Remember the AIDS pandemic?

June 12, 2008 8:40 AM

Remember the heterosexual AIDS pandemic?There isn't one outside of Africa. Actually, there never was. Well, at least not for straight people.
posted by falameufilho (81 comments total)

Not to LOLAFRICA (or "woeafrica") this, but for all of the head-scratching as to why? why? why?, where is the bit where they pick up on, ah ... "dry sex" as an African practice (tradition? I am having a difficult time locating a less offensive word) which might contribute to the issue?
posted by adipocere at 8:48 AM on June 12, 2008

There wasn't a hetereosexual Aids pandemic for straight people?
Was there a heterosexual Aids pandemic for gay people?
posted by CitrusFreak12 at 8:48 AM on June 12, 2008 [1 favorite has favorites]

Very interesting, I wonder how this will affect the charitable organizations dedicated to fighting AIDS. Also...

Dr De Cock, an epidemiologist who has spent much of his career leading the battle against the disease...

How droll.
posted by voltairemodern at 8:48 AM on June 12, 2008 [2 favorites has favorites]

"In the first official admission that the universal prevention strategy promoted by the major Aids organisations may have been misdirected..."

Or, you know, maybe it worked.
posted by Plutor at 8:49 AM on June 12, 2008 [13 favorites has favorites]

Well, you know, if it only happens in Africa then it hasn't really happened, AMIRITE?

(also, I'm curious how a heterosexual pandemic would affect the non-straight)
posted by delmoi at 8:51 AM on June 12, 2008

What a relief, I for one am happy to have one less thing to care about.
posted by I Foody at 8:52 AM on June 12, 2008

it was now recognised that, outside sub-Saharan Africa, it was confined to high-risk groups including men who have sex with men, injecting drug users, and sex workers and their clients.

Whew! Since none of those groups ever dovetail with heterosexuals, we're all in the clear!
posted by kittens for breakfast at 8:53 AM on June 12, 2008 [5 favorites has favorites]

I'm sure all those straight non-Africans would be happy to hear they died of something that wasn't AIDS.
posted by DU at 8:54 AM on June 12, 2008

Or, you know, maybe it worked.

Heh, reminds me of the conservatives who say environmentalism is pointless because pollution has been going down on it's over the past few decades.
posted by delmoi at 8:54 AM on June 12, 2008 [1 favorite has favorites]

I heard Elizabeth Pisani talking about this on CBC, and she said it was a way to get funding for an otherwise unpopular cause. But then much of the money was spent where it wasn't needed.
posted by weapons-grade pandemonium at 8:57 AM on June 12, 2008

Or like Y2K. I remember being told that "nothing happened, the eggheads were wrong again" after helping my organization reach compliance for 3 or 4 months in 1999.
posted by damn dirty ape at 9:01 AM on June 12, 2008 [1 favorite has favorites]

Americans with AIDS under-counted by 25% in previous studies.
posted by batmonkey at 9:02 AM on June 12, 2008

To me, that report says that hetero non-drug using westerners were at low risk, and remained so - that the disproportionate amount spent on advertising and education for those groups might have been better spent targeting those groups that were and are at much greater risk with effective measures (i.e. not abstinence only); gay men, intravenous drug users sharing needles and poorly educated africans, or even on badly underfunded programs like water-borne diseases and malaria.

In effect, wealthy hetero westerners got a lot of money spent on them they didn't need, that could have been spent on other groups at much greater risk that needed it more.

That said, maybe the education helped prevent a crisis, who knows. Plenty of people say now that all the money and effort spent on the Y2K bug was wasted, whereas I know personally - having working on many real problems for years in preparation of it - that the vast effort of preparation and spending was the reason why nothing much happened on the day itself. That just means the prevention job was done right!
posted by ArkhanJG at 9:05 AM on June 12, 2008 [4 favorites has favorites]

damn dirty ape, that was my experience as well, but I credit my tiger repellent with having warded off Y2K.
posted by JaredSeth at 9:07 AM on June 12, 2008

might have been better spent targeting those groups that were and are at much greater risk

The one thing that the Thatcher government can take credit for, IMO, was its sensible response to the emergence of HIV/AIDS. Not only did they unreservedly support needle exchange, they actually spent sizeable sums of money on making them available across the UK. (People in a position to know about this stuff tell me that their view was heavily influenced by the number of cabinet members who had close family members affected by drug dependence. Think Parkinson, Guinness, etc.)

In contrast, if a Cameron-led Conservative Government ever gets elected, this consensus is likely to break down. The party has already committed to withdrawing support for a drug policy based upon harm reduction, and a shift towards treatment services based on abstinence and away from the mixed economy based on patient choice that UK drug treatment services are currently supposed to offer.
posted by PeterMcDermott at 9:22 AM on June 12, 2008 [4 favorites has favorites]

In effect, wealthy hetero westerners got a lot of money spent on them they didn't need

Exactly. Oddly it's usually this kind of point the Mefites get all fired up about. But put "Africa" in the link or thread somewhere and...
posted by tkchrist at 9:22 AM on June 12, 2008

In effect, wealthy hetero westerners got a lot of money spent on them they didn't need, that could have been spent on other groups at much greater risk that needed it more.

