Transmission of Hepatitis C in HIV-positive populations

via pubmed.gov, by Danta M, Rodger AJ.

Abstract

Purpose of Review
The epidemiology of hepatitis C virus (HCV) in HIV has changed significantly over the past decade. This review will outline the current epidemiology of HCV in HIV infection, focusing on the recent changes and factors which have been related to the increase in HCV transmission in HIV-infected men who have sex with men (MSM).

Recent Findings
Since 2000 there has been recognition in the postindustrialized world that there has been a dramatic rise in the incidence of HCV in HIV-infected MSM. Whereas sexual transmission of HCV remains controversial in the general population, there is increasing evidence that permucosal (sexual and mucosally administered drugs) rather than parenteral risks have become key factors in HCV transmission in HIV-infected MSM. At the most basic level, transmission depends on disruption of a barrier and exposure to infected fluids, usually blood. Whereas transmission factors are often closely entwined, they can be characterized as behavioural and biological factors.

Summary
With an improved understanding of the epidemiology of HCV in this population, interventions by relevant health authorities could be better focused.



[If an item is not written by an IRMA member, it should not be construed that IRMA has taken a position on the article's content, whether in support or in opposition.]

Chimp to Man to History Books: The Path of AIDS

via The New York Times, by Donald G. McNeil, Jr.

Our story begins sometime close to 1921, somewhere between the Sanaga River in Cameroon and the Congo River in the former Belgian Congo. It involves chimps and monkeys, hunters and butchers, “free women” and prostitutes, syringes and plasma-sellers, evil colonial lawmakers and decent colonial doctors with the best of intentions. And a virus that, against all odds, appears to have made it from one ape in the central African jungle to one Haitian bureaucrat leaving Zaire for home and then to a few dozen men in California gay bars before it was even noticed — about 60 years after its journey began.

Most books about AIDS begin in 1981, when gay American men began dying of a rare pneumonia. In “The Origins of AIDS,” published last week by Cambridge University Press, Dr. Jacques Pépin, an infectious disease specialist at the University of Sherbrooke in Quebec, performs a remarkable feat.

Dr. Pépin sifts the blizzard of scientific papers written about AIDS, adds his own training in epidemiology, his own observations from treating patients in a bush hospital, his studies of the blood of elderly Africans, and years of digging in the archives of the European colonial powers, and works out the most likely path the virus took during the years it left almost no tracks.

Working slowly forward from 1900, he explains how Belgian and French colonial policies led to an incredibly unlikely event: a fragile virus infecting a small minority of chimpanzees slipped into the blood of a handful of hunters, one of whom must have sent it down a chain of “amplifiers” — disease eradication campaigns, red-light districts, a Haitian plasma center and gay sex tourism. Without those amplifiers, the virus would not be what it now is: a grim pilgrim atop a mountain of 62 million victims, living and dead.

Read the rest.



[If an item is not written by an IRMA member, it should not be construed that IRMA has taken a position on the article's content, whether in support or in opposition.]

A Donor Deferred: The Lifetime Ban on Blood Donations from Gay Men

via The Huffington Post, by Robert Valadez

"Save a life, give blood," read the sticker on a colleague's lapel. It sounds wonderful -- where do I sign up? Unfortunately, I can't donate blood because I'm gay. Many people are surprised to hear that gay men are prohibited from donating blood in most countries around the world, including the U.S. I've sat at several dinner parties, perched atop my advocacy soapbox, informing straights and gays alike of the U.S. Food and Drug Administration's (FDA) policy that permanently defers any man who has had sex with another man, even once, since 1977, from donating blood.

It wasn't long ago that I was unaware of the policy. Like many college students across the nation, I happily signed up to donate blood at the campus blood drive. In fact, I rallied a group of friends to join me in participating in one of our country's most noble civic duties. One by one, we were called to donate. However, when my name was called, I was escorted to speak with a phlebotomist rather than fitted with an arm tie and stress ball. I was informed that my blood would not be accepted. Not today, not ever again. It had nothing to do with having consumed questionable British meat products or having a deficiency in iron. Rather, I had answered yes to the question -- the one that asked if I had had sex with a man since the 1970s. Given that I was born in the 1980s, the question seemed oddly phrased to me, not to mention unclear as to the definition of sex. Regardless, I checked the box, unaware of its repercussions. Suddenly, I was blacklisted.

Read the rest.


[If an item is not written by an IRMA member, it should not be construed that IRMA has taken a position on the article's content, whether in support or in opposition.]

Phylodynamics of HIV-1 Subtype B among the MSM Population in Hong Kong

via pubmed.gov, by Jonathan Hon-Kwan Chen, Ka-Hing Wong, Kenny Chi-Wai Chan, Sabrina Wai-Chi To, Zhiwei Chen, and Wing-Cheong Yam

