Complacency and crystal add to crisis of H.I.V. strain
By Ronda Kaysen
By Valentines Day, Mike, a bartender at the Chelsea bar Rawhide who declined to give his last name, had heard nothing about last weeks news of the diagnosis of a New York City gay man with a new rapidly progressive and highly drug resistant strain of H.I.V. The gay community isnt paying any attention, he said, mixing a drink for a customer. People are totally oblivious.
Sitting alone at the bar was Shaim from Queens, who also declined to give his last name. He had heard about the new strain, but was not alarmed. Im not concerned and Im not upset, he said. Shaim was not concerned about his own health risks because he avoids penetration to prevent infection, he said. The gay community, he added, is not comfortable discussing H.I.V. and AIDS. A lot of people in the community try to sweep [AIDS] under the carpet, he said.
The healthcare community, however, is paying very close attention to the news that a man in his 40s contracted a rare strain of H.I.V. that appears to be resistant to virtually all retro-viral drugs and has rapidly progressed into full-blown AIDS.
If this is not an isolated case, this is very, very concerning, said Dr. Dawn Harbatkin, medical director at Callen-Lorde Community Health Center on W. 18th St., in a telephone interview. It means that were going to go back to what we were seeing in the 80s, where the H.I.V. drugs dont work and everybody dies.
Researchers led by Dr. David Ho at the Aaron Diamond AIDS Research Center are studying two other H.I.V.-infected men, one of whom was a sexual partner of the carrier, to determine if they also share the drug-resistant strain or if this is an isolated incident.
Even if this is a new, more virulent strain, it is not clear how the unique characteristics of the infected mans immune system or his genetic makeup may have contributed to his rapid progression to AIDS after his initial infection.
Because the man was a frequent crystal methamphetamine user who engaged in unprotected sex with numerous partners, health officials and H.I.V. activists fear that the rise of crystal meth use in the gay community has created an ideal environment for a new super virus to emerge.
Crystal meth is playing a huge role in this in that crystal meth addiction really fuels sexual behavior and particularly unsafe sexual behavior, Harbatkin said. Two-thirds of all newly infected H.I.V. patients that Callen-Lorde treats say that crystal meth played some role in their infection, Harbatkin added.
Dr. Frieden, commissioner of the Department of Health, made no effort to conceal the infected mans crystal meth use, a move that many say was a much-needed wakeup call. With the ever-escalating epidemic of crystal use among gay men and the preponderance of men having sex without condoms, Frieden was absolutely brilliant in using this to say, Hey fellas, wake up, pay attention, things could happen and this is something that did happen to one man and it could happen to you, said Michael Shernoff, an H.I.V.-positive Chelsea psychotherapist for the gay and H.I.V.-affected community and author of the upcoming book Sex Without Condoms: Unprotected Sex, Gay Men and Barebacking (2005, Rutledge).
But whether one isolated case, although alarming for healthcare workers and activists, will have any recognizable effect on peoples sexual behavior is unclear.
I kind of doubt that all the sex places closed their doors on Saturday night, and I really doubt that peoples behavior changed overnight, said Tim Gay, former Chelsea Democratic district leader and chairperson of the New York County Democratic Committee.
At Rawhide, the new strain had given at least one patron pause. I thought we were getting a handle on this and all of a sudden we have a major problem, he said. The news, said Steve, was very upsetting, reminding him of his early teens spent in San Francisco in the 1980s when AIDS first emerged. It was very scary, he remembered. He also remembers the new virus radically changing his sexual behavior.
Although Steve agreed that crystal meth is a concern in the gay community, he noted, There are responsible crystal users, not all of them forget about being safe.
Since anti-retroviral drugs were first introduced in the mid-1990s and life expectancy rates for H.I.V.-infected people increased dramatically, fear of death from AIDS has diminished, say activists.
The younger generation of gay men did not grow up seeing men with lesions and seeing men that look like they came out of concentration camps that my generation of gay men did, psychotherapist Shernoff said. They dont have a visual representation of AIDS as a deadly illness.
Many of the images that young people do see, reinforce the myth that AIDS is an easily treatable and manageable illness. The visual representations that are given by the pharmaceutical companies for anti-retrovirals are of people with H.I.V. climbing mountains, sailing seas and looking like muscled hunks, Shernoff said. Everything that is going on is reinforcing the complacency that H.I.V. is no big deal and in fact it is an enormous deal.
To combat a growing nonchalance, activists insist that now is the time to launch a new, more vigilant awareness campaign. Gay men need to be re-introduced to H.I.V. and what it means to have that in your body through public education campaigns and forums, Dan Carlson, co-founder of H.I.V. Forum, said.
Carlson suggests moving away from the Safe Sex is Hot Sex condom-centric campaign model and focusing instead on deeper physical and psychological concerns within the gay community. We have to teach gay men to love themselves and take care of themselves and take care of their health, he said. That may mean getting treated for depression. That may mean getting tested twice a year. That might mean being adherent to your H.I.V. meds.
But under the Bush administration, AIDS awareness funding has changed. According to Harbatkin of Callen-Lorde, the new emphasis on abstinence-only education is a far cry from ideal. An abstinence-only approach is not as effective as a multifaceted approach and a lot of the funding has been focused on an abstinence-only approach, she said.
The gay community itself needs to respond to a social climate that if it has not already may spread a potentially untreatable strain of a deadly virus through its population, says Carlson. This conversation about drug use and H.I.V. transmission has to happen within the gay community, he said. It has to be gay men talking to gay men about what were doing to each other, why we are using this drug [crystal meth] as much we are using it and why we are allowing this to persist within this community.