Tuesday, January 15, 2008

H.I.V. Rises Among Young Gay Men

AIDS appears to be making an alarming comeback. The Journal of the American Medical Association reports that the incidence of H.I.V. infection among gay men is shooting up, following an encouraging period of decline. The rise of infections among younger gay men, especially black and Hispanic men, is troubling, and the study carries the clear implication that people at high risk of contracting the disease are becoming less cautious.

Statistics gathered by New York City health officials show that new diagnoses of H.I.V. infection — the virus that causes AIDS — in gay men under age 30 rose 32 percent between 2001 and 2006. Among black and Hispanic men, the figure was 34 percent. Most troubling, the number of new diagnoses among the youngest men in the study, those between ages 13 and 19, doubled.
New York officials say increased alcohol and drug use may be partly responsible since they make unprotected sex more likely. Other basic precautions, including finding out whether a potential partner is infected, are also apparently being ignored.

The one bright spot in this bleak picture was the 22 percent decline in infections among men over 30 in the New York study. Awareness of the disease’s devastating effects, as much as maturity, may explain the difference. A large number of these older men came of age when AIDS was all but untreatable. They may have buried friends who died after being horribly ill.
When the disease was new and terrifying, the gay community helped change behavior by preaching loudly against taking sexual risks. From San Francisco to New York, bathhouses notorious for promoting casual sex changed the way they did business or closed down. Condoms were encouraged, and so was H.I.V. testing. “Silence equals death” was the motto of the day.

Silence now seems to be winning the day. Nearly 6,000 gay men died of AIDS in the United States in 2005; still, many young men appear to have persuaded themselves that the infection is no longer such a big deal. It is true that antiretroviral therapy has improved the outlook for anyone who becomes infected. But the treatments are still too new to know whether they can work much beyond a decade. Public health officials need to continue to distribute condoms, encourage testing and treat those who are ill. Leaders in the hardest-hit communities need to start speaking out again. The fight against AIDS is far from over.


Wednesday, January 9, 2008

Examining bathhouse policy, NYC says HIV infections up

Gay City News

An internal city health department memo addressed to Dr. Thomas Frieden, the commissioner, lays out options for dealing with sex clubs, and concedes that HIV infections are up among gay and bi men.

Health dept. memo suggests sex clubs could be closed with circumstantial evidence

After saying for years that new HIV infections among gay and bisexual men are high, but stable, a city health department memo given to Gay City News is asserting that new HIV infections among those men are increasing.

"New York City is now experiencing an increase in syphilis and an increase in HIV infection in men who have sex with men," Dr. Thomas Farley, a special advisor to Dr. Thomas R. Frieden, the city's health commissioner, wrote in the November 2007 memo.

The six-page memo, titled "Policy Regarding Bathhouses and Other Commercial Sex Venues in New York City," was drafted for Frieden and explores the options for dealing with sex clubs and bathhouses.

"In view of this increase it is appropriate to re-evaluate New York's current policies regarding commercial sex venues to see if policy changes could reduce the spread of these infections," wrote Farley, previously a professor and department chair at Tulane University's School of Public Health and Tropical Medicine.

While some gay and AIDS activists have said for some time that new HIV infections among gay men have increased, as far back as 2002, Frieden said that new infections in that group were stable. The health department has maintained that position since then and data it has released support that view.

In early 2007, the department released a four-year study showing that the estimated new infection rate among all groups in the city, except gay and bisexual men, had fallen with many showing significant declines.

In that study, roughly three percent of the gay men were newly infected in each year, posting the highest rate among all groups in the city, and that rate matched earlier city estimates dating back to 1993.

Farley, who has a medical degree and a masters degree in public health, was referring only to recent reported increases among men who have sex with men (MSM) under 30, Sara Markt, a deputy press secretary in the health department, wrote in an e-mail.

"The info about increases in infection applies to young MSM only (under 30), as previously announced," Markt wrote. "Infections are decreasing among older MSM."

The memo explores four options for dealing with the city's sex clubs and bathhouses.

At present, those businesses are subject to the same building, fire, and other codes that govern any business in the city. The only regulation that deals with the sex in these places is a state health code that bans oral, anal, and vaginal sex, with or without a condom, in "any place in which entry, membership, goods or services are purchased."

Since the code was written in 1985, the city has closed roughly 40 to 50 businesses that allowed such sex on their premises. The vast majority served gay and bisexual men. Frieden has dramatically increased the number of inspections for code violations since 2002 when he became health commissioner.

The first option spelled out in the Farley memo is to maintain the status quo - more inspections, warnings to those places that are found to violate the code, and close those businesses that do not respond to warnings.

