Showing posts with label HIV Aids. Show all posts
Showing posts with label HIV Aids. Show all posts

May 5, 2020

15 Years of Unmitigated Deaths From A Virus, Those long Term Survivors Have something to Teach

I usually don't publish articles from The Guardian because they are a little similar(similar not the same)to adamfoxie.
Sean Monahan....
 wrote this article (published at The Guardian) of which I like very much because it makes the connection of two cousin virus and how millions of gay men had to deal with this other Pandemic and how still we deal with it because even though HIV is not causing AIDS anymore but is only because of the meds who took out their balls. There is much to learn from those dark days. Even the funeral homes going by street talk would not bury the son of a crying mother begging to bury her son.
Straight people simply aren’t used to constantly disclosing very private health information to new friends, and sometimes, strangers.’ Can you imagine meeting someone new and one of the first questions is a health sex question? Not conductive to a relaxing athmosphere for either men.

To be gay is to get used to blood tests. If you are positive, you do them to monitor your HIV status. If you are negative and on PrEP, a daily medication that helps prevent HIV, you do them to ensure it’s working. If you are negative and not on PrEP, you do them to maintain your sanity. Every gay person has their own rhythm to testing, defined by their relationship to HIV, their sexual practices and their neuroses. No matter your status, waiting for test results is never easy. You count the minutes until you hear via text, in person, over the phone, in an app: your body is OK for now.
It won’t end until there is a cure. What we have right now is management. Since around 1980, when the first cases were identified in the US, 700,000 people have died of Aids. In my lifetime, it went from an epidemic with no cure to one for which we have the tools to at least approximate herd immunity. People still die. There are no certainties. And the blood sacrifice we give at the clinic every few months reminds us of this.
We also remember not to blindly trust experts. Before writing this, I rewatched the Aids activism documentary How to Survive a Plague by David France, Woody Richman and Tyler Walk (full disclosure: Jordan Richman, my collaborator, is Woody Richman’s cousin). It’s inspiring because a group of activists rejected the incompetence and ignorance of politicians and played a decisive role in forcing them to find treatment. Act Up, the HIV/Aids activist group, was not always right, but neither were the experts. There was no time to wait for gay representation in the CDC, the FDA, Congress or White House. They used the tools of self-education and critical engagement to ensure they understood the issues and were able to call bullshit on their credentialed betters when necessary.
We spoke to David France about his recollections from that moment: “There were 15 dreadful years of unmitigated death – 15 years! – before treatments finally became available to make an HIV infection survivable. I spent those years in brutal terror, flat-out convinced I would be one of the dead. I have always thought that it was fear that saved my life. But 15 years after that, when I returned to the troves of archival videotape to make How to Survive a Plague, I was surprised to see how much joy there was among us. Some of the humor was dark, naturally, but all of it was affirming and forward-focused. Someone once said to me, ‘We had so much fun when everybody was dying,’ which sounds awful, but what she meant was not that we didn’t grieve or weep; she meant that we didn’t give up on the vision of a life we so fiercely defended. I think now that the power to imagine, put to the test by a plague, is the strongest tool we can deploy.”
The movie was released in 2012, and I went to see it at the IFC Center in New York. What struck me then was that this was still necessary. I remember returning home after college, and feeling like I had gone too long without STD testing. I made an appointment with my GP but got bumped to a physician’s assistant in his office. When I asked for screening, she replied incredulously: “Why do you want these tests? You think you have all the STDs?!” I remember my monotone and annoyed response: “I’m a gay man. I have multiple sexual partners. Men are oftentimes asymptomatic. I’m just here to get my periodic screening.” Sometimes you have to be the waiting room pamphlet you want to see in the world.  
Just because someone is a doctor doesn’t mean they’re not an idiot. I don’t mean that to demean healthcare workers, only to point out they are humans, too. So let’s keep our wits about us. Let’s evaluate people based on actions, not positions. Let’s not forget that sometimes we do know more than experts. If we don’t, they will never be able to refine and update their opinions. They will not see what they don’t see. 

