World AIDS Day: linking HIV activism and cannabis decriminalization
On the occasion of World AIDS Day, we share with you a brief overview of the activism for the decriminalization of cannabis use undertaken by people living with the Human Immunodeficiency Virus (HIV).
Since 1988, December 1 has been recognized as a date to remember those who have dedicated their lives to supporting patients and families facing this sexually transmitted infection (STI). In turn, the World Health Organization(WHO) has made this date an opportunity to highlight the work of non-governmental organizations (NGOs) and collectives.
The fight against HIV is one of the most documented examples of the possibilities of civil society organization and advocacy. At the regional level, there are several initiatives. Fundación Huésped, Fundación Decida, Organización de Apoyo a una Sexualidad Integral frente al SIDA (OASIS), Acción Solidaria, Fundación Amigos de la Vida, Manos Amigas por la Vida, Mujeres Positivas and Asociación de Ayuda al Sero Positivo (ASEPO) are some of them (1).
In the case of Mexico, we can trace the trajectory of Acciones Voluntarias sobre Educación en México A.C., VIHve Libre, Centro de Atención Vive Aguascalientes (CAVA), Red Mexicana de Jóvenes y Adolescentes Positivos, Inspira A. C. and Fundación Mexicana para la lucha contra el SIDA.
Medical perspective: basic notions
Alongside the microorganisms that cause smallpox, measles and coronavirus, HIV is considered one of the 15 viruses that have changed the history of mankind (2). It has therefore been one of the protagonists of the professionalization of specialists in different fields of medicine.
However, there is still no cure. According to experts from the Infectious Diseases Service (Hospital Universitari Barcelona Clínic), this is due to the fact that HIV can remain in the organism by four mechanisms: latently infected cell reservoir, permanent replication, anatomical sanctuaries and immune dysfunction (3).
In order not to delve into complex terms and explanations, we will limit ourselves to demarcate HIV as a virus that directly affects the cells of the immune system. These cells are called targets (commonly known as CD4). Once HIV is in the cell, it begins to multiply. This is how it manages to transport itself to the rest of the body through the blood.
As a result, the body is greatly weakened. As a result, a person living with HIV is much more susceptible to complications from infections and diseases that, in the absence of HIV, he or she could safely cope with.
One of the particularities of HIV is that its symptoms are not always immediate. Following research since the 1980s, it is known that signs of HIV include canker sores, severe fungal infections, chronic pelvic inflammatory disease, extreme fatigue, dizziness, sudden weight loss, abnormal bruising, swollen glands, dry coughing spells, numbness of the feet and hands, and prolonged night sweats.
Therefore, it is important that if you are sexually active or have been in a risky situation (e.g., sex without a condom, drug use, blood transfusions, exposure and contact with fluids from a person living with the virus or suffering from an STI such as gonorrhea, chlamydia, syphilis, bacterial vaginosis and herpes), you should undergo the corresponding tests. To date, there are three types of HIV tests (5):
Nucleic acid testing (NAT), also known as "viral load testing".
Antigen and antibody testing
Antibody test
Activism: link between the fight against HIV and the decriminalization of cannabis use
The second half of the 20th century brought with it the articulation of different social movements. By the 1980s - just at the time of the so-called "HIV crisis" - a joint action was evident between activists of sex-generic diversities and collectives that advocated the recreational and medicinal use of the plant.
Because of the context, the LGBT+ community focused its attention on the second reason. While the scientific sector remained in the arduous task of providing an explanation for a seemingly new virus, representatives of sexual dissidence began to realize that cannabis could emerge as an alternative to treat HIV.
One of the leading figures in LGBT+ and cannabis activism was U.S. Air Force pilot Dennis Peron. Peron's motives for getting involved in cannabis decriminalization were many. Initially, when he returned from Vietnam (16), he was one of the activists who militated alongside Harvey Milk, soccer player, opera singer, student of excellence, founder of the Castro Village Association and -primarily- one of the first politicians to declare himself openly gay.
