June 12, 2005

The Wizard of POZ

This week's burning questions: Is it prime time, wartime or both for Trojan condoms? Will a new study help black junkies with HIV get respect—and treatment? Which famous British soccer mom took off her clothes for AIDS funding? And will the great and powerful POZ rock out with Madonna for aid for Africa?

FRIDAY, JUNE 3, 2005

While casually channel surfing on Wednesday night—yes, the Wizard does live like ordinary HIV mortals when down-timing from the AIDS crusade—your beloved blogger suddenly had the bizarre experience of shock and horror at a condom ad, as if the Wizard of POZ were a card-carrying member of the American Family Association (AFA). It’s a pity, too, because we would like nothing better than to cheer Trojan for having the guts to court controversy from the  abstinence-only crazies by pioneering prime-time TV pitches for rubbers. But this long-overdue breakthrough from “America’s Most Trusted Condom” left us feeling like “America’s Most Hated.”
      The 30-second MTV-vid-like spot opens with cool rock music and white fadeout type against a black screen: “40 percent of people…who know they are…HIV positive…do not tell their partners.” Cut to: A cute young couple at a train station sharing an iPod, snuggling, smiling and in tune with the lyrics: “This is your love, this is your life, this is the perfect chance to get it right.”
      Well, this was Trojan’s perfect chance, and they got it all wrong. Not necessarily the stat—which may reflect reality (69 percent of the 1,371 POZ readers who answered our sex survey last year say they do disclose before sex)—but everything else, as far as HIVers go. The problem is, by reducing us to that single chiding stat, the ad portrays us to the millions of neggie viewers in middle America as, once again, diseased pariahs and moral monsters.
      There’s no mention of how many people who know their HIV status practice safe sex—even when they don’t fess up. No mention of last month’s CDC report that people who know they are positive are 53 to 68 percent less likely to have high-risk sex than those who do not know they are positive. No mention of the Emory University study tracking the sexual behavior of HIVers for full-on 22 years that has found that 95 percent of us never infect anyone else. And, of course, no mention of the number of times we get rejected, insulted, beaten and even killed when we…do…tell…our…partners.
      “The unfortunate reality is that some people with HIV are not forthcoming about their status,” a Trojan rep told POZ. But if the company wants to scare people out of their HIV fatigue and into buying their products with a dose of the truth, the Wizard suggests this instead: “One third of people with HIV don’t know they’re positive.” And what ever happened to asking your partner about his or her status before busting out the jimmy hat?
      The Wizard isn’t the only one who’s whining. In our corner, the ever-awesome Terje Anderson, National Association of People With AIDS head, slammed the ad as “irresponsible,” “incendiary,” “deeply disturbing” and likely to “heighten the stigma and discrimination against people with HIV.” He even called on the condom manufacturer to withdraw the ad—a bold, risky move that no AIDS advocate we know of has dared to second.
      In the other corner, of course, the AFA came out swinging. “Condoms are the line in the sand,” an AFA rep warned. “We oppose condom ads because they promote promiscuity.” Then the ever-awful Donald Wildmon, AFA founder, penned an Action Alert to the group’s faithful to contact their legislators to force the networks to stop “abusing the use of public airwaves to air offensive and inappropriate material.”
      Trojan, welcome to the culture wars. Let’s hope these Trojans are more successful than the ancient ones in their head-butting with the Greeks. The Wizard will join Anderson’s army—and, yes, “America’s Most Trusted Condom”—against the wild man Wildmon’s murderous anti-condom missives. It turns out that a pair of African-American sweethearts are spot ad No. 2 on Trojan’s prime-time highway, all the better to reach one half of the market hardest hit by new infections. But the Wizard is none too happy to report that prime-time TV (or is it Trojan?) is not yet rising to the challenge of including both gay men and condoms in the same 30 seconds.

