It's one thing to be deliberately obtuse and out-to-lunch about something as important as a person's health. It's another thing entirely to maintain that ignorance for an extended time.
You all know by now of the exposure to bright sunlight of the recent travails of Mike South, part-time porn producer/director/webminister, and full time gadfly/critic of the LA porn industry and its testing system for STI's.
Michael Whiteacre of The Real Porn Wikileaks has been running a series over there revealing South as a grand hypocrite who mocks LA producers for not forcing condoms down their perfomers throats and not universally testing them for every single infective threat, while he relies on oral swab tests, no condoms, and his own "common sense"/ESP/Spider-Man senses/boner blood as his own screenage against STI's and HIV.
As it turns out, though, South's "expertese" in HIV testing goes a long way back...like even before the initial Darren James/Lara Roxx outbreak hit in 2004. And, the need for real experts to correct his errors go back just as far, too.
The following is a repost of an article that was posted to AVN.com back in June of 2003, where AIM Medical Foundation director Sharon Mitchell responds point-for-point to some comments Mike South made at his blog the weekend before. South was responding to a viewer/reader asking questions about the testing regime used back then; and apparently, the answers he gave didn't quite tell the whole story.
You will note, of course, that the PCR-DNA test that was the gold standard back then has now been itself upended by the Aptima test, which further cuts the latency period down from 14-30 days to 6-10 days. Also, the "protease inhibitors" that used to cloak HIV+ readings for viral load or antibody tests do not affect DNA-based tests or Aptima; and neither do the more recent "retroviral" drugs now used today as treatment for HIV+ people. Other than those caveats, what was said then is as much true today.
I will simply reprint the article in its entirity; the original can be found by clicking the title.
Over the weekend, Mike South, a producer/director in the adult video
business and Internet columnist, answered a question from a reader who
asked him to explain the differences between the RT-PCR/PCR-DNA test(s)
and the ELISA test. Since AVN is in the process of preparing a
series of articles on healthcare within the adult industry, we asked AIM
Healthcare Foundation executive director Sharon Mitchell to comment on
South's answer to his correspondent's questions. What follows are
South's answer, broken into its component parts, and Mitchell's comments
on each part, with some amplification questions from AVN Senior Editor Mark Kernes:
Mike South: The
Viral load tests measure the amount of virus in a blood sample by one
of two methods. The first, the PCR is a process by which the RNA is
chemically treated to cause it to replicate itself, the idea is to
induce replication to a high level, then measure that level knowing that
the replication factor is a constant. This is called an indirect test
because it indirectly measures the amount of RNA in the sample.
Sharon Mitchell: That's a PCR-RNA test.
second called bDNA, this is a direct measurement of the RNA. The sample
is treated to induce the RNA to lumenesce [sic] or "glow" the amount of
light given off indicates how much virus is present.
That's a branch DNA test, which is a form of an RNA test. It's still a
viral load test. We do neither the bDNA nor the RT-RNA. We do PCR-DNA.
Mark Kernes: When Mike South says, "RT-PCR," that's incomplete? It has to say either RT-PCR-DNA or RT-PCR-RNA?
Mitchell: That's correct, and we do the PCR-DNA, not the PCR-RNA.
problem with these tests is that they are only accurate to about forty
parts per million, below that point the virus is undetectable. Someone
who has HIV and has been on protease inhibitor drugs can fall well below
this level and the tests determine them to be HIV Negative which they
clearly are not. They are also most certainly still capable of passing
on the virus to someone else.
Mitchell: That's all
correct, bearing in mind that "forty parts per million" is equivalent of
400 copies per milliliter [see below], but it refers to the PCR-RNA
South: The ELISA test tests for antibodies to
the virus to be present in your system, even though you may show no
signs of illness 95% of all people will develope [sic] antibodies to HIV
within 3 weeks of exposure.
Mitchell: No, no. In
fact, some people can go without developing antibodies for six weeks to
six months, and while six weeks may be great for the general population,
it's not good for people having multiple partners in porn. And
remember, we are using monitoring. We're not looking for a one guy/one
time diagnosis here; we're looking for monitoring based on every 30 days
by PCR-DNA — not RNA, not viral loads. That's why USA Referral [a
testing referral service] is not a good facility for that very reason.
So the first time someone came into you, if you gave them an ELISA test
and it showed negative, they could actually have been HIV positive for
up to six months and you would not necessarily be able to see it on the
Mitchell: Yes. That's why we don't use the ELISA test.
