Too Much Information (TMI) has in many instances been the story of my adult life certainly from the age of 18 on. Particularly in the areas of my HIV infection and sexual orientation in general I have often not held back on the details. Personally, I’d like to think that at least some of the time this was speaking truth to power. At other times it may have been no more than a childish attempt to gain the upper hand in a conversation, something perhaps far less noble than speaking truth to power.

Several personal examples of providing TMI come to mind but a couple may even be too much information for this group, so I’ll let them be for now. One I will share occurred back in the early 1980s when I was working in the medical ICU at University Hospital and involved my getting, I think, Hepatitis A or perhaps it was Hepatitis B. Both were viruses that health care providers and nurses in particular were prone to get. Now of course there are very good vaccines for both and part of getting nearly any nursing job requires checking for protective antibody levels for both A and B. These protective antibodies most often these days are conferred through a vaccine or if you are an older provider you may have actually had the real deal.

Hepatitis A overwhelmingly is not fatal and a lifelong immunity results. Hepatitis B infection 2-6% of the time in adults results in a chronic infection that one does not clear, and this chronic state is then a very common cause of liver cancer. Per the CDC website up to 90% of infants though who contract it develop a chronic infection. This is why newborns are given Hep B vaccine within 24 hours of birth unless they have had the misfortune to be born to whack-a-doodle parents who are anti-vaxers.

An effective vaccine for Hep B was made available in 1981, I believe, and thanks in large part to gay men. Gay men have always been at greater risk for both Hep A and Hep B. At the risk of providing TMI as to why we, prior to vaccines, were at more risk I am going to let you all do the math on that one. I will provide a couple of hints: Hepatitis A is primarily oral/fecal transmission and Hep B is blood and semen transmitted.

Since gay men were at high risk for these infections, they were also great candidates for vaccine trials. Giving a vaccine to people at low risk for a particular infection would take a long time to provide results. I think if memory serves me right these were placebo-controlled trials, the gold standard for showing efficacy or not. Denver was a site for this trial, and it was done through Denver Public Health (DPH) and I believe much of the recruitment occurred through the STD clinic at DPH. Men coming in for the treatment of sexually transmitted diseases were, I suspect, a gold mine of recruits for this vaccine trial. In the spirit of TMI, I did not participate in this trial so my information here on the study may be a bit sketchy.

As a bit of diversion here one thing that has been bantered about regarding COVID 19 vaccine development is to actually give the candidate vaccine, and there are many, to volunteers and then inject COVID and see what happens. I do not think this is occurring yet, but it would be a fast track for sure.

So, this whole piece has probably been TMI for many of you but let me get to my example of a past life exercise in TMI. This occurred in the early 1980s and involved Hepatitis A. As I mentioned nurses were in those pre-vaccine days for Hepatitis A at considerable risk of contracting it on the job not though sexually in case anyone was wondering. Nursing in an acute care setting often involves cleaning up poop and at times lots of it. I at that time had come down with a case of Hep A and was out sick for a fair amount of days as I recall. When I returned to work for a 12-hour night shift it was a topic of conversation on from where I had gotten it and a gaggle of nurses was all speculating on what patient from a few weeks prior I might have gotten infected from. I listened to this conversation for several minutes and then piped in saying I doubted I got it from a patient but much more likely from being at the Empire Bathes with my legs in the air. And that bit of TMI brought the conversation to a screeching halt.