November 30, 2019

Half of Women Diagnosed with HIV in Europe Will Advance to AIDS

 Immune cells being attacked by HIV virus cells

More than half (54%) of European women with HIV are only diagnosed when the infection is progressing towards AIDS, research suggests.
The human immunodeficiency virus (HIV) damages cells in the immune system, preventing them from fighting off everyday infections, like colds. 
HIV is treatable if caught early, with 97% of those on therapy in the UK being “virally suppressed”, National AIDS Trust (NAT) statistics show. This means they cannot pass the virus even if they have unprotected sex.
Left untreated, however, HIV can develop into acquired immune deficiency syndrome (AIDS).
This occurs when the immune system is so severely damaged by HIV, the patient is at risk of life-threatening infections and diseases.
Data from the European Centre for Disease Prevention and Control (ECDC) and the World Health Organization for Europe found women made up one-third of the 141,000 HIV diagnoses in the continent last year.
While most women are told they have the infection late, patients in their forties were up to four times more likely to have a delay in their diagnosis than their younger counterparts.
The late diagnosis was defined as a specific immune cell count of fewer than 350 cells/mm³. Healthy levels are generally considered between 500 and 1,200 cells/mm³.
Overall, countries in central Europe had six times fewer diagnoses among women than men last year, while those in the EU and European Economic Area - like Iceland and Norway - had three times less. 
“We do not know why but it seems systems and testing efforts in Europe are failing women”, Dr Andrea Ammon, ECDC director, said.
TV medic Dr Ranj Singh previously claimed women are now more “sexually liberated”, while high divorce rates mean many have new partners in later life.
Having gone through the menopause, some also mistakenly believe they do not need to use condoms, he added.
In the UK alone, 103,800 people are thought to be living with HIV, NAT statistics show. Of these, one in 14 is unaware they carry the infection.
While AIDS’ exact prevalence is unclear, there were 428 “AIDS-related deaths” in England alone last year, according to the charity Avert.

How does HIV spread?

HIV spreads via certain bodily fluids, including those in the vagina, semen, blood and breast milk, according to the US Department of Veterans Affairs. It cannot be transmitted via tears, sweat, feces or urine.
Unprotected vaginal or anal sex is the most common route of infection.
Anal sex may be particularly problematic due to the lining of the anus being more delicate than that of the vagina, according to Avert. This means it is more easily damaged, allowing the virus into the body.
Blood-borne infections can come about by sharing needles, transfusions or even splashing blood in your eyes, the US Department of Veterans Affairs reports.
The virus can also pass from pregnant women to their babies, both in the womb and during labor. Once the infant is born, breast milk can also cause transmission.
HIV cannot be spread via insect bites, like mosquitoes.

What are the symptoms?

Around 80% of people infected with HIV develop flu-like symptoms two-to-six weeks later, according to the NHS.
These include fever, sore throat, and a rash. Some also experience fatigue, swollen lymph nodes, and muscle and joint pain.
Once this has passed, the infection may cause no further illness for years. During this time, the virus is still damaging the immune system.
It can take 10 years before the immune system is severely damaged enough to be diagnosed as AIDS.
This can trigger weight loss, chronic diarrhea, night sweats, recurrent infections, and life-threatening illnesses.

How to get tested for HIV

The NHS provides free HIV tests for everyone, however, eligibility for different tests varies.
They can be carried out at sexual health clinics and some GP surgeries. Concerned people can also request an at-home test.
Home sampling kits involve collecting a saliva or blood sample, which then gets sent off for testing. You will be contacted within a few days with your results.