Another cause that brought Dennis to the streets in favor of cannabis was his own history. Under prohibitionist policies he was jailed on more than one occasion. One of the arrests stemmed from a raid at the hands of the police. Dennis lived with Jonathan West, who was his romantic partner and living with HIV.
Upon receiving his diagnosis, Jonathan began treatment with the drugs known at the time. To lessen his discomfort, including nausea and pain, he turned to cannabis. On the night of the police raid, traces of the plant were found and Dennis was arrested and spent six months in prison.
Although the couple joined forces with groups fighting against HIV, Jonathan passed away. In his name, Dennis founded Californians for Compassionate Use. One of the great contributions of this association was the promotion of Proposition 215, which, in 1996, requested the government of San Francisco to recognize cannabis as a complementary treatment for HIV patients (17). It also advocated for people living with multiple sclerosis, glaucoma and .
Of course, the initiative for medical cannabis as an adjunct to HIV treatment was not a legacy of Peron alone. Other names recognizable in this struggle include Anna Boyce, John Entwistle, Valerie Corral, William Panzer, Dale Gieringer, Leo Paoli, Scott Tracy and Mary Jane Rathbun. It was with Rathbun (popularly known as Brownie Mary) with whom Dennis opened the first medical cannabis clinic in San Francisco.
The pioneering activism of the members of Californians for Compassionate Use had an impact on other generations. Among the ranks of the association's supporters were Andrea Tischler and Paul Scott. Andrea (also called Nurse Mary) was a lesbian activist. She was one of the most important figures in HIV information work. In the early 1990s, she became involved in the legislative arena.
For his part, Paul founded the LA Black Gay Parade. This was one of the initiatives denouncing that prohibitionist policies had a greater impact on racialized, LGBT+ and HIV-positive people. In addition to mobilizing important debates, Paul Scott helped LGB+ people of African descent gain access to medication. The area where he focused his activities was Oakland (18).
What is known about cannabis use by people living with HIV?
In early March 2019, UNAIDS released a text in which it described the legalization of the plant as problematic (19). However, by the following year, the HIV Treatment Working Group (gtT-HIV) expressed that "users may be less likely to experience cognitive impairment" (20). According to the observations of the experts, the benefit could derive from the plant's anti-inflammatory properties.
In the same year, gtT-HIV reported that the number of HIV patients using cannabis increased at least threefold. Users said it helped relieve pain and nausea. They also noted that they found benefits in other aspects of their lives. For example: improved mood and restored appetite.
Despite HIV being the most studied virus in history, research on cannabis is still scarce. In the same July 2020 publication, gtT-HIV shared details of a study conducted by the University of California, San Diego. In order to have reliable information, the specialists in charge collected data corresponding to the period between 1998 and 2016.
A total of 952 people participated, 679 of whom were living with HIV: 75% were on treatment, 47% remained undetectable and 27% reported the presence of the virus in the cerebrospinal fluid. For the assessment, participants completed interviews and underwent neurocognitive tests to obtain data on verbal fluency, processing speed, learning, memory and motor skills. Of the 679 people with HIV, 106 reported using cannabis. After a comparison, it was concluded that this sector of the study was 47% less likely to experience cognitive impairment.
In order to provide further scientific evidence on cannabis and HIV, the Spanish Observatory of Medicinal Cannabis has a special section on its website (21). In a 2014 study, three researchers found that cannabinoids "have potential to serve as a therapeutic agent in decreasing HIV-associated neuroinflammation" (22).
Meanwhile, in 2015, researchers from Temple University (Philadelphia, USA) added that, by binding to the CB2 receptor, "cannabinoids could reduce the multiplication of the virus in certain white blood cells" (23). In addition to the findings of such research, there are the opinions of some health professionals.