But isn't that true for just about... well... EVERYTHING?
posted by incessant at 9:23 AM on June 12, 2008 [4 favorites has favorites]

Because you know, viruses are very unchanging and predictable things. But hey as long as we give AIDS Africa, it'll just be happy and leave the rest of us alone, right?
posted by Citizen Premier at 9:26 AM on June 12, 2008 [1 favorite has favorites]

This article makes we want to slap somebody, but I am not sure who.
posted by chillmost at 9:28 AM on June 12, 2008

In effect, wealthy hetero westerners got a lot of money spent on them they didn't need

This isn't exactly right. Budgets for AIDS in developing countries come from different pots than AIDS work in rich countries. Global Fund money (which accounts for something like 60% of international AIDS funding - I'm not remembering the exact number off the top of my head) doesn't get spent in Western Europe or North America. We pay for our own AIDS research, prevention, and treatment programs. And in defense of the Global Fund, they already have aknowledged that money should reinforce existing health systems and also address TB and Malaria which are pandemic as well.

In Southern Africa, I think its already understood by many in the public health world that improving basic health care, funding safe water projects and local health infrastucture is necissary to imporve health generally and reduce HIV specifically. Even if some big funders like the Gates Foundation are kind of clueless, there are influential organizations like Partners in Health who have been saying for years that we need to improve overall health in order to address HIV.

I'm not sure what the impact of de Cock's pronouncement will be. I hope that it will increase funding for respectful, effective work with people who are generally marginalized - sex workers, men who have sex with men, and injection drug users. I hope it doesn't serve to undermine international HIV work generally. But I do think that for the majority of the people in most of the world, a move towards reinforcing basic health care instead of providing funding based on a specific disease is a good thing.
posted by serazin at 9:40 AM on June 12, 2008 [2 favorites has favorites]

Aids still kills more adults than all wars and conflicts combined,

Then it's still a primary concern, regardless of how little it affects heterosexual non-intravenous drug users.
posted by quin at 9:42 AM on June 12, 2008

Also, that 50% stat about circumcision is highly suspect in light of recent findings.
posted by The White Hat at 9:45 AM on June 12, 2008

The perceived risk of AIDs to the straight non-drug-using population has certainly had an impact on sexual promiscuity. As Bill Hicks said...

I dunno how much AIDS scares y'all, but I got a theory: the day they come out with a cure for AIDS, a guaranteed one-shot cure, on that day there's gonna be fucking in the streets, man

If it turns out the risk was exaggerated, it seems very convenient for the religious right.
posted by phrontist at 9:47 AM on June 12, 2008

In effect, wealthy hetero westerners got a lot of money spent on them they didn't need, that could have been spent on other groups at much greater risk that needed it more.

AMEN. A-FUCKING-MEN.

I came out in 1983 having read that story about "the new gay cancer" in Rolling Stone. Within two years (give or take) I saw a PSA from some AIDS-prevention group that did not feature a single MALE actor, never mind gay men. None. And so I spent my 20s losing dozens of friends, lovers, and associates to AIDS, every one a gay man, and in that entire period I saw ridiculously more AIDS related education aimed at straights. The ONLY place for gay men- you know, the ones dropping like flies- to get any information was in gay bars, gay mags, or gay service centres- precisely the places that young, in-the-closet gay kids either avoided or didn't know about.

The straight pandemic never happened because female-to-male transmission (in western settings with western hygiene- and you know exactly what I mean) is next to impossible. I was saying this in 1984 and I am saying this now. Education had nothing to do with it- but delimiting all of the education to focus on straight people and misinforming gay kids that "it's not a gay disease," which means "we're all at zero risk because straight people are" really, I feel, killed thousands of gay men.

It IS a gay disease, it WAS a gay disease then even moreso, and the people who sold the public that pile of shit about the straight AIDS epidemic have blood on their hands. Filthy, filthy gay blood.

Jim Markiewicz, if you're reading this: I said in 1991 that someday I'd be in a position to say I told you so. I told you so.
posted by ethnomethodologist at 10:03 AM on June 12, 2008 [3 favorites has favorites]

ethnomethodologist, you've got good points here, and I completely agree that the 80s were a horror in terms of lack of public education (or funding, or anything) for gay men. Reagan and many others will rot in hell for what they did and what they failed to do.

But, most HIV education material I see NOW here in the US is geared towards gay men. Given, I live in the SF Bay Area, which is kind of like Atlantis, but HIV education here seems to be targeted at the communities where HIV has had the biggest impact: gay men, IV drug users (we've got needle exchanges etc), and urban poor people of color including straight people of color. If you look at the CDC stats, these are the groups most impacted by HIV in this country. At the same time, HIV can spread to anyone - its a virus not a sentient being - and so anyone who shares blood, semen, or yes, vaginal fluids with others can get the disease. I do think its responsible to make that clear too. There are major limitations to focusing on "risk groups" namely stigmatization of those risk groups and lack of information to the minority of people outside of those risk groups who will be effected (or infected).
posted by serazin at 10:14 AM on June 12, 2008

In effect, wealthy hetero westerners got a lot of money spent on them they didn't need, that could have been spent on other groups at much greater risk that needed it more.

