Different HIV/AIDS Prevention Strategies Being Debated After Detection of Rare, Drug-Resistant HIV Strain

Following New York City health officials' announcement last week that they have detected a rare, drug-resistant HIV strain, HIV/AIDS experts and advocates are examining different prevention strategies, some calling for a "renewed commitment to prevention efforts and free condoms" and others hoping to "track down those who knowingly engage in risky behavior" to prevent the spread of the virus, the New York Times reports (Jacobs, New York Times, 2/15). New York City Department of Health and Mental Hygiene officials on Friday at a news conference announced they had detected in a local patient a rare strain of HIV that is highly resistant to most antiretroviral drugs and causes a rapid onset of AIDS. The city health department also issued an alert to physicians, hospitals and medical providers asking them to test all HIV-positive patients for evidence of the strain. City Health Commissioner Thomas Frieden said, "We have not seen a case like this before. It holds the potential for a very serious public health problem" (Kaiser Daily HIV/AIDS Report, 2/14). Advocates' and health officials' discussions have concentrated on reducing risky behavior among men who have sex with men, including confronting people at "impromptu sex parties," "infiltrating" Web sites, "thwarting liaisons" that involve crystal methamphetamine use and working together to track down the sexual partners of people who test HIV-positive, the Times reports. The advocates say that "gay men must start taking responsibility for their own, before a resurgent epidemic draws officials who could use even more aggressive tactics," according to the Times (New York Times, 2/15).

Prevention Obstacles
The discovery of a multidrug-resistant HIV strain "illustrates the enormous difficulty of promoting and sustaining changes in sexual behavior," according to social scientists, the New York Times reports. Some researchers and AIDS advocates say a lack of federal funding is an obstacle to providing HIV/AIDS prevention education and public awareness campaigns. "Prevention has always been the neglected stepchild in terms of funding," Dr. Anke Ehrhardt, director of the HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute, said, adding that regardless of whether the new strain is an isolated case, "we will have another epidemic unless we put behavioral change front and center and do it better than we are doing it now." Researchers cite several other factors in current efforts' failures to curb unsafe sex and promote prevention strategies, including antiretroviral drugs that extend life and lessen the fear associated with being HIV-positive; the use of the Internet to find casual partners, which bypasses traditional meeting places where health care workers can reach people; crystal methamphetamine use associated with sexual activity; and prevention messages that are not tailored to people who are at highest risk of contracting or transmitting HIV, according to the Times (Carey/O'Connor, New York Times, 2/15).

Public Alert
Some HIV/AIDS experts and advocates believe that New York City officials' announcement of the new HIV strain in one patient was premature, the Chicago Tribune reports. "There's not a lot we can conclude from these isolated cases," Dr. Julio Montaner, chair of AIDS research at the University of British Columbia, said, but he added that these cases can "inspire vigilance and caution among groups at risk for HIV," according to the Tribune. Others say that focusing attention on the New York City man's rapid progression from HIV to AIDS is "confusing" because it could be a result of the man's genetic susceptibility, according to the Tribune. "I think it's pretty strange that they're making a tempest in a teapot over this," Dr. Steven Wolinsky, chief of infectious diseases at Northwestern University, said (Manier, Chicago Tribune, 2/15). Some AIDS experts said the decision to go public with just one case and before all testing has been completed was "too hasty, alarmist and unscientific," the New York Times reports. However, Frieden, who made the announcement, said, "I don't know whether this is of tremendous scientific importance," adding, "But I do know that from a public health practice standpoint it is of great concern and it has immediate implications for what the community does and what doctors do and what we do." Frieden said he made the announcement for other reasons, including a desire to send a "wake-up call" to the public and health care workers that HIV/AIDS remains an epidemic, concern that physicians are not detecting HIV in its early stages and hope that more HIV-positive people would learn their status and "change their risk behavior," according to the Times (Altman, New York Times, 2/15).

Philadelphia Inquirer Examines Crystal Methamphetamine
The Philadelphia Inquirer on Tuesday examined crystal methamphetamine use and efforts to stop the use of the drug, which some say "destroys lives and relationships and encourages risky behavior." According to the Inquirer, crystal meth is "especially popular" among MSM because it "erases inhibitions" and allows men to "stay up partying and having sex for several days before crashing." Some experts believe this type of behavior might lead to the spread of HIV/AIDS, including drug-resistant strains (Hill, Philadelphia Inquirer, 2/15). The complete article is available online.

Reprinted with permission from kaisernetwork.org. You can view the entire Kaiser Daily HIV/AIDS Report, search the archives, or sign up for email delivery at www.kaisernetwork.org/dailyreports/hiv. The Kaiser Daily HIV/AIDS Report is published for kaisernetwork.org, a free service of the Kaiser Family Foundation, by The Advisory Board Company. © 2004 by The Advisory Board Company and Kaiser Family Foundation. All rights reserved.