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.]
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