Bill Weintraub

Rare and Aggressive H.I.V. Reported in New York

Rare and Aggressive H.I.V. Reported in New York

2-12-2005

Rare and Aggressive H.I.V. Reported in New York

By MARC SANTORA and LAWRENCE K. ALTMAN

The New York Times

Published: February 12, 2005

A rare strain of H.I.V. that is highly resistant to virtually all anti-retroviral drugs and appears to lead to the rapid onset of AIDS was detected in a New York City man last week, city health officials announced on Friday.

It was the first time a strain of H.I.V. had been found that both showed resistance to multiple drugs and led to AIDS so quickly, the officials said. While the extent of the disease's spread is unknown, officials called a news conference to say that the situation is alarming.

"We consider this a major potential problem," said Dr. Thomas R. Frieden, the commissioner of the New York City Department of Health and Mental Hygiene. The department issued an alert to all hospitals and doctors in the city to test all newly detected H.I.V. cases for evidence of the rare strain.

The virus was found in a New York City man in his mid-40's who engaged in unprotected anal sex with other men on multiple occasions while he was using crystal methamphetamine. Health officials have long said that the drug's stimulating effect and erasure of inhibitions contributes to sex marathons that have increased the spread of H.I.V.

The man, whose name was not released to protect his privacy, is believed to have had unprotected sex with hundreds of partners, according to one person briefed on the case who insisted on anonymity because the investigation is continuing.

Some AIDS specialists outside New York City expressed skepticism about the alarm, believing that it might be an isolated case related to the patient's immune system. But Dr. Frieden said the case heightened the importance of using condoms.

"This case is a wake-up call," Dr. Frieden said. "First, it's a wake-up call to men who have sex with men, particularly those who may use crystal methamphetamine. Not only are we seeing syphilis and a rare sexually transmitted disease - lymphogranuloma venereum - among these men. Now we've identified this strain of H.I.V. that is difficult or impossible to treat and which appears to progress rapidly to AIDS."

While H.I.V. strains that are resistant to some anti-retroviral drugs have been on the rise in recent years, both in New York City and nationally, city and federal officials said that the new case was worrisome for several reasons.

The viral strain in the unnamed patient was resistant to three of the four classes of drugs used to treat H.I.V. from the start of treatment. Typically, drug resistance occurs after a patient is treated with retroviral drugs, often because the patient veers from the prescribed course. And more often than not, a person is resistant to only one or two classes of drugs.

But in this case, the drug resistance is combined with a rapid transformation into AIDS. Both of those phenomena have been seen before, but are not believed to have occurred together.

"What's unique about this is the combination of multiple drug resistance and a rapid course," said Dr. Ronald O. Valdiserri, the director of H.I.V./AIDS prevention at the Centers for Disease Control. "To folks in the public health community, that is a particularly dangerous combination." He said that while it was an isolated case at this time, the C.D.C. had informed other health departments around the country out of concern.

Dr. David Ho, the director of the Aaron Diamond AIDS Research Center, which did the testing that identified the rare strain, described the convergence of the two problems as "a scary phenomenon."

But not everyone agreed. Dr. Robert C. Gallo, a co-discoverer of the AIDS virus and director of the Institute of Human Virology at the University of Maryland, was very skeptical of yesterday's announcement.

"My guess is that this is much ado about nothing," he said. "Though it's prudent to follow it, I don't think it's necessary to issue a warning or alert the press."

Dr. Gallo said that it was well known that some patients progressed from initial infection to AIDS very rapidly, but that it was usually because they were highly susceptible, not because the virus was virulent. He said that this case, in which the virus is drug-resistant and the progression rapid, was rare but not necessarily alarming.

Dr. John P. Moore, an AIDS researcher at Cornell University's Medical School, agreed.

"If there was a cluster of these, that would be different," he said. "But I wouldn't get bent out of shape about what is literally an anecdotal case right now."