South: This "window period" is in reality no worse than that of the PCR tests, and may even prove better in some cases.
Kernes: He's talking about the PCR-RNA test, apparently.
Right, I know, and this is all relevant to PCR-RNA, but we don't do
PCR-RNA. We can't afford to wait for the window periods of an ELISA or
Kernes: So an ELISA test and a PCR-RNA are really about the same in the sense —
No. One's an antibody test and one's a viral load test; they're two
entirely different things, but they're not effective for this population
when dealing with monitoring.
Kernes: So if someone
had HIV and was not taking protease inhibitors, and got an ELISA test
and a PCR-RNA, which one would be likely to detect the virus first?
Well, it depends. Now, remember, HIV is going to surge in the first
18-30 days, so if you're catching it early, HIV-RNA is going to show a
sky-high viral load. But if we're not catching it early, there'll be
some viral load and it will be relatively over 400 copies per
milliliter, and that could occur any time, at any point. But usually
when I've done the RNA tests, I've done them very early because I've
done them as a confirmatory after ELISA, Western Blot and then RNA,
after a positive PCR-DNA.
Kernes: So they're confirmatory tests for you?
Mitchell: For us, yeah.
And even then, the tests may not confirm because depending on a variety
of circumstances — how long the person has been positive; whether or
not they're taking protease inhibitors — the only one that will actually
show that they have the virus is the PCR-DNA.
Correct. In this case [see below], the RNA will mask the virus because
they still have HIV but they're undetected, and the patient can still
transmit the virus at least 15 percent of the time. Therefore, the one
that we depend upon in case someone is trying to hide the fact that they
have HIV is PCR-DNA, because it will always show the virus is detected.
am surprised that AIM would not offer the ELISA test if you requested
it, specially since it is the ONLY HIV test that is recognized by either
the CDC or the AIDS Foundation as a valid HIV Screen.
Kernes: Why would you give the PCR-DNA in preference to the ELISA test or the PCR-RNA test?
Because of the window period. It's not three weeks; it can be minimum
six weeks to as long as six months, and that's most of the time. Young,
healthy people, for the antibody to mature, could take a lot longer than
your average Joe, and we're dealing with young, healthy people between
the ages of 18 and 25. And also remember, we're monitoring for the HIV
disease every 30 days. That's key here. It's a monitoring system.
Kernes: Is the ELISA test the only test that's recognized by the CDC or the AIDS Foundation as a valid HIV screen?
Mitchell: I don't know.
South: PCR and bDNA testing are emphatically stated as NOT to be used as an HIV screen.
That may very well be, but again, they're dealing with average,
everyday people, everyday tests for the general population. We are
dealing with adult entertainers for pornography and this is a system
that has kept HIV successfully out of porn since the inception of this
Foundation in 1998.
South: Some companies and
performers have been mislead [sic] by AIM so make sure that the person
you are going to work with knows that you have not been tested by AIM,
but have tests from a certified independent [sic] lab. I only accept an
ELISA test but some in porn valley [sic] may only accept a PCR test,
until they have been educated to the facts.
He's got the wrong facts. PCR-DNA is the one that will always show the
virus. PCR-RNA is the one that hides the virus. I've got the proof right
[Note: To support her statements, Mitchell produced two
tests given to the same HIV-positive individual who is currently taking
protease inhibitors, the standard treatment for HIV: A PCR-RNA test,
which indicates that the individual is "Within Range Result" with "Fewer
than 400 copies/ml" of the virus, which would indicate to a physician
who had no idea of the person's actual HIV status that the person was
HIV negative; and a PCR-DNA test, which indicates that the person is
"Outside of Reference Range" and is "Positive" for HIV.]
So if someone in porn attempted to work with just an ELISA test or just
a PCR-RNA, what would be your advice to their partner or to the company
that's employing them?
Mitchell: Do not do it. To a
performer, I'd say you're putting yourself at risk because these two
types of methods, ELISA and PCR-RNA, are hiding HIV at its earliest, and
you may be working with someone that just has gotten HIV — it's not
going to show up on either of those tests — or you may be working with
someone that's HIV positive that's on medications and is not showing up
on this RNA test, that can still transmit the virus 15 percent of the
time. PCR-DNA test always will show up, and that's why we did this
experiment here with Kevin.
Kernes: And on the PCR-DNA, the virus can show up within seven days?
Mitchell: No. Let's say minimum 14, to 30. We've seen it at 14 days.
Kernes: But it will definitely show itself by 30 days?