AIDS at 35: The Anniversary of the First Report on a Mysterious New Disease

mmwrOn June 5, 1981 — 35 years ago this Sunday — the Centers for Disease Control and Prevention published a report with an inauspicious title: “Pneumocystis Pneumonia — Los Angeles.” Nestled between pieces on dengue and measles, the article in the Morbidity and Mortality Weekly Report briefly described five patients, all young men from Los Angeles with cases of life-threatening pneumonia. While it didn’t immediately grab headlines, its publication represented a turning point in public health: the beginning of the AIDS era.


In another 35 years, will AIDS be a fading memory?


These patients’ pneumonia had been caused by a particular species of fungus, which back then was responsible for fewer than 100 pneumonia cases annually. Young, healthy people weren’t supposed to be vulnerable to this fungal infection, and the fact that men with no known risk factors were suddenly falling victim to it was a huge red flag that something strange was afoot.

The patients shared other characteristics as well, and at that point, scientists could only speculate what, if any, of these traits were associated with the strange new disease. All five patients were “active homosexuals,” were positive for cytomegalovirus (CMV), had yeast infections, ranged in age from 29 to 36, and used inhalant drugs (aka “poppers”). The CDC knew right away that this mysterious cluster of illnesses must have been caused by “a common exposure that predisposes individuals to opportunistic infections” — an observation that, in hindsight, was incredibly accurate, as HIV destroys the immune system and opens its host to normally rare infections. The editors posited that “some aspect of a homosexual lifestyle” might increase risk for this type of pneumonia — perhaps a sexually transmitted disease that somehow caused pneumonia. Continue reading

Square Pegs, Round Holes: Building Trans-Inclusive Health Care

transgenderFor the first time in history, trans persons are being recognized in the mainstream and their identities are being embraced like never before. Laverne Cox’s cover story for Time and Amazon Prime’s original series Transparent winning four Emmys are examples of this recognition.

Kinda.


Today is National Transgender HIV Testing Day.


Truth is, the trans persons in the media are not representative of the norm. The findings of the National Transgender Discrimination Survey — a survey that collected responses from more than 6,000 transgender and gender-nonconforming individuals — give a clearer picture, and it’s not pretty. The authors of this study found trans persons faced adversity in almost all aspects of life, from experiencing double the rate of unemployment to suffering through a high rate of violent attacks (26 percent and 10 percent of the respondents reported being physically and sexually assaulted, respectively) because of their gender identities. Among all these results, I found one to be particularly unsettling:

“Respondents reported over four times the national average of HIV infection, with rates higher among transgender people of color.”

To me, a person born after the AIDS epidemic of the ’80s and privileged with a world that now has readily accessible condoms and HIV prevention medication (i.e., Truvada), HIV seemed like a relic of the past. Examining the amount of new HIV infections in the cisgender population (0.4 percent for females and 1.2 percent for males), this is an easy assumption to make. I was wrong. Other studies echoed the large disparities of HIV incidence and prevalence in trans persons. One systematic review uncovered four studies that found that 24.8 to 30.6 percent of male-to-female (MTF) transgender persons tested positive for HIV. Another study — conducted in Ontario, Canada — sampled 433 trans persons and found 7 percent of female-to-male (FTM) transgender persons and 19 percent of MTF persons had a high-risk sexual experience in the last year. Yet another found that 35 percent of MTF persons (and 2 percent of FTM persons) had HIV, and again, persons of color — in this case, African-American identified individuals — were at a greater risk. Indeed, in this study, African-American trans persons (FTM and MTF) were approximately three to 12 times more likely to have HIV. Given these data, the cynic in me questions, “Is anyone even trying to prevent HIV in trans persons?” Continue reading

World AIDS Day: Fighting the Stigma Is Half the Battle

RibbonThey say words can never hurt you, but in certain parts of the world, there are three letters that can take away everything dear to you: HIV.

Can you imagine having your family disown you? What if doctors refused to treat you, even with basic care? What would it feel like if you were not allowed to pursue any form of education? How about if you had no possibility of a future with a romantic partner?


We will never make strides in preventing HIV transmission until we confront the taboos that surround it.


This is reality for millions of men, women, and children in sub-Saharan Africa who have been diagnosed with HIV/AIDS. As of 2013, that number was 24.7 million, which accounts for the vast majority of the world’s total reported cases, which by 2014 approached 37 million people, 2.6 million of whom were children. In 2013 alone, 1.5 million sub-Saharan Africans were newly infected. Since the first case was reported in 1981, a certain stigma has always lingered around the disease. Many in the United States refer to it as the “gay disease” or accuse those infected of bestiality. They may say that someone who has been diagnosed should avoid intimacy, believing that a person with HIV is incapable of functional relationships without infecting their partner. In Africa, the implications are even more harsh. Often believed to be a “curse from God,” many regions exile an infected person from their community.

Worse, the stigma does not stop with individuals. It bleeds into the legal, political, and economic arenas as well. This is true worldwide. Some places have prosecuted women for transmitting the virus to their child, or have prosecuted individuals for not disclosing their positive status even if they have reached an undetectable viral load through antiretroviral therapy (ART). The discrimination surrounding a positive diagnosis is cited as the primary hurdle in addressing prevention and care. Continue reading

STD Awareness: HIV Testing

HIV testIt’s often been said that young people view HIV as a chronic disease rather than the “life sentence” it was before there were effective treatments. The fact that an HIV infection can be managed with antiretroviral drugs is a boon from modern medicine, and there are hopes for better treatments on the horizon.

