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Thursday, February 1, 2007

A Seattle Patient Zero? Four Linked Cases of Drug-Resistant HIV Reported Here

posted by on February 1 at 11:00 AM

We’d heard rumors of this, and now the local health department confirms it:

Four King County men have tested positive for similar HIV viruses that are highly resistant to several antiretroviral drug classes. One of the men was tested in late 2005, and the other three were tested in 2006. Last month researchers identified a likely link between all four cases.

Translation: Seattle may have a patient zero, a gay man who contracted a multi-drug-resistant strain of HIV and spread it to other local men.

Public Health is working with the four patients and health care providers to locate and test their sexual partners for HIV infection and drug resistance.

Translation: The number four may be just a starting point, although so far the health department hasn’t found any other cases.

In the current cluster, all four were men who had sex with men; all had a history of methamphetamine use, and had multiple, mostly anonymous, sexual partners. The partners who have been found to date either were not HIV-infected or their HIV infection was not related to the current drug resistant strain.

Attention gay men: Read Christopher Frizzelle’s 2006 story on Club Z and crystal meth. Read my 2003 story on the “Immoral Minority” of gay men in Seattle who disproportionately contribute to the spread of sexually transmitted diseases in the local gay community (a group it sounds like this cluster was a part of). Read my interview with Peter Staley from The Stranger’s 2005 Queer Issue, in which he says:

I firmly believe that if it weren’t for crystal meth we would be experiencing a decline of newly HIV-infected gay men every year.

Here’s what the health department recommends gay men do with the news of this local drug-resistant HIV strain:

Public Health recommends testing every three months for those gay and bisexually active men who use methamphetamines, have a recent history of sexually transmitted diseases, or have had unprotected anal sex with an HIV-positive man or a man whose HIV status is unknown. Other persons at high risk should test at least yearly.

Here’s what The Stranger recommends: Don’t use crystal meth in the first place, don’t have unprotected sex with meth heads — duh — and tell your friends that there’s now one more compelling reason (as if you needed one more compelling reason) not to bareback with people whose HIV status you don’t know.

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I remember a story in the Stranger (by Eli, maybe?) about Gay City, and how social service orgs that serve the gay community were advocating bad health practices and what not...

I gotta reread that, but this seems interesting...

Posted by Will | February 1, 2007 11:23 AM

It was a fantastic piece of investigative journalism.

Posted by Jonathan | February 1, 2007 11:41 AM

The King County article didn't seem to specify how the men got the disease. Was it barebacking?

It's my understanding that oral sex and mutual masturbation are still relatively safe in regards to HIV risk.

Any thoughts?

Posted by Original Andrew | February 1, 2007 11:55 AM

it is EXTREMELY difficult to contract hiv through oral sex, and nearly impossible through mutual masturbation. in fact, there are no documented cases in the medical literature where someone has contracted hiv from oral sex when anal sex was not also regular activity.

there are plenty of other things you don't want, though, like herpes - which can be contracted through oral sex.

so, you know, be careful.

Posted by jak | February 1, 2007 12:50 PM

If a guy engages in low risk oral sex with a heap of other guys, the risk factor is additive.
Do the math.
Not to mention the lack of interest in the long term health of somebody you're only going to do once. It's time for the gay to grow up.

Posted by Jake | February 1, 2007 12:53 PM


I'm not attempting to evaluate the morality of one-off hook-ups by "the gay."

It's my understanding that the HIV virus dies once it leaves the body so mutual masturbation and oral sex (especially if you don't come in your partner's mouth) are both relatively safe, but our knowledge and understanding of HIV is inadequate at best and the virus itself may be mutating.

Posted by Original Andrew | February 1, 2007 1:14 PM

I agree with Jake. The more people you fuck, the higher your odds of drawing the short straw -- in the form of a sociopath, or an unlucky bloody-gums-meets-poz-precum moment.

Posted by Dan Savage | February 1, 2007 2:16 PM

And I think Eli got it almost right: Don't have sex with meth users. Period.

Posted by Dan Savage | February 1, 2007 2:17 PM

What a god-damn mess. If we were in the 20th century, and public health departments still had some teeth, there would be some hope of containing this.

Despite two decades of education and warning, some people still insist on being utter and complete fools.

And remember, having another STD already dramatically increases the risk of contracting HIV. Doing the math: Oral Herpes + Oral Sex with HIV positive partner does not equal "low risk."

Posted by golob | February 1, 2007 2:40 PM

"one more compelling reason (as if you needed one more compelling reason) not to bareback with people whose HIV status you don’t know."

But Andrew Sullivan was caught advertising for that exact scenario a few years back. On one of his ads, he didn't even disclose his HIV status. And he didn't discriminate on the status of those he 'gifted'. When this was all exposed, Sullivan wrote and article "Sexual McCarthyism" defended his actions saying "I did nothing wrong". Don't you respect Mr. Sullivan's intellectual reasoning and spiritual values?

