At a time of looming federal budget shortfalls that threaten to cut off vital funding to many of the nation's AIDS service organizations and other HIV programs, a powerful enemy may be having disastrous consequences for people living with HIV. Street drugs-or party drugs-such as ecstasy, cocaine, ketamine, and GHB have been found to negatively interfere with anti-HIV medications and in some cases speed up the replication of the virus in the body.
As we reported earlier this year, researchers from the University of California, Los Angeles, presented evidence in the March 1 online edition of The Journal of Infectious Diseases that cocaine more than doubled the viral load of HIV-infected laboratory mice while causing a ninefold drop in CD4 cells. The disturbing results of the study reflect information published by San Francisco's Project Inform suggesting that mixing street drugs with anti-HIV medications may prove deadly. Project Inform and other sources confirm that there has already been one death in England associated with combining the anti-HIV medication Norvir (ritonavir) with the popular club drug ecstasy. The report goes on to state that mixing Norvir with ketamine-popularly known as special K-may cause chemical hepatitis, an inflammation of the liver resulting in jaundice.
Although much is still unknown about the harmful effects illicit drugs have when combined with antiretroviral medications, current data suggest the need for a swift public-health response.
Widespread Ignorance
Brian, a 31-year-old HIV-positive man and self-described "circuit boy," explains, "I have been taking anti-HIV medications for a year now, and I still party on X [ecstasy], G [GHB], tina [crystal methamphetamine], and cocaine." In a disturbing revelation that points to widespread ignorance of this threat to public safety, Brian adds, "Most of my friends are positive, and we all take the cocktail," referring to combination antiretroviral therapy. "The HIV pills keep us alive, but party drugs make us feel alive."
The potential danger of mixing club drugs with anti-HIV medications appears to be woefully misunderstood by some health care providers as local AIDS service organizations struggle to find scarce dollars to target effective public-health messages. "I have told my doctor that I use party drugs," Bryan says, "and the only response she has had is that I should stop using them because they are illegal. Nobody ever told me that taking X with my HIV pills was dangerous. All of my friends take some type of HIV medication, and they all use some kind of party drug. Nobody is talking about this so-called problem."
A Public-Health Disaster
The ignorance regarding the dangers of mixing street drugs with anti-HIV medications is emblematic of a larger issue, say officials at many of the nation's prominent AIDS organizations. As the nation recovers from the trauma of September 11, some believe the Bush administration has been acting irresponsibly in the midst of a public-health crisis.
Ringing the alarm bells of concern, a consortium of 17 leading HIV activist groups from around the United States issued a joint report card to President Bush in the spring, grading the Administration's actions. Specifically, the report card graded Bush on his work relating to funding and leadership on various HIV issues since he took office in 2001. The report card does not bode well for the Administration.
Bush received an F in leadership on HIV prevention, a D in funding for AIDS care, and a D- in leadership regarding minority initiatives. The report card included a written plea from the consortium requesting that Bush take immediate steps to increase funding for HIV programs, suggesting the epidemic is a threat to homeland security.
"The report card was created to highlight the Administration's inaction relating to the AIDS crisis," says David Ernesto Munar, who is associate director of policy and communications at the AIDS Foundation of Chicago and who spearheaded the report card's creation. "All of the organizations got together on a very intensive conference call and graded the president on his work relating to the AIDS crisis." The Bush administration's proposed budget for fiscal year 2003 seeks to keep funding at 2002 levels for the Ryan White act, the AIDS Drug Assistance Program, and various HIV prevention programs, while calling only for modest increases for research and the Housing Opportunities for People With AIDS program. Reflecting the consortium's frustration with Bush's apparent deprioritization of AIDS spending, Munar says, "His flat-funding of prevention is irresponsible."
Munar continues, "We are going back in time-back to the '80s. We are dealing with people in this administration who are afraid to use the word condom. Can you believe that?" referring to Tom Coburn's appointment as cochair of the Presidential Advisory Council on AIDS. "Coburn is anticondom and has made antigay remarks in the past. How do we expect him and others in the Administration to be at the forefront of this threat regarding club drugs and HIV?" Deeply concerned with scientific data regarding the negative effects club drugs are having on people taking anti-HIV medications, Munar adds, "To date, the Administration has not responded to our plea or the report card."
More Officials Under Fire
Munar and the consortium have reservations about other key Administration appointments that directly influence HIV policies. "We are very concerned at the appointment of John P. Walters as drug czar because he has demonstrated an irresponsible, punitive approach to illegal drug use rather than one of knowledge and support," Munar says.
Walters, who was formerly with the Department of Education and aligned with "czar on morals" Bill Bennett, headed a program in public schools called Schools Without Drugs. Advocating a faith-based and criminal approach to drug policy, Walters has made remarks denouncing attempts to view drug use as an addiction. In a 1996 hearing before the Senate Judiciary Committee, Walters criticized the "therapy-only lobby" and went on to state, "This ineffectual policy [is] the latest in the manifestation of the liberals' commitment to a 'therapeutic state' in which government serves as the agent of personal rehabilitation." "Walters is embracing the failed policies of the past and has a 'Lock them up and throw away the key' mentality," Munar says, adding, "This administration is just trying to gain support with its conservative base, not realizing we are facing a public-health crisis."
Perhaps even more troubling to many AIDS organizations is the appointment of Janet Rehnquist, daughter of U.S. Supreme Court chief justice William Rehnquist, as inspector general for the Department of Health and Human Services. "She has called current HIV/AIDS outreach campaigns obscene," says Munar. "Her comments sparked a congressional investigation of valuable HIV/AIDS programs because she made the misinformed claim that they were ineffective."
Sharing the consortium's concern regarding ineffective drug policies and abstinence-only approaches on the part of the Bush team is Chris Powers, coordinator of recruitment and retention at the department of research for Howard Brown Health Center in Chicago. As part of his job, Powers recruits volunteers for a program called Project Dance, a research study that seeks to discover the long-term effects of ecstasy on the memory in HIV-positive and HIV-negative people. The project is scheduled to last several years and relies on a grant from the National Institutes of Health. "Right now we just don't know how ecstasy affects HIV-positive people," Powers says.
Powers points out the contrast between popular cable television shows and what he believes is the Bush administration's failed message of abstinence from drugs and sex: "Shows like Flipped on MTV give a more accurate portrayal of the dangers of drug use, sex, and HIV. Unlike the Bush administration, MTV at least knows that if you present accurate information to viewers, people are smart enough to make their own decisions. Unlike the Bush administration, MTV trusts its audience."
The Wrong Message
Quinn Tyler Jackson, Ph.D., an author and researcher who is being nominated for a scientific award for his contributions in the field of psychology, also expresses concern about the Bush administration's approach to illegal drugs and HIV. "As for the 'say no' approach to life-people respond to such 'no' policies as the 'don't talk to strangers' message because it is very simple to show them that their interests and lives are at immediate stake if they aren't careful," he says.
"Why aren't they responding as well to the same messages about drugs? Saying 'no' to drugs is not the same as saying 'no' to a stranger. 'No' to a stranger may save your life-right now. 'No' to drugs in a highly social setting may put you in immediate social discomfort without any immediately perceived benefit except a clear head to think about that discomfort. Any message about illegal drug use has to be delivered in a way that takes into account the perceived immediate best interests of the target group."
As the nation's AIDS service organizations fight to preserve the hard-won progress made over two decades in HIV care, "circuit boy" Brian represents the current state of affairs. "This business about club drugs and HIV is news to me," he says. "Do you hear anybody talking about this problem? When is the last time that Bush even said 'HIV' or 'AIDS'?"
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