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Author Topic: Treat all HIV infections, Global Panel Says  (Read 6541 times)

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Offline buginme2

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Treat all HIV infections, Global Panel Says
« on: July 22, 2012, 01:51:41 PM »
An international health panel has recommended for the first time that all HIV patients be treated with antiretroviral drugs, even when the virus's impact on their immune system is shown to be small.

"We are no longer only focused on traditional AIDS-defining infections. We know that HIV is doing damage to the body all the time when it is not controlled," said Dr. Melanie Thompson, principal investigator of the AIDS Research Consortium of Atlanta and a member of the Antiviral Society panel.

>>This is from day one of the conference in DC.  I have a feeling that there are going to be some pretty big policy shifts coming from the conference this year.

http://www.msnbc.msn.com/id/48275721/ns/health-aids/t/treat-all-hiv-infections-drugs-global-panel-says/?
« Last Edit: July 22, 2012, 01:53:15 PM by buginme2 »

Offline Solo_LTSurvivor

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Re: Treat all HIV infections, Global Panel Says
« Reply #1 on: July 22, 2012, 02:14:59 PM »
An international health panel has recommended for the first time that all HIV patients be treated with antiretroviral drugs, even when the virus's impact on their immune system is shown to be small.

"We are no longer only focused on traditional AIDS-defining infections. We know that HIV is doing damage to the body all the time when it is not controlled," said Dr. Melanie Thompson, principal investigator of the AIDS Research Consortium of Atlanta and a member of the Antiviral Society panel.

>>This is from day one of the conference in DC.  I have a feeling that there are going to be some pretty big policy shifts coming from the conference this year.


I can only imagine the spike in psychotropic drugs being prescribed, as well as psychotherapy, if these guidelines become the new "norm".

After all, we see it here all the time on these forums, the level of anxiety from people over just starting meds when they continually attempt to rationalize and justify that their immune systems don't warrant taking meds because somehow it doesn't make having hiv a reality.

And because of this, I don't think that many people who are hesitant about starting meds or looking for any and every side effect to justify going off meds, will be happy about having to start meds shortly after hearing that they have tested positive for hiv antibodies.

A case in point, this person keeps trying to convince herself that she isn't even positive because she thinks that her CD4 count is well within the normal parameters of still being uninfected, despite the fact that she has been advised to confirm a positive result.  And I would imagine that many people would also refuse to get tested because of the fact that there might be a chance they would be placed on meds meaning they would be forced to deal with something they weren't mentally prepared for.

Just some food for thought.... (But) I personally agree with it and feel that people should be able to start treatment as soon as diagnosed, regardless of CD4/VL
don't equate intelligence with lack of masculinity
Jim Phelps, Mission Impossible
____________________________

Seroconverted: Early 80s
Tested & confirmed what I already knew: early 90s

Current regimen: Atripla. 
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Past regimens
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Still UD after all these years

Offline Rockin

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Re: Treat all HIV infections, Global Panel Says
« Reply #2 on: July 22, 2012, 09:33:10 PM »
I do agree, on a personal level, that people should be under medication from diagnosis.

I know this is controversial...Ann, one of our moderators, is not under meds herself and is doing fine. But she might be a rare case and we cannot all compare ourselves to her.

Maybe I`m saying this because I do not suffer from side effects from the meds. I know some people do and its a struggle. But all I want to say is that taking meds everyday might not be the worst thing in the world. And might make you feel a little safer.

Unless, of course, you live in the USA and you have to pay insane amounts of money for your meds. 

Offline leatherman

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Re: Treat all HIV infections, Global Panel Says
« Reply #3 on: July 22, 2012, 10:17:16 PM »
Maybe I`m saying this because I do not suffer from side effects from the meds. I know some people do and its a struggle. But all I want to say is that taking meds everyday might not be the worst thing in the world. And might make you feel a little safer.

Unless, of course, you live in the USA and you have to pay insane amounts of money for your meds.
earlier tonight I wrote a post about the low percentage of side effects that are produced by most medications (package insert info shows well under >10% of patients are effected by most any given side effect), so I've always thought the "omg side effects!" response was a cop-out anyway. I'm not a gambling man, but I'll gamble on taking HAART and stopping HIV - especially when if I've got that 90+% chance of having NO side effects. ;) win-win situation, I say. :D

many people in America thankfully do NOT pay insane amts of money for meds. Working people are often covered by insurance with ADAP and co-pay assistance stepping in to help defray other costs; while others receive their meds through medicare/medicaid and sometimes ADAP, ASOs, or other agencies. Even though 9 states have ADAP waiting lists, because of the many non-profits and ASOs set up to deal with HIV in America, few (if anyone) who needs HIV meds go without meds. As crazy as our system is, even when someone does have to pay out large sums of cash, eventually they reach a point of being bankrupted by their healthcare costs which enables them then to get assistance to get their meds cheaper or for free.


Personally, while I agree with Solo that many people will panic, I say "get over it!". :D Approximately 1/3 of all positive people find out their status when they present at a hospital with symptoms. Many of those people already have AIDS or already are "sick enough" to need medications. (that's why they're showing up at the hospitals. ;) ) Those people are quickly started on meds, and for the most part these days (that is if they report to the hospital in time) recover. Except for a very tiny portion of the HIV-infected population, HIV positive people have to have meds to stop HIV from turning into AIDS and killing them. We all wish we could be like Ann in this respect, but very very few are. You have as much chance of being that lucky as winning the powerball lottery. ;D As I said I'm not a gambler, so I sure wouldn't ever suggest that anyone gamble on being part of the small percentage of LTNP; so buck up and take the meds. It's going to happen sooner or later anyway. ;)
leatherman (aka mIkIE)


chart from 1992-2013; updated 2/09/13  Reyataz/Norvir/Truvada

Offline Rockin

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Re: Treat all HIV infections, Global Panel Says
« Reply #4 on: July 23, 2012, 11:36:03 AM »
That was very enlightnening Leather, I think I had the wrong idea about the situation in America. However, you have to admit that it's still not as good as in South American or European countries. 

My public doctor from the very beginning told me to start HAART regardless of my CD4 or VL...one of the reasons I have complete faith in him and the way he is treating me. He was completely right. I respect people like Ann who decides to stay off HAART as long as her body allows her to but I really enjoy the fact that I'm pretty much a non-contagious person while UND.

The medicine allows me to not worry about the little monster and to go about my life and focus all my energy on my work, my family and my friends.   

Offline LM

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Re: Treat all HIV infections, Global Panel Says
« Reply #5 on: July 23, 2012, 04:59:24 PM »
To be honest, I'm not too fond of this idea. They are pushing meds just for the sake of prevention. I agree the person should have a choice to start whenever (I myself am seriously considering it), but not to have it pushed. I do think some people might avoid getting tested of fear of taking pills straight away. Not to mention the increased cost to governments around the world, which might resort to cheaper drugs instead of providing the most modern ones that are coming out.

That's not the way to end this epidemic, and it won't work, since, as we know, many (probably most) infections come from people who don't know they are infected.

