(Credit: Navajo AIDS Network)

A Navajo reservation on the Arizona-New Mexico border has seen its HIV diagnoses go up by 20 percent since 2011. Despite a concerted push by the federal Indian Health Service (IHS) and public health advocates to expand tribal HIV education programs, doctors have found treatment and prevention efforts to be stymied by cultural stigma surrounding the disease and homosexuality.

Since the Navajo tribe is a comparatively isolated population, the topline numbers of HIV infections among tribe members are relatively low, and at least part of the rise is attributable to enhanced screening efforts. However, that same seclusion allows stigma and the fear of community repercussion to prevent infected Navajo men from seeking care once they are diagnosed. “Our communities are very small, and that can lead to people avoiding stigma, rather than getting the care they need,” IHS chief medical officer Dr. Susan V. Karol told the New York Times.

In turn, that stigma can prevent tribe members from even discussing the disease and their various treatment and prevention options:

Melvin Harrison, the executive director of the Navajo AIDS Network, which provides services for tribal members with H.I.V., said that of the 65 people his group treats, a majority have not told family or friends.

“That’s how big the stigma is here,” he said. “They are afraid of rejection.” [...]

One Navajo man, who contracted H.I.V. from his partner in 2001, recalled how his mother refused to hug him and served him food on plastic plates when she found out he was infected. [...]

[The] man has not told his three brothers that he has H.I.V. because he fears they will shun him. “I don’t think I’ll ever tell them,” he said. “I don’t want to be pushed out of their lives.”

This dynamic devolves further due to the added stigma regarding homosexuality in the tribe. The IHS estimates that men who have sex with men (MSM) accounted for accounted for nearly half of the new cases since 2011, and 75 percent of the Navajo AIDS Network’s clients are closeted homosexual men.

But this tendency to sweep HIV infection under the rug presents a major barrier to an effective treatment regimen. Family and community awareness of the disease is an important tool for making sure that HIV-positive men are following through on their medications and checkups. Conversely, the desire to keep a diagnosis secret can create tensions in tribal doctor-patient relationships and contribute to treatment noncompliance. Teen mothers and mentally ill Americans have faced similar stigma, and have either forgone care or been denied access to adequate medical and social resources as a consequence.

For the Navajo community in particular, overcoming these archaic cultural mores is literally a matter of life and death. Although the medical reason for it remains ambiguous, researchers note that Native Indians diagnosed with HIV and AIDS have a lower chance of survival compared to other racial groups.

State legislators in Kansas are considering a bill that would allow the quarantine of people with AIDS or HIV.

Kansas House Bill 2183 was originally created to serve first responders who might be at risk of contracting HIV through their work. But the Kansas Department of Health and Environment rewrote the language in the bill, broadly deregulating when isolation can take place and opening up the possibility that HIV positive people could be quarantined.

Activists fear this oversight could be used to openly discriminate.

“Our state’s health department is willing to roll back a 25-year old civil rights protection,” Thomas Witt, the Executive Director of the Kansas Equality Coalition, told ThinkProgress. “LGBT Kansans are already subject to harassment and legal discrimination, and removing the existing HIV quarantine exemption from law leaves vulnerable Kansans at risk of discriminatory, unfair treatment by local officials.”

Other activists have also expressed concern that Kansans might not understand how HIV can be spread, and have implicit biases thanks to a lack of knowledge. “We live in a very conservative state and I’m afraid there are still many people, especially in rural Kansas, that have inadequate education and understanding concerning HIV/AIDS,” Cody Patton, of sexual health group Positive Directions told Gay Star News. This theory was also evidenced by a debate earlier this year, when the Kansas health department eliminated HIV testing for most counties in the state.

The Kansas senate has approved the HIV quarantine bill, and it looks likely to pass. During a hearing about the measure on Wednesday, however, the Kansas Department of Health and Environment said it would be willing to work with groups to fix what they considered problematic aspects of current proposal.

ABC News reports that a recent outbreak of deadly bacterial meningitis has now infected men in all five boroughs of New York, apparently spurred by anonymous sexual encounters facilitated by social mobile apps and Internet sites. 22 New Yorkers have been infected to date, and another seven have died from the disease.

The outbreak has prompted swift responses from city public health officials, who are urging men who have had intimate contact with other men to get vaccinated against meningitis as a precautionary measure:

“Vaccination is the best defense,” City health commissioner Dr. Thomas Farley said in a statement. “I urge all men who meet these criteria – regardless of whether they identify as gay – to get vaccinated now and protect themselves from this disease before it is too late.” [...]

