AIDS Action Committee’s Blog

I’m blogging to vent about what I consider shoddy reporting on the occurrence of MRSA infections among gay men. MRSA is short for “methicillin-resistant Staphyloccus aureus.” It is a type of bacteria that is resistant to the antibiotic methicillin, which is commonly used to treat Staphyloccus (staph) infections. Some strains of MRSA are multi-drug-resistant (MDR), meaning that they are also resistant to other antibiotics.

Clusters of MRSA cases among gay men aren’t new. They’ve been the subject of research reports and news stories for several years. The most recent stories were sparked by a study in the Annals of Internal Medicine. In a nutshell, the study found high rates of a particular strain of MRSA called USA300 among gay men in Boston and San Francisco. The USA300 strain includes an MDR type that is resistant to many antibiotics.

This is very troubling news that deserves media attention. MRSA is a major cause of serious illness not just in gay men, but in the general population. During 2005, MRSA accounted for more than 94,000 life-threatening infections and nearly 19,000 deaths in the U.S.

But from reading some of the recent headlines, you might have thought that the end of the world was at hand – and that gay men were the bringers of doom.

Of the press coverage I’ve seen, my vote for the worst headline goes to the British tabloid Metro, which proclaimed: “Strain of superbug may be new HIV.” I detest the word “superbug,” whether it is applied to HIV, MRSA, or any other germ. What makes a germ a superbug? Drug resistance? Ease or speed of transmission? Serious health consequences? Or simply the fact that it is new or difficult to treat? The word has no consistent or practical meaning. Its main effect is to incite fear and sell newspapers. And, by the way, there’s no evidence whatsoever that the USA300 strain is the “new HIV”: It’s not a virus, it doesn’t specifically attack the immune system, etc.

The British Telegraph’s headline was also outrageously overblown: “’Flesh-eating’ MRSA strain threatens Britain.” Interestingly, the Telegraph article noted that a grand total of two cases of the MDR USA300 strain have been recorded in England. Leading the headline with the words “flesh-eating” is certainly an attention-grabber. This lurid term is all too often used to refer to a severe skin and tissue infection called necrotizing fasciitis, which can destroy soft tissue.

Like many other types of bacteria – including both nonresistant and drug-resistant staph – the USA300 MRSA strain can, in severe cases, cause necrotizing fasciitis if it is not recognized and treated properly. But there is nothing inherently “flesh-eating” about USA300 MRSA. The New York Times also earns a dishonorable mention for its alarmist description of the MRSA strain as “flesh-eating” in the lead sentence of its story.

The Philadelphia Inquirer’s headline was also far from stellar: “Possible MRSA link to gay sex seen.” Granted, it’s less alarming. But what do they mean by “gay sex”? Anal intercourse? Fellatio? Last I heard, straight and gay folks alike engage in these and a broad spectrum of sexual activities. Of course, there’s nothing like a little “gay sex” in a headline to stoke people’s imagination and get fundamentalists all riled up.

Both the Inquirer and Times articles also failed to mention that the USA300 strain has been reported in athletes, military recruits, and heterosexual couples. Simply mentioning this fact might have helped reduce the tendency for people to blame gay men or “gay sex” for this health concern.

Oh, and if you read the research study, you’ll find that “anal sex” (no specific type mentioned) is just one of the possible explanations given for the high rates of USA300 MRSA seen among gay men in Boston and San Francisco. Other possibilities include “skin-abrading sexual practices” (rough sex? body shaving?) and “increased frequency of intimate skin-to-skin contact.”

But I suppose the Inquirer’s headline could have been worse: How about this one?: “Possible MRSA link to intimate touching.” That headline might have led to generalized panic rather than gay panic.

So what’s the bottom line about MRSA in general, and multi-drug-resistant staph among gay men in particular?

• The recent reports of multi-drug-resistant MRSA in gay men deserve our attention. But they should not be a cause for panic. Nor should they be used as an excuse to stigmatize gay men or demonize “gay sex.”

