Wednesday, December 10, 2008

Incidence is the number of new HIV infections in a given year (say, in the US).

Prevalence is the number of people living with HIV in that year (say, in the US).

Transmission rate is incidence divided by prevalence (and then multiplied by 100)….this tell us, for every 100 people living with HIV in a given year in the US, how many transmission are there to HIV negative partners.

Saturday, December 06, 2008

.
        > Getting tested together may be a viable prevention strategy for some. However, this depends very much on the nature of the sexual relationship. If sex is occurring spontaneously and/or anonymously, mutual health screens would not be a viable prevention strategy.

Nevertheless, you would know something about your potential partner.


        > For those who are more intentional about their sexual relationships this can be a valid option. However, there are some pitfalls. If the relationship is to be ongoing, will it be monogamous and how do you assure that? Also, when the HIV/STD tests are conducted, what length of time has passed since the last possible exposure? In view of these questions, mutual health screens can present a false sense of safety or security.

Especially for those who imagine an HIV test protects you from
AIDS or cures it! People have to start taking the first steps towards
being responsible for themselves and others. If they don't then I
predict that the AIDS crisis marches on.


        > Unless, there has been some honest and open conversation prior to entering into the sexual activity, every negative test in the world cannot protect you from disease.

And no imaginary "honest" conversation will detect or predict or
cure any of the diseases a potential partner may have. Tests are
predictably "honest". Conversation should never be relied on for
honesty. Would you like a list of dead people who believed in
"honest" conversation?


        > You must first establish a rapport with the partner that allows for honesty, trust and open communication.

We know from reality/experience just how well that has worked out.
Check your above list of dead people.

        > Unless that is happening, other prevention strategies (condoms, abstinence, etc.) should be considered.

How has that been working out? Know any dead people who "said"
they "always" wear a condom or practice abstinence?

Friday, December 05, 2008

.
        > and honestly..In my experience, even as a safe-sex activist, as men who are horny, we want to have sex right away-

Then you're not a safe sex advocate as you thought you were. http://www.google.com/search?q=all+hat+and+no+cattle All hat and no cattle that's called. Say one thing and do another is that train of thought.


        > I get that that might be the problem, but there's a very small chance that either party is going to get tested before giving or receiving a casual blowjob.

Right there... casual. Still not a safe sex advocate.


        > How about "Educate yourself before hooking up.

Hooking up... right there. More unsafe sex.


        > Discuss status and your interests in sex BEFORE having sex?"

Yeah, forget the testing before sex
.
        > I have not seen any data that gives an answer to your question.

It's important to continue looking into all enquiries as premise of the program you're offering, including the enquiries you want to get and you've prepared scripts for and the enquiries that appear contrary to your own point of view. Some ideas remain the same. Some ideas change.


        > Getting tested together may be a viable prevention strategy for some. However, this depends very much on the nature of the sexual relationship. If sex is occurring spontaneously and/or anonymously, mutual health screens would not be a viable prevention strategy.
        >
        > For those who are more intentional about their sexual relationships this can be a valid option. However, there are some pitfalls. If the relationship is to be ongoing, will it be monogamous and how do you assure that?

Ankle cuffs.

The strategy "Let's get tested TOGETHER BEFORE we have sex, for A VARIETY of STDs.", a sexual health checkup reduces ambiguity/risks and can be like anything else POTENTIAL sex partners do together. The strategy is getting tested to share information about existing infections and using the information.There's no test for mutual fidelity.


        > Also, when the HIV/STD tests are conducted, what length of time has passed since the last possible exposure?

The length of time before any latency is a lot more time, than the window period. If you don't get tested together, that doesn't provide opportunity to get information about the STDs that could've been detected. If you don't get tested together there's no opportunity to know that persons status. The words that come out of a person's mouth provide no real information about that person's status and neither does their imagination.

        > In view of these questions, mutual health screens can present a false sense of safety or security.

That's true only if you believe testing only cures aids or prevents you from getting it. It's what you do a moment after you take the test that matters. If you go on and do something irresponsible after you do something responsible getting the test it completely nullifys what you did.


