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Success Breeds Failure

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Rig Rush, left, and Bennett Everett Jr. are prevention specialists for the Pittsburgh AIDS Task Force's M2M project. - RENEE ROSENSTEEL
  • Renee Rosensteel
  • Rig Rush, left, and Bennett Everett Jr. are prevention specialists for the Pittsburgh AIDS Task Force's M2M project.

When one of the first tests for HIV became available in Allegheny County, Mike Hellman and a group of his acquaintances wasted no time in taking it.

It was 1985 -- the year the HIV/AIDS epidemic in America first grabbed headlines.

"I wanted to take it, to find out either way," he says.

Hellman tested positive.

"It was devastating. At the time they just said, 'Reduce stress, put your life in order and you'll be dead in 18 months,'" says the Morningside resident. "Never did I think I'd be here 25 years later."

Hellman attributes his well-being to taking care of himself -- something he says wouldn't have been possible if he hadn't known he was infected. And that's something he advocates for when he speaks to health classes around the city as part of the Pittsburgh AIDS Task Force speakers bureau.

But Hellman -- along with other HIV/AIDS activists and organizations -- has noticed a lull of sorts in general awareness of the virus. Positive steps in treating the disease have inadvertently contributed to why it's still spread.

In some ways, "Success is your worst enemy," says Dr. Charles Rinaldo, who heads the Pitt Men's Study (PMS), which has been tracking the history of the disease since the 1983.

According to the federal Centers for Disease Control and Prevention, one in five men who have sex with men are infected with the virus. But "[s]ince young [men having sex with men] did not experience the early HIV epidemic," a CDC fact sheet on the virus warns, "some may falsely believe that HIV is no longer a serious health threat."

Hellman says he frequently hears, "Oh, you just take a pill a day." But, he continues, "They don't realize all the side effects." Some of his medications, for example, cause hallucinogenic dreams that require a sleeping pill. He's also developed peripheral neuropathy, or nerve damage. "I've had so many toxic drugs."

In the early days of the disease, a very visible public campaign was underway to prevent the spread of HIV. Condoms were handed out at bars, and even in 1997, Downtown bar owner Gary Van Horn recalls being handed condoms when walking into a bar. Once inside, patrons were often greeted with posters suggesting "Wrap it up, boys."

But at some point, that kind of activism trailed off. 

Van Horn, president of the Delta Foundation that's part of the (Pittsburgh) RED HIV/AIDS awareness campaign, agrees that there has been some complacency. "People were dying in the '80s and '90s daily," he says. "We aren't putting people in caskets like we used to. People are living full lives now, but it's not a pretty life."

The PATF, Persad, Pitt Men's Study and University of Pittsburgh's Graduate School of Public Health are trying to bring some of that activism back, and reverting to some familiar techniques. 

As part of the M2M (Man to Man) prevention project that launched nine months ago, the Task Force has been distributing free condoms and condom-dispensers "to any bar who will take them," says PATF executive director Kathi Boyle. "There's an interplay with substance use and sex, because you have diminished capacity to make wise decisions."

For the M2M project, prevention specialists also hand out information and condoms at sex clubs, movie theaters and events like OUTrageous Bingo. The project also uses person-to-person social networking to connect those infected and those at-risk to examine their substance use, compare it to the community and adopt new behaviors.  

The project hopes to diminish risky behavior that could lead to infection. "We're not suggesting they quit having sex," Boyle says. "We're just saying there are ways to do it safely."

The PATF wants to reach populations most vulnerable for infection: African-American men and women under 30; and men having sex with men, particularly in the black community. 

According to the CDC, one in 16 black men and one in 30 black women will be diagnosed with HIV in their lifetime. Boyle says the PATF and its collaborators want to "refocus the black community" through education.

"Gay men in Pittsburgh don't talk about this, because the stigma in this town is so exceptional," Boyle says.

When an infected individual's viral load -- how much HIV is in the blood -- is low, usually as a result of treatment, they are less likely to infect someone else. But if they aren't in treatment, the risks of infection are much greater.

In the Pennsylvania Department of Health's most recent statistics from 2008, Allegheny County accounted for 76 percent of HIV-infected persons in Southwestern Pennsylvania. In Allegheny County, men having sex with men (MSM) accounted for more than half of those living with HIV in 2008, according to the state health department. Just 11 percent were injection-drug users, and public-health researchers commend free needle-exchanges for reducing those rates.

Ninety-four percent of HIV infections in Allegheny County were among the MSM community; people 40 and older accounted for most of the infections. But the younger generations -- from ages 20 to 29 -- showed a consistent increase, from 5 percent in 2003 to 7 percent in 2008. Rinaldo, of the Pitt Men's Study, says such a rise, though low, is disturbing. 

"People are getting it at an age of coming out ... and have an educational capacity to understand the message." Rinaldo believes the education is available. But, he asks, "Are they listening? ... People are still getting infected at a rate that's unacceptable in the United States, given our 25-plus years of knowledge of how this infection is spread."

Still, he adds, "As bad it as it is, it's not as bad as was back then." But Rinaldo's considering opening up the men's study again to look into such trends.

Dr. Ron Stall, a professor at Pitt's Department of Behavioral and Community Health Sciences, says that while he sees little sign of complacency among gay men, "I see complacency in terms of governmental and public-health organizations giving interventions that actually work for them."

Funding for HIV prevention has been "vanishingly small" compared to that of care for those already infected, Stall says; according to The American Foundation for AIDS Research, prevention receives about only 3 percent of total federal HIV spending.

This lack of  investment makes it difficult to put a significant dent in lowering infection rates, Stall says.

Meanwhile, activists like Van Horn question whether outreach has kept up with the times. Citing avenues like social media and online dating sites, the gay community is more connected than ever, he says.

"Condoms are just one piece of the puzzle," he says. "We need to have an in-your-face message."

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