11/28/2007
Health Officials Note Disturbing Trend in MSM HIV Infections
In an article published Wednesday in the Journal of the American Medical Association, Dr. Harold Jaffe, department of public health director at Oxford University, Dr. Kevin de Cock, head of HIV-AIDS at the World Health Organization and Dr. Ronald Valdiserri, chief consultant to the public health strategic health care group of the U.S. Department of Veterans Affairs, make note of the trend of increasing HIV infections among men having sex with men:
"The commentary looks only at trends in western countries, where men who have sex with men have always made up the lion's share of people living with HIV-AIDS. They noted there was a 13-per-cent increase in American MSM living with HIV-AIDS between 2001 and 2005. A 10-fold increase in syphilis cases among MSM in the United States over the same period is further evidence of an increased frequency in unprotected sex, the authors said. HIV-AIDS rates among men who have sex with men are also in the increase in Canada. David Boulos, a senior epidemiologist with the Public Health Agency of Canada, said Tuesday that MSM accounted for only about 37 per cent of new HIV infections in this country in 1996, an all time low. But since then the rate has again begun to climb, reaching about 45 per cent in 2005. Jaffe and his co-authors suggest the reversal is at least in part the product of complacency. 'Our feeling is that there's now a complacent attitude towards the epidemic in general and particularly in gay men. Somehow it's just being accepted that yes, of course, the epidemic is continuing,' he said from Oxford."
The UN recently cut the number of people it believes to be infected worldwide with HIV by 6.3 million cases. World AIDS Day is December 1.
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Bad news. Do y'all think it's because these young Gay guys see so many HIV positive folks who are living healthy long lives. They think it's no big deal. Who's going to pay for their expensive meds? The taxpayers? Oh, my God, I sound like a Republican! How disgusting. I'm sorry.
Posted by: Derrick from Philly | Nov 28, 2007 11:27:20 AM
I don't really know what to say, other than this saddens me big time, and, hopefully, one day soon, this trend will be reversed.
Posted by: Sebastian | Nov 28, 2007 11:39:57 AM
I believe that, in many places, actual statistics about numbers of new HIV infections have shown an increase in infections among men who have sex with men.
But most of the information quoted above has little or nothing to do with that.
1) "They noted there was a 13-per-cent increase in American MSM living with HIV-AIDS between 2001 and 2005." Well, yes. But that increase is largely due to the fact that HIV deaths in America have dropped precipitously. People with HIV are living longer, so there are a lot more of them.
2) "A 10-fold increase in syphilis cases among MSM in the United States over the same period is further evidence of an increased frequency in unprotected sex, the authors said." Well, except that what's generally considered safer sex for HIV among gay men (using a condom for anal sex), will not protect you from syphilis. Many cases of syphilis are contracted through oral-genital contact. So this huge increase in syphilis cases could be occurring without any uptick in unprotected anal sex. You can't assume it's a sign of a tremendous rise in unsafe sex. Where is the data?
3) "David Boulos, a senior epidemiologist with the Public Health Agency of Canada, said Tuesday that MSM accounted for only about 37 per cent of new HIV infections in this country in 1996, an all time low. But since then the rate has again begun to climb, reaching about 45 per cent in 2005." What is the point of looking at percentages of new HIV infections among different groups? A decrease in the number of infections in one group will show up as an increased percentage of infections in another. The mix is only important when you're looking at allocating funds for prevention and treatment in different communities. It tells you nothing about what's happening within one community.
It's infuriating when supposed AIDS experts pass off crap like this as evidence of anything. They should all know better.
There are plenty of data that show an increase in HIV infections among MSM. And yes, it is almost certainly due to "complacency." But if you want to make that point, you've got to support it with meaningful data, the right data.
This is junk science.
Posted by: 24play | Nov 28, 2007 11:45:05 AM
I just recently had a friend seroconvert. He doesn't even care. He said well it was bound to happen sometime. He is 24. So there is your answer Derrick from Philly. No you don't sound Republican. You sound like any taxpayer.
Posted by: Matt | Nov 28, 2007 11:46:52 AM
I think it's the same attitude people have towards war. Younger generations have not been touched by war personally as much as older generations (WW2 particularly comes to mind) so younger people don't hold the same horror. Younger gay people who didn't see the outbreak of the epidemic first hand and weren't personally touched by people dying don't have the same instilled horror some of us have. That coupled with the notion that is it now a chronic disease that can be controlled only makes them more complacent.
However, Matt brings up a really important point. I know a lot of people (including myself) who at least at some point have resigned themselves to the idea of seroconverting. On some level it seems like a losing battle to stay HIV- and that most of all scares the bejesus out of me.
Posted by: MT | Nov 28, 2007 11:55:17 AM
24play: Point 3 is bogus.
If the total number of infections has increased, and if the percentage of MSM hiv infection has also increased, it can only mean one thing.
HIV infections has increased in MSM as an absolute number.
I didnt think that's bullshit mathematics.
