ARV gel almost ready to roll out

via the Daily News, by Liz Clarke

In the time it takes parents to see their children grow from birth to adulthood, the vaginal gel containing the antiretroviral tenofovir has been under close and intense scrutiny.

Now nobody is more keen to see the fast-track roll-out of the life-saving microbicide than Professor Quarraisha Abdool Karim.

Research initiated 20 years ago at the Medical Research Council and in the past ten years at Caprisa finally culminated in a definitive proof that a microbicide, namely tenofovir gel, reduces the risk of women contracting HIV.

“Twenty years might sound a long time,” she said this week, “but this sort of science requires painstaking input from every member of the research team. We have had to ensure that every avenue – from concept to proof – has been covered. Now that we can prove that tenofovir gel works, we are looking forward to implementing the next step.”

That next step, awaiting approval from the Medicines Control Council, will test the feasibility of integrating tenofovir gel provision into family planning services.

As a principal researcher in the Caprisa 004 scientific research programme, Abdool Karim demonstrated that the gel prevented both HIV and Herpes Simplex Virus (HSV) Type 2 infection.

It’s a finding that has been lauded as one of the most significant scientific breakthroughs in the fight against Aids by WHO, UNaids and several leading organisations

“But there is no time to rest on these laurels,” she says. “There is much work still to do.”

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.]

Treatment alone will not win war against HIV

via Cape Argus, by Sipokazi Fokazi

If South Africa is to win the battle against HIV/Aids it cannot rely solely on treatment, and must explore prevention strategies that would target those most at risk, including women and children, a Cape Town scientist and HIV researcher has cautioned.

Professor Linda-Gail Bekker, head of the Desmond Tutu HIV Centre, at UCT, said although the effect of HIV treatment was starting to show with the number of deaths beginning to even out, the country would not win the battle with treatment alone.

Bekker was speaking during a meeting hosted by the Microbicide Media and Communication Initiative, an advocacy group that gathers research in microbicides by a range of organisations.

She warned that reliance on treatment would at some stage become unaffordable and unsustainable.

Finance continued to be a problem for many countries, and paying for antiretroviral drugs was becoming expensive.

“Given the financial difficulties, countries will somehow have to come up with plans on how to bring infection levels down.”

The focus needed to be on strategies that achieved behavioural change.

One of the most important things for South Africa was knowing its epidemic – who was most at risk, who was passing HIV to whom, and where the epidemic was concentrated.

UNAids information was that four population groups remained at risk: men who had sex with men, commercial sex workers, prisoners, and intravenous drug users.

In South Africa, young women and pregnant women could be added to that list.

Bekker suggested targeting, directing and tailoring prevention interventions to reduce infection rates.

“You need to know where most of your infections are occurring, and then to work out how best to intervene. I believe it has been a mistake to think one size fits all,” she said.

One area in which South Africa could start shutting the door was in the mother-to-child transmission of HIV.

“We need to wipe out paediatric infection.”

South Africa could not afford to allow transmission of the virus from mother to child.

“If we don’t prevent this, those children will need treatment for the rest of their lives and it will be expensive for the country. We can bring our mother-to-child HIVinfection rate to below 1 percent.”

Researchers had made great strides in HIV prevention studies, particularly in the field of microbicides.

Bekker said it was important that prevention packages be tailored to population groups that were most at risk.

Such strategies would have to take into account biomedical, behavioural and structural components.

“We are in a very exciting period where a whole range of biomedical technologies are showing partial but significant efficacy. Combinations of these prevention technologies in the future will give people options.”

Among the most promising interventions being researched by the Desmond Tutu HIV Centre and its partners was a rectal microbicide, for those practising anal sex. The proposed study would be carried out here and in other places around the world.



[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.]

First Phase 1 Double-Blind, Placebo-Controlled, Randomized Rectal Microbicide Trial Using UC781 Gel with a Novel Index of Ex Vivo Efficacy

via PLoS ONE, by Peter A. Anton, Terry Saunders, Julie Elliott, Elena Khanukhova, Robert Dennis, Amy Adler, Galen Cortina, Karen Tanner, John Boscardin, William G. Cumberland, Ying Zhou, Ana Ventuneac, Alex Carballo-Diéguez, Lorna Rabe, Timothy McCormick, Henry Gabelnick, Christine Mauck, Ian McGowan

Objectives:

Successful control of the HIV/AIDS pandemic requires reduction of HIV-1 transmission at sexually-exposed mucosae. No prevention studies of the higher-risk rectal compartment exist. We report the first-in-field Phase 1 trial of a rectally-applied, vaginally-formulated microbicide gel with the RT-inhibitor UC781 measuring clinical and mucosal safety, acceptability and plasma drug levels. A first-in-Phase 1 assessment of preliminary pharmacodynamics was included by measuring changes in ex vivo HIV-1 suppression in rectal biopsy tissue after exposure to product in vivo.

