Category Archives: HIV Prevention

Test-and-treat could slash new HIV infections among gay men

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From POZ.com…

Testing men who have sex with men for HIV and immediately treating those who are HIV positive could greatly reduce new infections among the MSM population as a whole, at least in the Netherlands, Medscape reports. Publishing their findings in Science Translational Medicine, researchers analyzed medical records data as well as genetic information about the virus in 617 recently diagnosed Dutch MSM, in order to make estimates about the likely source of their infections.

An estimated 71 percent of the new HIV cases transmitted from undiagnosed men, 22 percent from men who were diagnosed but not on antiretrovirals (ARVs), 6 percent from men who had started treatment, and 1 percent of diagnosed men who had not been linked to medical care within 18 months. About 43 percent of the transmissions derived from men infected for less than a year.

The researchers estimated that 19 percent of the new HIV cases could have been averted if MSM tested annually for HIV and if those who tested positive were immediately provided treatment. (Half of the at-risk men tested at least annually.) Two-thirds of cases could have been averted if all men testing positive received ARVs and if Truvada (tenofovir/emtricitabine) as pre-exposure prophylaxis (PrEP) was provided to half of all men testing negative.

The researchers concluded that their findings support making PrEP available worldwide.

To read the study abstract, click here.

Gay/bi men are 2% of population but 67% of all new HIV infections in 2014

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From Reuters Health…

HIV still on the rise among gay menNew strategies to reduce risky sexual behaviors among young gay and bisexual men with human immunodeficiency virus may be needed to reduce new infections, according to a new study.

Researchers found that most young gay and bisexual men with HIV don’t have the virus suppressed by medication, making them more likely to infect others, and more than half reported recent unprotected sex.

While medications for HIV and access to those treatments improved over time, lead author Patrick Wilson said addressing unemployment, education and mental health is also important.

“I think we have to take a multipronged approach,” said Wilson, of the Columbia University Mailman School of Public Health in New York City.

Gay and bisexual men represent about 2 percent of the U.S. population, but accounted for about 67 percent of all people diagnosed with HIV in 2014, according to the HIV Surveillance Report released on Sunday by the Centers for Disease Control and Prevention (see Reuters Health story of December 6, 2015 here).

The steepest rise in HIV diagnoses between 2005 and 2014 was among young gay and bisexual men, with increases ranging from 56 percent among young white men to 87 percent among young black and Latino men.

Continue reading.

University of Pittsburgh’s Dr. Ken Ho talks about PrEP

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Dr. Ken Ho at Pitt

Dr. Ken Ho at Pitt

The Centers for Disease Control and Prevention are working to inform patients and health care providers of a new, anti-viral pill that they estimate can drastically reduce the risk of infection.  Here to tell us more about this treatment and discuss why it hasn’t been adopted by clinicians in the region are Dr. Ken Ho, an HIV specialist at the University of Pittsburgh and Jason Herring, director of programs and communications at the Pittsburgh AIDS Task Force.

Listen to the broadcast on Essential Pittsburgh 90.5 WESA, Pittsburgh’s NPR station.

Awareness of treatment’s impact on transmission is transforming the lives of couples of mixed HIV status

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From aidsmap.com…

A greater understanding of the impact of HIV treatment on prevention is changing the experience of being in a relationship with a partner of a different HIV status, according to a qualitative Australian study published last week in the Sociology of Health and Illness. A biomedical intervention appears to be having unexpected effects – loosening the association of serodiscordant relationships with ‘risk’ and helping couples to experience their relationships as normal and safe.

Asha Persson of the University of New South Wales reports that people’s views about treatment as prevention have changed significantly in recent years. She previously researched the topic in 2009, soon after the ‘Swiss Statement’ was issued. At that time, people in a relationship with a partner of a different HIV status often expressed scepticism or uncertainty about the idea that HIV treatment could make a person non-infectious. They did not always see the relevance of the information to their own lives.

