Tuesday, February 15, 2005

New AIDS Fears Spark Policy Reappraisal

The possible discovery of a new and more virulent strain of HIV/AIDS - apparently resistant to most of the anti-viral drugs used to slow the disease - in New York City has prompted gay activists and leaders to reconsider their tactics for disease prevention.

While many are calling for a renewed commitment to prevention efforts and free condoms, some veterans of the war on AIDS are advocating an entirely new approach to the spread of unsafe sex, much of which is fueled by a surge in methamphetamine abuse. They want to track down those who knowingly engage in risky behavior and try to stop them before they can infect others.

It is a radical idea, born of desperation, that has been gaining ground in recent months as a growing number of gay men become infected despite warnings about unsafe sex.

Although gay advocates and health care workers are just beginning to talk about how this might be done, it could involve showing up at places where impromptu sex parties happen and confronting the participants. Or it might mean infiltrating Web sites that promote gay hookups and thwarting liaisons involving crystal meth.

Other ideas include collaborating with health officials in tracking down the partners of those newly infected with H.I.V. At the very least, these advocates say, gay men must start taking responsibility for their own, before a resurgent epidemic draws government officials who could use even more aggressive tactics.

"Gay men do not have the right to spread a debilitating and often fatal disease," said Charles Kaiser, a historian and author of "The Gay Metropolis." "A person who is H.I.V.-positive has no more right to unprotected intercourse than he has the right to put a bullet through another person's head," he said.

While not endorsing specific strategies, even mainstream organizations like the Gay Men's Health Crisis support the idea of trying methods that would have been anathema a few years ago. "It makes a community stronger when we take care of ourselves," said Ana Oliveira, the organization's executive director, "and if that means that we have to be much more present and intervene with people who are doing this to themselves and others, then so be it."

The possible new strain was discovered in a 40-something man who admitted to heavy methamphetamine use while engaging in unprotected sex with a large number of other men. The patient had been previously tested negative for HIV - allowing doctors to establish a relatively accurate timeline for his infection - and progressed from infection to AIDS in a matter of months, apparently resisting the major anti-viral drugs which have slowed the disease's progression in other patients. Some AIDS researchers remain skeptical, however, noting that the man's immune system may have already been severly depressed due to his frequent use of crystal meth (methamphetamine).

Nevertheless, the fact that gay activists are openly discussing forcibly curbing individual activity to restrain the spread of the possible new strain represents a dramatic change of attitude.

In the early years of the AIDS epidemic, gay men protested attempts to close down bathhouses and strenuously opposed efforts by health officials to trace those infected with the virus. Until now, those advocates, driven by concerns about privacy and the stigma associated with the disease, have successfully fought off efforts to impose a traditional public-health model for tackling the spread of the virus.

"You have to remember that was the era when Jesse Helms and others were saying that gay people got what they deserved, and that the government shouldn't spend any money to help them," said David Evans, an H.I.V. treatment advocate who writes about prevention. "There was a time when people thought, 'Oh my god, they're going to put us in camps.' "

While gay activists may have had justifiable fears over how coercive government policies would have stigmatized their community, by circumventing the "tradition public health model" for dealing with a lethal contagious disease, they may have drastically increased the death toll amongst homosexuals. Had traditional methods been employed, the infected would have been isolated (quarantine) and those they had engaged in sex with identified, tested and placed in quarantine as well if they were also infected. Gay activists believed that such a program would have been used to persecute the gay community and possibly to exterminate it. To forestall that, gay activists pushed an agenda that granted HIV-infected people a broad bill of privacy rights. Test results were to be kept strictly confidential; health workers could not notify an individual's sex partner even when the individual tested positive. Curtailing and infected person's behavior was almost legally impossible. All emphasis was directed toward educating people about HIV transmission and developing treatments. However, despite a very public campaign in favor of safe sex and the life-saving effects of the new classes of anti-viral drugs "the rate of new [HIV] infections has remained unchanged at about 40,000 cases a year, frustrating many advocates."

Those frustrations were given voice in November by Larry Kramer, the playwright and activist who himself has AIDS, in a widely discussed speech at Cooper Union in which he criticized gay men for their behavior. "You are still murdering each other," he said then. "Please stop with all the generalizations and avoidance excuses gays have used since the beginning to ditch this responsibility for this fact." <> In an interview, Mr. Kramer said on Sunday that the warning of a possibly aggressive new strain of H.I.V. confirmed his fears and filled him with a sense of hopelessness. "Even in the days of the worst infections, no amount of prevention seemed to work, and that's probably the scariest thing of all," he said.

Mr. Kramer has finally grasped one of the saddest, but most elementary, facts of human existence: many people do not act in accordance with their long-term best interests, or with any concern to the best interests of others. This fact manifests itself every day in a thousand ways from the continued prevalence of smoking, to drug use, alcohol abuse, obesity and the rampent spread of sexually tranmitted diseases (including AIDS). This understanding undergirded the "traditional public health model" that was used so effectively to combat diseases from typhoid to syphilis. By relying solely on people to police their own actions in an area as emotionally and hormonally conflicted as sex, gay activists only insured that a certain percentage of infected gay men would have continued license to transmit the disease to other gay men.

"You can't have a core group of people having sex with large numbers of people without amplifying any sexually transmitted disease that enters the system," said Gabriel Rotello, author of "Sexual Ecology: AIDS and the Destiny of Gay Men." "I don't have any doubt that a resurgent H.I.V. epidemic will hit the gay population in the near future," he said.
<>The gay community did make progress with its prevention programs in the late 1980's, but that progress began to fail in the mid-1990's as younger homosexuals became tone-deaf to the program and anti-viral drugs seemed to mitigate the lethal nature of the disease. Drug use and promiscuity (always complimentary) are spiraling upward as the crystal meth epidemic escalates. Forcible containment measures would have greatly reduced the spread of HIV/AIDS and saved many gay men from infection and death. Unfortunately, the gay community opted for the identity politics of left, which easily accomodated bad behavior and prevented public health intervention. In fairness, the political right, dominated by religious conservatives who despise homosexuality, offered no support. Nevertheless, the gay community must take responsibility for its own actions, regardless of the hostility of others. Some policies work. Some don't. No matter what others think.
<>The above-mentioned Mr. Rotello has been branded a "reactionary" for attempting to educate the gay community about the biological realities of sexually transmitted disease and the consequences of promiscuity. But there are no free lunches in life. No actions without consequences. And in the end, of course, biology always wins.


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