The limited epidemiological investigation in this case shows that the patient could have developed AIDS in as little as 2 months, but that it might have taken as long as 10, Dr. Frieden said. On average, it takes 10 years from the time a person is first infected with H.I.V. for AIDS to develop. But it can take only months for some people, and 20 years for others.

At the news conference in Lower Manhattan, Dr. Frieden was joined by nearly a dozen AIDS experts and community leaders. Several participants said they were experiencing the same worried feeling they had more than two decades ago, when AIDS first appeared and there was no treatment.

Health officials cautioned that the emergence of the rare strain did not mean that people who are currently responding well to H.I.V./AIDS treatment needed further testing, unless ordered by a physician. They did warn, however, that people with H.I.V./AIDS could be re-infected with a different and more dangerous strain if they practiced unprotected sex.

More tests need to be completed before it is clear if any combination of drugs can effectively treat this strain of the virus, but Dr. Frieden said that therapy now appeared to be extremely difficult.

The man is currently receiving a cocktail of drugs, including one, Enfuvirtide, that is believed to be effective. Doctors cautioned, however, that single-drug therapy was rarely effective against AIDS in the long term.

From the moment the Health Department learned about this case on Jan. 22, its scientists have been studying complex laboratory tests to decipher the patterns of resistance, and epidemiologists have tried to trace the man's sexual partners and notify them of the potential risk.

In May 2003, the man tested negative for H.I.V., health officials said. Investigators believe he contracted H.I.V. in October 2004, when he engaged in unprotected anal sex with multiple partners while using crystal methamphetamine. The man found some of his partners on an Internet Web site, officials said, though they would not identify the site. Health officials said they were working with those who used the Web site to reach as many people as possible who might have been infected or are worried that they could have been.

Dr. Frieden said in an interview that it was probable that the man had sex with someone who had a strain of H.I.V. that was resistant to multiple drugs.

"Whoever gave it to him most likely did not have sex only with him," Dr. Frieden said.

Health officials became aware of the situation after the man began to feel sick in late November and the next month went to see his doctor, who had him get an H.I.V. test. The test came back positive in December. By January, the H.I.V. had progressed to AIDS.

The man's doctor referred him to the Aaron Diamond AIDS Research Center in Manhattan, where for many years Dr. Martin Markowitz has been conducting a study of patients in the earliest stages of H.I.V.

The Health Department asked doctors to be alert for patients experiencing flulike symptoms who had engaged in high-risk sexual activity. Such symptoms might indicate acute retroviral syndrome, indicating a need for H.I.V. testing

In fact, Dr. Frieden said, all people with newly diagnosed H.I.V. should be tested to see if the strain is drug resistant. But the tests are complex and expensive. Dr. Frieden asked physicians to report any case in which a strain is resistant to three classes of drugs.

Dr. James Braun, the president of the Physicians Research Network, a nonprofit organization formed in 1990 to serve clinicians who treat tens of thousands of AIDS patients, said doctors have been worried for some time about something like this.

"We believe that the transmission of treatment-resistant H.I.V. was a disaster waiting to happen, particularly in communities where safer sex is not practiced regularly and in light of people using drugs like crystal meth," Dr. Braun said. "All primary care providers in acute care settings need to know how to diagnose H.I.V. in its earliest stages and where to refer people so that new infections are properly worked up and treated."

Health officials have been worried for some time that city residents, particularly gay men, are growing lax in their attitudes about sex practices, lulled into complacency by the success of antiviral drugs. In the past four years, the number of new syphilis cases in the city has slowly increased, with gay men accounting for most of them. Only 45 percent of gay men surveyed by the Health Department in 2003 said they used a condom during sex.

An estimated 88,000 New Yorkers have H.I.V./AIDS, and health officials estimate that another 20,000 people are infected but do not know their status. The officials urged all New Yorkers who are sexually active to check on their H.I.V. status.

"Risky behavior may be even more dangerous now, since there is a chance of infection with a virus we may not be able to treat," said Dr. Jay Dobkin, director of the AIDS Program at Columbia University Medical Center.

