AIDS Action Committee’s Blog

Advocates for a new HIV prevention that would provide men and women with an alternative to condoms are reveling in our moment. The results of the first ever completed – not closed – microbicide trial of the product Carraguard are absorbing the trial’s results released today. The short answer is this study showed Carraguard, a microbicide derived from carrageenan which is more popularly known for it’s use in thickening food products, was safe to use and not harmful to women, but not effective in preventing HIV.

This is far from the end for microbicides, or HIV prevention research in general. We’re just making history. Carraguard was the first new microbicide candidate to enter clinical trials (in 1996) and the first to complete a Phase 3 trial. Other Phase 3 trials were stopped early for various reasons. These large-scale trials rely on participants to use the product consistently over a long period of time. Over 6,000 women participated in the Carraguard trial for up to two years, proving that such trials can be done with scientific rigor and ethical integrity.

More will be learned from this trial beyond Carraguard’s (lack of) efficacy as a gel that would allow women say in protecting themselves against HIV. What happened in these three South African sites where over 6,000 women volunteered their bodies and their sex lives for the greater good was a glimpse into their bedroom behaviors and the role research plays in the health of a community. Findings that may be considered ancillary to the research’s aim are perhaps the groundbreakers for advocates working with communities at risk, including those in South Africa: condom use by trial participants DOUBLED during the trial and STI rates decreased.

Add this to the reality that the presence of research infrastructure in these communities means increased access to health services for the trial volunteers, their partners and those who get screened but are not involved in the trial (over 9,000 people were screened in connection to this trial).

Opponents of research based on ethical concerns should have no issue with the Carraguard trial. The efforts by the researchers, by the advocates who relentless push for truly informed consent and access to care (think “No Woman Left Behind”) related to these trials, and by the women from the communities where the trial happened who fight stigma, sexual violence, and a lack of power in their primary relationships, all demonstrate how research can be the catalyst for a bigger intervention just awaiting the resources needed to make it happen.

Microbicide advocates have not run out of things to do. Three more candidate products are now in late clinical trials that will produce results soon. Developing new tools to prevent HIV– particularly among women – is an urgent priority. According to UNAIDS, approximately 3,500 women are becoming infected with HIV each day. Microbicide advocates have been actively, visibly and vocally involved in the process of microbicide research and development from the very beginning. Our involvement will continue until the goal in achieved – and safe, effective, accessible and affordable microbicides are in the hands of all who need them.

As the U.S. recognizes the 8th National Black HIV/AIDS Awareness Day today, we herald this year’s theme, “Prevention is Power” and take to heart the call for and challenges in the day’s annual reminder for people to Get Educated; Get Tested; Get Involved; Get Treated.

Annual recognitions such as this, and this one in particular, remind us to mark our location in our battle to end AIDS in America, demand bold and calculated action and seize special opportunities that get us closer to stopping new infections and ending HIV/AIDS in the African-American community and throughout the U.S.

Where are we in America? AIDS is still a leading cause of death for African-Americans and the leading cause of death for African-American women aged 24-34. Half of new HIV infections each year are among young people, and 56 percent of them are African-American. The President’s FY2009 budget is shameful in its recommended funding reductions. We still have no National AIDS Strategy although we require countries that receive U.S. funds for HIV/AIDS to have national plans. Infection rates of HIV are ramping up among African-American people, especially African-American gay and bisexual men and in some cities including New York and D.C., young African-American gay men.

What can we do in America? In this election year, we call for the next President to create a National AIDS Strategy with measurable outcomes, a specific timeline and adequate funding to address HIV/AIDS as a domestic priority. And we call for head-on action to address stigma, discrimination and denial that inhibit enacting the most effective interventions to deal directly with HIV prevention, education, testing, treatment, care and research, especially to curb the devastating effect of this disease on people in Black communities.

How can we seize special opportunities in America? Both of the Democratic and one of the three leading Republican Presidential candidates have committed to creating a National AIDS Strategy. Visit www.NationalAIDSstrategy.org to learn what you can do to help. Also, on National Black HIV/AIDS Awareness Day, more than 800 communities across the country are hosting informative and inspiring events to honor this day. Find one near you and support it. For example, in Los Angeles tonight, Black AIDS Institute hosts an event recognizing honorees as part of “Heroes in the Struggle,” a photographic tribute to African-Americans who have made outstanding contributions in the fight against HIV/AIDS. Established on World AIDS Day, Dec. 1, 2001, the traveling exhibit has raised awareness, challenged people and communities to be involved and recommit to ending HIV/AIDS in the U.S., and it has inspired needed dialogue about HIV testing and treatment. Visit www.BlackAIDSday.org to find an event near you.

In my work in AIDS Action’s Health Library, I’m often asked this question.
Last week, a group of Swiss HIV experts issued a statement basically saying: “No, condom use isn’t necessary – provided that certain other conditions are met.” [Emphasis mine]

Before going into more detail, I think it’s important to note that some other expert groups have disagreed with the Swiss group’s conclusions. The U.S. Centers for Disease Control and Prevention (CDC) issued a brief statement, saying that the CDC “underscores its recommendation that people living with HIV who are sexually active use condoms consistently and correctly with all sex partners.” Likewise, UNAIDS and the World Health Organization stated that, to prevent transmission of HIV, they “strongly recommend a comprehensive package of HIV prevention approaches, including correct and consistent use of condoms.”