Methods:

HIV-1 seronegative, sexually-abstinent men and women (N = 36) were randomized in a double-blind, placebo-controlled trial comparing UC781 gel at two concentrations (0.1%, 0.25%) with placebo gel (1:1:1). Baseline, single-dose exposure and a separate, 7-day at-home dosing were assessed. Safety and acceptability were primary endpoints. Changes in colorectal mucosal markers and UC781 plasma drug levels were secondary endpoints; ex vivo biopsy infectibility was an ancillary endpoint.

Results:

All 36 subjects enrolled completed the 7–14 week trial (100% retention) including 3 flexible sigmoidoscopies, each with 28 biopsies (14 at 10 cm; 14 at 30 cm). There were 81 Grade 1 adverse events (AEs) and 8 Grade 2; no Grade 3, 4 or procedure-related AEs were reported. Acceptability was high, including likelihood of future use. No changes in mucosal immunoinflammatory markers were identified. Plasma levels of UC781 were not detected. Ex vivo infection of biopsies using two titers of HIV-1BaL showed marked suppression of p24 in tissues exposed in vivo to 0.25% UC781; strong trends of suppression were seen with the lower 0.1% UC781 concentration.

Conclusions:

Single and 7-day topical rectal exposure to both concentrations of UC781 were safe with no significant AEs, high acceptability, no detected plasma drug levels and no significant mucosal changes. Ex vivo biopsy infections demonstrated marked suppression of HIV infectibility, identifying a potential early biomarker of efficacy. (Registered at ClinicalTrials.gov; #NCT00408538)

Read a more detailed description 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.]

Microbicide Trials Network Statement on Decision to Discontinue Use of Oral Tenofovir Tablets in VOICE, a Major HIV Prevention Study in Women

via Microbicide Trials Network

VOICE, an HIV prevention trial evaluating two antiretroviral (ARV)-based approaches for preventing the sexual transmission of HIV in women – daily use of one of two different ARV tablets or of a vaginal gel – will be dropping one of the oral tablets from the study. The decision to discontinue use of tenofovir tablets in VOICE comes after a routine review of study data concluded that the trial will not be able to demonstrate that tenofovir tablets are effective in preventing HIV in the women enrolled in the trial. VOICE will continue to test the safety and effectiveness of the other oral tablet, Truvada®, a combination of tenofovir and emtricitabine, and of the vaginal gel formulation of tenofovir.

Importantly, the review, which was conducted by the National Institute of Allergy and Infectious Diseases (NIAID)’s independent Prevention Trials Data and Safety Monitoring Board (DSMB), identified no safety concerns with any of the products being studied in VOICE.

VOICE – Vaginal and Oral Interventions to Control the Epidemic – involves 5,029 women at 15 trial sites in Uganda, South Africa and Zimbabwe. The trial is being conducted by the Microbicide Trials Network (MTN), an HIV/AIDS clinical trials network funded by the National Institute for Allergy and Infectious Diseases with co-funding from the Eunice Kennedy Shriver Institute for Child Health and Human Development and the National Institute of Mental Health, all components of the U.S. National Institutes of Health.

The study was designed with five study groups: tenofovir gel, an inactive placebo gel, oral tenofovir, oral Truvada and an inactive placebo tablet. The women in each group (about 1,000) are asked to take their assigned study product daily. VOICE is the only trial evaluating the daily use of an ARV tablet – an approach called oral pre-exposure prophylaxis, or PrEP – and a vaginal 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 prefer.

On September 16, 2011, the NIAID Prevention Trials DSMB reviewed VOICE study data for the period between Sept. 9, 2009, when the study began, and July 1, 2011. Based on this interim review, the DSMB determined that it was not possible to show whether oral tenofovir tablets were any better than a placebo for preventing HIV in the women assigned to that study group. The DSMB therefore recommended that the women randomized to the oral tenofovir tablet group discontinue their use of the study product. This recommendation does not apply to the women in the groups using either the tenofovir gel or oral Truvada tablets, or the corresponding placebos; the DSMB recommended that these four study groups continue in VOICE.
 
Read the rest.
 