Edit to add: I also think this is very dangerous in terms of focus. More than one scientist has already said that people with HIV are doing well and don't need anything else. To have this complacent view on HIV is very, very dangerous. They might think (and some do) they already have all that's necessary to end the epidemic and let it be, when we should be focusing more and more on research for better treatments, a cure, and a vaccine.
« Last Edit: July 23, 2012, 05:02:45 PM by LM »

Offline Miss Philicia

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Re: Treat all HIV infections, Global Panel Says
« Reply #6 on: July 23, 2012, 05:29:44 PM »
LM, I don't think anyone has suggested tying a patient down on a gurney and forcing HIV meds down their throats like one would do to a goose to fatten them for foie gras production.
"I’ve slept with enough men to know that I’m not gay"

Offline Ann

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Re: Treat all HIV infections, Global Panel Says
« Reply #7 on: July 23, 2012, 05:34:40 PM »
LM, I don't think anyone has suggested tying a patient down on a gurney and forcing HIV meds down their throats like one would do to a goose to fatten them for foie gras production.

Mmmmm....  Atripla Pâté. Yummy! And so trippy too! ~swoon~

Before anyone else jumps on the "Ann's not on meds yet" bandwagon, I started Prezista, Norvir and Truvada on July 11th. No problems and none expected. I'll write more about it when I feel like writing about it. ;)
Condoms are a girl's best friend

Condom and Lube Info  



"...health will finally be seen not as a blessing to be wished for, but as a human right to be fought for." Kofi Annan

Nymphomaniac: a woman as obsessed with sex as an average man. Mignon McLaughlin

HIV is certainly character-building. It's made me see all of the shallow things we cling to, like ego and vanity. Of course, I'd rather have a few more T-cells and a little less character. Randy Shilts

Offline Miss Philicia

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Re: Treat all HIV infections, Global Panel Says
« Reply #8 on: July 23, 2012, 05:36:28 PM »

Before anyone else jumps on the "Ann's not on meds yet" bandwagon, I started Prezista, Norvir and Truvada on July 11th. No problems and none expected. I'll write more about it when I feel like writing about it. ;)

Want a parade?
"I’ve slept with enough men to know that I’m not gay"

Offline leatherman

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Re: Treat all HIV infections, Global Panel Says
« Reply #9 on: July 23, 2012, 05:38:14 PM »
To be honest, I'm not too fond of this idea. They are pushing meds just for the sake of prevention. I agree the person should have a choice to start whenever (I myself am seriously considering it), but not to have it pushed. I do think some people might avoid getting tested of fear of taking pills straight away. Not to mention the increased cost to governments around the world, which might resort to cheaper drugs instead of providing the most modern ones that are coming out.
I have some issues with some of your logic there.  ;) Try looking at those issues some other points of view.

Actually if ALL infected people were properly treated and the risk of transmission was down to 1%, it would basically eradicate HIV within a period of time. It's the people who are untreated who are currently continuing to spread the disease, not the people who are UD.

A person's unfounded fear of taking the only treatment available for a terminal illness is not a very compelling reason of giving them the option of refusing medication. This sounds like a situation calling for more education to the prospective patient. I mentioned before that almost all HIV positive people are eventually going to be on HAART, sooner or later, so in the long run it's only a fantasy for patients to believe that they have a choice about going without proper treatment. No other disease I know of does the diagnosis give you the option to not treat the disease until some time in the future. I could be wrong; but personally if I'm ill, I want treatment so that I can remain well enough to enjoy life and be productive.

Although the only treatment for the terminal illness of HIV is HAART, no one is really "pushing" meds onto anyone. Patients always have the choice to not take the meds and die instead. However since HAART is the only treatment to guarantee life and health, most doctors are going to strongly recommend this course of action.

Although cost IS an issue, we shouldn't hold people's lives hostage for the cost of medication. Surely there can be some method of funding to treat all positive people. For example, in SC the HIV task force produced a report showing that while it may cost $12-24k a year to treat people, it could cost up to about $68k a yr to deal with the illnesses and hospitalization costs for several yrs before a person died of AIDS resulting in untold millions lost in wage, productivity and tax losses not to mention the societal costs to friends and family. Surely the costs of meds can be budgeted rather that society incurring all those awful losses.
leatherman (aka mIkIE)


chart from 1992-2013; updated 2/09/13  Reyataz/Norvir/Truvada

Offline Ann

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Re: Treat all HIV infections, Global Panel Says
« Reply #10 on: July 23, 2012, 05:39:25 PM »
Want a parade?

I held one last night around my 9'x12' back garden. It was quite spectacular. We had Atripla Pâté afterwards.
Condoms are a girl's best friend

Condom and Lube Info  



"...health will finally be seen not as a blessing to be wished for, but as a human right to be fought for." Kofi Annan

Nymphomaniac: a woman as obsessed with sex as an average man. Mignon McLaughlin

HIV is certainly character-building. It's made me see all of the shallow things we cling to, like ego and vanity. Of course, I'd rather have a few more T-cells and a little less character. Randy Shilts

Offline leatherman

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Re: Treat all HIV infections, Global Panel Says
« Reply #11 on: July 23, 2012, 05:39:58 PM »
Before anyone else jumps on the "Ann's not on meds yet" bandwagon, I started Prezista, Norvir and Truvada on July 11th. No problems and none expected. I'll write more about it when I feel like writing about it. ;)
well, surprising news; but I'm very glad to hear that things are going well and you're not having any problems.  :-*
leatherman (aka mIkIE)


chart from 1992-2013; updated 2/09/13  Reyataz/Norvir/Truvada

Offline Rockin

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Re: Treat all HIV infections, Global Panel Says
« Reply #12 on: July 23, 2012, 06:29:06 PM »
I have some issues with some of your logic there.  ;) Try looking at those issues some other points of view.

Actually if ALL infected people were properly treated and the risk of transmission was down to 1%, it would basically eradicate HIV within a period of time. It's the people who are untreated who are currently continuing to spread the disease, not the people who are UD.

A person's unfounded fear of taking the only treatment available for a terminal illness is not a very compelling reason of giving them the option of refusing medication. This sounds like a situation calling for more education to the prospective patient. I mentioned before that almost all HIV positive people are eventually going to be on HAART, sooner or later, so in the long run it's only a fantasy for patients to believe that they have a choice about going without proper treatment. No other disease I know of does the diagnosis give you the option to not treat the disease until some time in the future. I could be wrong; but personally if I'm ill, I want treatment so that I can remain well enough to enjoy life and be productive.

Although the only treatment for the terminal illness of HIV is HAART, no one is really "pushing" meds onto anyone. Patients always have the choice to not take the meds and die instead. However since HAART is the only treatment to guarantee life and health, most doctors are going to strongly recommend this course of action.

Although cost IS an issue, we shouldn't hold people's lives hostage for the cost of medication. Surely there can be some method of funding to treat all positive people. For example, in SC the HIV task force produced a report showing that while it may cost $12-24k a year to treat people, it could cost up to about $68k a yr to deal with the illnesses and hospitalization costs for several yrs before a person died of AIDS resulting in untold millions lost in wage, productivity and tax losses not to mention the societal costs to friends and family. Surely the costs of meds can be budgeted rather that society incurring all those awful losses.

Incredibly well said.

Offline jkinatl2

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Re: Treat all HIV infections, Global Panel Says
« Reply #13 on: July 23, 2012, 06:37:41 PM »
I agree with Leatherman wholeheartedly on this issue.

I further think that fear makes for some serious cognitive dissonance.

People think that taking meds would not end HIV infections?

Well, it would certainly go a long way towards ending that person's infection = or as close as we've got to that end at this point in time.

I absolutely understand the financial worries of being able to afford drugs, at least in developing countries without universal health care and free access to the meds. You know, like mine.



"Many people, especially in the gay community, turn to oral sex as a safer alternative in the age of AIDS. And with HIV rates rising, people need to remember that oral sex is safer sex. It's a reasonable alternative."

