Will HIV Ever Be Safe Enough for You?

This post originally appeared on Mark S. King's Blog.

There is a classic episode of Oprah from 1987 that can still raise my blood pressure. That year, the tiny town of Williamson, West Virginia, became part of a national discussion about AIDS when Mike Sisco, who had returned to his home town to die of the disease, dared to step into a public pool.

The community freakout was immediate. Sisco was quickly labeled a psychopath (rumors emerged accusing him of spitting into food at the grocery store), and the town pool was closed the next day to begin a Silkwood-style pressurized cleaning.

Soon thereafter, Oprah Winfrey arrived with cameras for a town hall forum about the incident.  Fear was the order of the day. “If there’s just one chance in a million that somebody could catch that virus from a swimming pool,” the town’s mayor told Winfrey’s worldwide audience, “I think I did the right thing.”

Sure. Why not react in the most extreme way possible, if there is a chance in a million?

Williamson citizens were not swayed by health officials who calmly explained the established routes of HIV transmission and the impossibility of infection from a pool. “The doctors can say you can’t get it this way,” a woman countered, “but what if they come back someday and say, ‘We were wrong?’”

Indeed. What if? If there’s a chance in a million…?

That broadcast might have remained a sad footnote in HIV/AIDS history, an instructive example of people ignoring scientific fact to protect a satisfying fear, if history didn’t enjoy repeating itself so much. Today, though, the willful ignorance isn’t coming from uneducated residents of a southern town you can barely find on a map.

It’s coming from gay men. And they are just as threatened, frightened, and dismissive of science as the townsfolk of Williamson were thirty years ago.

Recently, research known as The PARTNER Study was presented at the prestigious Conference on Retroviruses and Opportunistic Infections (CROI). PARTNER proved something HIV advocates have long suspected: people with HIV with an undetectable viral load are not transmitting the virus to their partners. The study included nearly 800 couples, all involved in an HIV positive/negative relationship, gay and straight, with the positive partner maintaining an undetectable viral load. Over the course of two years, more than 30,000 sex acts were reported and documented (couples were chosen based on their tendency to have sex without condoms).

Not a single HIV transmission occurred during the study from someone with an undetectable viral load. If PARTNER had been researching a new medication, they would have stopped the trial and dispensed the drug immediately.

The PARTNER results bolster the prevention strategy known as “Treatment as Prevention” (TasP), meaning, a positive person on successful treatment prevents new infections. To date, there is not a single confirmed report of someone with an undetectable viral load infecting someone else, in studies or in real life.

Just don’t tell that to a sizable contingent of skeptical gay men, many of whom took to their keyboards to dismiss the PARTNER findings. Phrases like “false sense of security,” “positive guys lie,” “junk science,” and “if there’s even a small risk” appeared on Facebook postings and in web site comment sections. The people of Williamson must be slowly nodding their heads.

Resistance to the PARTNER study corresponds with stubborn doubts about PrEP (pre-exposure prophylaxis, or HIV negative people taking the drug Truvada to prevent infection). Although virtually every nervous argument against PrEP has been overruled by the facts, naysayers continue to either reject the evidence outright or make moral judgments about the sex lives of HIV negative gay men on PrEP.

Yes, there are unknowns. There always are when scientific studies meet the real world. And every strategy will not work for every person. But the vehement rejection of such profound breakthroughs suggests there is something more, something deeper, going on in the minds of gay men. What is it?

Our collective memories of AIDS horror are hard to shake, and that’s a good place to start. On a gut level, any study suggesting that HIV could be neutralized is met with a weary doubt. Good news is no match for the enduring grief that has shadowed us for 30 years.

The PARTNER study also threatens the view that positive men are nothing more than risks that must be managed. The study kills the HIV positive boogeyman. It means positive gay men who know their status might actually care enough about their health to seek out care, get on treatment, and become undetectable. And, once the positive partner is no longer a particular danger, both partners would bear responsibility for their actions. What an enormous psychic change that would require in our community.

It’s tough to do that when fear creeps in and “what if?” fantasy scenarios take hold. What if my partner missed a dose yesterday and, even though HIV meds stay in the bloodstream for extended periods, his viral load has inexplicably shot up? What if he isn’t being truthful about his viral load? What if he doesn’t know?