October 31, 2019

The End of HIV is Here and Many Don't See It

                        Illustration of two toolboxes

Factual case: A senior male became HIV at just pre-midlife. Started on Crixivan which was the first antiretroviral that started keeping people alive if not with awful side effects. Some people prefer to have died than to have had a came back or any of the other problems associated with this pill. But the research continued and meds we made specific to the immune system of the person and the type of virus they had. He took all the meds as they came out. As the test was made to show the efficacy of the meds he kept burning most of them. Six months a year ..but eventually he did become undetectable which means the virus could not be detected (under 50)> He has stayed undetectable for 8 yrs  except for the last news he got from his doctor was "if you burn these meds you will be shit out of luck because there is nothing else"(they have a straight honest relationship the Doctor and the patient). So imagine he has no more meds but he is doing well on what he is taking  (it's happened before, when he was doing well and then the meds failed) but with the knowledge that he is undetectable and can not give to anyone else which was always his fear particularly at one time he had a partner for five years and his partner was negative. When the relationship his partner went the same way he came into the relationship, the same health if not better. The way this HIV man looks at it if he lasts 5-10 years everything would have worked out. He is single now and hoping to find his last relationship and happy THAT HIV AT LAST FOR HM IS NOT A PROBLEM. IF HE CAN GET 10 YEARS OF JUST A NORMAL HAPPY LIFE HE WOULD HAVE BEEN GLAD OF THE LIFE HE HAS HAD. This man shows us how you beat HIV: You don't spread it and you keep your self as healthy as you can, nothing extraordinary just take the meds and stay off the K and cocaine drugs which will destroy you inside out. We still need improvement to have meds taken once a month and this should be done already tomorrow. The science of HIV was complicated with republican politics. Money was withheld but now it is time to floor the gas and get the speed because we see the end of the tunnel. The government of the US has a lot of blood on their hands for ignoring and then cutting benefits to keep on living and for science. Let's do our parts and then we can throw it in their faces where they have failed but first we need to do our part particularly this new young generation. 

Optimal implementation of existing HIV prevention and treatment tools and continued development of new interventions are essential to ending the HIV pandemic, National Institutes of Health experts write in a commentary in Clinical Infectious Diseases.

Today, many highly effective HIV treatment and prevention interventions are available. Antiretroviral therapy (ART) not only improves the health and prolongs the lives of people with HIV but also plays an important role in HIV prevention. People living with HIV whose virus is durably suppressed to undetectable levels by ART cannot sexually transmit HIV to others, a concept known as Undetectable=Untransmittable, or U=U. Antiretroviral drugs taken by people without HIV as pre-exposure prophylaxis (PrEP) are highly effective at preventing the acquisition of HIV.

Theoretically, the widespread provision of ART and PrEP could end the HIV pandemic. However, a gap exists between theory and reality, write Anthony S. Fauci, M.D., director of NIH’s National Institute of Allergy and Infectious Diseases (NIAID), and colleagues. Implementation gaps exist at all stages of the HIV care continuum. Progress in cities like San Francisco, which has dramatically reduced new HIV cases by deploying ART, PrEP and other tools, suggests that these gaps can be overcome. Such examples offer lessons for optimizing implementation strategies. 

Even with the availability of simplified HIV drug regimens, medication adherence remains a challenge for many. Thus, there is a need to develop new treatment and prevention strategies and products that can be efficiently taken up by people from diverse communities. Potentially, these new tools will have improved efficacy and broader uptake due to better acceptability and usability. 

Researchers are pursuing multiple approaches to achieve durable control of HIV without daily ART, including pursuing a cure that would eradicate HIV from the body or keep it at very low levels, and developing long-acting ART and broadly neutralizing antibodies (bNAbs) that could be dosed once every few months or less often. Approaches to optimizing HIV prevention include long-acting injectables and implants, bNAbs, multi-purpose tools for HIV prevention and contraception, and other innovative strategies. Scientists also are working toward the development of a safe and effective preventive HIV vaccine. Currently, three large HIV vaccine efficacy clinical trials are underway globally.

RW Eisinger, GK Folkers, and AS Fauci. Ending the HIV pandemic: optimizing the prevention and treatment toolkits. Clinical Infectious Diseases DOI: 10.1093/cid/ciz998 (2019).
NIAID Director Anthony S. Fauci, M.D., is available for comment.

NIAID conducts and supports research—at NIH, throughout the United States, and worldwide—to study the causes of infectious and immune-mediated diseases and to develop better means of preventing, diagnosing and treating these illnesses. News releases, fact sheets, and other NIAID-related materials are available on the NIAID website.