But in her more recent interviews, conducted in 2013 and 2014, couples readily discussed the implications of having an undetectable viral load. HIV treatment appears to be transforming the social and sexual lives of people living with HIV and their partners.

The research specifically focuses on so-called ‘serodiscordant couples’, in other words those in which one person has HIV and the other does not. The public health literature on serodiscordant relationships typically focuses on the risk of HIV transmission and tends to see such a relationship as inherently problematic. In contrast, Persson found that her interviewees wanted to stress how normal and positive their relationships were, with HIV being seen as ‘no big deal’.

Read the full article on aidsmap.com.

Increasing levels of engagement with care is key to controlling HIV epidemic in US

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From aidsmap.com…

engagement with care key to controlling HIVTest-and-treat’ is unlikely to be an effective strategy to control the HIV epidemic in the United States without improvements in retention in care, investigators argue in the online edition of Clinical Infectious Diseases. A mathematical model suggested that without interventions to address poor levels of engagement in HIV care, there could be as many as 1.39 million new HIV infections in the US over the next 20 years, at a cost of $256 billion. Targeting testing and linkage would only prevent 21% of these new infections. But a package of interventions comprising testing, linkage and retention in care would prevent over half of the projected new infections, reduce AIDS-related mortality by almost two-thirds and be cost effective.

“To alter the course of the HIV epidemic in the United States, strategies of ‘test and treat’ alone may be insufficient; attention to the full continuum of care will be essential,” comment the authors.

United States guidelines recommend expanded HIV testing and antiretroviral therapy at any CD4 count as strategies to reduce rates of AIDS-related deaths and HIV transmissions. However, this approach may not be as effective as hoped. Recent research has shown that there is significant attrition at each stage of the HIV care continuum in the US. Up to a fifth of HIV-infected individuals are undiagnosed; 20% of recently diagnosed patients are not linked to care within 90 days; 54% of patients are not retained in care; only 30% of diagnosed patients have an undetectable viral load.

Continue reading.

Paying for PrEP without breaking the bank

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From thevoice.com…

paying for PrEPThere’s a lot of misinformation circulating around the internet and in conversations about PrEP (Pre-exposure prophylaxis), the single-daily dose of Truvada, once only used to treat those living with HIV, but now available and approved by the FDA to prevent new HIV infections in negative individuals. PrEP has proved to be more than 90 percent effective in clinical trials when taken as prescribed along with condom use. That’s great. But paying for PrEP, whether you’re insured or not, can be a stressful and expensive experience.Georgia Voice is here to provide you with some basic information about how you can get access to and pay for PrEP. This is by no means a comprehensive list. And of course, you’ll want to consult your health care provider before beginning any drug regimen.

Get more information on thevoice.com.

Research shows structural barriers need to be addressed for PrEP to have an impact

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From aidsmap.com…

The uptake of PrEP in people who need it risks being limited due to low levels of awareness, gaps in health insurance, opaque bureaucratic procedures, under-usage of medical services, and limited awareness and skills in healthcare providers, according to an analysis published online ahead of print in Clinical Infectious Diseases. Also taking into account sub-optimal adherence among some PrEP users, the researchers conclude that just 15% of gay men in the American city of Atlanta who could benefit are likely to achieve protection from HIV with PrEP.

The PrEP care cascade

Colleen Kelley and colleagues at Emory University outline a ‘care cascade’ or ‘continuum of care’ for PrEP which identifies the key steps in the process of getting hold of PrEP and using it effectively. Analysis of the care cascade can help focus attention on where there are significant barriers to a person moving on to the next step.

Continue reading.

Exactly zero men on PrEP contract HIV in 2.5-year study

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From hivplusmag.com…

Zero men on PrEP get HIV new study findsAfter two and a half years of trials, a new study has found no new HIV infections among a group of people on pre-exposure prophylaxis (PrEP). For 32 months, researchers at the Kaiser Permanente Medical Center in San Francisco tracked the health of over 600 people as they used Truvada daily to prevent the virus in a real-world setting.

