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March 2005 NORA Discusses Implications of New York’s Multi-Drug Resistant HIV Case On Monday, March 14, the National Organizations Responding to AIDS (NORA) coalition, for which AIDS Action serves as the convener, held it’s monthly meeting. The topic for this month’s meeting was “New York’s Multi-Drug Resistant HIV Case: What Really Happened and What are the Implications?” Ronald Johnson, associate executive director of New York City’s Gay Men’s Health Crisis (GMHC), an AIDS Action member, was the featured speaker. Mr. Johnson opened his presentation by providing a brief overview of the case and related events which had taken place in New York last month. On February 11, the New York City Department of Health and Mental Hygiene held a press conference to announce that a local man had been diagnosed with a rare, multi-drug resistant strain of HIV. His infection had rapidly progressed to AIDS, the department further reported. At that time, the city issued a health advisory to medical providers asking that they be on the lookout for other cases of this strain. GMHC participated in the February 11 press conference, although, Mr. Johnson noted, the organization was not given advance notice of what was to be discussed. Following the initial announcement, the case received a great deal of media attention. According to Mr. Johnson, much of what was reported in the media was exaggerated or inaccurate. For example, initial reports suggested that the man with the multi-drug resistant infection may have had hundreds of sexual partners; in fact the actual number was closer to two dozen. In addition, his strain of HIV was neither as rare—nor as virulent—as the press first reported. In fact, Mr. Johnson noted, the scientific community was quick to question the significance of this particular case. Between eight and 22 percent of new HIV infections are resistant to at least one class of anti-retroviral drugs, and one to four percent are resistant to more than one class. In addition, there have been many documented cases of individuals who have rapidly progressed to an AIDS diagnosis after being infected with HIV. Mr. Johnson also said that there is not yet enough evidence to determine if this is a new or unusual strain of HIV; further tests and research are needed. Thus the case should not be a cause for immediate public health concern, Mr. Johnson stressed. He continued by suggesting that although it remains unclear what the true public health implications of this case will be, what had happened in New York provided advocates with some valuable lessons about what is and is not working in HIV prevention. According to Mr. Johnson, this case involved a gay man in his 40s. He argued that by virtue of the man’s age, sexual orientation, and residence in a large metropolitan area, his exposure to HIV prevention messages ought to have been sufficient in helping him to avoid infection. Thus, the question that must be answered is: “How and why did [the HIV prevention messages] break down?” Mr. Johnson stated that this case should be a “wake-up call” for organizations working in HIV prevention and that these groups need to make more of an effort to explore the “mental, social, and behavioral factors” that are leading people to ignore prevention messages and engage in risky sexual behavior. He also noted that HIV prevention is “increasingly under funded and increasingly under attack.” A growing emphasis on abstinence within federally funded prevention programs, as well as overall decreases in funding, are putting more and more people at risk by keeping them from hearing messages that are targeted and relevant to their lives, Mr. Johnson believes. The solution, he concluded, would be a comprehensive continuum of HIV prevention and substance abuse programs that are based on an accurate unasderstanding of social and behavioral norms within specific communities. Mr. Johnson concluded his presentation by mentioning the public policy implications of the New York case and the attention that it received. Because this case has brought increased attention to HIV testing policies, Mr. Johnson anticipates that it might be used to push for more routine testing and a relaxing of pre-test counseling requirements. In addition, it has been suggested that New York may move to a more aggressive form of HIV surveillance, which would include increased monitoring of individual treatment histories and outcomes. Advocates will need to evaluate where the boundaries should be as far as ensuring individual privacy while providing for public health needs. Finally, Mr. Johnson suggested that this case highlights the need for increased emphasis on treatment education. Policies that support education as a means of increasing adherence need to be put into effect to reduce the likelihood of developing drug resistance. Following Mr. Johnson’s presentation, members of the coalition engaged in a discussion about the national implications of this case. With the reauthorization of the Ryan White CARE Act set for this year, advocates are concerned that what happened in New York may be used to push for including mandatory testing, mandatory partner notification, and contact tracing within the CARE Act. For more information about NORA, e-mail Jessica Tytel at jtytel@aidsaction.org. |
