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J B
Somerville, MA
A "public intellectual" with experience and publications in education, health, the arts, politics, and economics. Organizational links in local, state, national and international organizations. Too long a resume and never enough time. Current projects spanning secondary school reform and international suicide prevention, HIV/AIDS prevention and civic engagement, universities' partnerships and new, low cost public transit.
Recent Activity
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J signed the petition | -
J signed the petition | -
J commented on the article |What a nice and timely update. I thought the 2008 report was dramatic, reporting annual declines of 19.5 to 16.2%, but the trend continues, with 2009's drop of 16.6%, supporting the British Columbia finding that it even accelerates a bit. The total decline from 2004 through 2009 seems to be 48.49%, just about what I suggested, however. Thank you for the update. The report I cited is still available, however, in spite of your suggestion that it no longer exists, at http://www.sfdph.org/dph/files/reports/RptsHIVAIDS/AnnlReport2008-20090630.pdf. Thanks for this update, it will help our proposal invited by the NIH.
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J commented on the article |
I've, frankly, given up trying to argue with you, Joseph B., but I really don't want you to continue to cite statistics out of context. The source of your numbers is the San Francisco report, the most recent of which is 2008 (http://www.sfdph.org/dph/files/reports/RptsHIVAIDS/AnnlReport2008-20090630.pdf). On page 4 of that report it does, in truth, cite both 520 and 523 as the number of new cases in 2006, declining only slightly to 518 in 2007, and then dropping 25%, as I suggested, to 434 in 2008. And this from a base, in 2004, of 798 or 639, depending on how (or who) you count. As you say, the Department - like most departments - cites this problem of counting as explaining the drop, yet the rate remains downward, and in some years precipitously so.
You might also register the chart on the previous page. There you will find the numbers averaging 700 to 800 since about 1996. As I've said repeatedly, when the numbers trend down and remain approximately level for a number of years, and then drop sharply, it is reasonable to infer that the cumulative undercount - reflecting people not tested or choosing to ignore a test result and not be counted as HIV - has been gradually eroded due to HIV becoming increasingly symptomatic over a period of three to five years.
That rationale of the undercount, incidentally, is increasingly dubious in an era of anonymous or internet-available or pharmacy-available private rapid testing. One might reasonably distrust a public "anonymous test," when states are so eager to count as many as possible for their Ryan White formula. But a level number for a period of years, for a disease which eventually generates more symptoms than the famed flu-like temperature rise, clearly indicates that many un-counted old cases have matured to census state.
That, at least, was the conclusion of the British Columbia study and the Massachusetts DPH commissioner, cited above. So please, cease and desist complaining about my data. It's plenty good, and plenty universal. The facts are in the reports. You may choose to ignore them. Fine.
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J commented on the article |
Dear Joseph B,
I do think this dialog is not good for you. You are rambling. There are no 100% preventives, and no cures; there are no arguments made or countered which are absolute. The world is imperfect.
There are at least three US clinical trials for PEP, and more than the one clinical trial of PrEP which I know with some detail. All of them have had a 1% to 2% seroconversion rate, estimated by those conducting the study as failures to adhere to the prescribed regimen. PEP has a history of more than 15 years of "relative" success - that is, success at reducing HIV conversion among medical practitioners to less than a fraction of a percent. It was only after more than ten of those years that they thought to explore whether the same treatment would work with non-professionals, and conducted their first clinical trial of what they called nPEP (non-professional PEP). What this brilliantly, and horribly, demonstrated was how incredibly isolated the medical profession was from its own clients: to presume the chemistry of PEP differed in the least from medical professional to nonprofessional goes beyond most of our capacity to define arrogance and isolation.
THAT is the problem with your formulation, Joseph B., combined with the effects of what seem to be years of treatment. As I mentioned earlier, I founded an ASO in about 1985; consulted with several for several years thereafter; and worked in state public health departments on and off for decades. My data are all over the net. Nothing works for everyone all the time. Many, many things work quite well of which most people are kept deliberately ignorant. Your knowledge is exception, Joseph B., but your almost religious adherence to the arguments of homophobia and the good deeds of ASO's is sad and will, when the general public knows how much they've held back on ending the epidemic, result in a huge blow back. So be it. Who knows where any of us will be then, but I've done what can be done to save them, and, in the course of that, to help turn them to broader healthcare disparities. It's a shame they are captive to their own destruction.
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J commented on the article |
One of the most critical dangers is self-involvement and a kind of myopia rampant among caregivers who mistake good intentions with good works. The truth is that we have a solution to the "AIDS Epidemic," which is documented and was reported in several different themes in Vienna last week: Easy access to HAART with reduced side-effects; to universal insurance that reduces the risk of a positive diagnosis; to, therefore, more, more accurate and more rapid testing; PEP as well as PrEP to reduce the probability of contracting the virus after a possible exposure; and ultimately microbicides that will, after more double blind testing at the expense of thousands of African lives, eliminate the prospect of unwitting exposure.
The irony is that microbicides will also make all sex safe from both HIV, most STD's, as well as pregnancy, and are designed to be used without informing partners. That irony will profoundly change human sexuality, making sex inconsequential unless those consequences are intended. And no one - gay, straight, bi or trans - is prepared for the cultural impact of that transformation.
Meanwhile, ending delayed is ending denied, and delays in discussing, analyzing and implementing these critical changes are seriously undermining the prospect of universal health care in America, and perpetuating the virulence of the virus in developing nations in Africa, Asia and elsewhere. In fact, given the capacity of HIV to mutate, such delays are probably perpetuating the virus altogether, since its end could close out several strains.
