How a ‘Perfect Storm’ in New Hampshire Has Fueled an Opioid Crisis

By Katharine Q. Seelye

The New York Times

Jan. 21, 2018

MANCHESTER, N.H. — They sat on plastic chairs in a corner of the Manchester fire station, clutching each other in a desperate farewell.

Justin Lerra was 26 when he turned himself in last summer to the fire department’s “safe station” program, which helps get drug users into treatment. He had been using drugs for seven years. His girlfriend, Sarah, who asked that her last name not be published, was pregnant and had told him that if he didn’t stop using, she would leave him.

Emotional scenes like this play out daily at firehouses in Manchester and Nashua, a measure of how deeply the opioid scourge has ravaged New Hampshire. The state leads the nation in overdose deaths per capita from fentanyl, a powerful synthetic opioid that has virtually replaced heroin across New England. Because fentanyl is so potent, the risk of overdose is high.

In New Hampshire, which President Trump has called a “drug-infested den,” the opioid crisis is almost a statewide obsession.

A man who overdosed after injecting opioids was revived by firefighters and paramedics with two doses of Narcan in Manchester.CreditTodd Heisler/The New York Times

An astonishing 53 percent of adults said in a Granite State poll last year that drugs were the biggest problem facing the state — the first time in the poll’s history that a majority named a single issue as the most important. (Jobs and the economy lagged a distant second.)

While West Virginia leads the nation in overall drug overdose deaths per capita, New Hampshire is essentially tied with Ohio for second place.

Unlike West Virginia, New Hampshire is relatively prosperous, which makes an opioid crisis here seem all the more jarring. This state has the highest median household income in the country, ranks low in unemployment and crime, and often lands at or near the top of lists of the best states in which to live.

Researchers at Dartmouth College in Hanover, N.H., have been studying the issue to try to understand why the state’s opioid problem is so dire.

One big reason, they say, is the proximity to an abundant drug supply in neighboring Massachusetts, the center of drug distribution networks that traffic opioids throughout New England.

Another, they say, is New Hampshire’s low per capita spending on services to help drug users break free from addiction. Nationally, the state, which has no income or sales tax, ranks at the bottom in availability of treatment programs. The fire departments’ safe stations are one effort to fill that void.

The researchers also noted that the state has pockets of “economic degradation,” especially in rural areas where jobs are few, and that may contribute to the problem.

Beyond that, the researchers say, doctors here have long prescribed “significantly higher rates” of opioid pain relievers, almost twice the national average. When the government cracked down on legal painkillers, New Hampshire residents were primed to seek out illegal street drugs.

“This is a kind of perfect storm,” says Lisa A. Marsch, a professor of psychiatry and health policy at Dartmouth’s Geisel School of Medicine and the study’s principal investigator.

“We have highly available, highly potent opioids in New Hampshire,” she says. “And highly limited resources to reduce the risk.”

The researchers noted other factors, too:

• A shortage of workers in addiction and recovery. Northeast states have an average of 15.5 doctors per 100,000 residents who can prescribe Suboxone and other medication-assisted treatments; New Hampshire has seven.

• No needle exchanges, which can reduce the transmission of diseases like hepatitis C and save health care costs. New Hampshire finally legalized needle exchanges in June, long after many other states had done so, but did not fund them. Dartmouth medical students, using donations and grants, opened the first needle exchange last summer in a Claremont, N.H., soup kitchen, but it was shut down in October because it was too close to a school.

• “Live Free or Die.” The researchers said the New Hampshire ethos of “self-sufficiency and individualism” could inhibit some residents from seeking help. And for some, they said, the state’s “Live Free or Die” motto might justify risky behaviors. The state does not require drivers to wear seatbelts. It allows motorcyclists to ride without helmets. And state liquor stores are right on the major highways.

New CDC director aims to end AIDS epidemic in seven years

By Allen Cone

March 30 (UPI) -- The new director of the Centers for Disease Control and Prevention said in a speech the AIDS epidemic could be ended within seven years and pledged to bring the opioid crisis "to its knees."

Dr. Robert Redfield Jr. spoke at a staff meeting of the CDC in Atlanta on Thursday, three days after replacing Dr. Brenda Fitzgerald, who resigned in January after about six months on the job. She reportedly bought shares in tobacco, drug and food companies last year roughly one month into the job.

For 50 minutes, Redfield spoke to staff at the Atlanta headquarters and CDC operations around the country.

Redfield, 65, said he was honored to lead the best "science-based, data-driven agency in the world. I've dreamed of doing this for a long time." The CDC has nearly 12,000 employees worldwide.

"We're not an opinion organization," he said. "That's why CDC has the credibility around the world that it has."

Redfield added: "Academia does not solve problems. Academia is not a service organization."

The former AIDS researcher has spent decades treating people who have HIV.

"Ending the AIDS epidemic in America? It's possible," he said. "I think it could be done in the next three to seven years, if we put our mind to it."

Although there is no effective HIV vaccine, Redfield said existing tools for treating HIV and preventing its spread can stop the U.S. epidemic.

"I've never been an abstinence-only person -- just ask my wife," said Redfield, who is Catholic. "I believe in every measure we have scientific evidence for, including condoms."

Only about 10 percent to 20 percent are using condoms, he noted. In 2016, nearly 40,000 people in the United States were diagnosed with HIV. The CDC reported 12,497 people died with AIDS in the United States in 2015.

He pledged that CDC would play a key role in other agencies in the Department of Health and Human Services in dealing with opioid misuse and abuse, which he called "the public health crisis of our time." He said they will work on "bringing it to its knees."

Opioids killed more than 42,000 people in 2016, more than any year on record, according to the CDC. And 40 percent of all opioid overdose deaths involve a prescription opioid.

"If any of you have tried to access care for addiction in this nation, I can guarantee you it's complicated," he said. "It needs to not be complicated."

Redfield also said emergency preparedness to protect "the health of the American public from that which we don't expect" is the agency's top mission. He called a pandemic influenza "my biggest fear." And he wants the CDC to be "100 percent prepared" for new or re-emerging infectious diseases threat or bioterrorism.

"I pray it doesn't happen on our watch. But I want to make sure we're all prepared, whether it's flu -- my biggest fear -- or MERS or something else," he said, referring to the viral Middle East respiratory syndrome.

"I respect the mission we have, which is to be prepared for what we don't expect."

Marijuana legalization could help offset opioid epidemic, studies find

By Mark Lieber, CNN

(CNN)Experts have proposed using medical marijuana to help Americans struggling with opioid addiction. Now, two studies suggest that there is merit to that strategy.

The studies, published Monday in the journal JAMA Internal Medicine, compared opioid prescription patterns in states that have enacted medical cannabis laws with those that have not. One of the studies looked at opioid prescriptions covered by Medicare Part D between 2010 and 2015, while the other looked at opioid prescriptions covered by Medicaid between 2011 and 2016.

The researchers found that states that allow the use of cannabis for medical purposes had 2.21 million fewer daily doses of opioids prescribed per year under Medicare Part D, compared with those states without medical cannabis laws. Opioid prescriptions under Medicaid also dropped by 5.88% in states with medical cannabis laws compared with states without such laws, according to the studies.

    "This study adds one more brick in the wall in the argument that cannabis clearly has medical applications," said David Bradford, professor of public administration and policy at the University of Georgia and a lead author of the Medicare study.

    "And for pain patients in particular, our work adds to the argument that cannabis can be effective."

    Medicare Part D, the optional prescription drug benefit plan for those enrolled in Medicare, covers more than 42 million Americans, including those 65 or older. Medicaid provides health coverage to more than 73 million low-income individuals in the US, according to the program's website.

