Stigma Against Gay People Can Be Deadly

Published by the New York Times on October 9, 2018

L.G.B.T. people experience a range of social, economic and medical disparities that jeopardize their long-term health.

I’ve never been sure what to expect when meeting someone who’s just tried to take his own life. But I’ve learned to stop expecting anything.

Sometimes, the person in front of me barely speaks, staring right through me, lost in a deep catatonic depression. Sometimes he or she can’t stop talking, breathlessly describing what happened as if we’re gossiping at brunch after an hour of SoulCycle.

Yesterday, my patient, a 20-something graduate student, swallowed a jumble of unmarked pills, hoping to die, after his father told him never to come home again. Today, he greeted me with a soft smile, his delirium starting to clear, his heart beating normally again.

“Whoops,” he said.

He’d been a happy kid who aimed to please. He once felt so bad for lying about having done his homework before playing video games, he told me, that he’d grounded himself.

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Eamonn Vitt
H.I.V. Drugs Cost $75 in Africa, $39,000 in the U.S. Does It Matter?

Published by the New York Times September 18, 2018

By Tina Rosenberg

In the United States, pharmaceutical companies have built a system which supports high costs for H.I.V. drugs. But that may be starting to change.
First of two articles

A new gold-standard triple therapy for H.I.V. has just made its debut in Africa. It costs $75 a year. In the United States, many people with H.I.V. take an almost identical therapy. It costs $39,000 a year.

The United States is infamous for its high cost of health care — and H.I.V. medicines are a big part of that. Plenty of drugs carry outrageous prices: EpiPens, insulin, cancer treatments, even some antibiotics. But no class of medicines is more scandalously expensive than for H.I.V. These medicines are by far the largest item in Medicaid’s drug budget, the third largest for the insurance exchanges and the fifth largest for commercial insurers.

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

Published by the New York Times January 16, 2018

By Robert D. McFadden

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.

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Eamonn Vitt
‘Brilliant,’ 41 and Lost to AIDS: The Theater World Asks Why

Published by the New York Times October 11, 2017

By Michael Paulson

The death of Michael Friedman, a much-admired composer and lyricist, has left friends and fellow artists asking if they could have done more to help him amid signs of trouble.

--

Michael Friedman couldn’t make it to Minneapolis this summer. Rehearsals were beginning there for his new musical, but he was homebound in Brooklyn, trying to regain strength after a series of H.I.V.-related infections had landed him in the hospital.

So Mr. Friedman, a hyperkinetic and much-admired young songwriter with two theater jobs and a head full of projects, improvised: He would sing the score by phone to the show’s music director, who would then teach the songs to actors portraying high school hockey players and their overeager parents.

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Eamonn Vitt
My Struggle to Take Anti-H.I.V. Medicine

Published by the New York Times September 21, 2017

By Daryl Hannah

I am a 30-something African-American gay man in New York. H.I.V. is constantly on my mind. Not so much my H.I.V.-negative status. Rather, even though I watched my parents die of AIDS when I was young, I still struggle with whether I should take the drug Truvada, a pre-exposure prophylaxis (PrEP) that can protect almost completely against H.I.V.

My father was convicted of manslaughter and sent to prison in 1989, where he contracted H.I.V. No one in my family is exactly sure how. In 1991, six months after he returned home, he died. Less than two years later, my mother also died. I was only 7.

I don’t remember my parents in any great detail, but I do remember that people in our rural South Carolina community ostracized my sister and me once they learned our parents were H.I.V. positive. One parent even transferred her daughter out of my second-grade class.

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Eamonn Vitt
A Dangerous, ‘Silent Reservoir’ for Gonorrhea: The Throat

Published by the New York Times on July 31st, 2017

By Aneri Pattani

The human throat houses billions of bacteria, most of them harmless. But one species is becoming more common, and it is anything but benign.

Drug-resistant gonorrhea has been on the rise for years; the World Health Organization has reported an increase in more than 50 countries. Now scientists say the epidemic is being driven by a particular mode of transmission: oral sex.

“The throat infections act as a silent reservoir,” said Emilie Alirol, the head of the sexually transmitted infections program at the Global Antibiotics Research and Development Partnership. “Transmission is very efficient from someone who has gonorrhea in their throat to their partner via oral sex.”

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Eamonn Vitt
Antibiotic-resistant gonorrhoea on the rise, new drugs needed

Published July 7, 2017 by the World Health Organization

Data from 77 countries show that antibiotic resistance is making gonorrhoea – a common sexually-transmitted infection – much harder, and sometimes impossible, to treat.

"The bacteria that cause gonorrhoea are particularly smart. Every time we use a new class of antibiotics to treat the infection, the bacteria evolve to resist them," said Dr Teodora Wi, Medical Officer, Human Reproduction, at WHO.