Abstract

The men-having-sex-with-men (MSM) population has become one of the major risk groups for HIV-1 infection in the Asia Pacific countries. Hong Kong is located in the centre of Asia and the transmission history of HIV-1 subtype B transmission among MSM remained unclear. The aim of this study was to investigate the transmission dynamics of HIV-1 subtype B virus in the Hong Kong MSM population. Samples of 125 HIV-1 subtype B infected MSM patients were recruited in this study. Through this study, the subtype B epidemic in the Hong Kong MSM population was identified spreading mainly among local Chinese who caught infection locally. On the other hand, HIV-1 subtype B infected Caucasian MSM caught infection mainly outside Hong Kong. The Bayesian phylogenetic analysis also indicated that 3 separate subtype B epidemics with divergence dates in the 1990s had occurred. The first and latest epidemics were comparatively small-scaled; spreading among the local Chinese MSM while sauna-visiting was found to be the major sex partner sourcing reservoir for the first subtype B epidemic. However, the second epidemic was spread in a large-scale among local Chinese MSM with a number of them having sourced their sex partners through the internet. The epidemic virus was estimated to have a divergence date in 1987 and the infected population in Hong Kong had a logistic growth throughout the past 20 years. Our study elucidated the evolutionary and demographic history of HIV-1 subtype B virus in Hong Kong MSM population. The understanding of transmission and growth model of the subtype B epidemic provides more information on the HIV-1 transmission among MSM population in other Asia Pacific high-income countries.

Read the rest of the study here.



[If an item is not written by an IRMA member, it should not be construed that IRMA has taken a position on the article's content, whether in support or in opposition.]

My Summer with IRMA

By Aldona Martinka, IRMA Intern

Today is my last day at the AIDS Foundation of Chicago, where I had the pleasure of interning this summer. I am one of the last summer interns remaining, and the empty intern “sweatshop” surrounds me. I had the opportunity to work with AFC and IRMA, as well as with Mapping Pathways and Project CRYSP for the summer at this desk, facing a window with blinds that are always closed. The closed blinds never bothered me, though, because whenever I was at my desk my eyes were fixed on my computer screen. I know that statement does little to separate me from the rest of my generation, but there is a good reason that I did not often look away from my work: I was fascinated.

I joke with my friends that I read about sex all day for work, but it’s true. In my work with HIV, and especially in my work with IRMA, I am constantly exposed to sex. My days are spent absorbing information about it: clinical studies showing the effectiveness of antiretroviral-based prevention methods, laws that criminalize and stigmatize high-risk groups, public health efforts in deeply-affected areas, or even sexual advice for HIV-positive people looking for love in modern America. Not only that, but for IRMA much of my reading was about the sexual act that is perhaps the most taboo, anal sex, because of the high risk of transmission and the sociocultural issues surrounding it. For a shy girl from a Catholic family this was a lot to take in. I quickly adjusted, though, and as my internship comes to a close I can discuss lubricant distribution in the rectum with a straight face and a confident smile. Though initially kind of shocking, I learned so much in these past several months, and what I learned has crystallized so much for me.

I learned that there are more HIV prevention tools even than there were 4 years ago when I took sex ed in high school. Rectal and vaginal microbicides, PrEP, and treatment as prevention represent real methods of preventing HIV that should be added to condoms as tools in the global prevention toolbox. Not only are they effective enough to warrant more exploration and consideration, but they provide protection in the wide variety of cases where condoms are a less desirable option, or not an option at all. With these prevention methods sex workers, wives in patriarchal societies, members of sero-discordant couples, and many other at-risk people can be protected that may not want to or be able to use condoms for a variety of reasons.

I learned just how inextricably HIV/AIDS is linked to my other passion: human rights. I learned about how government and cultural views toward sex workers, women, and LGBT people affects everything from the availability of condoms to the accessibility of treatment, and can create many difficulties in between. I also learned about the criminalization and stigmatization of HIV-positive individuals, something which surprised and horrified me, and how the continuation of these only obstructs public health efforts.

I learned so much, but I learned one last thing of personal significance to me. I was chattering excitedly at my father about the internship portion of my upcoming semester abroad in India, and how I hoped to work with an organization there that fights HIV. He asked if I wanted to look at other internships as well, to broaden my areas of knowledge in public health. While answering that question, I realized that everything I’ve learned in this internship, all of the related issues and exciting science, had led me to this seemingly unexceptional question. “No,” I said, “I want to continue to work with HIV.” Everything about it, the human right issues, the new advances in prevention and treatment, and my personal experiences with advocacy work, have captured my attention and drawn me to the fight against AIDS. I hope to continue in the field of HIV prevention and advocacy, and my time at the AIDS Foundation of Chicago with IRMA has provided me with invaluable experience. Thank you to all of the IRMA community for allowing me this opportunity. With a bit of luck and a lot of hard work, hopefully someday no one will have to go without a way to prevent HIV, for any reason.

[If an item is not written by an IRMA member, it should not be construed that IRMA has taken a position on the article's content, whether in support or in opposition.]

Criminalizing HIV Transmission Will Only Spread the Problem

Via the Vancouver Sun, by Peter McKnight.

It sounds like the synopsis of a B-movie: Thanks to the long arm of the law, the world is once again safe from The Attack of the Killer HIV-people.

Safe from Johnson Aziga, the Ontario man who had sex with more than a dozen women without informing them of his HIV-positive status. Several of the women contracted HIV, including two who subsequently died, which led to Aziga being declared a dangerous offender and handed an indeterminate sentence earlier this week.

And safe from the 17-year-old Edmonton girl who was charged this week with two counts of aggravated sexual assault after allegedly having sex with two men without informing them of her HIV-positive status. The girl had been the subject of an urgent police bulletin, which led to the worldwide publication of her name, picture and health status. Aside from painting a rather ghoulish picture of people living with HIV, such unusual cases inevitably send the message that the best way to handle HIV-non-disclosure is through the criminal law.

