Comments on: HIV spreads in those slutty phases: new evidence from a UK study http://www.wisdomofwhores.com/2008/03/19/hiv-spreads-in-slutty-phases/ Of sex and science. Elizabeth Pisani's blog about HIV and other sundry things. Tue, 06 Jan 2009 07:45:47 +0000 http://wordpress.org/?v=2.7 hourly 1 By: Chris Green http://www.wisdomofwhores.com/2008/03/19/hiv-spreads-in-slutty-phases/comment-page-1/#comment-478 Chris Green Thu, 20 Mar 2008 11:02:17 +0000 http://www.wisdomofwhores.com/2008/03/19/hiv-spreads-in-slutty-phases/#comment-478 Lee, there's no doubt that a person is most infectious in the period before seroconversion, when the viral load its probably at its all-time peak. That's why the virus spreads so quickly among groups of injecting drug users (IDU). In fact, although I have difficulty in fully understanding what's new in the article, it does seem to me that the risk behaviour of the MSM surveyed is similar to that of IDU, except perhaps they didn't have sex together three times a day, so the period would be longer. Of course, once the group is all infected, no more infections take place as long as no-one breaks out of the group. And when he does, he may by then have a lower viral load, and so a lower infectiousness, so it takes a little longer for the next cluster to form. Lee, there’s no doubt that a person is most infectious in the period before seroconversion, when the viral load its probably at its all-time peak. That’s why the virus spreads so quickly among groups of injecting drug users (IDU). In fact, although I have difficulty in fully understanding what’s new in the article, it does seem to me that the risk behaviour of the MSM surveyed is similar to that of IDU, except perhaps they didn’t have sex together three times a day, so the period would be longer. Of course, once the group is all infected, no more infections take place as long as no-one breaks out of the group. And when he does, he may by then have a lower viral load, and so a lower infectiousness, so it takes a little longer for the next cluster to form.

]]> By: elizabeth http://www.wisdomofwhores.com/2008/03/19/hiv-spreads-in-slutty-phases/comment-page-1/#comment-476 elizabeth Thu, 20 Mar 2008 09:11:46 +0000 http://www.wisdomofwhores.com/2008/03/19/hiv-spreads-in-slutty-phases/#comment-476 Chris: of course I'm not suggesting that we abandon the SAFE approach. And yes, I would advocate that we increase people's awareness of the symptoms of primary infection -- doctors as well as people whose behaviours put them at risk (as I've said in earlier posts). I'm just concerned that with the increasing focus on access to treatment, what little is left of the prevention agenda is getting skewed more and more towards those known to be infected. Yes, we need to provide prevention services for positives. But we also need to renew efforts to increase safe behaviour in areas where the majority of new infections are likely to be taking place. Lee: You'd have to control for the ordinary cycles of sluttish and non-sluttish behaviour in people without the virus, I suppose. Can I be on your IRB? Chris: of course I’m not suggesting that we abandon the SAFE approach. And yes, I would advocate that we increase people’s awareness of the symptoms of primary infection — doctors as well as people whose behaviours put them at risk (as I’ve said in earlier posts). I’m just concerned that with the increasing focus on access to treatment, what little is left of the prevention agenda is getting skewed more and more towards those known to be infected. Yes, we need to provide prevention services for positives. But we also need to renew efforts to increase safe behaviour in areas where the majority of new infections are likely to be taking place.

Lee: You’d have to control for the ordinary cycles of sluttish and non-sluttish behaviour in people without the virus, I suppose. Can I be on your IRB?

]]> By: Lee Rudolph http://www.wisdomofwhores.com/2008/03/19/hiv-spreads-in-slutty-phases/comment-page-1/#comment-472 Lee Rudolph Thu, 20 Mar 2008 02:16:11 +0000 http://www.wisdomofwhores.com/2008/03/19/hiv-spreads-in-slutty-phases/#comment-472 "They also show that a quarter of all new infections occured within the first six months after a person was infected, and close to half in the first year." I have read that there are various viruses that induce quite marked changes in the behavior of their hosts (for instance, making some sort of buggish creature climb to the tops of grassblades, where passing birds can more easily find them and eat them) in ways that favor the transmission of the virus. Is it possible that HIV, in the first 6 to 12 months of residence in a new human host, induces an increase in that host's sluttishness? And if that were somehow found (at the moment, I can't quite imagine the experimental protocol) to be likely true, what would a good public-health response be? “They also show that a quarter of all new infections occured within the first six months after a person was infected, and close to half in the first year.” I have read that there are various viruses that induce quite marked changes in the behavior of their hosts (for instance, making some sort of buggish creature climb to the tops of grassblades, where passing birds can more easily find them and eat them) in ways that favor the transmission of the virus. Is it possible that HIV, in the first 6 to 12 months of residence in a new human host, induces an increase in that host’s sluttishness? And if that were somehow found (at the moment, I can’t quite imagine the experimental protocol) to be likely true, what would a good public-health response be?