 
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An end to AIDS is within our reach

via The Washington Post, by Desmond Tutu

A study published in the New England Journal of Medicine last month has demonstrated that antiretroviral treatment can prevent the spread of HIV, in addition to saving those infected from sickness and death.

Armed with this new data, President Obama should lead the world in a massive effort to expand access to treatment and rid humanity of AIDS — the most devastating disease of our time.

But just as the end of AIDS has finally come within reach, we are witnessing an unprecedented drop in financial and political support for the cause.

The Joint United Nations Programme on HIV/AIDS and the Kaiser Family Foundation reported in August that donor funding for HIV/AIDS leveled in 2009 and then declined — 10 percent — in 2010 for the first time ever. The United States, which accounts for more than half of global contributions to fight the disease, disbursed $700 million less in 2010 than in 2009. And projected U.S. funding in 2011 is roughly $28 million less than in 2010.

This is a great shame, as millions of people receiving treatment worldwide depend on these funds to stay alive.

Our support should be increasing. AIDS remains the leading cause of orphanhood and of death among women of reproductive age. It is a major driver of opportunistic infections — particularly tuberculosis — and keeps tens of millions of Africans mired in poverty.

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.]

Early ARV Treatment Will Save Lives in South Africa

Via All Africa.

Government's decision to offer free ARV treatment to people with CD4 counts of 350 or less has been welcomed as a life-saver.

The South African government's announcement that it will give antiretroviral medication to people with HIV who have CD4 counts of below 350 will save lives and prevent infection.

This is according to Medecins Sans Frontieres (MSF), which welcomed the announcement made by Deputy President Kgalema Motlanthe on Friday (12 August).

Until Friday, people were only able to get ARVs if their CD4 count was below 200 unless they were pregnant or had tuberculosis.

"The decision to start people on HIV treatment earlier, before they become sick with diseases like tuberculosis, marks a critical moment for this country that is so hard hit by the epidemic," said Dr Gilles van Cutsem, Medical Coordinator for MSF in South Africa.

"When people are started earlier on ARV treatment, they are less likely to die, less likely to become ill, less likely to need hospitalisation and more likely to stick to their treatment in the long run."

A study conducted by MSF last year in Lesotho found that patients who started treatment above CD4 200 were 68% more likely to survive than patients those who started ARVs when their CD4 count was below 200.

Van Cutsem added that starting people on ARVs earlier was likely to prevent new infections as "ARV treatment dramatically reduces the spread of the virus to others, by making people living with HIV less infectious by up to 96 percent".

Meanwhile, a study published in PloS journal in July predicts that making ARVs available to people from CD4 of 350 would have a dramatic effect on the community of Hlabisa in northern KwaZulu-Natal.

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.]

The crazy things they say: politicians and HIV

Via PlusNews.

Political commitment is key to the success of HIV programmes and African leaders have been at the forefront of the fight against HIV on the continent, but politicians also have the power to harm HIV/AIDS campaigns.

Uganda's recently appointed health minister, Christine Ondoa, has been berated by AIDS activists for comments she allegedly made in an interview with a local newspaper on 1 August. According to The Observer, Ondoa claimed to know three people who had been cured of HIV through prayer.

"I am sure and I have evidence that someone who was [HIV] positive turned negative after prayers," she said.

Activists described her comments as "careless and misleading". Ondoa joins a long list of African leaders who have been criticized for comments deemed detrimental to the fight against HIV; here are some of the more controversial statements made by politicians:

Thabo Mbeki - In 1999, the then South African president said the ARV zidovudine - also known as AZT - had toxic side-effects and was dangerous to health, and as such, the government would not provide it free of charge to HIV-positive pregnant women.

Mbeki stirred controversy when he questioned the causal link between HIV and AIDS; in 2000 he set up a Presidential AIDS Advisory Panel, largely comprising AIDS denialists, to discuss how South Africa should deal with the crisis.

Mbeki also evoked conspiracy theories by alleging that the US Central Intelligence Agency, working with large pharmaceutical companies, was part of a conspiracy to promote the view that HIV caused AIDS.

In 2001, the NGO Treatment Action Campaign (TAC) filed a lawsuit against the government aimed at giving HIV-positive pregnant women access to the ARV, nevirapine, used to reduce the risk of HIV transmission from mother to child. TAC won the case, and the government was forced to provide the drug through the public health system.

According to the authors of a 2008 Harvard study, more than 330,000 lives were lost as a result of the delays in implementing a feasible and timely ARV treatment programme in South Africa.