• MRSA infections are a serious health concern. If you have signs of a skin infection, such as pimples, boils, or rashes, see your doctor promptly. They can diagnose the condition and provide appropriate treatment. If a particular treatment doesn’t appear to be working as it should, let your doctor know.

• Washing with soap and water is the best way to keep from getting or spreading staph infections, including MRSA.

According to a fact sheet from the Massachusetts Department of Public Health, other ways to prevent infection, include:
• Avoiding contact with other people’s wounds or bandages.
• Keeping scrapes and cuts clean and covered with bandages until they have healed.
• Avoiding the sharing of personal items, such as towels and washcloths, which can transfer staph from one person to another.
• Keeping your skin healthy. Healthy skin helps keep any staph on the surface of the skin from causing an infection beneath the skin.

Here are a few other links with additional background on MRSA:

MRSA – an on-line fact sheet from The Fenway Institute with links to other resources

For other critiques of media coverage on the recent MRSA study, you can check out the following blog items:

Shock horror, superbug fears greatly exaggerated

Gay Sex Panic and Drug Resistant Staph

If you’d like more information about MRSA, please contact AIDS Action’s HIV Health Library. We have compiled a set of reliable articles and fact sheets about MRSA in general, as well as the USA300 strain in gay men.

I hear all about how guys my age are letting their guard down. I enjoy getting fingered as much as the next guy, but enough already. The following passages are not in any way meant to remove the ownership my generation should claim. I know it is my health, my choice and ultimately my life. I aim instead to add more to the myriad of reasons why infection rates are increasing in guy my age and slightly younger.

AIDS left us with a gap and injured as a community. As older men lost friends, brothers, lovers, and roommates, guys my age lost countless mentors. We, the younger generation, were left to fend for ourselves. The oral traditions, all puns intended, of our community all but completely stopped. There is an age bracket that was completely devastated. Those men should have helped out guys my age. Most guys my age didn’t get a hand in traversing the sticky mess that is the gay terrain. We, the younger generation, are left navigating for ourselves in a world that gets increasingly more complex.

I have been blessed to have been taken on by a wonderful group of men. One in particular refers to himself as my Auntie. They brought me under their wing and helped me navigate through what was an extremely overwhelming world. The big city homosexual can be a lot to handle. This city can feel so isolating and alienating. If it weren’t for those men I can say with all certainty that I would not be who I am today. My life, undoubtedly, would resemble an after school special. I ran around from bar to club six nights a week until someone who was caring enough to call me on what I was doing did just that. It was the voice of an older friend who watched so many go that route before me, who refused to watch another guy be taken in by those trappings.

A few of the bravest of these men have shared with me what it was like in the time back then, the time we don’t speak of. Some of them are positive some of them are not. They spoke candidly about the fears of not knowing. They didn’t know how it was transmitted. They didn’t know who would be next. They were never really sure what happened to those familiar faces across the bar they stopped seeing. Did he move out of town or did he get it too? Some people watched helplessly as their friend, disowned by his family, wasted away to nothing in the living room, stripped of dignity and pride, a skeleton on the couch.

That was not my life experience. I was born a few years before HIV was named. There is no time in my memory without the shadow of AIDS. AIDS wasn’t a gay disease to me. It was what killed the sweet boy Ryan from TV. He had hemophilia just like my best friend.

(Read on …)

Hello, New York Times… HIV isn’t making an alarming comeback; it has never gone away. It never stopped infecting and affecting our communities. It never stopped taking our friends and loved ones. What happened is that HIV has moved from the front pages of our newspapers, from the screens of our televisions, and from the forefront of many minds, and ultimately from the pens of funders. As the Director of The MALE Center, I cannot tell you how many times that I hear the question, “HIV is still around?” when I explain what I do.

The silence has been forced over many years. The muzzles of the CDC, federal and state material review panels, and the mandate from funders that agencies must utilize “boxed” interventions have stifled effective and grass roots HIV prevention and treatment in this country. Agencies had to throw away prevention materials and interventions because they were “too explicit” or “too racy” to be used in the community or because the agency lacked the funds to prove them effective. We have been mandated to tone down our language or face censure from our funders. Boxed effective interventions that have been created and tested in the early 80’s, often in populations unlike ours, are what we are required and forced to utilize in the new millennium.