Donald G. McNeil Jr. contributed reporting for this article.

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RISKS

Rare Strain of H.I.V. Raises Fear of a Resurgence in AIDS Cases

By NICHOLAS CONFESSORE

The New York Times

Published: February 12, 2005

An old fear returned yesterday to those fighting the spread of AIDS among gay men: fear itself.

For a decade, AIDS educators and activists have been fighting the growing complacency among gay men about the risks of unprotected sex, complacency fueled by medications that have drastically reduced the death rate of those infected; by the use of the Internet to enable casual sex; by the growing popularity of inhibition-lowering recreational drugs; and by the sheer emotional fatigue of those who had grown tired of confronting death.

But yesterday's announcement that a New York City man had contracted - and possibly spread - a deadly rare strain of fast-developing and drug-resistant H.I.V. may have the potential to change perceptions yet again.

"There's a growing perception that H.I.V. is a chronic and manageable disease, and so there's less fear of it," said Jay Laudato, executive director of the Callen-Lorde Community Health Center in Manhattan. "If anything, the case today should remind us how fearful we should be."

Other AIDS activists echoed his sentiment. "For the last 10 years," said Ana Oliveira, executive director of Gay Men's Health Crisis, "it's been challenging to create relevant and attractive ways to talk to the gay and bisexually active community about affirming life, preventing H.I.V., in ways that are not old. The dialogue just got more complicated."

According to a 2003 survey of sexually active New Yorkers by the city's Department of Health and Mental Hygiene, only 45 percent of men who had sex with men reported using condoms, though they were three times more likely to have risk factors associated with contracting H.I.V. than sexually active New Yorkers as a whole.

"There's a lot of evidence that gay men have backed away from safe sex practices. And as a nation, both gay men and the rest of us have become much more complacent about AIDS," said Dr. Thomas Farley, an expert in community health at the Tulane University School of Public Health and Tropical Medicine. "That sets us up for new sexually transmitted infections to emerge, and for any old ones to re-emerge."

The rare drug-resistant strain poses a particular challenge for activists serving groups in which contracting H.I.V. carries with it a much greater stigma than it does among openly gay men, leading people to avoid even being tested for the virus.

"The African-American and African immigrant communities that we serve are less likely to utilize H.I.V. testing than the gay community and less likely, therefore, to know their H.I.V. status," said Kim Nichols, co-executive director of the African Services Committee. "One of the hooks we've been using to get people to learn their H.I.V. status is the availability of effective H.I.V. treatment. So if this recent phenomenon calls into question the effectiveness of that treatment, it's a disincentive for learning one's H.I.V. status."

Among health experts focusing on the gay population, it is the combination of recreational drug use - the chief culprit is crystal methamphetamine, which has steadily gained in popularity among gay men since the 1990's - and the Internet that until now has provoked the most worry.

Web sites like gaydar dot com, manhunt dot net and chat rooms on America Online make "hooking up," as it is known, much easier than before. The drugs lower users' inhibitions against unprotected sex and encourage promiscuous behavior. Indeed, crystal meth users surfing the sites will often flag their drug habit with the tagline "PNP," short for "party and play."

Dr. Perry N. Halkitis, a psychologist at New York University is who studying the relationship between crystal meth use and H.I.V. infection in gay men, said he believes that the Internet also makes it much easier for like-minded partners to connect, compounding the spread of H.I.V. "If you think of the traditional way that guys meet each other in bars, there are social norms," he said. "But when you're home alone, potentially getting high by yourself, those social norms go out the window."

Some AIDS activists stressed that they were waiting for more information about the rare strain before making definitive pronouncements about its impact. Walter Armstrong, the editor in chief of Poz, a magazine about AIDS and H.I.V., said he was not entirely convinced that the alarm sounded yesterday by health officials was warranted. "A handful of cases does not an epidemic make," he said.

[Walter Armstrong -- the Marie Antoinette of AIDS. If there's a stupider person on this earth, I'd hate to meet him.]