    "Medicare and Medicaid publishes this data, and we're free to use it, and anyone who's interested can download the data," Bradford said. "But that means that we don't know what's going on with the privately insured and the uninsured population, and for that, I'm afraid the data sets are proprietary and expensive."

    'This crisis is very real'

    The new research comes as the United States remains entangled in the worst opioid epidemic the world has ever seen. Opioid overdose has risen dramatically over the past 15 years and has been implicated in over 500,000 deaths since 2000 -- more than the number of Americans killed in World War II.

    "As somebody who treats patients with opioid use disorders, this crisis is very real. These patients die every day, and it's quite shocking in many ways," said Dr. Kevin Hill, an addiction psychiatrist at Beth Israel Deaconess Medical Center and an assistant professor of psychiatry at Harvard Medical School, who was not involved in the new studies.

    "We have had overuse of certain prescription opioids over the years, and it's certainly contributed to the opioid crisis that we're feeling," he added. "I don't think that's the only reason, but certainly, it was too easy at many points to get prescriptions for opioids."

    Today, more than 90 Americans a day die from opioid overdose, resulting in more than 42,000 deaths per year, according to the US Centers for Disease Control and Prevention. Opioid overdose recently overtook vehicular accidents and shooting deaths as the most common cause of accidental death in the United States, the CDC says.

    Like opioids, marijuana has been shown to be effective in treating chronic pain as well as other conditions such as seizures, multiple sclerosis and certain mental disorders, according to the National Institute on Drug Abuse. Research suggests that the cannabinoid and opioid receptor systems rely on common signaling pathways in the brain, including the dopamine reward system that is central to drug tolerance, dependence and addiction.

    "All drugs of abuse operate using some shared pathways. For example, cannabinoid receptors and opioid receptors coincidentally happen to be located very close by in many places in the brain," Hill said. "So it stands to reason that a medication that affects one system might affect the other."

    But unlike opioids, marijuana has little addiction potential, and virtually no deaths from marijuana overdose have been reported in the United States, according to Bradford.

    "No one has ever died of cannabis, so it has many safety advantages over opiates," Bradford said. "And to the extent that we're trying to manage the opiate crisis, cannabis is a potential tool."

    Comparing states with and without medical marijuana laws

    In order to evaluate whether medical marijuana could function as an effective and safe alternative to opioids, the two teams of researchers looked at whether opioid prescriptions were lower in states that had active medical cannabis laws and whether those states that enacted these laws during the study period saw reductions in opioid prescriptions.

    Both teams, in fact, did find that opioid prescriptions were significantly lower in states that had enacted medical cannabis laws. The team that looked at Medicaid patients also found that the four states that switched from medical use only to recreational use -- Alaska, Colorado, Oregon and Washington -- saw further reductions in opioid prescriptions, according to Hefei Wen, assistant professor of health management and policy at the University of Kentucky and a lead author on the Medicaid study.

    "We saw a 9% or 10% reduction (in opioid prescriptions) in Colorado and Oregon," Wen said. "And in Alaska and Washington, the magnitude was a little bit smaller but still significant."

    The first state in the United States to legalize marijuana for medicinal use was California, in 1996. Since then, 29 states and the District of Columbia have approved some form of legalized cannabis. All of these states include chronic pain -- either directly or indirectly -- in the list of approved medical conditions for marijuana use, according to Bradford.

    The details of the medical cannabis laws were found to have a significant impact on opioid prescription patterns, the researchers found. States that permitted recreational use, for example, saw an additional 6.38% reduction in opioid prescriptions under Medicaid compared with those states that permitted marijuana only for medical use, according to Wen.

    The method of procurement also had a significant impact on opioid prescription patterns. States that permitted medical dispensaries -- regulated shops that people can visit to purchase cannabis products -- had 3.742 million fewer opioid prescriptions filled per year under Medicare Part D, while those that allowed only home cultivation had 1.792 million fewer opioid prescriptions per year.

    "We found that there was about a 14.5% reduction in any opiate use when dispensaries were turned on -- and that was statistically significant -- and about a 7% reduction in any opiate use when home cultivation only was turned on," Bradford said. "So dispensaries are much more powerful in terms of shifting people away from the use of opiates."

    The impact of these laws also differed based on the class of opioid prescribed. Specifically, states with medical cannabis laws saw 20.7% fewer morphine prescriptions and 17.4% fewer hydrocodone prescriptions compared with states that did not have these laws, according to Bradford.

    Fentanyl prescriptions under Medicare Part D also dropped by 8.5% in states that had enacted medical cannabis laws, though the difference was not statistically significant, Bradford said. Fentanyl is a synthetic opioid, like heroin, that can be prescribed legally by physicians. It is 50 to 100 times more potent than morphine, and even a small amount can be fatal, according to the National Institute on Drug Abuse.

    "I know that many people, including the attorney general, Jeff Sessions, are skeptical of cannabis," Bradford said. "But, you know, the attorney general needs to be terrified of fentanyl."

    'A call to action'

    This is not the first time researchers have found a link between marijuana legalization and decreased opioid use. A 2014 study showed that states with medical cannabis laws had 24.8% fewer opioid overdose deaths between 1999 and 2010. A study in 2017 also found that the legalization of recreational marijuana in Colorado in 2012 reversed the state's upward trend in opioid-related deaths.

    "There is a growing body of scientific literature suggesting that legal access to marijuana can reduce the use of opioids as well as opioid-related overdose deaths," said Melissa Moore, New York deputy state director for the Drug Policy Alliance. "In states with medical marijuana laws, we have already seen decreased admissions for opioid-related treatment and dramatically reduced rates of opioid overdoses."

    Some skeptics, though, argue that marijuana legalization could actually worsen the opioid epidemic. Another 2017 study, for example, showed a positive association between illicit cannabis use and opioid use disorders in the United States. But there may be an important difference between illicit cannabis use and legalized cannabis use, according to Hill.

    "As we have all of these states implementing these policies, it's imperative that we do more research," Hill said. "We need to study the effects of these policies, and we really haven't done it to the degree that we should."

    The two recent studies looked only at patients enrolled in Medicaid and Medicare Part D, meaning the results may not be generalizable to the entire US population.

    But both Hill and Moore agree that as more states debate the merits of legalizing marijuana in the coming months and years, more research will be needed to create consistency between cannabis science and cannabis policy.

    "There is a great deal of movement in the Northeast, with New Hampshire and New Jersey being well-positioned to legalize adult use," Moore said. "I believe there are also ballot measures to legalize marijuana in Arizona, Florida, Missouri, Nebraska and South Dakota as well that voters will decide on in Fall 2018."

    Hill called the new research "a call to action" and added, "we should be studying these policies. But unfortunately, the policies have far outpaced the science at this point."

    ‘Our greatest fear’: Highly drug-resistant gonorrhea confirmed by health officials

    A super-resistant strain of gonorrhea has been reported in the United Kingdom following warnings from global public health officials that the common sexually transmitted disease is becoming more difficult to treat.

    Health officials in England said it is the first time that a case of gonorrhea could not be treated successfully with antibiotics that are commonly used to cure it.

    Earlier this year, a man, who was not named, sought treatment there for symptoms that he developed about a month after he had sexual contact with a woman in Southeast Asia, according to a case report from Public Health England. The bacterial infection was treated with two antibiotics, azithromycin and ceftriaxone, but subsequent tests still came back positive for the disease, the officials said.

    “This is the first time a case has displayed such high-level resistance to both of these drugs and to most other commonly used antibiotics,” Gwenda Hughes, who leads the sexually transmitted infection section at Public Health England, said Wednesday in a statement.

    Gonorrhea, which is caused by the bacterium, Neisseria gonorrhoeae, is one of the most common sexually transmitted diseases around the world.

    Each year, there are an estimated 78 million cases across the globe — about 820,000 of which are reported in the United States, according to data from the Centers for Disease Control and Prevention and the World Health Organization.

