HIV/AIDS
(excerpts from Chapter 10)
HIV a "re-emergent epidemic" among MSM
[MSM = "men who have sex with men" – i.e., "gays" and bisexual men]
The health picture for MSM is looking worse, not better. An article in AIDS and Behavior from 2011 confirmed:
The sexual health of gay, bisexual, and other men who have sex with men (MSM) in the United States is not getting better despite considerable social, political and human rights advances. Instead of improving, HIV and sexually transmitted infections (STIs) remain disproportionately high among MSM and have been increasing for almost two decades.
The CDC’s update from February 2016 is grim:
Gay and bisexual men continue to be most affected by the HIV epidemic in the U.S. At current rates, 1 in 6 MSM will be diagnosed with HIV in their lifetime, including 1 in 2 black MSM, 1 in 4 Latino MSM, and 1 in 11 white MSM. African Americans are by far the most affected racial or ethnic group with a lifetime HIV risk of 1 in 20 for men (compared to 1 in 132 for whites) and 1 in 48 for women (compared to 1 in 880 for whites)....
In recent years (2009-2014), the rates of new HIV diagnoses have fallen within the general population: decreasing by 19% overall, by 35% among heterosexuals, 40% among women, and 63% among injected drug users. But the MSM rate rose by 6% from 2005-2014, “driven by increases among black and Latino MSM.”
A major report in the British medical journal The Lancet (2012) stated the HIV increase among U.S. MSM was 8% a year since 2001, calling it a “re-emergent epidemic.” ...
[MSM = "men who have sex with men" – i.e., "gays" and bisexual men]
The health picture for MSM is looking worse, not better. An article in AIDS and Behavior from 2011 confirmed:
The sexual health of gay, bisexual, and other men who have sex with men (MSM) in the United States is not getting better despite considerable social, political and human rights advances. Instead of improving, HIV and sexually transmitted infections (STIs) remain disproportionately high among MSM and have been increasing for almost two decades.
The CDC’s update from February 2016 is grim:
Gay and bisexual men continue to be most affected by the HIV epidemic in the U.S. At current rates, 1 in 6 MSM will be diagnosed with HIV in their lifetime, including 1 in 2 black MSM, 1 in 4 Latino MSM, and 1 in 11 white MSM. African Americans are by far the most affected racial or ethnic group with a lifetime HIV risk of 1 in 20 for men (compared to 1 in 132 for whites) and 1 in 48 for women (compared to 1 in 880 for whites)....
In recent years (2009-2014), the rates of new HIV diagnoses have fallen within the general population: decreasing by 19% overall, by 35% among heterosexuals, 40% among women, and 63% among injected drug users. But the MSM rate rose by 6% from 2005-2014, “driven by increases among black and Latino MSM.”
A major report in the British medical journal The Lancet (2012) stated the HIV increase among U.S. MSM was 8% a year since 2001, calling it a “re-emergent epidemic.” ...
Example of CDC graph in the book.
Dire life consequences; HIV as chronic disease
Deaths due to HIV/AIDS have been reduced, but many people with HIV are living longer lives burdened with serious illness. An article in The Lancet (2013) explained:
The success of antiretroviral therapy has led some people to now ask whether the end of AIDS is possible. For patients who are motivated to take therapy and who have access to lifelong treatment, AIDS-related illnesses are no longer the primary threat, but a new set of HIV-associated complications have emerged, resulting in a novel chronic disease that for many will span several decades of life. Treatment does not fully restore immune health; as a result, several inflammation-associated or immunodeficiency complications such as cardiovascular disease and cancer are increasing in importance. Cumulative toxic effects from exposure to antiretroviral drugs for decades can cause clinically-relevant metabolic disturbances and end-organ damage. Concerns are growing that the multimorbidity associated with HIV disease could affect healthy ageing and overwhelm some health-care systems …
Health Line notes that about one-fourth of those diagnosed with HIV still progress to AIDS, even with treatment. The National Institutes of Health (at AIDSinfo) posts information on HIV drug treatment failure. ...
Reduced life expectancy for HIV-positive persons
Infection with HIV/AIDS has a serious negative impact on lifespan. While antiretroviral drugs have extended the lives of those with HIV in recent years, the likelihood of shortened life expectancy and frequent illness is not well publicized.
Male youth are especially vulnerable and are not well informed about the reality of HIV infection, with the weakened immune system and co-infections that follow. Worse, HIV can proceed to full-blown AIDS (as determined by “viral load”) for some of those infected. The CDC admits there is no cure but adds, “with proper medical care, the virus can be controlled.”