-Kimberly Page-Shafer, PhD, MPH

Welcome Thread

Offline LM

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Re: Treat all HIV infections, Global Panel Says
« Reply #14 on: July 23, 2012, 08:51:29 PM »
LM, I don't think anyone has suggested tying a patient down on a gurney and forcing HIV meds down their throats like one would do to a goose to fatten them for foie gras production.

No, but I can totally imagine an approach saying "You have to start your meds now", instead of presenting it as a choice. It's heavy stuff for some people.


Actually if ALL infected people were properly treated and the risk of transmission was down to 1%, it would basically eradicate HIV within a period of time. It's the people who are untreated who are currently continuing to spread the disease, not the people who are UD.

A person's unfounded fear of taking the only treatment available for a terminal illness is not a very compelling reason of giving them the option of refusing medication. This sounds like a situation calling for more education to the prospective patient. I mentioned before that almost all HIV positive people are eventually going to be on HAART, sooner or later, so in the long run it's only a fantasy for patients to believe that they have a choice about going without proper treatment. No other disease I know of does the diagnosis give you the option to not treat the disease until some time in the future. I could be wrong; but personally if I'm ill, I want treatment so that I can remain well enough to enjoy life and be productive.

You missed my point. The problem is, we are not going to treat ALL infections because simply we haven't even identified ALL infections. Those unknown infections are what cause many (if not, most) new infections. And we probably never will unless we force the population to get tested. Also, even if we did, since we can't force people to get treated, many people will choose to not do so, at least for a while. Knowing the previous guidelines recommended treatment when CD4 is below 350 or 500, some people will prefer to wait for that. And a few, unfortunately, might refuse treatment completely.

But anyway, what matters is that because of this, we will absolutely never treat all HIV infections, and this is not the way to end the epidemic. To believe that is naive and dangerous.

And look, I'm not against giving the option of treating all infections, not at all. I'm against the notion that this is what's necessary to end the epidemic. It's not. It won't. History has a lot of examples to show that.

Mmmmm....  Atripla Pâté. Yummy! And so trippy too! ~swoon~

Before anyone else jumps on the "Ann's not on meds yet" bandwagon, I started Prezista, Norvir and Truvada on July 11th. No problems and none expected. I'll write more about it when I feel like writing about it. ;)

Good luck, Ann! Hope everything goes smoothly for you!

Offline leatherman

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Re: Treat all HIV infections, Global Panel Says
« Reply #15 on: July 23, 2012, 09:17:13 PM »
No, but I can totally imagine an approach saying "You have to start your meds now", instead of presenting it as a choice. It's heavy stuff for some people.
It's heavy stuff for a lot of people who don't get a "choice" and yet they deal with it. Like a situation when a doctor says to a patient, "you have diabetes and will need to start daily blood monitoring and injections. The nurse will be in here monentarily to teach you how to give yourself a shot." or "You blood pressure is sky-high. I'm writing you a prescription for a med that you'll need to take daily. I want you to fill this script and begin taking it today."

so it's really shouldn't be that different then when a doctor might say, "You have HIV and need to start taking this one pill a day". I just can't understand the notion that someone would go to doctor, get a diagnosis, be told to start treatment, get a prescription, and then choose to not take the medication and stay ill. No one "likes" medications (I still don't know why my norvir isn't cherry flavored?? ;D  I would like it a lot more) but reasonable people understand the importance of taking medications - especially when the alternative is a terminal disease.

I'm sure I mentioned earlier that 1/3 of positive people learn their status when they present in a hospital, usually with AIDS. You know, when you're lying there in a hospital bed, struggling to breath with PCP, and the doctor doesn't give you a choice (or technically you made the choice to get care by coming to the hospital) and he tells you that they're starting you on an HIV med, along with all the other antibiotics you're already on, and hopefully you'll be able to hang on to life long enough for it to work*, being told you'll be taking an HIV med every day isn't all that heavy.

*my last late partner was told that while they were also treating his non-hodgkins lymphoma. He sure didn't mind his HIV meds. Sadly he didn't live long enough for the meds to work though. Now that's heavy. ;)
leatherman (aka mIkIE)


chart from 1992-2013; updated 2/09/13  Reyataz/Norvir/Truvada

Offline LM

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Re: Treat all HIV infections, Global Panel Says
« Reply #16 on: July 23, 2012, 11:21:02 PM »
I know, leatherman, but you're taking it to the extreme side. I'm talking about, I don't know, someone newly infected, with a CD4 of 800, stable viral load and somewhat healthy. He may not see it as benefit to start treatment right away, since in today's guidelines, he would probably take years until a doc recommended treatment. Also, I can easily imagine people thinking "I had unprotected sex, I might have gotten HIV, but I don't want to take meds now, and since HIV takes a while to kick in, I'll take the test in a few years". It may seem stupid, and it is, but most people aren't knowledgeable about HIV anyway. People don't have any idea what you or others went through, so yes, they will whine about taking one pill a day, even if they don't have side-effects. I'm certainly cool with it, I'm already taking 6, and it's nothing related to HIV.

But anyway, what I'm worried about is this naive optimism that we already have the tools to halt the epidemic. It's this complacent approach I'm not fond of.

Offline leatherman

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Re: Treat all HIV infections, Global Panel Says
« Reply #17 on: July 24, 2012, 03:48:11 AM »
It's this complacent approach I'm not fond of.
but I think all your scenarios of people who don't want to test, who don't want treatment, who aren't knowledgeable about HIV, who don't think they're sick enough, who don't realize the seriousness of being infected with a terminal disease are examples of the complacent approach.

since sexual transmission is the main source of the spread of HIV, it seems that testing as many people as possible and treating all those infected (so that they are no longer a source of transmission) would be a huge step towards reaching the goal of stopping the spread of HIV. Obviously the more complacent approach of not testing enough people and waiting to treat hasn't done enough as the rate of HIV infection has stagnated (in the US) at a high level for numerous years now. It seems like another approach should be considered. Just like I think any media campaign, whether it's the soft sell or the obscenely graphic, should be used because they all reach some sort of target audience, so I think every option needs to be tried.

I think we need to be aggressively testing, actively treating, pushing much more education to the public, our children and our legislators, encouraging further research, and counseling everyone that engages in a risk behavior if we ever plan to stop this disease.
leatherman (aka mIkIE)


chart from 1992-2013; updated 2/09/13  Reyataz/Norvir/Truvada

Offline bocker3

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Re: Treat all HIV infections, Global Panel Says
« Reply #18 on: July 24, 2012, 07:53:19 AM »
What I find "naive" is the stance that unless something is going to act as a magic bullet and instantly cure and end this epidemic, it is not going to work.
It drives me completely bat shit  crazy that everytime something is introduced into the arsenal that might, some day, end this disease, someone has to say -- "no, people are in fear of "X", so doing "X" will stop them from testing.........".  I mean get a fucking grip.  While that might be true for some subset of people, it is most assuredly NOT TRUE for many others.  People have been and will likely be afraid to test since the beginning.  What this "argument" is really about, in most cases, is that persons own fears coming out and being projected onto the rest of the world.  Decreasing the number of people with a VL, will only help decrease the number of new infections.  All of them?  Instantly?  of course not.  We have to start somewhere.

