter of simple minor things--acts committed in ignorance, acts with consequences out of all seeming proportion--accumulating to produce a mass of horrors both individual and collective, and the vanishingly small likelihood that these horrors will come to an end. Or, at least, that they will come to as prompt as end as was enthusiastically predicted in the mid-1980s after the HIV virus was discovered, with effective vaccines and full cures in just a couple of years time.
In 1996, in response to the development of protease treatments, Andrew Sullivan proclaimed in an article for the New York Times Magazine that the AIDS epidemic was over. Eight years later, we're still waiting for that end to appear over the indefinitely receding horizon. In the meantime, there's nothing to do but be justifiably paranoid and careful, for anyone.
Contrary to its reputation, HIV is actually a difficult virus to pick up. This 1999 study from the American Journal of Epidemiology suggests that even if you completely ignore the principles of safer sex--first enunciated by Michael Callen and Richard Berkowitz in 1983 after their AIDS diagnoses--you've got almost surprisingly good chances of avoiding HIV infection through homosexual intercourse. It's even more difficult to transmit HIV heterosexually. Having unprotected sex with multiple partners is a relatively reliable way to acquire HIV sexually; so is having unprotected sex with a HIV-infected partner repeatedly. So long as you avoid either set of activities, the chances of becoming infected with HIV are remote.
The problem, from my perspective, is that HIV has become an endemic disease in the male GLBTQ community. According to the Ontario Men's Survey, one-tenth of this demographic is already infected with HIV, a rate comparable to that of Rwanda or Cameroon; perhaps one-quarter of these might not know that they're infected. Worse, HIV seroconversion rates aren't falling but rising, and have been for some time. There are various reasons for this: safer-sex fatigue and an increased willingness to task risks in certain contexts; the false belief that modern protease treatments make HIV infection a manageable condition, perhaps like diabetes; continued ignorance of safer sex principles; or, sometimes, disbelief of what's going on. It's a minor irony that last night on the subway, I read a letter to the editor in the most recent issue of Xtra claiming that the various HIV/AIDS organizations in Toronto are exaggerating rates of infections.
Of course, these rates of HIV infection are actually fairly low compared to other countries. Southern Africa's on-going catastrophe is well-known. What's less well-known is the fact that in Russia, Ukraine, and Estonia, proportionally twice as many people are infected as in the United States, while the United States has, in turn, proportionally twice as many infected as Canada, France, or Italy. Things could definitely be much worse.
But still, they're bad enough.
Randy Shilts' 1987 book And the Band Played On is a famed early description of the spread of AIDS. This book describes the confusion and growing horror that people began to feel, as suddenly, healthy young men first began to grow ill with a variety of baffling disease, then to start dying. Back in June of this year,
sandor_baci wrote about his experience as a gay man in New York City in the early 1980s, at the very beginning of the HIV epidemic in that city. No one knew the cause of the epidemic (was it an infectious disease or not? was it viral or bacterial? was the pathogen already known or was it a new one?), no one could provide effective medical treatment for even the symptoms, no one survived the onset of the disease, and no one had any idea when or if the epidemic would end. All that was present was an ever-growing fear that somehow, one might fall prey.In March 1983, Larry Kramer wrote the article "1,112 and Counting" for the New York Native. Just over eleven hundred people had been diagnosed with AIDS in the United States at the time that he wrote; 418 had died. The death toll had risen geometrically: 31 deaths by the end of 1980; 234 in 1981; 853 in 1982; 2304 in 1983. Unnoticed, the HIV epidemic began to rapidly spread beyond the relatively few people infected. Retrospective surveys in San Francisco for a hepatitis-B vaccine reveal that the percentage of participants with antibodies for HIV rose from 4.5% in 1978 to almost 67% in 1984. The result of this unchecked spread was the hundred thousand American dead over the 1980s.
The world was lucky in that AIDS appeared at a time when the study of medicine had advanced to the point when HIV could be discovered, after Gallo had already discovered retroviruses and the basic workings of the immune system were known. Interviewers for the National Institute of Health's AIDS oral history project frequently asked their subjects what would have happened had AIDS appeared in 1955; almost uniformly, they responded that it would have been a disaster. As Charlie Stross wrote two years ago in a depressing discussion on the topic,
HIV would be characterised as being a virus fairly rapidly, but the mechanism by which it spreads would be a bit of a mystery. HIV is an RNA virus and relies on reverse transcriptase to transcribe itself into the DNA of the host cell; this is well-understood today, but actually violated what was previously called the Central Dogma of DNA -- that transcription happens from DNA to RNA to proteins, and never in the opposite direction.
[. . .] Most people don't have a feel for this, but progress in biochemistry and genetics since the 1950's roughly mirrors the level of progress in computing; there have been *immense* developments. For example, the immune system was barely understood back in the early 1950's; the idea of using tailored antibodies linked to a UV-fluourescent dye in a blood test for a specific virus would have sounded science fictional. You identified viruses by seeing if they killed cells -- that was about the limit of what was then do-able.
Worst of all, the incubation period of HIV is measured in years or even decades. Only a handful of people would show symptoms in the first few years; by the time it was clear that the incidence was climbing a sigmoid curve with a period measured in years, the first generation of carriers would have spread it far and wide through the blood donor service. By the time the true scope of the disaster was visible -- a decade later -- it would be Much Too Late to get away with anything less than many millions dead.