So, what exactly did the Swiss experts say? And why is it controversial?

In brief: Based on their review of several medical studies, the Swiss group concluded that an HIV-infected person who is on HIV treatment and has a consistently undetectable viral load “is not sexually infectious, that is, cannot transmit HIV through sexual contact.”

However, according to their statement, the following conditions must also be met:

The Swiss group also acknowledges that “medical and biologic data available today do not permit proof that HIV infection during effective antiretroviral therapy is impossible,” but they believe that the risk is “negligibly small.”

Critics of the Swiss statement have emphasized that research on HIV transmission and viral load has focused on heterosexual couples and vaginal intercourse – and does not necessarily apply to anal intercourse.

A number of people have also pointed out that, even if the Swiss experts are right, their conclusions about unprotected sex would apply to only a small number of HIV-infected persons: people who have excellent adherence to their HIV regimen, a consistently undetectable viral load, and no other STIs.

Practically speaking, the “no STIs” restriction could probably be met only within a monogamous relationship in which both partners were tested for STIs before stopping condom use. STI testing would be essential, because many people with STIs have no symptoms.

The bottom line for me:
Several studies have shown that reducing a person’s HIV viral load tends to reduce their risk of transmitting the virus. This is very heartening, but it does not mean that people with undetectable viral loads have no risk of transmitting the virus.

(Read on …)

A new public service announcement by porn director Chi Chi La Rue urges gay adult video consumers to consider the implications of condomless, so called “bareback” porn, for performers and audiences alike. La Rue’s Internet Movie Database listing for direction credits includes an astounding 239 titles in hetero-, bisexual- and gay-themed erotica, beginning with 1989’s “Who Shaved Cassi Nova?” and topping off, as it were, with last year’s “Restless Youth.” So it’s clear La Rue is an insider who is well-versed on the ins and outs of the business, so to speak.

In 2006, La Rue opted to terminate a lucrative contract with Vivid Video, a major production company for heterosexual erotic movies. After releasing three years’ worth of La Rue-directed straight videos with condom-clad performers, Vivid decided to make condoms optional for its performers. Finding this arrangement incompatible with the La Rue philosophy, Chi Chi left Vivid and has since focused on gay condom-mandatory productions.

Presumably, a rise in the number of bareback titles available to gay video consumers motivated La Rue to create the public service announcement, featured prominently on a new website. What’s particularly notable about the PSA is how many different issues it touches upon, from testing to the blurry lines between fantasy and reality (especially when the fantasies star real live people) to the place of consumers in the “food chain” of bareback video production.

There’s a case to be made that sex without condoms is often a very pleasurable experience, and La Rue doesn’t take on that aspect of the discussion. But what’s remarkable at this stage of the game is that somebody is talking about the issue at all, when folklore is telling us that people are “over” talking about safe sex.

Thinking Positive
By EJ Mandigo

I’m writing this as a person who has been HIV+ for more years that I choose to count, but knowing it is close to 15 yrs. At some point during that time I went from being “positive” to having “advanced HIV” (which for me is really just an easier way to say that I have reached the stage of full blown AIDS). I don’t tell you this about me looking for pity but rather to give you a sense of my reality and how I can really share and appreciate how someone could go on national television and tell the world about their circumstances around being HIV+.

What I am referring to here is the amazing courage that Jack Mackenroth had when exposing his life of “living with” HIV on the show Project Runway. I remember all too well: I was sitting in my living room glued to the TV. This is a regular thing each week for my partner and I as we are avid fans of the show. In a recent episode Jack made an important yet difficult decision to let the world know that he was leaving the show due to an infection in his face and nose. I know the world must have sat in amazement wondering how this guy was going to make it when he seemed to already have a compromised immune system and now he was to battle this!

I on the other hand sat on my floor with tears in my eyes, but not for the reasons that most may have. I was choked up because I was so proud that someone like myself, who looked so healthy and stood so strong, was truly stronger than life, by being able to share all of this with the world. I thought how amazing it was that someone was given such a gift to break the stigma surrounding HIV & AIDS! Jack became a hero that day in my book and one that has shown strength and courage that so many of us can learn from.

It’s truly refreshing to see how times have changed and how perspectives are being transformed about those of us living with HIV & AIDS. Like Jack, I myself live a relatively healthy life and with new medications my viral load has become undetected and my t-cells are the highest they have been in over 6 years! Jack’s courage to make his situation known is what has enabled me to share my story via blogging. I only hope that the media continues to cover the lives of the many of us that are living with HIV and enlightens those that think that life is over when you find out you’re positive. Again a message to Jack, a great big thank you from someone who really shares in what you represent on Project Runway!

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EJ Mandigo has been a long term supporter and volunteer for the AIDS Action Committee and other AIDS organizations and has contributed many hours and services to the AIDS Walk, Mass Red Ribbon Ride and to the Harbor to the Bay Bike Ride.