I was doing some shopping in the grocery store the other day, listening as the new Bruno Mars song, “the lazy song” played overhead. My ears perked up when Bruno got to singing this line:

"Tomorrow I’ll wake up, do some P90x

Find a real nice girl, have some real nice sex . ."

Except he didn’t say "sex". He said “have some real nice …” The word “sex” had been censored. Apparently, nice sex with a nice girl is inappropriate and offensive.

What does it say about our cultural attitudes towards sex when the word itself is eliminated in public, even in its most vanilla form? I really have a hard time fathoming why the word "sex" is inappropriate. I suppose the easiest argument in defence of this kind of censorship is that parents might want to protect their children from hearing about sex. But I just don’t buy it. For one thing, if it opens up an opportunity for parents to sit down with their children and actually talk to them about sex, then all the better. For another thing, there is no shortage of songs in which sex is described.

Take a scan at some of the songs on the American Top 40 right now. Number 1 is Give me Everything by Pitbull. Number 18 is “Dirty Dancer” by Enrique Iglesias; 19 is S&M by Rihanna; 20 is Blow by Ke$ha; 29 is Where Them Girls At by David Guetta and 30 is Down on Me by Jeremiah. So it’s not as though graphic descriptions of sex in music or any form of media are hidden. They are, after all, everywhere.

And so is misogyny, hate, and violence, particularly violence against women (especially, but not limited to, sexual violence) which is often presented in the cloak of being sexy. For example, in the song “Love the way you lie,” Eminem describes being unable to restrain himself from repeatedly physically abusing his girlfriend. He ultimately burns her alive:

"If she ever tries to fucking leave again
I'ma tie her to the bed
And set the house on fire"

And as is frequently portrayed in music by women that condones violence against women, Rihanna claims she “likes the way it hurts” and “loves the way you lie” (in the song, Eminem is lying about his ability to stop hitting her.)

This is, unfortunately, so common that I could think of a thousand examples. The popular Ludacris song, “Move, Bitch” comes to mind, where he describes beating his girlfriend on the face and head until she passes out, killing her friends when they try to protect her, speeding while drunk driving and purposefully running over his female groupies.

I’m upset both that our society is so sex-negative that we try to deny even the very mention of sex, and yet condones sexual violence against women, no matter how graphic or sickening it gets. Somewhere, the sociologist and feminist in me should be able to pull together a decent theory about this phenomenon but I feel almost at a loss for words. For now I’ll just say that it makes me angry and perplexed to see consensual sex censored and sexual violence take the centre stage.

PositiveLite reports:  Pardon the late-posting.  This late post was a victim of the many communications snafus Brain experienced in Rome. It showed up only just now.

First report out of the Rome IAS 2011. I have to admit this has been a very difficult conference, first with communications being next to impossible, I was not able to post in the way I wanted to.

Then my subject at hand, when to start treatment, doesn't really have a lot of new things to add to the discussion. Basically we are at the point where the science definitely shows that initiating earlier is better due to the inflammation response of this virus.

A comparison was made to between HIV and CMV, another common virus that is not usually harmful unless one is immunocomprimised. It may hang around for a very long time, and does cause inflammation, but it is not until 3o to 40 years later that the damage is seen. This is the analogy that is given to HIV.

However, there is some difficulty sorting out exactly what is related to HIV, the medications and the body aging. It is a complex interaction.

The agreement is that CD 350 is the commonly agreed upon number for the igniting treatment, or even 500. I'm also hearing about keeping those who have not taken treatment before to stay off the class of drugs called Protease Inhibitors as they have more cardio vascular disease, including heart attacks.

One major physician and researcher tells me that he does not start the newly treated with PIs, and stay with other classes, NNRTIs, or otherwise known as non-nukes such as Sustiva, Efavirenz,, Intellence, Raltregravir, Raltegravir and some of the newer ones coming downy the pipeline.

Lifestyle choices are playing a big role, the largest being smoking. As someone who started again, I can assure you after this conference when I come back I'll be stopping. Smoking has come up time and time again.

I have some interviews on a couple of topics, and from the physician who told me that treatment is treatment for an individual, and to forget about treatment as prevention as it is something else. He also asked me if Julio Montaner was controversial in Canada as they received so much push back in San Francisco about treatment as prevention that they just let it go.