The second option is to move more aggressively against the city's remaining bathhouses and make "greater efforts to close sex clubs and 'private sex parties' that have fixed locations, regular hours of operation, and charge a fee."

In prior closings, the city has typically used information from two or three dozen inspections and cited in excess of 100 violations per business to get a court order temporarily or permanently closing a club. Farley said that standard might not be necessary.

"It is the opinion of the General Counsel's office that we may be able to close sex parties based on circumstantial evidence (that is, without direct observation of sexual activity)," Farley wrote.

The closings are handled by the city's Corporation Counsel's office, essentially the city's law firm, and they may not agree. Markt wrote that the health department had not discussed these options with other city agencies.

The third option is to use the state code "to close all commercial sex venues, including bathhouses currently in operation," Farley wrote.

"Based on conversations with the General Counsel's office, it may be possible to gather sufficient evidence to close bathhouses as well as 'private sex parties' under this rule based on circumstantial evidence, that is, without direct observations of sexual activity," he wrote. "[T]his is likely to be challenged in court and will cause anger among gay activists and some AIDS service organizations. Many will argue that closing bathhouses will disperse men to other locations where sexual activity may be riskier."

The fourth option is to regulate these businesses. The state code would be changed to allow "bathhouses to operate under strict safe-sex rules, and allow 'private sex parties' to either become permitted bathhouses under these rules or risk closure as in option 2."

The city, under that option, would require these businesses to post and enforce safe sex rules, ban private areas, offer HIV testing, and allow the health department to make regular inspections and survey customers. Markt wrote that the department had not yet selected any option.

"[T]his document was an internal backgrounder about our current policy, what other cities do, and what the options could be if this policy was ever to be revised," she wrote. "We don't have any plans to change the policy at this point, just wanted to evaluate how NYC and other cities are dealing with the issue... [W]e are not making any moves to change or recommend changes at this point."

©GayCityNews 2008

Saturday, January 5, 2008

HIV Rates Up Among NYC Gays Under 30

For years he had numbed his pain and fear with drugs, alcohol and anonymous sex. But in a flash of clarity one day, when the crystal meth was wearing off, Javier Arriola dragged himself to a clinic to get an H.I.V. test, years after he stopped using condoms.

Javier Arriola considered suicide when he learned he had AIDS. Instead, he stopped using drugs and found new reasons to live.
He knew the answer before he received the results, but it was far worse than he thought: At age 29, he had full-blown AIDS.

He had planned to have a party for his 30th birthday. Instead he was thinking of hanging himself in his apartment in Hell’s Kitchen.

“There were feelings of terror, like when you were a little kid and there’s that thing that terrifies you,” he said. “This was it. The worst nightmare, and I brought this onto myself.”

The number of new H.I.V. infections in men under 30 who have sex with men has increased sharply in New York City in the last five years, particularly among blacks and Hispanics, even as AIDS deaths and overall H.I.V. infection rates in the city have steadily declined.

New figures from the city’s Department of Health and Mental Hygiene show that the annual number of new infections among black and Hispanic men who have sex with men rose 34 percent between 2001 and 2006, and rose for all men under 30 who have sex with men by 32 percent.

At a time when the number of new cases among older gay men is dropping — by 22 percent in New York City during the same period — AIDS experts are bearing down on what they say is a worrisome and perplexing growth of H.I.V. infection among young men like Mr. Arriola.

So far, they say, the significant factors feeding the trend appear to be higher rates of drug use among younger men, which can fuel dangerous sex practices, optimism among them that AIDS can be readily treated, and a growing stigma about H.I.V. among gays that keeps some men from revealing that they are infected. There has also been a substantial increase in the number of new infection cases among young white men who have sex with men, but still that group had fewer new cases in 2006: 100, compared with 228 among blacks and 165 among Hispanics.

The rising rates for young men in New York City come as federal health officials acknowledge that infection rates nationwide, while flat, may be substantially higher than previously thought because of underreporting.

The highest rates of H.I.V. infection nationally are among gays, blacks and Hispanics, with a recent trend toward a younger infected population mirroring New York City’s experience, according to AIDS researchers, who say they are concerned that the country’s infection rates over all have not declined in the past 10 years.

“It’s really unconscionable that we haven’t had a decrease in new infections in the past decade in the United States,” said Wafaa El-Sadr, chief of infectious diseases at Harlem Hospital Center and a professor of public health at Columbia University. “It’s not anymore in the headlines; many people think it’s gone away, and it hasn’t gone away.”