Mike
Atripla - Started 12/05
Reyataz/Norvir - Added 6/06
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Offline Common_ground

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Re: Treat all HIV infections, Global Panel Says
« Reply #19 on: July 24, 2012, 09:02:53 AM »
We should not forget the history of this disease that we all share but to make the public DARE to test, get treatment and limit the spread we need to show that there is a life after testing positive in 2012. People are scared because it is still considered a death sentence to many.

If only more people like Larry Kramer, Magic Johnson and Thomas Duane as well as the average joe could step forward to give HIV a face I think it would ease the pressure and stigma.

I want empathy and support,but not pity.   
2011 May - Neg.
2012 June CD4:205, 16% VL:2676 Start Truvada/Stocrin
2012 July  CD4:234, 18% VL:88
2012 Sep  CD4:238, 17% VL:UD
2013 Feb  CD4:257, 24% VL:UD -viramune/truvada
2013 May CD4:276, 26% VL:UD

Offline ds4146

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Re: Treat all HIV infections, Global Panel Says
« Reply #20 on: July 24, 2012, 09:44:54 AM »
Before anyone else jumps on the "Ann's not on meds yet" bandwagon, I started Prezista, Norvir and Truvada on July 11th. No problems and none expected. I'll write more about it when I feel like writing about it. ;)

Wow, I am very surprised. How long will you keep us hanging on the "more about it" part? Curiosity killed the cat kinda of thing,  :P Wishing you well!

Offline Rockin

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Re: Treat all HIV infections, Global Panel Says
« Reply #21 on: July 24, 2012, 10:02:59 AM »
We should not forget the history of this disease that we all share but to make the public DARE to test, get treatment and limit the spread we need to show that there is a life after testing positive in 2012. People are scared because it is still considered a death sentence to many.

If only more people like Larry Kramer, Magic Johnson and Thomas Duane as well as the average joe could step forward to give HIV a face I think it would ease the pressure and stigma.

I want empathy and support,but not pity.

Agree and this is something that I started noticing ever since I found out my status (while sick of pneumonia with a CD4 of 290...i.e. AIDS, one of the 1/3 that Leatherman mentioned)...the huge problem with AIDS is that it has been somewhat swept under the rug. You don't see HIV characters in fiction, you don't see movies about HIV anymore, no one else has come forward about it...

So there lies the stigma. Cancer used to be scary as hell as well until we started to see works of fiction about people living and battling cancer. I know the very nature of these diseases is very different but still...

And LM...I understand your point but I still disagree. People HAVE to deal with it, no matter how scary it is. A person with a CD4 of 800 and a VL of 50,000 can still infect other people....a person who's UND has a very very low chance of causing that.

Offline LM

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Re: Treat all HIV infections, Global Panel Says
« Reply #22 on: July 24, 2012, 05:44:18 PM »
but I think all your scenarios of people who don't want to test, who don't want treatment, who aren't knowledgeable about HIV, who don't think they're sick enough, who don't realize the seriousness of being infected with a terminal disease are examples of the complacent approach.

People are complacent about HIV, but that's one problem. What I'm worried about is decision-makers getting complacent. Now that's dangerous.

I think we need to be aggressively testing, actively treating, pushing much more education to the public, our children and our legislators, encouraging further research, and counseling everyone that engages in a risk behavior if we ever plan to stop this disease.

Yes, and that I fully agree with. We need ALL of that.

What I find "naive" is the stance that unless something is going to act as a magic bullet and instantly cure and end this epidemic, it is not going to work.
It drives me completely bat shit  crazy that everytime something is introduced into the arsenal that might, some day, end this disease, someone has to say -- "no, people are in fear of "X", so doing "X" will stop them from testing.........".

The point, which you missed by far, is that nothing new is being introduced but it's being treated as enough to stop the epidemic.

I'm all for: "Let's try this approach while we look for other things, as it's not enough."

But I'm totally against: "Let's go with this, we have enough."

And LM...I understand your point but I still disagree. People HAVE to deal with it, no matter how scary it is. A person with a CD4 of 800 and a VL of 50,000 can still infect other people....a person who's UND has a very very low chance of causing that.

You don't have to agree with it. The fact is that people don't have to deal with it if they don't want to. Why would someone start treatment just to reduce the risk of infecting someone if can use condoms? He can start later, if following today's guidelines. And many will do so.

Offline bocker3

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Re: Treat all HIV infections, Global Panel Says
« Reply #23 on: July 24, 2012, 06:05:54 PM »

The point, which you missed by far, is that nothing new is being introduced but it's being treated as enough to stop the epidemic.

I'm all for: "Let's try this approach while we look for other things, as it's not enough."

But I'm totally against: "Let's go with this, we have enough."

Oh, but I didn't miss the point at all -- perhaps you have, but I have not.  Who said this would be all - you are now trying to work your way out of corner, perhaps? 
In theory, universal treatment could stop the epidemic -- the problem is that you aren't likely to get full compliance -- but if you cut transmissions down, you lessen the epidemic down the road.  You lessen the spread and things get better and a true end to the epidemic becomes "easier".

Why would someone start treatment just to reduce the risk of infecting someone if can use condoms?
Here's why -  if they always had used condoms, they wouldn't be having to make this choice, would they??!!

Mike
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Offline mecch

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Re: Treat all HIV infections, Global Panel Says
« Reply #24 on: July 24, 2012, 06:18:16 PM »
Lordy people ready to go to their graves scared of da meds.  Nothin evaaaaaaaah gonna convince these fools 'cept MAYBE near death or shuttin their damn exasperating, rote circular thoughts, swallowing, and living well on them for awhile. 
« Last Edit: July 24, 2012, 06:20:44 PM by mecch »
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Offline jkinatl2

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Re: Treat all HIV infections, Global Panel Says
« Reply #25 on: July 24, 2012, 06:27:36 PM »
Lordy people ready to go to their graves scared of da meds.  Nothin evaaaaaaaah gonna convince these fools 'cept MAYBE near death or shuttin their damn exasperating, rote circular thoughts, swallowing, and living well on them for awhile. 

Seriously. My patience with these people is narrowing, especially as the meds become easier to tolerate and easier to take. Make them universally accessible, and the only barrier will be people's irrational fear of them - or the denial that they have the bug in the first place.

Which is a problem for a therapist, methinks.

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Offline leatherman

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Re: Treat all HIV infections, Global Panel Says
« Reply #26 on: July 24, 2012, 06:57:23 PM »
Seriously. My patience with these people is narrowing....

Which is a problem for a therapist, methinks.
exactly. Am I just noticing this problem more lately, or is it irking me more, or is it happening more?? I seem to be posting similar things over and over in threads in rebuttal to these crazy notions of "I'm scared of the meds" or "the meds are toxic" or "meds have guaranteed ghastly side effects". ::)  ::)
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Offline LM

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Re: Treat all HIV infections, Global Panel Says
« Reply #27 on: July 24, 2012, 08:15:01 PM »
Oh, but I didn't miss the point at all -- perhaps you have, but I have not.  Who said this would be all - you are now trying to work your way out of corner, perhaps? 
In theory, universal treatment could stop the epidemic -- the problem is that you aren't likely to get full compliance -- but if you cut transmissions down, you lessen the epidemic down the road.  You lessen the spread and things get better and a true end to the epidemic becomes "easier

Mike

My, you're not a bright fellow, are you? Haven't you been reading the headlines lately? "We have the tools to end AIDS", they say, over and over. "Zero new infections, zero AIDS-related deaths", and the sort. The more you keep bitching, the more you show you haven't understood anything I said, as I haven't said anything different from your last three lines.

Here's why -  if they always had used condoms, they wouldn't be having to make this choice, would they??!!