I will be attending the session on HIV as an inflammatory disease, which really is why the data is showing that starting earlier is better. Get out of your head that you are "asymptomatic" meaning having the virus with no symptoms. The moment you get this thing it goes to work, and just because you can't feel the erosion of the foundation of your immune system, it doesn't mean it isn't happening.

People caught up with treatment as prevention will dispute this, but I insist on looking at this as a stand a long topic. I don't care who wants to prevent how, the important thing is that you get the best care and all the information, and to dismiss this because of politics is throwing out the baby with the bath water.

Of course any treatment decisions should be made in consultation with a physician you are comfortable with, and when you are ready to begin. The world won't end if you do put it off a while to think, but get all the facts.

I have a video on this subject, however because of the terrible time getting internet these will have to wait until I get back home.

My main take away points about HIV has been "we may be at a point where it is as good as it gets for awhile" I heard from one researcher. Is that true I don't know. The emphasis is turning towards treating the "non-AIDS" defined illnesses such as kidneys, hepatic, malignancies and cardio vascular disease.

The big one was to quit smoking. I heard that time and time again.

Otherwise the conference is dominated by very technical science, new therapies will be discussed once I get time to properly look at what is going on. This wasn't my purpose of the conference, but there are definitely a few new things.

There have been other talks about starting medications for the newly treated and then lowering the amount taken over time, and even five days on two days off kind of thing. All these were out loud musing's without any science to back it up. However, the way I accidentally miss my pills and everything still works out tells me there may be some truth to this. Again, talk to you doctor before you attempt any changes. These things are very individualized and you could be really hurting your future treatment options with resistance.

Off to do more sessions. Will be back with more.

ART at 350-550 CD4s Cuts Disease Rate 40% in Randomized HPTN 052 Trial

6th IAS Conference on HIV Pathogenesis, Treatment and Prevention, July 17-20, 2011, Rome

Mark Mascolini

Starting antiretroviral therapy (ART) at a CD4 count of 350 to 550 rather than waiting for a count of 250 lowered the risk of serious complications, especially extrapulmonary tuberculosis, by 40% in the randomized HPTN 052 trial, conducted in 5 African countries, Brazil, India, Thailand, and the United States [1]. Earlier ART did not cut the risk of death during this trial, which began in 2005.

HPTN 052 is the first randomized trial to demonstrate that antiretroviral treatment lowers the risk that an HIV-positive person will transmit the virus to an HIV-negative sex partner (reviewed separately by NATAP) [by 96% !] [2]. At the same time, HPTN investigators compared rates of HIV-related complications in people who started ART at a CD4 count between 350 and 550 and those who waited until their count fell below 250. Previous studies addressing the pluses and minuses of starting antiretrovirals at a CD4 count above 350 relied on modeling of observational data. HPTN 052 is the first randomized trial to examine this issue.

HPTN 052 enrolled 1763 HIV-positive people, 54% of them from Africa. Median age of study participants stood at 33 years, and half were women. Everyone had a CD4 count between 350 and 550 when they enrolled, and no one had taken antiretrovirals. Median CD4 count at enrollment was 436 and median viral load about 25,000 copies. Participants made a study visit every 3 months. While 7% of enrollees were taking prophylactic cotrimoxazole, 4% were using isoniazid to prevent TB.

The investigators randomized 886 people to start treatment immediately and 877 to wait until they had consecutive CD4 counts under 250 or an AIDS illness. The primary endpoint for this part of HPTN 052 was a World Health Organization stage 4 event, pulmonary tuberculosis, severe bacterial infection, and/or death.

Through 3304 person-years of follow-up, a study-defined clinical event affected 105 people, 40 in the immediate-ART group and 65 in the delayed-ART group. Those numbers translated into an incidence of 2.4 events per 100 person-years with immediate ART and 4.0 per 100 person-years with delayed ART. The clinical risk was 40% lower in the immediate-ART group (hazard ratio [HR] 0.60, 95% confidence interval [CI] 0.4 to 0.9, P = 0.01).