Police forces across the country seem to have got the message, given the increase in the number and severity of charges laid for HIV-non-disclosure in recent years. Well over 100 HIV-positive people across Canada - and at least 14 in B.C. - have now been charged with offences ranging from assault to first-degree murder.

Courts, too, have been enthusiastic in prosecuting cases of non-disclosure, with defendants receiving everything from suspended sentences to, in Aziga's case, an indeterminate and potentially lifelong sentence of imprisonment.

This enthusiasm for criminal prosecution exists despite - or perhaps because of - uncertainty about the disclosure obligations of HIV-positive people. The Supreme Court of Canada has held that individuals are under a legal duty to reveal their HIV-positive status before engaging in sex that poses a "significant risk" of HIV transmission, but what constitutes a significant risk remains unclear.

Read the rest here.

[If an item is not written by an IRMA member, it should not be construed that IRMA has taken a position on the article's content, whether in support or in opposition.]

HIV Prevention in Women Requires a Full Toolbox

Via Medscape, by Emily Paulsen.

Women account for more than 50% of the worldwide AIDS epidemic, and a disproportionate number of those women are people of color. In the United States, black women make up a growing share of new AIDS cases; the rate for black women is nearly 20 times the rate for white women.

Although these statistics are dire, new research, presented here at the National Medical Association 2011 Annual Convention and Scientific Assembly, offers hope that the tide will turn on HIV transmission.

"This has been an amazing year for HIV research," Gina Brown, MD, told meeting attendees. Dr. Brown coordinates research on microbicides at the Office of AIDS Research, part of the National Institutes of Health in Bethesda, Maryland. She offered a "walk-through of some of the interesting things we've learned about what puts women at risk for HIV, and some of the interventions available."

The biggest news in HIV prevention, reported recently at the 6th International AIDS Society (IAS) Conference on HIV Pathogenesis, Treatment and Prevention, has been the use of antiretroviral therapy (ART) to reduce the risk for transmission, according to Dr. Brown. The HPTN 052 study showed a 96% reduction in transmission in serodiscordant couples in which the HIV-positive partner received early ART. In another study, once-daily tenofovir/emtricitabine (Truvada, Gilead Sciences) resulted in a 44% reduction in HIV transmission in men and transgender women who have sex with men. In that study, those who adhered to their medications at least 90% of the time achieved a 73% reduction in HIV transmission.

Dr. Brown pointed out that the couples in many of these studies were in steady relationships and volunteered to participate in the study. "Does this sound like the patients you see in your practice?" she asked the audience. She also said that costs and adverse effects might affect the practicality of this solution for many patients.

"When can we give up condoms?," she asked, answering that it would not likely be any time soon.

Dr. Brown said a full HIV prevention toolbox is still needed to reduce the risk for transmission. Education, partner reduction, treatment for sexually transmitted infections, condoms, circumcision, 1% tenofovir gel, and ART all offer varying amounts of protection. All interventions offer only harm reduction at this point, she said, not full protection.

Read the rest here.

[If an item is not written by an IRMA member, it should not be construed that IRMA has taken a position on the article's content, whether in support or in opposition.]

Bacterial Bioshield Could Keep HIV at Bay

Via New Scientist.

A LIVING microbicide reduces HIV-like infection in monkeys, and might one day provide women with long-lasting defence against the virus.

Dean Hamer of the National Institutes of Health in Bethesda, Maryland, and colleagues engineered naturally occurring vaginal bacteria to produce the anti-HIV protein cyanovirin-N.

They applied a gel containing the bacteria to the vaginas of rhesus macaques before infecting them by the same route with a hybrid of SIV and HIV. The engineered bacteria cut the infection rate by 63 per cent (Mucosal Immunology, DOI: 10.1038/mi.2011.30).

Human females have 10 times as much of the bacteria as female macaques, so the engineered bacteria could reduce infection rates even more dramatically, says Hamer. Clinical tests could begin in a few years after safety testing.

[If an item is not written by an IRMA member, it should not be construed that IRMA has taken a position on the article's content, whether in support or in opposition.]

Homophobia in Ghana

Understanding the Drivers of Homophobia in Ghana

Via PlusNews.

Recent condemnation of homosexuality by religious and political leaders in Ghana has led to a climate of fear preventing men who have sex with men (MSM) from accessing vital health services, say local NGOs.

The minister of Ghana’s Western Region, Paul Evans Aidoo, publicly described homosexuality as “detestable and abominable” after media reports in late May that 8,000 homosexuals had registered with health NGOs in the country’s west (the information appears to come from records kept by the NGOs of people who accessed services for MSM). Aidoo has since called for increased security in the region and the arrest of all homosexuals. Other religious leaders and politicians have followed suit, condemning homosexual activity.

As a result, far fewer MSM are accessing safe sex education and support programmes run by the Centre for Popular Education and Human Rights (CEPEHRG) to prevent the spread of HIV, said MacDarling Cobbinah from the Coalition against Homophobia in Ghana and a member of CEPEHRG.

“It has brought about a lot of fear and stigma for the people. It is difficult to organize programmes,” Cobbinah said. “It is very difficult for people to walk freely on the street… The call for arrest has really pushed people down.”

He added that one of his colleagues was recently accused of being gay and beaten up by a group of men.

Cobbinah said numbers had dropped at a regular HIV peer education programme that once had more than 20 people attending; two weeks ago only half the people came, and last week no one came, he told IRIN on 27 July. “They said, ‘If we come, we might be arrested.'”

