Politics > Politics-USA > West Side story: a tale of unprotected sex which could be link to new HIV superbug
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Politics > Politics-USA |
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"Captain Compassion" |
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25 Mar 2005 10:13:58 PM |
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West Side story: a tale of unprotected sex which could be link to new HIV superbug |
West Side story: a tale of unprotected sex which could be link to new
HIV superbug
New fears for gay men after doctor breaks silence
Mark Honigsbaum in New York
Saturday March 26, 2005
The Guardian
From street level it looks like the entrance to any other New York
office block. But mount the stairs to the second floor and you
suddenly find yourself standing in front of a glass booth from behind
which an attendant is busy dispensing locker keys and towels to a line
of eager young men. No Drugs or Poppers, reads a notice beside the
fogged glass. No Sleeping in Public Areas.
This is the West Side Club, a Manhattan bathhouse where both
HIV-positive and HIV-negative men come to enjoy the steam and engage
in anonymous and often unprotected sex with other men. According to an
HIV/Aids practitioner whose clients are frequent visitors, it may also
be where the so-called Aids superbug, whose existence was revealed
last month, was first transmitted.
The extraordinary claim is made by Gary Blick, a Connecticut-based
physician who heads a regional taskforce aimed at educating gay men
about rising HIV and syphilis infections. Last week he decided to
break his silence about the bathhouse and his clients' possible role
in the transmission of the supposed new superstrain of HIV because of
his mounting concerns about what he views as the continued unsafe sex
practices in the gay community.
In particular, Dr Blick, who runs an HIV treatment centre in Norwalk,
a sedate commuter town to the north of Manhattan, wanted to warn men
to be vigilant ahead of last weekend's Black Party, a three-day
shindig at New York's Roseland Ballroom where gay men engage in
anonymous sex, fuelled by crystal meth, a highly addictive amphetamine
that lowers sexual inhibitions and which many doctors blame for the
recent increase in HIV transmissions.
Genetic match
"Most patients who abuse crystal meth do not care whether or not they
are practising safer sex," said Dr Blick. "Here in Norwalk we're only
45 minutes out of the city. I felt I had to get my message out."
He chose to do so by issuing a press release revealing that a
California laboratory had found a partial genetic match between the
middle-aged New York man who is at the centre of the superbug alert
and one of his clients. His announcement infuriated public health
officials who have been at pains to counter accusations of
scaremongering about the virus.
The existence of a possible new superstrain of HIV first surfaced on
February 11 when the New York health commissioner, Thomas Frieden,
gave details of the New York man, who remains anonymous, citing an
unprecedented combination in his case of multi-drug resistance and the
rapid onset of Aids. Mr Frieden too has faced criticism for going
public.
Further scientific backing to the thesis that the New York man could
be infected with a new strain of HIV that could be much more difficult
to treat and contain was provided last week in the medical journal the
Lancet which suggested that he might have gone from being infected
with the strain of HIV to developing full-blown Aids in the space of
just four months - something not seen since the advent of the epidemic
in the early 1980s.
The study, co-authored by Martin Markowitz and David Ho, researchers
at New York's Aaron Diamond Aids Research Centre, also found that the
new strain contained an extra key for latching on to human receptor
cells and evading the body's immune response.
For many gay activists and scientists specialising in Aids, such
findings are premature. "One man does not make an epidemic," said John
Moore, an Aids expert at Cornell University. "If they'd reported a
cluster of cases I would be much more concerned."
But what of the claims of Dr Blick of a connection between the New
York case and his client in Connecticut? Although Steve Wolinsky, a
specialist in HIV genetics at Northwestern University, points out that
without wider studies Dr Blick's claims are meaningless, the
California lab's findings are being taken sufficiently seriously for
the health department to request that Dr Blick forward further cell
samples to the Aaron centre.
And on Tuesday Dr Blick spoke directly to Dr Markowitz to inform him
that another lab had turned up a match for their New York patient.
Intriguingly, this time the match was the partner of Dr Blick's
Connecticut patient - a gay man also in his 40s whom Dr Blick has
simultaneously been treating for multi-drug resistant HIV.
Both men have given accounts to Dr Blick of how they may have passed
the infection to the New York patient - a story which leads straight
to the door of the West Side Club and shines an uncomfortable light on
the crystal meth sex scene and the widespread ignorance among gay men
about the risks associated with HIV transmission.
Unlike other venues where men meet for anonymous sex, West Side has a
reputation for being a friendly and pressure-free environment. Many
men undoubtedly visit the bathhouse simply to unwind after a hard day
at the office. Others go there in the hope of finding sympathetic
partners - or, in the phraseology favoured by crystal meths users, to
"party and play".
According to one regular attendee who asked to remain anonymous, the
West Side Club is attractive to many HIV positive men precisely
because "no one questions you about your HIV status" there. The result
is "everyone assumes everyone is positive".
He says that when he has offered to use condoms in the past he has
been told by the men he has partnered not to bother. Instead, like
many of the bathhouse's clientele, he goes "bareback" oblivious to the
fact that even HIV positive men need to protect themselves during anal
sex because of the risk of cross-infection with different strains of
the virus.
According to Dr Blick this appears to be precisely what happened one
weekend last autumn when his clients travelled to the club from
Connecticut. Not surprisingly, neither of the men was willing to speak
directly to a journalist - like the New York man they have only agreed
to cooperate with public health officials on the basis of anonymity.
