Crystal Meth Use Fuels Rise in HIV Cases Among White MSM; ‘Down Low’ Term Should Apply To All Races, Studies Say
Crystal methamphetamine use continues to fuel a rising number of HIV cases among white men who have sex with men and the term "on the down low" -- which typically describes men who have sex with both male and female partners but do not mention their male relationships to friends, family members or female partners -- should be applied to all races, not just to black men, according to studies presented Wednesday at CDC's 2005 National HIV Prevention Conference in Atlanta, the Atlanta Journal-Constitution reports (Wahlberg, Atlanta Journal-Constitution, 6/16). Officials from the L.A. Gay & Lesbian Center on Wednesday presented data based on 19,300 HIV tests conducted over four years. Center employees asked MSM if they had used crystal meth since their last HIV test or in the previous two years, whichever was more recent. Data showed almost one in three MSM who tested positive in 2004 said they had used crystal meth, nearly triple the rate of meth use among MSM testing HIV-positive in 2001, center officials said. More than 10% of all MSM tested at the center in 2004 said they had used meth, almost double the rate from 2001. Many experts agree that meth use is a "growing threat" to MSM nationwide because it increases arousal and reduces inhibition, often encouraging people to seek multiple sexual partners, which could put MSM at an increased risk of contracting HIV, the Los Angeles Times reports. Being Alive, a Los Angeles-area coalition of people living with HIV/AIDS, later this month plans to launch a campaign encouraging meth users to get HIV/AIDS education and treatment (Ornstein, Los Angeles Times, 6/16).
Down Low Study
In addition to black MSM, other races also use the term on the down low, though to a lesser extent, according to a CDC study -- the agency's first on the phenomenon. Researchers surveyed 328 MSM in 12 cities and found that 43% of black men, 26% of Hispanic men and 7% of white men reported being on the down low. About 13% of all MSM surveyed said they had a steady female sexual partner, and about one-third said they considered themselves to be gay. Most of the men reported using condoms during intercourse but not always regularly. The study recommends that the on the down low phrase be expanded to include other races and men who do not have steady female partners. Richard Wolitski, acting chief of prevention research in the CDC Divisions of HIV/AIDS Prevention, agreed, saying it is a myth that all men on the down low fit a specific profile (Atlanta Journal-Constitution, 6/16).
Internet Sex Study
MSM who meet sexual partners over the Internet are more likely to engage in risky sex, compared with MSM who meet partners in other ways, but they also are more likely to do so with people of the same HIV status, according to a study conducted by the Denver public health department and presented on Wednesday at the conference, Reuters reports. According to data collected from a Denver sexually transmitted disease clinic in 2003 and 2004, 41% of men who met sexual partners over the Internet reported having unprotected anal intercourse with their most recent partner, compared with 31% of men who met partners in bathhouses, 29% who used other public sex venues and 25% of men who met partners at bars or parties. The study also found that 51% of men who met sexual partners over the Internet chose someone with the same HIV status as themselves, compared with about 20% of men who met partners in bathhouses. Two other studies presented at the conference showed that many HIV-positive MSM are choosing sex partners based on their viral load level, a finding that prompted warnings from health officials, who said HIV, as well as other STDs, can still be transmitted when viral levels are low (Simao, Reuters, 6/15).
CDC To Study Nucleic Acid HIV Test
CDC this week at the conference announced plans to study an HIV test -- called the nucleic acid amplification test, or NAAT, which is able to detect the virus weeks earlier than standard screening -- in order to determine whether the test would duplicate conventional testing methods and be cost-effective, the AP/Las Vegas Sun reports. Health officials said they are waiting for CDC to endorse the HIV test for regular use in health departments nationwide. CDC "hasn't been as fast as some of us would like," Carlos del Rio, an Emory University HIV/AIDS expert, said, adding, "We're not being effective in doing what we're doing. If we want to make changes in this epidemic, we need to take novel approaches and try them" (Yee, AP/Las Vegas Sun, 6/15). NAAT, which can detect minute amounts of viral genetic material in pooled blood plasma samples by amplifying gene fragments of the virus, is used to screen about 14 million units of donated blood each year. If a pool tests positive for HIV, the individual sample can be detected and removed for further processing and the donor can be deferred and notified. Researchers from the University of North Carolina-Chapel Hill in collaboration with the North Carolina Division of Public Health last month announced they had found a cost-effective way to use the test (Kaiser Daily HIV/AIDS Report, 5/6). CDC will study the test in Florida and Los Angeles (AP/Las Vegas Sun, 6/15).
Rare, Drug-Resistant HIV Strain Isolated Case
The rare, highly drug-resistant HIV strain detected in a New York City man in February seems to be an isolated case and not the "superstrain" that was initially feared, New York City Department of Health and Mental Hygiene Assistant Commissioner Scott Kellerman told the New York Post at the conference on Wednesday (Edozien, New York Post, 6/16). Officials from the city health department on Feb. 11 announced they had detected the HIV strain, which is resistant to most antiretroviral drugs and possibly causes a rapid onset of AIDS. The city health department issued an alert to physicians, hospitals and medical providers asking them to test all HIV-positive patients for evidence of the strain. The strain's combination of high drug-resistance and rapid progression to AIDS had not been identified before (Kaiser Daily HIV/AIDS Report, 6/6). "This could have been very bad, but our worst fears haven't been realized," Kellerman said, adding, "We're never going to really know for sure if this is a severe case of primary HIV infection or whether this represented something brand new or something completely different." He added, "No patients with identical strains have been identified by the big labs in our attempts to find out whether this was more widespread, but the investigation is ongoing. It suggests that this might be an isolated incident" (New York Post, 6/16). Some HIV/AIDS experts have questioned the rationale behind the alert, saying it was scientifically naive and exaggerated, particularly because no superstrain emerged, the patient in question is responding to antiretroviral treatment and no other related cases have been found (Kaiser Daily HIV/AIDS Report, 6/6).
Several broadcast programs reported on data presented at the conference:
- NPR's "All Things Considered": The segment reports on the increasing number of HIV cases among MSM and includes comments from Wolitski; Grant Colfax, director of HIV prevention studies at the San Francisco Department of Public Health; Ken Mayer, director of the Brown University AIDS Program; and Ronald Valdiserri, deputy director of CDC's National Center for HIV, STD and TB Prevention (Wilson, "All Things Considered," NPR, 6/15). The complete segment is available online in RealPlayer.
- NPR's "Talk of the Nation": The program on Thursday is scheduled to include a discussion of the number of HIV cases among African Americans (Conan, "Talk of the Nation," NPR, 6/16). The complete segment will be available online in RealPlayer after the broadcast.
- PBS' "NewsHour with Jim Lehrer": The segment includes comments from Phill Wilson, executive director of the Black AIDS Institute, and Valdiserri (Suarez, "NewsHour with Jim Lehrer," PBS, 6/15). The complete transcript is available online. The complete segment is available online in RealPlayer.
Webcasts of select sessions of the National HIV Prevention Conference are available online from kaisernetwork.org. This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.