An estimated 25 percent of Ghanaian MSM were HIV-positive in 2006, according to the US Agency for International Development (USAID).

According to the UN World Health Organization, since the beginning of the epidemic in the early 1980s, MSM have been disproportionately affected by HIV. The organization said social discrimination of MSM led them to delay or avoid seeking HIV-related information, care and services.

Other organizations in Ghana are also facing obstacles to providing vital services. An NGO based in the Western Region’s capital Sekondi-Takoradi, which distributes condoms and safe sex information to MSM, told IRIN that since Aidoo increased security and called for arrests they have felt threatened.

Male-to-male sexual relations are a crime in Ghana. Considered a misdemeanor, it carries a maximum sentence of six months, according to Kissi Agyabeng, a law lecturer at the University of Ghana. However, despite Aidoo’s calls for a crackdown, arrests do not yet appear to be taking place.

A spokesperson for the Sekondi-Takoradi NGO, who did not want his name or the organization’s name published for security reasons, said the NGO was now coming under pressure from the government to stop their work on HIV prevention if they did not reveal the names of MSM who have registered to use their services.

Stopping this work would affect thousands of people. In 2008, 2,900 people accessed their services, and by this year numbers had quadrupled, the spokesperson said.

...

Read the rest of the article here. For a fascinating personal story from a gay Ghanaian, read Paula Stromberg's article A Good Day in Ghana here.

[If an item is not written by an IRMA member, it should not be construed that IRMA has taken a position on the article's content, whether in support or in opposition.]

Growing sense of hope at international Aids conference

From the Guardian, by Sarah Boseley.

There appears to be real excitement at the International Aids Society conference in Rome (sadly I'm not there in person, but that is the feedback). There is still no vaccine on the horizon - once the biggest hope - but the news from recent studies that taking antiretroviral drugs protects people without HIV from infection (see the story here) and reduces the risk of people with HIV passing it to their partners (here) has changed the landscape. Suddenly we are in a world where Aids is more preventable than ever before - and both prevention and treatment come pill-shaped.

So there is no shortage of important people calling for more funds and more action to roll out drugs to the nine million people in developing countries estimated to need them right now. Michel Sidibé, executive director of UNAIDS, said it was an affront to humanity that there were gaps in coverage.

"We have to remember that history will judge us not by our scientific breakthroughs, but how we apply them," he said.

There are practical difficulties in the way of getting the drugs to all who need them, but beyond the rhetoric and the big picture, there are organisations which are trying to find better ways forward. The Drugs for Neglected Diseases Initiative, for instance, which has been doing excellent work on a select group of conditions - human African trypanosomiasis, leishmaniasis, Chagas disease and malaria - has decided to take on the needs of children with HIV. Paediatric formulations of antiretrovirals are inadequate. Children are not small adults. They don't just need a few less tablets - they need drugs that can be given in doses suitable for their weight and may need syrups rather than pills. This is Dr Bernard Pécoul, executive director of DNDi:

"There are millions of children with HIV/AIDS in low- and middle-income countries, but their needs are absent from the HIV research and development agenda, and this is largely because they are poor and voiceless and do not represent a lucrative market. Working with partners, we hope to help fill this terrible gap and offer improved treatment options for children with HIV/AIDS."

Read the rest here.

[If an item is not written by an IRMA member, it should not be construed that IRMA has taken a position on the article's content, whether in support or in opposition.]

Building the momentum to prevent HIV in MSM

Via The Lancet, by Thomas J Coates.

Larry Kramer, on accepting the Tony Award last month from the Theatre Guild-American Theatrical Society for The Normal Heart as Best Revival of a Play said: “To gay people everywhere, whom I love so dearly…we are a very special people, an exceptional people, and…our day will come.” My day came in 1982 when I secured an Assistant Professorship in the Department of Medicine at the University of California, San Francisco. I set about establishing a behavioural medicine clinic fully integrated into general medicine practices, researching chronic disease prevention, and teaching interns and residents about psychological issues. One guest speaker, a social worker, led a discussion with the residents about the special medical needs of gay men. He was dead a month later from what later became known as AIDS.

The “special and exceptional people” cited by Kramer had lived through the 1970s and fought for human rights in the USA. That was followed in 1981 with the scourge of AIDS that could have knocked the wind out of the gay community. Instead, the community rallied and used its skills and talents to advocate for resources to develop community-based systems of care and prevention, and to ensure that human rights were not trampled.

Unleashing that energy and skill to build a global movement to improve HIV prevention and care services for men who have sex with men (MSM) is long overdue. Momentum is building and Chris Beyrer and co-authors make an important contribution. The Global HIV Epidemics among Men Who Have Sex with Men documents the extent of the HIV epidemic and outlines what needs to happen to ensure that everything possible is being done to prevent and treat HIV infection in MSM worldwide.

This volume documents the need in terms of the numbers, but also addresses the scenarios in which HIV epidemics among MSM exist in low-income and middle-income countries. The first scenario they describe, characterising the HIV epidemic in most of Latin America, is one in which MSM are the predominant exposure mode for HIV infection in the population. In these countries MSM are ten to over 100 times more likely to have HIV than the general population. By contrast, eastern Europe and central Asia have the highest rates of HIV among injection drug users (IDUs), but MSM are still several times more likely to have HIV than the general population. A different scenario is found in sub-Saharan Africa where HIV is widespread among heterosexuals, but even in these contexts MSM can have two to 20 times higher prevalence of HIV than the general population estimates. South, southeast, and northeast Asia are characterised by epidemics that have equal contributions from MSM, IDUs, and heterosexuals, although MSM are still at least ten times more likely to have HIV than the general population.