About the National Institutes of Health (NIH): NIH, the nation's medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit

September 19, 2019

HIV Broke Out in This Far Away Community Infecting children, 80 Yr Olds and Monks {The Sad Story}

The most advanced weapons used to be found only in the hands of the most powerful state actors, because of how much it costs to obtain them and the expertise required to use them. Now there is a much lower barrier to entry. More than 75 nations have cruise missiles and more than two dozen nations have armed drones. Those numbers will continue to grow as more sellers like China introduce the technology into the world arms market. (As fate would have it, the Saudis recently bought Predator-drone knockoffs from Beijing.) But there is no money for health on any of these nations including the US., But our story is about a small community who was hit very late by HIV and you figure, damn it's a good timing, we got stuff to even make HIV become not infected and thus it will disappear but not if all these little islands, communities in the jungle start getting it now as the west becomes their "Friends" whose friends they become infected.  Adam Gonzalez
                                   This is 'The sad story'

HIV-affected women in Battambang’s Roka commune, June 2019. (VOD/Saut Sok Prathna)
This edited article by Saut Sok Prathna is from VOD News, an independent news site in Cambodia, and is republished on Global Voices as part of a content-sharing agreement and adamfoxie blog International for professionally publishing the story.
The house of Yem Chrin, a local medic now serving a 25-year jail sentence, stands abandoned in Roka commune in Cambodia, located in Battambang’s Sangke district.
In 2015, a provincial court found him guilty of providing treatment without a license. Among a host of other charges, Yem Chrin was found to be responsible, ultimately, for spreading the HIV virus among hundreds of villagers in 2014 by reusing dirty syringes.
For a time, the case drew national and international attention as it was gradually discovered that almost 300 villagers — from young children to 80-year-olds, and monks at local pagodas — tested HIV positive.
With the attention came to support: Guidance on learning to live with HIV, the upgrading of local roads and clinics, extra programs to help children’s education.
But five years later, life in the commune has become one of mostly silence and early death. Ray*, a 66-year-old woman living with HIV said
No one pays attention. No one thinks about us. I don’t know why they don’t care.
Saloeun, 34, said she and five family members are HIV positive. She was weak and tired on most days and found she had trouble remembering things.
The children and older people in the commune needed more support, she said.
Some children have lost their mothers. They should be given support to continue their studies.
Samoeun’s 13-year-old son lives with HIV. The 34-year-old mother said she felt isolated as the family faced constant discrimination.
I’m so lonely. Don’t they want to recognize me? I don’t want it to be like this.
Local officials, however, said they were doing what they could for the commune. Su Sanith, the deputy director of Battambang’s provincial health department, said the local government paid close attention to Roka’s plight even as international and national aid dropped off.
When the outbreak of this disease happened, there was an increase in both national and international aid for them. But later on, it seems quiet.
Still, 95 percent of affected villagers were receiving antiretrovirals, with just 10 people who migrated or stopped taking the drugs, Sanith said.
Thirty-one of the 285 HIV-positive villagers had died since the outbreak, he said, though most of them were over the age of 60. One infant and three younger people were also among the deceased.
At least two new cases of HIV had also been discovered in the commune, Sanith added.
Battambang provincial governor Nguon Ratanak touted a newly paved road into the commune and the upgrade of its health center into a hospital with skilled doctors as evidence of the government’s support.
They get [support] from the Red Cross and so on. The people are now less afraid because they understand how to take care of their health.
But for the residents of Roka commune, the dwindling levels of care don’t seem on par with the difficulty of living every day with the disease. These days, it seems they are mostly left to cope alone, they said.
Samoeun, the 34-year-old mother, said she had taken to selling boiled ears of corn on her motorbike and making trips into Thailand to try to earn extra income for her son.
She had not seen any governmental officials visit the area in over a year, she said. A sense of neglect and disappointment was turning into resentment.
“I don’t want to be forgotten,” she said.
*The women’s full names have been withheld.

March 12, 2019

Little by Little Scientist Have Been Gaining Ground on HIV/AIDS~Let Me Tell You~

The unnamed “London patient” the second person apparently cured of H.I.V. — earned all the headlines. But other research released this week at the Conference on Retroviruses and Opportunistic Infections showed that scientists are making slow but steady progress on the tactics and medicines needed to fight the epidemic, especially in Africa.

Monthly injections of long-acting H.I.V. drugs proved as good as daily pills at suppressing the virus, according to two trials involving more than 1,000 patients. In another study, Descovy, a new formulation of the H.I.V. treatment Truvada, proved just as effective at suppressing the virus and may have fewer — or at least different — side effects.


