Chicago Dept Public Health: HIV Pre-Exposure Prophylaxis Medication: New Hope for Prevention Poses Important Questions

Analysis and guidance from the Chicago Department of Public Health

New research shows that anti-retroviral drugs, long used to treat people infected with HIV/AIDS, can also prevent at-risk individuals from being infected with the virus in the first place. The most recent trial results in the Pre-exposure Prophy-laxis Initiative (iPrEx) represent a major breakthrough for HIV prevention, which has relied heavily on strategies to change behavior. HIV infects as many as 2.7 million people each year throughout the world.

According to the study published in the New England Journal of Medicine on No-vember 23, 2010, high-risk populations who received a daily dose of Pre-exposure Prophylaxis (PrEP) on average reduced their incidence of HIV infection by 43%.

The issues discussed here will be the source of much debate as the federal government determines how to best craft HIV prevention policy in light of the new developments.


[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 Fenway Institute: Prescribing PrEP - Interim Guidance for Providers

Chemoprophylaxis To Prevent HIV Infection: An Interim Guidance for Clinicians

The New England Journal of Medicine published the results of an historic HIV prevention study on November 23, 2010: Preexposure Chemoprophylaxis for HIV Prevention in Men Who Have Sex with Men by Grant et al. The study demonstrated that men who were assigned to take a combination antiretroviral medication orally on a daily basis decreased their HIV risk by almost half compared to those assigned to take a placebo.

As this is the first published study on this novel approach to HIV prevention, called PrEP (pre-exposure prophylaxis), using available oral medication it is likely that clinicians will be approached by patients requesting PrEP for HIV prevention. The Fenway Institute offers this information for clinicians to review the findings of the study and as interim guidance for prescribing and supporting patients seeking PrEP in advance of development of guidelines by any government agencies or professional societies.

Click here to check it out.

[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.]

Age-Specific Prevalence of and Risk Factors for Anal Human Papillomavirus (HPV) among Men Who Have Sex with Women and Men Who Have Sex with Men

via The Journal of Infectious Diseases

Background

An increasing incidence of anal cancer among men suggests a need to better understand anal canal human papillomavirus (HPV) infection among human immunodeficiency virus–negative men.

Methods

Genotyping for HPV was conducted on cells from the anal canal among men who have sex with women (MSW) and men who have sex with men (MSM), aged 18–70 years, from Brazil, Mexico, and the United States. Factors associated with anal HPV infection were assessed using multivariable logistic regression.

Results

The prevalence of any HPV type and oncogenic HPV types did not differ by city. Anal canal HPV prevalence was 12.2% among 1305 MSW and 47.2% among 176 MSM. Among MSW, reporting a lifetime number of ≥10 female sex partners, a primary sexual relationship <1 year in duration, and a prior hepatitis B diagnosis were independently associated with detection of any anal HPV in multivariable analysis. Among MSM, a younger age, reporting ≥2 male anal sex partners in the past 3 months, and never using a condom for anal sex in the past 6 months were independently associated with detection of any anal HPV in multivariable analysis.

Conclusions

Number of sex partners was associated with anal HPV infection in both MSW and MSM. Anal HPV infection in men may be mediated by age, duration of sexual relationship, and condom use.

Read the full article.

[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.]

Prevalence of and Risk Factors for Human Papillomavirus (HPV) Infection Among HIV-Seronegative Men Who Have Sex With Men

via The Journal of Infectious Diseases

Background

We examined the baseline prevalence of penile, scrotal, perineal/perianal, and intra-anal human papillomavirus (HPV) infection in human immunodeficiency virus (HIV)–seronegative men who have sex with men (MSM).

Methods

Data were analyzed from 602 MSM aged 16–27 years with ≤5 lifetime sexual partners. Serum samples were tested for antibodies to HPV6/11/16/18. Swab samples were collected separately from several anogenital areas for detection of HPV6/11/16/18/31/33/35/39/45/51/52/56/58/59 DNA.

Results

The prevalence of any tested HPV type was 18.5% at the penis, 17.1% at the scrotum, 33.0% at the perineal/perianal region, 42.4% in the anal canal, and 48.0% at any site. Overall, 415 MSM (69.7%) were negative to HPV 6, 11, 16, and 18 at enrollment by both serology and DNA detection. Men residing in Europe and Latin America had significantly increased risk of HPV infection at external genital sites and the anal canal compared to men from Australia. Tobacco use and greater number of lifetime sexual partners was associated with higher HPV infection prevalence.

