Possible link to crystal meth use a 'wake-up call'
By RYAN LEE  and JAMES WITHERS
February, 2005

NEW YORK - New York City public health officials warned gay and bisexual men last week about the detection of a new strain of HIV that rapidly progresses to AIDS, and is immune to multiple classes of HIV-fighting drugs.

Flanked by representatives from several New York-based gay and AIDS organizations during a Feb. 11 news conference, New York City Department of Health & Mental Hygiene Commissioner Thomas Frieden announced that the new strain of HIV - known as three-class antiretroviral-resistant HIV, or 3-DCR HIV - was found in a gay man last December.

The man, whose identity is being withheld, is in his mid-40s and admitted to taking part in unprotected anal intercourse with multiple sex partners, often times while high on crystal methamphetamine, according to New York health officials.

"This is a wake-up call - first, it's a wake-up call to men who have sex with men, particularly those who may use crystal methamphetamine," Frieden said.
"Not only are we seeing syphilis and a rare sexually transmitted disease - lymphogranuloma venereum - among these men, now we've identified this strain of HIV that is difficult or impossible to treat and which appears to progress rapidly to AIDS," he said.

"This community successfully reduced its risk of HIV in the late 1980s, and it must do so again to stop the devastation of HIV/AIDS and the spread of drug-resistant strains," Frieden said.

But several prominent AIDS experts quickly condemned Frieden's announcement, calling the news conference and ensuing media reports about the possible emergence of a "super" strain of HIV "completely overblown."
"I have to say the reaction we had was that the announcement was more alarmist than we felt was appropriate for an anecdotal case report," said Terje Anderson, executive director of the National Association of People Living With AIDS.

"It felt like they were trying to scare people into safe activities, but fear is not always a lasting or effective public health strategy. The question still becomes: is this an isolated case or part of a pattern, and it's still too early to tell," Anderson said.

Federal health officials agreed that far too little is known about the New York case, but applauded the New York health officials with proactively calling attention to what "appears to be a very worrisome strain of HIV," said Ron Valdiserri, director of HIV/AIDS prevention at the federal Centers for Disease Control & Prevention in Atlanta.

"Clearly the concern is that with any kind of drug-resistant strain we want to make sure we intervene rapidly to ensure that the organism is not spread," Valdiserri said.
Ana Oliviera, executive director of the Gay Men's Health Crisis in New York and a participant in the Feb. 11 news conference, said it was important for health officials to make the announcement since the man diagnosed with 3-DCR HIV is a microcosm of the health dilemma many gay men are facing.

"As a community-based organization we know that we are here both to fight AIDS and HIV, and to maintain an enormous vigilance for the health of our community," Oliviera said in an interview Wednesday. "This particular life story of the man in this case leaves us with a lot to think about, and a lot of very challenging questions for our community."New strain detected?

The New York man was first diagnosed with HIV in December. Doctors at the Aaron Diamond AIDS Research Center in New York soon determined that he had already developed a resistance to three of the four major classes of antiretroviral drugs - nucleoside reverse transcriptase inhibitors, non-nucleoside reverse transcriptase inhibitors and protease inhibitors.

Drug resistance is becoming increasingly common among HIV patients, but usually takes years to develop and is rarely seen in people who have received no previous treatment, according to health officials.

The CDC estimates that drug resistance is found in less than 1 percent of people newly diagnosed with HIV, Valdiserri said.

But what makes the New York case alarming, Valdiserri said, is that in addition to being drug resistant, the strain of HIV also evolved into full blown AIDS in just a few months, as opposed to the years it usually takes.
After being diagnosed, the man told health officials that he had multiple episodes of unsafe sex with different partners while using crystal meth, Valdiserri said.

Citing an anonymous source close to the medical investigation, the New York Times reported that the man was believed to have had "hundreds of partners," many of whom he met on an unidentified gay hook-up Web site.
The New York Department of Public Health is offering HIV testing and counseling to those sexual partners whom the agency has been able to contact said Andrew Tucker, an agency spokesperson.'Disaster waiting to happen' James Braun, president of the Physicians Research Network, said the new case of HIV was not surprising considering reports of escalating risky sexual behavior among gay and bisexual men.