    But public health officials said it is becoming more and more resistant to drugs.

    Teodora Wi, medical officer of human reproduction at WHO, said in a news release last year that the bacteria that cause gonorrhea are highly intelligent, explaining that “every time we use a new class of antibiotics to treat the infection, the bacteria evolve to resist them.”

    It's not certain how the patient in England contracted the super-resistant strain. Although he had contact with a woman in Asia, he also had one female partner in the United Kingdom, according to the recent report from Public Health England. She avoided infection.

    Following treatment, a throat swab revealed that the man's infection was still present.

    The patient was then treated intravenously with another antibiotic called ertapenem, and preliminary tests show that the medication may be working.

    He will be tested again next month.

    “We are following up this case to ensure that the infection was effectively treated with other options and the risk of any onward transmission is minimized,” Hughes, with Public Health England, said in the statement. “PHE actively monitors, and acts on, the spread of antibiotic resistance in gonorrhea and potential treatment failures, and has introduced enhanced surveillance to identify and manage resistant strains of infection promptly to help reduce further spread.”

    David Harvey, executive director of the National Coalition of STD Directors, said that the report “is one more confirmation of our greatest fear: drug-resistant gonorrhea spreading around the globe.”

    “Here in the U.S. and around the globe, we have to take drug-resistant gonorrhea seriously in order to invest in finding new cures and preventing infections,” he said, according to CNN. “Working together, funding must be radically increased to combat this and other life-threatening STDs.”

    Oftentimes, there are no signs or symptoms associated with gonorrhea but, when symptoms do occur, they can include pain while urinating, abnormal discharge from the genitals and, with women, pain during sexual intercourse, among other things, according to the Mayo Clinic.

    Medical experts warn that when the condition is not treated, it can sometimes lead to infertility in both men and women, other infections throughout the body, as well as an increased risk of HIV/AIDS.

    The Mayo Clinic recommends that people and their sexual partners use prophylactics and undergo regular STD screenings to monitor for infections.

    “It is better to avoid getting or passing on gonorrhea in the first place,” Hughes said, “and everyone can significantly reduce their risk by using condoms consistently and correctly with all new and casual partners

     

    Lindsey Bever is a general assignment reporter for The Washington Post, covering national news with an emphasis on health. She was previously a reporter at the Dallas Morning News.

     

    New drug capsule may allow weekly HIV treatment

    Researchers at MIT and Brigham and Women's Hospital have developed a capsule that can deliver a week's worth of HIV drugs in a single dose. This advance could make it much easier for patients to adhere to the strict schedule of dosing required for the drug cocktails used to fight the virus, the researchers say.

    The new capsule is designed so that patients can take it just once a week, and the drug will release gradually throughout the week. This type of delivery system could not only improve patients' adherence to their treatment schedule but also be used by people at risk of HIV exposure to help prevent them from becoming infected, the researchers say.

    "One of the main barriers to treating and preventing HIV is adherence," says Giovanni Traverso, a research affiliate at MIT's Koch Institute for Integrative Cancer Research and a gastroenterologist and biomedical engineer at Brigham and Women's Hospital. "The ability to make doses less frequent stands to improve adherence and make a significant impact at the patient level."

    Traverso and Robert Langer, the David H. Koch Institute Professor at MIT, are the senior authors of the study, which appears in the Jan. 9 issue of Nature Communications. MIT postdoc Ameya Kirtane and visiting scholar Omar Abouzid are the lead authors of the paper.

    Scientists from Lyndra, a company that was launched to develop this technology, also contributed to the study. Lyndra is now working toward performing a clinical trial using this delivery system.

    "We are all very excited about how this new drug-delivery system can potentially help patients with HIV/AIDS, as well as many other diseases," Langer says.

    "A pillbox in a capsule"

    Although the overall mortality rate of HIV has dropped significantly since the introduction of antiretroviral therapies in the 1990s, there were 2.1 million new HIV infections and 1.2 million HIV-related deaths in 2015.

    Several large clinical trials have evaluated whether antiretroviral drugs can prevent HIV infection in healthy populations. These trials have had mixed success, and one major obstacle to preventative treatment is the difficulty in getting people to take the necessary pills every day.

    The MIT/BWH team believed that a drug delivery capsule they developed in 2016 might help to address this problem. Their capsule consists of a star-shaped structure with six arms that can be loaded with drugs, folded inward, and encased in a smooth coating. After the capsule is swallowed, the arms unfold and gradually release their cargo.

    In a previous study, the researchers found that these capsules could remain in the stomach for up to two weeks, gradually releasing the malaria drug ivermectin. The researchers then set out to adapt the capsule to deliver HIV drugs.

    In their original version, the entire star shape was made from one polymer that both provides structural support and carries the drug payload. This made it more difficult to design new capsules that would release drugs at varying rates, because any changes to the polymer composition might disrupt the capsule's structural integrity.

    To overcome that, the researchers designed a new version in which the backbone of the star structure is still a strong polymer, but each of the six arms can be filled with a different drug-loaded polymer. This makes it easier to design a capsule that releases drugs at different rates.

    "In a way, it's like putting a pillbox in a capsule. Now you have chambers for every day of the week on a single capsule," Traverso says.

    Tests in pigs showed that the capsules were able to successfully lodge in the stomach and release three different HIV drugs over one week. The capsules are designed so that after all of the drug is released, the capsules disintegrate into smaller components that can pass through the digestive tract.

    Preventing infection

    Working with the Institute for Disease Modeling in Bellevue, Washington, the researchers tried to predict how much impact a weekly drug could have on preventing HIV infections. They calculated that going from a daily dose to a weekly dose could improve the efficacy of HIV preventative treatment by approximately 20 percent. When this figure was incorporated into a computer model of HIV transmission in South Africa, the model showed that 200,000 to 800,000 new infections could be prevented over the next 20 years.

    "A longer-acting, less invasive oral formulation could be one important part of our future arsenal to stop the HIV/AIDS pandemic," says Anthony Fauci, director of the National Institute of Allergy and Infectious Disease, which partly funded the research.

    "Substantial progress has been made to advance antiretroviral therapies, enabling a person living with HIV to achieve a nearly normal lifespan and reducing the risk of acquiring HIV. However, lack of adherence to once-daily therapeutics for infected individuals and pre-exposure prophylaxis (PrEP) for uninfected at-risk people remain a key challenge. New and improved tools for HIV treatment and prevention, along with wider implementation of novel and existing approaches, are needed to end the HIV pandemic as we know it. Studies such as this help us move closer to achieving this goal," Fauci says.

    The MIT/BWH team is now working on adapting this technology to other diseases that could benefit from weekly drug dosing. Because of the way that the researchers designed the polymer arms of the capsule, it is fairly easy to swap different drugs in and out, they say.

    "To put other drugs onto the system is significantly easier because the core system remains the same," Kirtane says. "All we need to do is change how slowly or how quickly it will be released."

    The researchers are also working on capsules that could stay in the body for much longer periods of time.

    The research was also funded by the Bill and Melinda Gates Foundation, Bill and Melinda Gates through the Global Good Fund, the National Institutes of Health, and the Division of Gastroenterology at Brigham and Women's Hospital.

    Story Source:

    Materials provided by Massachusetts Institute of Technology. Original written by Anne Trafton. Note: Content may be edited for style and length.