But Dr. Halkitis and other researchers who have long predicted the outbreak of a so-called supervirus that resists the existing crop of drugs believed there was ample cause for worry. "This is what we were fearing all along," he said.

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Bill G

Re: Rare and Aggressive H.I.V. Reported in New York

2-12-2005

This is a really frightening though not unexpected development.

Frightening because anyone with half a brain could stop the spread of this and other STD's but I guess 45% of people are just too stupid.

Frightening because now after over 2 decades of work on drugs that can help, that effort is set back who knows how far.

But to me the most frightening thing is that there are still people(if you can call them that) that willingly infect others. Or those that could inform or promote a safer way, refuse to even acknowledge there are alternatives to anal sex. Instead the try to stifle people like Bill W.

Bill G

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Bill Weintraub

Re: Rare and Aggressive H.I.V. Reported in New York

2-19-2005

Thank you Bill G.

As I noted in a previous post, the great mythographer Joseph Campbell once said that gods denied become demons.

I would say something similar of masculinity.

That to deny one's manhood is to do deep and often irrevocable damage to oneself.

The result among anally-passive gay men has been a literal orgy of suicidal behavior.

The virus was found in a New York City man in his mid-40's who engaged in unprotected anal sex with other men on multiple occasions while he was using crystal methamphetamine. Health officials have long said that the drug's stimulating effect and erasure of inhibitions contributes to sex marathons that have increased the spread of H.I.V.

The man, whose name was not released to protect his privacy, is believed to have had unprotected sex with hundreds of partners ...

I repeat: a literal orgy of suicidal behavior.

The emergence of new, drug-resistant and ever more lethal strains of HIV has long been expected.

See, for example, the July 2004 post AIDS Inc. Cashes In.

It bears re-reading.

Because it points out that the development of these strains is a logical and predictable consequence of the failed strategy of relying on condoms while refusing to address the behaviors which actually spread the disease.

In the case of gay men, anal penetration and promiscuity.

We address those behaviors; and for so doing, we've been stifled and censored.

Yet what's the truth?

This man was barebacking with 100s of partners while on drugs.

The analists will tell you that he was "depressed" and has a "substance abuse problem" and that societal homophobia is to blame.

Is it?

This guy doesn't live in the Bible Belt or in James Dobson's living room or Jerry Falwell's backyard.

He lives in New York -- aka Sin City -- where not one but two Republican mayors, Rudolf Guiliani and Michael Bloomberg, have boasted of their many gay friends and their support for gay marriage.

And he's in his mid-40s.

He's had more than enough time to rid himself of childhood homophobia.

Analist theory says that patriarchy is the problem, and that once we're free of our masculinist Old Testament assumptions, we'll all be happily versatile, able to give or receive with the greatest aplomb.

The analists and the gender feminists and the multipartnered pansexualists are all wrong about that.

The reality is that human beings are sexually dimorphic, not just physically but behaviorally.

And that it's degrading and destructive for a man to be penetrated not because of the patriarchy, which has been in full retreat for more than a century, but because he's a man.

What we say about anal is true and true on its face:

Anal penetration is dirty because it's dirty: it requires direct contact with feces, a violation of the most basic hygiene human beings know and which we're taught as children.

Anal penetration is dangerous because it's dangerous: the anatomy and physiology of the anus make it extraordinarily vulnerable to disease and mechanical damage when penetrated.

And anal penetration is degrading because it's degrading: It is, for reasons of our most fundamental male biology and psychology, our psychobiology, degrading for a man to be passive and to be penetrated during sex.

During sex, the male must be able to be erect and must be capable of phallic thrusting.

That's not possible for a man who's anally penetrated.

Analist mythology claims that "the bottom's really in control."

Nonsense.

By virtue of anatomy alone, once penetrated, a man is helpless and completely at the mercy of the penetrative partner.

Which is how and why guys get raped.

Allowing another man to penetrate you anally puts you at his mercy -- utterly.