WHO reports widespread resistance to older and cheaper antibiotics. Some countries – particularly high-income ones, where surveillance is best – are finding cases of the infection that are untreatable by all known antibiotics.

"These cases may just be the tip of the iceberg, since systems to diagnose and report untreatable infections are lacking in lower-income countries where gonorrhoea is actually more common," adds Dr Wi.

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Eamonn Vitt
FDA Approves Generic Truvada for HIV Treatment and PrEP

Published by Poz June 9, 2017

By Benjamin Ryan

In a move that has taken HIV advocates by surprise and stewed considerable confusion, the U.S. Food and Drug Administration (FDA) has approved a generic formulation of Gilead Sciences’ blockbuster antiretroviral (ARV) Truvada (tenofovir disoproxil fumarate/emtricitabine). This decision could have major implications for the future cost of Truvada, to insurers and consumers alike.

However, Gilead insisted in a statement, “A generic version of Truvada will not be immediately available. It’s important to note that there are a number of factors involved in commercialization that are not tied directly to FDA approval.”

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Eamonn Vitt
America’s Hidden H.I.V. Epidemic

Published by the New York Times June 6, 2016 

By Linda Villarosa

Why do America’s black gay and bisexual men have
a higher H.I.V. rate than any country in the world?

Early on a balmy morning last October, Cedric Sturdevant began his rounds along the bumpy streets and back roads of Jackson, Miss. Sturdevant, 52, has racked up nearly 300,000 miles driving in loops and widening circles around Jackson in his improvised role of visiting nurse, motivational coach and father figure to a growing number of young gay men and transgender women suffering from H.I.V. and AIDS. Sturdevant is a project coordinator at My Brother’s Keeper, a local social-services nonprofit. If he doesn’t make these rounds, he has learned, many of these patients will not get to the doctor’s appointments, pharmacies, food banks and counseling sessions that can make the difference between life and death.

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Eamonn Vitt
In Vivo Excision of HIV-1 Provirus by saCas9 and Multiplex Single-Guide RNAs in Animal Models

Published by Science Direct on May 3rd, 2017

By Chaoran Yin, Ting Zhang, Xiying Qu, Yonggang Zhang, Raj Putatunda, Xiao Xiao, Fang Li, Weidong Xiao, Huaging Zhao, Shen Dai, Xuebin Qin, Xianming Mo, Won-Bin Young, Kamel Khalili, Wenhui Hu

CRISPR-associated protein 9 (Cas9)-mediated genome editing provides a promising cure for HIV-1/AIDS; however, gene delivery efficiency in vivo remains an obstacle to overcome. Here, we demonstrate the feasibility and efficiency of excising the HIV-1 provirus in three different animal models using an all-in-one adeno-associated virus (AAV) vector to deliver multiplex single-guide RNAs (sgRNAs) plus Staphylococcus aureus Cas9 (saCas9). 

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Eamonn Vitt
HIV Activist Peter Staley Talks PrEP

What if PrEP has long-term health effects that we’ve yet to discover? Or if it leads to a significant decrease in condom use and an increase in STI transmissions? If we let our guards down, couldn’t another virus come along that’s just as devastating as HIV? Is PrEP just setting us up for history to repeat itself? 

“If you have those kinds of fears, you shouldn’t be riding in cars,” says veteran HIV and gay rights activist Peter Staley, from his home in New York. “You should be very scared about the next swine flu virus and be taking precautions right now. It doesn’t make a whole lot of sense to live a life of fear based on a future unknown.”

Then why are there people doing just that? In the United States an estimated 44,073 people were diagnosed with HIV in 2014. At-risk populations show a moderate level of adherence to PrEP, according to one study, but we nevertheless had a tool that could have protected most of these people with 99 percent effectiveness. Yet we saw some of the leading voices in HIV and AIDS advocacy peddling such fears rather trying to reduce the diagnosis numbers. 

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Eamonn Vitt
Outbreak of Serogroup C Meningococcal Disease Primarily Affecting Men Who Have Sex with Men — Southern California, 2016

Published by the CDC September 2, 2016

Srinivas Nanduri, MD; Chelsea Foo, MPH; Van Ngo, MPH; Claire Jarashow, PhD; Rachel Civen, MD; Ben Schwartz, MD; John Holguin, MPH; Eric Shearer, MPH; Matt Zahn, MD; Kathleen Harriman, PhD; Kathleen Winter, PhD; Cecilia Kretz, PhD; How Yi Chang, PhD; Sarah Meyer, MD; Jessica MacNeil, MPH (View author affiliations)

During March 4–August 11, 2016, 25 outbreak-associated cases of meningococcal disease, including two deaths (8% case-fatality ratio), were reported in Southern California. Twenty-four of the cases were caused by serogroup C Neisseria meningitidis (NmC) and one by N. meningitidis with an undetermined serogroup (Figure). On June 24, 2016, in response to this increase in NmC cases, primarily among men who have sex with men (MSM) in Los Angeles County, the city of Long Beach, and Orange County, the California Department of Public Health (CDPH) issued a press release and health advisory, declaring an outbreak of NmC in Southern California (1).