A study of the “test and treat” strategy in one million people in South Africa and Zambia — the largest H.I.V. prevention study ever conducted — produced mixed results.

Offering widespread home testing plus treatment to the sickest patients did reduce the number of new infections. But offering immediate treatment to all did not help as much as had been expected. 

And a study of pregnant women in Uganda and South Africa showed that a relatively new drug, dolutegravir, was better than the standard treatment for women about to give birth.

The results of those trials were revealed at the C.R.O.I. meeting in Seattle, a scientific conference held each year in the United States. It tends to offer more research and fewer theatrics than the International AIDS Society conferences that move to new cities around the globe every two years.

Proving that injectable H.I.V. drugs work is important because many people forget to take their daily pills or cannot keep pills in their homes.

The success of the two injectable-drug studies — named Atlas and Flair — raised hopes among H.I.V. experts that these shots may eventually be used to protect the uninfected. (Trials testing that idea are underway now, but results are not expected for about three years.)
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Doctors working in poor countries are eager for injections or implants that will release small daily doses of antiretroviral drugs because the devices can be used in secrecy. Providing injections may be harder than handing out pills, but the option may attract patients with H.I.V. who would otherwise stay away.
A study of pregnant women in Uganda and South Africa found dolutegravir to be more effective in fighting H.I.V. than the standard treatment. 

A study of pregnant women in Uganda and South Africa found dolutegravir to be more effective in fighting H.I.V. than the standard treatment.CreditBaz Ratner/Reuters
African women often say they cannot be caught with pills, microbicides, vaginal rings or other anti-H.I.V. measures because they fear that their husbands, lovers, family members or neighbors will mistakenly assume they are infected.

Long-lasting contraceptive injections like Depo-Provera are much more popular in Africa than in the United States because many women must conceal birth control from their partners, who may get angry that they do not want more children.

Similarly, many gay or bisexual men would welcome a discreet way to take H.I.V. drugs because they are hiding from their spouses or families that they have sex with men.

Both studies tested monthly injections of cabotegravir and rilpivirine deep into the buttocks. The shots worked, and only a handful of participants dropped out complaining they were too painful. Post-trial surveys found that 98 percent of the subjects preferred injections to pills.

In poor countries, cabotegravir may be especially useful because it does not need to be refrigerated.

The clinical trial involving Descovy, a new pill from Gilead Sciences containing a form of tenofovir known as TAF — instead of TDF, the form in Truvada — showed that it suppressed the virus just as well as Truvada did.

People who take Truvada every day as PrEP, or pre-exposure prophylaxis, are almost 100 percent protected against getting H.I.V., whether from unprotected sex or drug injection.

The trial, known as Discover, found that Descovy was slightly less likely than Truvada to harm kidneys or bone density, but other studies have suggested that Descovy is more likely to raise cholesterol.

Gilead said it will soon ask the Food and Drug Administration to let it market Descovy as PrEP. Some AIDS activists worry that people at risk will be urged to switch to Descovy just as low-cost generic versions of Truvada become available.

Truvada has been very safe for most patients, but its high price — now about $20,000 a year — and the red tape needed to help the uninsured pay for it have become major obstacles to ending the AIDS epidemic in the United States.

Gilead has already sold $33 billion worth of tenofovir; it is now shifting its new H.I.V. drug cocktails to TAF, which will remain patented — and, presumably, expensive — for many more years.

The trial in 21 neighborhoods in Zambia and South Africa — a region where H.I.V. infection rates are the world’s highest — was designed to see whether infection rates could be dramatically cut if teams of counselors went door-to-door, testing anyone who agreed and offering pills to anyone testing positive. Counselors also offered advice, condoms, circumcisions, tuberculosis tests and other incentives to lower infection rates during the trial, which is known as PopArt and ran from 2013 to 2018.

It was assumed that communities, where patients were offered treatment immediately, would have by far the lowest rates of new infection. But they did not, even though tests suggested that more people there were taking their pills; further analysis of that quandary will be done, the investigators said.

“PopArt is a head-scratcher,” Mitchell J. Warren, executive director of A.V.A.C., an advocacy group for H.I.V. prevention, said in an email. 

Combining the results of the two main subgroups — those offered pills immediately and those offered pills only when they showed early signs of illness — showed that these strategies lowered new infections by about 20 percent.