The average age of the study participants was 37, and 99 percent were men who have sex with men. The average length of individual usage was 7.2 months. Members of this group also reported a higher likelihood of having multiple sex partners than those not using PrEP. No one in the study contracted HIV.

Lead author Jonathan Volk, a physician at Kaiser Permanente San Francisco, emphasized that this is the first time such a study has been done in a clinical practice setting at this size. The findings were published Wednesday in Clinical Infectious Diseases, a leading journal of studies on infection disease.

Continue reading.

The medical staff at the Pitt Men’s Study emphasize that PrEP is not a substitute for condoms. It should be used in addition to condoms, to further reduce your risk. It is also important to note that PrEP doesn’t protect against other STDs like syphilis, chlamydia, and gonorrhea. To learn more about PrEP, check out the CDC’s Website. If you have questions about PrEP, you can speak to your doctor. You can also call the PrEP clinic at the University of Pittsburgh Medical Center: (412) 647-0996.

Few gay teenage boys get tested for HIV

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From Medicalpress.com…

Few gay teens tested for HIVThe greatest barriers to these teenage males getting tested are not knowing where to go to get an HIV test, worries about being recognized at a testing site and—to a lesser degree—thinking they are invincible and won’t get infected.

“Understanding the barriers to testing provides critical information for intervening, so we can help young men get tested,” said study first author Gregory Phillips II, a research assistant professor of medical social sciences at Northwestern University Feinberg School of Medicine and an investigator for the IMPACT LGBT Health and Development Program at Feinberg.

“Rates of new HIV infections continue to increase among young gay and bisexual men,” said Brian Mustanski, principal investigator of the study, an associate professor of medical social sciences at Feinberg and director of IMPACT. “Testing is critical because it can help those who are positive receive lifesaving medical care. Effective treatment can also help prevent them from transmitting the virus to others.”

The study will be published Aug. 26 in the Journal of Adolescent Health. Continue reading.

HIV prevention pill a tough sell among Latinos

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From NPR.org…

“It hasn’t really hit the Latino community yet,” Jesse Hinostroza, an HIV prevention specialist with AltaMed health clinics, says while sitting at a table with a bowl of condoms and a stack of bilingual pamphlets about the pill. “They aren’t educated about it.” In California, New York, Texas and elsewhere, health workers are trying to get more high-risk Latino men to use the drug, Truvada. AltaMed’s efforts are being paid for by Gilead, the pharmaceutical company that makes Truvada.

The medication, which is used for “pre-exposure prophylaxis,” or PrEP, was approved by the FDA in 2012 for HIV prevention and has been shown to be more than 90 percent effective when used correctly. But health workers are encountering barriers among Latinos. Those barriers include a lack of knowledge about the drug, and the stigmas attached to sleeping with men and to perceived promiscuity. Many Latinos also have concerns about costs and side effects.

Read the full article.

Updated HIV/AIDS strategy and amfAR releases report

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From OUT online…

Last week the White House released the National HIV/AIDS Strategy for the United States updated through the year 2020. It’s vision statement read: “The United States will become a place where new HIV infections are rare, and when they do occur, every person, regardless of age, gender, race/ethnicity, sexual orientation, gender identity, or socio-economic circumstance, will have unfettered access to high quality, life-extending care, free from stigma and discrimination.”

The five-year plan discusses steps that are necessary to take across different facets of the HIV/AIDS topic, including reducing new HIV infections, increasing access to care for those infected and improving health outcomes for them, reducing HIV-related disparities and health inequities, and achieving a more coordinated national response to the HIV epidemic.

To accompany the strategy, the American Foundation for AIDS Research released a report commending the amount of coordinated efforts to tackle the HIV/AIDS epidemic on the federal level, but admits that to be successful, the same thing has to happen on a state level.