There's no evidence of lack of efficacy. You wrote you haven't seen any data. To make that claim is the same logical fallacy represented by attempting to make that claim. There's plenty of evidence for lack of efficacy for so called safer sex practices and condoms. 20 years of pushing it. After all the years of the campaigns the epidemics rage on out of control, see
http://www.cdc.gov/hiv/topics/surveillance/incidence.htm
http://www.cdc.gov/hiv/topics/surveillance/incidence.htm


        > Unless, there has been some honest and open conversation prior to entering into the sexual activity, every negative test in the world cannot protect you from disease. You must first establish a rapport

rapport doesn't cure or prevent aids



        > with the partner that allows for honesty, trust and open communication.

neither honesty, trust, open communication cures or prevents aids.


        > Unless that is happening, other prevention strategies (condoms, abstinence, etc.) should be considered.

Condoms, abstinence and other prevention strategies are clearly what has not worked.


That's what the strategy getting tested TOGETHER BEFORE having sex, for A VARIETY of STDs does. It raises the standard of health for POTENTIAL sex partners. You need to know about infections to reduce the ambiguity and communicate openly.


It also changes the consciousness of the two people involved. Would a genuinely responsible person refuse to get tested for example?

Sunday, November 23, 2008

.
    > This is a really good idea. The trick is to somehow get this to be
    > a social norm so that people aren't scared and embarrassed about
    > asking for this. As things are now, asking your significant other
    > to get tested before having sex would probably come across as
    > offensive to many people, therefor most people probably won't
    > ask. Hmm maybe a Planned Parenthood public service
    > announcement or something?

Until there is a cure-for-certain vaccine, or enough people die, testing is not likely to be the norm.
.
            >> Sounds like it would work well for some folks, not so well for a hookup.

    Gosh, I'm just thinkin out loud here, but could "hookups" have anything to do with the AIDS epidemic?

    > I was pointing out that there are common situations in the real world where the strategy you're touting wouldn't be especially helpful.

Not washing hands before operating was also once a very common strategy--even a standard practice.


    > Do hookups have something to do with the AIDS endemic? I suppose you could look at it that way.

I'm going out on a limb here, but will guess yes.


    > The broader question I'm asking is whether it is helpful to look at AIDS as the sum of behaviors and biologic test results (as current epidemiology & public health practice tend to do), or whether it might make sense to back off a bit and ask whether we might make more of a difference by laying off the moralism inherent in behavioral approaches

I'm going out on a limb here, but will guess that things like clean water, sterilized instruments, and washed hands have little to do with moralism.


    > and focusing on some of the structural forces, such as homophobia, gender hierarchies, racist ideologies, and poverty production that also obviously have huge impacts on the AIDS endemics across the world.

I'm guessing that some of the stanard practices mentioned above would work for homophobes, non-homophobes, racists, non-rascits, poor or rich people, etc, all over the world.


            >> I guess what I'm trying to figure out is how people react to the concept of risk,

Irrationally is the word I think you're looking for.


            >> and whether 'public health' might not better be focused on some of its more traditional success strategies that involve systemic changes, rather than individual coaching.

I'm thinking that people become infected one at a time.


    With something like tuberculosis the FIRST step is to get tested. Workin out pretty good so far...

            >> ...Traditionally, public health has had its greatest success{es} with things like water, sewage, & poverty remediation.

    and testing...

Individuals have to take care of the testing part.


    > Tuberculosis is a great example of how structural changes far outstripped the ability of medicine and individualized behavioral messages to curtail the spread.

Today everybody deals with it, first, by testing.


    > Arguably, the first successful steps in curtailing the spread of tuberculosis included addressing slum dwellings where people lived in extremely close quarters, pasteurization of milk, and various other public health approaches. (e.g. AJPH 1998 88(7):1105-1117)

Its still time for individuals to get tested...


A L Fairchild and G M Oppenheimer
Public health nihilism vs pragmatism: history, politics, and the control of tuberculosis
http://www.ajph.org/
cgi/content/abstract/88/7/1105

http://www.ajph.org/cgi/reprint/88/7/1105

    > Testing in NYC began in the late 1880's, well after tuberculosis incidence had started declining rapidly. It probably helped somewhat after that point, but we have tended to overlook the relatively larger impacts of structural interventions that preceeded testing and continued to affect the incidence of tuberculosis afterwards as well.

Once all the reading is finished you still need to go get tested.