Penetrating another man anally puts him at your mercy -- utterly.

Which is also why anal is not about sex but about dominance and control.

As Warrior Gene says, "There's no male connection, no bond, just raw lust. It's not sex or love, it's violence and power. The problem is implied in the politically-coerced masculine/feminine roles."

Those masculine/feminine butch/femme butch/bitch top/bottom roles are indeed politically and ideologically coerced.

Coerced by the gender feminists, who detest masculinity and believe emasculization is a social good.

Coerced by the multipartnered pansexualists, who hale each new sexual depravity as a "victory" for human liberation.

And coerced by the analists themselves, who revel in perversity and extol sodomy as the truest expression of male homosexuality.

They're wrong.

Homosex is an expression of the love shared by two men.

Yet once a man has been penetrated, he is in a fundamental way no longer a man.

For the reality is that a man cannot be passive, cannot choose that feminine role without severe damage to his masculinity.

To retain control of his sexual destiny, a man must either be penetrating, or be rubbing cocks: phallically thrusting his cock against that of another phallically thrusting man.

That's what cockrub is:

Mutual, connected, phallic thrusting.

Phallic thrusting is core to male sexuality.

Phallic thrusting is core to masculinity.

Strip that from a man, and you strip him of his manhood.

Coerce a man, and you strip him of his manhood.

Penetrate a man, and you strip him of his manhood.

There is no coercion in Frot.

There is no penetration in Frot.

Frot is mutual phallic thrusting, and that's what makes it at once so intense, so passionate, and so uniquely male.

You can have athletic, strenuous, sweaty sex with a woman, but you can't frot with her because she doesn't have a penis, and ultimately, you will penetrate her.

Only two men can Frot.

Frot is unique in celebrating the mutual, equal, and shared masculinity of two naturally aggressive and phallically thrusting men.

Nothing is more intense or more male.

And it is for saying so that we've been censored and silenced.

Because our words are a rebuke to the past 20 years of "safer-sex," which have given us rising infection rates and new and ever more lethal strains of HIV.

Yet we alone have a credible explanation for why the patient zero of this new strain was doing what he was doing.

No one else does.

Barebacking and bug-chasing have several roots:

One is the incessant and unending pro-anal propaganda, which tells men that sex without anal is not intimate and not real.

Another is the constant reminders from the AIDS Service Organizations to "use a condom every time you have anal or vaginal sexual intercourse," which reinforce the notion that anal and vaginal are comparable, when in point of fact, they couldn't be more different.

But the third is the search for male-male intimacy through a mode of "sex" which destroys any possibility of true intimacy by destroying the manhood of the anally-receptive partner.

Every time his masculinity is weakened by being penetrated, he becomes even more desperate to restore it through another act of penetration, which then weakens it further.

He then resorts to drugs to mask the pyschic and physical pain which penetration engenders.

Until he's caught in a vicious, body and soul destroying cycle of substance abuse and abusive sodomy, of mind-numbing chemicals and empty, body-destructive, sex.

Yesterday Joel and I were discussing the Shadow, the great Swiss psychoanalyst Carl Jung's term for that place of darkness where forces lurk which seek to do humanity physical and spiritual harm.

In the mid 70s, the analists created the backroom bar, a place of utter darkness where men went to penetrate and get penetrated by other men they literally could not see, and where HIV, which hates oxygen and is destroyed by sunlight, flourished.

Literally hundreds of thousands of men were infected in the gloom of the back-room bars and murky air of the bath-houses.

Now the bugchasers have created another shadow world of bareback parties and raves, places where one strain of virus can easily and readily exchange genetic information with another, and thus mutate into ever more lethal forms.

There's not much we can do about this, other than to continue to build our regional chapters, to get the word out to as many men as we can, and to be there when those who survive the analist madness are themselves ready to emerge from the shadows, come in out of the cold, and experience the fresh air and life-bestowing sunlight of the warrior ethos and true man2man love.

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