Manto Tshabalala-Msimang - South Africa's health minister from 1999 to 2008 under Mbeki, her years in office were characterized by controversy, largely due to her reluctance to develop public sector policies involving the use of ARVs to fight AIDS.

Even after ARVs became available, Tshabalala-Msimang continued to cast doubt on their safety and efficacy, actively endorsing alternative therapists who promoted scientifically untested alternatives to ARVs.

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.]

Risk factors for HIV vary between African cities, need tailored responses

Via AIDSMap, by Carole Leach-Lemens.

A comparative study in three large cities in southern Africa has found big differences in risk factors for acquisition of HIV infection, emphasising the importance of locally tailored HIV prevention strategies and up-to-date information on local risk factors.

The study looked at behavioural risk factors associated with acquiring HIV infection in 5000 sexually active women in Harare, Durban and Johannesburg who took part in a large trial of an HIV prevention method based on use of the diaphgram.

Sue Napierala Mavedsnege and colleagues report the findings of their prospective cohort analysis in the advance online edition of the Journal of Acquired Immune Deficiency Syndromes.

A total of 309 incident HIV infections were identified. Durban reported the highest incidence rate, followed by Johannesburg and then Harare (6.75 per 100 person years, 95% CI: 5.74-7.93; 3.33 per 100 person years, 95% CI: 2.51-4.44; 2.72 per 100 person years CI: 2.26-3.26, respectively).

Having more than one partner in the last three months was the only common factor associated with HIV incidence.

The majority of the estimated 35 million people living with HIV live in sub-Saharan Africa where 70% of all new infections occur. Women represent over 60% of all infections. Southern Africa, with the highest regional prevalence, reflects different phases of the epidemic.

In Zimbabwe, with an estimated prevalence of 14.3%, the epidemic began early, peaked in 1998 with a subsequent decline in incidence and prevalence.

From 1990-1998 South Africa had an exponential increase followed by a moderate increase until 2004 when apparent stabilisation began. In 2008 estimated provincial prevalence rates ranged from 5.3% to 25.8%.

In Gauteng province, with Johannesburg its largest city, prevalence appears to have peaked in 2002 at 20.3% and declined to 15.2% in 2008. In contrast, Kwa Zulu Natal province where Durban is the largest city, estimated prevalence rose from 15.7% in 2002 to 25.8% in 2008.

While cross-sectional studies looking at risk factors associated with HIV have taken place in Zimbabwe and South Africa, few have looked at risk factors for HIV incidence in women. A better understanding of these factors within local contexts will help develop targeted interventions so reducing transmission.

The authors looked at factors associated with differences of HIV incidence among women in Harare, Johannesburg and Durban enrolled between September 2003 and September 2005 in the Methods for Improvement of Reproductive Health (MIRA) study, a randomised clinical trial to look at the effect of the diaphragm plus lubricant gel for the prevention of HIV. The intervention did not reduce HIV incidence.

The authors undertook a prospective cohort analysis of trial participants who were followed for a median of 21 months (12-24 months).

Socio-demographic, biological and behavioural data were collected at baseline and at quarterly visits. Testing for HIV and STIs were conducted at each quarterly visit.

Each location had distinct characteristics as well as different patterns of individual risk factors.

In Harare women were more likely to live with their partner, be employed and not use alcohol or drugs but more likely to wipe inside their vagina. While they had a later sexual debut and fewer partners than in Durban or Johannesburg there was more transactional sex (for money, food, drugs or shelter) within the last three months.

Early sexual debut was more common in Durban, while in Johannesburg consumption of alcohol within the last three months, multiple sexual partners and sex under the influence of drugs or alcohol were more likely.

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.]

AIDS conspiracy believers less likely to condomise

Via PlusNews.

Thirty years after the discovery of AIDS, conspiracy theories that posit the virus as man-made continue to enjoy support among a segment of South African youth - and these beliefs may be putting them at greater risk of HIV infection.

A representative survey of more than 3,000 South Africans between the ages of 20 and 29 years in the greater Cape Town area has found that black South Africans were eight times more likely to believe AIDS conspiracy theories, specifically that scientists engineered HIV.

Among black respondents, 20 percent believed that HIV was man-made and created by scientists as an attack on people of African descent, according to a University of Cape Town (UCT) study.

New research by Nicoli Nattrass, director of the AIDS and Society Research Unit at UCT, also found that AIDS conspiracy believers are 50 percent less likely to report having used a condom the last time they had sex than non-believers. Respondents with traditional values, and those who had lower socio-economic status but were not religious, were more likely to believe there was a conspiracy.