The disease is spread by “prolonged close contact with nose or throat discharges from an infected person,” the health department said in a September 2012 statement after the death of a patient. While vaccination can help prevent new infections, “people that have been in prolonged close contact with infected people need to see their health-care provider immediately to receive preventive antibiotics,” the department added. [...]

“I strongly recommend all men who have intimate contact with other men get vaccinated,” Brooklyn Borough President Marty Markowitz said in a statement. “This disease is both potentially fatal and extremely contagious, so increasing the public’s awareness to this growing issue and encouraging vaccination are of the utmost importance.”

Particularly concerning is the fact that half of the recently-infected men are also HIV-positive. That raises the stakes considerably seeing as bacterial meningitis — which is already an extremely contagious and rapidly progressing disease — would be even deadlier for HIV-positive men with compromised immune systems.

While HIV transmission rates have steadily stabilized since 1980, men who have sex with men (MSM) remain particularly vulnerable to it, accounting for over 65 percent of all new infections in 2010. That trend is also reflected in New York City, which — despite its robust public school sex education requirements and plummeting teen pregnancy rates — has seen a troubling rise in syphilis and HIV transmission among MSM. Given that reality, vaccination truly is a crucial preventative measure for men in the city while the outbreak spreads.

On Election Day 2012, Los Angeles County voters approved Measure B, an ordinance “requiring producers of adult films to obtain a County public health permit” and for “adult film performers to use condoms while engaged in sex acts.” Porn producers, who have consistently opposed the measure, vowed to fight it tooth and nail. But as it turns out, one group is ready to fight back.

On Monday, the AIDS Healthcare Foundation (AHF) — an advocacy and lobbying outfit that has pushed for cheaper HIV medications and greater public health protections for HIV-positive Americans — became the first group to call out the Los Angeles County Department of Public Health over its allegedly lax enforcement of Measure B since its passage. The foundation lodged an official complaint with the County “after receiving an anonymous letter with an accompanying videotape filmed by someone on an Immoral Productions set” depicting unsafe sex practices and reviewing material on the production company’s website that also depicted intercourse without a condom.

For the well-funded advocacy group, this is just the latest skirmish in a decade-long battle. AHF president Michael Weinstein has spearheaded efforts to instill the same workplace safety and public health standards on straight porn sets as are already enforced in most gay pornography productions. Under his leadership, the AHF filed suit — to no avail — to make Los Angeles-produced pornography a “condom-only” enterprise; pushed for a citywide L.A. ordinance to the same effect; and spent over $1.6 million in its ultimately successful 2012 campaign to pass the more expansive, countywide Measure B. As he told L.A. Weekly in 2010, “AHF doesn’t give up on an issue, and we’re not going to give up on this.”

It appears that Weinstein and his group plan to follow through on that promise in the face of a combative Los Angeles adult entertainment industry and concerns over the Public Health Department’s enforcement prowess. “We’re putting them to the test,” Weinstein told the Los Angeles Times. “If democracy means something in L.A. County — if porn producers and county supervisors are not above the law — then they will enforce it.”

AHF and fellow public health advocacy organizations certainly have their work cut out for them. Trade groups associated with the multibillion dollar L.A. porn industry have promised to litigate the measure, citing freedom of speech concerns. This argument could potentially stand up in court — but only if the industry’s claims that it sufficiently tests all of its performers for sexually transmitted infections are true. An independent study by AHF that was published in the December Journal of Sexually Transmitted Diseases presents plenty of evidence to suggest that they are not, as “roughly a third of the 168 adult film actors who participated in the research project were found to have a previously undiagnosed STD.”

Earlier this month, scientists reported that they may have “functionally cured” a two-and-a-half year old child of her HIV infection by treating her with aggressive rounds of drugs as soon as she was born. They weren’t sure what that meant for adults living with HIV, since doctors may have simply prevented the transmission of the virus rather than eliminating an existing infection. But a new study suggests the same method may also work for individuals who contract HIV infections later in life.

French researchers are reporting that 14 adults have been “functionally cured” of their infections after undergoing initial treatment for HIV. The adults — just as the baby girl who was the subject of the earlier study — were aggressively treated with HIV drugs during the first two months of their infections. Now their infections are under control, and the ten men and four women in the group haven’t needed to take any HIV drugs for between four and 10 years. HIV-positive individuals are typically unable to stop undergoing HIV treatment without experiencing a “sharp and dangerous” increases in HIV replication.