]]> By: Chris Green http://www.wisdomofwhores.com/2008/03/19/hiv-spreads-in-slutty-phases/comment-page-1/#comment-466 Chris Green Thu, 20 Mar 2008 00:38:59 +0000 http://www.wisdomofwhores.com/2008/03/19/hiv-spreads-in-slutty-phases/#comment-466 Eli, First, you may wish to correct the link of this PLoS article - it should be I think your assumption that supporters of Positive Prevention advocate "Waiting until someone is diagnosed as infected before cranking up prevention..." is a little facile. The article that many consider the grandfather of this movement (The Serostatus Approach to Fighting the HIV Epidemic: Prevention Strategies for Infected Individuals - SAFE, by Robert Janssen et al, including your 'epi-hero' Kevin De Cock, Am J Public Health. 2001;91:1019–1024, ) proposes these Essential Components: "The 5 SAFE steps are as follows: (1) Increase the number of HIV-infected persons who know their serostatus. (2) Increase the use of health care and preventive services. (3) Increase high-quality care and treatment. (4) Increase adherence to therapy by individuals with HIV. (5) Increase the number of individuals with HIV who adopt and sustain HIV–STD risk reduction behavior." Recently infected people DO often experience symptoms of acute infection. These symptoms do sometimes cause them to go to the doctor. But rarely do they cause the doctor to consider HIV infection as the reason, and then ask the questions which might encourage the person to get tested. Similarly the International HIV/AIDS Alliance publication "Positive Prevention" notes that "People test for HIV when it makes sense for them to do so. Therefore it is important to work towards increasing the number of reasons for people to come forward for testing. Availability of ARV treatment is a major reason." I have frequently suggested that we should determine the reasons why people decide to get tested for HIV. In this way, we use are eforts to promote testing (limited as they are) to strengthen these reasons. I'm sure you would accept that prevention efforts require multiple "focuses"; positive prevention, in particular as proposed by the SAFE approach, must be one important element of these efforts. Chris Eli,

First, you may wish to correct the link of this PLoS article - it should be

I think your assumption that supporters of Positive Prevention advocate “Waiting until someone is diagnosed as infected before cranking up prevention…” is a little facile. The article that many consider the grandfather of this movement (The Serostatus Approach to Fighting the HIV Epidemic: Prevention Strategies for Infected Individuals - SAFE, by Robert Janssen et al, including your ‘epi-hero’ Kevin De Cock, Am J Public Health. 2001;91:1019–1024, ) proposes these Essential Components:

“The 5 SAFE steps are as follows: (1) Increase the number of HIV-infected persons who know their serostatus. (2) Increase the use of health care and preventive services. (3) Increase high-quality care and treatment. (4) Increase adherence to therapy by individuals with HIV. (5) Increase the number of individuals with HIV who adopt and sustain HIV–STD risk reduction behavior.”

Recently infected people DO often experience symptoms of acute infection. These symptoms do sometimes cause them to go to the doctor. But rarely do they cause the doctor to consider HIV infection as the reason, and then ask the questions which might encourage the person to get tested.

Similarly the International HIV/AIDS Alliance publication “Positive Prevention” notes that “People test for HIV when it makes sense for them to do so. Therefore it is important to work towards increasing the number of reasons for people to come forward for testing. Availability of ARV treatment is a major reason.”

I have frequently suggested that we should determine the reasons why people decide to get tested for HIV. In this way, we use are eforts to promote testing (limited as they are) to strengthen these reasons.

I’m sure you would accept that prevention efforts require multiple “focuses”; positive prevention, in particular as proposed by the SAFE approach, must be one important element of these efforts.

Chris

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