The needs come not only from the numbers. Beyrer and his co-authors document well the lack of prevention technologies focused on male-to-male transmission. They note that much effort has been expended on encouraging voluntary HIV counselling, testing, and behavioural interventions to decrease rates of unprotected anal intercourse by encouraging less risky sexual behaviours. Although important, such strategies are probably insufficient to produce immediate or lasting change in HIV transmission. Male circumcision may be effective for reducing acquisition of HIV through anal intercourse but we will never know for sure because of the challenges of conducting a trial to prove efficacy. Antiretroviral-based prophylactic approaches provide the best opportunity for managing HIV among MSM. In the wake of the IPREX, CAPRISA 004, and HPTN 052 trials, it is now time to accelerate efforts to determine if similar benefits can be obtained with rectal use of these or similar compounds. In some countries, like Peru where the epidemic is concentrated in MSM, providing universal access to care with MSM-sensitive services could actually change the overall trajectory of disease spread.

Read the rest here.

[If an item is not written by an IRMA member, it should not be construed that IRMA has taken a position on the article's content, whether in support or in opposition.]

Ugandan Lawmakers okay HIV/Aids Bill

Via the Daily Monitor, by Mercy Nalugo.

Ugandan Lawmakers Wednesday resisted pressure from the human rights defenders and backed the new HIV /Aids Prevention and Control Bill that seeks to criminalise the intentional spread of HIV/Aids.

Briefing the new members on the Parliamentary HIV/Aids committee about their expectations, work plan and how far the eighth Parliament had gone with scrutinising the controversial Bill, the new committee chairperson, Ms Rosemary Najjemba Muyinda (NRM, Gomba) said most of the controversial clauses in the Bill were dropped.

“The Bill is now in its advanced stages since it was discussed by our colleagues in the eighth Parliament. So many stakeholders have been consulted and all the contentious issues were dropped. The Bill once passed into law will protect those without HIV from being infected. We have to take the Bill forward,” Ms Najjemba said.

She said the principles in the Bill were agreeable to the committee members since they are aimed at combating the intentional spread of HIV/Aids.

“For example why should someone infect the other with aids intentionally? That is a crime that should not go unpunished,” she said.

The controversial Bill that hands down a 10 year penalty in jail to individuals that knowingly infect others with the deadly aids disease has faced a lot of criticism from the human rights defenders both local and international.

They argue that the Bill violates human rights and threatens the progress the country has so far attained in fighting HIV/Aids as it legislates for mandatory testing for HIV and forced disclosure of HIV status.

Some of the human rights defenders against the Bill include Action Aid International,l Uganda Global AIDS Alliance,United States,the Global Forum on MSM & HIV United States,Global Coalition of Women against AIDS in Uganda,Uganda Network of AIDS Service Organisation (UNASO) and Uganda Young Positives among others.

Also in the Bill, Women who transmit HIV to their infants after birth through breast milk would also be subject to criminal prosecution. The activists concern is that it would be difficult, if not impossible, to determine who infected the other in courts of law hence making ignorance of one's status an effective defence.

Read the rest here.

[If an item is not written by an IRMA member, it should not be construed that IRMA has taken a position on the article's content, whether in support or in opposition.]

Microbicide Trials Network Statement On The Partners PrEP Study And The CDC's TDF2 Study: VOICE Study Will Continue

Via Medical News Today.

Researchers from two major HIV prevention trials announced favorable results of an approach called oral pre-exposure prophylaxis, or PrEP. One of these trials, the Partners PrEP Study, has provided the strongest evidence yet of PrEP's effectiveness.

Information from both studies will need to be fully evaluated before it can be determined what impact they will have on another major trial that is ongoing. Investigators for VOICE - Vaginal and Oral Interventions to Control the Epidemic, and the study's sponsor, the National Institute of Allergy and Infectious Diseases (NIAID), part of the U.S. National Institutes of Health (NIH), hope to complete their evaluation as soon as possible. In the meantime, the five-arm study involving more than 5,000 women in sub-Saharan Africa will continue as currently designed.

PrEP involves the use of antiretroviral (ARV) drugs commonly used in the treatment of HIV by individuals who are not infected. In the Partners PrEP Study, researchers from the University of Washington and their collaborators in Uganda and Kenya, evaluated the safety and effectiveness of daily use of two ARVs - tenofovir and Truvada®, the brand name for a tablet combining tenofovir and emtricitabine - among men and women in a discordant relationship with a partner who is HIV-positive. The study enrolled 4,758 serodiscordant couples.

There were 62 percent fewer HIV infections among participants assigned to take the ARV tenofovir daily compared to participants who took a placebo tablet, and 73 percent fewer infections among those who took Truvada. In statistical terms, the results leave little doubt they are not due to chance. However, the study was not able to say whether Truvada or tenofovir works better than the other in preventing HIV.

The results came to light during a review conducted by Partner PrEP's independent Data Safety and Monitoring Board (DSMB) just a few days ago, on July 10. The DSMB found the results so compelling that it recommended that it stop testing in the placebo group. The research team will be making arrangements so that participants who had been randomly assigned to take a placebo tablet can instead receive one of the study's active study products. Participants in the other two groups will continue to be followed.