At least some of that money would not have been spent on other groups. For example, a shit-tonne of money was spent developing programs to educate me and my peers (in the late '80s, in urban Nova Scotia) about how important condom use was, and how any guy who wanted to have sex without one was putting your life at risk, etc. That was education budget money. It wouldn't have otherwise been spent on higher-risk groups. It would have otherwise been spent teaching those same wealthy westerners math or grammar or how to correctly model the anatomical structure of the eyeball.
posted by joannemerriam at 10:21 AM on June 12, 2008

ethnomethodologist: I think you've got a point when it comes to education. But I'm curious what you think about the research situation. I was all of two years old in 1983, and so my understanding of the situation is second-hand, but the impression I get is that there simply wasn't enough funding or political support in those days for gay men's health. AFAICT, doing research on AIDS treatment back then meant supporting the lie that Your Straight White Daughter might someday be HIV-positive.

Obviously, the long-term solution was for gay men to get enough political capital to fund AIDS research. But that's been a decades-long struggle, and medical research was necessary right away.

At least, that's the story I've been told. I'm curious what you think, as someone who was old enough to see it with your own eyes. Would it have been better to maintain that AIDS was a gay disease, and let the research into treatment go unfunded for the next decade or two while gay rights was working its way into the political mainstream?
posted by nebulawindphone at 10:25 AM on June 12, 2008

There are not insignificant segments of the heterosexual population in the US and Europe that currently live by many of the same rules of promiscuity that the gay community did in the 1970s.

Frequent unprotected oral, anal and vaginal sex with many anonymous partners. I'm referring to swingers, a lifestyle that is getting more and more widespread year over year. And yet AIDS has yet to (re)emerge. So either the epidemiologists were quite mistaken about transmission, or its about to be deja vu all over again.
posted by Fupped Duck at 10:27 AM on June 12, 2008

Ummm, I don't believe this. It is still pretty easy for a straight person to get AIDS.

Let me take you through a scenario.

Straight boy meets straight girl in a bar, straight girl and boy go out a few times, straight girl and boy have sex, straight girl admits she is a drug addict.... Really it is pretty hard to tell when someone likes drugs when you just meet them, and yes prudence does say you should try to protect yourself but most of us are never 100%....

Let's be realistic about human behaviour too, there are places in Africa which have huge sex tourism industries which are seldom talked about since they tend to be frequented by white western women... it is no stretch to say that members of your community have been there (its more popular in Europe but I know women from NA who went to this otherwise uninteresting country). Sex tourists are one thing, but International Development workers tend to attract a lot of attention -- the agency I went overseas with even provided a "sex/dating/health" component of their pre-departure training. I can also think of one, very mousy, quiet, librarian-looking women, who contracted HIV this way and is now living quietly in her home country.

I don't think OMG HIV! is the right attitude but its a huge problem in every community.
posted by Deep Dish at 10:48 AM on June 12, 2008

Deep Dish - yes, the woman may have HIV, but it is unlikely that she will transmit it to a male partner:

Overall, there was a 1 in 159 risk of female to male HIV transmission (95% confidence interval: 110, 286) per act of vaginal sex. This risk was 2.49 times greater in uncircumcised men (1 in 196 vs. 1 in 78, p = 0.04).^
posted by MythMaker at 11:07 AM on June 12, 2008

So this means that either my brother never had AIDS and is still alive, or he was secretly homosexual? If he faked his death he sure gave a convincing performance as someone dying of tuberculosis. Thanks, internets, I never would've guessed.
posted by mullingitover at 11:12 AM on June 12, 2008

There are not insignificant segments of the heterosexual population in the US and Europe that currently live by many of the same rules of promiscuity that the gay community did in the 1970s.

Frequent unprotected oral, anal and vaginal sex with many anonymous partners. I'm referring to swingers, a lifestyle that is getting more and more widespread year over year. And yet AIDS has yet to (re)emerge. So either the epidemiologists were quite mistaken about transmission, or its about to be deja vu all over again.

So all swingers are having unprotected anal sex now? Um, I think not. College kids, maybe, in a drunken stupor, but I think swinging is enough of a fetish without adding unprotected anal to it as well. Most swingers are nice, normal people who just like to swap partners, with protection, on occasion.

The lifestyle to which you are referring, on the contrary, is not the swinger lifestyle: It's the "giant steaming douchebag" lifestyle, and it's not limited to swingers.
posted by Saydrah at 11:44 AM on June 12, 2008

I just quoted this in the thread about Pisani's article, but it is very topical to this discussion. The Economist relied heavily on Pisani's book in a June 7th article (and mentioned that they reviewed it in May). In that article, they stated directly what is very rarely discussed so clearly:

It has been known for years that HIV is hard to pass on during normal heterosexual intercourse. Only one copulation in 500-1,000 with an infected individual will do so. The risk comes with certain behaviour (anal intercourse, which risks tearing the lining of the gut; and injecting drugs using dirty needles), certain professions (prostitutes of both sexes) and certain ways of life (multiple, simultaneous lovers, rather than serial polygamy). Aiming propaganda at heterosexual teenagers is (outside the special case of Africa) a waste of money. It is, however, often an easier course than tackling drugs, whores and buggery, which many politicians would prefer to pretend have no place in their countries.
posted by Forktine at 11:47 AM on June 12, 2008

So this means that either my brother never had AIDS and is still alive, or he was secretly homosexual?