The Nattrass research, co-authored with colleague, Eduard Grebe and presented at the 1st HIV Social Sciences and Humanities Conference in Durban, South Africa, also showed that people who had heard of the Treatment Action Campaign (TAC), a South African AIDS lobby group, were much less likely to believe a conspiracy existed and twice as likely to use condoms.

"We picked up the effect of TAC in counteracting conspiracy theories," Nattrass told IRIN/PlusNews. "It's another way to show the importance of civil society resistance to the [former] government."

TAC strenuously opposed not only South Africa’s former health minister, Dr MantoTshabalala-Msimang, but also former South African President Thabo Mbeki over their AIDS denialism and his administration's delay in rolling out HIV treatment.

AIDS conspiracy origins

The research will be included in a forthcoming book by Nattrass on the effects and history of AIDS conspiracy theories, and their origins as a Cold War propaganda tool by the East German state security service, known as Stasi, and the national security agency of the former Soviet Union, the KGB.

The conspiracy theories were then taken up by right-wing white supremacists in the US and expounded in a book, "Behold the Pale Horse", excerpts of which were circulated by Tshabalala-Msimang to her nine provincial counterparts, according to Nattrass.

Given the deep distrust of Western science, and the history of racial oppression of African Americans and black South Africans, Nattrass said it was understandable that the prevalence of AIDS conspiracy beliefs would be higher in segments of both these populations.

"There's definitely a racialized aspect to this," Nattrass told IRIN/PlusNews. "Most anthropologists tend to look at it as a narrative of resistance against stigmatization; against imperialist discourses by policy-makers."

In a review of existing research on the prevalence of AIDS conspiracy beliefs by Nattrass, up to 80 percent of surveyed African-American respondents believed HIV was man-made. US studies have found a strong link between AIDS conspiracy theories and lack of condom use, not testing for HIV and not adhering to antiretroviral (ARV) treatment. In South Africa such theories have been associated with never testing for HIV.

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.]

New Light Shed on Male Sex Work

Via PlusNews.

Commercial sex work, dominated by a focus on women, could be redefined as new research launched today in Nairobi, Kenya, sheds light on the complicated HIV prevention needs of what may be Africa’s most deeply underground group at high risk of HIV - male sex workers.

The report co-authored by the United Nations Development Programme (UNDP) and South Africa's Sex Workers Education and Advocacy Taskforce (SWEAT) seeks to better understand the social contexts, sexual practices and risks, including that of HIV, among these men.

The professional debut of many of the 70 male sex workers surveyed in Kenya, Namibia, South Africa, Uganda and Zimbabwe was often prompted by the family rejecting the men’s sexual orientation; for others, it was a way to survive in a foreign country.

Men reported being at risk of HIV in many ways, including the unavailability of speciality health services, the premium clients placed on unprotected sex, violence and the lure of substance abuse. Although the work often placed them at risk of substance and physical abuse as well as HIV infection, the researchers found that it also provided the men with a sense of freedom and empowerment.

The report cautions that mitigating these risks may require specialised HIV prevention services unlike those targeted at female commercial sex workers or men who have sex with men (MSM).

A series of interviews with male sex workers at a five-country workshop in Johannesburg, South Africa, and country visits to Kenya and Namibia has produced a significant addition to the paucity of data on male sex workers, according to Paul Boyce, a UNDP researcher.

While data on MSM from Malawi, Namibia and Botswana indicated that about 17 percent were HIV positive - almost twice the national prevalence rates of their respective countries - not much has been written on the specific HIV risks of male sex workers, which may be higher than those of MSM.

While male sex workers reported working at a range of venues, including Namibian truck stops and Zimbabwean mines, most of the available information on male sex work has come from those operating in the sex tourism hot spot of Mombasa, Kenya, with limited data from a 2009 study in South Africa that showed male sex workers were twice as likely to engage in anal sex than MSM who were not selling sex.


Not necessarily the same old risks:

Unprotected receptive anal sex carries almost 20 times the HIV risk associated with unprotected vaginal sex.

Interviewees told researchers that the unavailability of water-based lubricant, which reduces the risk of condoms breaking during anal sex, and the higher financial reward of unprotected anal sex, made consistent condom use difficult.

Some clients forced unprotected intercourse on sex workers, while others admitted to practicing unsafe sex due to the disinhibition often brought about by the drug and alcohol abuse that is reportedly part of the social scene in sex work. Drugs and alcohol also helped the men mentally cope with the omnipresent risks of this lifestyle, including police harassment.