The greater threat, folks, isn’t positive guys who think they are undetectable but are not. It’s men who think they are HIV negative but are not. But we’d rather stay focused on the positive person being at fault, because, well, people with HIV lie a lot. We miss doses constantly because we have a death wish or we’re too busy finding our next victim.

I have some “what if?” questions of my own. What if these unrealistic fears were meant tostigmatize and isolate HIV positive people? What if I am undetectable and feel no responsibility to discuss my status with a sex partner because I don’t care to engage in a science lesson? What if everyone availed themselves to prevention options that worked best for them? What if my HIV status were none of your damn business?

These risks could be alleviated, of course, if everyone simply protected their own bodies when having sex with people they don’t know or trust. But that would place an equal burden on negative men, and what a bother that is.  Better to leave that discomfort to those with HIV, vectors of disease that we are. Just consider us criminals, lying to you about our viral loads and spitting in the food in Williamson, just waiting to infect you when we get the chance.

FACE OFF -- An HIV+ Man Faces His Accuser 

As long as we’re giving undue attention to fantasy scenarios we’re not focused on the real threats. The rates of STD’s are up. Young gay black men in the United States don’t have proper access to healthcare and have infection rates worse than any developed country. Our community is plagued by  alcoholism, addiction, and mental illness. Do we want to debate established science or should we devote that energy to other challenges to gay men’s health?

If you still have the arrogance to believe you could win the HIV Powerball Lottery and be the one person who gets infected in ways science has disproven, you’re perfectly entitled to that point of view.

Here are some helpful instructions, however. Carefully step away from your computer and don’t touch the cords because 50 people die of product related electrocutions each year. Walk slowly to your bedroom, being mindful of debris in your path because slip-and-falls kill 55 people every single day. Once there, refuse food or water because, well, you never know. Now slip into your bed of willful ignorance and try to make yourself comfortable.

The good people of Williamson are keeping a spot warm just for you.

Mark

p.s. In the time it took you to read this article, the number of people who were infected by someone with HIV who had no viral load was zero.

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Thank you to Mark for allowing us to share this post. If you would like to know more about his work, you can follow his twitter feed here.

A Timeline for National HIV Testing Day

Happy National HIV Testing Day #stigmawarriors! Today we decided to present a timeline to show how far testing of HIV and AIDS has come in the United States, especially since there is a renewed effort by the LGBT community, HIV community, and the medical community to remove the stigma surrounding getting tested! 

The history of HIV testing is almost as old as the history of HIV in the United States, and since the 1980s the types of tests and how they detect HIV have changed so much. Let's take a look at how far HIV testing has come!

1980-1984:

• The City and County of San Francisco, working with the Shanti Project and the San Francisco AIDS Foundation, set up the San Francisco Model of Care in 1982, emphasizing home and community testing, care and treatment services [1]. 
• The following year, in May 1983, Congress passed the first bill that included funding specifically targeted at AIDS research, which lead to developments in testing and treatment [2].

1985-1989:

Between 1985, there was a lot of developments when it came to HIV testing! 

• The FDA licensed ELISA, the first commercial blood test which tested for HIV antibodies in the blood. Blood banks immediately began testing the US blood supply [3]. 
• Unfortunately, the Pentagon announced in the summer of 1985 that the military would immediately begin testing all new recruits for HIV infections, with the intention to reject anyone who tested positive. This policy sadly continues today [4]. 
• On December 6, 1985, the US Public Health Services issued the first recommendations for the prevention of mother-to-child transmission [5].
• In April 1987, the FDA approved the Western Blot Blood Test Kit, a more specific test for HIV antibodies [6]. 
• On August 14, 1987, the CDC issued the Perspectives in Disease Prevention and Health Promotion Public SafetyGuidelines for Counseling and Antibody Testing to Prevent HIV Infection and AIDS [7].
• On August 18, 1987, the FDA sanctioned the first human tests of a candidate vaccine to prevent HIV [8]. 
• At the end of 1987, the FDA published regulations which required all blood and plasma collected in the US to be screened for HIV [9].
• IN 1988, the FDA doubled its efforts to test the US blood and plasma supply, and by the end of the year 100% of the US blood supply had been tested for HIV antibodies [10]. 
• More importantly, the first World AIDS Day took place on December 1, 1988 [11].
• In 1989, the FDA licensed the first diagnostic kit to test for HIV antigens. Prior to this all HIV tests had only tested for antibodies [12].

