Two potentially deadly disease outbreaks in Alaska have public health officials on edge, particularly at Fort Wainwright in Fairbanks.
Since January 2011, newly-reported cases of HIV in Fairbanks have more than doubled, according to Susan Jones, Alaska's HIV/STD program manager. In any given year, between two and four new cases are reported in Fairbanks. Last year, they spiked, with at least nine individuals newly diagnosed as HIV positive.
Statewide, between 20 and 40 newly-acquired and newly-reported cases of HIV/AIDS are reported to public health officials most years, Jones said. But in 2010, the last year official numbers were reported, there were 77 cases reported: 38 people who'd been infected that year, and 39 people who'd been previously diagnosed HIV positive, possibly elsewhere, but who were new to Alaska.
"If you look at the total numbers for 2011, we really haven't increased the overall state numbers at all. You really have to break down the numbers" to find the Fairbanks outbreak, Jones said.
A few things stand out about it:
- Seven of the newly-infected patients were connected in some way to the military. They were either active duty soldiers at Fort Wainwright, sexual partner(s) of someone in the military, or the family members of someone in the military.
- Gay or bisexual men account for all but one of the new cases.
- Six had a documented, negative HIV diagnosis in the 13 months prior to testing positive.
- Four were not yet 20 years old.
"An increase of nine is certainly cause for us to look at," Brandi Ostanik, a spokesperson for Medical Activity Alaska (MEDDAC-AK), the military's umbrella health-care organization here. "In 2010, for Fairbanks and Fort Wainwright, there were only three (newly-reported) cases of HIV/AIDS."
Online 'hookups' account for most new HIV cases
In post-diagnosis interviews with public health officials who track HIV infections, the patients answered questions about sexual activity and partners. Eight of the new patients acknowledged having high-risk, unprotected and/or anonymous sex with random partners. Jones said Craigslist and Adam4Adam were the two most-cited websites used in Alaska to cruise for anonymous hookups.
The first generation of HIV/AIDS patients, whether men or women, often contracted the illness by sharing syringes, having sex with prostitutes or, for men who have sex with other men, at public bath houses. Today's generation of HIV-positive people overwhelmingly hook up online, anonymously, Jones said. And that poses another problem for public health professionals on the front lines, attempting to stop disease from spreading.
"It's very difficult for us to track and notify" everyone who is exposed to HIV online, Jones said. "Anonymous sex partners are people (patients) don't know very well. Or sometimes they don't want to tell us" about all of the partners who may have been exposed.
"We simply don't know how many people in Alaska have been exposed and are infected and are not aware," she said.
Another problem: newly-positive men and women are more infectious in months immediately after contracting the virus. The sheer quantity of virus in a newly-positive person's blood can increase likelihood of transmitting HIV to others. Fairbanks' HIV spike in 2011 and 2012 appears to come from those recently infected. That could mean greater potential for "increased transmission as persons with acute HIV infection often have higher (viral loads)."
The virus has evolved since its discovery in the early 1980s. Whereas early HIV patients might have lived 10 years without showing a single symptom of illness, today's virus can be even deadlier, depleting a person's immune system on a much faster timeline and leading to an AIDS diagnosis. Health risks can grow when newly-positive people continue engaging in unsafe sex and contract another strain of the virus. This can then potentially spread so-called "superinfections," some of which may be resistant to the medications credited with transforming HIV/AIDS from deadly epidemic to manageable chronic illness.
These concerns prompted the state to release the bulletins Tuesday, Jones said. The sooner that people know their HIV status, the quicker they can receive treatment and manage the disease. HIV testing isn't mandatory in Alaska but is available at public health clinics across the state, as well as through community programs.
In Fairbanks, free HIV testing was available this week at the Fairbanks Regional Public Health Center and from Interior AIDS Association, Greg Wilkinson, a Department of Health and Social Service spokesperson, said Tuesday. In Anchorage, the Alaskan AIDS Assistance Association (Four A's) offers free HIV testing daily.
The U.S. military tests soldiers for HIV every two years and requires annual training on high-risk sexual behaviors, Ostanik said. The military does not accept HIV positive applicants but does require additional testing for soldiers who are deploying or returning from overseas.
HIV-positive soldiers can stay on active duty, though they "have special rules" and become ineligible for deployment. Ostanik said soldiers shouldn't avoid testing: those who test positive can remain active duty until they become really sick and begin to "demonstrate progressive clinical illnesses or immunological deficiency."
Early on after infection, most HIV symptoms are similar to other common maladies like seasonal flu or a really bad cold, sometimes leading to misdiagnoses. That's why health officials encourage regular testing. According to the Centers for Disease Control and Prevention and other HIV/AIDS health sites, a person may experience swollen lymph nodes, fever, night sweats, rapid weight loss, diarrhea, prolonged herpes outbreaks, thrush or, recurring vaginal yeast infections, usually about two weeks after contracting the virus.
19 new cases of syphilis in Alaska
At the same time Army and public health officials battle HIV in Fairbanks and on Fort Wainwright, another dangerous STD has resurfaced across the state, though it appears concentrated in Southcentral Alaska.
Between Jan. 1, 2011 and Valentine's Day 2012, 19 new syphilis cases have been reported, Jones said. Of those, 10 were Anchorage residents, two were in Fairbanks, one was from an unnamed rural village, and three were patients who'd already tested positive for HIV. The 19 new cases ranged in age from 20 to 56, and included eight women and 11 men. Eight of the men were gay or bisexual and seven reported having anonymous sex with multiple partners, according to a state report.
Syphilis, if untreated, can lead to neurological complications and in advanced cases can cause dementia. Early-stage symptoms include open sores or a rash. Those types of sores, Jones said, can make it easier for an HIV positive person to transmit the virus to someone who's negative.
Indeed, syphilis infection rates decreased dramatically in the mid-1900s with the broad availability of antibiotics. Infection rates have been on the rise again since the emergence of HIV/AIDS.
Alaska hasn't had a serious outbreak of syphilis since 2004, Jones said. People who contract syphilis can "clear" the infection -- the closest thing to "curing" the malady. But Jones warned that sexually active people engaging in high-risk behaviors can re-contract syphilis.
"One person in the 2004-2007 syphilis outbreak actually got it twice," Jones said. "Clearly he didn't change his behaviors."
Contact Eric Christopher Adams at eric(at)alaskadispatch.com