South African male sex workers said substance abuse - not HIV infection - was the greatest threat to their health.

Those who tried to access health services for HIV testing and treatment, or the diagnosis of sexually transmitted infections (STIs), reported being ridiculed and stigmatized by health workers, even in countries like Kenya, where the Ministry of Health has introduced new guidelines on MSM and sex work, and health and HIV.

"[At the] government hospital, the nurses just [stand] in front of everyone and shout out loud to the people waiting for assistance: 'If you have HIV, go to room nine, TB room 12, STD [sexually transmitted disease] room 8,'" said one man quoted in the report.

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.]

Anti-AIDS Gel Also Boosts Sexual Pleasure

Via Times of India.

 South African scientists, who launched a 24-month trial to confirm the efficacy of a microbicide gel that would reduce the risk of women getting HIV, have found an unexpected spin-off – it also boosts sexual pleasure.

Wits professor Helen Rees, of the university's reproductive health and HIV institute, said the R300m trial would involve about 2,200 sexually active women at seven locations countrywide.

The Tenofovir gel study - known as Follow-on African Consortium for Tenofovir Studies (Facts) study - would be a follow-up to the Caprisa 004 study, which showed that a highly consistent use of the microbicide by women resulted in a 59 per cent reduction in the risk of HIV infection.

Rees said during a previous study involving another gel - that proved unsuccessful in the fight against HIV - participants had noted the gel improved their sexual pleasure.

"One of the big messages we got, was many women said 'We liked this', News24.com quoted her as saying. 

 

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.]

Meet Brian Kanyemba - a Friendly Rectal Microbicide Advocate

via IRMA

Rectal microbicides are important and should be a top priority among new HIV prevention because anal sex occurs between heterosexuals as well as homosexuals, says Brian Kanyemba of Cape Town, South Africa. Awareness of anal sex and continuing discussions on anal sex could bring down homo-negativity and prejudice against MSM.

Brian is an IRMA member, an Advocate Fellow with AVAC, and a Research Assistant with the Desmond Tutu HIV Foundation. He has been very involved with IRMA's Project ARM - Africa for Rectal Microbicides, and an integral member of the Project ARM video working group which is producing an African-focused video on anal sex and rectal microbicides.

At the May 23 - 25 Top2Btm symposium in Cape Town, Brian presented an excellent poster called "Developing Rectal Microbicides (RM) in Africa - the advocacy needed to make it happen." Click here to check it out.

Brian feels lucky to have been part of the African arm of the iPrEx study, the results of which have been extremely meaningful to the MSM community. As an advocate Brian works on comprehensive community awareness of HIV prevention tools.One way in which Brian does this is to let people know that rectal microbicides are not just for MSM, but also have the potential to greatly affect the heterosexual community.

Brian also works to increase awareness and reduce stigma. "Sex is a taboo in the African context, now it's the time to call a spade a spade and send the message around," he says. He hopes that progress in sex education curriculums will aid the process, thereby bringing the epidemic out of the shadows.

In his free time, aside from his ceaseless interest in discussions of HIV prevention, Brian can be found dancing, playing pool, and drinking a good beer.

Read about other friendly rectal microbicides advocates.
Newly featured advocates include Margaret Onah, Paul Semugoma, and Ian Lemieux.

Want to join the best e-mail discussion list on new prevention technologies on the planet? Send a note to IRMA here - rectalmicro@gmail.com - and we will get you signed up.Joining the list makes you an automatic IRMA member too!

[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.]

SOUTH AFRICA: MSM still sidelined in HIV programming

"Biomedical strategies can only have a limited impact if MSM live in fear, live hidden or have limited access to safe and effective clinical care." 

via PlusNews

South African men who have sex with men are twice as likely to be HIV-positive as heterosexual men, but spending on research, prevention and treatment for this group remains low, delegates at a conference on MSM and HIV in Cape Town heard.

"We see HIV incidence rates for MSM continue to increase in all studied countries; we must advocate for more research," Linda-Gail Bekker, deputy director of the Desmond Tutu HIV Centre, said in a statement.

Bekker called for the introduction of specific HIV packages tailored to the needs of particular groups, including one for MSM.

Studies show that the risk of contracting HIV during anal sex is 18 times higher than during penile-vaginal sex.

According to research whose results were revealed at the conference, held on 23-25 May, more than one in 20 men taking part in the survey reported consensual participation in a sexual act with another man and MSM were twice as likely to be HIV-positive as their heterosexual peers.