Or secretly an IV drug user, either of which is much more likely than that he got it from intercourse with a woman.
posted by nicwolff at 11:52 AM on June 12, 2008

The headline for this is misleading. The report (opinion piece) talks about epidemic not pandemic. It only cuts the numbers down to homosexuals after you exclude injection drug users, sex workers and people who visit sex workers (of which, there are quite a few and they need to be addressed). Even to do that it seems to be quoting one expert (with a gag name). Furthermore, I would also dispute his claim of "outside of Africa." Latin America and Caribbean HIV pandemic are largely heterosexual.
This digs at one of my pet peeves. HIV has been marginalized as homosexual. If someone had HIV and was a bisexual it was assumed they got HIV through the gay sex. There have been a lot of studies done about what types of sex will transmit HIV at what rate. Unprotected anal intercourse (whether heterosexual or homosexual) has a higher rate than unprotected heterosexual vaginal intercourse. (unprotected lesbian sex has a low rate - but only because God loves lesbians). Anal sex has a higher rate, but not such a difference as to warrant lack of concern among those engaging in vaginal sex.
posted by dances_with_sneetches at 12:04 PM on June 12, 2008 [1 favorite has favorites]

I'm referring to swingers, a lifestyle that is getting more and more widespread year over year. ^{[citation needed]}

FTFY.
posted by oncogenesis at 12:09 PM on June 12, 2008

nicwolff writes "Or secretly an IV drug user, either of which is much more likely than that he got it from intercourse with a woman."

This makes sense since he was living in Guam, which is a major military base and is notorious for its IV drug use and not its whore houses massage parlors.
posted by mullingitover at 12:13 PM on June 12, 2008

hmmm...this is probably the third or so story i've read telling straight people not to worry so much about aids...funny, when the largest increase in new cases (in the u.s.) is among straight teens in long island, NY. Sure, your odds might be a lot better having hetero sex (unless of course, you are a black woman), but go on, keep publishing articles like this, see if they stay that way.

i'm not saying the information is incorrect or shouldn't affect policy, just that publishing it to the widest possible audience is the surest way to MAKE it incorrect.
posted by sexyrobot at 12:17 PM on June 12, 2008

College kids, maybe, in a drunken stupor, but I think swinging is enough of a fetish without adding unprotected anal to it as well.

If this is just unutterably kinky to you, I don't foresee you having much of a future in swinging.
posted by kittens for breakfast at 12:26 PM on June 12, 2008

This makes sense since he was living in Guam, which is a major military base and is notorious for its IV drug use and not its whore houses massage parlors.

Ah, you neglected to mention that he was not-secretly visiting prostitutes in Guam. Gonna be a whole pandemic of that?
posted by nicwolff at 12:26 PM on June 12, 2008

So, if male to female transmission is rare, how did Kimberly Bergalis, Alison Gertz, Amanda Blake and Mary Fisher get it? I'm not being snarky, I've always sort of wondered why this handful of females contracted AIDS even though they didn't engage in risky behavior.
posted by Oriole Adams at 12:30 PM on June 12, 2008 [1 favorite has favorites]

Jesus Christ, nicwolff. Back the fuck off.

Look: men can get AIDS from straight sex — it's just that it's comparatively rare. The odds of a guy getting infected through vaginal sex are, last I checked, down around one-tenth the odds of a guy getting infected through receptive anal sex.

This means that in an entirely-straight population, AIDS will spread much more slowly than in a population of men having anal sex with each other.

But it will still spread. Some straight guys do get AIDS, even outside Big Bad Scary Africa, and without sleeping with men or using needle drugs. And that's still tragic. This is so basic I can't believe I actually need to point it out, but the decent response to "My brother died of AIDS" is still "I'm sorry," and not "I bet he was a junkie" or "Let's talk about the whores he went to."
posted by nebulawindphone at 12:35 PM on June 12, 2008 [7 favorites has favorites]

So, if male to female transmission is rare, how did Kimberly Bergalis, Alison Gertz, Amanda Blake and Mary Fisher get it? I'm not being snarky, I've always sort of wondered why this handful of females contracted AIDS even though they didn't engage in risky behavior.

I missed this one on non-preview, but it's the same deal. "Rare" doesn't mean "non-existent." Some people outside the risk groups get AIDS — fewer, but some.

As for "why," there's only ever one answer — they took a risk and got unlucky. It may have been a smaller risk than others take, but still a non-zero risk; their luck may have been worse than others', but it was still just ordinary bad luck.
posted by nebulawindphone at 12:39 PM on June 12, 2008

I really hope it's true.
posted by Nelson at 12:59 PM on June 12, 2008

So, if male to female transmission is rare, how did Kimberly Bergalis, Alison Gertz, Amanda Blake and Mary Fisher get it?