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Eamonn Vitt
Oral Sex and HIV Risk: CDC Updated Fact Sheet 5/23/16

Published by Center For Disease Control

May 23, 2016

Oral Sex and HIV Risk May 2016 Fast Facts 

• There is little to no risk of getting or transmitting HIV from oral sex. • Other STDs and hepatitis can be transmitted during oral sex. 

• Latex barriers and medicines to prevent and treat HIV can further reduce the very low risk of getting HIV from oral sex.

Oral sex involves using the mouth to stimulate the penis (fellatio), vagina (cunnilingus), or anus (anilingus).

Risk of HIV

The chance an HIV-negative person will get HIV from oral sex with an HIV-positive partner is extremely low. However, it is hard to know the exact risk because a lot of people who have oral sex also have anal or vaginal sex. The type of oral sex that may be the riskiest is mouth-to-penis oral sex. But the risk is still very low, and much lower than with anal or vaginal sex. Though the risk of HIV transmission through oral sex is low, several factors may increase that risk, including sores in the mouth or vagina or on the penis, bleeding gums, oral contact with menstrual blood, and the presence of other sexually transmitted diseases (STDs). 

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Eamonn Vitt
Half of Gay Black Men Are Projected to Get HIV

Published by Bloomberg Business, February 23, 2016

By John Tozzi

If you’re a white American woman, your risk of being diagnosed with HIV is pretty small, lower than the odds of dying in a car crash. If you’re a gay black man, the chances of getting an HIV diagnosis are closer to a coin flip.

About 43 percent of black men who have sex with men will be diagnosed with HIV in their lifetimes if the epidemic’s current trends hold, according to research being presented on Tuesday by the Centers for Disease Control. For Hispanic men who have sex with men, the rate is 22 percent. For white men who have sex with men, it’s about 10 percent.

The latest report is a staggering reminder that gay men of color bear the brunt of the HIV crisis. That fact has been evident for years in the data on HIV, but it has often gone unmentioned as public health campaigns focus on broad-based prevention strategies.

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Eamonn Vitt
HIV PrEP drug Truvada as safe as aspirin, study finds

Published by United Press International, January 20, 2016

By Stephen Feller

LOS ANGELES, Jan. 20 (UPI) -- Pre-exposure prophylaxis, or PrEP, a drug taken daily to prevent HIV, was shown in a new study to be as safe for users as taking aspirin.

PrEP is a combination of the drugs emtricitabine and tenofovir, marketed as the drug Truvada, that can be taken by HIV-negative people at risk for contracting the virus.

Studies since at least 2011 have shown the efficacy of the drug at stopping the spread of HIV, and none of the people at high risk for HIV using PrEP in a 2.5-year study in San Francisco contracted the virus.

The lack of significant side effects, which were shown in the new study to be comparable to those of taking aspirin every day, may help the Centers for Disease Control and Prevention raise awareness and use of PrEP.

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Eamonn Vitt
San Francisco Is Changing Face of AIDS Treatment

Published by the New York Times

By DONALD G. McNEIL Jr. OCT. 5, 2015

SAN FRANCISCO — It wasn’t his first broken condom, so Rafael didn’t worry. But three weeks later, the man he’d met in a bar called to say that he had “probably been exposed” to H.I.V.

Rafael, a muscular, affable 43-year-old, went to a clinic and within 45 minutes learned he was infected. Although it was already closing time, a counselor saw him immediately and offered him a doctor’s appointment the next day.

At Ward 86, the famous H.I.V. unit at San Francisco General Hospital, the doctor handed him pills for five days and a prescription for more. Because he was between jobs, she introduced him to a counselor who helped him file for public health insurance covering his $30,000-a-year treatment.

“They were very reassuring and very helpful,” said Rafael, who, like several other men interviewed for this article, spoke on condition that only his first name be used to protect his privacy. “They gave me the beautiful opportunity to just concentrate on my health.”

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Eamonn Vitt
Insurer Says Clients on Daily Pill Have Stayed H.I.V.-Free

Published by the New York Times September 2, 2015

By DONALD G. McNEIL Jr.

Demonstrating that taking a daily pill to prevent H.I.V. infection can work in the real world, San Francisco’s largest private health insurer announced Wednesday that not one of its 657 clients receiving the drug had become infected over a period of more than two years.

That outcome contradicted some critics’ predictions that so-called pre- exposure prophylaxis, or PrEP, would lead to less condom use and more H.I.V. infections.

A study published in Clinical Infectious Diseases found that the San Franciscans on PrEP, almost all of whom were gay men, did use fewer condoms — and contracted several other venereal diseases as a result. But none got H.I.V. 

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Eamonn Vitt