The foundation gave recommendations for the states so they can improve their HIV prevention and care, and align with the vision set out by the national strategy. “The burden of HIV, and the responses to it, varies across states due to a number of social, political, and economic factors,” said Jeffrey S. Crowley, Program Director of the National HIV/AIDS Initiative at the O’Neill Institute for National and Global Health Law in a release. “But we have found that if states focus on a handful of priority action steps and implement them successfully, they can begin to close critical gaps and dramatically accelerate progress toward ending their HIV epidemics.”

Continue reading.

HIV PEP with emtricitabine/tenofovir/rilpivirine has excellent completion and adherence rates

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From aidsmap.com…

Daily post-exposure prophylaxis (PEP) with single tablet emtricitabine/tenofovir/rilpivirine (Complera, Eviplera) has excellent completion rates and good side-effect and safety profiles, Australian investigators report in the online edition of Clinical Infectious Diseases.

The open-label, non-randomised study involved 100 men who have sex with men (MSM) requiring PEP after possible sexual exposure to HIV. Treatment lasted 28 days and was completed by 92% of participants. Side-effects were mild, the most common being nausea and tiredness. There were no serious adverse events.

Prompt PEP, after possible sexual or occupational exposure to HIV, can reduce the risk of infection. Guidelines recommend triple-drug therapy, ideally commenced within 72 hours of exposure. Failure of PEP has been linked to poor treatment adherence or the premature discontinuation of treatment. A recent analysis of 97 PEP studies found that only 57% of patients completed their four-week course of treatment.

The combination pill emtricitabine/tenofovir/rilpivirine provides well tolerated and easy-to-take once-daily HIV therapy. Though it must be taken with food, investigators from Australia hypothesised that the combination pill would provide convenient and safe PEP.

Continue reading.

Study links homophobia with gay and bisexual men not seeking HIV-prevention and testing services

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From hcplive.com…

A Yale University study of 38 European countries’ attitudes about homosexuality has uncovered homophobia was associated with gay and bisexual men not seeking HIV-prevention services, HIV testing, and disclosing their orientation to doctors.   The authors believed their study highlighted a dangerous trend: One where men who live in more homophobic countries were not only becoming less knowledgeable about HIV treatment, prevention, and resources, but also that this demographic seemingly had more opportunities for sexual activity through “hook-up” mobile applications and websites, a Yale University statement pointed out.

For their study published in the June 19 issue of AIDS, investigators used data from the European MSM Internet Survey (EMIS), a questionnaire that delved into gay and bisexual participants’ HIV-related knowledge, behaviors, and healthcare use.

Continue reading on hcplive.com.

AIDSVu releases updated interactive online maps

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map2

Click on the map to go to AIDSVu interactive online maps

AIDSVu releases its annual interactive online maps that show HIV prevalence data for 34 highly-impacted U.S. cities, including for the first time Birmingham, AL, updated state- and county-level prevalence data, and year-by-year new diagnosis data for 2008 to 2013. HIV testing and treatment locator maps include, for the first time, housing opportunities for persons with AIDS, and also show NIH-funded HIV prevention, vaccine and treatment trials locations.

 

 

HIV testing ad causes controversy

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From OUT.com…

An ad for FreeHIVTest.net that appeared earlier this spring has caused controversy in Los Angeles, San Francisco, and other areas where it has appeared on billboards and on public transportation kiosks. In the “white” version, the AIDS Healthcare Foundation’s ad features a gay couple in bed, covered only by a sheet and looking ashamed of what they’ve just done. A blond man clutches his pillow and looks suspiciously over the shoulder of the other man who appears to be almost catatonic. Above them, written in big letters is, “Trust Him?”

 

trusthim_gayaa_1094x335After the campaign launched this spring in Los Angeles, it’s been slated to appear in Oakland, California; Washington, D.C.; Columbus, Ohio; and Broward County, Florida. In a press release, AHF president Michael Weinstein explained:

“In today’s tabloid culture when it can seem that the game called ‘Life’ should be more appropriately tiled ‘Lies,’ the old adage holds true now more than ever, ‘It’s better to be safe than sorry.’ While infidelity is nothing new, the level of risk in contracting STDS from bed-hopping partners is at an all-time high. We want to remind couples that STDs linger around much longer than a wandering eye and that secret sexual experiences can often produce much more than what one bargained for.”