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.]

South Africa: Dept. of Health Admits MSM Neglected

via Mambaonline

The Minister of Health has admitted that not enough has been done to reach men who have sex with men (MSM) in South Africa when it comes to HIV.

Speaking at the opening of the Top2Btm symposium in Cape Town, Dr. Yogan Pillay, Chief Director of Strategic Planning at the National Department of Health, emphasised the need for an HIV strategy that is “much more nuanced and targeted”.

Minister of heath Aaron Motsoaledi [pictured] was due to open the three day symposium dedicated to the sexual health of men who have sex with men, but was unable to attend and sent Pillay in his stead.

Reading the Minister’s speech, Pillay said: “Even though the Strategic Plan mentions men who have sex with men, we certainly haven’t done enough to protect this group”.

Recent studies have indicated that the prevalence of HIV is much higher among MSM than the general population. “We do not know how the epidemic affects MSM nationally as we only have small regional studies to rely on at this point,” Pillay said, emphasising the need for more data.

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Symposium to unravel HIV issues amongst MSM

via Behind the Mask

On 23 to 25 May this year, the Anova Health Institute together with PEPFAR will hold a regional symposium aiming to consolidate and review current trends and research related to HIV prevention, treatment and care among men who have sex with other men (MSM) in South Africa to be held at the Vineyard Hotel in Cape Town.

Glenn de Swardt, Programme Manager for Anova Health Institute, said the symposium will serve as a valuable platform for exchange of information and ideas in terms of increasing knowledge and insight into MSM and HIV, and will help stimulate more research and commitment to more services for MSM, through plenary sessions and presentations, workshops and poster displays, prepared for the symposium.”

“There is an ever-increasing awareness of MSM being both at increased risk of HIV infections, as well as being marginalised and often ignored by the mainstream health care system. Significant research is being undertaken among diverse MSM groupings and it is important that this data is shared and discussed with peers in order to broaden our scope on the issues at play and the services that are required”, de Swardt revealed.

The symposium will feature plenary sessions on prevention among MSM, diverse aspects of treatment and care, presentations and a series of skills building workshops.

“In addition to sharing information and research, we are hopeful that the symposium will renew participants’ commitment to the on-going challenges we face. The symposium will also feature an international expert on HIV among transgender people, which we hope will focus attention on the health care needs of this very marginalised community”, de Swardt added.

De Swardt revealed that little is being done to respond to the escalating HIV prevalence amongst MSM’s.

“MSM are generally excluded from traditional heterosexist safer sex messaging, and prejudice against such men remains institutionalised within some sectors of the public health system. For example, many organisations distribute free condoms to men but forget that people who engage in anal intercourse require water-based lubrication; countless men are using products such as petroleum jelly, body lotions or margarine as lubricants, all of which contribute to condom failure because of their oil content”, said de Swardt.

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Soweto Clinic Reaches Out To Men Who Have Sex With Men

via Global Forum on MSM and HIV, by Yngve Sjolund

The Health4Men clinic is putting up a determined effort in the fight against high HIV and STI infection rates amongst men-who-have-sex-with-men (MSM) in and around Soweto.

Thanks to support from PEPFAR and USAID, the Simon Nkoli Centre for Men’s Health can offer free and confidential clinic services, which include men's health care check-ups, STI and HIV screening and medical treatment and prevention care. Innovative outreach projects, counselling for individuals and same-sex couples, a range of support groups - including groups for men living with HIV - as well as regular seminars and talks addressing topical issues related to men’s sexual and psychosocial health are also available for MSM.

MSM living in the township are aware that various studies have documented the very high HIV prevalence amongst MSM Sowetans in the past two years.

David Motswagae an outreach worker at the clinic, confirms: “Yes, they know – and it was great to see that most of them knew about the findings of the study, even if they found out from gay media on the web. Participants raised the issue during discussion groups, and most of them said: ‘why are you saying one in three of us are HIV positive? Why is it that other people are still in the closet – and we don’t know their status?”

Same-sex relationships remain difficult terrain for media and health communication in South Africa, and a lack of coverage of MSM issues in the media fuels the marginalization of MSM and their HIV prevention needs. At most, the media tends to reinforce stereotypes that all MSM are gay – or that they have the same HIV prevention needs as gay men. Typecasting all MSM – who do not usually self-identify as being gay - may also alienate this vulnerable group, and deter them from accessing targeted HIV services for fear of being labelled “gay”.

