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AIDS in Maine, 2005
First, the good news that few know about
BY TONY GIAMPETRUZZI


PART ONE OF TWO

Itís 10 a.m., Saturday morning. Youíve awoken with a start. Thereís a guy lying next to you. Yeah ó you hooked up after a fun night out. You donít remember how many drinks you had or how you got home. And thereís something else you forgot.

You look on the floor next to the bed.

A used condom. Phew! íCause, damn, your ass is sore.

Maybe everything is okay. As a gay guy, youíve been inundated with safe-sex messages. Then there have been those pesky reports that some strains of HIV donít respond to life-saving drugs. And that new strain of chlamydia, LGV, sounds really gross. So, you try to be safe while still having fun. Maybe last night was a blast, and maybe safe, too. Sigh.

Back to sleep.

For many gay men, this is the best-case scenario these days, and thatís why health officials are concerned. In fact, they are so concerned people, particularly gay men, are having too much fun and hurling too much caution to the wind when it comes to safe sex that they have recently taken bold steps to counter the spread of HIV in the US.

First, the Centers for Disease Control (CDC) recently suggested that all people make testing for HIV part of their annual health inspection. Second, and more revolutionary, last month the CDC recommended that anyone who even thinks that they have been exposed to HIV through risky sexual or IV-drug contact should get to a hospital, for something called post-exposure prophylaxis, a one-month regimen of the so-called HIV drug cocktail that can be as much as 80 percent effective in knocking the virus out of your system before it nestles in for the rest of your, and its, life.

Doctors in Boston have been implementing the procedure for years now. And, believe it or not, health officials in Maine say that demand for the treatment is up. Problem is, numbers would be even higher if people knew that that rip in the condom didnít spell doom. In other words, while doctors know how to treat those infected, those infected donít necessarily know that they can be treated.

"We are certainly aware of the [CDC] guidelines, but we havenít prepared a specific announcement. I read about the guidelines in the Portland Press Herald," said Sally Lou Patterson of the stateís Division of Disease Control. "Are we reaching out? Not at this moment, but it probably will be a part of our outreach in the future."

Dora Mills, the director of the Bureau of Health, when contacted, had only anecdotally heard about the CDC guidelines, but she noted that she had been out of the office for a few weeks on medical leave.

So, what is this new treatment? Actually, itís nothing new ó just newly available to the general public. Stephen Boswell, the executive director of Fenway Community Health, who worked as an external consultant to the CDC on what are called non-occupational post-exposure prophylaxis (NPEP) guidelines, says that, while NPEP is an aggressive regimen of medications that can halt HIV, itís no panacea.

"[The effectiveness] of the treatment drops off dramatically with time. If you can catch someone relatively soon after exposure, within an hour, or within 10 hours, well, the sooner you can catch someone the better," says Boswell, acknowledging that the CDC recommends treatment within 72 hours to halt the onset of HIV. "We donít have data that suggests that it would be of much value after three days. Based on lab work, in all of the right settings, you want to get a hold of someone within a few hours. Personally, I think that 12 hours [after exposure] is the critical period, but there is some data that suggests 72 hours."

Scientists have been using a rigorous, four-week regimen of the so-called drug cocktails used to treat long-term HIV infection to halt infection in health and public-safety workers who have been exposed to the virus for years. Last year, Rhode Island made non-occupational prophylaxis part of its strategy for stemming the spread of AIDS.

Boswell says Fenway Community Health, along with most large hospitals, should be prepared to offer such treatment.

However, he cautions that only those who have a dangerous exposure to the virus should attempt the regimen. For instance, he says giving or receiving oral sex from someone who is known to be HIV+ would not, under most circumstances, be considered grounds for seeking treatment.

"Having receptive anal intercourse with someone who is known to be HIV+ and the condom breaks, or if there is no condom at all, thatís a setting where this should be considered," says Boswell, adding that, in some cases, he would recommended treatment for someone who was raped and suffered significant trauma. Overall, says Boswell, though it pays to be careful it should be remembered that HIV is not always easily transmitted.

"Iíll give you an example: One of the scariest routes of transmission is, in many peopleís minds, a needle stick. So, if I draw blood from a patient here at the Fenway and I know that person is HIV+, and I accidentally jab that needle into my hand, how likely do you think it is that I might become HIV+?" asks Boswell, supplying an answer that most would find surprising.

"Itís one in 300, which is relatively low. People almost always think that that is high risk, and it is high risk, which means that the [overall] chance of transmission is relatively low. If you take that among the routes of transmission that are pretty risky, and compare to oral sex for example, [the chance of transmission through oral sex] is off the charts."

Because of side-effects, the prophylaxis treatment may not be worth it if the chance of exposure is that low.

 

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Issue Date: March 4 - 10, 2005
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