Friday, November 06, 2009

Viral Load by Neighborhood

The Bay Area section of today's New York Times has a fascinating article by Carol Pogash about the local health department using HIV viral load mapping to ask some important new questions about using new technology to better help people with AIDS and the larger communities in which we live. Full disclosure: I'm quoted, but that is not the only reason why I say the piece is fascinating. ;-)

The HIV research under discussion could potentially become a valuable tool both for treatment and prevention protocols. From the Times:

[A shaded DPH map] shows where the sickest AIDS patients live. Many are untreated. The map is the product of a groundbreaking effort to identify where care should be focused.

The research combines medical records and epidemiological tools to show the intensity of the illness, measured by individual’s viral load, the number of viral particles in a patient’s bloodstream. [...]

Using the data of individuals’ viral load levels, the city can track where the virus is circulating and focus attention on the deepest reservoirs of H.I.V. Successful anti-retroviral treatment reduces the load in an individual so it is undetectable in the blood. The less virus in the blood, the lower the chance of infecting others.

There is good and bad news, isn't this always the case with anything to do with HIV?, showing up in data. One example:

[Researcher and DPH head of HIV prevention] Dr. Colfax worries about disparities both in viral load and in care. The Castro, for example, has more H.I.V. cases, but individuals in lower-income neighborhoods tend to have higher viral loads, the new research shows.

It's a positive step that the people with AIDS in the gay Castro district tend to have lower viral loads, but that should be replicated in all areas of the city. Much truth-telling comes from the leader of a person of color HIV org, Jimmy Loyce, who I always liked when he was head of the DPH AIDS Office many years ago:

The results of the mapping were not surprising to James Loyce, executive director of Black Coalition on AIDS in San Francisco. [...]

Historically, he said, sections like Potrero Hill have felt “benign neglect,” suspecting that services were geared to the Castro, where more H.I.V.-infected people in the city live. [...] The sickest people of color, he said, have many issues: violence, heart disease, diabetes, obesity and the perceived stigma of homosexuality.

Good for Jimmy, bringing in a larger context to black people and AIDS issues. For local activist color, the Times turned to me:

Michael Petrelis, an AIDS blogger and self-proclaimed provocateur, said, “It’s feeding two birds with one seed, helping a patient extend his life by keeping his viral load down, and that in turn makes him less infectious.”

And summing it all up, rather well, I think, is the lead researcher:

Dr. Colfax must balance individual and communal care. “I think we’re asking the right questions,” he said. “Now the issue is, What are the answers?”

FYI, the reporter, Carol Pogash, is a longtime Bay Area writer and wrote the first SF Examiner story about the murder of George Moscone and Harvey Milk. She is also the author of "As Real As It Gets," a history of SF General Hospital in the first years of the epidemic. Click here to check out her web site.

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