In the second study, a smaller trial that involved 1,200 heterosexual men and women in Botswana, researchers from the U.S. Centers for Disease Control and Prevention (CDC) found that 62.6 percent fewer HIV infections had occurred in the group of participants assigned to take Truvada than in the placebo group. The CDC team will be reporting more details about the findings of the study, known as TDF2, at the International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention in Rome next week.
 
Both sets of results bolster the findings of iPrEx, which late last year provided the first evidence that oral PrEP can help prevent HIV. iPrEx found Truvada - together with a comprehensive HIV prevention package - was safe and 44 (43.8) percent more effective than a placebo tablet for protecting against HIV in men who have sex with men. The two studies' favorable results also raise more questions about what happened with FEM-PrEP. Two months ago, researchers announced the trial would be stopping earlier than planned because an interim review of the study's progress by its data monitoring committee determined that even if the study were to continue, it would not be able to conclude whether or not Truvada is effective in its population of women. The study team is still collecting data. A final report is not expected until late this year or early 2012.

Few conclusions can be drawn from the CDC study concerning the effectiveness of Truvada specifically in women. And although Partners PrEP found tenofovir and Truvada worked well for both men and women, the study provides more information about how these drugs can protect heterosexual men from getting infected than it does about how these drugs can protect women from getting infected from a partner with HIV. That's because in most of the 4,758 couples enrolled (62 percent) it was the male who was the uninfected partner.

VOICE involves 5,029 women from Uganda, South Africa and Zimbabwe. VOICE is testing not only daily use of an ARV tablet - Truvada or tenofovir, but also a vaginal microbicide containing tenofovir in gel form. VOICE is the only trial evaluating both a tablet and a gel in the same study. This design is important for determining how each product works compared to its control (placebo gel or placebo tablet) and which approach women may prefer.
 
Read the rest here.
 
[If an item is not written by an IRMA member, it should not be construed that IRMA has taken a position on the article's content, whether in support or in opposition.]

PrEP Media Round-Up - It Works for Heterosexuals Too!

[UPDATED JULY 18]

The exciting news was announced last week that pre-exposure prophylaxis has been shown to work for heterosexual men and women as well as MSM. This is HUGE for HIV prevention.

Below is a selection of news items and press releases we have collected on the two studies that reported out last week. In the comments feel free to share your reactions to this news.

Washington Post: Two studies show that drugs used to treat AIDS can be used to prevent HIV infection, too

EurekAlert (Microbicide Trials Network): VOICE study will continue as it considers what action to take after results of 2 trials

CDC: CDC Trial and Another Major Study Find PrEP Can Reduce Risk of HIV Infection among Heterosexuals

iPrEX News: Two Major Studies Prove HIV Pre-Exposure Prophylaxis (PrEP) Works in Heterosexual Women and Men; Build on iPrEx Data Showing PrEP Reduces HIV Infections in Men Who Have Sex with Men

Wall Street Journal: AIDS Drugs Can Prevent Infection, Studies Show

AIDSMAP: Two major studies show that HIV drugs prevent infection

New Vision: Drugs prevent HIV infection up to 73%

Science Now: Anti-HIV Pills Show Powerful Effect Against AIDS

Reuters: 2-Once-daily AIDS pill can slash HIV infection risk

POZ: PrEP Reduces HIV Risk in Two Major Studies

PlusNews: HIV/AIDS: More proof that PrEP works

New Scientist: One cheap pill protects healthy people from HIV

The Daily Nation: Daily dose of drug ‘lowers risk of HIV infection’

Fit Perez: New Pill Could Prevent HIV

Project Inform: Project Inform urges government action following the positive results of two PrEP studies in heterosexual men and women

[If an item is not written by an IRMA member, it should not be construed that IRMA has taken a position on the article's content, whether in support or in opposition.]

Intensive and targeted PEP counselling leads to less risky sex afterwards, fewer HIV infections

Via AIDSMap, by Roger Pebody.

Researchers in San Francisco wished to measure the impact of providing risk reduction counselling to people taking post-exposure prophylaxis (PEP) to prevent HIV infection. They measured changes in sexual behaviour one year later.

They randomised 457 people receiving PEP to either receive two sessions of standard counselling, or an enhanced programme of five counselling sessions.

The standard counselling intervention consisted of two sessions of 20 to 30 minutes each, individually tailored on the basis of social cognitive theory, motivational interviewing, and coping effectiveness training. In the first session, the counsellor and participant explored the details and context of the risk exposure and developed a written risk reduction plan. At the second session a week later, the baseline HIV test result was given. The participant was asked about risk behaviour in the past week and the effectiveness of the risk reduction plan, which was adjusted if necessary.

People receiving the enhanced intervention received the same two sessions, as well as three further sessions, during which difficulties in implementing the plan were explored, contextual factors (such as particular places or emotions) that led to high or low risk behaviour were identified and an increasingly personal risk reduction plan was developed. (A detailed protocol for the five sessions is freely available on the journal’s website).

Adherence counselling was also separately provided on three occasions.

Almost all participants were men, and PEP had commonly been prescribed after unprotected anal sex (80.1%), unprotected vaginal sex (7.5%) or oral sex to ejaculation (5.9%) in the previous 72 hours. Four out of ten people receiving PEP knew that their partner was HIV-positive.

To assess the impact of the two styles of counselling, the behaviour of participants was assessed at the time of taking PEP and one year later.

