Joel Gallant:Q&A Expert
Joel Gallant and his online creation.
Dear Dr. Gallant...Can I get HIV from being kissed on the
neck, given that the skin on my neck is intact?
Dear Joel...Been on AZT/3TC/NVP for 18 months. Good response.
100% compliant. Is there any reason why I should not ask for my medication
to be changed to AZT/3TC/EFV? Many thanks for this forum. Kind regards,
Dr. Gallant...My sister is a barber at a barber in a very
bad part of town. When I went in there the other day, she was washing
out her mouth because she had gotten some hair in her mouth from some
guy who she thinks is not in very good shape. Is hair infectious, especially
in the mouth? P.S. If it is, how could she protect herself without quitting
For more than six years, HIV/AIDS specialist Joel Gallant has been fielding
questions like these as director of Expert Question & Answer, online
forums that appear on the Johns Hopkins AIDS Service Web site. The Q&A
forums attract several hundred questions each month on topics ranging
from complex antiretroviral therapies to basic lifestyle issues. "They
have helped to make the AIDS Service site one of the most distinctive
and important HIV resources in the world," says Sharon McAvinue,
director of point-of-care information technology for the Division of
The entire site receives about 93,000 visits per month. Besides the
Q&A forums, the site carries two publications that are a sort of
bible for HIV practitioners: Medical Management of HIV Infection,
a 300-page book published each year, and The Hopkins HIV Report,
a 12-page, bimonthly newsletter. There are also excerpts from the patient
newsletter Moore News Quarterly, case rounds, and information
on conferences and events, clinical trials, HIV/AIDS epidemiology, prevention
With it all, Expert Q&A is the most visited part of the site. A
free service provided by faculty members who answer the questions, it's
a two-part affair designed for HIV-treating physicians and HIV-positive
patients. The patient forum receives about five times as many queries
as the clinician forum. Gallant himself answers more than 100 questions
a month, including more than half in the clinician forum and practically
all those he deems suitable on the patient forum. Thanks to his clinical
expertise, not to mention his advice-column know-how, he can dash off
an answer-even a long, technical one-in just a minute or two. He does
it at intervals here and there, in clinic when a patient misses an appointment,
or in a hotel room late at night when he can't sleep.
Questions, some of them extremely complex, come in from all around the
world. Over time, what's become clear is the tremendous disparity in
the care patients are receiving. "Some ask questions that are very
sophisticated; others know little," says Gallant, associate director
of the Division of Infectious Diseases. Some are not even patients-a
source of both exasperation and some of the humor on the site. "This
site is designed for those who are HIV positive. But it also attracts
the worried well, whose hypochondriasis, obsessive-compulsive disorder
or sexual guilt lead them to become hysterical over inconsequential
encounters and symptoms."
Q: I had sex with a woman!!! I used a condom and she doesn't seem
to be sick! I had sex with her 7 months ago! Should I worry????
A: What you're asking me is whether you should worry about
having had safe sex. If the answer were yes, then everyone would have
to worry every time they had sex, which would mean either that people
would stop having sex and the world's population would dwindle (unlikely),
or that everyone would just go around in a perpetual state of anxiety.
If you're going around in a perpetual state of anxiety, then maybe you're
just not ready for sex.
The weighty world of academic medicine may seem an unusual setting for
a Miss Manners-styled advice column, but it is precisely this unlikely
combination that makes the forum so arresting. Gallant's scathing wit
and breezy style percolates through the patient forum, and some of the
most entertaining responses are collected in a "Favorites"
With an archive of more than 6,000 questions dating back to 1997, the
Q&A forums reveal a chronological portrait of the AIDS pandemic
that is rich, real and constantly evolving. "People have forgotten
what it was like [in '97] when effective therapies were just beginning
to be used, and everyone was afraid they were going to die. Now, people
take that effectiveness for granted; they're worried about side effects
and long-term toxicity."
Q: I recently read an article that said it is very unlikely that
scientists will EVER find a real "cure" for HIV. This is really
upsetting news, to me. It seems to mean being condemned to a lifetime
of taking multiple drugs whose long-term effects are unknown.
The Q&A forums got their start in the mid-1990s when Gallant began
answering some of the HIV-related questions pouring into an AOL newsroom-and
was promptly deluged with hundreds of personal e-mails. He turned pro
when he began fielding questions for The Body, an online HIV/AIDS resource.
Then he brought his creation to the Hopkins site.
At first, Gallant worried that the forum's "racy content"
wouldn't pass muster, but he got the go-ahead, and so far, no one's
objected. Well, almost no one. When Gallant queried the JHU Press about
doing a Miss Manners-style book compiling questions and answers, he
was asked to replace the forum's earthy language with proper medical
terminology, a request he promptly rejected. "You can't talk about
AIDS without talking about sex, and you have to use the language everyone
Long a lover of literature and writing, Gallant says the forum is his
"one opportunity to be creative, a way of helping out by giving
information, and of expressing myself at the same time." It beats
writing for dry, technical research journals, he insists, and it may
reach a wider audience, too. "One of the great challenges in HIV
is the speed with which data are generated and recommendations change."
Books, and even journal articles, he says, are out of date by the time
they're printed. But the Web, while it may not be "peer reviewed,"
is the ideal medium for disseminating information about HIV. "The
journal AIDS costs $400 a year. They're not subscribing in Kinshasa,"
says Gallant, "but they are surfing the Web."
Gallant's ability to disperse expert information on HIV/AIDS has been
the inspiration for a new consultation tool, the HIV Guide. Set to debut
this fall, the HIV Guide will absorb the content of the current AIDS
Service Web site (the didactic information, as well as Expert Q&A,
will remain) and deliver concise, up-to-the-minute clinical assessments
to handheld devices.
"And all of this," says McAvinue, "has blossomed out
of Joel's Q&A forums and his ability to lend expert clinical assistance
to people all over the world. Joel has made himself available in ways
that no one ever has. He provides compassion in helping people deal
with the awesome burden of HIV. He has been a lifeline to people everywhere."
- Ann Bennett Swingle
[Visit Expert Q&A at www.hopkins-aids.org/ask.html]