The structure of our funders and their inability to work together has failed to mitigate the changing epidemic of HIV and has failed to coordinate local prevention efforts. We know that HIV is a complex issue. To address HIV, one must utilize a multifaceted approach to health. HIV prevention cannot occur in a vacuum. It occurs with the complexities of substance use, mental health, STDs, homelessness, violence, racism, homophobia, stigma, employment, socioeconomic status, and fear, just to name a few. Linear funding streams inhibit coordinated, comprehensive, and synergistic programming.
Bureaucratic indoctrination to doing nothing beyond what has been “proven” has led to limited funds for innovation and creativity. It has effectively gagged the true voices of HIV prevention. The “proven” has also led to increased infection, decreased concern, and a malaise of apathy. Gay men have been at the forefront of this epidemic. We are a resilient community. We have no less need to band together now than 25 years ago. Our voices are not silent, but our messages are not unified. This is the call to action! Find your voice and in doing so help create ours!

The MALE Center provides the opportunity to mobilize, empower, embrace and promote our community. Contact us to get involved!

By J.T. Jacoby

I agree with Denise McWilliams to some extent of course; but from where I sit, party, play and relax…it’s much bigger than that.

Repatriating from Asia this summer and having lived in Europe, I’ve been part of gay culture, gay party culture, drag, ptown, going to church, “straight” stuff (I hate that term) - you name it. I’ve been all over Americana and the world - pick a global or US party city: been there done that. The culprit of the immense rise in HIV has been under out noses all of the time: American culture. Why is it that a Parisian or Madrileno does not think twice about a condom but an American is often almost afraid to “insult” by using one? I can assure you their libido is no different than ours. Ha! Try India or Brazil for some libido…and condoms (no public comment for me there…you’ll have to make a leap of playful faith).

It’s our “American culture” of fitting in, looking like this, numbing our minds to the many messages of keeping up with the Jones’. I’m too skinny, I’m too fat, I’m poor, my whatever is too small, I’m so ghetto. We are killing ourselves and the disintegration of the American male gay community is accelerating our own demise. #1 globally at 16% of GPD for healthcare? ($23B federal only for HIV/AIDS alone!) THAT IS HUGE! It’s not a healthcare issue. It’s not a political issue.

It’s cultural and we never caught this. Americans, specifically unlike other cultures (because we do know better), reject self preservation/respect in favor of acclimation. It’s no different than straight culture - we just happen to have an intimate disease that kills. The numbers are in and they don’t lie - they tell a terrifying truth. It’s time for us to come together again. I’ll host the first chat. Will you join me?

JT Jacoby is a member of the Board of Directors of the AIDS Action Committee and a Senior Director at Fidelity Investments. Having just returned to Boston recently from an overseas, multi-year assignment to India, JT served on the Board up to his departure to India. He spearheaded, along with his fellow AAC Board members, a three-part community project titled “Community Conversations,” which was the precursor to the formation of The MALE Center, a community and wellness center for gay, bi and trans men and a program of AIDS Action Committee.

Three things I know for sure after living half my life under the cloud of the HIV/AIDS epidemic is that life is complicated, sex is complicated, and HIV is complicated. There are almost-countless numbers of tributary issues that flow into the ocean we find ourselves navigating, metaphorically speaking, that it can sometimes feel as if we’re trapped in a perfect storm of relentless waves of watery doom.

But I’ll be damned if the New York Times editorial didn’t dash off more than half a dozen of them (and that’s just the tip of the iceberg, to belabor the high seas references) in a mere 403 words with a thorough veneer of judgment buoying the proceedings. There’s the “problem with these young whippersnappers of today” angle; the “people are irresponsibly letting their guard down” angle; the “what is the deal with young men of color?” angle; the “gasp! people drink and do drugs” angle; and the hope-undermining “nobody even knows how long these treatments are going to work, anyway” angle.