Saturday, November 22, 2008

        > I don't know how common that
        > strategy is. Sounds like it would work
        > well for some folks, not so well for a
        > hookup.

Gosh, I'm just thinkin out loud here, but could "hookups" have anything to do with the AIDS epidemic?


        > I guess what I'm trying to figure out is
        > how people react to the concept of
        > risk, and whether 'public health' might
        > not better be focused on some of its
        > more traditional success strategies that
        > involve systemic changes, rather than
        > individual coaching.

With something like tuberculosis the FIRST step is to get tested. Workin out pretty good so far...


        > I don't know if there are home tests for
        > chlamydia. By systemic changes I mean
        > addressing homophobia, sexism,
        > racism, wealth extraction
        > (redistribution to the rich), etc.
        > Traditionally, public health has had its
        > greatest success with things like
        > water, sewage, & poverty
        > remediation.

and testing...

Thursday, November 20, 2008

.
        > Because I think it's always good to
        > be prepared for sex.

A thought experiment
http://en.wikipedia.org/
wiki/Thought_experiment


How widespread is the phenomenon?... The strategy of
"Let's get tested TOGETHER
  BEFORE we have sex, for A VARIETY of STDs."

Sexual health checkups reduce ambiguity/risks and can be like anything else POTENTIAL sex partners might do together.


_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
> And also that brings up a very important thing.
>
> This is good that we're having this conversation.
>
> Because I think it's always good to be prepared for sex.
>
> Okay, you want to have all the tools you need by your bedside or potentially in a carryall, allright, in your purse, allright, so you're prepared for sex.
>
> And that's why we're having this conversation.
>
> Because if we don't talk about it first right we're very un likely to be unprepared when it comes time for sex.
>
> That's why communication's really important with your partner.
>
> And also the boy scout motto of "Be prepared" is essential which includes condoms and water based lube.
>
> That's what's recommended.

Tuesday, November 18, 2008

Please note that in my remarks I made no reference as to which test or tests, the individuals using this approach should take.

Please note that by making reference to the blood supply I have indicated a personal knowledge about how blood is tested differently from the standard clinic test for "HIV".

          > Hi. You are obviously free to make
          > whatever decisions you want regarding
          > your safety and your body. But we did
          > want to point out a serious
          > misunderstanding that you might have.
          >
          > You wrote that it is not necessary to
          > worry about the three month window
          > period, because the blood supply is
          > safe and they don't wait three months.
          > The problem with that thinking is that
          > you are confusing two different types
          > of tests.
          >
          > The blood supply is screened for HIV
          > using a variation of a viral load test
          > (p24 antigen test), and the blood
          > samples collected are *pooled* in order
          > to test them for HIV. This is a very
          > different test, and pooling blood
          > samples changes the accuracy results.
          > This is *not* the test that someone is
          > given when they go for an HIV test.
          > Those tests are HIV anti-body tests,
          > and anti-bodies can take up to three
          > months to show up accurately on the
          > test, so that's the reason people are
          > told they should wait as close to three
          > months as possible.
          >
          > Individuals are not given the same type
          > of tests that the blood supply
          > undergoes because that test has not
          > been approved by the FDA for diagnostic
          > purposes, and individual samples cannot
          > be pooled due to the timing of each
          > person requesting a test.
          >
          > So please understand that if you merely
          > get an HIV test and a negative result,
          > and then discontinue practicing
          > safer-sex (which we believe is what you
          > are implying) you are putting yourself
          > at a higher risk than necessary for two
          > reasons. One is what we've already
          > discussed -- due to the three month
          > window period, it is possible that
          > someone was recently infected but it is
          > too soon to register on the test, and
          > so you will receive a false negative
          > result. The other reason is that if
          > someone should expose themselves to HIV
          > any time after the test, and the two of
          > you are not playing safely, then one
          > person can infect the other. Sadly, we
          > have had many calls from people who got
          > infected because of that reason.
          >
          > So our goal is not to get into a debate
          > with you, but rather to make sure you
          > understand our perspective, so that you
          > can make an informed decision about
          > what you want to do. We hope this
          > additional information is helpful for
          > you and we send you our best wishes.

Monday, November 17, 2008

.
          > We can't really tell you how widespread
          > that particular strategy is, because
          > with so many gay and lesbian people,
          > it's difficult to know what everyone is
          > choosing to do.
         