But HIV is only a manageable infection if you, well, manage it, and most Americans with HIV aren’t being treated with the medications we have in our arsenal. Only 3 out of 10 Americans who are infected with HIV are controlling the virus with medication — but when you zoom in on that population and look specifically at young people, the numbers are even more dismal, with only 13 percent of youth, ages 18 to 24, receiving treatment.


Knowing your HIV status is easier than it’s ever been.


Much of this problem is due to a lack of access — without adequate health coverage, these medications can be out of reach for many. But that’s not the whole story — it’s estimated that nearly half of 18- to 24-year-olds with HIV don’t know it. If they haven’t been diagnosed, they can’t know to seek treatment; if they don’t seek treatment, they can’t manage their infection; if they can’t manage their infection, their risk of health problems and early death increases — as do the chances of transmitting the virus to someone else.

So, if a 20-year-old tests positive for HIV and begins antiretroviral treatment right away, he or she can expect to live another five decades — to age 71, not bad compared to the average life expectancy of 79. But if that 20-year-old does not take antiretorvirals, he or she can only expect to live another dozen years — to age 32.

That’s why it’s so important to get tested and know your status. Continue reading

The Condom Broke. Now What?

oopsProtecting yourself with barriers like condoms is an important part of keeping yourself healthy when you and your partner don’t know one another’s STD status. Condoms are also great for pregnancy prevention. You can improve their effectiveness by learning how to put them on correctly, using a generous amount of lubricant, and checking their expiration dates.

But, sometimes, despite your best intentions, condoms break.

When that happens, you might wonder about your vulnerability to sexually transmitted diseases (STDs). And, if pregnancy is a possibility, you might also be concerned about sperm meeting egg. Luckily, there are still options. One, getting tested for STDs can help you receive treatment, if needed, in a timely manner. Two, if you act quickly, you can still take steps to minimize the risk of certain STDs or help avert an unwanted pregnancy.

Don’t let a broken condom immobilize you with fear! Take matters into your own hands, and learn what to do if a condom breaks.

How long does it take after a potential exposure until an STD test is likely to be accurate?

The answer to this question is: It varies. Each STD has a different “window period,” that is, the time it takes for an infection to be detectable. Some STDs can be tested for within days (if symptoms are present), while other STDs can take months to show up on a test. Also, while you might be inclined to wait and see if symptoms show up, remember that most STDs don’t have symptoms at all! When infections don’t have symptoms, they are said to be “asymptomatic.”

Check out this handy chart to see how long it takes for symptoms to appear, how common asymptomatic infections are, and how soon you should be tested.  Continue reading

STD Awareness: Do Sexually Transmitted Diseases Increase HIV Risk?

virion HIVYou might have heard that having an STD like syphilis, herpes, or gonorrhea can make it easier to catch HIV, the virus that causes AIDS. But have you ever wondered if this was true? Maybe it’s just a simple correlation — for example, someone who doesn’t practice safer sex would be more likely to catch HIV along with any other STD. That doesn’t mean that one causes the other, does it?


Common STDs like herpes and trichomoniasis can increase HIV risk.


But it’s not a mere correlation. If you take one person with an STD and one person without an STD and expose them both to HIV through sexual contact, the person with the STD will be at least two to five times more likely to become infected with HIV. Why is that? First, many STDs can make you more susceptible to an HIV infection. Second, the immune response triggered by many sexually transmitted infections can summon the types of immune cells that HIV targets.

Furthermore, if a person with HIV is co-infected with another STD, he or she is more likely to transmit HIV to a partner. In other words, STDs can make a person with HIV more infectious. HIV is more likely to appear in their genital secretions, making it easier to transmit HIV through sexual activity. Continue reading

STD Awareness: Is Syphilis Making a Comeback?

men syphilisBefore antibiotics, syphilis was the most feared sexually transmitted disease (STD) out there. It was easy to get, quack cures were ineffective and often unpleasant, and it could lead to blindness, disfigurement, dementia, or even death. When we were finally able to zap infections away with drugs like penicillin, it seemed like we’d finally won the battle against this scourge. Whereas syphilis rates were highest before antibiotics became widespread in the 1940s, by 2000 we saw a low of 2.1 cases of syphilis per 100,000. At the dawn of the new millennium, many scientists thought the United States was at the dawn of the complete elimination of syphilis.


Using condoms, regular STD testing, and limiting sex partners are the best ways for sexually active people to stay healthy.


Must all good things come to an end? They shouldn’t have to, but in the case of syphilis, the Centers for Disease Control and Prevention (CDC) has announced that syphilis rates are rising, with incidence doubling since 2005. In the United States, there are now 5.3 cases of syphilis per 100,000 people, but that number is a bit misleading because it represents an average across the general population. When you break the population down by age, race or ethnicity, gender, or sexual orientation, that rate might be much higher or much lower. For example, syphilis rates are actually on the decline among women (at only 0.9 cases per 100,000), but among men it is 9.8 per 100,000. In fact, most new syphilis cases — 91.1 percent of them, to be precise — are in men, most of whom are gay or bisexual.

Syphilis is rising the most dramatically among men in their twenties, especially among men who have sex with men (MSM). While some wonder if syphilis is growing among twenty-somethings because this group didn’t live through the early era of AIDS, when HIV was seen as a death sentence and safer sex practices were more common, it might also be due to the fact that STD rates are higher among young people in general. Continue reading