However, the men told Dr Blick that the New York patient had already
identified them to public health officials who have been working with
him to trace his contacts. "He remembered key details about my
clients' occupations. He also recalled particular markings on their
bodies," said Dr Blick.
The officials believe that until November, when he started complaining
of a febrile illness, the New York man was probably HIV negative (when
he had last been tested in May 2003 he was clear). However, in the
autumn of 2004, fuelled by his addiction to crystal meth, he had begun
trawling the internet for new partners. By October, the period when he
met the Connecticut couple at the West Side Club, he was having scores
of casual encounters. It was only in December, when his health began
to deteriorate and he was diagnosed with HIV, that he ceased his
sexual activity.
Unlike the New York man, Dr Blick says his clients were not addicted
to crystal meth. However they liked to binge on the drug and told Dr
Blick that tragically on this particular weekend in October the New
York man did not volunteer his HIV status and neither did they.
This week Dr Blick informed his clients that they might have
inadvertently been responsible for infecting the New York patient and
hence triggering the emergence of the possible new strain of HIV. He
said the pair were devastated by the news. "They said that if they had
know the guy was HIV negative they wouldn't have had sex with him,"
said Dr Blick.
However, Dr Blick's link between his patients and the New York case
are far from certain. He has stressed himself that the lab report was
preliminary, did not prove there had been direct transmission from his
patients, and that the Aaron centre would need to do further screening
of the gene "envelope" to be certain.
But whatever the truth, there is little doubt that Blick's tale is a
further wake-up call for New Yorkers who, after the anxious chatter
that followed Mr Frieden's announcement six weeks ago, had once again
slipped into complacency about the risks of transmission.
It has added to anxieties that a degree of complacency about the risks
of transmission of HIV may have entered the New York gay scene,
encouraged by the use of crystal meth. "People have safe-sex fatigue -
they are fed up of having to be afraid of HIV," explained Peter
Staley, the founder of Aids Med, an internet-based treatment site for
people living with HIV, and himself an HIV positive recovering crystal
addict. "In those circumstances, crystal is the perfect Petri dish for
disease transmission."
The most worrying aspect of the New York case is how rapidly the man
progressed to Aids and how difficult his infection has proved to
treat. When the man was first diagnosed with Aids in January his
T-cell count - the measure of his ability to mount an immune response
- was negligible and by February he had lost 20 lb (9kg). Although he
has since put on weight, according to the latest medical reports he is
responding to only one of the 21 anti-retroviral drugs.
Unique
Does that mean that his virus is a unique superstrain, one that could
spark a new epidemic? And is Dr Blick right to say that recombination
between his clients' strains of HIV may be the reason the New York man
developed Aids so quickly?
According to most scientists it is simply too early to say. Treatment
specialists at Gay Men's Health Crisis, New York's leading advocacy
group for men with HIV, point out that rapid progression on its own is
hardly news. In a trawl of the medical literature GMHC turned up
several recent cases where individuals infected with HIV had developed
Aids and died within six months.
Neither is there anything new about multidrug resistance. Studies have
found resistance to at least one drug in up to 15% of new infections
and multiple resistance in 1.3% of new infections.
What GMHC concedes is worrying is the possibility that the New York
patient may have been infected with one or more multidrug resistant
strains at the same time - not just from the Connecticut men but other
men he may have had unsafe sex with. It is also concerned about the
widespread perception in gay circles that it is safe to have
condom-free anal sex with other positive men because one strain of HIV
is somehow protective against another.
"That's where we need to do more work to educate people," admitted
George Ayala, the director of GMHC's Institute of Gay's Men's Health.
"There is no doubt that the safe-sex message - use condoms - is not
considered as relevant today as it used to be." But there is also a
risk of crying wolf, Mr Ayala warns. In a clear swipe at Mr Frieden he
says officials should take care "not to make announcements that
demonise gay men and the choices they make around sex and drugs".
In an editorial accompanying the Aaron research study last week, the
Lancet agreed that alarm about any so-called superbug was premature,
pointing out that the rapid progression of the disease in the New York
man could be due to an "as yet undetermined host susceptibility". But
the journal praised Mr Frieden's decision to go public, arguing that
it could speed up the investigation by encouraging the man's sexual
contacts to come forward.
According to a public health official quoted last week by the New York
Times, that strategy is already paying dividends. The department has
heard from more than a dozen men believed to have had sex with the
patient and is now testing their blood to see if he passed on the
virus.
Scientists say we will have to wait and see whether newspapers were
right to brand the new strain a superbug. But the case is already a
timely reminder that, for all the advances in anti-retroviral therapy,
HIV remains a formidable foe.
----------------------------------------------------------------------
"Gotta love the left. Life isn't a right but death is."
-- Captain Compassion
"America is a vast conspiracy to make you happy." -- John Updike
"Why would I listen to losers?" -- Arnold Schwarzenegger
"Long term commitment in relationships is only necessary because it takes
so damn long to raise children. Marriage may well be some kind of trick
to keep the males around beyond sexual satiation." -- Captain Compassion
"Progress is the increasing control of the environment by life.
--Will Durant
Joseph R. Darancette
res0mp8t@NOSPAMverizon.net
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