For Immediate Release
February 23, 2005
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Contacts:
Lynn Schulman, 212.367.1210
Noel Alicea, 212.367.1216
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MDR HIV CASE WHERE WE STAND
Background: On February 11, 2005, the New York City Department of Health
and Mental Hygiene (NYCDOHMH) issued a health advisory describing the identification of a New
York City resident with a multi-drug resistant (MDR) and possibly highly virulent variant of
HIV-1.
Gay Men's Health Crisis (GMHC) participated in the media briefing at the NYCDOHMH and
has been very active since then in placing the announcement in its proper context for our
own clients, interested reporters, politicians, and the general public. We have stressed
that there is insufficient information at this time to form firm medical or public health
conclusions regarding this case. Additional cases with the same characteristics will need
to be found to get a better understanding of the medical and public health implications.
We have also called attention to the continued need for social and economic investment in
HIV prevention (regardless of HIV status), treatment adherence and substance abuse services.
Further, we have made it clear that nothing about this case supports stigmatizing gay men,
nor justifies proposals to criminalize HIV transmission or institute mandatory, involuntary
testing for HIV.
We are concerned that the announcement occurred at a time when HIV prevention efforts
in the U.S. are seriously underfunded and increasingly censored. It also comes at a time
when the federal government is shifting focus toward HIV prevention initiatives that are
increasingly based on scientifically discredited abstinence-only approaches, and moving
away from effective primary prevention work.
HIV Prevention and Harm Reduction: Last week's announcement placed discussions
about HIV prevention at center stage in national and global communities — with particular
emphasis on the psychological and social issues that drive drug use and risk-taking behavior.
The subject of last week's press briefing was a gay man with an alleged addiction to
methamphetamine, which has raised concerns about the resurgence of HIV infection and drug
use in the gay community. For GMHC, the rise in new infections in New York City, among gay
men and, in particular, gay men of color, has been a serious and paramount concern throughout
our work.
Research: Research on sexuality and drug use has been under increasing
attack by federal government officials. In order to confront continued infections among gay
men and the rise in the use of methamphetamine and other illicit drugs, research on these
topics must receive increased support from Congress and the President. Specifically, additional
research is needed on the factors that drive HIV transmission among gay men, new prevention
interventions, and novel approaches to methamphetamine addiction, which is particularly resistant
to standard drug treatment models.
Treatment Education: This case illustrates the need for treatment education
as a core component in the management of HIV disease, with adequate funding from federal, state,
and local governments. Patient education about the importance of taking medications on time and
in the manner prescribed has been shown to enhance adherence and minimize viral replication,
lessening the chance for the development of drug resistance. Most people acquire multi-drug
resistant HIV through improper use of antiretroviral drugs, not through HIV transmission. The
prevalence of multi-drug resistant HIV can best be minimized by increasing access to quality HIV
care and treatment education.
HIV Testing: GMHC supports efforts to enhance voluntary HIV testing in the United
States where up to a third of HIV+ people still do not know their HIV status. Community
based prevention programs have been effective in reaching those who cannot or do not access
health care routinely. Promoting these programs will ensure that greater numbers of HIV
infections can be identified and infected individuals referred to care, with those at highest
risk counseled and linked to supportive services (e.g. drug and alcohol treatment, STD treatment,
domestic violence counseling, mental health services) that address core issues that may drive
risk behavior.
The current case under review shows that a system of voluntary contact tracing and partner
notification is working well in New York City. New York's current partner notification system
requires the active involvement of infected individuals coming forward for testing and divulging
past partners. We believe that proposals that mandate compulsory contact tracing would create
an environment hostile to testing and ultimately harm efforts to promote notification of partners.
HIV Surveillance and Patient Registries: It has been reported that the
Commissioner of the NYCDOHMH has proposed to expand surveillance of HIV infection, from simply
assessing incidence and prevalence, to include ongoing monitoring of patient's viral load,
resistance testing for those newly diagnosed, and collection of patients' treatment histories
and outcomes. We share the Commissioner's desire to understand better the dynamics of the HIV
epidemic in New York. We believe that this can best be addressed through large scientific cohort
studies with patients enrolled from a broad cross-section of clinics and private providers, under
a research protocol with informed consent. Academically-based studies of this kind in Europe have
proven to be effective vehicles for tracking emerging trends, as well as uncovering changing
patterns of resistance, side effects and treatment outcomes in the epidemic. They also are likely
to be implemented in a more cost efficient and expeditious manner.
GMHC is working with our colleagues in the community, our clients and government to address
these complex issues. We will continue to advocate for comprehensive prevention, treatment
adherence and testing, which when adequately funded are the critical and powerful weapons needed
to fight the AIDS epidemic.
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Gay Men's Health Crisis (GMHC) is a not-for-profit, volunteer-supported and community-based organization
committed to national leadership in the fight against AIDS. Our mission is to reduce the spread of HIV
disease, help people with HIV maintain and improve their health and independence, and keep the prevention,
treatment and cure of HIV an urgent national and local priority. In fulfilling this mission, we will remain
true to our heritage by fighting homophobia and affirming the individual dignity of all gay men and lesbians.
We provide services and programs to over 15,000 men, women and families that are living with or affected by
HIV/AIDS in New York City. For more information, please visit www.gmhc.org.
© 2005 Gay Men's Health Crisis
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