Deciding where to begin this month has been a challenge. There is no easy way to condense a week at the XVII International AIDS Conference (August 3-8 ) into just one more monthly column. Nonetheless, I did agree to write further about my week in Mexico City, and my word is what I hope earns your trust in me as a community resource around HIV/AIDS/STD/and Hepatitis issues. 

First, however, since August I have been made aware of some important public health information I must share.

Some of you may know that there has been a recent syphilis outbreak in Western North Carolina.  To be more specific, in the past two months, among men who have sex with men (MSM), there have been 13 new case reports of syphilis identified in Buncombe County (Asheville) and a couple of other North Carolina mountain counties a hop-skip-and-a-jump away. There are usually only 5-6 total cases reported in a year within the same counties. I was contacted by the state health department, and our local clinic, WNCCHS, (Western North Carolina Community Health Services 828-285-0622 Free HIV/STD tests – Walk-in. No appointment needed) to try to coordinate a quick awareness campaign and encourage anyone who has had unprotected oral or anal sex to get tested, and treated, as soon as possible. 

Syphilis is a tricky bacterial infection; it can initially produce a small sore around the penis, mouth, or rectum that isn’t painful and goes away. However, syphilis is not gone when that sore goes away, and it can spread to other organs in the body, and to the next sexual partner.  One more note about syphilis; it increases the possibility of getting or transmitting HIV by 3-5 times, (if either partner is HIV+) according to the Centers for Disease Control and Prevention (www.cdc.gov). 

That has to do with the inflammation caused within the cells of the genital tract particularly.  Dr. Myron Cohen, Professor of Medicine, Microbiology and Public Health – UNC Chapel Hill also mentioned at the Tuesday plenary session of the International AIDS Conference that inflammation causes easier transmission probability in the genital tract – “So, get your STDs treated!”

P.S.  If any of you out-of-towners are reading this and have visited our fine city recently and had some great unprotected sex, please go get tested at your local health department or call 1-800-CDC-INFO (232-4636) to find a place near you that offers free syphilis testing. 

Now, back to the conference…

I suspect that those of you who wanted complete coverage have already visited the website www.aids2008.org.  Perhaps a visit to www.POZ.com offered enough information to create a discussion over lunch or dinner last month.  Maybe www.kaisernetwork.org was the perfect fit for what you additionally sought to read about the conference.  A website more for medically related interests in capsule summaries is provided by Clinical Care Options www.clinicaloptions.com/HIV/Conference.  It allows nurses and other medical personnel to gain certification credits, and has comprehensive reviews of certain sessions about drug treatments and results of clinical trials and studies.

At one plenary session during the week, Dr. Robert Siliciano (pronounced Sil-ih-cah-no) of Johns Hopkins University Howard Hughes Medical Institute said in his presentation: “What do we need to do to cure HIV infection? Stop ongoing viral replication; identify all stable reservoirs; find a way to eliminate each one.”  He spoke about the success of HAART – the AIDS cocktail (Highly Active Antiretroviral Therapy), which may reduce viremia to below 50 copies/ml – and is what doctors mean when they describe “undetectable viral load”. 

But then he also talked about the persistence of HIV in a reservoir of resting T-cells, and patients having a residual viremia with ongoing viral replication.  What sometimes is not clear to the general public is that an “undetectable” viral load does not mean HIV is gone or cured – the Magic Johnson story.  Magic takes his meds, and over the years has reported an undetectable viral load, which was misconstrued as a statement that he was cured and no longer has HIV.  There is no cure at this time, and HIV still lives with him, as it does with an estimated 33 million people worldwide.

Looking through my notes and press releases, I also found the August 8th plenary presentation by Justice Edwin Cameron, of the Supreme Court of Appeals in South Africa.  He has openly spoken about being HIV+ and gay and frequently addresses the disparities found among the “haves and have-nots” in the world.  In his speech entitled, “HIV is a virus, not a crime: Criminal statutes and criminal prosecutions”, he provided case examples of the criminalization of people with HIV in Texas, Zimbabwe, Sierra Leone, and other places where men and women have been imprisoned for spitting on an officer (Saliva has never been shown to result in transmission of HIV – CDC), for having unprotected consensual sex with a lover who, under a court order to be tested, was negative but did not want to press charges in the first place (yet was still charged with ‘deliberate transmission of HIV’), or even being an HIV+ mother who gets pregnant and transmits HIV to the fetus by not taking “reasonable measures” to prevent transmission to her baby.

Judge Cameron argues that criminalization and prosecution are ineffective and “bad policy in the AIDS epidemic” and gave 10 reasons why.  Part of that list includes: laws are often poorly written; unfairly and selectively applied; victimize, oppress and endanger women; place blame on one person instead of the responsibility of two [takes two to Tango]; criminalization increases stigma, creates a strong disincentive to testing, and assumes the worst about people with HIV.  He is a strong advocate for human rights and concluded by stating, “Let us return [home] strengthened in our resolve to fight against stigma, against discrimination, and against criminalization – and to fight for justice, good sense, effective prevention measures, and for access to treatment.”

If you can put up with just a bit more, I can’t end my coverage of the XVII International AIDS Conference without briefly mentioning the feminist advocate Zonibel Woods, born in El Salvador, but now living in Canada. Her conference biography states, “In 2005 as the Senior Advisor for the International Women’s Health Coalition, Ms. Woods launched and coordinated an initiative aimed at focusing global attention to the increasing feminization of the AIDS epidemic. …Since then she has worked tirelessly to make gender equality and women’s empowerment an explicit part of the global HIV response.” 

Additionally, in her powerful speech, which can be read at the Kaiser Network site for Friday’s plenary session, she repeats what we already know, “Today, women account for half of all people living with HIV worldwide with more than 60 percent of new infections in Sub-Saharan Africa. In almost every region, there are increasing numbers of women becoming infected even in countries that have had successful AIDS responses such as Brazil. And in the US, black women represent 65 percent of new infections among women and are 23 times more likely to be diagnosed with HIV than white women.”  We must invest in HIV prevention, and treatment and care for women by thinking globally, and acting locally – as the bumper sticker reads.

Of course, there’s tons more from the conference.  My offer still holds that you are welcome to come by the new WNCAP office and see what I brought back from Mexico.  Call and let me know you are coming by.

I know I wrote a long column this month, but of all of it, I am most concerned that folks get the syphilis test to put this STD back in check around here. If I can be of help getting you to the clinic to get tested, or if you just want to talk about what puts us at risk, please be in touch. Treat your trick this Halloween.

Peace,

Michael Harney, the Rubberman, can be reached at WNCAP: 828-252-7489 ext. 311 or wncap@wncap.org.