AIDS activists and medical providers say the rates among young men could signal a new wave of the disease.

“Unless you start pulling it apart, unless you start looking at really addressing this and talking honestly, unless you start talking about it in a real way,” said Soraya Elcock, deputy director for policy at Harlem United Community Aids Center, in a neighborhood that has one of the highest infection rates in the city, “we’ll be here in another 20 years having the same conversation.”

As a young, black gay man, Lynonell Edmonds says it seems like a miracle that he has not contracted the AIDS virus. Before he turned 20, he had a haunting realization: in his group of 20 close gay friends, he was the only one without H.I.V.

Mr. Edmonds, now 25, does outreach work for the Harlem AIDS center, trolling Craigslist and other online meeting spots as a “sexpert,” encouraging men to be tested. He and a crew of outreach workers also go to gay nightclubs late at night, with a van carrying H.I.V. tests that can be conducted on the spot. The crew parks the van, which has no obvious signs of its mission, on the street. When they go into the clubs, they make conversation and delicately inquire whether a clubgoer would like to take the test.

Mr. Edmonds said that for many gay black men there is a sense that getting the virus is almost inevitable.

“A lot of guys say, ‘I’m going to get it anyway,’” Mr. Edmonds said.

Mr. Edmonds and other gay men say the stigma of being infected with H.I.V. is growing, and may be greater now than it was in the 1990s, when the AIDS epidemic became a unifying cause, a shared tragedy for gay men.

“I call it, ‘Don’t ask, don’t tell,’” Mr. Edmonds said. “People are not asking — it’s like it’s an offensive question.”

Kyle, who found out that he had the virus two years ago, at the age of 23, said he had grown weary of what he called “pity dates,” men who agreed to go out with him after he revealed he was infected, but had no intention of pursuing a relationship. He said that out of about 10 men he had dated in the last two years, only one — who was, at 40, the oldest — was willing to go beyond pity dates.

“They blame you and want nothing to do with you; they put you at the end of the line,” said Kyle, who spoke on the condition that his last name not be used because he said he believed his condition would hurt him professionally. “The older generation sees AIDS as a tragedy, the younger generation sees it as self-destructive behavior.”

He said he was infected by someone who did not reveal that he had the virus until after they had unprotected sex.

For Mr. Arriola, who struggled with being molested as a child, the H.I.V. diagnosis put him at rock bottom, he said.

He continued to use drugs for several more months, but then, as his suicide plan was becoming an obsession, he called a friend who was a recovering addict. He got clean and sober, joined a 12-step group, started going to therapy and has slowly pieced his life back together.

“For me today, I’ve done a lot of work to accept myself. I don’t drink and drug, I meditate, there’s a lot of visualization of the person I want to be,” he said. “A lot of it is acceptance. I’m 32, I’m Latin, I’m gay and I have H.I.V. And I don’t feel bad about it. It’s very, very important for me to not feel shame about this.”

As the face of the epidemic grows younger, city health officials acknowledge that their efforts — including a widespread condom distribution program, new investments in education programs at places including churches, and more availability of H.I.V. testing — are falling short.

“It leaves us a little bit scratching our heads: What is it that is going on?” said Christine C. Quinn, the City Council speaker. “Something clearly is not working, and it’s literally about life or death.”

The city, which has the highest number of AIDS cases in the nation, about 100,000, and one of the highest H.I.V. infection rates, according to the health department, has made great strides in bringing down H.I.V. rates among intravenous drug users and pregnant women. The department, which is giving out three million condoms a month in a program begun last year, has also recently announced several efforts to expand rapid testing, which provides results within a day.

The city’s health commissioner, Thomas R. Frieden, said in an interview that the increasing rates among younger men was being driven by stubbornly high rates of substance abuse, involving drugs like crystal methamphetamine and cocaine, which not only reduce inhibitions but can also lead to “hypersexuality”: extended periods of sexual activity, potentially with multiple partners.

Dr. Frieden also said that another likely explanation was “treatment optimism,” and the many messages gay men receive through AIDS drug advertisements that people like Mr. Arriola can live long and normal lives.

“People who grew up watching their friends die of AIDS are a lot more careful than those who didn’t,” said Dr. Frieden, who said he cared for large numbers of AIDS patients in his earlier medical practice.

He said the department was planning to begin a new H.I.V. prevention campaign aimed at younger men, and a new marketing strategy for their condom campaign later this year. “When’s the last time we saw someone with lesions walking through Chelsea and Hell’s Kitchen?” said Victoria Sharp, director of the Center for Comprehensive Care, which is currently providing medical care and other services to 3,000 H.I.V. patients at Roosevelt Hospital and in Harlem. “You don’t see it, and we haven’t seen it since the mid-1990s, so there is a whole generation or two who have grown up without seeing the physical manifestations.”