Therefore, Mr. Warren said, offering treatment without offering PrEP at the same time “is not the way to epidemic control. Frustrating!”

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The pregnancy trial, called Dolphin-2, showed that 74 percent of women who got dolutegravir-based drug cocktails in their third trimester had no H.I.V. in their blood when they gave birth. Only 43 percent of the women who got older efavirenz-based combinations reached that benchmark.

That was a “highly significant” difference in how fast each drug drove the virus out of the blood, said Dr. Saye Khoo, an H.I.V. specialist at the University of Liverpool who led the trial.

That is important because many women in Africa find out they are infected late in pregnancy, and it can be hard to prevent them from infecting their babies.

Some babies in each test group died, and a few were born infected anyway. The investigators believed the deaths were from unrelated causes like sepsis or pneumonia, and that the rare H.I.V. infections occurred early in the pregnancies before either drug regimen could kick in.
Donald G. McNeil Jr. is a science reporter covering epidemics and diseases of the world’s poor. He joined The Times in 1976 and has reported from 60 countries.

Don't be shy with questions!~~~~~~~

December 3, 2018

Mile Pence Seems to Hate AIDS and The One Affected By It {There Was a President Who Would Not Mention AIDS and delay Treatment for a Year

YES PAPI GIVE ME YOUR LOVE and show me your empty heart full of dogma and ideas of Christ who Love us and gives you love to love us. In The Case of the of the Catholic church and contrary to it who hates the Sin but not the Sinner, Pence hates AIDS and the Homosexual but how about the one with AIDS and Heterosexual?? Adam🦊

Yesterday, in a speech given in advance of World AIDS Day, Vice President Mike Pence didn’t bother mentioning LGBTQ victims of the epidemic. Given what we know of Pence and his anti-gay Christian values, we can’t even call that hypocrisy, much less an oversight. It’s right in line with his character.
The neglect, however, is worth bringing up since conservatives and faith-based groups were the ones who looked the other way while LGBTQ people suffered.
Pink News reports:
Thousands of men who have sex with men lost their lives in the AIDS crisis, with homophobic stigma fuelling social and political rejection on the issue.
Pence failed to wear an AIDS ribbon for the speech and also failed to mention gay people or homophobia.
Instead, Pence recalled stories of straight people who contracted HIV/AIDS from contaminated blood and other sources.
Pence also pledged new funding to “faith-based organisations” who he claims are on “the frontline against HIV/AIDS.”
That makes as much sense as a future headline all about how evangelicals led the way in the struggle to achieve civil rights for LGBTQ people. They were, historically speaking, the obstacle, no matter what they’re doing about it now. 
It’s not the first time that Pence has made a mess of HIV prevention activism: As a congressman back in 2002, Pence condemned condom use as a means to prevent STDs, claiming they were in fact “poor protection,” a statement that contradicts virtually every study on the subject. He also insisted that abstinence was the best means of HIV prevention… which, while technically true, avoided reality. (You can also avoid gun violence by never leaving your bedroom. That doesn’t make it good advice.)
As governor of Indiana, Pence also cut funding for HIV testing and banned needle exchanges, resulting in a predictable — and highly preventable — HIV/AIDS outbreak: the largest in the state’s history.
But what else would you expect when toxic ideology is held to be more important than the facts?
(Image via Shutterstock)

By Patheos

This Angel Doctor is Responsible For Lowering HIV Rates/Deaths in NYC, Young and Gay He Was in The Middle of It

 On a brisk November afternoon at Mount Sinai Comprehensive Care Clinic in Manhattan, Dr. Demetre Daskalakis sat in a brightly lit exam room, clicking away on a keyboard as his next patient walked in. The patient was in his 50s, and his first question was about his mental health. He felt depressed, but he didn’t know why. The patient recently stopped smoking and drinking, and an abdominal pain had him worried. He said his libido was nonexistent, even though he had a regular partner.

“How much of it do you think is because of your brain, and how much of it is because of your penis?” Daskalakis asked. He peppered his patient with questions about the nature of his erectile dysfunction. 