Conclusions

The prevalence of HPV infection is high among young sexually active MSM, with the anal canal being the most common site of infection. Lifetime number of sexual partners was the most important modifiable risk factor for anogenital HPV infection.

Read the full article.


[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.]

External Genital Human Papillomavirus Prevalence and Associated Factors Among Heterosexual Men on 5 Continents

via The Journal of Infectious Diseases

Background

We examined the baseline prevalence of penile, scrotal, and perineal/perianal human papillomavirus (HPV) in heterosexual men (HM). We also evaluated baseline characteristics of HM to assess factors associated with prevalent HPV detection.

Methods

We tested serum samples from 3463 HM aged 16–24 years with 1–5 lifetime female sexual partners for antibodies to HPV 6, 11, 16, and 18. We collected baseline swab specimens for the detection of DNA of HPV 6, 11, 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, and 59 from 3 areas: penile, scrotal, and perineal/perianal. Risk factors for prevalent HPV DNA detection were evaluated.

Results

The prevalence of any tested HPV type was 18.7% at the penis, 13.1% at the scrotum, 7.9% at the perineal/perianal region, and 21.0% at any site. Having >3 lifetime female sexual partners had the greatest impact on HPV prevalence: odds ratio (OR) 3.2 (95% confidence interval (CI) 2.1–4.9) for HPV 6, 11, 16, and 18; and OR 4.5 (95% CI 3.3–6.1) for all HPV types tested. HPV DNA detection was highest in Africa. Neither condom usage nor circumcision was associated with HPV DNA prevalence.

Conclusion

Genital-HPV DNA detection is common in young, sexually active HM. We found HPV to be most prevalent in African men and least prevalent in men from the Asia-Pacific region. Increased numbers of sexual partners was an important risk factor for HPV DNA prevalence.

Read the full article.


[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.]

Oral Pre-Exposure Prophylaxis by Anti-Retrovirals Raltegravir and Maraviroc Protects against HIV-1 Vaginal Transmission in a Humanized Mouse Model

via PLoS ONE

Abstract:

Sexual HIV-1 transmission by vaginal route is the most predominant mode of viral transmission, resulting in millions of new infections every year. In the absence of an effective vaccine, there is an urgent need to develop other alternative methods of pre-exposure prophylaxis (PrEP). Many novel drugs that are currently approved for clinical use also show great potential to prevent viral sexual transmission when administered systemically. A small animal model that permits rapid preclinical evaluation of potential candidates for their systemic PrEP efficacy will greatly enhance progress in this area of investigation. We have previously shown that RAG-hu humanized mouse model permits HIV-1 mucosal transmission via both vaginal and rectal routes and displays CD4 T cell loss typical to that seen in the human. Thus far systemic PrEP studies have been primarily limited to RT inhibitors exemplified by tenofovir and emtricitabine. In these proof-of-concept studies we evaluated two new classes of clinically approved drugs with different modes of action namely, an integrase inhibitor raltegravir and a CCR5 inhibitor maraviroc as potential systemically administered chemo-prophylactics. Our results showed that oral administration of either of these drugs fully protects against vaginal HIV-1 challenge in the RAG-hu mouse model. Based on these results both these drugs show great promise for further development as orally administered PrEPs.

Read the full article.



[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.]

Straight talk with Ellen 't Hoen: Bringing down the price of ARVs

via Nature Medicine, by Asher Mullard


In July, the global health financing mechanism UNITAID established an intellectual property–sharing scheme focused on scaling up access to new and lower-priced antiretroviral drugs in the developing world. The initiative—called the Medicines Patent Pool (MPP)—aims to streamline licensing processes, drive the combination of multiple HIV medicines into one pill and foster the development of drug formulations for children. In September, the US National Institutes of Health (NIH) became the first contributor to the venture, licensing a suite of patents related to protease inhibitors that are used to treat HIV. The task of bringing drug firms and other key stakeholders into the fold now falls on Ellen 't Hoen, a lawyer who became MPP's executive director last month after previously heading up Médecins Sans Frontières' Campaign for Access to Essential Medicines. Asher Mullard spoke to Hoen about the challenges of encouraging companies to share their intellectual property in a normally guarded sector.