Asier Sáez-Cirión, who helped analyze the findings at the Institut Pasteur in Paris, told MedPage Today that the study’s results suggest that early treatment may have some hope of “curing” HIV infections:

Although the phenomenon may not have immediate clinical implications, he said, it’s “proof of concept” that the immune system can control HIV in some circumstances.

It may also offer hope for a vaccine, he said. “It shows there is some immune response,” he said, “that can be stimulated not just to control infection but to prevent infection if that part of the immune system can be primed and activated.”

Indeed, the researchers argued that study of these patients and others like them could “open up new therapeutic perspectives” for people with HIV.

To be clear, scientists don’t know if these cases of “functional cures” will have broader implications for the 34 million people living with HIV around the world. As Sáez-Cirión points out, additional scientific research is needed to assess whether the phenomenon can be replicated on a wider scale. But it may help direct public health advocates’ energy toward effective methods of combating the virus in the very early stages of infection, and it also highlights the importance of regular testing so that newly infected individuals can become aware of their HIV status before going too long without treatment.

Here in the U.S., the CDC is focusing its efforts on expanding access to affordable HIV testing, particularly in the low-income urban areas where the virus tends to be most highly concentrated — but there’s still more work to be done, considering that about a quarter of the HIV-positive Americans aren’t aware they have the virus. Fortunately, HIV testing will be covered under Obamacare.

In Nebraska, state lawmakers are considering updating the public school system’s sexual education standards so that each school district’s health classes will be required to meet comprehensive, medically accurate standards. As legislators debated the measure this week, one Nebraska resident testified in favor of the sex ed bill by citing her own personal story: since she doesn’t believe she was fully educated about the HIV virus, she wants to prevent other students in her state from making the same mistakes she did.

Janine Brignola urged lawmakers to ensure that Nebraska’s youth don’t grow up to be as “naive” as she was about sexually transmitted infections:

Janine Brignola grew up in a rural area near Ord, Neb., but graduated from high school in Lincoln.

Not once, said the 30-year-old who is HIV-positive, was she warned of the dangers of the virus that causes AIDS at the schools she attended.

Her peers, Brignola said, told her it was a “dirty disease” that could kill her, but she believed that only the sexually promiscuous or “junkies or prostitutes got HIV.”

“I was naive and thought Nebraska was not a place that it could happen,” she said.

That lack of information about HIV isn’t specific to Nebraska. In fact, CDC data shows that HIV infections throughout the country are most concentrated in regions where students don’t learn about the virus in school. Just 20 states mandate both sex education and HIV education, and even those states may not necessarily require health classes to adhere to basic standards to ensure scientific accuracy.

But, just as Brignola highlighted in her testimony, it’s crucial to educate adolescents about effective methods to prevent HIV — rather than feeding them shame-based messages about sexual promiscuity, as if sexual health somehow doesn’t exist outside of “junkies and prostitutes.” Public schools started teaching information about sexually transmitted infections in the 1980s, at the height of the national HIV/AIDS epidemic, but religious conservatives rolled back much of that progress under former President George W. Bush, when sex ed classes became replaced with abstinence-only programs in states across the country.

Now, the CDC worries that today’s young people aren’t getting the message on HIV. Young Americans continue to put themselves at risk for the virus, and half of HIV-positive individuals between the ages of 13 and 24 aren’t even aware they have it.

Scientists believe they may have discovered an unlikely weapon in the fight against the global HIV/AIDS epidemic: bee venom.

According to researchers at the Washington University School of Medicine in St. Louis, bee venom contains a powerful toxin called “melittin” that can effectively kill the HIV virus while leaving the surrounding cells unharmed. Now that they’ve isolated the toxin, they’re using it to develop a vaginal gel to prevent the spread of HIV — a new tool that will hopefully help stop the transmission of the virus in places with high rates of infection:

“Our hope is that in places where HIV is running rampant, people could use this gel as a preventive measure to stop the initial infection,” says Joshua L. Hood, MD, PhD, a research instructor in medicine. [...]

According to Hood, an advantage of this approach is that the nanoparticle attacks an essential part of the virus’ structure. In contrast, most anti-HIV drugs inhibit the virus’s ability to replicate. But this anti-replication strategy does nothing to stop initial infection, and some strains of the virus have found ways around these drugs and reproduce anyway.