"We believe that the transmission of treatment-resistant HIV was disaster waiting to happen, particularly in communities where safer sex is not practiced regularly and in light of people using drugs like crystal meth," Braun said at the news conference.

But many AIDS doctors and activists are unconvinced that the New York case represents anything new in the fight against HIV and AIDS.

"For 25 years, we've learned that it is often best to approach isolated incidences and one-time, sensational announcements with a bit of skepticism," said Jeff Graham, executive director of AIDS Survival Project in Atlanta.

While the New York case may eventually turn out to be a new phenomenon, HIV doctors "have seen lots of stuff like this in the past," said Howard Grossman, executive director of the American Academy of HIV Medicine.
Grossman said the current New York case is reminiscent of the experience of a friend in the early 1980s who was diagnosed with HIV, rapidly lost 45 pounds and a significant portion of his T-cells - only to eventually recover without the assistance of HIV-fighting drugs.

The New York patient could have followed a similar course, but it will be impossible to know because he is now being treated with drugs, Grossman said.

"This is not the first time a drug-resistant strain of HIV has been detected," said Don Bux, a research associate at the Center for Addiction & Substance Abuse at Columbia University. Scapegoating feared
Frieden's announcement made national headlines and has become the center of conversations among gay men in New York and beyond.
The thought of a new, more intense form of HIV emerging is unsettling, but Turner said he hopes the announcement does not further marginalize gay and bisexual men.

"What is most distressing is that it is viewed mainly as a gay problem," Turner said.

New York City Councilmember Margarita Lopez and Council Speaker Gifford Miller stressed their concern about the messages being sent about gay men during a news conference Feb. 15.

"They are trying to send messages in here that are confusing and can create a backlash on the gay community," Lopez said.

Graham, from AIDS Survival Project in Atlanta, agreed that there is a danger that Frieden's announcement could be used politically against gay men.
"Where caution needs to be urged is making sure folks don't fall into a place where they demonize gay male sexuality, and in this political environment, that's something we certainly need to be worrying about," Graham said.
Jason Riggs, communications director for the Stop AIDS Project in San Francisco, said it was useful for public health officials to draw attention to a potential new form of HIV.

"What isn't helpful is transmitting a sense of panic when we don't have all the facts yet," Riggs said.

But knee-jerk announcements about potential STD outbreaks among gay and bisexual men have recently become commonplace among some state and federal health agencies, said Julie Davids, executive director of the Community HIV/AIDS Mobilization Project in New York.

"I'm concerned about at what point they felt they had enough information to go public with this [New York case] when there still seems to be so much confusion," Davids said. "I have the concern of seeing the fallouts of these types of announcements in the past, where preliminary reports are used and ignite fear and confusion, then seeing the agencies backing off a few weeks later after creating shock waves, until eventually they disappear."

Repeated false alarms surrounding HIV adversely affects those living with HIV, who may suffer a loss of T-cells due to stress, Davids said.
But the "sky-may-be-falling" announcements also make it more difficult for HIV doctors to perform their job, Grossman said.

"It becomes harder to convince people to follow conventional prevention practices because it makes it look like the scientists don't know what they're talking about, and just panic," Grossman said.

But sex education experts have not adequately updated safer sex messages to reach young gay men, said Anderson from NAPWA.

The role of religious conservatives in shaping White House policy on sex education has led to "prevention being sabotaged tremendously," particularly for gay youth, Grossman said.

One of the factors widely suspected of fueling an increase in unsafe sex among gay and bisexual men is crystal meth use. The presence of crystal meth in the New York HIV case is another key element that needs to be discussed by gay men and AIDS experts, Oliviera said.

Stop AIDS Project officials estimate that 30 percent of new HIV infections in San Francisco involve crystal meth use, with users being 300 to 400 times more likely to contract HIV than non-users, Riggs said.