Eventually, Daskalakis discussed the patient’s HIV viral load and CD4 count, markers of the progress of his HIV infection. The patient’s blood tests indicated his viral load remains undetectable — meaning the amount of HIV in his blood is so low, thanks to HIV medications, that he can’t transmit the virus sexually.

                                                                        Demetre Daskalakis speaks at the formal dedication ceremony of New York City AIDS Memorial Park at St. Vincent's Triangle on Dec. 1, 2016.

Daskalakis, 45, updated his patient’s cholesterol medication and wrote him prescriptions for six Viagra tablets and a flu shot. He gave the man a hug goodbye and, before he walked out, said “Text me.”

Daskalakis still sees patients, as he has since the late 1990s, but today he’s just moonlighting as a clinician. The infectious disease specialist squeezes his patients in around the busy schedule of his main job: deputy commissioner for the Division of Disease Control at the New York City Department of Health and Mental Hygiene, one of the world’s largest public health agencies.


Demetre Daskalakis speaks at the formal dedication ceremony of New York City AIDS Memorial Park at St. Vincent's Triangle on Dec. 1, 2016.Erik McGregor / Sipa USA via AP 

Since joining the city’s health department in 2013, Daskalakis has promoted a framework for treatment and prevention strategy that he calls “status-neutral care,” which uses the same approach to initial patient care regardless of one’s HIV status. This type of care is intended to reduce HIV stigma and encourage frank discussions about sexual health, HIV risk and prevention options.

Today, the results of “status-neutral care” are beginning to be seen in public health data. On Thursday, the city released its annual raw data on diagnoses, which showed a record low 2,157 new HIV diagnoses in 2017, a 5.4 percent drop from 2016. The decline is most dramatic among men who have sex with men, whose rate of new infections is estimated to be 35 percent lower than 2013.


Before entering the municipal public health world, Daskalakis earned a reputation as “a progressive, radical gay doctor,” according to Mark Harrington, the executive director of Treatment Action Group, an HIV/AIDS organization.

During a 2012-2013 meningitis outbreak in New York City, Daskalakis went straight to those most at risk — including men who have sex with men, patrons of commercial sex venues and weekenders in Fire Island — and set up a popup vaccine clinic, occasionally dressed in drag as a nurse to take the edge off the injection. The effort was so successful that by August 2013, the outbreak was contained, and officials credited this aggressive vaccination campaign with halting it, according to The New York Times. Shortly after the meningitis campaign, a position opened at the NYC Department of Health for assistant commissioner of the Bureau of HIV/AIDS Prevention and Control. Daskalakis said his “email sort of exploded with people saying, ‘Hey, you should apply for this.’” He threw his hat in the ring and was offered the job, and as he was deciding whether to accept the offer, he said his mind was made up after he received an email from Mark Harrington, saying, “History’s calling. Are you going to answer?”

Harrington recalled telling Daskalakis, “This kind of opportunity won’t come around again, and you’ve got a new [mayoral] administration, you’ve got a governor committed to ending the AIDS epidemic.”

Daskalakis said this made him realized the job offer came at an “opportune moment in the history of HIV in New York City.”

“There was an effort that was motivated by the community to look at New York City and New York State as a place where we could prove that we could end an epidemic of HIV,” he explained.


Around 2012, Harrington said it became clear that “we had the tools to bring down the rate of new HIV infections so drastically that it was possible — even without a cure or vaccine — that we could essentially end the epidemic in places where there was access to high-quality treatment and prevention.”

Part of the reason it was possible, he added, was the passage of the Affordable Care Act in 2010, which meant more young people and poor people were eligible for health insurance than ever before.

                                                                               Bottles of antiretroviral drug Truvada.

The way to end the HIV epidemic without a cure or a vaccine, according to Harrington, is by scaling up the use of two novel prevention tools: PrEP and TasP.

PrEP means “pre-exposure prophylaxis,” and it involves taking a daily Truvada pill to prevent HIV infection. Studies proving PrEP works were published in 2011. Since then, the government has recommended that more and more people consider the drug. This November, the U.S. Preventive Services Task Force recommended that doctors assess all Americans’ HIV risk, and counsel patients to take PrEP if they are at risk, including women who recently had any sexually transmitted infection, vastly increasing the number of people recommended to take the drug.