“We are attacking an inherent physical property of HIV,” Hood says. “Theoretically, there isn’t any way for the virus to adapt to that. The virus has to have a protective coat, a double-layered membrane that covers the virus.”

Beyond prevention in the form of a vaginal gel, Hood also sees potential for using nanoparticles with melittin as therapy for existing HIV infections, especially those that are drug-resistant. The nanoparticles could be injected intravenously and, in theory, would be able to clear HIV from the blood stream.

Researchers haven’t yet explored all of melittin’s potential to be used for contraceptive purposes, but Hood pointed out that the gel could likely be adapted to target sperm as well as HIV — essentially creating a spermicide that could protect against both pregnancy and sexually transmitted infections. But as of now, the gel is safe for both sperm and vaginal cells, and may be particularly useful for HIV-positive individuals who want to safely conceive.

And, since melittin could also help combat viruses other than HIV, bee venom could have broader implications for public health efforts. Melittin may be able to similarly destroy the hepatitis B and C viruses.

Bee venom’s important toxin is just the latest unexpected breakthrough in HIV treatment and prevention efforts. Last week, scientists reported that they may have “functionally cured” a two-year-old child of her HIV infection by aggressively treating her infection from the time of her birth. Unfortunately, the automatic cuts that recently began taking effect as a result of the sequestration may hamper future HIV research, as scientists will now have fewer resources to invest in research projects focused on unlocking the keys to treating the epidemic.

A months-long investigation by the American Independent has uncovered that the Michigan Department of Community Health has been secretly collecting detailed demographic information for the people who take HIV tests at community clinics — a practice that has been going on for more than a decade, despite the fact that it raises serious privacy concerns about the way the state is handling sensitive health care information.

When Michigan residents get tested for HIV at a federally-funded community clinic, their information — including age, birth date, and potential “risk categories” for contracting the virus — is entered into a massive state database that stores it indefinitely, regardless of the outcome of the test. The state-owned data could even include the identities of people who have sexual relationships with HIV-positive individuals. There’s no way for a Michigander to remove their information from the system once it has been entered.

The Department of Community Health says they simply want to track the number of tests conducted with federal grant money, and state officials claim that the database “does not contain personally identifiable information.” But outside investigations have found that there’s not enough security to safeguard the sensitive information, and anyone who works for the health department is able to access it. In fact, some of Michigan’s local health departments are using the database’s information to build criminal cases against HIV-positive individuals who they want to prosecute for failing to disclose their status — something that represents a potential breach of civil liberties:

“There are certainly privacy rights involved, particularly when clients are not being told that the information they are providing is being put in a database which can be utilized to assist with criminal prosecution of people living with HIV,” said Jay Kaplan, staff attorney for the American Civil Liberties Union of Michigan LGBT Project. “It’s ironic that in its effort to try to prevent transmission of HIV as part of the HIV-testing process, this policy and practice will likely discourage people from being tested, because they fear criminal prosecution for having knowledge of their HIV status.”

Rose Saxe, from the National ACLU AIDS Project, also weighed in on the issue. She said the state is collecting confidential health information, but also “deeply personal information.”

“The state has a constitutional obligation to keep this information secure, and to protect the privacy rights of people testing for HIV,” Saxe told TAI in an email. “Because of the sensitivity of this information, the ACLU believes it is critically important that the state have in place policies to ensure that this information is used appropriately. This includes safeguards to prevent inadvertent disclosure, and ways to ensure that it is only accessed for legitimate reasons by health department employees. If the state cannot or does not undertake steps to protect this deeply private information about people in Michigan, it has no business collecting and storing it indefinitely.”

Several studies have demonstrated that criminalizing HIV is not an effective policy to combat rates of infection. In fact, just as the ACLU’s Jay Kaplan points out, those type of punitive laws can actually dissuade people from learning their status because they’re worried about facing legal action. They also serve to reinforce the lingering stigma associated with the virus. Nevertheless, 34 states — including Michigan — have adopted criminal laws based on perceived exposure to HIV.

The Presidential Advisory Council on HIV/AIDS (PACHA) has called for the repeal of criminalization laws across the country. Even if Michigan doesn’t throw out its HIV-specific criminal laws, it could take immediate steps to stop secretly collecting data to enforce those laws without its residents’ knowledge.