    Journal Reference:

    1. Ameya R. Kirtane, Omar Abouzid, Daniel Minahan, Taylor Bensel, Alison L. Hill, Christian Selinger, Anna Bershteyn, Morgan Craig, Shirley S. Mo, Hormoz Mazdiyasni, Cody Cleveland, Jaimie Rogner, Young-Ah Lucy Lee, Lucas Booth, Farhad Javid, Sarah J. Wu, Tyler Grant, Andrew M. Bellinger, Boris Nikolic, Alison Hayward, Lowell Wood, Philip A. Eckhoff, Martin A. Nowak, Robert Langer, Giovanni Traverso. Development of an oral once-weekly drug delivery system for HIV antiretroviral therapy. Nature Communications, 2018; 9 (1) DOI: 10.1038/s41467-017-02294-6

    Cite This Page:

    Massachusetts Institute of Technology. "New drug capsule may allow weekly HIV treatment: Replacing daily pills with a weekly regimen could help patients stick to their dosing schedule." ScienceDaily. ScienceDaily, 9 January 2018. <www.sciencedaily.com/releases/2018/01/180109153443.htm>.

    ‘I don’t feel like I’m a threat anymore.’ New HIV guidelines are changing lives.

    by Lenny Bernstein

    Last year, Chris Kimmenez and his wife asked their doctors a simple question. Could Chris, who has been HIV positive since 1989 but keeps the virus in check through medication, transmit it sexually to Paula?

    They were pretty sure they knew the answer. Married for more than 30 years, they had not always practiced safe sex, but Paula showed no signs of having the virus.

    Their physicians were less certain. "They had a conversation, and they did some research on it," Kimmenez said. "They came back to us and said there may still be a risk, but we're comfortable enough" that unprotected sex is safe.

    "We knew that all along," said Kimmenez, 56, who works with ex-offenders in Philadelphia.

    Simple acknowledgments like that one, spoken quietly in the privacy of doctors' offices, mark the arrival of a historic moment in the history of HIV: Medical authorities are publicly agreeing that people with undetectable viral loads cannot transmit the virus that causes AIDS.

    The policy change has profound implications for the way people view HIV. The change promises not just unprotected sex for couples like Kimmenez and his wife, but also reduced stigma for the 1.2 million Americans living with HIV. The policy change also offers the hope that more people will be tested and begin treatment if they are found to have the virus rather than live in denial.

    "There was something in me that said I'm damaged and I made a mistake, and people see it and I'm a danger," said Mark S. King, 56, a writer and activist who tested positive for HIV in 1985. But now, treatment has fully suppressed the virus. "When I finally internalized this message . . . something suddenly lifted off of me that is hard to describe. It was almost as if someone wiped me clean. I no longer feel like this diseased pariah."

    Once considered a death sentence, HIV infection can now be managed via medication, much like chronic diseases such as diabetes, and people with the virus live full lives. The rate of new infections in the United States dropped by 10 percent from 2010 to 37,600 in 2014, according to the U.S. Centers for Disease Control and Prevention. Fewer than 7,000 people died of HIV/AIDSthat year.

    In July, Anthony S. Fauci, head of the National Institute of Allergy and Infectious Diseases and one of the world's leading authorities on HIV, publicly agreed at an international conference that people with undetectable viral loads in their blood cannot transmit the virus.

    On Sept. 27, the CDC followed, releasing a letter that said people who take medication daily "and achieve and maintain an undetectable viral load have effectively no risk of sexually transmitting the virus to an HIV-negative partner."

    The influential British medical journal the Lancet HIV endorsed the idea in an editorial this month. All told, more than 500 organizations in 67 countries now agree, according to Bruce Richman, who is leading the "Undetectable = Untransmittable" (U=U) campaign credited with beginning to change public perception of HIV transmissibility.

    A recent breakthrough in HIV research shows patients who are taking their medicine, and have no detectable signs of HIV, cannot transfer the virus to others. (Joyce Koh/The Washington Post)

    Like many developments in the four-decade history of HIV, this one has been slow to gain acceptance among mainstream health-care providers. Many are not aware of it or must unlearn the habit of drilling safe-sex lessons into patients, as they have been doing almost since the AIDS epidemic began. HIV-positive people also must alter deeply ingrained beliefs that nothing good can come of revealing their status.

    The change in philosophy also has sparked concerns, for which there is some evidence, that more condomless sex will lead to an increase in other sexually transmitted infections. And experts acknowledge that a few people whose viral load is not truly suppressed will eventually transmit HIV to others.

    Laws in many states also are out of date. Many still criminalize the failure to reveal HIV status to a sex partner, even when there is no danger of transmissibility.

    But on balance, authorities said, the agreement that people with HIV can prevent sexual transmission by taking a single pill each day is nothing less than revolutionary.

    "Nothing is completely risk-free," Fauci said in an interview. "What the community feels is that all of the good that will come from the lack of social stigmatization" is worth the risk. "This means a lot to them. This has a lot to do with their self-worth, their identity."

    An undetectable viral load is defined as fewer than 200 copies of the virus in a milliliter of blood. Generally, people with HIV should maintain that level or a lower level for six months before beginning to consider themselves incapable of transmitting the virus sexually.

    Many who faithfully take antiretroviral medication and lead healthy lifestyles can bring their viral loads considerably lower, to 50 or even 25 copies.

    But progress raises other questions, said Jonathan Mermin, director of the CDC's National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. What if a person forgets to take medication for one day? What about two, or more? How long after resuming therapy should someone wait before once again considering himself or herself incapable of transmitting the virus? And what about people who go above and below the 200-copy threshold over time? Studies show that to be the case for about 10 percent of the people with HIV, Mermin said.

    As yet, there are no evidence-based answers to these questions, he said. "The public-health challenge now is moving from theory to implementation," he said. "Many questions arise following the information that when a person with HIV has an undetectable viral load, he has effectively no risk of transmitting the virus."

    In 2008, Swiss experts announced that those with undetectable levels of HIV could not transmit HIV through sex. But the world was not ready to hear the message then.

    Starting in 2011, three large studies confirmed the idea, tracking more than 75,000 vaginal and anal condomless sex acts without finding a single HIV transmission to an HIV-negative partner from someone whose viral load was undetectable. The initial 2011 study was named "breakthrough of the year" by Science magazine.

    Now the challenge is to get the message out to HIV-positive people, caregivers and the public. And that process has been slow.

    "I would tell everyone about this, friends and family and people I wanted to date, and I was coming across so much resistance, because major institutions were saying this is wrong," Richman said.

    He launched U=U last year, initially a lonely and sometimes controversial campaign to let the world know something that many people with HIV had concluded for themselves. His breakthrough moment came in August 2016 when New York City's health department signed on. Soon, other cities and organizations were joining.

    Still, the message is moving mainly from people with HIV to health authorities and policymakers, rather than in the other direction, Richman said.

    "This is a radical challenge to the status quo and to 35 years of HIV and fear of people living with HIV," Richman said.

    Brigitte Charbonneau, 71, of Ottawa, found out this year that she could not transmit the virus after 23 years of being HIV positive. "I thought, 'My God, I've been living with my man for 20 years, and we've been using condoms,' " the retired hairdresser recalled. "And I phoned him right that afternoon."

    Jennifer Vaughan of Watsonville, Calif., vividly remembers the moment she learned she could not transmit the virus to her boyfriend. The mother of three tested positive in February 2016 after she became critically ill with what was finally determined to be AIDS. HIV was not among the possibilities she or her doctors considered, until a blood test revealed the virus. She thinks she was infected by a previous boyfriend with a history of intravenous drug use.

    Vaughan attended a speech Richman gave and was talking with him in a parking lot outside a Starbucks.

    "I'll never forget him saying those words, 'You can't transmit the virus if you're undetectable,' " the 47-year-old substitute teacher recalled. "And I said, 'Wait, what?'

    "It was like the sky opened. Are you kidding? There's, like, zero risk? I don't feel like I'm a threat anymore. I don't feel like I'm dirty. I don't feel like I'm a dangerous person."

    Courtesy:  The Washington Post

    He Took a Drug to Prevent AIDS. Then He Couldn’t Get Disability Insurance

    By Donald G. McNeil Jr.