HIV can be controlled to some degree – if it is caught early, if there is proper medical care, and if the patient sticks with the difficult drug regimen. But controlled to what extent? What does “proper medical care” entail? Drug treatment failure can occur even when used as prescribed. The virus cannot be eliminated from the body. ...
MSM have 157 times higher risk of death from HIV-related causes, with 13% of MSM (vs. 0.1% of heterosexual men) dying of HIV-related causes.
Yet the CDC gives an optimistic prediction on longevity in their page written for the general public:
Before the introduction of ART [antiretroviral meds] in the mid-1990s, people with HIV could progress to AIDS in just a few years. Today, someone diagnosed with HIV and treated before the disease is far advanced can live nearly as long as someone who does not have HIV.
How many lives will be cut short by co-infections (hepatitis, TB, pneumonia, cancer) which were connected to the strain on the immune system from the HIV infection? How many diagnosed with HIV/AIDS will cut their lives short through suicide? (As noted above, the GLB community shows higher incidence of suicidal thinking and attempts than heterosexuals, but records of completed suicides are not categorized by “sexual orientation.”) ...
On a more specialized page (not likely to be read by the general public), the CDC projected less optimistic estimates on average life expectancy after diagnosis with HIV, ranging from an additional 22.5 to 32.1 years. These estimates are for patients (male and female) in routine care (receiving anti-HIV drug treatments) ...
This would mean a 20-year-old diagnosed with HIV receiving “routine outpatient care” could expect to live (on average, using the most optimistic estimate above) to 52 (from a 2006 study). This is far short of a normal life expectancy for an American male (who was 20 in 2010), which is 78 or 79. An HIV-positive young man’s estimated lifespan could be 26 or 27 years shorter, on average.
The CDC projections above apply to all persons with HIV, male and female, homosexual or heterosexual. The situation for MSM only may be grimmer, if they continue to engage in risky sexual practices which could lead to infection with other STDs, or a second strain of HIV.
A 2008 article in The Lancet (British medical journal) analyzed research findings from North America and Europe, and found remaining years to live after HIV diagnosis to be about two-thirds that of the general population:
Life expectancy in HIV-infected patients treated with combination antiretroviral therapy increased between 1996 and 2005, although there is considerable variability between subgroups of patients. The average number of years remaining to be lived at age 20 years was about two-thirds of that in the general population in these countries.
… there is still a large discrepancy between the life expectancy of the general population and the life expectancy of an HIV-infected individual. A person starting combination therapy can expect to live about 43 years at 20 years of age, about two-thirds as long as the general population in these countries.
Our life expectancy results are representative of all individuals who started combination therapy, including those who did not remain on such treatment throughout follow-up.
That is, an HIV-positive 20-year-old (who at least started on anti-HIV drugs) will on average live to the age of 63, 15-16 years less than U.S. male life expectancy of 78-79. The Lancet study also noted that HIV-infected women live longer than the infected men. ...
Deaths due to HIV/AIDS have been reduced, but many people with HIV are living longer lives burdened with serious illness. An article in The Lancet (2013) explained:
The success of antiretroviral therapy has led some people to now ask whether the end of AIDS is possible. For patients who are motivated to take therapy and who have access to lifelong treatment, AIDS-related illnesses are no longer the primary threat, but a new set of HIV-associated complications have emerged, resulting in a novel chronic disease that for many will span several decades of life. Treatment does not fully restore immune health; as a result, several inflammation-associated or immunodeficiency complications such as cardiovascular disease and cancer are increasing in importance. Cumulative toxic effects from exposure to antiretroviral drugs for decades can cause clinically-relevant metabolic disturbances and end-organ damage. Concerns are growing that the multimorbidity associated with HIV disease could affect healthy ageing and overwhelm some health-care systems …
Health Line notes that about one-fourth of those diagnosed with HIV still progress to AIDS, even with treatment. The National Institutes of Health (at AIDSinfo) posts information on HIV drug treatment failure. ...
Reduced life expectancy for HIV-positive persons
Infection with HIV/AIDS has a serious negative impact on lifespan. While antiretroviral drugs have extended the lives of those with HIV in recent years, the likelihood of shortened life expectancy and frequent illness is not well publicized.
Male youth are especially vulnerable and are not well informed about the reality of HIV infection, with the weakened immune system and co-infections that follow. Worse, HIV can proceed to full-blown AIDS (as determined by “viral load”) for some of those infected. The CDC admits there is no cure but adds, “with proper medical care, the virus can be controlled.”