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.]

Thanks, IRMA!

via IRMA, by Kelly Nichols, IRMA Intern

Over the last few months the biggest lesson I've learned is what it means to be an advocate. Admittedly, when I first joined Jim Pickett and the IRMA team I was skeptical of the utility of my incessant shouting into cyberspace. But, fellow advocates, I now know that you're out there.

Last month, when the iPrEx results were announced, IRMA was there with questions, and answers. It was exciting and inspiring to watch the listserv members dissect and discuss the results in real time, from all sides of each issue and from every corner of the globe. And, it's not just a theoretical, intellectual discussion; IRMA advocates come from all over the prevention community and are people that have a real impact on policy, treatment and technology. (By the way, if you're not already a member of the listserv, you really should be.) 

That's what advocacy is: talking, even when it seems like no one is listening. So, I'm going to keep talking about rectal microbicides, and I hope you all will too. It's been a pleasure, and I'll still be here, listening.

[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.]

Is a Pill a Day for HIV Prevention Enough?

via Chelsea Now, by Robert W. Moeller and Perry N. Halkitis

While PREP provides us an innovative and powerful strategy for curtailing HIV in gay men, we believe that PREP will only be effective if coupled with behavioral approaches that pay attention to emotions and desire and that speak to aging as well as new generations of gay men.

For years, the HIV prevention field has understood the potential for PREP to help contain the HIV epidemic, particularly in light of programs solely targeting behavior change that have simply fallen short. Ultimately, our success in eradicating HIV may be realized by coupling PREP with effective behavioral interventions. Over the last decade, our collaborators at Harlem United and Gay Men’s Health Crisis (www.gmhc.org) have developed innovative programs geared toward helping individuals reduce their behavioral risk. These programs often focus on providing individuals with a combination of knowledge and skill to make sexual decisions that reflect their desire to prevent infection or transmission. Fortunately, these agencies have had the foresight to recognize that any approach to safer sex must move beyond overly simplistic models of “rational” decision-making.

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.]

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.]

Don't Miss It! Recent Trends in Microbicide Formulations

via ScienceDirect, edited by David R. Friend

The most recent edition of Antiviral Research includes a series of review articles that cover every facet of microbicide development, evaluation and dissemination.


Editorial Board

Trends in microbicide formulations workshop

Preventing mucosal HIV transmission with topical microbicides: Challenges and opportunities

Preclinical evaluation of anti-HIV microbicide products: New models and biomarkers

Advances in development, scale-up and manufacturing of microbicide gels, films, and tablets

Advances in microbicide vaginal rings

Clinical evaluation of microbicide formulations

Combining prevention of HIV-1, other sexually transmitted infections and unintended pregnancies: Development of dual-protection technologies

Novel Approaches to Vaginal Delivery and Safety of Microbicides: Biopharmaceuticals, Nanoparticles, and Vaccines

Notes to Authors

[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 Truth Wears Off: Is there something wrong with the scientific method?

via the The New Yorker, byJonah Lehrer

[fascinating stuff, and very relevant to our work. a must read]

In the late nineteen-nineties, neuroscientist John Crabbe investigated the impact of unknown chance events on the test of replicability. The disturbing implication of his study is that a lot of extraordinary scientific data is nothing but noise. This suggests that the decline effect is actually a decline of illusion. Many scientific theories continue to be considered true even after failing numerous experimental tests. The decline effect is troubling because it reminds us how difficult it is to prove anything.

Read more of the summary [subscription required for the full article]


[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.]

Anal HPV Infection in HIV-Positive Men Who Have Sex with Men from China

via PLoS One

Lei Gao, et. al


Background

Anal HPV infection, which contributes to the development of anal warts and anal cancer, is well known to be common among men who have sex with men (MSM), especially among those HIV positives. However, HIV and anal HPV co-infection among MSM has not been addressed in China.

Methods

A cross-sectional study was conducted in Beijing and Tianjin, China. Study participants were recruited using multiple methods with the collaboration of local volunteer organizations. Blood and anal swabs were collected for HIV-1 serological test and HPV genotyping.