    Feb. 12, 2018

    [Update: State financial regulators in New York said that they would investigate reports that gay men have been denied insurance policies covering life, disability or long-term care because they were taking PrEP.]

    Three years ago, Dr. Philip J. Cheng, a urology resident at Harvard’s Brigham and Women’s Hospital, nicked himself while preparing an H.I.V.-positive patient for surgery.

    Following hospital protocol, he took a one-month course of Truvada, a cocktail of two anti-H.I.V. drugs, to prevent infection. Later, because he was an unattached gay man, he decided to keep taking Truvada to protect himself from getting H.I.V. through sex.

    The practice — called PrEP, short for pre-exposure prophylaxis — is safe and highly effective. Several studies have shown that users who take the drug daily are at nearly zero risk of H.I.V. infection.

    But when Dr. Cheng applied for disability insurance — which many young doctors do to protect a lifetime’s worth of income should they be hurt — he was told that, because he was taking Truvada, he could have only a five-year policy.

    Dr. Cheng is healthy, has never had surgery or been hospitalized, and takes no other medication. “And I never engaged in sexually irresponsible behavior,” he said. “I’ve always been in longer-term monogamous relationships.”

    “I was really shocked,” he added. “PrEP is the responsible thing to do. It’s the closest thing we have to an H.I.V. vaccine.”

    Unable to get the company to change its decision — even after he offered to sign a waiver voiding his policy should he become H.I.V.-infected — he did what some other gay men in similar situations have been forced to do. He stopped taking Truvada.

    He then applied to a different insurer — and was offered a lifetime disability policy.

    There are nearly 800 life insurers in this country, according to the American Council of Life Insurers. There are no national figures on how many of them have denied coverage to men because they take PrEP.

    But insurance brokers, gay-rights advocates and staff at medical clinics said in interviews they had heard of numerous such cases. H.I.V. specialists say the denials endanger men’s lives by encouraging them to drop PrEP if they need life, disability or long-term-care insurance.

    By contrast, health insurance companies usually cover PrEP, which the Centers for Disease Control and Prevention endorsed in 2014 for anyone at substantial risk of H.I.V., which includes any gay or bisexual man who might have sex without a condom with anyone of unknown H.I.V. status.

    The denials turn the insurance industry’s risk-management standard on its head: men who do not protect themselves can get policies, while men who do cannot.

    “It doesn’t make any sense,” said Dr. Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases, and perhaps the nation’s best-known AIDS doctor. “It ought to be the other way around.”

    Dr. Robert M. Grant, the AIDS researcher at the University of California, San Francisco, who led the clinical trial that established the value of PrEP, said such denials “really are silly — it’s like refusing to insure someone because they use seatbelts.”

    Moreover, advocates argue, the practice singles out gay men for discriminatory treatment. Women, for instance, are not denied coverage if they use birth control pills or get the vaccine against human papillomavirus, which can cause cervical cancer. Yet like Truvada, use of these drugs suggests an active sex life, with the accompanying risks.

    And insurers routinely cover applicants with actual diseases controlled by medications, including diabetes, epilepsy, high blood pressure and bipolar disorder.

    Bennett Klein, a lawyer for GLAD (GLBTQ Legal Advocates and Defenders), based in Boston, said he knew of 14 instances in which companies denied life insurance, long-term-care insurance or disability insurance to gay men on PrEP, or told brokers they would do so if asked.

    Courtney Mulhern-Pearson, policy director for The San Francisco AIDS Foundation, said denial of life insurance to men on PrEP was “an increasing trend.”

    When companies did offer explanations, they said applicants were turned down because the company believed they must be engaging in high-risk sexual behavior.

    When she explained to some insurers that PrEP was protective, regardless of behavior, “there seemed to be an understanding,” she said. “But so far I haven’t seen any policy changes.”

    Dr. Cheng’s stethoscope at home. He said his insurer claimed not to know about Truvada’s side effects, even though it was approved in 2004.CreditKayana Szymczak for The New York Times

    The foundation considers the practice discriminatory, and Ms. Mulhern-Pearson has requested a meeting with California’s state insurance department “to see if there’s anything we can do legislatively or through regulation.”

    The Times contacted the A.C.L.I., the industry’s trade association, and four of the companies named by Mr. Klein, sending each detailed questions about underwriting policies related to Truvada and the sexual habits of applicants, and what other medical conditions caused them to deny coverage.

    An A.C.L.I. spokesman said the council did not collect such information from members.

    For competitive reasons, companies do not publicize their underwriting standards and often do not explain why they deny an individual policy. Each policy is denied — or offered at a higher price or shorter term — based on many medical factors, including weight, blood pressure, cholesterol, smoking status and so on.

    Mutual of Omaha, which Mr. Klein is suing for denying long-term-care insurance to an unnamed gay man, declined to answer any questions and said it did not comment on pending litigation.

    In motions filed in GLAD’s suit, Mutual of Omaha conceded that it had denied an applicant coverage because he took Truvada.

    The drug is indicated only for persons with H.I.V. or at high risk of acquiring H.I.V., the company said. Therefore it turned down everyone taking Truvada.

    “The fact that the drug is less than 100 percent effective adds yet another layer to the risk profile,” the company added.

    According to internal underwriting guidelines obtained by Mr. Klein, Mutual of Omaha sells long-term-care policies to people with Addison’s disease, bipolar disorder, depression, mild coronary artery disease, diabetes, epilepsy and high blood pressure, as long as they are controlled by medication for various periods, from six months up to three years.

    It also insures former alcoholics who were alcohol-free and in support groups, as well as people who had recovered from heart valve surgery or cancers of the bladder, breast, prostate and skin.

    “The irrationality is enough to make your mind spin,” Mr. Klein said.

    Other insurers replied to The Times’s questions with brief answers saying they did not deny coverage solely for taking PrEP but declining to describe what conditions or behaviors would cause them to exclude coverage.

    A spokesman for Lincoln National Life, in Fort Wayne, Ind., said it had approved policies for men on PrEP and had offered some lower rates reserved for low-risk clients. A spokesman was unsure when the company began doing so.

    A spokeswoman for Principal National Life in Des Moines said the company “doesn’t decline individuals just because they’re taking Truvada” and did not quiz applicants about their sexual history. She declined to answer further questions.

    A spokeswoman for Protective Life Insurance of Birmingham, Ala., said it “did not deny coverage based solely on Truvada use,” and might even offer a low-risk rate to someone taking the drug. She, too, declined to answer further questions.

    Mr. Klein said he had sometimes heard similar answers from insurers even as men are denied coverage.

    “I am fairly certain that this is just slippery language, and that they are excluding applicants when they see a diagnosis of ‘high risk sexual behavior’ or ‘exposure to H.I.V.’ in an applicant’s medical record.”

    Those descriptions are linked to diagnostic codes that doctors use for reimbursement from health insurers when a patient asks for a prescription for Truvada. “That’s no different from excluding based on PrEP usage alone,” Mr. Klein argued.

    Aaron E. Baldwin, a financial planner in San Francisco who specializes in clients living with H.I.V., said he had been seeing such denials for three years.

    Some clients denied coverage, he said, were young executives with large student debts who wanted insurance so that should anything happen to them, their parents would not be saddled with payments.

    In his experience, Mr. Baldwin said, companies in Midwestern and Southern states were reluctant to insure men taking Truvada, while Prudential, for example, insured even men with H.I.V. as long as they could show they took their medications every day.

    In his case, Dr. Cheng said, a broker told him that the insurer claimed to be unsure about Truvada’s side effects. But the drug was approved by the Food and Drug Administration in 2004, and a study published in 2016 concluded that it was safer for long-term use than aspirin, which can cause gastrointestinal bleeding.