Health officials said they were also concerned about the growing number of patients receiving concurrent diagnoses of both H.I.V. and AIDS, after waiting too long to be tested. And while some policymakers say more aggressive testing could partly explain the higher infection rates, experts say one in four people with H.I.V. do not know they are infected, so the actual rates could be much higher.

Since receiving the AIDS diagnosis, Mr. Arriola, now 32, has developed a large group of sober friends, become a licensed real estate broker, repainted his apartment — all things that seemed impossible to imagine in the darkness of his drug use and when he learned he had the disease.

Then, he said he would look in the mirror and see the worthless person he believed he was. “I won’t make it to 35,” he would say.

But these days, with the antiviral drugs he takes, about five pills a day, his health is good, he said. Around his apartment, he has posted upbeat messages to himself, like the one on his mirror, where he has written “thank you.”

On the refrigerator he has a list of goals: “Write a book, own New York City property, spread love, own a business (20 million), get a college degree, run a triathlon, have a family (partner, car with driver and kids) and 190 pounds (muscle).”

Source: NY Times

Tuesday, December 4, 2007

Health watchdog warns of UK sexual health crisis

“The UK has one of the highest rates of HIV infection in Europe largely due to a growing epidemic of the disease in the black African community and among gay men, the Health Protection Agency (HPA) warned today.”

“The findings came as a separate report found that the UK had one of the highest rates of new HIV infections in Europe last year.”

“The report by the European Centre for Disease Prevention and Control (ECDC) found the UK HIV infection rate was more than double the European Union average - almost 149 cases per million inhabitants compared with an EU average of 67 cases per million.”

“The ECDC found that HIV/Aids cases in Europe have doubled in six years, bucking the trend elsewhere in the world where infection rates have fallen.”

“The HPA, which monitors infectious diseases in the UK, also raised concern about the "disturbing" rise in HIV among gay men. “

“There were 2,700 new cases of HIV in this group last year, breaking the previous record high of 2,650 set in 2005. There were 31,100 gay men living with HIV in the UK last year - more than 40% of the total number of people infected, which is 73,000.”

“Rates of other STIs in gay men have also risen dramatically in recent years, which the HPA blamed on a growing failure among this group to practise safer sex.

Dr Valerie Delpech, the head of HIV surveillance at the HPA, said: "In recent years we have seen steady increases in all sexually transmitted infections, including HIV, in gay men and since 2003, the number of HIV diagnoses reported annually has consistently increased and exceeded the annual number of diagnoses throughout the 1980s and 1990s."

Professor Pete Borriello, the director of the HPA's centre for infections, said it was imperative to get across the importance of practising safer sex, particularly among high-risk groups such as gay men and young adults.

He said: "We recommend that gay men should have regular HIV tests, STI clinic attendees should be tested for HIV at every visit and young sexually active adults should be screened for chlamydia annually and after a partner change.

"We need to reinforce the safe sex message for gay men, young adults and the broader community. The best way to protect yourself from contracting an STI including HIV is by practising safer sex by using a condom with all new and casual partners."


Monday, December 3, 2007

Bareback model seeks legal action over HIV infection

"One of three young men who was infected with HIV during a bareback porn shoot is seeking legal advice to make a claim of negligence against the film’s producers, write Karl Riley and Paul Steinberg.

The film, entitled British Bareback Vacation, was released on DVD last week by Load XXX Films, and is now available for purchase through numerous online adult shopping sites. Craig* told Boyz that he was outraged that the company had released the film, the production of which resulted in three new cases of HIV, as we exclusively reported last month. Since then, the story has been picked up by gay media across the world.

After a difficult few months trying to come to terms with his HIV status, Craig has now begun to explore the options available to prevent such a tragedy occurring again. ‘It makes me feel sick that the DVD is on sale,’ said Craig. He told us that he hoped any potential legal action might prevent other young people from experiencing the same fate.

In an interview with Boyz, Craig, who has learning difficulties, told us: ‘My doctor told me to just concentrate on getting back on my feet first before I started looking into it. I’ve been suicidal and cut [myself]. I felt so dirty. I now feel that I’m 100% committed to stopping other models becoming infected with HIV’.

The background to the case has become clearer since Boyz first reported the story in October. Several weeks after the filming of British Bareback Vacation, many of the same models were involved in the filming of a new production in a field in Kent. That same day, one of the original models from the first film also tested positive for HIV.