Each of these points needs a nuanced dissection and discussion of its own, but the most important thing to get at is the underlying nostalgia for the Good Old Bad Old Days that often tints the discussion of the AIDS epidemic now, particularly across the generations in communities of men who have sex with men. When the disease was new and terrifying, the Times informs us, the gay community helped change behavior by preaching loudly against taking sexual risks. Hold the phone. Are we really going to argue that if only we could go back to when we were all terrified, to a simpler time when AIDS was all but untreatable and we buried friends who died after being horribly ill that the complicated business of prevention would all but take care of itself?

I can’t believe that anybody who actually lived through those first waves of the epidemic could ever think it would be worth going back to that time, even for what they perceive as our own good. Instead, I would argue, that it’s more important than ever for us to look toward the future with cautious optimism by sharing our stories with each other, stories of our hopes and dreams and our successes and failures and our pleasures and our problems in all their messy complication. You know, to tell the stories of our real lives now and acknowledge the possibility of a better future. That was what was at the heart of early and mid-period HIV prevention efforts, and what lies there today, often encumbered by funding dollars with strings attached. That is the true power that needs to be unleashed again.

Let’s be clear. The silence described by the NY Times in HIV Rises Among Young Gay Men is the result of explicit policies of the CDC, which have hamstrung prevention efforts by rewarding poorly vetted cookie-cutter approaches and stifling innovation and efforts at community building.

In June 1992, the waning days of Bush 41, the CDC created Program Review Panels “to consider the appropriateness of messages” used by recipients of CDC funding to communicate with various groups. [Source.] The Review Panels were to take their guidance from federal law which explicitly prohibited education “designed to promote or encourage directly, homosexual… sexual activity.” (It also prohibited messages designed to promote heterosexual activity but there are already plenty of supportive messages about heterosexuality throughout the culture.) The universal response of anyone who has prepared prevention materials in light of these Program Review Panels is that the Panels have a chilling effect on prevention work. Any comparison of the gay prevention efforts of the 80s to those of the 90s clearly illustrates the move away from condom distribution and edgy, graphic messages designed to catch the attention of a younger gay population.

Systems produce the results they were designed to produce. It should be no surprise that dramatic increases in HIV infections have resulted from the prohibition of messages positively portraying gay sexual activity.

The Times is right–there is a silence. But the silence has been imposed by the government while it is the gay community that is increasingly paying the cost.

This week, the New York Times ran an op-ed and a story which together illustrated the challenge facing AIDS advocates. The op-ed made the point that poor countries in Africa get too much money for AIDS and not enough for some basic infrastructure which would have more impact on people’s health. [Read the op-ed.] The story described the precipitous increase in new HIV infections among gay men under 30, particularly gay black and Latino men—between 2001 and 2006 the increase was more than 30%. [Read the article.]

I’m certainly not arguing against investing more money in improving the infrastructure in poor countries—I do challenge the zero sum mentality of the op-ed. And the story makes clear the challenge of reducing new infections. After all of the money and the studies and the social marketing etcetera, the issue remains sex: who should have it and what kind exactly they should have. Much greater strides have been made in combating intravenous drug use-related transmission of HIV than have been made in curtailing sexual transmission. Look at the numbers—new infections are increasing in young gay men, particularly young gay men of color. Because of cultural taboos, we have been unable to stop everyone from engaging in unhealthy sexual behaviors with AIDS-specific funding. How could anyone imagine it could be done in the more general context of public health?

God, yes, fund the infrastructure needs. But don’t do so at the expense of sexually active people here and abroad. And let’s not wait till AIDS sickens as many people as dirty water before we figure this out.