Extrapulmonary TB explained most of the difference between the immediate group and the delayed group. Three people randomized to immediate ART and 17 randomized to delayed ART got diagnosed with extrapulmonary TB during the trial (P < 0.002). Incidence of extrapulmonary TB was 0.2 per 100 person-years in the immediate arm and 1.0 per 100 person-years in the delayed arm. In contrast, incidence of pulmonary TB was 0.8 per 100 person-years in the immediate arm and 0.9 per 100 person-years in the delayed arm.

Twenty-three people died during HPTN 052, 10 in the immediate arm and 13 in the delayed arm, but this difference lacked statistical significance (HR 0.8, 95% CI 0.3 to 1.8). The HPTN 052 researchers noted that longer follow-up could disclose other complications of delayed therapy.

Notably, 1-year responses to ART differed hardly at all in the immediate arm and the delayed arm [3]. Although the immediate group began treatment at a median CD4 count of 442 and the delayed group at a median count of 225, 90% in the immediate group and 93% in the delayed group had a viral load below 400 copies after 1 year. One-year CD4 gains averaged 158 in the immediate group and 191 in the delayed group. These findings indicate that more time spent with a lower CD4 count in the delayed group--rather than a worse response to ART--explain their higher risk of disease progression. (from Jules: and more time with replicating virus is likely important as well.)

For the clinical advantage conferred by earlier antiretroviral therapy, people in the immediate-ART group did pay a price in toxicity: Adverse events possibly related to ART affected 24% of people in the immediate-treatment group versus 5% in the deferred group. Laboratory abnormalities were recorded in 27% in the immediate-treatment group and 18% in the delayed-treatment group. But severe or life-threatening adverse events affected the same proportion in each group, 14%.

References

1. Grinsztejn B, Ribaudo H, Cohen MS, et al. Effects of early versus delayed initiation of antiretroviral therapy (ART) on HIV clinical outcomes: results from the HPTN 052 randomized clinical trial. 6th IAS Conference on HIV Pathogenesis, Treatment and Prevention. July 17-20, 2011. Rome. Abstract MOAX0105.

2. Cohen M, Chen Y, McCauley M, et al. Antiretroviral treatment to prevent the sexual transmission of HIV-1: results from the HPTN 052 multinational randomized controlled trial. 6th IAS Conference on HIV Pathogenesis, Treatment and Prevention. July 17-20, 2011. Rome. Abstract MOAX0102.

3. Hosseinipour MC, Wang L, Cohen MS, et al. Immunologic and virologic disease progression and responses to ART across geographic regions: outcomes from HPTN 052 study. 6th IAS Conference on HIV Pathogenesis, Treatment and Prevention. July 17-20, 2011. Rome. Abstract MOAX0104.

According to this late breaker presentation HPTN 052 is the first clinical trial to show that waiting unitil a CD4 of 250 increases risk of disease where as initiating between 350 to 550 decreases this risk.

For the sake of saving time, and already having a great summary from NATAP, which is most likely the Press Release.

I am not closely following every track being one person, NATAP has some great coverage, some of which I will return to when I can sort through all the information presented.

I can’t believe tonight I blast off to the next International AIDS Society’s Pathogenesis (and a whole lot of other big words) conference tonight.

As you can see my little Chihuahua doesn’t want me to leave.

Last year at the larger IAS conference in Vienna I learned so much during that experience, most what not to do. Having gone through that, I feel so much more prepared to cover what I want and not be loaded down with unnecessary equipment, etc.

Equally exciting, even though many years ago I lived in Europe, and I’ve been many times back, I’ve never made it tor Rome. I’ve always been drawn to the history and architecture.

Since my trip to Paris almost two years ago to see my French superstar Mylène Farmer, I started renting apartments for these short trips. They are so much cheaper.  This time I snagged up a one bedroom with air conditioning (last I year I didn’t have it and there was a heat wave going on), and wifi for 65 Euros a night. Pretty good eh.

Once I arrive at the train station I have someone waiting for me with a sign to drop me off at the apartment, at no extra cost. Of course I’ll be tipping him. I’ve always had to pay quite a bit to be picked up, so I’m astonished he doesn’t charge for this.

As I mentioned in my last post, I’m keeping my focus extremely narrow: when to start treatment guidelines. Are there any changes? What have been the reactions to the changes announced last year? Is there any new available research?