Meantime over on Channel Myth-Busters, this just in: African-American drug users with HIV are cheating death by means of combo therapy about as successfully as HIVers in general—news that may help soften up not only HIV docs’ tough-love approach to treating druggies (“junkies can’t adhere to daily dosing”) but also the deep-rooted doubt about the safety and benefits of HIV meds in much of black America (“HIV meds are poison”).
       Here’s the deal. According to a new report from the New York Academy of Medicine (NYAM), death rates among IV-drug users and crack smokers in the Baltimore African-American HIV community have fallen a full 90 percent since HAART became available in 1996. The study of some 665 HIVers over 14 years concludes that “before HAART, 15.9 percent of study participants were dying each year. After 1996, when patients in the study received HAART, the annual mortality rate plunged to only 1.2 percent per year.”
      These data so wowed the wonky Wizard that we placed a call to the study’s own wizard, David Vlahov, PhD, of NYAM and Johns Hopkins University (hence the Baltimore focus). How, the Wiz wondered, do you know that these folks are actually proving all the experts wrong by successfully taking their meds and keeping their virus suppressed? After all, the study admits that adherence wasn’t measured. Vlahov had answers—and they were plenty provocative: First, strict (95 percent) adherence may be less than it’s cracked up to be because the study clearly shows that “even if people were only somewhat adherent, they still had a tremendous benefit from HAART.”
      What’s more, he advised, his current research is revealing that this population actually has less resistance than HIVers in general—a standard way to test for adherence. (In yet another of his studies, Vlahov said, “76 percent of 366 drug-using HIVers said they’d taken 90 percent of their doses over the prior three days.”) The dutiful doc also downplayed the Wizard’s worries about African-Americans’ mistrust and myths about the meds, saying that it’s not nearly as widespread as we might think—at least in his Baltimore community.
       Vlahov, who has devoted more than a decade to this issue, hopes his research will encourage HIV doctors to do unto drug-using HIVers as they do unto others: provide combo therapy and the best possible treatment—without making getting clean and sober a qualification. “In a study we did the year after HAART was introduced, of the drug users eligible for the meds, only 7 percent had been given them.” The reason, he says, is “not so much prejudice as ignorance. Doctors tend to be suspicious of drug users. If we think their lives are chaotic and they won’t be adherent, we won’t give them meds.”
      Adherence is hard for everyone and for addicts most of all, whether you’re chasing a needle or a news story 24/7. (You want chaos? Spend a day slinging data and hot dish with the Wizard.) So how do you explain all these great findings and counter those doctor arguments? Again with the answers: “Does a person take their HIV seriously? That’s the issue,” Vlahov said. “If they take it casually, adherence will be an issue for anyone. If they take it seriously, it doesn’t matter who they are—they will attend to their health.”
       Of course, life as a drug user in downtown Baltimore or the Bronx is still no bowl of cherries, even with once-a-day combos and all. Most are coinfected with hep C and fear looming liver failure. That goes for former users, too, who can be 12-stepping their way down the yellow brick road, never missing a single dose of their HIV meds and heading straight off the cliff of liver shutdown with no transplant in sight. Barbara Zeller, MD, who treats many drug users with HIV at Project Samaritan in Brooklyn and the Bronx, says, “Of the deaths we see now, one of three is from AIDS, and the other two are from organ failure—mostly liver, some kidney.” That’s why Jason Farrell of Positive Health Project argues that this study should influence doctors to test and treat their junkies for hep C, too. Let’s give the good doctor from Baltimore the last word: “This study tells doctors that drug users can take HAART and have positive benefits. Don’t exclude drug users from treatment.”

The Wizard’s favorite celebrity sighting this week was that new nudie pic of  Victoria ‘Posh Spice’ Beckham, shot with just her Jimmy Choos along with 43 of “the world’s [other] most beautiful women” and auctioned at an Elton John AIDS Foundation fundraiser on Wednesday. London Daily Mail art critic Robin Simon called the former Spice Girl’s contribution “titillating totty snap.” But what the Wizard really wants to know is this: Can Posh bend it like hubby David?… And this: With the Global Fund starving to death and Asia hurtling after Africa into a black hole of disease and indifference, what do you do? Invite Madonna, the Dalai Lama, Pink Floyd, Nelson Mandela, 50 Cent and Pope Benedict XVI to a five-city concert and protest event to kick-start a global salvation! Not quite. Bob Geldof’s Live Eight concert fundraiser on July 2 is to fight global warming and African poverty. Still, the millions raised will benefit HIVers—at least indirectly. A hell of a lot more helpful, in the Wizard’s opinion, than the United States’ new tactic to skirt the Fund’s grassroots networks and go unilateral.