    Dr. Cheng is now in a long-term relationship with an H.I.V.-negative man, and so he no longer takes Truvada. But the sting of his insurance denial lingers.

    “It was blatant discrimination,” he said.

    Correction: February 12, 2018

    An earlier version of this article misstated the name of a company that provides insurance to men with H.I.V. It was Prudential, not New York Life.

     

    Courtesy:  The New York Times

    Mathilde Krim, Mobilizing Force in an AIDS Crusade, Dies at 91

    Mathilde Krim, who crusaded against the scourge of AIDS with appeals to conscience that raised funds and international awareness of a disease that has killed more than 39 million people worldwide, died on Monday at her home in Kings Point, N.Y. She was 91.

    Her death was confirmed by Bennah Serfaty, a spokeswoman for amfAR, the Foundation for AIDS Research, of which Dr. Krim was the founding chairwoman.

    When the nation learned in the early 1980s that the virus that causes AIDS had begun its terrifying attack upon the human immune system, Dr. Krim, a geneticist and virologist with wide experience in cancer research and a passion for causes, plunged into a fight not only against the virus but also for the civil rights of people who had it.

    Over the next several decades, she became America’s foremost warrior in the battle against superstitions, fears and prejudices that have stigmatized many people with AIDS, subjecting them to rejection and discrimination. There is still no cure for acquired immune deficiency syndrome, which has become pandemic, although antiretroviral medication can slow the disease and may lead to near-normal life expectancy with prompt diagnosis and treatment.

    In 2016, there were more than 36.7 million people, worldwide, infected with the human immunodeficiency virus, or H.I.V., which causes AIDS. That was 300,000 fewer than in 2015, but the cases nevertheless resulted in one million deaths, down from a peak of 1.9 million in 2005.

    The virus that causes AIDS is spread by many vectors: through sex, needle-sharing among drug users and accidental needle sticks among medical personnel, as well as through blood transfusions and from mother to infant during pregnancy or breast feeding.

    In Africa, where the disease originated and where it is most widespread, most transmission is through heterosexual sex.

    In the early days of the American epidemic, AIDS killed large numbers of hemophiliacs, infected by tainted blood-clotting factors, and Haitians, because the virus had apparently reached the Americas there first.

    But the American public focused on two other high-risk groups, gay men and drug addicts, people long shunned by family-oriented Americans and the mostly heterosexual establishment.

    “They felt that this was a disease that resulted from a sleazy lifestyle, drugs or kinky sex — that certain people had learned their lesson and it served them right,” Dr. Krim told The New York Times Magazine in 1988. “That was the attitude, even on the part of respectable foundations that are supposed to be concerned about human welfare.”

    In his book “The Gay Metropolis: The Landmark History of Gay Life in America” (1997), Charles Kaiser wrote: “One scientist outside the government was more important than any other heterosexual in New York City in sounding the alarm about the growing crisis. Her name was Mathilde Krim.”

    Dr. Krim in 1992 with Dr. Mervyn F. Silverman, then the president of amfAR, the AIDS research organization of which she was the founding chairwoman. Credit Don Hogan Charles/The New York Times

    Money for research and literature to educate the public were needed, and Dr. Krim had access to both. Her husband was the entertainment lawyer Arthur B. Krim, a former chairman of United Artists and Orion Pictures and of the Democratic National Finance Committee. He was a confidant of many national leaders, including Presidents John F. Kennedy, Lyndon B. Johnson and Jimmy Carter.

    Dr. Krim mobilized a galaxy of friends from the worlds of politics, the arts, entertainment, society and Wall Street. She organized art sales, auctions, fashion shows and other fund-raisers, held benefit parties at her Manhattan townhouse, gave television interviews, lobbied government officials and testified before Congress.

    And she dazzled them with her scientific knowledge, grounded in her doctoral studies at the University of Geneva, and her dignified appeals to conscience, in many languages. The daughter of parents of Swiss, Italian and Austrian heritage and a convert to Judaism who had joined the Zionist underground, Dr. Krim spoke Italian, German, French and Hebrew as well as English.

    In 1983, she and others created the AIDS Medical Foundation to raise money and support AIDS research. It often acted faster than federal agencies, which could take a year to process grants. In 1985, her group and another in Los Angeles merged to form the American Foundation for AIDS Research, or amfAR. Elizabeth Taylor was its founding international chairwoman, and Barbra Streisand, Woody Allen and Warren Beatty lent their names.

    The foundation became the nation’s pre-eminent private supporter of AIDS research, prevention, treatment and advocacy. In 2005, when Dr. Krim stepped down as founding chairwoman, it was renamed the Foundation for AIDS Research, or amfAR, reflecting its international scope. The foundation has raised and invested an estimated $517 million for thousands of programs.

    Using the foundation as her platform, Dr. Krim promoted needle-exchange programs and the use of condoms and other safe-sex practices; castigated religious leaders who denounced homosexuality as immoral; fought mandatory AIDS testing that might be used to persecute gay people; opposed the use of placebos in experimental drug trials, saying patients might be dead before outcomes were proved; and campaigned for laws to bar discrimination against gay people in housing and employment.

    Her effectiveness derived partly from her credentials. Besides earning her doctorate in biology, she had served on White House commissions and conducted research at the Weizmann Institute of Science in Israel and at the Cornell Medical College and Sloan Kettering Cancer Center in New York.

    But it also arose from a moral perspective that could supersede science. She argued, for example, that heterosexuals and homosexuals were all one big risk group. American epidemiologists did not concur at the time, because so many victims were gay, but she was partly right: Although gay sex now accounts for most transmission in the United States, about 24 percent is through heterosexual sex, and women bear the brunt of that, often through sex with partners who conceal the fact that they are bisexual or injecting drugs.

    Dr. Krim sometimes waded into deep political waters. In 1990, Mayor David N. Dinkins of New York asked her advice on naming a city health commissioner. She recommended Indiana’s commissioner, Dr. Woodrow A. Myers Jr.

    But gay groups objected when they learned that Indiana, by law, recorded the names of people with AIDS and could even quarantine those who knowingly had unprotected sex. Although recording the names of carriers and tracing their contacts is standard practice in fighting venereal diseases, and though quarantine has been used to control outbreaks of, for example, drug-resistant tuberculosis, the advocates felt such measures would be stigmatizing.

    Dr. Krim and others on a search committee first stepped back for a reassessment, then re-endorsed Dr. Myers, then withdrew the endorsement. Dr. Myers was appointed anyway, and Dr. Krim found herself at odds with longtime allies. But her admirers tempered their ire with respect.

    Dr. Krim, left, with Elizabeth Taylor, amfAR’s founding international chairwoman, and Dr. Silverman in Oviedo, Spain, in 1992. Credit Denis Doyle/Associated Press

    “I think she’s exceptionally naïve politically,” said the playwright Larry Kramer, a prominent advocate for people with AIDS. “We are all very angry with her, so far as one can ever get angry with Mathilde, because we love her so.”

    She was born Mathilde Galland in Como, Italy, on July 9, 1926, to Eugene Galland, a Swiss-Italian, and the former Elizabeth Krause, an Austrian. Her father was an agronomist. The family moved to Geneva when Mathilde was 6.

    At the University of Geneva, Mathilde was a brilliant student of biology and genetics. Appalled by newsreels of Nazi concentration camps in 1945, she sought out Jewish activists, joined the Zionist underground Irgun and spent a summer smuggling guns over the French border for resistance fighters against British rule in Palestine.

    After earning a bachelor’s degree in 1948, she married an Irgun comrade, David Danon, a Bulgarian medical student, and converted to Judaism. The couple had a daughter, Daphna, in 1951, and in 1953, after Mathilde received her doctorate, they emigrated to Israel, where the marriage ended in divorce.