Brilliant logic. And a hint of judgment also. Nice!  ;)

Offline bocker3

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Re: Treat all HIV infections, Global Panel Says
« Reply #28 on: July 24, 2012, 10:01:03 PM »
My, you're not a bright fellow, are you? Haven't you been reading the headlines lately? "We have the tools to end AIDS", they say, over and over. "Zero new infections, zero AIDS-related deaths", and the sort. The more you keep bitching, the more you show you haven't understood anything I said, as I haven't said anything different from your last three lines.

Darling, I'll take my Master of Public Health degree over your fears any day of the week. 
These are goals and tools -- so I think you might want to turn up your own dimmer, because apparently the light is way too low.
By the way -- we DO have tools to end AIDS, what we don't have is the money and the ability to force meds down peoples throats (no, I'm not advocating that we do that) -- we have condoms, what we don't have is a way to have consistent use of them -- shall I go on??  Having the tools and achieving the goals aren't always the same thing, however.  But...............  we can start by advocating treatment as both a lifesaving thing for the patient and a way to stop the spread - and of course continue preaching about condom use.

I know, arguing with you is generally futile, as you only see what you see.  While I acknowledge the audaciousness of the goal, I can still see the good it will do.  You on the other hand, will continue to see the glass half empty and stand firm in your fear of treatment.


edited to add:
Brilliant logic. And a hint of judgment also. Nice!  ;)

Here is where we see someone missing a point -- that quote was because of what you said here
Why would someone start treatment just to reduce the risk of infecting someone if can use condoms?

No judgement, other than showing you why multiple tools are a GOOD THING.  Again -- turn up the dimmer, sugar.

Mike
« Last Edit: July 24, 2012, 10:05:04 PM by bocker3 »
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Offline Rockin

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Re: Treat all HIV infections, Global Panel Says
« Reply #29 on: July 24, 2012, 10:09:09 PM »
Brilliant logic. And a hint of judgment also. Nice!  ;)

What judgement LM? How were all of us here infected in the first place? By people who were not UND. Not saying is solely their fault, we obviously are to blame as well...but if the people who infected us were UND (and yes, I'm aware some people here got infected way back when that didn't even exist) maybe we would have remained negative.

That was certainly my case. So we cannot trust people to use condoms all the time and I include my negative self on that. 

Offline LM

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Re: Treat all HIV infections, Global Panel Says
« Reply #30 on: July 25, 2012, 05:29:44 AM »
Darling, I'll take my Master of Public Health degree over your fears any day of the week. 
These are goals and tools -- so I think you might want to turn up your own dimmer, because apparently the light is way too low.
By the way -- we DO have tools to end AIDS, what we don't have is the money and the ability to force meds down peoples throats (no, I'm not advocating that we do that) -- we have condoms, what we don't have is a way to have consistent use of them -- shall I go on??  Having the tools and achieving the goals aren't always the same thing, however.  But...............  we can start by advocating treatment as both a lifesaving thing for the patient and a way to stop the spread - and of course continue preaching about condom use.

I know, arguing with you is generally futile, as you only see what you see.  While I acknowledge the audaciousness of the goal, I can still see the good it will do.  You on the other hand, will continue to see the glass half empty and stand firm in your fear of treatment.


Ooh, throwing diplomas on the table, are you? Signs of insecurity, I see. You see, you went so far from the point, that you think I'm afraid of treatment. Now, when did I ever say that? Actually, I even said I'm actually considering to start treatment, even though the guidelines in my country say I shouldn't.

Here, quotey:

I agree the person should have a choice to start whenever (I myself am seriously considering it)

And another:

People don't have any idea what you or others went through, so yes, they will whine about taking one pill a day, even if they don't have side-effects. I'm certainly cool with it, I'm already taking 6, and it's nothing related to HIV.

See how a few quotes can beat a diploma any day of the week?  :)

It's not because I recognize this fear in many people that I have it myself.

edited to add:
Here is where we see someone missing a point -- that quote was because of what you said here
No judgement, other than showing you why multiple tools are a GOOD THING.  Again -- turn up the dimmer, sugar.

Mike

Once again, your diploma is not helping you, you should head back to school to learn how to read again. Never said multiple tools is a bad thing, quite the opposite. But you keep firing the other way. You make it seem that people with HIV, because they didn't use condoms in the first place and got infected, will continue to do so, so need meds to stop them being biohazards to others. Sure, some might be indeed, but to consider all of them as such? Not nice, dude. Certainly, not.

What judgement LM? How were all of us here infected in the first place? By people who were not UND. Not saying is solely their fault, we obviously are to blame as well...but if the people who infected us were UND (and yes, I'm aware some people here got infected way back when that didn't even exist) maybe we would have remained negative.

That was certainly my case. So we cannot trust people to use condoms all the time and I include my negative self on that. 

You see, that's exactly it. You're blaming your infection on the poz person when it's totally your fault. Who said you didn't get infected from someone who was undetectable, first of all? After all, being undetectable doesn't reduce by 100% the chances of infection. But most important, getting HIV was your fault. YOU didn't use condoms. Not that you should beat yourself because of it, but thinking "oh, if only he was undetectable" is really running away from the real deal.

And it's not because we cannot trust people to use condoms all the time that it will be right to make everyone take meds for the sake of prevention. Once again, I'm not saying I'm against the option of starting treatment whenever, I think that's awesome, but yes, once again, someone might refuse treatment early if he (and maybe his doctor) sees no benefit to his health and life as of yet and believes he can take the appropriate precautions towards others.

Just pointing out how this whole thing, while helpful and everything, won't be a panacea.

Offline Rockin

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Re: Treat all HIV infections, Global Panel Says
« Reply #31 on: July 25, 2012, 10:21:22 AM »
You see, that's exactly it. You're blaming your infection on the poz person when it's totally your fault. Who said you didn't get infected from someone who was undetectable, first of all? After all, being undetectable doesn't reduce by 100% the chances of infection. But most important, getting HIV was your fault. YOU didn't use condoms. Not that you should beat yourself because of it, but thinking "oh, if only he was undetectable" is really running away from the real deal.

And it's not because we cannot trust people to use condoms all the time that it will be right to make everyone take meds for the sake of prevention. Once again, I'm not saying I'm against the option of starting treatment whenever, I think that's awesome, but yes, once again, someone might refuse treatment early if he (and maybe his doctor) sees no benefit to his health and life as of yet and believes he can take the appropriate precautions towards others.

Just pointing out how this whole thing, while helpful and everything, won't be a panacea.

LM, I get your point, I really do. But saying its only MY fault I got infected is a fail point to me. Everyone makes mistakes but we, the HIV+ ones, have the information, know our status full well and know what we have inside of us. Its up to us to be the responsible ones here. It's up to us to say "Hey, you don't want to wear a condom? Let me tell you something then...". You are right, it would not be 100% our fault but we do know whats going on, the other doesnt.

And saying that even being UND you can still infect someone well...I think I would need proof of that. Researchers say its not 100% fail safe because they CANNOT say that, as they cannot say its impossible to get it from oral sex. But I've read the articles and the odds are slim to none. So for that I would need proof.

If people cannot be mature enough to be responsible for their own health and the health of others then yes, sometimes they have to be "forced" to make the right choice.

Some people can drink half a bottle of wine and drive pretty well, never harming anyone. Some drink 2 beers and hit people with their cars, destroying lives. Which means, some people ruin it for everyone and that is why we have laws for that.