Posted by Dave | February 1, 2007 2:50 PM


Very easily spread by oral sex. Even without ejaculation. Penis to mouth contact is all it takes.

Syphilis is making a huge resurgence in Seattle. There were 209 reported cases in Seattle in 2006 (and probably many more cases lurking undiagnosed).

Syphilis is treatable but it's an awful disease. I could link to photos but they're a bit gruesome for a family show like this. Syphilis is much more awful and destructive than the more typical, treatable STD's like gonorrhea or chlamydia.

So oral sex without condom may be safer than anal sex, but thanks to syphilis and multi-drug resistant HIV it's a lot less safe than it used to be.

Posted by Barak Gaster | February 1, 2007 3:02 PM

Ok, no one here is advocating barebacking or using meth, quite the opposite.

What I'm saying is that there are some men, gay and straight, who are wired to fuck everything they can get their hands on. It's not our society's ideal, but there it is. Shouldn't we be asking them to only engage in relatively safe activities like mutual masturbation and oral sex? They're still going to get off. And yes some STDs may still be an issue, but those are the treatable ones.

I'm just being pragmatic.

Posted by Original Andrew | February 1, 2007 3:52 PM

Hey, Dan!

I remember that you didn't think the NY "superstrain" scare was credible. What's your take on THIS one?

Posted by BD | February 1, 2007 4:11 PM

So what's the difference between 'hard-wiring' and addiction?

Should chronic DUI offenders be told it's okay as long as they stick to beer?

Apologies for the rhetoric, but I know too many guys whose non-ejaculatory oral adventures turned into a very expensive pill, everyday. Forever.

Posted by Jake | February 1, 2007 4:18 PM


I hadn't heard of any confirmed cases of people becoming HIV positive solely from oral sex, giving or receiving.

Do you have any links? I haven't found anything about that on my own.

Maybe addiction and high volume sex behavior is linked. It would make sense if the same parts of the brain are stimulated, but that's just supposition on my part.

The point is that there are some men who are going to have risky sex no matter what, so persuading them to engage in less risky behavior than barebacking may be more effective than trying to stop them from hooking up.

Posted by Original Andrew | February 1, 2007 4:35 PM

Why are we still talking HIV as only a gay man's disease?

Posted by dre | February 1, 2007 4:46 PM

for whatever it's worth dre, I am a straight man and this scares the shit out of me not as 'gay man's disease' but rather as a public health disaster in the making. It is worth noting that there are far more straight people with HIV than gay (in absolute numbers). Still doesn't excuse irresponsible behavior, gay or straight.

A tidbit: the most dangerous species of HIV, HIV-2, is both adapted to tranmission through heterosexual intercourse AND instrinsically resistant to an entire class of HIV meds (non-nucleoside analog RT inhibitors).

Posted by golob | February 1, 2007 4:53 PM


could you explain to us JUST WHY these strains are resistant to reverse transcriptase inhibitors?

Posted by BD | February 1, 2007 4:56 PM

@11: you say there were 209 cases of syphilis in Seattle in 2006. Yet, according to data from the Washington State Dept. of Health (as of last week), there were 147 cases in King County in 2006.

@15: Well there are some cases where HIV does appear to be tied to oral transmission. Don't have the refs offhand, but there were some cases in Toronto of female prostitutes in the late 90s whose risk factor was identified as giving oral sex. All were heavy crack smokers and had chronic mouth lesions and gum infections.

In the southeastern US (where the epidemic is largely heterosexual, in answer to dre @ 16), there is some belief that there is a fair amount or male to female oral transmission...again largely among crack smokers.

Posted by gnossos | February 1, 2007 5:03 PM

here's a link to one article:

doing googles on: "crack oral HIV" and "toronto crack oral HIV" yields others cites.

Posted by gnossos | February 1, 2007 5:13 PM

HIV-2 is confined to sub-saharan Africa. The rest of the world, including North America, has HIV-1 strains.

HIV-2, while closely related to HIV-1, diverged quite a while ago. Its reverse transcriptase is quite different from HIV-1's. Nucleoside analog RT inhibitors, like AZT, work on both. Non-nucloside inhibitors have nowhere they can bind to HIV-2's RT enzyme.

The new strains reported here in King County are almost certainly HIV-1 strains that have mutated to be resistant to drugs, but probably in a different way than HIV-2.

Sorry if I caused confusion. I was (ineptly) trying to make the point that the scariest HIV running around in the world is one almost entirely a disease of straight people.

Posted by golob | February 1, 2007 5:24 PM

Ok, Golob,

then why are they pushing NEVIRAPINE on Africa? It's a NNRTI.

Posted by BD | February 1, 2007 5:29 PM


seriously, let's get your input on this one.

You didn't take the NYC superstrain to be credible.

Is this one credible or not?

Let's hear it!