Posted by: Landis | Nov 28, 2007 11:58:13 AM
I don't think it's that we (as a young person) see HIV positive people living healthy long lives; I think it's more that we DON'T see HIV pos people dealing with all of the horrible problems that were around before the advent of retroviral medications. Call it a kind of ignorance. Couple that with the invincibility of youth and you have a dangerous combination. This isn't to say I live promiscuously or dangerously, but I definitely understand that it just doesn't seem the fear is there to the extent that it should be.
Posted by: David | Nov 28, 2007 12:00:54 PM
Landis,
Did I not open (and close) my comments by saying that I know plenty of data show an increase in new infections among MSM?
There's no doubt that the number of new infections among MSM has grown—or that the rate of infections has recently increased. But trying to make either of those points by extrapolating from the percentage of all infections is ass-backward. Just bring the correct data, the hard numbers that show the increase among MSM.
Posted by: 24play | Nov 28, 2007 12:07:34 PM
Um... the doctor's name is Kevin de Cock??
Posted by: Chesnut | Nov 28, 2007 12:33:44 PM
Why are any of you concerned about who is going to pay for treatment? Shouldn't you be concerned about people dying? It sounds like if your precious tax dollars weren't involved you wouldn't care about gay men becoming infected with HIV. Selfish indeed.
Posted by: wetcnt | Nov 28, 2007 1:03:21 PM
Wetcnt,
I do care and I'm sure Derrick from Philly cares but we can only be taxed so much before it starts hindering our lives as well. There is plenty of pork in washington to be cut for HIV funding without increasing our taxes. I won't my friends who are positive to live for a long time. Saying I don't won't them treated would be saying I want them to die. I have to say though I feel as stongly about free treatment for those who know to wear a condom and choose not to because they can just treat it.
Posted by: Matt | Nov 28, 2007 1:12:46 PM
I too am saddened by this news. I do hear the points about people not seeing the complications of HIV and not taking the same precautions as a result.
But, the fact of the matter is that we're talking about sex. Unfortunately, sex and reason, generally, don't go together. Sex is about emotion. Humans are animals and, like all animals, emotion tends to beat out logic much of the time.
My doctor just told me about a patient of his that became HIV positive. He'd been in a committed relationship with his boyfriend for a year and they stopped using condoms. His boyfriend didn't even know that he was positive. Logic would have dictated both guys getting tested before going without condoms, etc.,etc. But, I'm sure that they were in love and caught up in the moment.
The "old" me never understood why anyone would ever have sex without a condom. I was like, why take the risk. I thought, don't you love yourself enough to protect yourself. The new me, for better or worse, has a greater appreciation of how "human" people are. If you're hurting, don't like who you are, etc., the desire to have sex without "limits" may be to great to ignore.
Given how human people are, I am praying for a medical cure. As much as I wish it were otherwise, it may be too much to expect human behavior alone to end the epidemic.
Take care of yourselves! Hugs B!
Posted by: Brandon | Nov 28, 2007 1:14:25 PM
please change all my "won't"s to "wants". I'm having a grammar deficient day.
Posted by: Matt | Nov 28, 2007 1:15:01 PM
WETCNT,
Matt and I do make strange political bedfellows on this issue, don't we? Being concerned about the cost of taking care of AIDS patients doesn't mean you don't care about Gay men (or anybody, for that matter) dying. It just makes you wonder about the irresponsible mindset of too many young folks.
Up until 1985, I behaved irresponsibly. Went out and worked "trade" whenver the spirit hit me. When I found out that someone I'd had unprotected sex had died of the Virus, I stopped. I aint lying to you. From 1986 to 1993, NO ANAL SEX(a few oral sex episodes because I thought that was safe). For eight years I believed I was HIV positive and abstained from sex that I thought would be a danger to others--wouldn't get tested until '93.
Now, I aint no saint (more like a frustrated whore),but I do wonder what makes some young gay/closeted & dl homos so damn irresponsible.
It's a legitimate quesion: who's going to take care of you? You don't have to contract the damn virus if you act responsibly.
Posted by: Derrick from Philly | Nov 28, 2007 1:22:01 PM
Dr. Cock really sounds like a porn name.
Wonder if he's gay.
Posted by: 1♥ | Nov 28, 2007 1:26:43 PM
It's Cliche to say this, but becoming HIV + was one of the best things to happen to me, I've never been mentally emotionally or physically more solid. It's not necessarily a bad thing anymore. We're all going to pass away one day, and becoming HIV+ makes you cherish life and take care of yourself in ways you never were capable of understanding before.
Posted by: Jake | Nov 28, 2007 2:12:58 PM
Re: Jake
Good for you, but I'd rather learn to cherish life and take care of myself without a deadly contagious virus in my bloodstream. I think part of the problem is this attitude: "It's not necessarily a bad thing anymore. We're all going to pass away one day..."
It *is* a bad thing. I think the understandable drive not to stigmatize HIV+ individuals has tipped over into normalizing HIV and that's a bad thing. And no one should have to face passing away at a young age if they can reasonably avoid it. And they can.
