SF DPH: Swiss HIV Study Must Be Evaluated;
Cocktails, Not Condoms
Yes, I was seated when I read the following quaking news in the new SF DPH study on HIV and other gay STDs are hyperendemic.
What rocks and shocks in this little sentence is a huge shift away from the 2008 official city and AIDS Inc position on the controversial recommendations of Swiss experts that HIV poz people on cocktails and with no detectable, or much-reduced viral loads, were highly unlikely and very near nil chance of passing on the virus.
From the DPH study, published in Sexually Transmitted Infections, page 5:
Whereas most prevention for positive interventions has focused on reducing risk behaviours, other outcomes, such as increasing treatment adherence to lower viral loads and thereby potentially reducing infectivity, should be evaluated from a community-wide prevention perspective.
Click here to read the Swiss recommendations of HIV treatment adherence, regular viral load testing, and prevention without condoms.
You'll recall that in February 2008, after the Swiss issued their recommendations, without a single public forum, the SF DPH, in collaboration with the SF AIDS Foundation, soundly rejected the Swiss document and pushed again for condom code adherence:
The San Francisco AIDS Foundation and San Francisco Department of Public Health urge individuals living with or without HIV infection to continue to use appropriate HIV prevention measures, specifically, to use male latex condoms correctly and consistently during sex. A recent Swiss AIDS Commission report demonstrating that, in some cases, HIV-positive partners did not transmit the virus to their partners in the absence of condoms, is insufficient evidence to abandon safer sex practices for several reasons.
A month later, Project Inform put out a statement on the Swiss study, treating it more seriously than the SF DPH and SFAF, and the good that came from the controversy upon the recommendations' release, but still endorsed the condom code for all sexual activities, they went a step further and issued a call for poz guys sleeping with poz guys to use condoms. How last century of them!
Project Inform encourages HIV-positive people to consider the use of condoms during intercourse with other HIV-positive people in order to avoid potential re-infection and, as importantly, to avoid receiving or transmitting sexually transmitted infections other than HIV during sexual intercourse.
Despite the 2008 fierce opposition of the AIDS mafia to conduct any public community discussion on the idea of using the serosorting phenomenon, widespread cocktail usage, emerging epidemiology and honestly about gay male sexual intimacy in the third decades of AIDS, our local DPH is now bypassing any call for community discussion on the Swiss experts basic contention, increasing treatment adherence to reduce infectivity, and calling for outright evaluation of the recommendations.
When do DPH and AIDS Inc plan to announce implementing the necessary programs to bring about more treatment adherence, and designs for proper evaluation?
I'd like to see San Francisco move from hyperendemic levels of HIV infections to decreases. The way to do that is better use of cocktails, and community engaged that respects the intimacy needs of people living with HIV/AIDS.
3 comments:
This business that HIV positive gay men need to use condoms with other HIV positive gay men is ridiculous. If that were dangerous, we would know by now -- actually, years ago. When public health officials say that all gay men should use condoms, even when in monogamous relationships where both partners are negative, they lose all credibility. We have to separate public health realities from Sex-Negative, homophobic politics. Serosorting can work to a certain degree, but mostly with poz-poz unprotected sex, rather than neg-neg, unless the partners have been tested together and are proven neg consistently. Gay men hate condoms, as most straight men AND women do. We need to develop alternatives that work for HIV prevention on a practical level for real-live, gay men. Why? Because the popularity and income generated by bareback porn reveals that the community demands it! And if the Swiss study is right, especially if we can extrapolate it from straight unprotected vaginal sex, to gay male anal sex, that news is waaay too good to suppress!
If gay men, for any reason, should accord themselves, or win for themselves, the social liberty to have condomless sex in the presence of HIV antibody, it would be hypocritical, indeed selfish, if they did not simultaneously fight for the rights of heterosexuals (primarily African American men) who are currently serving long prison sentences around the world for practicing unsafe sex in the presence of HIV antibodies. Ditto the mothers who, in the total absence of any evidence showing infectious levels of HIV in breastmilk, are nonetheless criminalized and persecuted, even losing custody of their children, because they declare their intent to breastfeed.
Who will fight for them?
My understanding of the literature is that infectious levels of HIV have never been found in seminal fluid, breast milk, or saliva.
There must be a community wide re-examination of the data pertaining to all forms of transmission, in the face of the ghastly blights upon civil liberties that have occurred as a result of superstitious, racist, and homo-phobic "science."
The Swiss Study has long been well known and accepted in Europe, with France being the only country to express any official cautions. French scientists have a poor track record of resolving any major health challenges, so they often try to compensate for their lack of accomplishment by expressing caution about what others have discovered. In the USA, our CDC and other policy makers have privately concurred with the information content disclosed by the scientists who authored the Swiss Study. However, unlike European officials, U.S. officials have concluded that the American public is not intellectually equipped to safely apply this information to their own real life decision-making process. For this reason, U.S. officials have instead decided to leverage the knowledge gained from the Swiss Study by applying it tactically to greatly increased outreach efforts and advertising campaigns that encourage at-risk populations to seek testing and treatment, because the U.S. officials now understand that effective treatment of HIV+ persons is the key to preventing the spread of HIV to the rest of the population. In fact, they are encouraging testing & treatment primarily for this reason, and only secondarily because of the actual health benefits to the HIV+ patient.
Shortly after the Swiss Study was released, the U.S. CDC quickly accelerated their HIV testing & treatment efforts to the increased level that we see being promoted today.
It is interesting that most gay men remain unaware that HIV medication is being pushed on them primarily as a CONTAINMENT STRATEGY to prevent the epidemic from spreading, rather than because of a primary and sincere concern only for the health of the HIV patient. The CDC is fully aware that putting them on medications is an effective substitute for condoms. The recent FDA approval of Truvada for prophylactic use in HIV-negative persons is an extension of this non-condom oriented containment strategy.
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