NAPWA

In a story that generated massive worldwide media interest, public health authorities in New York announced on 11 February that they had detected a single case of an apparent 'new strain[HIV strain] Any subgroup of the HIV species. Because HIV mutates very easily, there are many different strains (and may be multiple strains within a single person).' of HIV which could lead to AIDS in months, not years, and was resistantHIV which has mutated and is less susceptible to the effects of one or more anti-HIV drugs is said to be resistant. to virtually all antiretroviralA medication or other substance which is active against retroviruses such as HIV. drugs.

The patient at the centre of the story, a gay New York man in his 40s who was first diagnosed with HIV in December, was said to have frequently engaged in unprotected sex, often while also using methamphetamine (crystal meth).

Calling the case a "wake-up call to men who have sex with men, particularly those who may use crystal methamphetamine," the city's health commissioner, Dr Thomas Frieden, described the man's condition as "difficult or impossible to treat."

The announcement led to the issue of a national alert by the Centres for Disease Control (CDC) and, within hours pundits, commentators and experts across the US and around the world were weighing in with their assessment of the significance -- or insignificance -- of the case.

While the official announcement and much of the media response to the case was sensational, at least some clinicalPertaining to or founded on observation and treatment of participants, as distinguished from theoretical or basic science. experts urged caution. Dr Robert Gallo, one of the co-discoverers of HIV, said he thought the story was "much ado about nothing."

Thomas Jefferson University specialist Dr Roger Pomerantz went further: "Every medical centre in a major metropolitan area will have a case like this," he said. "You've got to really prove something before you go on CNN and scream about a super-strain."

Dr Andrew Grulich of the National Centre in HIV EpidemiologyThe branch of medical science that deals with the study of incidence and distribution and control of a disease in a population. and Clinical Research told PL that he believes the response of the US authorities was somewhat alarmist given that only a single case had been identified. "The way it emerged appeared to be pretty much like 'science by press release'," he said.

Grulich doubts the case represents a new strain of HIV, as has been widely claimed. "I don't think based on a single case you can make any conclusions about a new strain of HIV," he said.

The natural course of HIV can be "extraordinarily variable," Grulich explained -- numerous cases of people progressing from infection to AIDS within a year or less have occurred, although not before with such a highly drug-resistant virusA small infective organism which is incapable of reproducing outside a host cell..

"We've certainly seen cases in Australia where people have progressed rapidly from HIV infection to AIDS within a year -- we would have seen many cases of that over the last 20 years -- but it's not a common occurrence," he said. Likewise, there have been many cases of people having multi-drug resistant virus, but it is unusual that the two should occur in the same individual.

In the days following the New York announcement, Canadian HIV physician Dr Julio Montagner pointed out that several similar cases had been detected in Vancouver in 2001 and were described in the medical literature, but had not proven to be a new strain of HIV.

Grulich cautions that further evidence would be needed to support the idea that a new strain was emerging. "If we saw a cluster of ten or 20 of these cases in New York -- or in Sydney -- then there absolutely would be something to worry about but there's no evidence that will be the case or has been the case," he said.

He is also troubled by the way the impact of the man's drug use has been represented. "Some of the press implied that crystal meth might have caused this organism to be resistant or caused it to be rapidly progressive, and that's pure and simple nonsense," he said. There is evidence that crystal meth and other recreational drugs are linked to unsafe sex, he noted, but said media reports linking them to resistant HIV were unhelpful.

Michael Hurley, a senior research fellow at the Australian Research Centre in Sex, Health and Society, says the media handling of the story is an example of the way in which sex, drugs and HIV are represented by the media as scandal.

"It's a ready-made news story akin to 'sex, drugs and rock and roll'," he said.

"Culturally, gay men are 'other' in the sense that their perceived sexual excesses are both envied and anxiety-provoking," Hurley said. "The price of this is that they can be easily represented as out of control and shockingly dirty."

"None of this is to deny that New York City has a major HIV epidemic that sits on the edge of being out of control. That's the real issue, the real scandal, but in a country that cannot deal politically or officially with sexual and other life realities it's very difficult to do sensible public health," he said.

Grulich believes the case should remind us that HIV remains a serious disease. "This unfortunate person developed AIDS within a year with a multiply drug-resistant organism that's going to be very difficult to treat," he said. "Some people who are being infected with HIV even today are unlucky enough to have very difficult to treat disease, so it does highlight that HIV still is a serious disease and in some cases is close to untreatable still."

But he does not believe that generating fear is helpful: "We have a very sophisticated gay community and HIV-positive community," he said, "and if it sees bad science and inappropriate use of fear it'll see straight through it -- that can have a counterproductive effect of leading to a lack of trust of health authorities such as the one that released these results."