HIV can be controlled to some degree – if it is caught early, if there is proper medical care, and if the patient sticks with the difficult drug regimen. But controlled to what extent? What does “proper medical care” entail? Drug treatment failure can occur even when used as prescribed. The virus cannot be eliminated from the body. ...
MSM have 157 times higher risk of death from HIV-related causes, with 13% of MSM (vs. 0.1% of heterosexual men) dying of HIV-related causes.
Yet the CDC gives an optimistic prediction on longevity in their page written for the general public:
Before the introduction of ART [antiretroviral meds] in the mid-1990s, people with HIV could progress to AIDS in just a few years. Today, someone diagnosed with HIV and treated before the disease is far advanced can live nearly as long as someone who does not have HIV.
How many lives will be cut short by co-infections (hepatitis, TB, pneumonia, cancer) which were connected to the strain on the immune system from the HIV infection? How many diagnosed with HIV/AIDS will cut their lives short through suicide? (As noted above, the GLB community shows higher incidence of suicidal thinking and attempts than heterosexuals, but records of completed suicides are not categorized by “sexual orientation.”) ...
On a more specialized page (not likely to be read by the general public), the CDC projected less optimistic estimates on average life expectancy after diagnosis with HIV, ranging from an additional 22.5 to 32.1 years. These estimates are for patients (male and female) in routine care (receiving anti-HIV drug treatments) ...
This would mean a 20-year-old diagnosed with HIV receiving “routine outpatient care” could expect to live (on average, using the most optimistic estimate above) to 52 (from a 2006 study). This is far short of a normal life expectancy for an American male (who was 20 in 2010), which is 78 or 79. An HIV-positive young man’s estimated lifespan could be 26 or 27 years shorter, on average.
The CDC projections above apply to all persons with HIV, male and female, homosexual or heterosexual. The situation for MSM only may be grimmer, if they continue to engage in risky sexual practices which could lead to infection with other STDs, or a second strain of HIV.
A 2008 article in The Lancet (British medical journal) analyzed research findings from North America and Europe, and found remaining years to live after HIV diagnosis to be about two-thirds that of the general population:
Life expectancy in HIV-infected patients treated with combination antiretroviral therapy increased between 1996 and 2005, although there is considerable variability between subgroups of patients. The average number of years remaining to be lived at age 20 years was about two-thirds of that in the general population in these countries.
… there is still a large discrepancy between the life expectancy of the general population and the life expectancy of an HIV-infected individual. A person starting combination therapy can expect to live about 43 years at 20 years of age, about two-thirds as long as the general population in these countries.
Our life expectancy results are representative of all individuals who started combination therapy, including those who did not remain on such treatment throughout follow-up.
That is, an HIV-positive 20-year-old (who at least started on anti-HIV drugs) will on average live to the age of 63, 15-16 years less than U.S. male life expectancy of 78-79. The Lancet study also noted that HIV-infected women live longer than the infected men. ...
HIV/AIDS as part of syndemic among MSM
The CDC confirms that HIV is part of an MSM syndemic (complex of interrelated diseases). The connection between STDs and contracting HIV is strong, and frequent testing for both STDs and HIV is encouraged:
Persons who have an STD are at least two to five times more likely than uninfected persons to acquire HIV infection if they are exposed to the virus through sexual contact. In addition, if a person who is HIV positive also has an STD, that person is more likely to transmit HIV through sexual contact than other HIV-infected persons. ...
Ron Stall, PhD, explained that the concept of the MSM syndemic goes beyond just the interaction of these physical diseases, and encompasses the “intertwining epidemics” (especially in urban communities) of sexual abuse experienced as a child, partner violence, depression, substance abuse, failure to access health care, “community viral load,” and “psychosocial health problems” (such as high-risk sexual behaviors).
Researcher Dale O’Leary explains that our public health system’s faulty response has compounded the syndemic among MSM:
The various elements of the syndemic have an additive effect, each one intensifying the others. These factors include the number of infectious diseases endemic in this population, the high rate of substance abuse problems and psychological disorders, and the significant percentage of MSM who have experienced childhood sexual abuse and other adverse events. While MSM are disproportionately affected by HIV, syphilis, and other STDs, health activists from the gay community have systematically resisted the application of the full range of public health strategies traditionally used to prevent their spread....
The CDC confirms that HIV is part of an MSM syndemic (complex of interrelated diseases). The connection between STDs and contracting HIV is strong, and frequent testing for both STDs and HIV is encouraged:
Persons who have an STD are at least two to five times more likely than uninfected persons to acquire HIV infection if they are exposed to the virus through sexual contact. In addition, if a person who is HIV positive also has an STD, that person is more likely to transmit HIV through sexual contact than other HIV-infected persons. ...
