I recently blogged on this site to take issue with Andrew Sullivan for his relentless campaign to convince gay men that the AIDS epidemic is effectively over and to get us to stop worrying about HIV -- even though HIV transmission rates among gay men gallop along at tragic levels of 2-3% per year.
I had neglected to consider that when it comes to AIDS and Andrew Sullivan, the best policy is benign neglect. Because the great danger is that Andrew will get his dander up and let loose with some whacky claim that threatens to make things even worse.
Alas, that's exactly what happened last week. And Andrew's latest pronouncement is so potentially deadly it demands immediate correction.
I won't rehash the details of our debate. You can read my criticism here, and his initial response here.
I'll just cut to the chase.
In one of his follow-up responses, Andrew goes where no man has ever gone before in terms of AIDS misinformation.
In arguing that gay men have actually done a pretty fabulous job of crafting new strategies to stop HIV transmission in a brave new world where combination therapies have led to complacency, he brings up the controversial practice of 'sero-sorting.'
This is generally described as a homegrown form of AIDS prevention among gay men in which people decide to have unsafe sex, but HIV-positives restrict themselves to sex with positives and HIV-negatives restrict themselves to sex with negatives.
Andrew then makes this startling claim:
Sero-sorting -- restricting sex to people within the same HIV-status -- has been by far the most effective barrier against HIV transmission among gay men in this new world. San Francisco has led the way in reducing HIV transmission through sero-sorting.
It's a broad, sweeping declaration, and if it were true -- if sero-sorting were the "most effective barrier against HIV transmission among gay men" -- it would stand as the biggest news in the history of AIDS prevention.
But, as every AIDS researcher I have spoken to agreed, sero-sorting isn't even remotely the 'most effective' form of HIV prevention. It is, instead, an untested, extremely problematic practice, and studies indicate that in some forms it could make the epidemic significantly worse, and possibly already has.
How can this be? After all, if HIV-positives restrict themselves only to sex with other positives, and negatives to other negatives, the chain of transmission should be broken and new infections should go down, right?
Well, not necessarily.
One big reason is that there are two kinds of sero-sorting. In theory one kind theoretically might be marginally helpful, despite some very serious downsides. We just don't know.
The other kind clearly threatens outright disaster.
The possibly helpful kind, from the epidemic's point of view anyway, might be for positives to decide only to have unsafe sex with other positives. Or what you might call 'positive sero-sorting.'
True, this may not be great for the personal health of those who practice it. For one thing, researchers say that unprotected sex between positives can lead to 'super-infection' with multiple drug resistant strains of HIV.
And 'positive sero-sorting' -- which encourages positive men to abandon condoms but says nothing about reducing partners -- clearly contributes to epidemics of other sexually transmitted diseases, to which HIV-positive people are particularly susceptible.
Just this week, for example, the CDC reported that a rare and dangerous strain of syphilis has been detected in a cohort of 49 HIV-positive men in four US cities.
This difficult-to-treat strain, called neurosyphilis, can cause blindness and stroke, and a CDC researcher said that it's spreading among this cohort because, although they're already HIV-positive, they are not using condoms.
Some researchers worry that if core groups of sero-sorting positive men stir up epidemics of multiple drug resistant strains of HIV and other difficult-to-treat STDs like neurosyphilis and then occasionally have sex with negative men -- watch out.
But those significant caveats aside, the case can be at least theoretically made that if these folks maintain strict sero-sorting -- a big 'If' -- the only people they're hurting are themselves.
That's because 'positive sero-sorting,' as long as it's strict and permanent, effectively removes those who practice it from the equation of HIV transmission to HIV-negative people, and that could potentially slow the epidemic.
I say 'potentially' because the data are not yet in and the downsides are so considerable.
Epidemiologists in San Francisco, for example, initially theorized that sero-sorting might be one possible explanation for why HIV transmission seemed to level off in that city last year. But they were very nuanced in their report, declined to draw conclusions, and were quick to say that other factors, like the high number of San Franciso gay men on therapies that drive down HIV infectiousness, might also be responsible.
(Their initial cautious report is the apparent source of Andrew's wild claim that "San Francisco has led the way" in reducing new infections through sero-sorting.)
Yet a year later those same experts now express serious questions as to whether sero-sorting played a role, and plan a major new study to try to figure this out.
But that brings us to the other kind of sero-sorting, the really scary kind.
This is when HIV-negative men adopt the same strategy, deciding to ditch condoms and have unsafe sex, but only with other negatives.
The reason 'negative sero-sorting' is so scary is simple.
Not counting those who deliberately lie about their status, lots of gay men who honestly think they are HIV-negative are actually HIV-positive. And I mean lots.