Offline Ann

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Re: Treat all HIV infections, Global Panel Says
« Reply #32 on: July 25, 2012, 10:45:18 AM »
Yeah yeah yeah, one salient point that some here are missing is that it is estimated that a majority of hiv infections are occurring when the positive partner has no idea they are positive. It's pretty difficult to "force" or even suggest treatment to an individual who has no idea they have the virus.

Here's relevant linkage for youse.

And yeah yeah yeah, I know, I'm still on the fence about the new in-home test, but that's because of it's high rate of false NEGATIVE results, which has the potential of creating a new sub-group of people who confidently think they're hiv negative when nothing could be farther from the truth.

But like others have mentioned, there's never going to be a one-size-fits-all solution. Just like you don't do a house renovation with only a hammer, we need many tools in the prevention toolbox.
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Offline buginme2

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Re: Treat all HIV infections, Global Panel Says
« Reply #33 on: July 25, 2012, 11:31:24 AM »
While these recomendations do take into account the treatment as prevention theory it is not the only reason for this change.

The report that was issued recommending this change speaks a lot about how we measure and quantify the positive persons health.  Historically, a positive persons health has been measure by cd4 count.  A count above 500 was assumed they were doing fine and below was time to start meds.  The report that acommpanied this change stated this is out of date.  A positive persons health is affected even if they have a normal cd4 count with an increase in heart disease, kidney disease, cancer etc.    This change was meant to address that.

Also, this report states that there is no need to measure a patients cd4 count more than twice a tear and in most cases once a year is enough.  Its not just a "put everyone on meds" report but looking at more than one way to quantify health.

Offline Rockin

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Re: Treat all HIV infections, Global Panel Says
« Reply #34 on: July 25, 2012, 01:42:42 PM »
I think theres also a big difference between a doctor saying "I RECOMMEND that you start treament right away, regardless of your CD4" and saying "You HAVE to star treatment right away".

Even so...I believe that just a recommendation from doctor might cause some change in people's behavior. That's how my doctor reacted in the first place. He said "You could wait a while and see if your CD4 increases on its own...but if I were you I'd stay on the safe side and start it right away. I'd even suggest that even if your CD4 was high".

And following Ann's topic...was it ever suggested by any government a mandatory annual HIV test on every citizen, say between ages of 16-60? I was thinking...a lot of people would oppose this and call it outrageous but you can't deny that that would be a huge step in fighting the spread of the virus.

Offline LM

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Re: Treat all HIV infections, Global Panel Says
« Reply #35 on: July 25, 2012, 03:24:50 PM »
And saying that even being UND you can still infect someone well...I think I would need proof of that. Researchers say its not 100% fail safe because they CANNOT say that, as they cannot say its impossible to get it from oral sex. But I've read the articles and the odds are slim to none. So for that I would need proof.

If people cannot be mature enough to be responsible for their own health and the health of others then yes, sometimes they have to be "forced" to make the right choice.

If you need proof, you need to read the study with heterosexual couples that showed that being undetectable reduced infections by 96%. You see, it wasn't 100%, so yes, there were infections. Bear in mind that while you may have undetectable viral load in your blood, many times it is not undetectable in semen. So yes, that may cause infections. And remember, this study was with heterosexual couples. We know anal sex has a higher risk for HIV, so with homosexual couples, the percentage of reduced risk of infection might be lower.

Also, you can't force people to make the "right choice", and answering also your last post, you can't force people to get tested. It's violating a person's freedom, it's against human rights. It would only increase stigma also. That's only possible in a brutal dictatorship, not a democracy.

While these recomendations do take into account the treatment as prevention theory it is not the only reason for this change.

The report that was issued recommending this change speaks a lot about how we measure and quantify the positive persons health.  Historically, a positive persons health has been measure by cd4 count.  A count above 500 was assumed they were doing fine and below was time to start meds.  The report that acommpanied this change stated this is out of date.  A positive persons health is affected even if they have a normal cd4 count with an increase in heart disease, kidney disease, cancer etc.    This change was meant to address that.

Also, this report states that there is no need to measure a patients cd4 count more than twice a tear and in most cases once a year is enough.  Its not just a "put everyone on meds" report but looking at more than one way to quantify health.

It would be interesting to know more details about this. I'm anxious about the results of the START study. Actually, I can only start treatment now if I enroll in it. My doctor suggested it to me a few months ago when they were recruiting, but I was not at a good moment, so I said no. Now, it could be a good idea, but I have to check if they're still recruiting.

Yeah yeah yeah, one salient point that some here are missing is that it is estimated that a majority of hiv infections are occurring when the positive partner has no idea they are positive. It's pretty difficult to "force" or even suggest treatment to an individual who has no idea they have the virus.

Exactly! That's what I've been saying. Like I discussed with leatherman, this has to be accompanied by more testing and such. People who are aware of their infection usually take the necessary precautions to avoid infection, they don't need to be treated as biohazards to the rest of the population.

Offline buginme2

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Re: Treat all HIV infections, Global Panel Says
« Reply #36 on: July 25, 2012, 03:33:25 PM »
Where are you people getting that these recommendations were made soley to reduce infections? 

Offline jkinatl2

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Re: Treat all HIV infections, Global Panel Says
« Reply #37 on: July 25, 2012, 04:01:38 PM »
Where are you people getting that these recommendations were made soley to reduce infections? 

It was my understanding that mitochondrial damage and damage to organs, including the brain, were evident in patients even before they reached the "critical mass" of 350 cd4 cells.

There are those of us on these forums who still seem to carry a 2001-era understanding and skepticism of HIV meds. And of course these folks always trot out the whole "no long term studies to see what happens in 20 years" line, which I totally understand and which is absolutely true.

But given the standard of medication TODAY, and given the pipeline drugs and the VAST number of combinations available in case unwanted effects prove too much, I am starting to see that reasoning as based not on skepticism, but fear. Warranted fear perhaps, as many of these people have sen the dreadful effects of earlier itenerations of the meds. But fear nonetheless.

It has been my experience that fear, even warranted fear, tends to be rather impervious to reason. And it trumps rational thought quite often.

Would treatment prevent many onward infections? Of course. Would it prevent ALL of them? Of course NOT.

You want to talk testing, I would recommend routine testing. We will soon have an at-home kit. Walgreens Drug Stores in the US (one of the largest chains)already has walk-in clinics where other standard STD tests are performed (along with other routine testing - sort of an in-between choice for illnesses/injuries that do not warrant an ER or Urgent Care Clinic, but would rather not wait for a family physician - which many people simply don't have) is planning to roll out HIV testing as part of it's repertoire.

If other clinics in drugstores did the same, if urgent care clinics did the same, and did it at a reasonable cost, then a real impediment to testing would be overcome. This would also help prevent onward infections. It would also pair wonderfully with immediate treatment suggestion.

Making the state-of-the-art test like what is currently used in Massachusetts globally available would reduce the window period to six weeks. This would further reduce false negatives which come from testing too early.

This would require a lot of cooperation from pharma and government. Which, IMHO, is long overdue. Ironically, it would spur competition, rather than deter it.

Insofar as UD viral loads and infections, that really depends on where that possibly viral load-blipping semen is going, doesn't it? An UD woman stands about a zero chance of infecting a negative male. An UD male bottoming stands about a zero chance of infecting a male who is topping without a condom.

Condom use has plateaued, and has remained stagnant since the dawn of the pandemic. Scare tactics, Condom Man and the Latex League, free condoms in bars have had little effect. While I freely admit that changing the paradigm of treatment accessibility and testing availability will be difficult, changing human nature has proven to be much, much moreso.

