Pictured A protest against Norvir's price jump.
AIDS remained the No. 1 health concern within the GLBT community. The news was modestly good on the medical side with new drugs advancing in the pipeline and coming to market, though nothing to significantly change the standard of care for the disease.
HIV became costlier to treat with the 400 percent price increase for Norvir ( ritonavir ) that Abbott Laboratories introduced in December 2003. The drug is used primarily to 'boost' other protease inhibitors by slowing their clearance through the liver.
Many of the nation's leading AIDS docs formed an ad hoc group to protest the increase and boycott the company, an action that continues to this day. Opponents of the increase claimed it was an attempt by Abbott to gain market share at the expense of its competitors. They said the company had not invested any money in developing this use and it was cutting back on other AIDS research.
The NIH contributed $3.5 million to the very early development of ritonavir and owns key patents on the drug, which it licenses to Abbott. In May, because of the price increase and based on a petition asking it to do so, the NIH held a meeting to consider whether to initiate a never before used regulation and allow other companies to produce the drug. In the end it decided not to do so.
'Facial lipoatrophy has become the scarlet letter of AIDS,' veteran San Francisco AIDS doc Marcus Conant told an FDA advisory committee at the end of March. 'It is the thing that is bothering our patients the most ... even doctors wait to start their medication.' Nearly half of all patients experience a degree of facial lipoatrophy within three years of beginning therapy.
The meeting discussed Sculptra, an injectable material used to fill in and restore those facial ravages. The FDA approved its use in August.
The cost of treating HIV continued to increase, as did the number of people seeking government help in gaining access to those medicines and services. Federal funding did not keep pace.
State AIDS Drug Assistance Programs ( ADAP ) , financed largely by the federal government with additional contributions by some states, were hardest hit. Close to half of the programs experienced waiting lists; a tightening of eligibility requirements, or cutbacks in the number of drugs covered.
The Bush administration found an emergency $20 million for the program, which advocates called a band-aid to help cover over the problems until after the election.
May saw large-scale AIDS demonstrations return to Capitol Hill for the first time in years to press for increased funding. It did little good. A combination of tax cuts and the war in Iraq squeezed revenue, and most social programs took it on the chin. The increases for AIDS barely kept pace with inflation and fell short of meeting the continually growing need.
There were disturbing signs that the practice of safer sex continued to erode within the gay community.
In March, the explosion of syphilis among gay and bisexual men caused the Centers for Disease Control and Prevention ( CDC ) to sound the alarm. They 'probably account for more than 60% of all current syphilis cases in the U.S.,' said Ronald O. Valdiserri, deputy director of the CDC's National Center for HIV, STD and TB Prevention. Five years ago MSM constituted only 5% of all syphilis cases.
Crystal methamphetamine is reportedly the driving force behind the increased syphilis numbers in gay men, even while the disease is declining among other populations in the United States.
The spread of drug-resistant gonorrhea prompted the CDC to change its guidelines for treating that infection in gay men but not in heterosexuals. The revisions, released at the end of April, called for a switch from Cipro to the antibiotics ceftriaxone and cefixime.
'Lesbian/bisexual girls were more than six times more likely to have smoked in the past month and almost 10 times more likely to have smoked at least weekly in the past year, compared with heterosexual girls,' according to a study by researcher at Children's Hospital in Boston, released in April.
Fortunately the federal government has begun to fund local programs to urge lesbians to stop smoking and to help them to do so.
The fight for medical use of marijuana won a victory in April when a California judge barred federal law enforcement officials from harassing those growing or using marijuana for use with terminal illness.
However, the victory may be short-lived. In November the U.S. Supreme Court heard arguments on the ruling upon which that decision was based, and the Justices did not appear to be very sympathetic to the legal arguments. A decision is likely in the spring.
