HIV

I am so sad about the death of Marty Delaney. I am wondering if those of us who are coming to CROI could meet up to remember him together. Here is a quick remembrance - please forgive its incompleteness but it is with a heavy heart that i wanted to send something:

Marty died from liver cancer surrounded by family and friends in San Francisco.

He was a groundbreaking AIDS activist who fought for access to treatment for all in need. He was the founder of Project Inform, which set up its own clinical trials of possible HIV therapy when there weren't any, and he continued throughout his life to go toe-to-toe with the drug companies on pricing issues.

He knew all the data, but could break it down into common language that schooled me as a young activist in Philly and that provided a backbone for the information we shared through Project TEACH at Philadelphia FIGHT. No matter how long he had already been on the road, or if he was sick or tired, he showed up for annual town meetings there for years - representing just one small part of his untiring efforts to connect people with information, and information to power.

He was a great person to argue with. He was unrelenting on what he thought was right. But like my mentor Kiyoshi Kuromiya, he would push through the doors of the corridors of power but then didn't let them slam shut after he got in - he brought others along with him, even if they had disagreements. He was a hard-core negotiator, and a talented communicator.

In later years, Marty was working with people advocating for a variety of diseases to learn from the work of AIDS treatment activists in influencing research and drug pricing. His loss resonates will resonate far beyond the AIDS community, but so deeply within it.
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Even though we've talked over the last year about the new HIV infections rate (incidence) in 2006, I haven't given any thought to the issue of transmission--how many people actually transmit HIV to an HIV negative person every year? And what does the looking at the rate of transmission over the course of the epdemic tell us about what's working or not working with prevention, testing, treamtment or care efforts?

Well that's why we have smarty pants like David Holtgrave, PhD at the Bloomberg School of Public Health at the John Hopkins University. His study, which JAIDS released online ahead of the publication date, looks precisely at HIV transmission rates over the course of the epidemic. They conclude that the highest rates of transmission occurred in the early years of the epidemic--in the early/mid 80s, and then began to drop off at several different points, particularly from 1985-1986 (31.4-17.4), and 1990-1991 (11.7-6.6). By 2006, the transmission rate declined to 5.0.

In other words, 95% of all people with HIV did not transmit the virus to people who are HIV negative.The study goes on to explain the possible causes for this drop in transmissions:

The general decline in HIV transmission rates over time could be considered a rough measure of prevention success, in that even as prevalence grew over time incidence did not grow proportionately. HIV diagnosis is known to significantly reduce HIV risk behavior, and in the past decade, there has been an increasing emphasis on prevention programs for persons living with HIV that further reduce HIV risk behavior and 2006.

Another interesting thing Holtgrave and co-authors note is that AIDS drugs (anti-retrovirals) didn't have a grand impact on transmission rates, as transmission was declining long before ARVs were on the market. Could it be that marginalised communities with no access to treatment is where those transmission rates did not decrease? Could it be that the prison boom and/or Welfare Reform Act of 1996 (when prison construction peaked and we hit the 2 million prisoner mark for the first time) disrupt or change sexual networks enough to create new HIV transmissions in social networks where they had been stable? Holdgrave doesn't ask these questions, but notes that further research needs to happen to explain why ARVs do not seem to have significantly decreased transmission of HIV. But in a Q & A on Johns Hopkins' website, he addresses the impact of housing stability on HIV risk, and also says what he would do if he was AIDS Czar in the Obama Administration:

I think it is critical to address unmet HIV prevention needs in the U.S. As I testified recently before Congress, my wish for a five-year plan would be for $1.3 billion in prevention funding per year. I might front-load that a bit, so maybe it’s $1.6 billion in the first year, and so on. Over that five-year period, I estimate that as a nation we could reduce transmission by half—but we’d need that substantial investment. And if we really saw a drop in new infections, that higher level of funding might sunset in several years, so we wouldn’t necessarily have to continue to fund it at $1.3 billion per year.

Let's hope we're as lucky to have this come to fruition.

UPDATE: The CDC has published a factsheet and podast on HIV Transmission Rates in the US, based on the release of this data.

 

World AIDS Day: We’re still living with AIDS

By Kenyon Farrow

(originally written for the NGLTF Policy Institute)

December 1, 2008

Today, many of us will dust off those red ribbons, and “remember” to remember the people who we’ve lost, and who are currently living with HIV/AIDS.

Some of us may even donate money to an AIDS charity doing work in some far flung place. But red ribbons and prayer services that commemorate only hide the reality that here in America, we are still living with AIDS.  read more »

On Wednesday October 8, CHAMP held a community forum entitled Black Women and the Fight for HIV/AIDS Prevention Justice. The forum was moderated by Janna Zinzi of WBAI 99.5 FM, and featured four inspiring and informative panelists.  read more »