    In 1954, she joined the research team of the German-born Israeli molecular biologist Leo Sachs at the Weizmann Institute of Science in Rehovot. She studied cancer-causing viruses and helped write a dozen papers, including one by Dr. Sachs that laid groundwork for the prenatal diagnostic technique of amniocentesis, detecting gender and possible defects in a fetus.

    She married Mr. Krim, a Weizmann trustee, in 1958 and moved to New York the next year, exchanging pioneer life in a perpetual war zone for the Upper East Side and an illustrious social milieu.

    Restless for challenges, Dr. Krim resumed research — at Cornell Medical College from 1959 to 1962 and at Sloan Kettering from 1962 to 1985. She thought she glimpsed a cure for cancer in interferons — proteins released by body cells to fight pathogens — but it was not the cure-all she had envisioned. She was later an adjunct professor at Columbia University.

    Dr. Krim is survived by her daughter, Daphna Krim; two grandchildren; and a sister, Maria Jonzier. Arthur Krim died in 1994.

    Dr. Krim’s many awards included the Presidential Medal of Freedom, the nation’s highest civilian honor. Awarded by President Bill Clinton in 2000, it recognized her “extraordinary compassion and commitment.”

    In his book “The Gay Metropolis,” Mr. Kaiser wrote that Dr. Krim had been disturbed by the initial indifference to the AIDS crisis in the 1980s in part because it carried echoes of her past.

    “The reaction of many of her heterosexual friends,” he wrote, “reminded her of the stories she had heard about Jews during the war, before she knew any herself, that they were dirty and evil and deserved to die.

    “Dr. Krim was determined to prevent America from using AIDS to stigmatize homosexuals,” he continued, “and with the help of many of her famous Hollywood friends, she would be magnificently successful.”

     

    Courtesy: The New York Times

    World AIDS Day 2017 Open House

    Please join us for an open house to commemorate people whose lives have been affected by HIV/AIDS. We will be screening "Etched from Granite: Digital Stories of HIV in New Hampshire."

    Friday, December 1 from 2-4 pm                                                                                                                                            2 Blacksmith Street in Lebanon (just behind Steve's Pet Shoppe)                                                                                    Snacks will be served!                                                                                                                                                        For more information, call (603) 448-8887

     

     

    Losing a Father and Husband to AIDS, and Finding Him Again

    My second child was born two days after Father’s Day in 1990. Three weeks later, my husband collapsed, disoriented and feverish, in a restaurant. Soon, he was lying in a hospital bed with full-blown AIDS.

    It’s hard for people who weren’t around then to imagine what AIDS used to look like. It was an epidemic that turned young men old; murdered beauty and promise. You knew someone at work who wouldn’t feel well, you wouldn’t see him for a few days, you would never see him again.

    AIDS made men ghosts.

    Before he got sick, John was an attentive lover to me, a doting dad to our 2-year-old, a gracious son-in-law to my aging parents and a successful journalist. He was home for dinner every night like clockwork. He was someone it was hard to believe could get AIDS.

    In the months before our son was born, John had been experiencing a string of nagging illnesses, including intestinal distress and a persistent cough. The many doctors he consulted, because he was “straight,” married and overworked, did not even consider AIDS. They diagnosed stress.

    After John’s AIDS diagnosis, I was rushed in for my own test. It remains the scariest thing I’ve ever done. Back then, it could mean a death sentence.

    I asked him how he happened to contract a disease largely transmitted through gay sex. He told me he’d slept with men, which, at the time, surprised me. It was the beginning of a world falling apart.

    My AIDS test came back negative: The kids and I had been spared. But nine months later, John died, leaving me asking, “What just happened?”

    He left me crying out for him in the night. He left me with many painfully unresolved feelings and unanswered questions. John also left me with two small children, and I was determined to raise them free from the stigma of AIDS.

    I resolved that I had to keep how he died a secret. No one could know. We never talked about him. I stashed away all his pictures. When the kids were old enough, I shared the truth with them, and emphasized why they couldn’t talk about it — or their father.

    I then determined to give us a picture perfect life, in a suburban Connecticut house with a white picket fence, and a really nice man, a former altar boy and Eagle Scout, no less, filling John’s Italian loafers. I worked in children’s publishing and brought home cute books. We had a rescue dog!

    Life was good, and I was proud of how I’d restored us.

    What I wasn’t proud of, though, was continuing to keep John a secret. I wanted my kids to know about their father, who had once been a great guy — before AIDS. I wanted to Photoshop John into our family picture, undiseased.

    For a while I found a way to do this by taking them to New Hampshire every summer, to visit John’s grave in a sunny corner of a maple-shaded family plot. It was hushed, peaceful and green. They’d stand at shy attention at his footstone, their sneakered feet pressed tightly together, their chubby hands offering up tired-looking daisies. Sometimes they’d sing camp songs, and leave behind dream catchers.

    Beneath the dignity of his tombstone, desexed, sanitized and dead, John could be a father my kids could really respect. He could even be a husband I could like again.

    But by the time they hit middle school, my kids didn’t want to go to New Hampshire anymore. They didn’t seem to want to do anything connected to their late father.

    They left for college at about the same time I lost both my job and my elderly parents. My relationship with my boyfriend also flattened; we’d been wonderful caretakers together, now what? I began to feel compelled to thaw those unresolved feelings I’d put on ice in 1990.

    No more Photoshop. No more family tableaux. No more sanitizing cemeteries. Just me, John and AIDS.

    I read his love letters. I looked at pictures from when we were young, beautiful and smitten. I began to practice saying, “My husband died of AIDS.” I began to write.

    And I began to stop caring if my kids ever felt anything at all for their late father they barely knew. I realized you can’t manufacture such things.

    Then, in 2009, my daughter graduated from John’s alma mater, Brown University, where the alumni participate in the processional. After the ceremony was over, my daughter surprised me by asking, “Mom, didn’t you think today was sad? I looked at the Class of ’76 and thought, where’s Dad? Why isn’t he here?”

    Three years later, after receiving his diploma from Claremont McKenna College, my son said, his eyes glistening, “Mom, you know who I thought about during the whole ceremony? My father.”

    Relieving John of his ghostly status after he died of AIDS has been a long and, at times, painful process. Some family members and friends have viewed my talking and writing about John truthfully as a form of “outing.” “Why now, after so long?” they ask. Can’t I just get over it? Mostly heterosexual and married, virtually none had walked in my — or his — shoes. They failed to grasp the weight of John’s closeted lifestyle, and how crippling it was, first for him, and then for me, to keep it closeted.

    They failed to grasp how powerful and indelible was the stain of his disease.

    This reaction, for me, has been painful, causing me many nights of fitful sleep. Was I doing the right thing, telling John’s truth — now mine?

    I now know that telling our story honestly was the right thing to do. To relieve John of ghostly status has been liberating. For so long I’d thought I was just among a handful of women who’d lost their husband to AIDS; but during AIDS Walks, I have marched alongside thousands of women who have lost a husband to this “gay man’s disease.” We have stories we can finally tell.

    Recently my kids and I went to a revival of the musical “Falsettos,” which deals with familiar issues: a gay husband and father, a man lost to AIDS, a wife calling into the night.

    My children and I went to dinner and talked afterward, about their father, and about how hard it’s been, for so long, to not talk about him, to deny his existence. In telling our story honestly, we have brought John back in three-dimensional, human terms. He happened, we happened, it happened.

    On Father’s Day 2017, John is no longer a ghost.

    Maggie Kneip is the author of the memoir “Now Everyone Will Know: The Perfect Husband, His Shattering Secret, My Rediscovered Life.”