And that delay is "justified" in rhetorical self-flagellation of long dead myths and stupidities. There are many who still think babies come from storks, god knows, and the pattern - particularly in the gay community - of recycling the absurd arguments of discredited hacks merely maintains the political viability of such arguments. For many too many centuries gay people have been abused. The brutal truth is that now all they can remember is abuse. In truth, anyone who works with people under 20 knows that such myths are usually ignored, and that that age of abuse is passed. Move on.
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J commented on the article |
There are only two areas of real health controversy beyond these general rules. First, how long should PEP really take. The CDC/NIH guideline is 30 days but it's never been tested and most HIV viruses don't live nearly as long as the ones that established that 30 day window decades ago. Yet, it's probably wiser to be safe. The admonition about double blind testing being immoral for this intervention is blatantly two-faced, since that is precisely how they are evaluating the microbicides in Africa. Oh, I forgot, that's Africa so it's different - only for the Nazis!
The second unsolved problem is why you guys are so obsessed about hiding these facts. The numbers are decisively down. Again, in the words of the Associate Commissoner of Public Health in Massachusetts: "In fact, we have seen a full 50% reduction in reported HIV incidence between 2000 and 2008 (1,237 to 563 cases reported). While a number of factors might be suppressing reports (the change to name-based HIV reporting for one), it is hard to imagine that we are missing a large number of cases."
In a followup note, the Associate Commissioner went further: "It is a big deal, and yet I get remarkably little play out of it, even when I present to CDC or other epidemiologically sophisticated groups. Re: money, a drop in incidence, while a good thing in and of itself especially for folks who don’t therefore have to live with HIV, saves health care costs certainly, but can actually have a long-term negative effect on discretionary federal grants like Ryan White. But I’ll take successful control of the HIV/AIDS pandemic any day.
"The data I shared with you and those on the website are all official and public, so share away. Same goes for my commentary in the email."
So, Mr. Joseph B, why are you so upset! It IS ending. That doesn't mean it's over, and certainly if you already have the virus it is a terrible living condition, with serious health and emotional costs. Yet it ain't what it was - a death sentence - and it need never be shared again! It also means that, delaying its end in the developed states only extends it in less developed states and condemns those in Africa to ... death. If that's your intent, you're doin' just fine.
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J commented on the article |
Regarding the prophylactic byproducts of HAART, there are several, they are distinct, and they are hardly 100% but, nevertheless, substantial. Incidentally, on the way to those byproducts, I wonder if Joseph B actually spent $1500/month since he seems to have cribbed the list of side-effects from a 2007 study. If he went to Brazil he'd save a lot of money, by the way, since the price of HAART is artificially protected to support the drug industry. In the course of that protection, as a final way-station to the point of this paragraph, most people use their insurer, and that insurer will soon not be able to dump your HIV case, which is a nasty side effect of Obamacare and, I strongly suspect, the source of the whole say-nothing pattern.
HAART's two most salient byproducts are (a) sero-sorting, since people in treatment try not to infect those without the virus and (b) much, much lower viral load. The first reflects several other conditions - higher rates of insurance in those states and jurisdictions (notably, again, Massachusetts, New York, San Francisco, and, according to a recent study announced in Vienna, British Columbia, all of whom had the same effect of 20% to 25% declines in new cases); as well as easier and less risky access to testing. Most people don't know, by way, again, that, in most jurisdictions, you can buy a rapid-test at your local drug store with 100% confidentiality. All ya gotta do is look http://tinyurl.com/2b3hf2k.
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J commented on the article |
Glad you guys woke up. First, recognize that I am not in the business. I'm not citing studies nor do I work for an ASO, although I founded one and worked with several over the past decades.
Second, my view of the entire AIDS enterprise is guided by data and networks of pros in the business. The official policy of the NIH is to promote PEP, as is the official policy of the CDC and the Mass Department of Public Health. Unfortunately, they fail to monitor, police, or hold accountable many of those they actually fund to deliver these services. Incidentally, check the date of that defense that it's not a "morning after" pill. Many of the first PEP studies were done when the preferred prophylactic medication was AZT whose side effects Joseph B quite adequately documents. Today its Truvada, but many others work quite as well, since it is the shock of an antiviral which, in timely fashion, usually (but not 100% perhaps) kills the HIV virus. It is not HAART, incidentally, which is the preferred PEP and PrEP intervention. Rather it is the more mundane - and considerably less expensive - medication of any of several tested antivirals. They all require a prescription, so the choice should be between a literate doctor and an actualized patient. In a recent informal poll of funded PEP providers, one state administrator discovered what several of us had suggested for months: they still don't provide PEP very willingly, preferring, it would seem, to have you get sick to then treat the illness - for another $200,000 to $600,000 according to one of those Harvard studies a few years ago!
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J commented on the article |
That failure of advocacy, incidentally, ignores the huge financial changes occasioned by lowering rates of infection. New York alone, at 3,000 fewer cases, is saving $1.5 billion annually in new liabilities. That annual saving could end the epidemic in many more communities, through pro-active medical insurance, HIV testing, and the same sequence of prevention that works so well where we have it. And ignoring those tested and verified facts (see the Lancet's article on British Columbia for the verification http://www.natap.org/2010/IAS/IAS_07.htm) condemns more and more to worse and worse treatment from stupid and inept caregivers. Too bad you seem to so committed that ignorance in spite of demonstrable facts.
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