It's F-to-M transmission that is really rare. M-to-F transmission is depressingly common--look at the skyrocketing rates of HIV infection amongst African-American women in the past few years.
posted by dirtynumbangelboy at 1:00 PM on June 12, 2008

Sorry, should have been more precise.. F-to-M transmission via vaginal intercourse is really rare. I imagine that chances of F-to-M transmission via unprotected anal intercourse would be the same as M-to-M rates (from bottom to top, that is).
posted by dirtynumbangelboy at 1:20 PM on June 12, 2008

"It is very unlikely there will be a heterosexual epidemic in other countries. Ten years ago a lot of people were saying there would be a generalised epidemic in Asia – China was the big worry with its huge population. That doesn't look likely. But we have to be careful. As an epidemiologist it is better to describe what we can measure. There could be small outbreaks in some areas."

"The Caribbean, with an HIV prevalence rate of 1%, is the second-most affected region in the world after sub-Saharan Africa, and the most affected in the Americas.1,2 AIDS is a leading cause of death among 25–44 year-olds in the Caribbean.1 Within the region, the epidemic varies significantly by country and population, reflecting the Caribbean’s cultural, ethnic, and geographic diversity. Some Caribbean countries have adult HIV/AIDS prevalence rates (the percent of people living with HIV/AIDS) of at least 1%, the highest rates in the world outside of sub-Saharan Africa.1,3

[snip]

HIV is spread primarily through heterosexual sex in the Caribbean, with commercial sex playing a large role in many places, although transmission patterns vary across the region and within countries.1 While sex between men is also an important factor in HIV transmission in the region, stigma and discrimination make it difficult to assess the extent of its role and to reach those at risk.1,4,5,6 Injecting drug use plays a small role in transmission in most countries in the region, with the exception of Bermuda and Puerto Rico, where injecting drug use is the key factor in transmission.1

[snip]

• Women comprise an increasing share of those with HIV/AIDS in the region, now accounting for 43% of adults estimated to be living with HIV/AIDS, up from 37% in 2001.1,11"

Source (pdf)
Usual disclaimer: I work for the place that profuced this report, but I do not write the reports or do anything on the policy side
posted by rtha at 1:48 PM on June 12, 2008

rtha, Caribbean men having sex with other men lie about it. There is horrific stigma surrounding homosexuality.
posted by ethnomethodologist at 2:18 PM on June 12, 2008 [2 favorites has favorites]

The only reason this is anywhere near correct is the success of clean needle programs. Places which do not protect their addicts wind up with heterosexual epidemics amongst the poor, even if they don't end up widespread in the general population.

This is why this bit from the article is particularly dumb:

But the factors driving HIV were still not fully understood, he said.

"The impact of HIV is so heterogeneous. In the US , the rate of infection among men in Washington DC is well over 100 times higher than in North Dakota, the region with the lowest rate. That is in one country. How do you explain such differences?"

Um, North Dakota is a rural, nonpopulous state with over-the-counter availability of needles for its tiny IV drug using population. Washington, DC is urban, has lots of IVDU's and poverty and has been under a federal government ban from providing clean needles to addicts, even if it spends its own money, until very recently. That's how you explain them: stupid policy decisions.

America chose to have the heterosexual epidemic it *does have* amongst the poor (particularly African Americans) by failing to do needle exchange early and widely.
posted by Maias at 2:26 PM on June 12, 2008 [1 favorite has favorites]

Caribbean men having sex with other men lie about it. There is horrific stigma surrounding homosexuality.

Additionally, some of the same things that are driving the HIV epidemic in Africa (notably, concurrent rather than serial sexual partners) are big factors in parts of the Caribbean. Additionally, there is so much migration (creating split families, as in southern Africa) and sex tourism that HIV in the Caribbean has a lot to do with risk factors in other countries, not just factors in the islands.
posted by Forktine at 2:29 PM on June 12, 2008

"A homosexual is someone who, in 15 years of trying, can't get a pissant anti-discrimination bill through City Council. They are men who know nobody, and who nobody knows. Now, Henry, does that sound like me? No. I have clout. Lots. I have sex with men; but, unlike nearly every other man of which this is true, I bring the guy I'm screwing to Washington, and President Reagan smiles at us and shakes his hand."

posted by matteo at 2:50 PM on June 12, 2008 [2 favorites has favorites]

Maias, I don't care if you disagree with the article, but de Cock isn't just some clown shooting off at the mouth. He's an epidemiologist who has made a career studying HIV around the world. Before becoming the head of the WHOs HIV program he directed massive HIV programs in Uganda which is where a large percentage of HIV research happens.

What your saying about needle exchange is the current public health wisdom. And I agree that needle exchange is awesome and necissary. But Eastern European governments have really sucked at providing needle exchange or any other support for injection drug users. Yet the epidemic is still mostly confined to that community there. de Cock is observing the hardest numbers available and sharing those numbers with the public - even though we were all afraid that HIV would quickly "jump" from the IDU community to the heterosexual, non-drug using community, it just hasn't there.
posted by serazin at 3:01 PM on June 12, 2008

The 'Angels in America' Roy Cohn scene to which matteo refers -- video | 7:57.
posted by ericb at 3:09 PM on June 12, 2008 [1 favorite has favorites]

Premiere webisode from HIV Big Deal, a new website promoting awareness and prevention of HIV and AIDS among gay men.
posted by ericb at 3:12 PM on June 12, 2008

H.I.V. Rises Among Young Gay Men

"AIDS appears to be making an alarming comeback. The Journal of the American Medical Association reports that the incidence of H.I.V. infection among gay men is shooting up, following an encouraging period of decline. The rise of infections among younger gay men, especially black and Hispanic men, is troubling, and the study carries the clear implication that people at high risk of contracting the disease are becoming less cautious.