    Wine Tasting Event to Benefit the HIV/HCV Resource Center

    Wine tasting event to benefit the HIV/HCV Resource Center

    Wednesday, May 17 from 5-7 at the Norwich Inn

     

    Dan and Whits and the Norwich Inn team up together to offer monthly wine tastings that support local non-profits. We will receive a percentage of the proceeds from both ticket and wine sales from the the May 17 wine tasting.

     

    The Norwich Inn will offer cheese platters, and several local vendors will also bring food to sample. There will be five or six reds and whites to try.  Advance tickets ($15) are available at the HIV/HCV Resource Center. Please contact Ryan (Ryan@H2RC/ 603 448 8887) for more details. We hope to see you there!

     

    One in 10 children has 'Aids defence'

     

     

    _91380739_c0276065-hiv_illustration-spl.jpg

    By James Gallagher Health and science reporter, BBC News website

    A tenth of children have a "monkey-like" immune system that stops them developing Aids, a study suggests.

    The study, in Science Translational Medicine, found the children's immune systems were "keeping calm", which prevented them being wiped out.

    An untreated HIV infection will kill 60% of children within two and a half years, but the equivalent infection in monkeys is not fatal.

    The findings could lead to new immune-based therapies for HIV infection.

    The virus eventually wipes out the immune system, leaving the body vulnerable to other infections, what is known as acquired human immunodeficiency syndrome (Aids).

    The researchers analysed the blood of 170 children from South Africa who had HIV, had never had antiretroviral therapy and yet had not developed Aids.

    Tests showed they had tens of thousands of human immunodeficiency viruses in every millilitre of their blood.

    This would normally send their immune system into overdrive, trying to fight the infection, or simply make them seriously ill, but neither had happened.

    Keep calm and carry on

    Prof Philip Goulder, one of the researchers from the University of Oxford, told the BBC: "Essentially, their immune system is ignoring the virus as far as possible.

    "Waging war against the virus is in most cases the wrong thing to do."

    Counter-intuitively, not attacking the virus seems to save the immune system.

    HIV kills white blood cells - the warriors of the immune system.

    And when the body's defences go into overdrive, even more of them can be killed by chronic levels of inflammation.

    Prof Goulder said: "One of the things that comes out of this study is that HIV disease is not so much to do with HIV, but with the immune response to it."

    For scientists, the way the 10% of children cope with the virus has striking similarities to the way more than 40 non-human primate species cope with simian immunodeficiency virus or SIV.

    They have had hundreds of thousands of years to evolve ways to tackle the infection.

    "Natural selection has worked in these cases, and the mechanism is very similar to the one in these kids that don't progress," Prof Goulder said.

    War or peace?

    This defence against Aids is almost unique to children.

    Adult humans' immune systems tend to go all-out to finish off the virus in a campaign that nearly always ends in failure.

    Children have a relatively tolerant immune system, which becomes more aggressive in adulthood - chickenpox, for example, is far more severe in adults due to the way the immune system reacts.

    But this does mean that as the protected children age and their immune system matures, there is a risk of them developing Aids.

    Some do, some remain Aids-free.

    Dr Ann Chahroudi and Dr Guido Silvestri, from Emory University in the US, said the study may have found the "very earliest signs of coevolution of HIV in humans".

    In a commentary, they added: "It is not known whether it would be clinically safe for these newly identified HIV infected paediatric non-progressors to remain off-therapy.

    "This assessment is further complicated by the fact that prevention of HIV transmission to sexual partners becomes relevant in adolescence."

    People with HIV can have normal life-expectancy if they have access to antiretroviral drugs.

    But their super-heated immune system never returns to normal, and they face greater risks of cardiovascular disease, cancer and dementia.

    Prof Goulder believes these findings in children could ultimately help rebalance the immune system in all HIV patients.

    He told the BBC: "We may be identifying an entirely new pathway by studying kids that in the longer term could be translated to new treatments for all HIV infected people."

    Follow James on Twitter.

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    Prince Harry Gets Tested for HIV

    Prince Harry Gets Tested for HIV

    Prince Harry's recent posting of his HIV test live on Facebook lead to an upsurge of testing in England. 

    Let's keep up the momentum here; if we all get tested, we will all know our status.                                                         Call for an appointment today! (603) 448-8887

     

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    The World Could End AIDS if It Tried

    NY Times Editorial; June 13, 2016

    The world has made so much progress in reducing the spread of AIDS and treating people with H.I.V. that the epidemic has receded from the public spotlight. Yet by any measure the disease remains a major threat — 1.1 million people  from AIDS-related causes, and 2.1 million people were infected with the virus. And while deaths are down over the last five years, the number of new infections has essentially reached a plateau.

    The United Nations announced a goal last week of ending the spread of the disease by 2030. That’s a laudable and ambitious goal, reachable only if individual nations vigorously campaign to treat everyone who has the virus and to limit new infections.

    The medicines and know-how are there, but in many countries the money and political will are not. Besides shining a spotlight on the disease, it’s crucial that wealthy nations like the United States continue to pony up generously to underwrite what must be a global effort. Donors and low- and middle-income countries need to increase spending to $26 billion a year by 2020, the United Nations says, up from nearly $19.2 billion in 2014.

    While still high, deaths attributable to AIDS are down 36 percent from 2010. That is largely because many more people are receiving antiretroviral drugs — 17 million people in 2015, compared with 7.5 million five years earlier. These medicines allow people to live near-normal lives and greatly reduce the risk of transmission to others.

    But while some countries like South Africa (once a disaster zone) and Kenya have made tremendous progress in increasing treatment, many people who need the lifesaving therapy do not have access to it. Only 28 percent of those infected in Western and Central Africa were being treated in 2015, according to a recent United Nations report. The numbers were even lower in the Middle East and North Africa (17 percent) and Eastern Europe and Central Asia (21 percent). In some countries, people who test positive are told to come back when they get sick because of budget constraints, says Sharonann Lynch, an H.I.V. policy adviser at Doctors Without Borders. Many never return.

    In other places, it can be hard to even reach people who need drugs because of war or the lack of a functional public health system. And many who need help are unwilling to come forward because they fear being ostracized or worse because they are gay, use drugs or are engaged in sex work. Discriminatory laws and attitudes in countries like Nigeria, Russia and Uganda have probably forced tens of thousands of people who need help into hiding.

    In some countries, infections have actually increased, which helps explain why progress has plateaued over all. In Eastern Europe and Central Asia, for instance, 190,000 people became infected last year, up from 120,000 in 2010. And while the number of deaths is way down, the number of new infections was flat or down modestly over the same five-year period. This was also true of the United States, where an estimated 44,073 people were diagnosed in 2014, the most recent year for which the Centers for Disease Control and Prevention have published data, down from 44,940 in 2010.

    These numbers do not argue for complacency, but instead for more vigorous public health campaigns, increased access to condoms, clean needles for drug users and prescriptions for pre-exposure drugs. There is still no cure for AIDS. But there are many ways to minimize its deadly consequences.

     

    "Out and Safe" at the Main Street Museum

    Please join us Tuesday, April 12th @ 6:30 pm for “Out&Safe”, a workshop all about keeping safe in conflicts of all kinds. In this forum centered around presentations by Grace Alden and Hilary Mullins, we will be discussing approaches to deescalation and non-defensive communication, as part of TRANSpossibilities, the Main Street Museum’s ongoing educational, outreach, and advocacy series.

    https://www.facebook.com/mainstreetmuseum/photos/gm.189598248086155/977438712345043/?type=3

     



    Syringe Exchange NHPR Interview

    HIV/HCV Resource Center Executive Director Laura Byrne, NH Rep. Joe Hannon, Greenland Police Chief Tara Laurent and others discuss Syringe Exchange on NHPR's "The Exchange." 

    http://nhpr.org/programs/exchange

    March 22,2016                                      9:00am-10:00am