Ron Stall, PhD, explained that the concept of the MSM syndemic goes beyond just the interaction of these physical diseases, and encompasses the “intertwining epidemics” (especially in urban communities) of sexual abuse experienced as a child, partner violence, depression, substance abuse, failure to access health care, “community viral load,” and “psychosocial health problems” (such as high-risk sexual behaviors).
Researcher Dale O’Leary explains that our public health system’s faulty response has compounded the syndemic among MSM:
The various elements of the syndemic have an additive effect, each one intensifying the others. These factors include the number of infectious diseases endemic in this population, the high rate of substance abuse problems and psychological disorders, and the significant percentage of MSM who have experienced childhood sexual abuse and other adverse events. While MSM are disproportionately affected by HIV, syphilis, and other STDs, health activists from the gay community have systematically resisted the application of the full range of public health strategies traditionally used to prevent their spread....
CDC now predicts: "Gay and bisexual men continue to be most affected by the HIV epidemic in the U.S.
At current rates, 1 in 6 MSM will be diagnosed with HIV in their lifetime, including 1 in 2 black MSM, 1 in 4 Latino MSM, and 1 in 11 white MSM."
At current rates, 1 in 6 MSM will be diagnosed with HIV in their lifetime, including 1 in 2 black MSM, 1 in 4 Latino MSM, and 1 in 11 white MSM."
Is the CDC spreading treatment optimism?
... “treatment optimism” (along with “prevention fatigue”) is likely dampening the success of the HIV/AIDS prevention efforts. The CDC has warned of complacency, especially among youth, now that anti-HIV drugs are available. Yet the campaign to encourage MSM to get tested broadcasts that there is effective help for them to “stay healthy” if they become HIV-positive.
[A] CDC graphic in the section ... clearly conveys “treatment optimism” in its advice: “Get Tested. Get in Care. Stay in Care. Stay Healthy.”
Some may still not realize that there is no cure for HIV/AIDS – and that other illness will plague them – when they are told they can “Stay Healthy” even if infected.
Other posters from CDC’s campaign to encourage testing among African-American MSM state, “Testing Makes Us Stronger.” Does this message imply that one can be infected with HIV yet still be strong, or even stronger than before? One in this series shows a muscular, fit, shirtless man flexing his muscles. Is this pandering to MSM sexuality, and even suggestively encouraging it? If that “empowering” message is working, why aren’t new infections in the African-American MSM population declining?
Increased testing and anti-HIV drug therapies have not brought down new HIV infection rates among MSM overall. Perhaps they have even contributed to the increase in highly risky sexual practices – because they foster “treatment optimism.” After all, the CDC poster (below) says, “HIV Treatment Works” and you can “live a longer and healthier life” even if you have HIV. “Longer and healthier” than without treatment: true. But that’s not how the casual reader intent on “gay” sex might read it.
... “treatment optimism” (along with “prevention fatigue”) is likely dampening the success of the HIV/AIDS prevention efforts. The CDC has warned of complacency, especially among youth, now that anti-HIV drugs are available. Yet the campaign to encourage MSM to get tested broadcasts that there is effective help for them to “stay healthy” if they become HIV-positive.
[A] CDC graphic in the section ... clearly conveys “treatment optimism” in its advice: “Get Tested. Get in Care. Stay in Care. Stay Healthy.”
Some may still not realize that there is no cure for HIV/AIDS – and that other illness will plague them – when they are told they can “Stay Healthy” even if infected.
Other posters from CDC’s campaign to encourage testing among African-American MSM state, “Testing Makes Us Stronger.” Does this message imply that one can be infected with HIV yet still be strong, or even stronger than before? One in this series shows a muscular, fit, shirtless man flexing his muscles. Is this pandering to MSM sexuality, and even suggestively encouraging it? If that “empowering” message is working, why aren’t new infections in the African-American MSM population declining?
Increased testing and anti-HIV drug therapies have not brought down new HIV infection rates among MSM overall. Perhaps they have even contributed to the increase in highly risky sexual practices – because they foster “treatment optimism.” After all, the CDC poster (below) says, “HIV Treatment Works” and you can “live a longer and healthier life” even if you have HIV. “Longer and healthier” than without treatment: true. But that’s not how the casual reader intent on “gay” sex might read it.
Above: Treatment optimism from the CDC.