The Bay Area Reporter - August 17, 1998
Don Howard, ACT UP/Golden Gate Writers Pool

People in San Francisco are being infected with HIV that is resistant to currently available drug therapies, according to research presented at the 12th World AIDS Conference in Geneva last month. University of California, San Francisco (UCSF) doctors documented a case in which a man was infected with a strain of HIV that didn't respond to combination drug therapy. When the infected man's HIV was analyzed, it was shown to be resistant to all anti-HIV drugs, including all available protease inhibitors.

For many people this came as shocking news. Even for gay men who live in ground-zero HIV cities like San Francisco, the news has been greeted with surprise or with denial. But researchers have long known that it was possible to transmit HIV that is resistant to AZT. It was only a matter of time before protease inhibitor-resistant HIV was documented. And they suspect that, as more and more people take anti-HIV drugs and fail the drugs, the pool of multi-drug resistant virus will grow. This means the chances of being infected with an untreatable strain of the virus will continue to grow.

So, why did it take two years from the introduction of combination therapy before men at risk of infection were told about the potential for being infected with drug-resistant virus HIV?

The sad truth is that in the euphoria over the success of combination therapies for people with HIV we dropped the ball on HIV prevention. Instead of addressing the realities of how new HIV treatments affect HIV prevention, we continued to repeat the same tired and increasingly irrelevant safer sex messages from the early 1990s. We allowed the only new messages about HIV to be communicated through newspaper headlines of HIV cures and by pharmaceutical company advertisements touting the new wonder drugs. People saw these headlines and read ads with pictures of healthy men climbing mountains and, in the absence of real information, they have started to believe that the epidemic is over and they can strop using condoms.

Well, if the Geneva conference proved anything it proved that the AIDS epidemic ain't over yet. The documentation of multidrug-resistant HIV transmission should serve as a wake up call to all of us that we need new HIV prevention campaigns and messages that address the changes in the epidemic. These messages need to emphasize that the epidemic isn't over and infection today may mean starting out with virus that cannot be treated with current drugs.

We also need to give better information to people living with HIV and let them know that anyone having unsafe sex could infect partners with drug-resistant HIV. Equally important, those HIV-positive people could be reinfected with a strain of the virus that is resistant to drugs. This would limit your future treatment options or blow your current drug therapy or both.

The San Francisco AIDS Foundation (SFAF) heard the wake up call from Geneva and quickly developed a two-page warning about transmission of drug-resistant HIV in the Bay Area Reporter. They addressed both HIV-negative men and HIV-positive men to help them understand their risks.

In an effort to get some of this information out to gay men, ACT UP/Golden Gate has been importing posters created last year by Boston's AIDS Action Committee. We have been putting the posters in bars and sex clubs to let gay men know what the changes in HIV treatment mean for safer sex. One of the posters emphasizes that the epidemic isn't over and that, while progress has been made, the new drugs are not a cure. You either have the option of continuing to use condoms or taking 10 or more pills a day, which will make you nauseated, can have toxic and disfiguring side effects, and require you to alter your daily routine and meal schedules. Two other posters from Boston address HIV-positive men and let them know that having undetectable virus does not mean that you are uninfectious. (Addressing HIV prevention messages to people living with HIV may be considered politically incorrect by some people. But, we believe that all of us, both negative and positive, have a responsibility to avoid HIV transmission.)

The SFAF performed an important service to the community by publishing their well-prepared and thoughtful warnings in the B.A.R. but we need more and better messages in long-term campaigns that target all the at-risk communities. Other San Francisco prevention agencies must also hear the wake up call from Geneva and develop relevant and up-to-date HIV prevention campaigns, messages, and programs. Two years of inaction have put people at risk and we cannot wait a minute longer to give people the information they need to keep themselves and their lovers healthy.
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Always watch for outdated information. This article first appeared in 1998. This material is designed to support, not replace, the relationship that exists between you and your doctor.

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