Posted by: Charles | Nov 28, 2007 2:26:50 PM
Charles, in Jake's defense, even way back in 1994, when the prognosis was a lot more terrifying, POZ profiled many people with HIV who said basically the same thing, that facing life with HIV had forced them to grow in ways that they might otherwise never have achieved. And they were thankful for that.
And what does contracting HIV in 2007 have to do with "passing away at a young age"? A recent study determined that young people infected today can expect to live an average of 35 years post-diagnosis.
Posted by: 24play | Nov 28, 2007 2:36:46 PM
Thanks for the support on my point 24Play. Its a shame that we are taught that the longer the live, the better. No the better you live, the better. Living in New York as a 20something I had my share of amazing fun, and equally immature gay male role models sharing the fun along side me. It was only until I discovered that I was HIV+ that I TRULY began to see gay men living life HUMBLY, and not with some invincibility that is clearly a fantasy that we have to concoct. The real problem with HIV in America right now as I type this is the stigma that HIV- people have toward us. It's the second coming out of the closet and this one is much harder. But look around and know this - there should be no shame in being HIV+, and Charles I would hope that you can take that from this post. There is no shame in cancer, there is no shame in being hit by a car, there is no shame in dying in your sleep. There is shame in not relishing life for what it is, and maybe to be happy for what may happen after you and I or all of us pass on.
Posted by: Jake | Nov 28, 2007 2:46:44 PM
The same attitude is prevailing with those (older) people who continue to court lifestyle problems like high cholesterol because they have a safety-net with drugs like Lipitor.
People don't understand that health costs are not contained by improved medicine - they INCREASE because a) we can cure more; and b) people abdicate responsibility for their own health.
Posted by: Mike | Nov 28, 2007 2:50:47 PM
The only tax payer paying for my medication is me. When should I expect all this free medication that you people are paying for? Just wondering so I can be home to sign for them.
Posted by: Pete | Nov 28, 2007 3:01:52 PM
If I didn't have good ego strengths I would have cut on myself after this blogwash. I am not dirty but you describe me so. You may not think that you are but read over your musing so casually thrown about full of impending doom and death rattles loud enough to wake up the neighbours. I am an older doctor, we used scare tactics (poor excuses for education and harm prevention) when I first started practising medicine 30 years ago. It did not work then either. Most disease knowledgeable men and women would never speak in these drama charged terms. Forgive my spike of anger, there is no need to read this type of opinion from brothers and sisters in this awful time. We must SHINE on those living and recovering, Shine bright and proud. Shine on the uninfected sexualy curious newbie, shine on the baby unaware, the accidental injury, the men, women and children of other lands that just do not understand why. Shine love , hope and inspiration that if whatever their lives bring to them and their choices made , that you are there to shine for them, hating the taxes, hating the mega rich pharmaceutical company, the ignoring administrations. I borrow that "shine" from Joni Mitchell's new song, SHINE, give it a listen, and shine always , never give someone the dirty feeling, it doesn't wash off so easy.
Posted by: s tremer | Nov 28, 2007 3:15:02 PM
WETCNT, PETE, S TREMER, and especially, JAKE. Thanks for your input. Again, we learn from discussions on some Internet blogs--Andy's is one. I shouldn't allow my frustration to block what I thought was my sense of compassion.
Posted by: Derrick from Philly | Nov 28, 2007 3:27:59 PM
Brandon, you said "Humans are animals and, like all animals, emotion tends to beat out logic much of the time."
I would argue that humans are almost unique in feeling emotions. Certainly some domestic animals and nearly human primates can exhibit emotions, but most wild animals are not controlled by their emotions; they are controlled by the drive to survive and reproduce. It's human emotions that make things messy---thank god most animals don't exhibit them!
And Jake, you said "There is no shame in cancer, there is no shame in being hit by a car, there is no shame in dying in your sleep." I'm glad that HIV has made you happier and more mature. But the examples you cite are not health problems that people bring on to themselves (aside from some types of cancer related to smoking). I'm not at all suggesting that you feel shame in being positive, but it's unfathomable that you make it a point of pride. Being on any sort of medication is a pain in the ass, and you will eventually have to deal with side effects. There are other, healthier ways to transform yourself into a thinking, feeling, compassionate person.
Posted by: Paul | Nov 28, 2007 3:35:54 PM
Paul, cervical cancer in women (and anal cancer in both men and women) is frequently a result of HPV infection. Your risk of esophageal cancer, as well as many others, rises if you drink heavily. Not getting enough fiber in your diet or eating too much red meat are risk factors for colon cancer.
Sometimes people who get hit by cars were crossing against the light, or jaywalking, or talking on their cellphones and not paying attention to traffic. I'm sure billions of people have gotten colds or the flu because they don't wear gloves to ride the subway or take an elevator or don't bother washing their hands every time they've touched something another person has touched (or breathed on).
Many, many afflictions and misfortunes have roots in people's behaviors. Do people bring all those afflictions on themselves? Where should we apportion blame? Who decides?
Certainly some behaviors are more risky than others. But there is risk everywhere. We all choose to take risks. Who decides which risk-taking qualifies as irresponsible?
Posted by: 24play | Nov 28, 2007 3:55:29 PM