Results

A total of 602 MSM were recruited and laboratory data were available for 578 of them (96.0%). HIV and anal HPV prevalence were 8.5% and 62.1%, respectively. And 48 MSM (8.3%) were found to be co-infected. The HPV genotypes identified most frequently were HPV06 (19.6%), HPV16 (13.0%), HPV52 (8.5%) and HPV11 (7.6%). Different modes of HPV genotypes distribution were observed with respect to HIV status. A strong dose-response relationship was found between HIV seropositivity and multiplicity of HPV genotypes (p<0.001), which is consistent with the observation that anal HPV infection was an independent predictor for HIV infection.

Conclusions

A high prevalence of HIV and anal HPV co-infection was observed in the MSM community in Beijing and Tianjin, China. Anal HPV infection was found to be independently associated with increased HIV seropositivity, which suggests the application of HPV vaccine might be a potential strategy to reduce the acquisition of HIV infection though controlling the prevalence of HPV.


Read the full paper.


[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.]

"Berlin Patient" declared to be cured of HV

via The Huffington Post, by Carly Schwartz

On the heels of World AIDS Day comes a stunning medical breakthrough: Doctors believe an HIV-positive man who underwent a stem cell transplant has been cured as a result of the procedure.

Timothy Ray Brown, also known as the "Berlin Patient," received the transplant in 2007 as part of a lengthy treatment course for leukaemia. His doctors recently published a report in the journal Blood affirming that the results of extensive testing "strongly suggest that cure of HIV infection has been achieved."

While Brown is the first person to ever be declared cured of HIV, his case paves a path for constructing a cure for HIV through genetically-engineered stem cells.

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.]

Journal of Sexual Medicine: Study examines effect of water-based and silicon-based lubricant

via EurekAlert

A new study by sexual health researchers at Indiana University found that women who used lubricant during sex reported significantly higher levels of satisfaction and pleasure.

The study, involving 2,453 women, is the largest systematic study of this kind, despite the widespread commercial availability of lubricant and the gaps in knowledge concerning its role in alleviating pain or contributing to other health issues.

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.]

Can scientists rid the body of HIV?

via physorg.com, by Erin White

A new Northwestern Medicine study will undertake a bold new protocol to completely eradicate latent HIV cells that current drugs don't affect. Participants, with diagnosed HIV, in the experimental group will be given an investigational HIV vaccine that actually wakes up dormant cells at the same time regular HIV-drug therapy is aimed at extinguishing the activated cells.

“If we can effectively decrease the reservoir then we can think about curing HIV," said Robert Murphy, M.D., founding director of Northwestern University Feinberg School of Medicine’s Center for Global Health and an infectious disease physician at Northwestern Memorial Hospital.

Many people with HIV are living with nearly undetectable levels of the virus in their blood, but they can’t entirely clear HIV out of their bodies with the current treatment regimens. Dormant HIV cells linger, hiding in the body and resisting the powerful benefits of anti-HIV drugs. Through the study, called EraMune 02, researchers at Feinberg’s Center for Global Health plan to activate dormant HIV cells, fight them off and kill the virus.

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.]

Washington Post: Gays in Africa face growing persecution, activists say

via Washington Post, by Sudarsan Raghavan

Persecution of gays is intensifying across Africa, fueled by fundamentalist preachers, intolerant governments and homophobic politicians. Gay people have been denied access to health care, detained, tortured and even killed, human rights activists and witnesses say.

The growing tide of homophobia comes at a time when gays in Africa are expressing themselves more openly, prompting greater media attention and debates about homosexuality. The rapid growth of Islam and evangelical forms of Christianity, both espousing conservative views on family values and marriage, have persuaded many Africans that homosexuality should not be tolerated in their societies.

"It has never been harder for gays and lesbians on the continent," said Monica Mbaru, Africa coordinator for the International Gay and Lesbian Human Rights Commission, based in Cape Town. "Homophobia is on the rise."

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.]

The Role of Fear in HIV Prevention - Attention Grabbing, But Does it Work?

We've been rather animated on this topic of late, owing to the controversial new "It's Never Just HIV" campaign from the NYC Dept of Public Health.