...The one bright spot in this bleak picture was the 22 percent decline in infections among men over 30 in the New York study. Awareness of the disease’s devastating effects, as much as maturity, may explain the difference. A large number of these older men came of age when AIDS was all but untreatable. They may have buried friends who died after being horribly ill.

When the disease was new and terrifying, the gay community helped change behavior by preaching loudly against taking sexual risks.

...Silence now seems to be winning the day. Nearly 6,000 gay men died of AIDS in the United States in 2005; still, many young men appear to have persuaded themselves that the infection is no longer such a big deal. It is true that antiretroviral therapy has improved the outlook for anyone who becomes infected. But the treatments are still too new to know whether they can work much beyond a decade. Public health officials need to continue to distribute condoms, encourage testing and treat those who are ill. Leaders in the hardest-hit communities need to start speaking out again. The fight against AIDS is far from over."

posted by ericb at 3:16 PM on June 12, 2008

Adding to the above, "The plague is over, let's party."
posted by blucevalo at 3:39 PM on June 12, 2008

Adding to the above, "The plague is over, let's party."

Be sure to check out the recent FPP -- and the contributions to the thread made by the author (Elizabeth Pisani) of the article you cite.
posted by ericb at 4:02 PM on June 12, 2008

Whoops ..... should've searched that before posting. Sorry about that.
posted by blucevalo at 4:28 PM on June 12, 2008

Jesus Christ, has nobody ever heard of bisexuality before? Straight non-IV drug using men might have less to worry about, but I don't see how this changes anything for straight women.

(lesbians are also safe, but we all knew that, so lets move on. . .)
posted by dinty_moore at 4:29 PM on June 12, 2008

Article: "It is the question we are asked most often – why is the situation so bad in sub-Saharan Africa? It is a combination of factors – more commercial sex workers, more ulcerative sexually transmitted diseases, a young population and concurrent sexual partnerships."

Could these authors not imagine the other commonality that differentiates most sub-Saharan African countries from virtually everywhere else on earth?
posted by Adam_S at 4:30 PM on June 12, 2008

Could these authors not imagine the other commonality that differentiates most sub-Saharan African countries from virtually everywhere else on earth?

Uh, what would that be?
posted by Avenger at 5:25 PM on June 12, 2008

Extreme grinding poverty is what I am hoping he meant. Along with attendant lack of education, lack of agency (for women) in their own sexual decisions, etc.
posted by dirtynumbangelboy at 7:29 PM on June 12, 2008

Yes, exactly. The focus on behavioural aspects and exclusion of social factors leaves the analysis a bit incomplete.

He mentions Russia being on a precipice of catastrophe. Do the same factors that lead Russia to this position mean it can expect similar results as South Africa? After all, "Sexual behaviour is obviously important but it doesn't seem to explain [all] the differences between populations". Injection drug use may be the most common vector now, but there's no reason it will remain that way.

Obviously South Africa's sexual behaviour (in the sense of some inherent social norm of multiple partners) didn't change from 1991 to today, while the infection rate went from 1% to 25%. This was a period of rapidly widening economic inequalities. Focusing so exclusively on behavioural aspects, circumcision, etc., seems to miss this point.
posted by Adam_S at 8:22 PM on June 12, 2008

Obviously South Africa's sexual behaviour (in the sense of some inherent social norm of multiple partners) didn't change from 1991 to today,

Why is this obvious? The lifting of travel restrictions, increases in both inequality and some kinds of social mobility, and increased immigration from other southern African countries, not to mention twenty years of change in religion, education, and everything else, could be presumed to have had some impact on sexual behavior. Why would sexual norms be fixed? And even if the norms didn't change, I can't see how you can be so sure that sexual behavior did not change, and is not continuing to change.

Just to pick one example, South Africa now has the highest rate of reported rape in the world. (Here's an unpleasant article from the BBC on the subject, with some statistics that if true are genuinely horrifying.) While sexual violence was always a component of the apartheid system, and most sexual assault went unreported in the bad old days (making then/now comparisons hard), the post-apartheid crime wave, which has ebbed and flowed, demonstrates how risk factors can shift over time.

I may be misunderstanding your point -- and if I am reading you correctly, I agree that poverty and structural biases are a fundamental part of why some populations are so at risk from HIV. But social factors and other structural limitations do not take away people's responsibility for their actions or their ability to make decisions or vice versa. HIV, like modern TB, is a disease that requires both marginalized populations (structure) and individual choices (behavior). It takes both; focusing on only one, as you point out, means that you are unlikely to prevent the disease from spreading.
posted by Forktine at 10:50 PM on June 12, 2008

I read a collection of interviews about twelve years ago in which one young man claimed he contracted HIV from a girlfriend who had also given him crabs. I consider transmission from the bite sore of the infected woman into the bite sore of the guy who wasn't to be credible.
posted by brujita at 11:31 PM on June 12, 2008

Forktine, I definitely don't want to argue that sexual behaviour in general is fixed. In my mind anyway, I was trying to differentiate between different descriptions of sexual behaviour. Say, prostitution increasing because of increasing economic inequalities versus a general 'African' preference for dry sex or non-monogamy. This article and the media in general seem to group all of these things together without looking at structural factors.