In this group we find David Alberto Montoya Tavera, who is an agent at the Universidad de la Sabana (Colombia). In mid-2020, the pediatrician also had an interview with the organization Red Somos. During the talk he pointed out that "95% of HIV patients improve in relation to appetite" (24). According to what he said, the use of the plant also helps to improve mood. From a less enthusiastic point of view, the National Institute of Health of the United States (NIH) offers the following observations (25):
At least in the United States, no comprehensive surveys have been conducted to obtain reliable data on the potential improvement of HIV patients who use cannabis.
Research on the anti-nausea properties of cannabis has focused on chemotherapy-induced emesis in people suffering from cancer.
Many people in the AIDS phase turn to cannabis to counteract weight loss.
There are no studies to assess the health status of people living with HIV who smoke cannabis.
Research is needed to address the question of whether cannabis use can lead to dependence in HIV patients.
HIV Express Glossary
It is very important to be clear that HIV and AIDS are not synonymous. While HIV refers to the condition of the immune system, the term AIDS is used to talk about the final stage of HIV. To further explain this, HIVve Libre reminds us that "living with HIV is not the same as being in the AIDS stage. AIDS does not give you AIDS; it is the late stage of HIV" (4).
In other words, AIDS can be defined as "the set of diseases and symptoms related to the weakening of the immune system". And now that we have taken this point into account, we will share with you some of the central concepts in the approach to HIV:
Window period: interval in which HIV antibodies take time to be detected. On its website, Fundación Huésped states that it ranges from three to four weeks after transmission (6).
Antiretroviral therapy (ARV): drugs used for the treatment of HIV infection. It consists of a combination of three ARV drugs, which are classified as: nucleoside reverse transcriptase inhibitors (NRTIs); non-nucleoside reverse transcriptase inhibitors (NNRTIs); boosted protease inhibitors (PI/r); integrase inhibitors (INSTIs); fusion inhibitors (FIs); CCR5 co-receptor antagonists (7). According to the National Center for HIV/AIDS Prevention and Control (Censida), medication is independent of CD4 cell count and the presence or absence of symptoms. It is also emphasized that the purpose of antiretroviral treatment is the maintenance of virological suppression (8).
Pre-exposure prophylaxis (PrEP): a complementary prevention tool that is part of safer sex practices. It is considered a valuable option for those who have tested negative for HIV but are at substantial risk. Medically it is defined as the systematic use of antiretroviral drugs. The pills consist of emtricitabine (FTC) and Viread (tenofovir). As noted by WHO, the PrEP pill is taken once a day (9).
Post-exposure prophylaxis (PEP): unlike PrEP, it is taken only when the patient has been in a risk situation. The maximum time to administer it is 72 hours. The shorter the time the better. If taken six hours after exposure, it is 98% effective. If it is taken during the limit period, the percentage drops to 80 %. The drug combination must be maintained for 28 days (10).
Serodiscordant couples: sex-affective relationships in which one of the partners is living with HIV (11).
Indetectabilidad: persona con carga viral <50 copias VIH/ml (12).
Intransmissibility: inability to transmit HIV due to viral load.
Undetectable = untransmissible: people living with HIV are on antiretroviral therapy and have an undetectable viral load. This means that they have a negligible risk of transmitting the virus through sexual intercourse (13).
Patient B24: according to notes from the Pan American Health Organization (PAHO), this is a category for classifying AIDS with its different complications. Such as: malignant tumors, infectious and parasitic diseases (14).
Serophobia: stigma and discrimination against people with HIV in various areas of daily life, in affective and sexual relationships (15).
References
1. Organización Panamericana de la Salud (1999) Catálogo de Organizaciones No Gubernamentales (ONGs) dedicadas al Sida en Argentina. Recuperado de <sitio web>, última consulta 25 de noviembre de 2021.
2. Rivas, R. (2020) Quince virus han cambiado la historia de la humanidad. Recuperado de <sitio web>, última consulta 27 de noviembre de 2021.
3. Rodríguez-Muñoz, J. y Moreno, S. (2018) Estrategias de curación de la infección por VIH. Recuperado de <sitio web>, última consulta 25 de noviembre de 2021.