          > But getting tested is certainly
          > important. However, we would stress the
          > importance of not using negative test
          > results as a reason to start putting
          > yourself at risk.
         
          > If you and a partner decide to get
          > tested together and both have negative
          > HIV results, for instance, that's great
          > news. But because it can take up to
          > three months before HIV infection shows
          > up on an HIV test, the test results you
          > are getting are always three months
          > out-of-date. There really is no way to
          > know for sure what someone's HIV status
          > is at the moment you may have sex with
          > them.

If this three month rule were the case then why
is the testing of blood donations so effective?
Look here:

http://www.google.com/search?
q=%22how+long+can+blood+be+stored%22


It seems that testing is extremely
reliable--which accounts for so few cases of HIV
via blood transfusions.

There is some risk of infection from any
encounter even if both partners turn out
negative. However, you are more likely to die in
an automobile accident driving to an encounter
than you are to die from HIV from a
just-tested-negative individual.

Again, its not RISK FREE! But many other things
in life are far more risky


          > That's why we encourage people to
          > always assume it's possible that the
          > person they are with might have been
          > exposed to HIV either within the last
          > three months (and before it could show
          > up on a test) or at any time after they
          > were tested. So if you always play
          > safe, then you are taking
          > responsibility yourself for your own
          > body, and not relying on sometimes
          > outdate test results to keep you
          > healthy.

Always "playing it safe" is far more risky than
sex with a just tested negative person. There is
only safer sex--not risk free sex.

Sunday, November 02, 2008

The only way you can be sure you haven't killed anyone with
HIV (assuming you are positive) is to test every one of your
sexual contacts over the course of their life. If they get sick
or die, then it is still possible, with the best of current technology,
to determine if they died from a strain of the virus they got from
you. So, unless you've done this level and intensity of testing,
then you can't say for certain if anyone has died or gotten
sick after having sex with you.

What probably happens, in reality, is that uninfected people
have sex with a number of infected people and get the virus
from one or more of them. So it then becomes possible for
any one HIV+ person to say, with some belief, that they did
not pass HIV on to a given person--so responsibility is lost
in the crowd. There is the possibility for each infected person
to say some other person didn't get the virus from them. This
is nature's way of saying that having sex is more important
than being responsible.

Unless a complete fix is found for HIV, then you can look
forward to the epidemic continuing largely unabated.
http://gaymenshealth.ning.com
The Gay Men's Health Summit is a national call to all LGBT/ queer communities and our important allies from across this nation.

http://www.fenwayhealth.org/
site/PageServer?pagename=FCHC_ins_fenway_EducPro_modules

...we encourage feedback from clinicians, clinical educators, students from all health professional fields, and LGBT patients.
Please read through our modules, and/or try them out with students or colleagues, and let us know your thoughts on content, format, etc.
Email us at: professionaleducation at fenwayhealth.org

http://www.aac.org/
site/PageServer?pagename=malecenter_resources_events

http://malecenter.org
The MALE Center 571 Columbus Ave Boston Massachusetts 02118 USA 617 450-1987
The Men’s Action Life Empowerment Center MALE is a community resource and wellness center for gay and bisexual men in Boston. We conduct outreach and a wide variety of other activities that promote health and community

Wednesday, September 17, 2008

Couples based HIV testing

Attitudes Towards Couples-Based HIV Testing
among Gay and Bisexual Men

Are you a gay or bisexual man
in a relationship with another man?

Howard Brown is running focus groups to better
understand attitudes toward couples-based HIV testing.

This type of testing would allow you and your partner to
receive your HIV results together.

Participants will be compenstated $20-$50 for their time.

Focus groups will be held on
Saturday, October 4th, at
Howard Brown Health Center
4025 N Sheridan Road
Chicago Illinois 60613
USA
http://howardbrown.org

Please call 773 388-8880 to participate!

You must be at least 18 years old to qualify.
All information will be kept confidential.

This study has been approved by the Institutional Review Boards
at both Howard Brown Health Center and Emory University.