1990-1994:

• The early 1990s brought more new HIV tests and health regulations to the public. The first HIV test to test for both HIV-1 and HIV-2 antibodies was licensed in 1990 [13], and that same year the CDC adopted the HIV-prevention counseling model, a “client-centered” approach that focuses on the patient rather than the disease [14]. 
• On May 27, 1992, the FDA licensed a 10-minute diagnostic test kit which can be used by health professionals to detect the presence of HIV-1 [15]. 
• The following year, the FDA published an interim rule on December 14th establishing a requirement for certain infectious disease testing, donor screening, and record keeping to help prevent the transmission of HIV and Hepatitis B and C through human tissue used in transplantation [16]. 
• Later that month, on December 23rd, the FDA approved the first non-blood based collection kit utilizing oral fluid for use in the detection of the antibody to HIV-1 [17].

1995-1999:

• The National Association of People Living with AIDS launched the first National HIV Testing Day on June 27, 1995 [18]. 
• That same year, the FDA recommended that blood establishments should implement donor screening for HIV-1 antigen using licensed test kits [19].
• 1996 brought some of the biggest and quickest advancement in HIV testing to date. Within four months the FDA approved the first at-home testing and collection kit, a viral load test, and the first HIV urine test [20]. 
• In 1998, the FDA approved Cambridge Biotech HIV-1, a HIV-1 (Western Blot) test with a new indication for urine specimen testing [21].

2000-2004:

• The first National HIV Vaccine Awareness Day was observed in 2001, and the CDC announced an HIV Prevention Strategic Plan to cut annual HIV infections in the US by half within five years that same year [22]. 
• The following year, 2002, marked an important development in HIV testing. On November 7, the FDA approved the first rapid HIV diagnostic test kit for use in the United States that provides results with 99.6% accuracy in as little as 20 minutes. Unlike other antibody tests for HIV, this blood test can be stored at room temperature, requires no specialized equipment, and may be used outside of traditional laboratory or clinical settings, allowing more widespread use of HIV testing [23].
• HIV testing became even more widespread on February 3, 2003, when the Department of Health and Human Services expanded availability of the rapid HIV test from the current 38,000 laboratories to more than 100,000 sites, including physician offices and HIV counseling centers [24]. 
• In 2004, the first rapid oral fluid test and the first rapid-body test for plasma which detects HIV-1 and HIV-2 were approved by the CDC [25].

2005-2009:

• The CDC officially recommended routine HIV screenings in US health care settings for people aged 13-64, and yearly screening for populations considered to be "at-risk" in 2006. 
• The WHO and UNAIDS updated their global guidelines in 2007 to include that same recommendation [26]. 
• On December 30, 2008, the FDA approved the first nucleic acid test to detect the presence of two less common types of HIV, HIV-2 and HIV-1 Group O, in donated blood plasma and human tissue [27]. 
• The following year, in 2009, the FDA, CDC, and other federal agencies promoted National HIV Testing Day to increase awareness of the importance of HIV testing to help improve the health of those at risk for getting HIV and to prevent future infections [28]. 

2010-2014:

• In 2010, the CDC approved the first test which detects HIV antigens and antibodies [29]. 
• The first rapid oral fluid home test, Oraquick, was approved by the CDC in 2012 [30]. 
• And in 2013, the CDC approved the first rapid test that detects HIV antigens and antibodies, and distinguishes between acute and established HIV-1 infections [31]. 

What a trip! I learned so much about the history of HIV testing that I never knew before! I hope you did too! 

It shows just how far HIV testing really has come from the early days. With new testing technology people can even test inside the comfort of their own homes. Now the next step is removing the stigma surrounding HIV testing, which several public campaigns are striving to do. But the campaigns won't be successful without you, #stigmawarriors! Let's get out there today and every other day to reduce the stigma surrounding HIV testing, through our words and actions. That way, more people will feel encouraged and supported in taking charge of their health!

We hope National HIV Testing Day inspires you to get out there and be the best #stigmawarrior you can be!