This is an archived article that was published on sltrib.com in 2005, and information in the article may be outdated. It is provided only for personal research purposes and may not be reprinted.
The lethal virus hits a new generation
In the public mind, the HIV virus has mutated from a feared killer to an illness easily managed with new medications.
But under the microscope, HIV's rapid mutations defy new drugs and outpace science's attempts to find a cure. That gap is troublesome to Utah activists and doctors, who worry years of medical advances and declining media coverage have left Americans vulnerable to HIV's growing threat.
"There's a younger generation that denies the danger because they weren't around when everyone was dying," says Kristen Ries, a physician at the University of Utah's infectious disease clinic.
Jake, a 27-year-old student in Salt Lake County, was stunned when he tested positive for HIV just after his 23rd birthday.
"I really didn't think anything about [HIV/AIDS]," he said. "I thought it was one of those things in America that had taken care of itself."
Wendel Kirkbride, who has been living with HIV for more than 17 years, is frustrated that people don't seem concerned about HIV/AIDS. He attributes a recent rise in cases among males age 20 to 29 to their perception of the success of new treatments, which "makes you so you don't want to use protected sex."
At the urging of his church leaders and family, Jake attended weekly sessions at the controversial Evergreen International in Provo, which tries to "cure" same-sex attractions. At age 20, two years into the program, he scrapped Evergreen and came out of the closet.
But being raised with the conservative values of the The Church of Jesus Christ of Latter-day Saints left him ill-prepared to handle the dangers of alcohol and sex, he said. His close friends were either from Evergreen or also LDS, and shared his limited experience.
Most of what he knew about HIV came from a brief mention in a high school health class and pamphlets the Utah AIDS Foundation passed out in bars or clubs.
"I was lied to my whole life. All I was taught about AIDS was that if you are gay, you'll catch AIDS and die," he said. "And then I came out and nobody had it."
He admits he was naive - both in drawing that conclusion and in his thinking that "obviously, the people that I'm sleeping with don't have [HIV/AIDS], because I could tell." He says now: "I just didn't think it was as prevalent as it is."
Testing positive for HIV "was a major wake-up call," he said. "I was thinking, 'Oh my God, I'm going to die by the time I'm 24."
It was a dark and confusing time for Jake, who struggled to absorb what his diagnosis would mean for his life. Dave Ferguson of the Utah AIDS Foundation remembers Jake's reaction.
"Jake was really unsure of his future. With all of the other things going on in his life, this was very overwhelming," Ferguson said. But within nine months, he had told his immediate family about his HIV status, although he asked The Salt Lake Tribune to use only his first name to preserve his privacy with others. He received a grant through the foundation to create a support group for youth with HIV, which has restored his belief in his future.
Ferguson is glad Jake is telling his story.
"The best thing for prevention," he said, "is someone who can say, 'Hey, it happened to me and I didn't think it would, but it did.' "
Mutating at "light speed": After his diagnosis, Jake immediately began taking anti-viral medications, and remains healthy today.
But Ries warns the drugs can cause severe side effects, such as diabetes and high cholesterol. The regimen is expensive and grueling. "You can't miss one dose a week," she said.
When patients stop taking the drugs even briefly, the virus multiplies more easily, potentially causing more mutations. Mutations in the viral genome, the set of genes present in HIV, inhibit the effectiveness of medications.
"There are some people who there are no drugs left for," said Ries, whose clinic treats 90 percent of Utah's HIV/AIDS patients. "In our clinic, we've had more deaths and people in nursing homes and hospice [recently] than we have in a long time."
An increasing number of people with HIV - some experts put it at one in four internationally - are infected with a version that is drug resistant.
Researchers are trying to understand HIV's genetic changes, hoping to develop new drugs. But mutations are occurring too quickly for science to keep up.
Warner Greene, director of the Gladstone Institute of Virology and Immunology in San Francisco, describes HIV as "an evolutionary machine traveling at light speed."
The way HIV replicates is "remarkably error-prone," he said. "Every time it replicates itself it makes a mistake. As soon as you add a drug to one of the mutant viruses, it is resistant to the drug and has a growth advantage."
Further complicating research: There are many different genetic strains of HIV. In 1998, French researchers found a previously unknown strain in a woman from Cameroon in West Africa. In one of the most extreme scenarios recorded, a prisoner in Texas tested positive that year for nine different drug-resistant strains.
Because the various strains exist, people who are HIV positive and have unprotected sex with others who are are HIV positive may contract or pass on other strains.
Researchers believe a vaccine may not be available for another 10 years. Human trials around the globe are still in fairly early stages.
"I was hoping that we'd be further along with a vaccine," Greene said, "but the news is not encouraging."
Fighting prevention fatigue: Kirkbride, who helps the Utah Department of Health allocate funds for those needing assistance obtaining HIV/AIDS related health care, stood up at a recent meeting and vowed to try a personal approach.
He'd like to see photos of himself as a healthy 22-year-old and now, weighing a mere 104 pounds, on an I-15 billboard.
"Maybe they just need it in their face. If I can make even one person stop and think, then maybe me having HIV hasn't been a complete disaster," the Salt Lake City resident said.
But getting people to listen to new information about HIV/AIDS is a struggle, said Tyler Fisher, testing coordinator for the Utah AIDS Foundation. Prevention fatigue, as he calls it, challenges AIDS educators.
"We have to show them how to be healthy as a whole person and include HIV prevention in that package," Fisher said. "We need messages geared toward youth and women and minorities. HIV does happen to them."
A December report by the state health department shows increases in the number of new HIV cases during the last two years in both men and women. Increases were also seen in the Latino and white communities, and in general for those ages 20-29.
The majority of new infections reported between 1998 and 2003 - 53 percent - were among men who have sex with men. The second-highest-risk category, at 13 percent, was injecting drug users. The number of newly infected men who said both they have sex with men and inject drugs doubled from 2000 to 2003.
Another challenge for prevention: About 75 percent of the patients Ries sees have substance abuse problems or are mentally ill.
"We have a major epidemic in Utah with methamphetamine," Ries said. "A lot of people get infected because they use drugs and aren't careful."
Utah's culture, she said, also is a contributing factor.
"It's hard to grow up in such a religious atmosphere if you are gay," Ries said. "Some people come out with a cigarette in one hand, alcohol in another and use drugs. Until we can improve our care of the mentally ill and substance abuse, we're not going to be able to touch the problem."