"Many people, especially in the gay community, turn to oral sex as a safer alternative in the age of AIDS. And with HIV rates rising, people need to remember that oral sex is safer sex. It's a reasonable alternative."

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Offline leatherman

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Re: Treat all HIV infections, Global Panel Says
« Reply #38 on: July 25, 2012, 06:56:51 PM »
Condom use has plateaued, and has remained stagnant since the dawn of the pandemic. Scare tactics, Condom Man and the Latex League, free condoms in bars have had little effect.
I don't quite agree with the way you wrote these last few lines. ;)

I think scare tactics, media campaigns, and free condoms have had a HUGE effect. They have gotten us to, and kept us at, where we are with the current level. Without those prevention/education programs, I'm sure the infection rate would either still be increasing or stagnated at a much higher level. Just because those methods haven't totally solved the problem is no reason to diss the good benefit that they provide at keeping the infection rate at the level it is. ;)  :D


a bit of disclosure as to why I want the role of condoms in affecting infection rates to be acknowledged:
I am actually a huge proponent of condoms. :D

I work with, and have forged links to, many agencies here in my state to increase condom distribution. This work started when I was representing my ASO at a local summer fest/health fair. I met a lady at that venue who was also passing out condoms. While I was distributing them as HIV prevention, she was distributing them as teen-pregnancy prevention. When I realized we were working towards some of the same goals (lowering the huge rates of HIV, teen pregnancy and chlamydia here in SC), I began to network with and connect various agencies representing sexual health care, teen pregnancy, STD/STIs, health dpt etc. Condoms are incredibly cheap, easy to use with no side effects, and prevent a lot of issues saving a lot of heart ache and a lot of money. ;)

While I'm all for adding new methods to the arsenal (like increased testing, at home testing, increased treatment for everyone infected) we have to keep using and increasing the methods (like condoms, scare tactics, counseling, and media campaigns) that have been working so well for years. ;)
leatherman (aka mIkIE)


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Offline jkinatl2

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Re: Treat all HIV infections, Global Panel Says
« Reply #39 on: July 25, 2012, 07:29:24 PM »
I ran a non profit HIV prevention and information/outreach program for several years (1993-2001) and I can only speak for my own experience.

Seeing the half dead people stagger through the clubs, seeing the bar rags swell in size to the length of small town telephone books, tossing thousands upon thousands of condoms to people did combine to have an effect.

An effect that scarcely reflected the effort and funds, not to mention the manpower that powered these efforts.

The introduction of crystal meth into the gay scene in the 90s was a game-changer, in the worst possible way. It's only been in the last five years or so that the popularity of the drug seems to be winding down slightly. Those who would have worn condoms anyhow were appreciative of the availability. But those who were tweaking routinely forewent the use.

The impact of condom outreach, in my experience, was and is largely a "preaching to the choir" situation. What was needed in condom outreach, what would STILL make a difference, is in'school condom education. Not only the discussion of using them, but the importance (and procedure) for using them correctly. This should be done in middle school, as soon as testicles begin to drop.

But it wasn't, and it isn't, and it likely won't. Not here in the USA anyhow.

I put in my time in the trenches of condom outreach, believe me. And I would do so again in a heartbeat. But I harbor no illusions (anymore) about the role such outreach plays in HIV prevention.

In a DDF/UB2 universe, showing up to the party with condoms is a grim and unwanted reminder of a fact intentionally, often chemically overlooked.

The fact that the CDC gave out condoms laced with Nonoxynol-9 until roughly 1998 was another deterrent not only to condom use, but to HIV prevention as a whole. If the government's state-of-the-art scientific branch could fail to notice the obvious issues with using such caustic material (and this failure had little to do with the understanding of HIV at the time, more to do with the grants and contracts with condom companies and a disregard for the obvious safety issues) it was no large feat to simply disregard the CDC's attempts to educate (meager though they were) and forego them altogether.

I am not at all ashamed nor do I regret my time and effort. But I am able to look back at it now with a perspective that I am certainly glad I didn't have then.

But glad I have now.


"Many people, especially in the gay community, turn to oral sex as a safer alternative in the age of AIDS. And with HIV rates rising, people need to remember that oral sex is safer sex. It's a reasonable alternative."

-Kimberly Page-Shafer, PhD, MPH

Welcome Thread

Offline leatherman

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Re: Treat all HIV infections, Global Panel Says
« Reply #40 on: July 25, 2012, 08:14:46 PM »
The introduction of crystal meth into the gay scene in the 90s was a game-changer,

What was needed in condom outreach, what would STILL make a difference, is in'school condom education. Not only the discussion of using them, but the importance (and procedure) for using them correctly. This should be done in middle school, as soon as testicles begin to drop.

But it wasn't, and it isn't, and it likely won't. Not here in the USA anyhow.
In a state where chlamydia (#1), gonorrhea (#3), hiv (#8) and teen pregnancy (#13) are at some of the highest percentages in the US and meth usage not as bad (#26), condoms are an important tool against our major health problems.

Amazing for such a red-state, SC is one of the states that does teach abstinence along with contraception and condom usage. Although our legislators frequently try to pass laws restricting sex-ed and/or funding abstinence-only programs, parents have spoken out and keep comprehensive sex-ed in the public schools.

Our prevention specialists regularly visit the local high schools giving special class presentations about HIV, STIs, condoms, etc. These presentations do include condom usage demonstrations, using either health dept supplied dildoes or simple phallic models (the usage of which is based upon the age group or teacher-request).

As has been mentioned several times in this thread, it takes all kinds of approaches to deal with these health care issues (like HIV), and that's probably because some of these approaches work better in some areas than others.
leatherman (aka mIkIE)


chart from 1992-2013; updated 2/09/13  Reyataz/Norvir/Truvada

Offline LM

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Re: Treat all HIV infections, Global Panel Says
« Reply #41 on: July 25, 2012, 08:58:54 PM »
I believe scare tactics is only harmful as it increases stigma. And about condom use, it's just like jkinatl2 said, it's human nature. Expanding treatment may reduce infections, but I think that infections will also rise because there is a worldwide fatigue with condom use now that I believe is irreversible. I don't know how it's going in the US, but over here, the number of infections is going up in younger people, like, ages 15-24. And I think it will continue to go up.

Offline Ann

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Re: Treat all HIV infections, Global Panel Says
« Reply #42 on: July 26, 2012, 05:38:50 AM »

I believe scare tactics is only harmful as it increases stigma.


Scare tactics are something that absolutely should not be present in the prevention arsenal. Studies have shown them to be counterproductive. Not only do they not work on any appreciable level, but as LM points out, they add to the stigma we face.

Here's a short excerpt from the 2011 article Fear-based campaigns: The way forward or backward? - please also read the whole article. It's interesting and informative.

Are HIV fear-based campaigns effective?

A 2005 meta-analysis of fear-based HIV prevention campaigns found that the strategy of appealing to people's fears did not work.7 This analysis synthesized the results of 194 studies that evaluated HIV prevention interventions aimed primarily at promoting condom use. The meta-analysis found that the most effective HIV prevention interventions:

    contained arguments aimed at changing attitudinal beliefs (for example, discussions of the positive implications of using condoms for the health of one’s partners);
   
    provided educational information (for example, factual information on the transmission and prevention of HIV); and
   
    provided people with behavioural skills (for example, discussions of what to do when a partner won’t wear a condom and role-playing activities that promote condom use)

However, this meta-analysis found that fear-based approaches did not increase rates of condom use and that such strategies were the least effective. Surprisingly, it found that fear-based approaches may be associated with decreases in condom use.


