New Study: 95% of HIV Positive Don’t Transmit HIV

Even though we’ve talked over the last year about the new HIV infections rate (incidence) in 2006, I haven’t given any thought to the issue of transmission–how many people actually transmit HIV to an HIV negative person every year? And what does the looking at the rate of transmission over the course of the epidemic tell us about what’s working or not working with prevention, testing, treatment or care efforts?

Well that’s why we have smarty pants like David Holtgrave, PhD at the Bloomberg School of Public Health at the John Hopkins University. His study, which JAIDS released online ahead of the publication date, looks precisely at HIV transmission rates over the course of the epidemic. They conclude that the highest rates of transmission occurred in the early years of the epidemic–in the early/mid 80s, and then began to drop off at several different points, particularly from 1985-1986 (31.4-17.4), and 1990-1991 (11.7-6.6). By 2006, the transmission rate declined to 5.0.

In other words, 95% of all people with HIV did not transmit the virus to people who are HIV negative.The study goes on to explain the possible causes for this drop in transmissions:

The general decline in HIV transmission rates over time could be considered a rough measure of prevention success, in that even as prevalence grew over time incidence did not grow proportionately. HIV diagnosis is known to significantly reduce HIV risk behavior, and in the past decade, there has been an increasing emphasis on prevention programs for persons living with
HIV that further reduce HIV risk behavior and 2006.

Another interesting thing they note is that AIDS drugs (anti-retrovirals) didn’t have a grand impact on transmission rates, as transmission was declining long before ARVs were on the market.

Could it be that marginalized communities with no access to treatment is where those transmission rates did not decrease or increased?

Could it be that the prison boom and/or Welfare Reform Act of 1996 (when prison construction peaked and we hit the 2 million prisoner mark for the first time) disrupted or changed sexual networks enough to create new HIV transmissions (and sexually transmitted infections in social networks where they had been stable?

Holtgrave doesn’t ask these questions, but notes that further research needs to happen to explain why ARVs do not seem to have significantly decreased transmission of HIV. But in a Q & A on Johns Hopkins’ website, he addresses the impact of housing stability on HIV risk, and also says what he would do if he was AIDS Czar in the Obama Administration:

I think it is critical to address unmet HIV prevention needs in the U.S. As I testified recently before Congress, my wish for a five-year plan would be for $1.3 billion in prevention funding per year. I might front-load that a bit, so maybe it’s $1.6 billion in the first year, and so on. Over that five-year period, I estimate that as a nation we could reduce transmission by half—but we’d need that substantial investment. And if we really saw a drop in new infections, that higher level of funding might sunset in several years, so we wouldn’t necessarily have to continue to fund it at $1.3 billion per year.

Let’s hope we’re as lucky to have this come to fruition.

UPDATE: The CDC has published a factsheet and podast on HIV Transmission Rates in the US, based on the release of this data.

Shock of The Week: Remy Ma Gets 8 Years

The hip-hop world had better get it together. Fame and celebrity will not protect your ass from the prison if you’re Black. Wesley Snipes just learned that lesson (OK so he’s not a hip-hop star, but he’s Black and he’s famous, so stay with me!), and Lil Kim and Foxy Brown have as well, and Snoop Dogg seems to get pulled over by the cops every time he leaves his driveway. The list could go on.

The latest hip-hop star to face prison time is Remy “I look too good to be fcukin’ you” Ma for shooting her homegirl in the gut over $3000 and fleeing the club in the meatpacking district of Manhattan where the incident took place. She was sentenced to 8 long years in prison. The details from E-Online:

In March, a jury convicted her on four counts, including assault, weapons possession and attempted coercion, for shooting Makeda Barnes-Joseph in the gut last July in a dispute over $3,000. She faced more than 25 years behind bars.

After State Supreme Court Justice Rena Uviller handed down the punishment, Ma’s fiancé, fellow hip-hopster Papoose, sparked a melee as he screamed invective at the victim, who took the stand earlier asking for a harsh sentence.

“Get the f–k off me. F–k y’all. F–k jail,” the performer [Papoose] yelled as the hearing ended and bailiffs escorted him out of the Manhattan court. “I don’t care. Lock me up. Lock me up. Take me to jail. Arrest me. It’s all about money.”

Papoose was caught by Rikers Island corrections officers last week allegedly trying to smuggle his betrothed a handcuff key as the two were about to tie the knot in a jailhouse wedding. He wasn’t charged, but the nuptials were nixed.

That key smuggling bit is so sad I can’t even laugh at it–obviously an act of desperation, if in fact it’s true. I do feel bad for her. I don’t think prison will solve anything–and I am not big on punishment as a form of social redress more generally. But can we just not shoot people?

Come on, people!

Just kidding.

But really. It’s been very clear that hip-hop stars are being widely surveilled (sp?) over the last several years, and the police, the FBI and other law enforcement agencies are clearly sending the message that if you’re associated with hip-hop and do some shit out of the bounds of “law,” you’re going to prison. Besides that, I find myself in between a rock and a hard place. I know the systemic issues at play that creat accessibility to guns and the kinds of urban poverty (in the face of gluttonous and violent wealth accumulation) that drives the kinds of acts of violence that seem senseless. I am from the same kind of community. I get the fact that I only made it “out”(not that I, as a Black gay man, escape the scrutiny, disgust, and violence of the state) because of the push of family, friends and some teachers who decided I was the one worth giving a damn about.

But sometimes I am at a loss for defending or even trying to put to words this kind of foolishness. What is the language for critiquing institutional racism, sexism and capitalism while also critiquing the fact that these systems support and drive individuals to be alienated, disaffected, and violent? I want to see a way out of this mess, but I sometimes come up short.