When the data for all participants were analysed together, the extra intervention appeared to provide a modest benefit, but perhaps one that could not justify the cost of its provision.

The study’s primary outcome was change in the number of unprotected anal or vaginal sex acts. In the six months before taking PEP, participants had had unprotected sex an average of 5.5 times. In people who received two counselling sessions, this dropped by a mean of 1.8, while those getting the extra sessions had 2.3 fewer unprotected sex acts.

The results are more interesting if we only look at those individuals who were taking more sexual risks to begin with. A fifth of the participants had had unprotected sex four or more times in the six months before taking PEP, and the extra counselling had much more impact in this group.

In terms of the primary outcome, those with higher risk receiving the standard two sessions had a reduction in 7.0 unprotected sexual acts, whereas in those getting the extra sessions the average reduction was 13.2 acts.

Whereas 31.5% of higher-risk individuals receiving the standard intervention felt the need to come back for a second course of PEP within a year, this was case in 17.1% of those receiving five sessions.

And most importantly, fewer people were HIV-positive one year later. Among those with higher risk who received two sessions, 12.3% seroconverted. In those who received five sessions, 2.4% did so. (These infections are likely to be due to risk behaviour in the months after taking PEP, not the failure of PEP to prevent infection).

Read the rest here.

[If an item is not written by an IRMA member, it should not be construed that IRMA has taken a position on the article's content, whether in support or in opposition.]

IAS 2011 HIV Prevention Research Roadmap

Via our friends at AVAC.

Where: Rome, Italy

When: July 17 - July 20, 2011

The IAS Conference on HIV Pathogenesis, Treatment and Prevention is held every two years, and this year it will take place in Rome, July 17-20. The 2011 conference has a program that includes many sessions on a range of HIV-related topics. AVAC has compiled a roadmap that includes the range of HIV prevention research-related sessions planned for the conference. You can download a PDF of the current roadmap here (both detailed and abridged versions).

Or view the conference's Programme-at-a-Glance system, go to pag.ias2011.org and select the HIV Prevention from the roadmap drop-down menu.


AVAC is working with various partners on the following sessions that may be of interest:

Sunday, July 17


•10:15–13:15: Satellite, MR 1: Controlling the HIV Epidemic, the Promise of ARV-based Prevention (A flyer for this session is available.)

•12:30–14:30, Satellite, MR 2: GPP in Action: Introducing the 2nd Edition of Good Participatory Practice Guidelines for Biomedical HIV Prevention Trials and Examples of its Implementation in Current Research

•14:45–16:45: Satellite, MR 2: HIV Vaccines and the Prevention Revolution: Shortening the Path to the End of the Epidemic


Monday, July 18

•18:30–20:30: Satellite, MR 3: Pre-Exposure Prophylaxis (PrEP): How Will the Future Pipeline Look Like?


Tuesday, July 19

•7:00–8:30, Satellite, MR 4: Zeroing out New Infections Through Prevention Tools and Technologies

•16:30–18:00, Bridging Session, SR 1: Use of Antivirals in Prevention—Current Challenges and Controversies
•18:30–20:30, Satellite, MR 3: Can We End the Epidemic?

And, for those of you who won't be attending in person, you can follow the conference proceedings from afar via regular reports from NAM, the official online partner for scientific reporting at IAS 2011, and post-conference coverage from Clinical Care Options (CCO), the official online partner for scientific analysis at IAS 2011. In addition, the Global Health Council will be blogging from the conference. Finally, you may follow IAS 2011 on Facebook and Twitter as well as AVAC on our own AVAC on our own Facebook and Twitter pages for updates.

[If an item is not written by an IRMA member, it should not be construed that IRMA has taken a position on the article's content, whether in support or in opposition.]

If you're HIV positive, safe sex isn't just about condoms

Via The Guardian, by Deborah Jack.

As the HIV epidemic has evolved over three decades, the "just use a condom" message has remained the cornerstone of prevention. But stubbornly high levels of new HIV infections in the UK show we've struggled to always translate this simple message into real life.

Most monogamous couples will decide to stop using condoms at some point, but what if one half of the couple is HIV positive? Until recently, it has been assumed there is no safe option other than condoms for life. But new research into the preventive benefits of HIV treatment (antiretroviral therapy) is set to change this, and could potentially revolutionise the way we think about HIV prevention and safer sex advice.

HIV treatment works by reducing the level of HIV in the body (the viral load) to such an extent that a person's infectiousness is almost zero (clinically referred to as "undetectable"). A big effect of this – in addition to keeping the person healthy – is that the risk of transmitting HIV to another person is dramatically reduced.

Last month we heard the conclusive results of the first global study into HIV "treatment as prevention" – a 96% reduction in transmission risk when the HIV-positive partner received treatment and responded effectively. When put into practice, this means people living with HIV who are on treatment can, like everyone else, consider giving up condoms when their relationship is committed and monogamous.

But before we get carried away, it is not time to throw away our condoms altogether. They are still the best protection against other sexually transmitted infections, so any couple wanting to rely on treatment rather than condoms to prevent HIV transmission must be confident they are both STI free and monogamous. Other STIs in the body can make HIV levels spike upwards, which seriously compromises the effects of treatment as prevention and significantly increases risk of transmission.

Read the rest here.

[If an item is not written by an IRMA member, it should not be construed that IRMA has taken a position on the article's content, whether in support or in opposition.]