Posted by BD | February 1, 2007 5:35 PM

If you research "Patient Zero," you will find that the whole story of a patient spreading HIV exponentially is false. First off, the term is Patient O - the O stood for "Out of California," not zero. Refer to Wikipedia's entry on Patient O, as it states that the doctor from the CDC has since repudiated his original findings. Also, remember the recent news story of an HIV+ individual in NY who supposedly had a super- resistant form of the virus proved to be false. This article is hysterical and in time will fade away as the spread of super bugs has never borne out in 25 years of AIDS.

Posted by MB | February 1, 2007 6:09 PM

Yes, Gaetan Dugas as patient O, who was made famous (or infamous) in "And The Band Played On" as somebody who Don Francis could supposedly tie a bunch of cross-country "AIDS" cases together.

Unfortunately, people still believe the fairy tale of Gaetan Dugas being "patient zero". But the CDC doesn't officially back that claim.

Now, I'm just waiting for Dan Savage to pipe in on this supposed Seattle superstrain (nice alliteration!). He didn't find the NYC superstrain to be credible, and neither did Bob Gallo, by the way.

So, Dan, Seattle superstrain...credible or not?

Posted by BD | February 1, 2007 6:19 PM

BD: Dan Savage is capable of "validating" whether there's a superstrain or not? The man may spout opinions, but opinions are like assholes, and god knows most of them just release shit.

Way to suck up, sheep. baaaaaaa.

Posted by OP | February 1, 2007 6:35 PM

I know he can't validate it or not. I would just like to see him go on the record.

C'mon, Dan!

You're always so chock full of opinions on AIDS. What's it going to be on the Seattle superstrain?

Posted by BD | February 1, 2007 6:43 PM

Mr. Sanders,

Being that the story of Gaetan Dugas being "patient zero" isn't supported by the CDC, what are you trying to say here with a "patient zero" in Seattle?

Maybe you can use your powers of investigative reporting and find Seattle's Gaetan Dugas?

Posted by BD | February 1, 2007 7:05 PM

Let me help you, Mr. Sanders...

Instead of the Christopher Frizzelle approach which is to focus exclusively on ugly old men at "Club Z", you'll need to go check out Club Seattle, where the younger, hotter guys go. And, you really should take a look at the various bareback websites. Last time I checked there were several thousand ads placed by men in Seattle. Oh, yeah, don't forget the blow job club.

Tell us when you find "patient zero"!

I smell a witch hunt!!

Posted by BD | February 1, 2007 7:21 PM

Super HIV Strains? Here's some important info I'm sure not too many of you have thought of . . . you may think oral sex is fine . . . I only practiced low or no risk behavior - but I caught HIV from freshly shaved balls! Trust me.

Posted by Seattle Out Here | February 1, 2007 9:44 PM

As far as HIV-2 and NNRTIs go, both HIV-1 (for which NNRTIs work) and HIV-2 exist in Africa, with the majority of cases being HIV-1. That's why neviripine is still being, ahem... "pushed" in Africa. It works quite well against HIV-1, especially in the setting of preventing vertical mother-to-child transmission during birth.

Posted by Dr. Richard | February 1, 2007 9:48 PM

An excerpt from an article about Nevirapine.

In “The Trouble with Nevirapine,” Brink points to another transmission study, done in July, 1998 (Journal of AIDS and Human Retrovirology). The study looked at 561 expectant African mothers and newborns to see what the rate of presumed HIV infection was with no drugs, no pills and no placebos. The result – 12%. Less than the 13.1%, with none of the drug toxicities. This result was roundly ignored in the quest to bring Nevirapine to market.

Link to the full article.

Posted by BD | February 1, 2007 10:00 PM

@19: Syphilis cases per King County Dept of Public Health were 209 in 2006 which is up from 52 in 2002.

Posted by Barak Gaster | February 2, 2007 9:50 AM

@33 -- thanks for that link Barak...I'll follow up on this...what's odd is that although the State and County numbers for reported gonorrhea and herpes match up, the numbers for syphilis are very discordant.

Posted by gnossos | February 2, 2007 2:22 PM

one mystery solved...another started?

Turns out the state DOH numbers I was using are for primary and secondary syphilis (and that's what they forward on to the CDC). The County numbers include early and late syphilis.

Posted by gnossos | February 2, 2007 2:43 PM

Eli Sanders has an agenda and I don't believe any of the stories he posts.

Posted by SkepticMO | February 3, 2007 4:54 PM

Bush and the Republicans were not protecting us on 9-11, and we aren't a lot safer now. We may be more afraid due to george bush, but are we safer? Being fearful does not necessarily make one safer. Fear can cause people to hide and cower. What do you think? How does that work in a democracy again? How does being more threatening make us more likeable?Isn't the country with
the most weapons the biggest threat to the rest of the world? When one country is the biggest threat to the rest of the world, isn't that likely to be the most hated country?
If ever there was ever a time in our nation's history that called for a change, this is it!
We have lost friends and influenced no one. No wonder most of the world thinks we suck. Thanks to what george bush has done to our country during the past three years, we do!

Posted by Antibush | February 12, 2007 12:52 PM

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