Subjects in this issue:

Banishing Chipmunk Cheeks

“Myths”

When Opposites Attract

Anal HPV

Medical Marijuana

Dr. Cruise Control

Kudos on HIV Drug Guide

HIV Drug Guide and AWP

Youth and HIV

Online Poll

Banishing Chipmunk Cheeks

Editor’s note: A reader of HCV/HIV Today wrote the following comment to that publication following a reprint of “Banishing Chipmunk Cheeks and Bullfrog Neck” [September/October 2006]: As a survivor of oral cancer, I know that maxillofacial radiation therapy causes soft teeth and dental caries. Most of this happens 20 years post-treatment, so patients have to balance risks and benefits—as usual. The article suggests that radiation is appropriate, as opposed to surgery, but the attendant issues are more complicated than that.

Correction: Banishing chipmunk cheeks
There was inaccurate information in a letter in the published May/June Readers Forum on “Banishing Chipmunk Cheeks and Bullfrog Neck” [September/October 2006]. A survivor of oral cancer had written to say that facial radiation therapy can cause soft teeth and dental caries over a long period of time. These are serious complications. The doctor quoted in the article, however, cancer specialist Patricia Gordon, says that, “This is absolutely not the case. The dose for head and neck cancer is substantially higher than what we need. Hence, the dental problems that are certainly seen in the cancer cases with high doses, while real for them, do not happen to [HIV patients using the treatment for enlarged parotid glands].” Positively Aware apologizes for printing the misinformation.

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“Myths”

I had a very upsetting phone conversation with my daughter the other day. She is pursuing a degree in Acupuncture and Oriental Medicine, and had just gotten out of a class where the instructor covered the topic of HIV/AIDS. The teacher espoused his personal view that HIV does not cause AIDS, and directed the students to a website that tries to discredit what it calls “myths” relating to the virus: www.virusmyth.net. She was very eager to share this news with me, but it was almost like listening to someone excitedly tell me that the Holocaust never happened or that they just found out that Evolution is just a theory. I got very upset with her, and the conversation ended badly.

I am trying to be an open-minded dad, but since I am living with the virus and see what it is doing in my own body, and have seen what it has done to many friends over the years, I am having a very difficult time not being defensive over what some very credible scientists are proclaiming on this website. Can you help me get to the truth, and sort out what are facts versus what are myths?

Dan in Chicago, via the Internet

Editor’s note: Visit the Treatment Action Campaign website at http://www.tac.org.za/debunking.html for excellent information on this topic.

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When Opposites Attract

Many thanks to Keith Green for his article on serodiscordant relationships [“When Opposites Attract,” March/April issue].

I too am in one. My partner and I were tested six months after my moving in. We recently stopped using condoms and I felt uncomfortable not knowing each other’s current status. The one thing we did before getting tested was to sit down and have a heart-to-heart about what it would mean if we both were no longer negative. We decided to stay together no matter the outcome. As it turns out, his test came back positive. He took it very well, I cried on and off for a week. The two things that helped were the “pre” discussion (so the only thing left was to make it work), and discussing safer sex practices with a professional. Fortunately we live in a large city with an excellent GLBT clinic. At the time he was on a city-appointed HIV/AIDS committee and I was working for an agency assisting HIV-positive people. Between the two of us, we should have known the best way to have safer sex, but there was a lot that we didn’t know. Some things we did are considered risky (used his semen as lube during masturbation) and fisting without gloves. Even in this article I learned that penis to penis sex is considered riskier that anal sex with a condom.

The person inside was far more important to me for our relationship to last forever than the inconvenience of having to put on the occasional condom. It’s been four years and his brain is the sexiest organ I have ever found.

Marc, Houston, Texas, via the Internet

I have a question about the article “When Opposites Attract” in the March/April 2007 edition of Positively Aware. In the sidebar to the article entitled “Dr. Bell’s Safer Sex Spectrum,” in the Male/Male sexual risks column, “oral sex without a condom/dental dam” is listed as riskier than both anal receptive and anal insertive sex, as well as “penis to penis sex.”

As an HIV prevention educator with a major hospital network, I am concerned that this information conflicts with other current information. I was wondering if someone there could support this information or offer sources which can support this risk assessment. As our prevention work with at-risk men follows a harm reduction model, our HIV counseling, by your chart, is actually increasing risk.

Lew Alessio, Men’s Health Educator, just guys—the men’s HIV Prevention Program at MaineGeneral Health, Augusta, Maine

Dr. Bell responds: Please note that the references for transmission are for STIs (STDs) and HIV. Using barrier methods with any sex act (versus unprotected sex, be it oral, anal or vaginal sex) makes it safer. Remember, STIs can be transmitted via body fluid and/or some via skin-to-skin contact.

