Safer sex strategies that leave condoms in their packages leave you vulnerable to other STDs, cancerCurt Hicks addresses the sexual risk-reductionists of the world and says, whoa nellies!
Advocates for HIV seroadaptation (also sero-sorting) or HAART (highly active antiretroviral therapy) as effective new risk reduction alternatives to the "condom code" rarely acknowledge how terribly vulnerable these risk reduction strategies would leave the community of sexually active PWHIV (people with HIV) to the ravages of co-infection of other incurable viral STI's.
The Annals of Internal Medicine (AIM) epidemiologic study summarized below finds that "As of 2003, anal cancer was 59 times more common among HIV-positive people than among the general population." The article itself, published here , states: "The interaction between HIV and HPV allows for persistence of HPV (human papillomavirus) infection in HIV-infected persons, who are more commonly infected with the oncogenic HPV subtypes 16 and 18, leading to development of dysplasia.
Because HAART does not alter the incidence or progression of anal intraepithelial neoplasia, persons who are successfully treated with HAART but are co-infected with HIV and HPV are expected to remain at greater risk for anal cancer over time and incidence rates are expected to increase as HIV-infected persons live longer."
The National Cancer Institute's (NCI) site summarizes research implicating (associationally or causally) several strains of HPV in many cancers of the anus, cervix, vulva, vagina, penis, soft palate, tongue, tonsils, pharynx and lungs. The AIM study found that HIV positive people were 21 times more likely to develop vaginal cancer, at 3.3 times greater risk of lung cancer, at 2.6 times greater risk for orophargeal cancers and at 2.3 times greater risk for colorectal cancers.
Over 100 HPV strains have been identified. NCI notes that while HPV types 16 and 18 alone cause about 70 percent of cervical cancers, fifteen strains of sexually transmitted, high-risk HPVs (types 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, 68, and 73) to date have been linked to cervical cancer. And research has barely scratched the surface of the health impacts of only a few of these, let alone longitudinally investigated their impacts on immuno-compromised individuals. We may yet learn that HIV coinfections with the 85+ other strains of HPV or other viruses contribute to the elevated cancer rates found by the AIM study among PWHIV, including Hodgkin's lymphoma (14.7x's higher), melanoma (2.6x's), leukemia (2.5x's), colorectal (2.3x's) or renal (1.8x's) cancers.
Enhancing freedom, sensation, and personal control are all deeply important, fundamentally human goals. Unfortunately, as any survivor can tell you, cancer can take a terrible toll on one's freedom, sensation and personal control.
The Gardisil vaccine protects against getting only four of these HPV strains. HAART prevents transmission of none of these oncogenic viruses. PrEP (pre-exposure prophylaxis) protects against none of them. HIV sero-sorting protects against none of them.
HPV sero-sorting would require CLIA labs in every bedroom, backroom, airport restroom, bathhouse and backseat. Not to mention the PDA database folks would need to store and match two up personal profiles of 100+ results.
And apart from HPV, we know that HIV/Human herpesvirus 8 (HHV8) coinfection contributes to PWHIV's 112x greater chances of getting Kaposi's sarcoma and that HIV/HCV co-infections impact the 7.7-fold elevation of liver cancer rates found among the 50,000 PWHIV followed by this AIM study.
The impulse to abandon condoms, expressed by advocates such as openly HIV-positive Tony Valenzuela, is easy to appreciate and should be acknowledged in prevention education. Enhancing freedom, sensation, and personal control are all deeply important, fundamentally human goals. Unfortunately, as any survivor can tell you, cancer can take a terrible toll on one's freedom, sensation and personal control.
Until microbicide research provides us with a sexier, more empowering, less obtrusive barrier that can block transmission of all sexually transmitted viruses, latex remains the only reasonably effective, general STV protection we've got. (Three cheers for all our fierce microbicide advocates/heroes out there!) But until we build that better barrier, to demonize public health, as Tony does, for pointing to the numerous undesirable health outcomes of condomless sex is to shoot the messenger and deny biological reality.
Likewise, to construct HIV-only risk models and to announce that these calculations show that PrEP or HAART or seroadaptation are now viable replacements for condoms could--to the extent folks take that advice--promote devastating outcomes from other STDs among all epidemiologically vulnerable communities, particularly PWHIV. This AIM study in a sense quantifies just how much more important consistent pan-STV prophylaxis use is for our planet's 40 million PW HIV, and the answer seems to be: 2.3 to 112 times more important.
[RELATED - Read "Killer Gay Sex" by Tony Valenzuela.]
The problem is that the train has left the station ... many HIV+ gay men are willing (eager in fact) to limit their hook-ups only to those with other known postives. They are also willing/eager to avoid sex with HIV- men, but not without a reward: condomless sex. The spector of STDs and cancer may be real but it registers as another attempt to limit the sex lives and fulfillment of already deeply sigmatized people struggling with gay and HIV+ identities.
ReplyDeleteWe need to find ways to acknowledge and affirm the real benefits of sero-adaptation by HIV+ gay men trying to limit HIV exposure to others. We also need to reframe condom use as a health choice to reduce risks from cancer/STDs that is not based on shame and oppression. Also, HIV+ gay men just don't believe that the risk are greater than the rewards and cannot articulate it with their HIV+ partners, so this is a challenge that must be address. It's not enough to preach if no one beleives or is willing to carry the mantle and right now, the persuasive pendulum is on the other side of this debate.
You can't, on the one hand, say that "enhancing freedom, sensation, and personal control are all deeply important, fundamentally human goals," and then retract that sentiment by suggesting that those who practice as much in their sex lives, even thoughtfully, are misguided because they might get cancer. Harm reduction, more often than not, is health promotion. Public health is doing its job by pointing out undesirable health outcomes of any number of behaviors including risky sex and poor diet. Public health saves lives in this work. And still, most people practice harm reduction in most areas of health - sex, alcohol/drugs, diet, even mental health.
ReplyDeleteArguing for an expansive arsenal of sexual harm reduction practices - including seroadaptation - is simply to articulate what many of us already do and what many others could learn as options in an arena - sex - that is not driven by rational thinking.
Pointing out (pointedly, I admit) that public health tends to pathologize gay men in particular for these practices is not demonizing public health. Its a way of saying: we're paying attention to what you tell us and what you say about us. We want you, not just to acknowledge, but to adapt to our deeply considered practices, concerns and desires.
Tony Valenzuela
> HPV sero-sorting would require CLIA labs in
ReplyDelete> every bedroom, backroom, airport restroom,
> bathhouse and backseat. Not to mention the PDA
> database folks would need to store and match two
> up personal profiles of 100+ results.
Sorry to cause you so much trouble, but what will
you use for an excuse when there's an instant test
requiring just a bit of saliva to tell if you are
HIV positive or negative?
Three cheers, Tony! I'm there with you. And you're pretty cute, too ;-P
ReplyDeleteZak, give it a rest. Test before you hook up ... we heard you! Tired and unpractical but youve made your point.