The South African AIDS rate actually went from 1% to 25% within a single decade. (Some statistics I happen to have in front of me show it growing amongst new mothers from single digits to 23% within 4 years) Factors like lower circumcision rates don't on their own explain how such a rapid increase occurs, and why it happened so rapidly in a particular country. Some areas which have "commercial sex workers, high STI infection rates, a young population and concurrent sexual partners" didn't experience as significant an increase.

But social factors and other structural limitations do not take away people's responsibility for their actions

No, but the focus on these behavioural aspects (as noted by many others above) often serves simply to stigmatize individuals. Further, the structural factors might offer a better explanation as to why actions and behaviours change over time. (Women who turn to prostitution out of economic desperation, economic migrants who use prostitutes after living away from their families for extended periods, etc) At the very least it might offer a more useful perspective for attempts to change such behaviour.
posted by Adam_S at 5:56 AM on June 13, 2008

I read a collection of interviews about twelve years ago in which one young man claimed he contracted HIV from a girlfriend who had also given him crabs. I consider transmission from the bite sore of the infected woman into the bite sore of the guy who wasn't to be credible.

You're joking, right? I mean.. theoretically possible, sure. But the chances are vanishingly remote.
posted by dirtynumbangelboy at 6:13 AM on June 13, 2008

No. I don't remember the title of the book, but the interviews had been conducted in the UK during the late 80's/early 90's.
posted by brujita at 7:17 AM on June 13, 2008

You do understand that the bite from a crab is tiny, yeah? And the chances of both parties having a bite which is an actively open sore, with one of them weeping body fluid carrying HIV, and both coming in contact for long enough for the virus to pass from one host to the other is so vanishingly remote as to be within the realms of fantasy, yes? You also realize that there are huge psychological and sociological reasons why many men who publicly identify as heterosexual, or hide their IV drug use, would be, shall we say, less than forthcoming about how they actually contracted the disease and thus make up ridiculous stories, yes?
posted by dirtynumbangelboy at 7:38 AM on June 13, 2008

"Some people fear that HIV might be transmitted in other ways; however, no scientific evidence to support any of these fears has been found. If HIV were being transmitted through other routes (such as through air, water, or insects), the pattern of reported AIDS cases would be much different from what has been observed. For example, if mosquitoes could transmit HIV infection, many more young children and preadolescents would have been diagnosed with AIDS.

All reported cases suggesting new or potentially unknown routes of transmission are thoroughly investigated by state and local health departments with the assistance, guidance, and laboratory support from CDC. No additional routes of transmission have been recorded, despite a national sentinel system designed to detect just such an occurrence.

[snip]

From the onset of the HIV epidemic, there has been concern about transmission of the virus by biting and bloodsucking insects. However, studies conducted by researchers at CDC and elsewhere have shown no evidence of HIV transmission through insects--even in areas where there are many cases of AIDS and large populations of insects such as mosquitoes. Lack of such outbreaks, despite intense efforts to detect them, supports the conclusion that HIV is not transmitted by insects.

The results of experiments and observations of insect biting behavior indicate that when an insect bites a person, it does not inject its own or a previously bitten person’s or animal’s blood into the next person bitten. Rather, it injects saliva, which acts as a lubricant or anticoagulant so the insect can feed efficiently. Such diseases as yellow fever and malaria are transmitted through the saliva of specific species of mosquitoes. However, HIV lives for only a short time inside an insect and, unlike organisms that are transmitted via insect bites, HIV does not reproduce (and does not survive) in insects. Thus, even if the virus enters a mosquito or another sucking or biting insect, the insect does not become infected and cannot transmit HIV to the next human it feeds on or bites. HIV is not found in insect feces."
(emphasis mine)
posted by rtha at 8:50 AM on June 13, 2008

This may seem like a (re)statement of the obvious, but perhaps not:

HIV is not easy to transmit .... HIV spreads from one person to another only through sexual contact (by vaginal secretions and especially semen) and direct entry into a person's blood (such as sharing IV needles or during the pregnancy of an infected mother, when the fetus and neonate are at risk). The virus must actually enter the bloodstream of the recipient before infection can occur; contact with normal skin is not enough. It does not spread like the common cold or with the relative ease of other sexually transmitted diseases. It is not even spread as easily as other viruses, such as hepatitis B, for which existing guidelines have been proven effective .... It should be apparent ... that if entry of a quantity of virus into the blood of the recipient is necessary to establish an infection, HIV cannot be spread by casual contact, by mere proximity to an infected person or by touching.

In addition, that CDC factsheet linked above by rtha is well worth perusing in its entirety.
posted by blucevalo at 9:13 AM on June 13, 2008

I'm a straight male, age 43, and all the AIDS hoopla of the 80s scared me a fair bit. I was never going to be much of a sexually promiscuous kind of guy, as that's just not me, but the AIDS epidemic scared me enough to be extremely cautious about sexual encounters, to the extent that in my entire life the number of women with whom I've had sex totals six, and only one for the last ten years.

