This is the second in a series of interviews with medical and health professionals in Fort Lauderdale about issues of interest to the LGBTQ community.
Dr. Patrick Kenney is a specialist in Infectious Diseases at Midland Medical Center on East Oakland Park Blvd., and specializes in the treatment of HIV/AIDS. Dr. Kenney completed his Infectious Disease fellowship at the University of South Florida Morsani College of Medicine. We interviewed him on a range of topics related to HIV in South Florida including the area’s alarming infection rate, advances in treatment and the precise significance of being HIV positive but “undetectable.”
JACKSON: If statistics are to be believed, the HIV infection rate among MSM (men having sex with men) is dropping nationally but increasing in South Florida. Can you offer a medical perspective on that trend?
DR. KINNEY: South Florida is a very popular destination among the MSM population, bringing travelers from all over the globe to come and enjoy our community. Unlike South Florida, other regions may not have the HIV awareness or have testing facilities readily available. Therefore, men who visit the area may not know their status and to their knowledge they are “negative.” There are many theories, but as a practitioner in the community, I can see that most transmission is occurring via anonymous unprotected intercourse.
JACKSON: The effectiveness of HIV medications has increased dramatically in the last decade. How much easier is it to manage HIV infection today on a long-term basis?
DR. KINNEY: HIV has become easier to manage than diabetes, honestly. I must stress, however, that the success of the treatment lies heavily in the compliance of the patient. The new medications are much better tolerated and do not possess nearly the amount of side effects as the older medications. That being said, it is imperative for patients to communicate with their health care provider so they can come up with a treatment regimen that works for that particular patient.
JACKSON: This year a new record was reached as more than half of individuals living with HIV in the United States were aged 50 or older. What are we learning about aging with HIV? What are the challenges, if any?
DR. KINNEY: We are very fortunate that HIV-infected individuals have the capacity to live a healthy life. But like any chronic illness, HIV can affect several body systems, especially the cardiovascular system. Also, our aging community was faced with having to take some of the earlier HIV medications which did have severe side effects including anemia, lipodystrophy (fat redistribution), and atherosclerotic disease. However, studies have shown that, with viral suppression from the HIV medications, we are able to decrease the amount of inflammation the virus causes on the vascular system. We still have a great deal to learn from our aging patients, but we are so happy that the majority of them are doing well despite the grim prognosis they may have been faced with 30 years ago.
JACKSON: The new buzzword in our community is being positive but “undetectable.” In medical terms, what does undetectable mean and how does it affect potential transmission of the virus to a sex partner who is HIV-?
DR. KINNEY: I hear this question quite a bit. Yes, if a person is HIV positive and is on medications that suppress the virus making the virus undetectable in the blood, the risk of transmission to an HIV negative partner is very slim. In serodiscordant couples (where one partner is HIV positive and the other is negative), viral suppression from the medications have allowed these couples to have unprotected intercourse with a decreased fear of transmission. In those patients who are HIV positive and having sex with multiple partners, there can be exposure to other strains of HIV which can lead to what is called “transmitted resistance.” This means that one person can acquire resistance to HIV medications from another person’s HIV status. However, use of antiretroviral medications and barrier methods with condoms reduce transmission substantially and is still the recommended practice.
JACKSON: Today we are experiencing an unprecedented popularity in barebacking – that is, having unprotected sex – among gay men, and a belief that an HIV negative top having anal sex with an HIV positive bottom faces little, if any, risk. What’s your response to that belief?
DR. KINNEY: Statistically, the receptive partner is at a higher risk for HIV transmission. However, in my practice, I have seen HIV transmission occur from HIV positive bottom to HIV negative top because, like all statistics, there is no guarantee that being a HIV negative top [means one] is absolutely safe from HIV transmission.
JACKSON: Biomedical advances have just given us pre-exposure prophylaxis and post-exposure prophylaxis (PrEP and PEP respectively) which, when taken as prescribed, are close to 100% effective in eliminating the transmission of HIV. Are your patients requesting PrEP and are you recommending it?
DR. KINNEY: Yes, I have several patients that are on PrEP. I believe PrEP has a huge potential for limiting the transmission of HIV in our community. We live in a high endemic area of HIV infection and we are fortunate to have several resources here in South Florida that give patients an access to HIV medications. I also firmly believe that if a person is interested in PrEP, they need to speak to a health care provider that is knowledgeable of it and what the potential risks and benefits PrEP has. I recommend PrEP for patients who are engaging in high risk sexual behavior with a known HIV positive partner or with multiple partners. I also recommend that PrEP be used in conjunction with condoms as PrEP will only protect from HIV but not from other sexually transmitted infections such as gonorrhea, chlamydia, or syphilis. STI screening should be done every three months as all of these infections have tremendously high prevalence in our community.
Peter Jackson is a fitness and nutrition expert and the owner of Push Fitness, Club One CrossFit and Inner G Yoga in Oakland Park, Fl. E-mail him your questions and concerns at [email protected] or visit him online at www.PushFitnessFTL.com
Photo courtesy of Dr. Patrick Kinney.
