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T he P rognosis
of P revention
Why is America failing while other countries are succeeding?
by Bob Roehr
For information call:
503/543*7474
X T T 7 e’ve fai,ed>” said
%
/ Howard Grossman,
% JE / pointing to the esti-
’L/
mated 40,000 new
▼ ▼
HIV infections a year
in the United States, a number that has held
steady for more than a dozen years. “Maybe it
would have been much worse without our inter
vention, but culturally, something is wrong, and
we are not getting the messages across.”
He spoke from his experience at the epicen
ter of the U.S. epidemic, Manhattan, where for
two decades he treated primarily gay men in his
HIV practice, and now as executive director of
the American Academy of HIV Medicine.
Grossman tied the successes in Europe and
Australia at controlling infection rates to simple
U
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The result of flat funding of the Centers for
Disease Control and Prevention during the past
five years has often been a kind of whack-a-mole
where the hammer of prevention Rinding comes
down on one population and rates of infection
fall, only to pop back up elsewhere.
The latest case numbers from Florida, the
state with the third-largest number of HIV
infections in the nation, are a good example.
From 1999 to 2004, the number of new HIV
cases among blacks declined by 30 percent. Dur
ing that same period they shot up by 23 percent
among whites and 29 percent among Hispanics.
“Prevention is not a one-shot deal. Each
generation must be reached with HIV preven
tion as they come of age. Both at-risk and
infected populations need assistance maintain
2005 National
wention Inference
Richard Voss, gri abr
Principal Broker / Owner
Peninsula Realty
6110 N. Lombard St.
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Business (503) 286-5826
Cell (503) 804-9424
Ronald O. Valdiserri, deputy director of the National Center for HIV, STD and TB Prevention,
addresses the 2005 National Prevention Conference in Atlanta.
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and explicit messages about using a condom
every time. He also thought the American psy
che of individualism, as opposed to a more soci
etal perspective elsewhere, played a role.
Steven Tierney, director of HIV prevention
for the San Francisco [)epartment of Public
Health, pushed for “targeted programs and serv
ices for gay men” as well as increased federal
Rinding for those activities.
ing safer behaviors over the long term,” said
Ronald O. Valdiserri, the CDC’s deputy direc
tor of the National Center for HIV, STD and
TB Prevention.
P revention and P ositives
A handful of studies from around the coun
try suggests gay men, both positive and negative,
appear to be serosorting—making calculated
U niting A merican
F amilies
Congressman introduces new version
of the Permanent Partners Immigration Act
by Bob Roehr
teve Boullianne and Olivier De Wulf threat of deportation looms over their heads.
have been together for a dozen years, Belgium recognizes gay marriages, so the couple
first in Belgium and then in San could live there, but it does not recognize their
Francisco. They adopted Reece and adoption and hence their children.
Laurent at 6 months and 6 weeks of
“Ever since September 11 th we’ve been hav
age, respectively. But the laws of the two ing
coun
difficulties
maintaining Olivier’s visa, hav
tries are threatening to tear apart this happy ing it removed and having to leave the country
nuclear family.
quite quickly. We’d like it to stop,” Boullianne
De Wulf can only obtain a two-year visa to said. “We think it’s important for our kids to be
live in the United States, and the perkxlic raised in the stable and wonderful community
S
decisions in choosing their sexual partners,
engaging in certain acts and deciding whether
to use condoms—based on HIV status and viral
load.
A study of 104 HIV-positive gay men at Fen
way Community Health in Boston found that
64 percent believed that viral load affects their
likelihocxl of transmitting the virus. If the per
son has an undetectable viral load as measured
in his bkxxl, then the risk of transmission is
thought to be low. And they use that informa
tion in deciding whether to use a condom.
The calculation is not without risk, some- |
times substantial risk. The genital tract is a sep
arate compartment behind a blood barrier that
some anti-HI V drugs do not penetrate very well.
Furthermore, an STD in the genital tract can
amplify HIV viral load significantly and lead to
transmission, even though the person has an
“undetectable” viral load as measured in his
blood.
The frequent asymptomatic nature of many
STDs is why all sexually active patients should
be screened for those infections, not merely for
symptoms. A survey by the HIV Medicine Asso
ciation found that physicians were most likely to
screen for syphilis. That is because they only
have to check off a box on the form for drawn
blood; they don’t have to gather other samples
and fill out an additional fonn.
The fact that the transmission rate of HIV is
dramatically lower through oral sex than
through unprotected anal sex has shaped a per
ception among many gay men that oral sex is
relatively safe across the board. That is not true;
the dynamics of transmission for HIV do not
apply to other STDs.
One of the CDC’s priorities is prevention for
positives, using AI[)S patients’ regular visits
with their health care providers as an opportu
nity to discuss and hopefully reduce their risky
sexual behavior. But surveys have shown that
most HIV docs don’t do that, in part because of
time pressures but also because they don’t feel
they have adequate training in the area of
prevention.
“Getting providers to ask the first question is
probably the most important component of all
of the different curriculums that are out there. If
we get people to ask, many times the conversa
tion will flow,” said Mark Thrun, an HIV doc in
Denver who has played a leading role in devel
oping a training program for physicians.
Grossman thought it was a good idea, but he
worries that physicians simply do not have time
to do all the things being asked of them, unless
they receive additional compensation. JM
B ob ROEHR is a free-lance reporter based in
Washington, D.C.
where we live now and not have our family
threatened by deportation.”
The family came to Washington to support
the Uniting American Families Act, introduced
by U.S. Rep. Jerrold Nadler, D-N.Y. An earlier
version of the legislation was known as the Per
manent Partners Immigration Act.
“The United States should not indulge in
wanton, gratuitous cruelty,” Nadler said. His bill
“helps to address one of the many areas where
unfair and unequal treatment creates undue
hardships for gay and lesbian U.S. citizens.” It
will treat a gay or lesbian permanent partnership
the same as a civil marriage between a man and
a woman for visa and immigration purposes.
“My bill would add the term ‘or permanent part
ner’ to the term of‘spouse’ everywhere that term
is found in the Immigration and Naturalization
Act.”
House Resolution 3006 defines the term as
“any person over 18 years of age who: is in a
committed, intimate relationship with another