The Big Bad Bug

Will questionable reports about a new drug-resistant strain of HIV jump-start prevention work or spread hysteria?

‘Drug-resistant HIV found in New York.” “NYC warns of powerful HIV strain.” “Boston, Too, Has Super-HIV Case.” The headlines blossomed worldwide last week after the New York City health commissioner announced that the department was tracking a patient with a form of HIV that was resistant to three out of four classes of AIDS drugs, and whose case had progressed to full-blown AIDS within a matter of months, rather than the more normal 10-year incubation period.

Almost as quickly, others responded, accusing New York City of being alarmist. Many doctors noted that multiple-drug-resistant strains have surfaced plenty of times before, without spreading. A July 2, 2004, study in the journal AIDS found that 13.1 percent of studied subjects had triple-class resistant strains (though this includes patients who developed resistance after years of treatment). “Our experience is they have not developed into clusters of cases, because as it mutates it’s less stable than the more common forms,” said Michael Kink of Housing Works, an AIDS advocacy, service, and policy organization. “There is currently too little information available, and doctors have followed the patient for too short a time, to draw any conclusions,” wrote Project Inform, a San Francisco-based AIDS advocacy group, in a response released Friday (Feb. 11).

Whether or not the New York City case is a particular harbinger of a new dangerous strain or not, one thing that is agreed upon is that drug resistance in HIV is a serious and growing concern. Drug- resistant strains of bacteria or viruses develop when a drug is taken in such a way as to wipe out most, but not all, of the target germ. Those that remain are the ones that were most resistant to the drug, and they multiply to form whole colonies that share that resistance. This is why doctors emphasize, for example, finishing a course of antibiotics, even when you feel better halfway through.

To understand why drug resistance is such a problem for HIV, consider this: People have a hard enough time finishing a 10-day course of one antibiotic pill a day. While some of them have become more simplified, AIDS treatment regimens can still include some or all of the following: dozens of pills a day; dosages scheduled to the hour, some in the middle of the night; some doses to be taken with food, some without; and many unpleasant side effects. And they have to be taken with 98-percent accuracy, for the rest of your life. That’s a tall order. And even then the drugs don’t wipe out all the HIV, so people who are in treatment for a long time still do develop resistant strains and need to switch to other classes of drugs, making treatment options for those who start out with a partially resistant strain much more limited.

Representatives of local AIDS organizations are keeping a wary eye on the details, but say that the fact that it’s got AIDS on everyone’s lips is likely to be the biggest effect of the announcement—and that could be for good or ill.

Randy Viele, assistant director of prevention services for the AIDS Council of Northeastern New York, has already seen it change the tone of the prevention and outreach work he does. On Monday he visited a residential substance-abuse recovery center for youth, he said, and “they were all [asking], ‘Could I possibly have this unique strain?’ ”

“It’s the topic of the week, I guess,” he said. “It’s definitely having an impact.” Viele added that the emphasis on drug resistance has also reinjected a sense of urgency to the issue that for some young people had been blunted by the ever- present advertising for AIDS drugs that show healthy, good-looking, HIV-positive people. “The perception is ‘OK, I can take the meds and I can deal,’ ” he said. “The glossiness . . . doesn’t portray the population that can’t handle the meds, or is resistant to the meds. . . . Not everyone who has HIV is going to look like they should be in a magazine ad.”

Vanessa Johnson, deputy director of the Capital District African American Coalition on AIDS, is seeing less effect. “The strange thing about it is, in the HIV community, awareness is heightening,” she said, “but I don’t hear anybody outside of the community talking about it.”

Raising the profile of drug-resistant HIV could also be an opportunity to push for better policy, said Kink. “Multidrug-resistant HIV is a predictable result of inadequate health care and government neglect,” he said. If an AIDS-drug regimen is difficult to stick to under the best of circumstances, he pointed out, it’s next to impossible for people with unstable access to healthcare—whether they are uninsured, being rotated in and out of Medicaid, unable to afford co-pays, in jail, or facing homelessness. According to a report from a committee of the Institute of Medicine, only half of the people in the United States who are aware that they are HIV-positive have ongoing access to anti-retroviral therapy.

This, says Kink and other advocates, has been paired with years of cuts in funding to prevention services, restrictions on what prevention workers can say regarding sexual activity and drug use, and specific attacks on harm-reduction approaches.

Unfortunately, according to Kink, instead of calls for better funding and stronger policy, much of the reporting in response to the announcement has focused on calls for what he calls “vigilante” approaches. A Tuesday New York Times story, for example, talked about gay activists calling for direct confrontations at sex parties, infiltration of hookup Web sites, and more proactive tracing of partners. Kink is afraid this will also fuel the push by some conservatives to weaken confidentiality protections or make HIV transmission a prosecutable felony.

Johnson is worried too. “People who are easily frightened or already have a misunderstanding of the disease will ask for mandatory testing or criminalization,” she said.

And that would not be a good public-health move, according to Kink. “The existing public health laws are working,” he said. “The case was reported. . . . The person is cooperating with contact tracing. . . . I don’t think that would have happened if the person’s name and picture were on the front page and they were facing felony prosecution. . . . If there’s an adversarial approach, they will be talking to their lawyers and remaining silent.”

Viele agrees. “I don’t think the demonizing of any population will do any good,” he said. “It will just drive behaviors and people further underground, so they’re harder to reach.”