I’m staying away from treatment as prevention. I treat these as separate issues, and people can do what they may with the information I find out about when to start treatment. The opinions are individualized, as our treatment has to be, so there is no one answer.

Hopefully I’ll come across a couple things that fall outside of this that may be of interest.

I’m also fortunate to have a lot of people at the conference. No shortage of doctors! Plus I have my, “Just in case” kit all ready. The one time I decided to take antibiotics (St. Martin last February) I needed them.

I’ll be posting touristy stuff, as well as stuff from the conference.

Since my last web developer went MIA I’m not able to create a separate category for the conference except under the featured content on the top menu.

Oh ya, I don’t speak any Italian. Usually I know a few words of the language spoken in the country, but this time I just didn’t have time to prepare. I should look for an Italian app.

Ok everyone, see you in Rome

With the success of the AIDS Committee of Ottawa’s sold out ‘No Pants, No Problem’  party last month, plans are currently underway to host a sequel in September! Originally conceived by Toronto’s Jessica Whitbread, Ottawa is looking to participate in the international edition of her famous party, joining Toronto, Mexico, Amsterdam, and others in a simultaneous live party feed! Be sure to watch this blog space and site for further details as they become available!

Distributing safer sex supplies, educational materials, party favours from www.Squirt.org , and helping with the front door and pants check made for a busy night! I wore a pair of tight blue boxer briefs from American Eagle that had hot dogs all over them, a cock ring designed by Ottawa’s George McBeth, and a free t-shirt from the new, invitation only poz dating site www.positivelyfrisky.com . (Look for the New York based social networking site on Facebook for more details!) The party was co-ed, and turned into quite the fashion show as many party goers changed into skimpier and skimpier underpants as the night progressed and the liquor flowed. One party goer was particularly fetching in his sheer, rainbow coloured, banana hammock, while another had us all hounding her about where she had bought her jean short inspired panties!  Thank you to everyone who made it out and took the time to talk to me about safer sex and what that could look like for them in their sex lives! Extra special thanks to DJ Skid Vicious, Gallery 101, After Stonewall, Venus Envy and my co-worker Zach Zimmel who did most of the leg work!

A few weeks later I had the privilege of joining a social media panel discussion on the use of social media in the AIDS sector. Organized by the Canadian AIDS Society (CAS), I was joined by PositiveLite’s own Bob Leahy and Xtra reporter Dale Smith. During the hour long discussion, we spoke about the roles and responsibilities of the mainstream media, the major HIV/AIDS issues covered by the Canadian media over the last 30 years, the criminalization of HIV non-disclosure, assault and blackmail of HIV+ guys in Toronto, and community mobilization. A big special thanks is owed to CAS’s Communications Consultant Lauryn Kronick who organized a great discussion and took great care of her nervous speakers.

I get asked a lot about my role as the AIDS Committee of Ottawa’s Men who have Sex with Men (MSM) Outreach Coordinator and what it entails. PositiveLite publisher Brian Finch has asked that I share more about my work life with my readers to better inform them about what is being done on a community level to combat HIV. I’m happy too report that in Ottawa there are many diverse, sex-positive, informed, educational initiatives happening all over the city, as is evidenced above.  Ottawa is home to many great HIV/AIDS service organizations and social justice advocates working on issues pertaining to poz health, prevention, education, and support, and I want my readers to keep watching this space to learn more about them!

P.S. Last Thursday I got to excitingly debut my new outreach cork board at Gay Zone (420 Cooper) after spending almost ten hours pulling ads, researching trivia, finding campaigns, using agency developed materials, laminating, and surfing the web for vintage porn, to create a dynamic, colourful outreach tool to encourage conversation, and promote safer sex. I felt like a big, dorky kid doing arts and crafts, but I was really happy that so many people liked the finished product!  Next time any of my Ottawa readers are stopping in at Gay Zone for STI testing, I hope you’ll come by my outreach table and have a look  at it!

No Pants, No Problem, Jessica Whitbread, AIDS Committee of Ottawa, Canadian AIDS Society , Outreach,  Bob Leahy, Dale Smith, Gay Zone, Media, Brian Finch.