Infection-resistant monkeys could be crucial in the fight against HIV

Via Io9, by Alasdair Wilkins.

Sooty mangabeys are a monkey species found on the western coast of central Africa. Their unique immunity to SIV, a relative of HIV, has intrigued medical researchers for decades. Now we know just how their immunity works.

SIV and HIV function in much the same way - the viruses find two molecules on the surface of the cell, which are known as co-receptors. These molecules function much like gates. One of these molecules is CD4, which is found on immune cells known as T cells. The immune response triggered by the appearance of the virus stimulates these T cells, which boost the level of the other co-receptor, CCR5, which in turn facilitates the deadly infection.

But sooty mangabeys are able to avoid that chain of events, thanks to a unique type of T cell called a central memory T cell. When this particular type of T cell responds to the virus, it does so without activating CCR5. This helps the T cells survive the SIV infection, and it's a crucial reason why these monkeys are able to avoid the onset of AIDS. Best of all, central memory T cells are long-lived in the body, and their positioning in the lymph nodes makes them particularly effective in stopping the spread of SIV.

Emory University researcher Mirko Paiardini explains what this means:

Read the rest here.

[If an item is not written by an IRMA member, it should not be construed that IRMA has taken a position on the article's content, whether in support or in opposition.]

“In it to save lives”

Via Science Speaks, by Meredith Mazzotta.

To the sound of a ticking metronome, Dr. Caroline Ryan of the Office of the Global AIDS Coordinator gave an update on the scale up of voluntary medical male circumcision in sub-Saharan Africa Wednesday morning at the premiere of the new short film “In It to Save Lives: Scaling Up Voluntary Medical Male Circumcision for HIV Prevention for Maximum Public Health Impact.”

The metronome was timed to tick once for each of the five new HIV infections that occur every minute worldwide, 3.5 of which occur in sub-Saharan Africa, Ryan said. During her ten-minute talk, fifty people around the world became infected, and of the 35 infections that would occur among those in sub-Saharan Africa, 12 could be averted through the scale up of voluntary medical male circumcision (MC), she said at the end of her presentation.

Clinical trials have shown MC to provide men 60 percent more protection from acquisition of HIV through vaginal sex than their uncircumcised counterparts. The one-time, relatively simple procedure is inexpensive and cost-effective, and governments in sub-Saharan Africa are encouraging men to get the procedure by offering it for free or very little cost with the help of funding from the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) and other programs.

Dr. Caroline Ryan of the Office of the U.S. Global AIDS Coordinator gives the opening remarks at Tuesday's premiere of the film "In It to Save Lives."

Dr. Ryan joined with other HIV/AIDS experts at the panel discussion and premiere of the film, produced by AIDSTAR-One with support from PEPFAR, which tells the story of how Kenya and Swaziland are turning the tide of the HIV/AIDS epidemic by embracing voluntary medical MC as prevention. Scale up was especially tricky in Kenya’s Nyanza province where Luo elders, the “custodians of culture” in the province, had to be convinced that the procedure was of benefit to its people. According to the film, assuring the elders that the procedure was voluntary was key to winning their approval.

Read the rest here.

[If an item is not written by an IRMA member, it should not be construed that IRMA has taken a position on the article's content, whether in support or in opposition.]

New Guidelines on HIV Programming for MSM

Via IRIN.

HIV and gay rights activists say new guidelines released by the UN World Health Organization (WHO) on HIV programming for men who have sex with men (MSM) will not only improve health service provision for MSM, but will also act as an advocacy tool in the fight for the rights of this marginalized population.

"The document provides well-researched and evidence-based recommendations for HIV prevention and treatment of MSM, which will be useful for clinicians," said Kevin Rebe, a doctor with Health4Men, a South African health service provider which caters specifically for MSM. "The language of the paper is couched in human rights, and makes a strong call for decriminalization of same sex sexual activity, so it will also be useful for activists seeking to end discrimination."

The guidelines are designed for use by national public health officials and managers of HIV/AIDS and STI (sexually transmitted infections) programmes, NGOs and health workers. They contain MSM-specific programme activities such as the use of water- and silicone-based lubricant for the correct functioning of condoms during anal sex.

The guidelines do not advise medical male circumcision - a measure WHO recommends for HIV prevention among heterosexual men - for HIV prevention among MSM due to the lack of sufficient research on its effect of its use in MSM sexual activity.

They further recommend that health services adhere to the principles of medical ethics and the right to health, and ensure that MSM feel comfortable enough to seek medical care, with MSM-specific health needs catered for within national health systems.

"Like many other African countries, all men in South Africa are assumed to be straight, so health workers are not aware of the need to identify people of different sexualities during consultations; outside of centres like ours, there is little competency in providing health care to MSM," said Rebe. "By availing this knowledge, the guidelines will empower health workers to provide better care to MSM."


Wake-up call

In countries like Uganda, where homophobia is deeply entrenched both within society and the law, gay rights groups hope the new guidelines will serve as a wake-up call to the government about the need to include MSM in HIV programming.

"I hope the new guidelines will be an eye-opener to the government, who have so far ignored MSM within HIV prevention, treatment and support; it should show them that MSM exist in Uganda and are at high risk," said Frank Mugisha, executive director of the NGO Sexual Minorities Uganda. "They therefore cannot be ignored and urgently require HIV interventions."
 
Read the rest here.

[If an item is not written by an IRMA member, it should not be construed that IRMA has taken a position on the article's content, whether in support or in opposition.]