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

STD Awareness: Are Condoms Really Necessary?

condoms in packetsCondoms are one of the best ways for sexually active people to avoid sexually transmitted diseases (STDs), but many worry that people are becoming more lax about protecting themselves. There are all kinds of myths swirling around about condoms — such as that they aren’t effective or that they kill the mood. And, thanks to anti-HIV medications, some people no longer see condom use as a matter of life or death.

The Centers for Disease Control and Prevention (CDC) recently announced that 2014 saw record highs in chlamydia, syphilis, and gonorrhea, which is a stark reminder that condoms protect against more than just HIV. So, even if you’re using medications to protect yourself from HIV, remember that syphilis is making a comeback, and can cause serious damage or even death when untreated, and that gonorrhea is rapidly evolving resistance to the last good drugs we have to treat it. Condoms are just as relevant as ever!

HIV

In 2014, the CDC announced it would start using the term “condomless sex” instead of “unprotected sex” to recognize that people could engage in condom-free sex, but still protect themselves from HIV by using Truvada, or pre-exposure prophylaxis (PrEP). Truvada is the first drug approved by the FDA to prevent HIV, and it can be taken by HIV-negative individuals to help their body ward off the virus before an infection can establish itself. The pill must be taken daily — using it inconsistently reduces its effectiveness. 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

The Imaginarium of Doctor Delgado: The Make-Believe Medicine Behind SB 1318

pillDr. George Delgado, a gynecologist based in San Diego, is probably not likely to win the Nobel Prize in Medicine any time soon — or ever. Delgado’s dubious medical claims have been one of the driving forces behind a piece of legislation, Arizona Senate Bill 1318, that pushes what physician and state Rep. Randall Friese calls “fringe medicine.”

Delgado runs a website called Abortion Pill Reversal, offering 24-hour medical advice to women who have taken the abortion drug mifepristone and regret their decision. “There is an effective process for reversing the abortion pill, called ABORTION PILL REVERSAL, so call today!” the website cheers. Most people have probably never heard that a medication abortion — that is, an abortion performed by administering two pills — can be reversed. If this medical breakthrough sounds new, it’s because it doesn’t exist — at least not within any kind of evidence-based, established medical practice.


So-called abortion reversal is untested for safety or effectiveness.


Unsafe abortions have always been the consequence of the anti-abortion movement. Now unsafe abortion reversals can likely be added to that, thanks to the procedure Delgado has performed and promoted — in spite of scant evidence of its safety and effectiveness. In the two-step process of a medication abortion, a provider first administers a dose of mifepristone and then follows it with a dose of misoprostol. Delgado claims he can intervene in a medication abortion so that the patient’s pregnancy can continue. If patients change their minds after the first step, Delgado claims, they can counteract the initial drug with a dose of progesterone.

For published medical literature, Delgado can claim a 2012 article he co-wrote in the Annals of Pharmacotherapy. The article describes six abortion reversal patients, four of whom, he claims, remained pregnant. Though published in a legitimate medical journal, Delgado’s findings were from a small sample of patients, none of whom were compared in a controlled study to patients who did not undergo the progesterone treatment. Moreover, not everything that’s published in medical journals is well received by the medical community. Dr. David A. Grimes, a physician formerly with the Centers for Disease Control and Prevention, calls the article “an incompletely documented collection of anecdotes.” Continue reading

Sniping, Not Debating: The Center for Medical Progress Videos

The following guest post comes to us via a Planned Parenthood Arizona volunteer.

health care providersI watched or read the first few full-length videos and transcripts posted by the Center for Medical Progress (CMP) beginning July 25, 2015. No doubt, coming weeks will bring more videos, but I would be surprised if they stray from themes of this first batch. In a nutshell, the heavily edited videos assert that uncompassionate Planned Parenthood representatives violate laws against collecting and selling fetal tissue for profit, “haggle” over pricing, and discuss abortion procedures and tissue in a distasteful, chilling manner.

I’m pretty weary of (though never surprised by) folks who oppose a woman’s right to make her own child-bearing decisions. Why? In this case, opponents refuse to stand and fight on the merits of their arguments. Instead, they use sniping tactics that trigger emotions and ignore facts.

CMP selected snippets of their hidden-camera videos to concoct a narrative not supported by the unedited videos. Consider these snippets they left out.

Planned Parenthood affiliates help WOMEN donate THEIR fetal tissue for medical research.

Dr. Deborah Nucatola, Planned Parenthood Federation of America’s senior director of medical services, spoke of the demand for fetal tissue donation programs:

“Patients will call up, make an appointment, and say, ‘I would like to donate my tissue.’ And the affiliates are really feeling like, ‘Oh, wow, I really need to figure out a way to get this done.’ Because patients are talking about — you know, in general, in health care, a provider is not going to offer a service unless there’s demand. And there is a demand now, I mean, women know that this is something that they can do.”

Continue reading

STD Awareness: Which STDs Are Vaccine Preventable?

scientistWouldn’t it be great if we could wipe sexually transmitted diseases off the face of the earth? If vaccinologists have a big “to-do” list out there, probably every single infectious disease is on it, including every STD. But some STDs have a higher priority than others, while other pathogens, unfortunately, don’t yield to our efforts quite as easily as other vaccine-preventable diseases.

Celebrate National Immunization Awareness Month by taking a look at a vaccinologist’s hypothetical “to-do” list below. While we already have a couple of STDs checked off that list, there is still more progress to be made!

check boxHuman papillomavirus: Gardasil, the most widely used HPV vaccine, introduced a new-and-improved version earlier this year. Gardasil 9 protects against seven strains of HPV that collectively cause 90 percent of cervical cancers and anal cancers, plus the two HPV strains that are jointly responsible for 90 percent of genital warts. Not only that, but vaccination against HPV will also reduce the frequency of “pre-cancers,” which are cellular abnormalities that can be treated before progressing into full-fledged cancer — meaning less time, money, and anxiety spent dealing with follow-up procedures and treatments. In fact, Australia is already seeing a huge nosedive in genital warts and pre-cancers — all thanks to their sky-high HPV vaccination rates.

check boxHepatitis A and B: Hepatitis, a disease of the liver, can be caused by several types of viruses, including hepatitis A virus and hepatitis B virus. Both can be transmitted sexually, but thanks to the vaccines, you can ask to be protected against them using a combination vaccine, meaning you’ll only have to get three shots over a six-month period rather than the five shots you’d receive if you were vaccinated for the two viruses separately. Continue reading