Even if the odds are 1 in 500 are 1 in 1000 of catching AIDS from a female partner who's infected, I still think those odds are worthy of respect. I mean, I spend $20 on lottery tickets whenever Powerball tops $100 million, and the odds of *that* are hundreds of millions to 1 against me. Improbable things do happen, and they're just as likely to happen to me as they are to happen to someone else.

African nations are, from what I can tell, pretty fucked so far as AIDS is concerned. They're pretty fucked so far as global warming is concerned too, for that matter.
posted by jamstigator at 4:17 PM on June 13, 2008

This was my interpretation of the scenario:
One partner has crabs and passes them on to the other. One of the partners is also infected with HIV.
They both scratch themselves bloody where they are bitten.
The bleeding areas on each person make contact.
The partner with HIV has then transmitted the virus to the other.


Long shot, but plausible.
posted by brujita at 11:37 PM on June 13, 2008

Mullingitover, I am sorry that you have lost your brother.
posted by brujita at 6:28 AM on June 14, 2008

Long shot, but plausible.

In the sense that 'being killed by falling airplane parts' is plausible, yes. In other words.. not really.
posted by dirtynumbangelboy at 7:50 AM on June 14, 2008

In the US, as of 2005, 2% of the African-American population was infected with HIV. That's an outrage and it's certainly an epidemic. Amongst the women, 75% comes from heterosexual sex and 25% from IV drug use directly.

So, to say that the idea of a heterosexual epidemic in a general population outside of Africa is a myth is simply false: if you don't do needle exchange early with widespread information to addicts about protection and you have 1/4 of the young male population in and out of prison, you will have one.

And, if you don't believe that heterosexuals and babies are at risk if you don't do clean needle programs and education, you don't do clean needle programs and education because people actually like the idea of killing off the junkies.

My problem with the contention that there was never really a risk of a hetero epidemic outside Africa is that there *was* a risk and it was averted in some places by clean needle programs, and not averted elsewhere by refusal to do them in time and other factors.

The places that did do needle exchange would never have gotten past the politics of it if they didn't believe there was a risk to the general population.
posted by Maias at 8:55 AM on June 14, 2008

Dnab, enough. I've never had crabs-- but plenty of mosquito bites. The surface area of my scratching has always been larger than that of the bite/welt.

I have read in HIV prevention literature that it is best not to give a blowjob shortly after one has flossed their teeth--even if their gums HAVEN'T bled-- because of possible transmission.
posted by brujita at 10:23 AM on June 14, 2008

But Maias, the point of de Cock's statement is that in Eastern Europe for example, where needle exchange programs have not been instituted on a large scale and injection drug users are marginalized and receive few services, even there HIV has not impacted the heterosexual, non-drug-using community much.

No one should get HIV - one case is too many - and I think HIV education belongs everywhere. In other words, I agree with you that de Cock's analysis sucks in that respect. But the pandemic that was predicted just hasn't happened in the way that certain people had said it would. HIV hasn't "jumped" on the scale that the public health world said it would.
posted by serazin at 10:50 AM on June 14, 2008

My point is that it's a pretty good bet that HIV would have broken out further into the poor population if clean needle stuff *wasn't* done and getting the clean needle stuff done required a message about risk to others to get past the politics.

And I don't think you can make the case that the poor population of Eastern Europe is safe (I bet if you stratify by SES, you *do* see an epidemic there that isn't just addicts-- just like in our African American community, but I haven't looked at the numbers myself).

It was clear a good ten years ago that the heterosexual, middle class population of Western countries with little contact with the poor and IV drug users were not at huge risk-- but before that (and that was the time when all the money was spent and the 'everyone is at risk' message was most widespread), it wasn't.

It was certainly clear that transmission was difficult-- but the "difference that made a difference" between the places at risk of spread into the general population was still unknown. I remember major arguments over whether the differences were primarily due to prevalence of other STD's, sexual behavior patterns, poor general health, nutrition, etc.

Given that, and given the lack of effective treatment at the time, I think the 'we're all at risk' message was absolutely justified. Just think about the discussions we'd be having if we'd erred in the opposite direction: "They told us it was safe, they hid the risk...."

And I just don't think you can make the case that the public health world *shouldn't* have sent the messages it did at the time and it's impossible to know if it was those very messages that made the difference by changing people's behavior enough to avoid the problem.
posted by Maias at 7:57 AM on June 15, 2008

As per the U.N.'s 2007 AIDS Epidemic Update [PDF]:

"In 2007, AIDS...result[ed] in the deaths of millions - 2.1 million...including approximately 330,000 children. And, in these United States, incidences of AIDS in the heterosexual community 'accounted for just under one third (32%) of newly diagnosed HIV infections and AIDS cases.'"^*

posted by ericb at 3:27 PM on June 18, 2008

Washington Times columnist,Wesley Pruden, calls AIDS ‘the gift of the gays.’

Pruden has a history of writing that heterosexuals having AIDS is a “myth.”
posted by ericb at 3:30 PM on June 18, 2008