4. Vihve Libre (2021) ¿Qué son el VIH y el sida? Recuperado de <sitio web>, última consulta 25 de noviembre de 2021.
5. Fundación Mexicana para la lucha contra el sida A.C. (2021) Pruebas de detección. Recuperado de <sitio web>, última consulta 25 de noviembre de 2021.
6. Fundación Huésped (2021) ¿Qué es el VIH y cómo se detecta? Recuperado de <sitio web>, última consulta 25 de noviembre de 2021.
7. Instituto Mexicano del Seguro Social (2017) Tratamiento antirretroviral del paciente adulto con infección por VIH. Recuperado de <sitio web>, última consulta 20 de noviembre de 2021.
8. Censida (2021) Guía de manejo antirretroviral de las personas con VIH. Recuperado de <sitio web>, última consulta 25 de noviembre de 2021.
9. Flores, A. (2021) 5 preguntas más frecuentes sobre PrEP. Recuperado de <sitio web>, última consulta 25 de noviembre de 2021.
10. Almazán, Y. (2019) Diferencias entre la PrEP y PEP que debes conocer. Recuperado de <sitio web>, última consulta 25 de noviembre de 2021.
11. Gaona, P. (2021) Parejas serodiscordantes cuentan su experiencia viviendo con VIH. Recuperado de <sitio web>, última consulta 25 de noviembre de 2021.
12. Red Mexicana de Jóvenes y Adolescentes Positivos (2021) Manual para Juventudes con VIH en Ciudad de México. Recuperado de <sitio web>, última consulta 27 de noviembre de 2021.
13. Onusida (2018) Indetectable = intransmible. La salud pública y la supresión de la carga vírica del VIH. Recuperado de <sitio web>, última consulta 20 de noviembre de 2021.
14. Organización Panamericana de la Salud (2019) Causa de fallecimiento: Sida. Recuperado de <sitio web>, última consulta 20 de noviembre de 2021.
15. Ministerio de Sanidad, Servicios Sociales e Igualdad (2018) Glosario de términos sobre diversidad afectivo sexual. Recuperado de <sitio web>, última consulta 25 de noviembre de 2021.
16. Roberts, C. (2020) The Man Who Didn’t Legalize Marijuana: Dennis Peron’s Complicated Legacy. Recuperado de <sitio web>, última consulta 27 de noviembre de 2021.
17. Flores, A. (2021) ¿Cómo ha contribuido la comunidad LGBT+ a la lucha cannábica? Recuperado de <sitio web>, última consulta 27 de noviembre de 2021.
18. Sarroco, V. (2020) The Intersection of LGBTQIA+ and cannabis culture. Recuperado de <sitio web>, última consulta 27 de noviembre de 2021.
19. Organización de las Naciones Unidas (2019) Cura para el VIH, cannabis, la noticia del martes. Recuperado de <sitio web>, última consulta 27 de noviembre de 2021.
20. Villar, M. El uso de cannabis reduciría la probabilidad de desarrollar deterioro cognitivo en personas con VIH. Recuperado de <sitio web>, última consulta 27 de noviembre de 2021.
21. s/a (2021) VIH y cannabis. Recuperado de <sitio web>, última consulta 27 de noviembre de 2021.
22. Rabon, E., Jamerson, M. y Marciano-Cabral, F. (2014) Cannabinoid inhibits HIV-1Tat-simulated adhesion of human monocyte-like cells to extracellular matrix proteins. Recuperado de <sitio web>, última consulta 27 de noviembre de 2021.
23. Ramirez, S. et. al (2015) Attenuation of HIV-1 replication in macrophages by cannabinoid receptor 2 agonists. Recuperado de <sitio web>, última consulta 27 de noviembre de 2021.
24. Red Somos (2020) Cannabis, sexo y VIH, ¿prejuicio o desinformación? Recuperado de <sitio web>, última consulta 27 de noviembre de 2021.
25. NIH (2001) Marijuana and Aids. Recuperado de <sitio web>, última consulta 27 de noviembre de 2021.