Infection rates have risen steadily in recent years among MSM, despite a decrease in the 1990’s – and according to the CDC (Centers for Disease Control and Prevention), MSM account for 71% of all HIV infections in the U.S.A., where statistics also showed a 30 percent rise in syphilis outbreaks in 2009.
But the numbers for MSM in the USA are not much different from those in South Africa, and the results of three studies conducted in Johannesburg and Durban found that HIV prevalence rates among MSM were as high as about 38 percent - or double that found among South Africa’s general population.

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[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.]

South Africa: Concern Over Theft of ARVs

Via safaids.net

Civil society organisations want to see government taking a firmer stand to stop antiretroviral drugs (ARVs) from being smuggled into the black market. 

"There are a number of people right now coming to us who have told us that they are scared to go to public healthcare facilities to get ARVs because they might be hijacked or robbed says NAPWA's Secretary-General, Nkululeko Nxesi.

Whoonga is a drug that has become a growing concern in the country. It is a detergent powder mixed with rat poison and crushed-up ARVs, then smoked. Nxesi says Napwa's concern is that people are getting away with stealing crucial treatment of AIDS patients to make a quick buck.

"Government will respond very late. That is our worry.  They must go where people are. Since they believe it is not true that ARVs are used for whoonga, then why was that woman in Hillbrow mugged? What about those policemen who stole ARVs ... why did they do that? Who is their supplier and who is their market?" asks Nxesi.

"We are very worried because we know our history and how far we've come for people to access ARVs. People who are HIV-positive are very angry and scared because this treatment is our life. Once you start it, you take it till death.  We are worried because if people are stealing our treatment, how can we live without them as it is a life time commitment?" said Portia Serote, deputy chairperson of the TAC in Ekhuruleni.


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HIV prevalence and risk practices among men who have sex with men in two South African cities

J Acquir Immune Defic Syndr. 2011 Feb 4. [Epub ahead of print]

Abstract

BACKGROUND:

In South Africa information on HIV among men who have sex with men (MSM) is limited and HIV prevention programs for men MSM are not widely available, despite global evidence that MSM are at substantial risk for HIV infection. The Johannesburg/eThekwini Men's Study (JEMS) was conducted during 2008 to provide information on HIV among MSM in Johannesburg and Durban.

METHODS:

MSM aged 18 years or older were recruited using respondent-driven sampling. Participants completed a questionnaire and provided finger-prick blood specimens for anonymous HIV testing in a laboratory.

RESULTS:

From July to December 2008, 285 MSM were recruited in Johannesburg (n=204) and Durban (n=81). Participants had a median age of 22 years and were predominantly black Africans (88.3%). The HIV prevalence was 49.5% (95% confidence interval [CI], 42.5%-56.5% in Johannesburg and 27.5% (95% CI 17.0%-38.1%) in Durban. HIV infection was associated with gay identification (adjusted odds ratio [aOR], 8.4; 95% CI, 3.7-19). Factors in the previous year that were associated with HIV infection included receptive unprotected anal intercourse (aOR 4.3; 95% CI 2.4-7.6); sex with a person known to be HIV positive (aOR 2.3; 95% CI 1.1-4.9); and a sexually transmitted infection diagnosis (aOR 2.4; 95% CI 1.1-5.2).

CONCLUSIONS:

HIV prevalence among MSM in Johannesburg and Durban is considerably higher compared to men in the general population. There is an urgent need to establish national HIV surveillance among MSM and to expand the availability of HIV prevention programs for MSM.

Source

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AVAC helps us understand male circumcision, and its impact on women

from AVAC

 It has been roughly four years since randomized controlled trials of medical male circumcision in Kenya, South Africa and Uganda showed that medical male circumcision is safe and reduces men's risk of HIV infection during vaginal sex by about 60 percent. The advent of this new biomedical strategy has prompted a range of implementation efforts and civil society responses. WHiPT is a response to women’s concerns that emerged from the earliest discussions of this new strategy.

WHiPT released its first findings on male circumcision rollout at the 2010 IAS conference in Vienna. Teams of women in Namibia, Kenya, South Africa, Swaziland, and Uganda were part of the first, pilot phase of this research, focusing on the implications of MMC for women. In all but one region of focus (Nyanza in Kenya), MMC had not yet been rolled out; therefore, the women documented perceptions and concerns around MMC’s pending rollout, not actual or anecdotal experiences of the rollout.

Read the report: Making Medical Male Circumcision Work for 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.]