The lives behind the diagnosis

Here is a bit of interesting information from the world of HIV and drug / alcohol use.

From October 2007 through to April 2010, researchers conducted a cross-sectional analysis of participants looking at HIV’s Evolution in Russia; called Mitigating Infection Transmission and Alcoholism in a Growing Epidemic (HERMITAGE), the study was based in St. Petersburg, Russia.

They managed to recruit 700  HIV positive people, who were also identified as  ‘risky drinkers’. This seems to have meant that the participants did not mind regularly having unprotected sex and indeed all had reported unprotected sex within the previous 6 months. Data were collected through interviews and self-administered questionnaires. This analysis included 605 of the participants enrolled on the HERMITAGE study.

in_bed2gether

To tell or not to tell? Is that the only question?

It was, I thought rather disturbing to note that more than half of the participants reported not disclosing their HIV serostatus to their sexual partners. The participants reported a total of 958 sex partners, and ‘48.9% of these actual partners were not informed of the participant’s HIV status’.

However the researchers felt that society could not lay the blame at the feet of alcohol, or alcoholics or even a drunk person. The idea that a drunk person is less likely than a non drinker to tell their sexual partner that they were actually HIV positive is in fact as the data showed,  completely wrong.  The researchers found no association between alcohol dependence, risky alcohol use in the past 30 days or drinking at the time of sex – with nondisclosure of HIV status.  They added “Among casual partners and seroconcordant couples, alcohol use at the time of sex was associated with decreased odds of nondisclosure.” In other words, alcohol use at the time of sex was actually associated with people being MORE LIKELY to tell their sexual partner of the HIV positive status.

BUT! This still leaves us with a POTENTIALLY disturbing figure that the majority of this particular Russian HIV-positive population did not disclose their HIV serostatus to practically half of their sexual partners, a figure that I expect is mirrored in many countries around the world. But before you recoil in horror, remember that people should not really have to tell anyone of their positive status -if couples are using condoms (and/or anti retrovirals) then there is no real risk of HIV transmission.

Now we would all like to assume that people DO and WOULD tell a sexual partner if they had HIV, especially if one was about to engage in unprotected sex. But who’s responsibility is it? Sex is a 2 (or 3, or 4!) way street, which means it is up to everyone involved to look out for themselves -but also, ideally, for each other too.  Sometimes we just have to weigh things up -am i putting myself at risk of violence or abuse by disclosing? If not, does the other person deserve to know the whole story before we sleep together so they can make an informed decision? Would their decision though, be properly informed? Most people don’t really know the whole facts on HIV transmission, and how would you deal with a person freaking out on you and grabbing up their clothes while calling a cab home!

possie and neggie? Now what?

possie and neggie? Now what?

Sex is a messy business: perhaps we could hope to ask that people would at least not lie about their status, or that if they did not wish to disclose it they could at least ensure that they used protection to protect both parties from problems down the line.  However, the discrimination that surrounds HIV is still such a degree that many simply cannot afford to divulge their status quickly, easily, regularly without the possibility of awful repercussions from family, or society.1347367131-1hivol_aids_pill_condom_retroviral

The result of these studies reiterated the importance of counseling of HIV positive persons about HIV disclosure to their sexual partners, something which should, according to the researchers, become standard practice. If however, people decided not to take anyones word for it but insisted on safer sex at all times, then one could avoid finding themselves in such difficult dilemmas. But of course, love and life are not black and white, and things are never that straightforward. It always behooves us to be as honest and trustworthy, caring and compassionate as we can be in this life, even if it is not returned. Yes we have to weigh things up, but it is also up to each and every one of us to educate our friends whenever we can on discrimination and its effects. We owe it to each other and our communities to try and be honest and open as often as we can, including in the bedroom, but we also have to allow people to feel able to share what can be frightening news, while feeling safe to do so.

One more thing before we leave the subject of HIV: 

hiv-aids-dating

Edelman EJ. AIDS Behav. 2014;doi:10.1007/s10461-014-0948-z.

E. Jennifer Edelman, MD, of Yale School of Medicine, said in a press release:

CD4 counts lower in occasional heroin users with HIV than in consistent users

Dr Edelman studied the data to emerge from a group of 77 HIV patients who were already enrolled within the HERMITAGE  trial ( mentioned above). Participants  were, as we said, in the class of ‘at-risk’ heavy drinkers,  drinkers who were not enrolled in anti retro viral treatment and reported unsafe behavior during the 6 months before the study began. Participants’ substance use was also self-reported at 6 and 12 month follow-ups as either no use (n=39), intermittent use (n=21) or persistent use (n=17).  (Note: Change between baseline and 12 month CD4 counts was the primary endpoint).

Dr Edelman found that, listen up positive junkies,  “Occasional heroin use, as opposed to persistent or no use, could lead to lower CD4 counts in people with HIV, according to recent data.”

“Our findings suggest that heroin withdrawal may be particularly harmful to the immune system, as measured by CD4 cell count.”

“We expected that HIV-positive patients who abused heroin on an ongoing basis would

Check out a terrific Canadian site on HIV and drug use - click this image -thanks to CATIE

Check out this Canadian site on HIV and HCV – just click this image -thanks to CATIE

have the greatest decreases in their CD4 count, but this preliminary study showed that those who abused heroin intermittently had lower CD4 cell counts, indicating a weakened immune system,” Edelman said in the release. “Our findings suggest that heroin withdrawal may be particularly harmful to the immune system, as measured by CD4 cell count.”

Well, we could have told you that Dr Edelman! Us junkies just KNOW that hanging out is bad for us! Okay, Okay, they do say that good research bears out what is already known to be true.

Dr Edelman continues, “This manuscript represents an important step toward identifying the need for future study of the effects of heroin withdrawal on HIV disease progression, as it may have unique effects compared with chronic and no heroin use,”

Therefore, HIV positive heroin users who are constantly going up and down in their use and thus their habits,  or, in other words, regularly ending up in cold turkey -sick, not sick, sick, not sick etc, seems to show that this on off approach is significantly worse on the immune system that consistent heroin use is.

In fact, the greatest change during the study period was seen in intermittent heroin users with a mean decrease in CD4 count of –103 cells/mm3, while those who reported consistent use had a mean increase of 53 cells/mm3.  And for those who reported no heroin use at all, a smaller mean decrease of –10 cells/mm3 was seen in this group.

Another piece of research that should underline the importance of HIV positive people being brought into either OST (Opiate Substitution Treatment) or given access to a continued, regulated supply of the opiates they need until they feel ready to stop using completely. Until then, it seems some kind of OST is essential. But again, we all knew that didn’t we?

Happy new year friends,

Erin at INPUD x

Here’s a good blog from a possie person talking about relationships and stuff and some of the things both possie and neggie people grapple with on the subject. Worth a read.

And here, if you want to start looking at the Swiss Study and the fallout from that -the one that finally said out loud that if you are on HIV anti retroviral treatment, your chance of transmitting HIV is virtually nil…

 

 

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About Erin

Freelance writer and journalist for the global drug user press
This entry was posted in HIV/AIDS, Injection Drug Use, Research and tagged , , , , . Bookmark the permalink.

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