For now, Johnson is taking a wait-and-see attitude. “We’ve got to remember they’re still learning a lot about this disease,” she said, “so every new development shouldn’t be greeted as the end of the world.”

—Miriam Axel-Lute

maxel-lute@metroland.net

Renaissance Woman: Connie Kaidas, captain of Russell Sage College’s basketball team, plays the national anthem on her violin before a game at the Troy-based college. photo:John Whipple

The Citizen’s Police Academy is a 13-week class that meets for three hours every week to explain the workings of the Albany Police Department and “law enforcement in general” to any interested citizen or businessperson of Albany. Sgt. Fred Aliberti, who runs the program, said the APD has been doing it since 1990, though it started as a measly six-week program. The curriculum covers such things as the geographic organization of the department and patrols, investigation procedures, administrative procedures, and a visit to the stables where the mounted units keep their horses.

Aliberti said it’s also a chance for the department to take suggestions and constructive criticism, and though he couldn’t call any specifically to mind, he said the police definitely have made changes in response to things they’ve heard.

What inspires people to make such a hefty time commitment? Many of the attendees are active in their neighborhood associations or neighborhood watches and are hoping to bring home information about how to better work with the police department. Attendance is required for members of the Citizen’s Police Review Board, and the department encourages members of the media who cover the police beat to attend. They also get some people who have had concerns with the department, and according to Aliberti, sometimes the class helps. “People who are concerned with police response time—they’ll see the communications department and they’ll see how the calls are prioritized, and why we have to prioritize, so they’ll understand, yes for that sort of call, they will take a certain amount of time, but for others it will be much quicker.”

The application for the privilege to be so educated requires two references and permission to do a background check—is sensitive information being revealed? No, said Aliberti. “We’re pretty down to earth about that. We just want to make sure we’re not letting the worst criminal in the world attend our class, someone who’s wanted. Someone who has had some problems in the past shouldn’t be a problem. Certainly we don’t reveal all our investigative secrets. . . . It’s not meant to be exclusive.” No word on whether a background check would seem inclusive to anyone who has had negative interactions with the police in the past.

—Miriam Axel-Lute

Yeah, It Was a Bunch of ‘Em This piece of graffitti was spotted in the Mount Pleasant neighborhood of Schenectady. Though the Southern Poverty Law Center doesn’t list any official hate-group chapters in the area except one black separatist group, things like this, and the “white power” banner hung over the Thruway in Malta in late January, are a sobering reminder that this blue state is not immune to racial hostility. photo: Martin Benjamin

Much Work to Be Done

New Albany elections commissioner faces challenging job in changing political climate

With stories of fraud, voter intimidation, and recounts becoming almost as common as elections themselves, a brighter spotlight than ever was cast on the recent election for the vacant Albany County Board of Elections Democratic commissioner post.

The election came with its own share of controversy. In what is being considered a major change in the Albany County political landscape, James Clancy—former chief-of-staff to state Sen. Neil Breslin and supported by the town Democrats—edged opponent Karen Shea, the candidate of the city Democrats, in a weighted vote of 42,137.5 to 31,260.6. This weighted vote (representatives were allotted votes based on the number of Democratic voters in their district during the last Assembly election), pushed for by the growing-in- number suburban Democrats tired of being overshadowed by their city counterparts, was the first of its kind since 1921. The Feb. 9 election was marked by hours of shouting and arguing between the two sides before the results were announced, silencing the city representatives and possibly signaling an end to their decades-old stronghold over the county party apparatus.

And while this has been the major story to come out of his election, Clancy refuses to see it that simply. “I had broad support from every faction of the Democratic party,” he stated. “It was very humbling. My support went across gender, race; it transcended suburban and urban, city and town.”

Clancy took over a part-time position that paid $33,661. Within a week, he and his Republican counterpart, John Graziano, were made full-time employees by the county Legislature in a bipartisan 26-11 vote. This puts Albany County in line with Rensselaer, Saratoga, and Schenectady counties, all of which have full-time elections commissioners.

This change was made after area politicians voiced the need for increased availability from their elections commissioners. With only a handful of employees serving under the commissioners—by law, only the top two represented parties elect commissioners, thus no third party assistance—the Board of Elections office itself also felt overworked. Prior to the move to full-time, Graziano had complained, “It’s becoming very difficult to succeed with the way [the board] is structured.”

It seemed that everyone supported expanding the position, though many doubted its fiscal feasibility. While a new annual salary of $80,000 had been floated, the county settled on $65,000.

Clancy’s election—which received approval from the county Legislature on Monday—fills the void left by the Dec. 31 retirement of former Democratic Commissioner Mike Monescalchi. With the election now behind it, the Board of Elections is facing a potentially tumultuous year ahead, with both a physical move from the county courthouse and pending legislation that may add to its responsibilities.

Gov. George Pataki’s current budget plan calls for a state purchase of new voting machines, and transfers the burden of handling the machines from the municipalities to the already stretched county election boards. There are also ongoing system changes required by the Help America Vote Act that will not be finalized until 2007.

Graziano and Clancy head up an agency responsible for the county’s election operations in both primary and general elections. They will work hand-in-hand in overseeing the voter registration process and reviewing residency claims. The board also supports “special elections,” such as school board and fire district, and conducts inspections and educational seminars for Albany County.

“I’m looking forward to my new position,” said Clancy. “I hope to help make the board a consumer-service-oriented entity helping the people of Albany vote.”

—Nolan Konkoski

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