BY DUNCAN OSBORNE | The mood at the XIX International AIDS Conference was exultant. For the first time in roughly 20 years, the biennial conference was held in the US. This was made possible by the Bush and Obama administrations ending the ban on HIV-positive individuals traveling to America. But that was just the beginning of the celebration.
Advocates and public health officials believe they have found interventions that, while not 100 percent effective, will prove to be powerful prevention tools when used together.
Among these new interventions is pre-exposure prophylaxis (PrEP), a daily regimen of Truvada, an anti-HIV drug, which was marginally effective, as in less than 100 percent effective, in keeping HIV-negative gay and bisexual men who took the drug in clinical trials from becoming infected with the AIDS virus.
A second new intervention is voluntary circumcision. Like PrEP, voluntary circumcision showed marginal benefits for heterosexual men in Africa who underwent the surgical procedure.
Another development that has been several years in the making is using HIV testing and treating those who test positive for HIV with antiretroviral drugs as a way of reducing the amount of virus in a person's body and so reducing their infectiousness. Obviously, treating HIV-positive people pays benefits to those individuals as well because they live longer, healthier lives.
The theory here is that if all of these strategies are deployed at one time in one population, their combined effect will cut new HIV infections. Some attack HIV’s ability to infect others and others, notably treatment, reduce the amount of HIV that is available to infect other people. When these are combined with traditional interventions, such as condoms and safe sex instruction, this will deliver a knockout punch to HIV.
These strategies made it possible for Secretary of State Hillary Clinton to say at the conference that we cannot “commemorate the birth of a generation” that is “free of AIDS,” but we are “closer to that destination than we’ve ever been.”
Similarly, aidsmeds.com quoted Dr. Anthony S. Fauci, the director of the National Institute of Allergy and Infectious Diseases, saying, “We are on scientifically solid ground when we say we can end the HIV/AIDS pandemic. We have the scientific tools to consider an AIDS-free generation.”
Heady stuff. And welcome stuff after more than three decades that began with the absolute horror of the epidemic that eventually succumbed to effective treatments.
The attendees at the conference were right to be excited. These interventions will very likely reduce new infections in populations that have a low rate of new infections and have a relatively low number of individuals who are already infected. Gay and bisexual men are not such a population. We are a high incidence, high prevalence population. We also enjoy a lot of sex and a lot of partners during that sex. We have a proven ability to overcome the effects of marginally effective interventions. But then, these strategies were not designed for us, or at least for widespread use among us, nor was this conference terribly interested in us.
At the conference, the Global Forum on MSM & HIV published over 120 research abstracts on transgender people and gay and bisexual men that the conference organizers had rejected. The forum produced this document after reviewing the 2010 abstracts and finding that 2.6 percent of the sessions that year concerned gay and bisexual men and “only 1.1% of sessions focused on transgender people.” These two populations may have some of the highest rates of new infections and highest prevalence in the world.
Here in the US, there is no question that these two populations have the highest incidence and highest prevalence. And we had more bad news on that front from the conference.
The HIV Prevention Trials Network found an overall new infection rate of 2.8 percent per year among African-American gay and bisexual men in this six-city study. That is nearly double the rate among their white peers. Among African-American gay and bisexual men who were 30 or younger, the rate was “5.9% per year, three times the rate among U.S. white” gay and bisexual men, the study authors wrote. Such rates are cumulative. After 10 years at 2.8 percent per year, 28 percent of that population will be infected if that rate is maintained.
Here in New York City, we have known for at least six years that new HIV infections were increasing among young, Black gay and bisexual men. Our city health department denies it, but I believe we are seeing increases in new infections among young Latino and white gay and bisexual men as well.
So what were the attendees at the XIX International AIDS Conference celebrating? All those nice liberals, and plenty of them were gay and lesbian, were whooping it up because of these new developments will ease the burden of HIV on heterosexuals. And who was ignored? As they have from the start of the AIDS epidemic, they ignored us.
This country, this world, has never spent serious cash on HIV prevention. Ever. That money was never spent because it was us faggots who were getting infected. This conference was a more polite version of what government has been doing since the start of the epidemic.
The world threw a party. And we were told to stay the hell away.