After contacting the production company to inform them of this result, the director rushed the other models to take HIV tests at an NHS sexual health clinic on the outskirts of London that evening, where they were also given PEP (Post-Exposure Prophylaxis). The next day, Craig’s HIV test came back positive. Some members of the cast tested negative. The three boys who tested positive were urged to continue to take the medication. PEP is only believed to be effective if used up to 72 hours after exposure to HIV. The producers have confirmed that they believe Craig was actually infected on the first film shoot.

After his diagnosis with HIV, Craig had accepted support and guidance from the production company, Ikandi, and its director, Adam Bailey. ‘I had no one to turn to other than Ikandi because I felt so ashamed telling my family I was doing porn. I was so frightened about what was going to happen’. Soon after, and against Ikandi’s advice, Craig told his family and moved away from relying on the company for support. ‘I felt they were looking out for themselves. When I was in hospital feeling suicidal, he told me that I had to check myself out straight away’.

Bailey has strongly refuted this claim. He told Boyz: ‘I didn’t know he was suicidal, he was saying how much he hated it in hospital and I knew that his state was always better when he was with us’. Bailey added that he had suggested to Craig that it might not necessarily be wise to rush into telling his family in case their response made the situation worse.

Looking back at his involvement in the summer porn shoot, Craig expressed his regret at becoming involved in the industry on the recommendation of a friend. What started out as a so-called ‘interview’, ended up as a hardcore bareback threesome with the cameras rolling. ‘I should’ve known from the start. It was just meant to be a solo to see how I was in front of the camera, but Adam Bailey said to me, “Do you mind if I throw you in at the deep end and put you into a three-way?” I had tested negative for HIV before but had left the certificate at the hospital. They just took my word for it and we shot the scene. I could’ve put the other models at risk.’

After moving back to his parents house, Craig saw his family doctor who told him to stop taking the PEP medication: ‘She just couldn’t understand why I’d been given it. I was so ill, I had to stop it’.

At this stage, no litigation has been commenced, although a prominent legal firm is currently exploring the possibility. It is also understood that a BBC news team is also investigating the story. On its website, Load XXX films promotes the DVD with the statement:
‘Pack your bags and join these bright young things as they set off on a British Bareback Vacation - where the only protection they will need is factor 50!’ Craig is clear that there was nothing to protect him from HIV."


Wednesday, November 28, 2007

Lack of HIV Prevention Efforts Among MSM

Lack of HIV Prevention Efforts Among MSM Fueling Increase in New Diagnoses, JAMA Commentary Says
[Nov 28, 2007]
A lack of HIV prevention efforts and an increase in risky sexual behaviors among men who have sex with men are fueling an increase in new HIV diagnoses among the group, Kevin De Cock, director of the World Health Organization's HIV/AIDS Department; Ronald Valdiserri of the U.S. Department of Veterans Affairs; and Harold Jaffe, a public health professor at the University of Oxford, write in a commentary in the Nov. 28 issue of the Journal of the American Medical Association, the Washington Times reports.

According to the commentary, the number of HIV/AIDS cases among U.S. MSM increased by 13% -- from 16,167 to 18,296 -- between 2001 and 2005. Syphilis cases also increased 10-fold among MSM (Wetzstein, Washington Times, 11/28). In addition, recent surveys have found an increase in risky sexual behavior among MSM who do not know their partners' HIV status, the authors write (Jaffe et al., JAMA, 11/28).

According to the authors, a lack of awareness about HIV and a decrease in HIV prevention efforts are fueling the increase. HIV/AIDS is "not as frightening as it was" when the epidemic first surfaced because antiretroviral drugs have allowed HIV-positive people to live longer, the authors write. In addition, younger MSM are unfamiliar with the effects of HIV among U.S. MSM in the 1980s, the commentary says.

The authors called on public health and community leaders to increase HIV prevention efforts and education about safer-sex behaviors to help curb the spread of the virus. Leaders also "must call for the end of stigma toward MSM, which may mitigate the internalization of homophobia leading to sexual risk behavior," the authors write. They add that leaders also should "advocate for legal domestic partnerships as a way to promote stable, longer-term" relationships among MSM (Washington Times, 11/28). In addition, HIV testing rates among MSM should be increased because many members of the group are not aware of their HIV status, the authors write. "Failure to address" issues such as testing, funding for public health strategies and community leadership "implies that the HIV/AIDS epidemic in MSM must be accepted as inevitable," the authors write, concluding that "this cannot be allowed to happen. The tragedy of the epidemic for an earlier generation of MSM must not be repeated" (JAMA, 11/28).