A Change Is Gonna Come!
By Lee F. Carson

World AIDS Day always inspires me to reflect on how I started doing HIV prevention work for Black gay men, which began officially, exactly 7 years ago today on December 1, 2000. I, at that time was thoroughly excited about landing a job with an organization in my hometown of Rochester, NY that provided services for Black men who have sex with men (MSM). I remember thinking, “Wow, how can an organization like this exist in a small city like Rochester?” But it did, and it still does, and it, like all of the organizations across the country serving Black MSM have more work to do than ever, because in spite of our best efforts with the limited resources the government has given us, we have fallen short of saving the lives of Black gay men from HIV/AIDS. A disease with a small name, but powerful punch, that has robbed our families and our communities of so many beautiful and talented Black gay men. However, I believe a change is gonna come!

(Read on …)

David Ernesto Munar, Vice President for Policy & Communications for AIDS Foundation of Chicago wrote a blog post below for the Prevention Justice Mobilization, commenting on the need for a national AIDS strategy as well as the CDC’s reluctance to release new HIV infection rate numbers. He is reporting from the National HIV Prevention Conference currently underway in Atlanta

Viral Marketing
By David Munar
ATLANTA–Resolute in its decision to delay the release of alarming new HIV infection estimates, the Centers for Disease Control and Prevention (CDC) kicked off the National HIV Prevention Conference amid widespread anger and concern that the nation may be losing ground in the fight against HIV/AIDS.

With speculation mounting about the motives and content of CDC’s unreleased data, official speeches of compassion and urgency received polite applause from the hundreds of assembled participants who seemed either unmoved or unconvinced.

Remarks from the openly HIV-positive co-chair of the HIV Advisory Committee for CDC and HRSA electrified an otherwise sedated opening plenary. Acknowledging a need to voice what might otherwise not be said, Jesse Milan Jr. told the audience the time had come for the U.S. to develop a national strategy against HIV/AIDS-something federal contracts require of developing nations that accept U.S. taxpayer money for AIDS relief.

Increasingly, the call for a national AIDS strategy is emerging wherever the topic of HIV is discussed. In an era of sustained funding bans for proven effective interventions, such as sterile syringe availability and comprehensive sexuality education, the fledging campaign has become its own promising “structural intervention.”

Inspired by an Open Society Institute report documenting the rationale and components an effective strategy development process, several leading AIDS organizations began promoting the idea among allied organizations earlier this year. The idea took hold like wild fire. More than 180 organizations and hundreds of individuals have endorsed the online “call to action” for a national AIDS strategy thus far.

Read more.

At AIDS Action, I let people know about HIV treatment advances and new approaches to prevent the spread of the virus. As exciting as these developments can be, it’s also essential to recognize the critical importance of support services for persons living with HIV.

There is extensive evidence that a person’s housing status – whether stably housed or homeless – has a huge impact on their health. The latest addition to this growing body of research is a special supplement to this month’s AIDS and Behavior journal. The supplement contains 18 peer-reviewed articles focusing on the relationship between housing status and a range of HIV-related health outcomes.

Several of these studies found that having stable housing reduces the likelihood that persons will engage in behaviors – such as sharing needles, having unprotected sex, or exchanging sex for drugs – that place them at high risk for becoming infected with HIV or transmitting the virus to others.

A group of Canadian researchers reviewed nearly 30 studies evaluating the effects of housing on health-related outcomes. These studies showed that, in addition to reducing risk behavior, stable housing helps HIV+ persons:

• Enter medical care and remain in care
• Access social services, including mental health and substance use programs
• Take their medications more consistently (better adherence)

Researchers in Chicago and San Francisco have found that programs providing stable housing for chronically homeless persons significantly reduce the number of emergency room visits and hospitalizations, as well as the length of time people spend in hospitals or nursing homes.

Taken together, these studies support the contention that housing itself independently reduces the risk of acquiring or transmitting HIV infection and improves the health of persons living with HIV.

“The findings reported here suggest that the condition of homelessness, and not simply traits of homeless individuals, influences risk behaviors and health care utilization,” according to Dr. Angela Aidala of the Columbia University Mailman School of Public Health. “This points to housing as a strategic target for intervention – a potentially exciting new tool to end the AIDS epidemic in America.”