The discovery of the HIV viruses and the development of testing procedures from 1984 on, as
sandor_baci wrote, at least gave people a chance to discover whether or not they were infected. The introduction of AZT in 1987 introduced the first drug to deal directly with the HIV virus; the introduction of protease inhibitors from the mid-1990s on gave further hope. A vaccine for HIV is still far off; given the mutability of the HIV virus, it's unlikely that a virus providing complete protection will be engineered for the foreseeable future. Even so, things could have been much worse.You're not paranoid when they really are out to get you. HIV isn't an entity with a volition of its own, of course, but it is a virus that continues to spread rapidly. It isn't hypochondriacal to worry about becoming infected with AIDS when you belong to a demographic--non-heterosexual men, young southern Africans, users of IV drugs, people who don't engage in protected sex--that's disproportionally at risk of infection. It's only sensible.
And yet, despite two decades of fairly solid and continuous education about HIV and AIDS, the number of infections continue to grow. The epidemic in southern Africa, where more than one-fifth of the population is infected, is well known; I explained the endemic status of HIV infection in male GLBT communities in the First World above. What isn't as well known is that the former Soviet Union has some of the highest growth rates in HIV infections in the world, with more than 1.5 million Russians infected already and the epidemic beginning to spread beyond its core demographic, or that 5.1 million Indians and a million Chinese are infected. The sigmoid curves of infection continue to rise, even as national governments continue to fumble with creating programs to prevent infection, or courses of medical treatment for people already infected. Things seem particularly bad in Russia:
It's a battle that Nikolai Panchenko has been fighting for half his adult life. He wants to hear a Russian leader give a speech about HIV and AIDS.
Mr. Panchenko, one of the first 10 people to test positive for HIV in what was then the Soviet Union, was thrown into prison in 1987, shortly after his fateful blood test. The nation was terrified by homosexuality and the prospect of AIDS, and the government thought that if it could just make Mr. Panchenko and the others disappear, the virus would go away too.
He was fired from his job as a high-ranking officer on the Kaliningrad police force and spent four years in jail because his infection was considered a threat to the entire region. Mr. Panchenko's name and HIV-positive status were broadcast on state television, and his friends and family were forced to undergo humiliating blood tests.
The Kremlin's attitude toward the epidemic has changed since then, Mr. Panchenko says, but not enough. Now that Chinese Prime Minister Wen Jiabao has admitted his country is in the grip of an epidemic and made a televised visit to an AIDS ward to help raise awareness of the disease, Russian President Vladimir Putin stands almost alone among leaders whose countries are being hit hardest because he has never given a significant speech about AIDS.
Russia has an estimated one million people with HIV and AIDS (the official count is lower, at about 300,000) and the world's fastest-growing rate of infection. A study this year by the United Nations Development Program said the country is on "the edge of disaster" and forecast a nightmare scenario in which the disease spreads to 8 per cent of the population by 2045, killing 20.7 million Russians and wiping out 14 per cent of the country's gross domestic product.
Despite the fact he heads a country under siege by HIV-AIDS, Mr. Putin has only mentioned the disease in passing on a handful of occasions and never given a major address on the topic. There was no reference at all to HIV or AIDS in his state-of-the-nation speech in May, and he turned down a direct invitation from the organizers to attend last week's International AIDS Conference in Bangkok.
"I think that if Putin talked about it, it might really help the situation," said Mr. Panchenko, who's thin, blond and at age 51 is healthy aside from his HIV status. "But for some reason, he responds to this problem with silence."
It's a silence reflected in Russian government policy. There is only $5.3-million allotted in the federal budget for fighting HIV and AIDS, or just over $17 for every registered person infected with the virus. The AIDS portfolio is handled not by the federal health department, but by the consumer-protection agency.
[. . .]
[M]any doctors remain reluctant to give expensive anti-retroviral medicines to patients they view as drug abusers unlikely to be able to maintain the complicated regime associated with taking the drugs. Nationwide, only 1,500 Russians are receiving the medicine, which is distributed at prices even higher than in Canada, despite the fact Russia remains outside the World Trade Organization and could buy cheap generic copies of the drug if it chose.
The terrifying thing about HIV, which over the past three decades has emerged from obscurity to become one of the fastest-growing epidemic diseases, is that it's still being contracted. It isn't a moral issue, save inasmuch as governments and other organizations do little to either halt the spread of the infection or to provide effective treatment for those already infected. (Thabo Mbeki, stand up.) It's rather a matter of simple minor things--acts committed in ignorance, acts with consequences out of all seeming proportion--accumulating to produce a mass of horrors both individual and collective, and the vanishingly small likelihood that these horrors will come to an end. Or, at least, that they will come to as prompt as end as was enthusiastically predicted in the mid-1980s after the HIV virus was discovered, with effective vaccines and full cures in just a couple of years time.
In 1996, in response to the development of protease treatments, Andrew Sullivan proclaimed in an article for the New York Times Magazine that the AIDS epidemic was over. Eight years later, we're still waiting for that end to appear over the indefinitely receding horizon. In the meantime, there's nothing to do but be justifiably paranoid and careful, for anyone.