Editor’s note: “Condom use” always implies “correct condom use.” Using a poorly-rated condom will increase the risk of condom failure. Always remember to use a water-based lube with latex condoms, as oil-based lubes will cause latex to disintegrate. And if the condom falls off or breaks during sex, the risk obviously increases.

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Anal HPV

I appreciated this article [Surviving Anal Cancer, May/June 2004]. I am an HIV-negative, straight woman recently diagnosed with HPV anal polyps after my routine, after 50, colonoscopy. My MD was surprised to find out that it was HPV and recommended a sigmoidoscopy in a year. Even though I have been a Registered Nurse for years it did not register how dangerous HPV was until all the recent advertisements for the vaccine.

Within a year I had developed high and moderate grade dysplasias. So I was off to surgery. My surgeon told me to come back in a year. But after much research and articles like yours, I had my first three month checkup at the University of California San Francisco (UCSF). My biopsies are pending. I don’t want to go through that surgery again so I will go back to UCSF for further treatment.

I have had a normal cervical Pap smear all my life. I was married for 15 years until my husband died three years ago, and I have not been in a sexual relationship since then. I had anal sex several times in one relationship 30 years ago. I am not the norm. What is scary is there are no support groups, and no one wants to talk about it. UCSF has no support group, even among the gay community.

If I can get it anyone can. How many anal cancers are developing because women my age are not having colonoscopies? Anal Paps should be routine for everyone in my view. But then the problem is that Dr. Barry at UCSF has only trained 30 MDs in the U.S. to examine and treat the problem. I found one MD in the state of Oregon that can, but he has to take patients to the operating room, which makes the price of treatment thousands of dollars more. So few can treat, few will talk—how many are dying? How long will it take for anal HPV to be recognized? Cervical and anal tissue are very similar.

Name withheld, via the internet

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Medical Marijuana

I am a medical writer and need to learn more about medical marijuana. Some AIDS patients use Marinol to treat appetite loss. Marinol is relatively expensive, and I would like to know if you are aware of any company developing a generic equivalent. If you do not know, please refer me to people who might have some information about generic Marinol. Thank you for your consideration.

Elisabeth Hefti, Ph.D., Biotech Business Link, NY, NY, via the Internet

Pharmacist Rupali Jain replies: Marinol is only currently available in the United States as the name brand product. Depending on length of the patent of the drug, I am unsure how long it will be until it goes generic. Many companies have patient assistance programs to help with the expense of the medication for those who qualify.

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Dr. Cruise Control

Hi, you have a great website. I’m going to recommend it to high school students. I’m planning a school wide Student/Parent HIV/AIDS awareness day (and praying for approval) and I would like to include the article “Dr. Cruise Control” [HIV Systems Check, Fall 2006 issue] in the handout package along with various periodicals and personal testimonies.

Alice Lang, PTA mom and Eternal Hope Community Development Corporation, Inc., East Orange, New Jersey, via the Internet

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Kudos on HIV Drug Guide

I am a medical writer and need to learn more about medical marijuana. Some AIDS patients use Marinol to treat appetite loss. Marinol is relatively expensive, and I would like to know if you are aware of any company developing a generic equivalent. If you do not know, please refer me to people who might have some information about generic Marinol. Thank you for your consideration.

Elisabeth Hefti, Ph.D., Biotech Business Link, NY, NY, via the Internet

Pharmacist Rupali Jain replies: Marinol is only currently available in the United States as the name brand product. Depending on length of the patent of the drug, I am unsure how long it will be until it goes generic. Many companies have patient assistance programs to help with the expense of the medication for those who qualify.

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HIV Drug Guide and AWP

Hello and thanks for the latest Positively Aware Eleventh Annual HIV Drug Guide. I actually discovered it on “The Body” website. I just have one question: You note that each drug in your guide has an AWP with the dollar amount, but was wondering what does “AWP” actually mean?

Thanks for the info!

Terry, via the internet

Editor’s note: AWP stands for Average Wholesale Price, and is a national average of list prices charged by wholesalers to pharmacies. AWP is sometimes referred to as a “sticker price” because it is not the actual price that larger purchasers normally pay, which is often considerably lower. It is not what your insurance company will pay for the drug, or even what you would have to pay if you did not have insurance—most of the time that amount will be much higher than the AWP. AWP information is publicly available.

Youth and HIV

I especially appreciated the July/August 2006 issue of Positively Aware—which presents a realistic but hopeful message for and about young people. When I received a box of copies I placed some in our clinic waiting room and others in the emergency room waiting room (keeping only a few for myself). They went like hot cakes!

I will soon be speaking with high school students about HIV and STDs. Some may be HIV-infected or have a family member who is positive. Others are probably just curious. I would greatly appreciate receiving another box (25 or 50 copies) of this particular issue. Also if you have an issue which speaks to HIV rookies, that would be very helpful also.

Thanks!

Barbara Lee Perlmutter, MD, Hoboken, NJ, via the Internet

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