Report of Potential New Strain of Drug-Resistant HIV

February 25, 2005

Position Statement on Report of Potential New Strain of Drug-Resistant HIV

On Friday, February 11, 2005 New York City Department of Health issued a statement that a highly resistant strain of rapidly progressive human immunodeficiency virus (HIV) had been diagnosed for the first time in a New York City resident who had not previously undergone antiviral drug treatment. The patient is a male in his mid-40s who reported multiple male sex partners and unprotected anal intercourse, often while using crystal methamphetamine (crystal meth).

He was first diagnosed with HIV in December 2004 and appears to have been recently infected. Concern has been expressed that this individual has been infected with a new strain of HIV that is resistant to many classes of anti-HIV medications, and results in fast progression to full blown AIDS.

Although this is a troubling report, further analysis is required to determine whether this is truly a new strain of HIV, as reports of viral resistance and rapid progression to AIDS have been documented in the past. For example, two cases of rapidly-progressing HIV resistant to three classes of antiviral drug therapies were reported in 2001 in Vancouver, British Columbia — yet researchers eventually determined that this was not, in fact, a new strain. About 1% of people infected with HIV are so-called ‘rapid responders’ whose infection rapidly leads to AIDS progression.

While this rare New York case definitely warrants attention, the AIDS Committee of Toronto (ACT) urges that we resist drawing conclusions until a thorough investigation of this isolated case has been undertaken. As we learned in the early years of the HIV/AIDS epidemic, fear, misinformation and blame can be very harmful. And, scaremongering has been shown to be an ineffective way of reducing the spread of HIV/AIDS.

Despite these past lessons, it is concerning that the announcement of a potentially new strain of HIV included mention of crystal meth use. These are, in fact, two separate issues. Linking them only creates blame.

Indeed, crystal meth use is a growing concern in gay communities, as its use is often associated with multiple incidents of unprotected anal sex. Given the role that recreational drugs play in the lives of some people, especially gay men, it is important that we better understand the links between their use — crystal meth use in particular — and unprotected sex, so as to provide accurate information and support. And there is a need for enhanced services for people who are struggling with their use of crystal meth and other recreational drugs. Unfortunately, the linking of a potentially new strain of HIV to a gay man who used crystal meth only further marginalizes those struggling with substance use.

The majority of gay men are taking steps to reduce their risk of HIV transmission, by using condoms when they engage in anal intercourse with a partner of unknown or different HIV status. A minority of men do put themselves at increased risk of HIV infection — for various reasons. To be effective, AIDS organizations and public health officials must examine and seek to address the social factors that lead to sexual risk-taking, and resist the urge to cast blame.

We call upon all levels of government to work with community health, addiction and AIDS organizations to better understand these complex issues and to ensure that appropriate services are available.

At the same time, we encourage all people who are sexually active to protect themselves and their sex partners from infection or re-infection with HIV.

Key Points

• Drug-resistant strains of HIV are not uncommon, and have been known to researchers for years. It remains to be seen whether the drug-resistant strain of HIV reported by the New York City Department of Health is, in fact, new. The rate at which HIV develops into AIDS depends as much on a person’s physiology as on the strain he or she is infected with. About 1% of all people infected with HIV are so-called rapid responders, whose infection progresses rapidly to AIDS.

• The reportedly new strain of HIV is not a ‘wake-up call’ to gay men. Studies show that the majority of gay men practice safer sex. While the first patient to be diagnosed with this so-called ‘super strain’ of HIV is a gay man and a crystal meth user, it is important to remember that HIV — whatever the strain — is an equal opportunity virus. It affects (and is transmitted by) people of all genders and sexual orientations.

• Research shows that people’s reasons for having unsafe sex are complicated. Scaremongering is an ineffective HIV prevention strategy. Prevention messages that simply tell people to wear a condom or face serious illness and death didn’t work in the 1980s — when there was no effective treatment for HIV/AIDS — nor do they work today. To be effective, HIV prevention messages must address the underlying factors that contribute to unsafe sexual behaviours.

• ACT will continue to provide prevention education that addresses the complexities of sexual risk-taking. We will monitor research about this reportedly new strain of HIV as it develops and make this information available to our clients and the general public. These reports will not, however, change our approach to HIV prevention.

• The effect of crystal meth in gay communities is a growing concern. While crystal meth use and the evolution of antiviral drug-resistant strains of HIV are separate issues, increased use of crystal meth among some gay and bisexual men puts them at greater risk for HIV infection. ACT will continue to develop resources that provide people with information about the effects of crystal meth use, and will work with other community organizations to ensure that there are adequate support systems in place for men who are concerned about their crystal use.

--30--