TasP means “treatment as prevention” and is a moniker given to the realization that HIV positive people can’t transmit the virus through sex if they are undetectable. Until 2015, treatment guidelines had HIV patients wait until their immune systems began to weaken before starting medication. Studies proving that starting treatment early helps HIV patients and also blocks transmission were published between 2008 and 2015.

“We were treating people late, and in many cases too late, to block transmission,” Harrington explained. When studies were published proving PrEP and TasP were both safe and beneficial, health bodies around the world overhauled their HIV guidelines and recommended that many millions more people begin taking antiretroviral drugs in order to control the HIV epidemic.

Harrington said this realization drove a “new wave of activism” at the 2012 International AIDS Conference in Washington, D.C. Activists began to talk about an idea that had been abandoned after the failure of HIV vaccine and cure trials: ending the epidemic.

In 2014, soon after Daskalakis joined the NYC Department of Health, New York Governor Andrew Cuomo announced the formation of “Ending the Epidemic,” a task force that would be responsible for devising a plan to use these new tools to draw down the state’s historically high HIV incidence. Daskalakis sat on the panel and was instrumental in developing the state’s robust PrEP program.


“The definition of ending HIV is a mathematical one,” Daskalakis explained. If New York City could get new infections down below 750 a year by 2020, he said new "transmission would no longer be fueling the epidemic."

When Daskalakis started work at the NYC Department of Health, he did so at a moment when it was suddenly possible, with proper inputs of political will and cold hard cash, to use antiretroviral drugs to engineer an end to HIV transmission in the city. The political will of Mayor Bill de Blasio and Governor Andrew Cuomo, he explained, helped secure the funding needed to scale up the distribution of expensive medications like Truvada.


Some of the language in this new HIV/AIDS prevention paradigm was coined by Daskalakis himself: “status-neutral care.” In an article in Open Forum Infectious Diseases, a medical publication, Daskalakis described status-neutral care as a “multidirectional continuum [that] begins with an HIV test and offers 2 divergent paths depending on the results; these paths end at a common final state,” which is the prevention of HIV transmission.

Daskalakis overhauled the city’s sexual health programs to make them status-neutral. STD clinics were renovated, streamlined and rebranded as “sexual health clinics.”

“All the services had to look alike, whether you're HIV-positive or negative, and the idea was that if you come in and you are newly diagnosed with HIV you get started on meds on the same day of your diagnosis,” he explained. “If you are at risk for HIV, and you test HIV-negative, we don't dilly dally and wait. We start you PrEP that same day.”

Ad campaigns that had attempted to shame people out of contracting HIV instead distilled prevention down to a simple formula: “New boo? Get tested!” That’s because in the status-neutral-care continuum, getting tested is the first step to getting a patient enrolled in PrEP or TasP.

An advertisement from the New York City Department of Health and Mental Hygiene.NYC Dept. of Health and Mental Hygiene / NYC DOHMH

Gone were the scare-tactic campaigns of the Bloomberg administration (one infamous YouTube ad showed a close up view of anal cancer). They were replaced by joyful, brightly colored ads that encouraged people to come in for STD testing. Joining those ads were public awareness campaigns aimed at underserved communities with higher-than-average HIV incidence, like Spanish speakers, transgender women and heterosexual women of color. For the past several years, New York City subways and buses have been plastered with health department PrEP ads.


The success of New York City’s revolutionary HIV prevention program is seen in the city’s declining rate of new HIV infections, but its success stark when compared to jurisdictions that haven’t implemented status-neutral care, or scaled up access to health care. The hotspots of HIV transmission today are in some of the poorest states that have refused to expand Medicaid, like Mississippi.

Daskalakis said his efforts prove the concept works, but he points to the challenges inherent in a model based on the distribution of expensive medications. “A lot of people doing this work are going from, ‘So now we can do it, we know we can,’ to 'How do you create sustainability?'”

Daskalakis describes the city’s new status-neutral-care regime as “the steam engine that's rolling through HIV in New York City and mowing it down in a pretty aggressive way.”

“We're reaping the benefits by consistently seeing HIV incidence decrease,” he said. Last week, in an announcement of the record low HIV incidence, the City of New York said the new data shows it is on target to meet its Ending the Epidemic goals by 2020.

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