Another article along the same lines by Gus Cairns - HIV prevention: does scaring people work?



edited to fix dodgy formatting
« Last Edit: July 26, 2012, 05:46:50 AM by Ann »
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"...health will finally be seen not as a blessing to be wished for, but as a human right to be fought for." Kofi Annan

Nymphomaniac: a woman as obsessed with sex as an average man. Mignon McLaughlin

HIV is certainly character-building. It's made me see all of the shallow things we cling to, like ego and vanity. Of course, I'd rather have a few more T-cells and a little less character. Randy Shilts

Offline wolfter

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Re: Treat all HIV infections, Global Panel Says
« Reply #43 on: July 26, 2012, 08:45:48 AM »
Seriously. My patience with these people is narrowing, especially as the meds become easier to tolerate and easier to take. Make them universally accessible, and the only barrier will be people's irrational fear of them - or the denial that they have the bug in the first place.

Which is a problem for a therapist, methinks.

EXACTLY!!!!   I'm just killing time waiting to head to the airport so I thought I'd read through this entire thread.  I don't think I have the tolerance to any longer coax and coddle people through the terrible ordeal of taking a freaking pill. 

And to have people diagnosed a year ago arguing with those of us who lived this disease from beginning instead of "googling" it is incredible.  And then having the nerve to declare we don't understand all the dynamics involved????

Wolfie, who gladly takes a handfull of pills twice a day and appreciates the advancements from having nothing available to having an effective treatment.
productivity breeds content

Offline newt

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Re: Treat all HIV infections, Global Panel Says
« Reply #44 on: July 26, 2012, 05:24:41 PM »
Except, dear expert panel at the World AIDS Conference, there is no decent evidence to say, in terms of individual health outcomes, treatment at a CD4 count above 500 (or to be strict perhaps 350) reduces risk of death or illness more than fractionally. And there is still minimal long term evidence on side effects from current combination therapy.

It seems to me, given the non-controlled trial evidence, that starting treatment or not immediately is a fair call either way, but as general policy it needs to be a bit more you decide rather than a universal recommendation.

Of course, supressing every HIV+ person's viral load asap would do wonders for prevention some say, but this is likely to be after the fact given than half (in the UK) of onward transmission is pre-diagnosis. And perhaps also moot (in the UK) given that CD4 count at diagnosis is more often than not around the point (CD4 count 350) where treatment is strongly recommended.

Me personally, today, knowing what I do, I would start at diagnosis, but that is not what I would have decided when I was actually diagnosed, there were a whole lot of thoughts and feelings to process.

- matt
"The object is to be a well patient, not a good patient"

Offline LM

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Re: Treat all HIV infections, Global Panel Says
« Reply #45 on: July 26, 2012, 06:10:18 PM »
Except, dear expert panel at the World AIDS Conference, there is no decent evidence to say, in terms of individual health outcomes, treatment at a CD4 count above 500 (or to be strict perhaps 350) reduces risk of death or illness more than fractionally. And there is still minimal long term evidence on side effects from current combination therapy.

Exactly. That's why this recommendation is clearly focuses on prevention, although it seems to ignore the fact that many (if not most) infections are from people who don't know they are infected.

But on another note, I see people that are poz for a long time here impatient and angry with those newly infected who are afraid of treatment and stuff. I totally understand why, after all, comparing what you guys went through in terms of personal losses and the treatments available to we have today, it seems like a piece of cake now. However, these are the same people that are first to remind how HIV is a big deal and should not be underestimated. So you see kind of a contradiction here? I mean, if treatment is a walk in the park today, why should HIV be a big deal then?

Anyway, my point is that, yes, HIV is a big deal, but treatment is a part of this. Of course people will be scared of what could happen to them, they fear the future, they fear if treatment will work, they see and hear about the effects on other people and they don't want it to happen to them, etc. And just because the situation has vastly improved, doesn't mean that it's ok now.

Just pointing out so there is more a bit more of understanding.

Offline Valmont

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Re: Treat all HIV infections, Global Panel Says
« Reply #46 on: July 27, 2012, 12:41:31 PM »
It difficult make generalities, in regard to my point of view and I believe there are 3 important considerations:

1.- it is clearly not the same having been diagnosed in 80´, 90´ or in these last years,

2.- it is not the same having been diagnosed with low CD4 or above 500,

3.- it is not the same being infected in a developed country in regard to developping world because of health qualities and access to medication (despite some low income countries have great HIV policy and some industrial one no)

These realities can make a real difference in regard to the way someone should perceive it...

By the way, I can understand these fears about starting treatment, but in regard to the harm relationated by HIV itself and its consequences, actual medicines are really a great thing...  If I had access to them, I would have started for a while...
Apr 2011: Diagnotized
Jun 2011: CD4: 504  VL: 176.000
Dic 2011: CD4: 714  VL: 95.000
May 2012: CD4: 395 VL: 67.000
Jun 2012: CD4: 367
Agu 2012: Starting Emtricitabine 200 mg / Tenofovir 300 mg and Efavirenz 600 mg (2 pills) different brands or VIRADAY/ATRIPLA/Mylan....
Sep 2012: VL: 138
Dic 2012: CD4: 708 VL: <34  %CD4: 32%
Jan 2013: CD4: 707 VL: <20
May 2013: CD4: 945 VL: <34 %CD4: 33%
Agu 2013: CD4: 636 VL: <34 %CD4: 50%
Dic 2013: Latent TB, started Isoniazid

Offline madbrain

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Re: Treat all HIV infections, Global Panel Says
« Reply #47 on: July 27, 2012, 08:08:16 PM »
As someone who was a viremic controller and held off meds for 3 years as a result of the low, but non-zero VL, I can attest that I have felt much better since I have been on meds.

I think the recommendation for everyone with HIV to start meds has health benefits for the individuals taking the meds. That should be reason enough to start. Anyone who is able to access or afford the meds, and is able to adhere to them, should consider it. There are so many different HIV meds and combos on the market today that most people should be able to find a combo that has acceptable to no side effects, at least for people without resistant virus.

The benefits from an HIV transmission / prevention standpoint are also quite obvious. Though I don't believe they obviate the need for condoms. STDs like syphilis, gonorrhea are chlamydia are not fun to have, and there are some antibiotic-resistant strains of them out there. They will certainly not end all transmissions since many people still don't know their status, are in denial, or are not willing or able to access the meds. Over the long term, if applied, the recommendation should still be very beneficial to public health.

Offline jkinatl2

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Re: Treat all HIV infections, Global Panel Says
« Reply #48 on: July 27, 2012, 10:15:28 PM »
As someone who was a viremic controller and held off meds for 3 years as a result of the low, but non-zero VL, I can attest that I have felt much better since I have been on meds.


This seems to be a near-universal sentiment.

"Many people, especially in the gay community, turn to oral sex as a safer alternative in the age of AIDS. And with HIV rates rising, people need to remember that oral sex is safer sex. It's a reasonable alternative."

-Kimberly Page-Shafer, PhD, MPH

Welcome Thread

Offline wolfter

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Re: Treat all HIV infections, Global Panel Says
« Reply #49 on: July 28, 2012, 12:28:54 AM »
Not sure if the Washington Post is available online, but with the IAC being held here, you'd all appreciate the articles written about this topic. 
productivity breeds content

 


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