The long and short of it is - fear doesn't work. Check out this short, well-sourced brief from Sigma on the role of fear in HIV prevention strategies and learn why.

Here are the 5 key points:

• Fear arousing imagery can be good at attracting attention and is often memorable.

• Fear-based campaigns are more persuasive for individuals who are already engaging in the desired, health-protective, behaviour.

• Arousing fear in individuals can have many unintended consequences, such as denial or othering.

• Most homosexually active men are already fearful of HIV.

• Arousing fear is not an effective means of facilitating sexual behaviour change.

*** Also of interest, from the American Journal of Public Health (1988) Effective and ineffective use of fear in health promotion campaigns.

 

[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.]

I am gay.

via Look At Vietnam

Nguyen Van Trung, 35, is as excited as a teenager going to his or her first party.

But the excitement is tinged with some nervous bravado, because Trung’s coming out party seeks to increase public tolerance toward the gay community in Vietnam.

A group of 100 gay activists is planning to raise awareness and visibility by wearing pink T-shirts proclaiming, "I am gay." They will walk together on the sidewalks in downtown Ho Chi Minh City, probably on the upcoming Valentine’s Day, Trung said.

“This will be the first time such an activity has been organized by the gay community in Vietnam,” said Trung, member of a HCMC voluntary group that seeks to advise men who have sex with men (MSM) on safe sex and HIV-related knowledge.

“I only hope that by doing so, the public will be more tolerant of people like us since we do no harm to the society.”

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.]

Do you find the new HIV ad campaign from the NYC Dept of Public Health offensive?

Watch and see what you think....

Is it helpful to paint the lives of people living with HIV as a horror show?

Is it honest?

Will it encourage people to get tested?

Will it encourage people to stay safe?

Will it further polarize HIV neg and HIV pos people?





[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.]

Community Forum: iPrEx - What Next? A Chicago discussion on HIV meds as prevention

Next Wednesday, December 15
Center on Halsted, Chicago

Click for a closer look

[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.]

'Whoonga' presents new challenge in South Africa's AIDS war

via The Washington Times

AIDS patients in South Africa are being robbed of their lifesaving drugs so that they can be mixed with marijuana and smoked, authorities and health experts say.

The concoction is called "whoonga" — less a word than an exclamation — and it adds a bizarre twist to the war on AIDS in the world's worst-affected country just as it embarks on a massive distribution of medications.

Whoonga's spread is so far limited to eastern KwaZulu-Natal, the country's most AIDS-stricken province, but AIDS and addiction specialists worry that it could reach other parts of the country.

There's no evidence that any ingredient of the AIDS drug cocktail is addictive or does anything to enhance the marijuana high. Whoonga smokers may be fooling themselves into believing the AIDS drugs are giving them a high, when it's really some other ingredient, says Dr. Njabulo Mabaso, an AIDS expert.

AIDS is already a source of damaging myths in South Africa, such as that the disease can be prevented by sleeping with a virgin or showering after sex with an HIV-positive partner.

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.]

Rachel Maddow interviews David Bahati, author of the Ugandan "kill the gays" bill

Visit msnbc.com for breaking news, world news, and news about the economy

[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 and MSM: Asia Takes Action

via 7th Space Interactive


About 140 overseas and local experts working in the AIDS sector are meeting in Hong Kong over three days (December 7 to 9) to discuss the prevention of Human Immunodeficiency Virus (HIV) infections among men who have sex with men (MSM), and also how to enhance efforts towards the treatment, care and support in the participating cities.

The event, entitled "Action Planning Meeting of Men Who Have Sex with Men and Transgender Populations Multi-City HIV Initiative", is jointly organised by the Department of Health (DH), the United States Agency for International Development, organisations under the United Nations system, the Asia Pacific Coalition on Male Sexual Health, the Asia Pacific Network of People Living with HIV/AIDS and regional partners.

The three-day meeting is being attended by about 140 participants from 12 countries and 30 regional organisations, with major participants from six Asian cities, namely Bangkok, Chengdu, Ho Chi Minh City, Jakarta, Manila and Yangon. They are joined by local experts and observers.

It is the first time an action meeting of this kind has gathered in the Asian region to review the current HIV epidemic trends, examine municipal response and identify innovative initiatives to step up efforts in HIV prevention, treatment, care and support amongst MSM and transgender populations in the six cities.