Investigators:
Rob Stephenson PhD Emory University
Patrick Sullivan PhD DVM Emory University
Beau Gratzer MPP Howard Brown Health Center
Blase Masini PhD Howard Brown Health Center

Monday, August 04, 2008

          > Some of us seem to be unable to move forward in
          > our dialogues or our conceptual contexts for our
          > work, and I think actually it is that rigidity
          > and fundamentalism that damages our community
          > most.

I should have thought that dying from acquired immune deficiency syndrome or getting sick from it would damage a community most.

Rather than some abstract concept.

Cliches of cliches, cliches piled on cliches, how many times have we heard all this stuff really.

People are not going to answer
  a) Is it considered a so called safer sex practice?... having
      greater numbers of multiple sex partners.
  b) Is it considered a so called safer sex practice?... having
      less numbers of multiple sex partners.
because they can't.
Nature has a power over us.
Beyond their own experience or these very typical cliches
they continually deny the facts of life.
This force is built in, because we have to do these things,
as it is for any given species.

Condoms can prevent pregnancy for example but the problem is failure and failure rates.
People just deny the power of nature over and over.

Have sex with an infected person or not have sex with him.
It's an option. Companions and friends are dying optionally.
That doesn't change the facts that companions and friends are dead and dying.
Call the words asinine until the cows come home and companions and friends will be dead and dying into the future.
Turn into a petri dish for this disease by serosorting and having sex only with positive people.
People are turning themselves into petri dishes for this disease where new variations, new varieties are getting created because they have new genetic material to work with, new bodies to work with.
Some people may find that unpalatable but it is a point of view in which two species are gaining ground.
Where in fact this tiny little unconscious virus is gaining ground on millions of our species.
You've got your death list of companions and friends as have I.

Sunday, August 03, 2008

by Lawrence K. Altman
H.I.V. Study Finds Rate 40% Higher Than Estimated
http://www.nytimes.com/2008/08/03/health/03aids.html
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
http://orthoprax.blogspot.com/
2008/07/informed-consent-for-hiv-testing.html

Thursday, June 26, 2008

          > What about the window period, the latency?...

Getting tested now, today lets potential sex partners know more about prior encounters over the years. Getting tested again later can detect change in testing results and set a time frame for recent exposure to infection, useful information for optimizing treatment.
The Home Access® Express (next day) HIV-1 Test System
http://www.homeaccess.com/ExpressHIV_Test.asp
Rapid HIV testing
http://www.cdc.gov/hiv/topics/testing/rapid/index.htm

Monday, February 18, 2008

by Carina Marquez
Nicola M. Zetola, MD
Jeffrey D. Klausner, MD, MPH
HIV testing: an update
http://www.mlo-online.com/articles/0208/0208cover_story.pdf

Wednesday, February 06, 2008

Recently in the mail...

          Not sure what you mean.. but if I guess correctly then if
men are going to be tested for HIV before they embark on a sexual
relationship (as 'negotiated safety' recommends they do) then
there is every reason to suggest that they get tested for STIs as well.

However whether such a test should not preclude regular STI testing
during the relationmship (see below).


          Within the strategy the partners decide to have unprotected
sex (anal intercourse) within the relationship but 'safe sex'
outside the relationship: they may decide that the 'safe sex'
outside the relationships is:
(1) no sex outside;
(2) no anal sex outside;
(3) if anal sex outside then only and always protected anal outside.

If the partners decide and commit to (1)
then there is no likelihood of any STI infection occuring
(unless one was present at the outset of the relatiosnhip).

On the other hand if (2) or (3) are decided on then an STI is always
possible during the relationship ... Men (indeed anyone) who engages
in sex with numbers of partners are advised to have regular STI checks..

> Within the strategy the partners decide to have unprotected sex
> (anal intercourse) within the relationship but 'safe sex'
> outside the relationship: they may decide that the 'safe sex'
> outside the relationships is:
> (1) no sex outside;
> (2) no anal sex outside;
> (3) if anal sex outside then only and always protected anal
> outside.

the correct term is always... safer
there's never zero risk.
if we don't even get the word right, how can we expect people to use
these safer sex practices?


> If the partners decide and commit to (1)
> then there is no likelihood of any STI infection occuring
> (unless one was present at the outset of the relatiosnhip).

if they keep the commitment. that's implied in the word commit.
people make a commitment. time passes. other things happen.
you've got to have testing. you've got to decide it's
the right thing to do.