In some cities up to 50% -- and in one city, Baltimore, even 60% -- of gay men who are actually HIV-positive mistakenly believe they are negative because they haven't been tested since they were infected.
What's worse, one of the biggest reasons such people mistakenly believe that they are HIV-negative is because they have been infected recently, say in the last year or less. And newly infected people tend to have the highest viral loads -- and are therefore the most infectious to others.
So if you're negative and decide to have unprotected sex with people who says they're also negative, you run the risk that some of your partners are not only positive, but possibly even 'super-infectious.'
No small risk in communities where up to 50% or more of the HIV-positives don't know they are positive.
Researchers from the University of California at San Diego recently conducted a study that ran such variables through sophisticated mathematical models of the epidemic. Their model confirmed what many epidemiologists suspected: that 'negative sero-sorting' can actually make the epidemic worse.
But that's just a model. There have been real-world studies that bolster this conclusion.
For example, one researcher combined data from San Francisco and Seattle and found that up to one-third of all new HIV infections occurred between men who say they are both negative. In other words, one third of new infections were among gay men who effectively thought they were sero-sorting.
Another study showed that among gay men who became infected, the single biggest risk factor was the number of supposedly 'negative' partners they had.
That's right. The single biggest risk factor -- even bigger than having unsafe sex with someone you know is HIV positive -- is the number of supposedly HIV negative men you 'sero-sort' with. Presumably for the reasons listed above.
Perhaps the most relevant study was another that showed that condom use was 76% effective in preventing new HIV infections, while 'negative sero-sorting' was only about 40% effective, and led to an annual rate of infection of 2.6% per year.
An annual incidence of 2.6% means that in ten years, 26% of those practicing it would become infected. In twenty years, more than half.
In other words, if you're negative and you use condoms, the odds are with you personally.
However, if you decide to stop using condoms and practice sero-sorting, the odds turn decisively against you personally.
And from a communal perspective you're practicing a form of supposed prevention that guarantees an endless epidemic, since an incidence of 2.6% is well above the epidemic's tipping point.
Or put another way, if you were using condoms until this week and then you read Andrew Sullivan's blog and decided to ditch the condoms and start sero-sorting because Sullivan declares it "the most effective barrier against HIV transmission among gay men," your risk of infection would DOUBLE.
This kind of reckless disregard for studies and science is the hallmark of Sullivan's approach to AIDS prevention. He has engaged in it for years.
Another of his time-honored approaches is to studiously ignore any bad news about HIV transmission. Or, when he cannot ignore it, to slyly suggest that the researchers are deliberately exaggerating in order to secure funding for their research or simply save their jobs - one of the most spurious and despicable claims in the history of AIDS research.
Another approach is simply to repeat dubious claims.
And where does Sullivan often get these dubious claims?
Andrew Sullivan is supposedly a journalist. But his main journalistic sources on HIV prevention are not epidemiologists, researchers, scientists or boring nobodies like that.
His main source is blogger Michael Petrelis.
And who is Michael Petrelis?
Well, Petrelis is a gadfly AIDS obstructionist who was arrested in 2001 for harassment so serious that he was held in jail for 72 days in lieu of $500,000 bond.
And who was Michael Petrelis harassing?
You guessed it. AIDS epidemiologists, researchers, and scientists who were conducting studies about HIV transmission among gay men that Petrelis didn't like. And reporters who were covering that research.
Like his mouthpiece Andrew Sullivan, Petrelis is obsessed with the idea that such experts are deliberately exaggerating the epidemic to make gay men look bad, and he has a history of stopping at nothing to shut those experts up.
Petrelis and fellow defendant David Pasquarelli's tactics included making calls in the middle of the night to diligent AIDS researchers and leaving phone messages like: "Are you there, or do you have a syphilitic penis in your mouth performing oral sex?"
(Full disclosure: The reason I did not mention the names of the AIDS researchers I spoke to for this article is because so many of them said to me, Gabriel, if you're going to mention Petrelis in your piece, please don't include my name. I and my family and children are terrified of him.)
Since his release from jail, Petrelis has continued his AIDS obstructionism in the form of a blog.
And it is from this blog that Andrew Sullivan, one of the most prominent voices in the public discourse about AIDS, primarily gets his supposed information.
The bottom line is that, like his pal Michael Petrelis, Andrew Sullivan has waged a relentless campaign to obfuscate the facts and discredit anyone telling the sorry truth about the current state of HIV transmission among gay men.
Normally he should be ignored, because when he gets riled up he links over to Michael Petrelis and together they cut loose with something even nuttier.
But nutty is one thing. Deadly is another.
When Sullivan and Petrelis start making wild claims that could actually cost gay men their lives, it's time somebody blew the whistle.