For some, it’s just a cautionary PSA about the realities of HIV and the importance of getting tested. For others, it’s been seen as a scare tactic to shame people out of having sex and demonize people with HIV — and many have spoofed the ads.

Continue reading.

New site answers your questions: “What is PrEP?”

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From whatisprep.org…

PrEP means Pre-Exposure Prophylaxis, and it’s the use of anti-HIV medication that keeps HIV negative people from becoming infected. PrEP is approved by the FDA and has been shown to be safe and effective. A single pill taken once daily, it is highly effective against HIV when taken every day. The medication interferes with HIV’s ability to copy itself in your body after you’ve been exposed. This prevents it from establishing an infection and making you sick.

Even though PrEP has been around in the U.S. for over a year, not a lot of people know about it. And, even fewer people feel like they know enough about it to be able to make an informed decision about whether or not to use it. For those who do use it, the information they have might be more focused on practical issues, like where to get it, rather than on what PrEP does in the body to prevent HIV infection.

By using animation to show PrEP in the body and why “once a day” is recommended, people can see what PrEP does and people who currently use PrEP can create an image of what happens when they take a PrEP pill every day.

View the video below to get information about PrEP and see an illustration of how it can work inside the body to prevent HIV infection.

Learn More About PrEP

See CDC 2014 Clinical Practice Guidelines at http://www.cdc.gov/hiv/pdf/PrEPguidelines2014.pdf

AIDS.gov – PrEP information page (aids.gov/hiv-aids-basics/prevention/reduce-your-risk/pre-exposure-prophylaxis)

AIDSinfoNet – Reliable, Up-To-Date Treatment Information(aidsinfonet.org/fact_sheets/view/160)

AVAC – Global Advocacy for HIV Prevention (avac.org/ht/d/sp/i/262/pid/262)

Avert – AVERTing HIV and AIDS (avert.org/pre-exposure-prophylaxis.htm)

CDC – Questions and Answers from the U.S Centers for Disease Control and Prevention (cdc.gov/hiv/prevention/research/prep)

My PrEP Experience – Real stories from real people who adopted PrEP for prevention in the US (myprepexperience.blogspot.com)

PrEP Facts – San Francisco AIDS Foundation PrEP information in visual format for MSM and heterosexual individuals, with an option for Spanish(prepfacts.org)

PrEP Watch – Interactive webpage with information and resources on gaining access to PrEP (prepwatch.org)

PrEParing for HIV – An Epidemic Interventions Initiative by the University of California

Project Inform – Videos, publications and resources (projectinform.com/prep)

SFHIV – City and County of San Francisco Department of Public Health’s PrEP information page (sfhiv.org/resources/prep)

Guidance for Use of PrEP in Practice and Research Settings

WHO – World Health Organization (who.int/hiv/pub/guidance_prep/en)

CDC – Downloadable PDF from the Centers for Disease Control and Prevention (cdc.gov/nchhstp/newsroom/docs/CDC-Interim-PrEP-Guidance-012811.pdf)

Human Rights Campaign (HRC) publishes updated guide to practicing safer sex

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Press release from the HRC…

The Human Rights Campaign (HRC) Foundation, in collaboration with Whitman-Walker Heath (WWH), released an updated guide to practicing safer sex that includes essential tips to minimize the spread of HIV and other sexually transmitted infections (STIs).

The guide, “Safer Sex,” an updated version of the first edition released five years ago, is written for people of all sexual orientations and gender identities, covering topics ranging from basic facts about HIV and STIs, and the importance of practicing safer sex, to the role of new HIV prevention regimens including Pre-Exposure Prophylaxis, or “PrEP.”

The pocket-sized publication is the latest collaboration between the HRC Foundation and WWH, building on their shared commitment to securing the health and well-being of LGBT people in the nation’s capital and beyond.

“It’s a fact that many LGBT people don’t see themselves, or their relationships, discussed in mainstream sexual health resources,” said Jay Brown, the HRC Foundation’s Director of Research and Public Education. “With rates of HIV and other sexually transmitted infections on the rise among young people and in communities of color, HRC and Whitman-Walker remain committed to providing crucial health and wellness information in a way that is medically accurate, culturally competent, and judgement-free.”

Read more on the HRC Website.

HIV risk among young gay, bi men tied to societal issues

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From Reuters Health…

Participants were recruited from the New York City area between 2009 and 2011 and were 18 or 19 when they entered the study. At that point they were all HIV-negative. Over the next three years, 43 participants became infected with HIV. About a third of black, Hispanic and mixed or other race participants became HIV-positive during the study, compared to about 7 percent of white participants. People who described themselves as being in low to average social and economic groups were more likely to become HIV-positive than those in higher socioeconomic groups.

Also, the authors found, young age at first sexual experience with another male was tied to an increased risk of becoming HIV-positive, compared to a first encounter at an older age. “The bigger point here is that it’s just too simplistic to (blame) everything on race,” Halkitis said. “We’re trying to get at the reason that’s happening. This paper starts to point to it.”

The researchers point out that social and economic status is closely tied to race in the U.S. People with lower social and economic status likely live in areas with more poverty, less access to healthcare and more untreated sexually transmitted infections (STI), they write. They also point out that young gay and bisexual men may not be properly educated about STIs, and their heterosexual parents may not be equipped to educate on those topics.

“I think that one way we can begin to address this issue is through comprehensive sexual health education,” said Jason Coleman, an expert on HIV and STI prevention at the University of Nebraska-Omaha.

Read the full article.

CDC dedicates $185M to prevent HIV among trans and MSM

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From edgeboston.com…

The U.S. Centers for Disease Control (CDC) recently announced $185 million in funding for three new programs to prevent HIV infection among transgender people and gay, bisexual, and other men who have sex with men (MSM), with a particular focus on MSM of color.

The programs are part of a multi-pronged strategy to address the disproportionally heavy burden of HIV infection on MSM and transgender men and women. These programs will help health departments and local HIV prevention partners deliver and apply the most effective HIV prevention tools.

In particular, CDC plans to award up to $125 million over a three-year period to state and local health departments to expand the use of: 1) pre-exposure prophylaxis (PrEP) for uninfected MSM and transgender people who are considered at substantial risk for HIV infection; and 2) ongoing medical care and antiretroviral treatment for people already living with HIV. Health departments will be funded to provide PrEP information and referrals and to conduct outreach and training to increase the number of healthcare providers who are knowledgeable about PrEP and offer it to their patients.

Backlash to New York City’s fear-based HIV prevention campaign

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From aidsmeds.com…

The New York City Department of Health and Mental Hygiene’s recent fear-based HIV prevention campaign may have led to unintended consequences by stigmatizing young black and Latino men who have sex with men (MSM). Publishing their findings in Health Affairs, researchers analyzed the 2010 “It’s Never Just HIV” campaign, which used fearful, horror-movie-like imagery and messaging to highlight health problems tied to HIV or its treatment, such as osteoporosis, dementia and anal cancer.

“Relying on fear is risky business,” the authors write in the paper. The health department came to appreciate that its analysis of the campaign’s success could not be governed simply by HIV rates among the target population. Rather, the department needed to consider the campaign’s social and political impact. Not only was there a huge amount of controversy among people in the HIV community, but according to certain criticisms, people at risk of HIV and those living with the virus may have suffered stigma as a result of the campaign.

New York City has since moved away from fear-based HIV prevention campaigns. For example, “Be HIV Sure,” which launched on World AIDS Day 2014, encourages HIV testing as part of sexual intimacy.

To read a press release on the study, click here.