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.]

Self-reports of sensitive sexual behavior, a review

via International Journal of Epidemiology, by Phillips et al.

A new study finds unexpected variations in reporting between traditional face-to-face interviews and non-interviewer-administered interview methods.



From the abstract:

Studies identifying risks and evaluating interventions for human immunodeficiency virus (HIV) and other sexually transmitted infections often rely on self-reported measures of sensitive behaviours. Such self-reports can be subject to social desirability bias. Concerns over the accuracy of these measures have prompted efforts to improve the level of privacy and anonymity of the interview setting. This study aims to determine whether such novel tools minimize misreporting of sensitive information.

Systematic review and meta-analysis of studies in low- and middle-income countries comparing traditional face-to-face interview (FTFI) with innovative tools for reporting HIV risk behaviour. Crude odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. Cochran’s chi-squared test of heterogeneity was performed to explore differences between estimates. Pooled estimates were determined by gender, region, education, setting and question time frame using a random effects model.

We found and included 15 data sets in the meta-analysis. Most studies compared audio computer-assisted self interview (ACASI) with FTFI. There was significant heterogeneity across studies for three outcomes of interest: ‘ever had sex’ (I² = 93.4%, P < 0.001), non-condom use (I² = 89.3%, P < 0.001), and number of partners (I² = 75.3%, P < 0.001). For the fourth outcome, ‘forced sex’, there was homogenous increased reporting by non-FTFI methods (OR 1.47; 95% CI 1.11–1.94). Overall, non-FTFI methods were not consistently associated with a significant increase in the reporting of all outcomes. However, there was increased reporting associated with non-FTFI with region (Asia), setting (urban), education (>60% had secondary education) and a shorter question time frame.

Contrary to expectation, differences between FTFI and non-interviewer-administered interview methods for the reported sensitive behaviour investigated were not uniform. However, we observed trends and variations in the level of reporting according to the outcome, study and population characteristics. FTFI may not always be inferior to innovative interview tools depending on the sensitivity of the question as well as the population assessed.

Read the article

[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.]

Differences in HIV-1 prevalence not linked to sexual behavior, study finds

via Journal of the International AIDS Society, by Mapingure et al.

A new study concludes that higher HIV-1 prevalence among pregnant women in Zimbabwe compared with Tanzania cannot be explained by differences in risky sexual behaviour.

From the abstract:

Substantial heterogeneity in HIV prevalence has been observed within sub-Saharan Africa. It is not clear which factors can explain these differences. Our aim was to identify risk factors that could explain the large differences in HIV-1 prevalence among pregnant women in Harare, Zimbabwe, and Moshi, Tanzania.

Cross-sectional data from a two-centre study that enrolled pregnant women in Harare (N = 691) and Moshi (N = 2654) was used. Consenting women were interviewed about their socio-demographic background and sexual behaviour, and tested for presence of sexually transmitted infections and reproductive tract infections. Prevalence distribution of risk factors for HIV acquisition and spread were compared between the two areas.

The prevalence of HIV-1 among pregnant women was 26% in Zimbabwe and 7% in Tanzania. The HIV prevalence in both countries rises constantly with age up to the 25-30 year age group. After that, it continues to rise among Zimbabwean women, while it drops for Tanzanian women. Risky sexual behaviour was more prominent among Tanzanians than Zimbabweans. Mobility and such infections as HSV-2, trichomoniasis and bacterial vaginosis were more prevalent among Zimbabweans than Tanzanians. Reported male partner circumcision rates between the two countries were widely different, but the effect of male circumcision on HIV prevalence was not apparent within the populations.

Read the article

[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.]

Video From the Netherlands - Young Gay Men Talk About Sex

"Gay guys can have sex in all kinds of ways. In this video gay guys are speaking about what their first time and what they like and don't like about sex."

"Video-kanaal van het Nederlandse Gay-Straight Alliance Netwerk. Een Gay-Straight Alliance of een GSA is een clubje van homo en heteroleerlingen die homo/biseksualiteit op school bespreekbaar wil maken. Jij kunt ook een GSA starten! Kijk op www.gaystraightalliance.nl"






[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.]

Critical reflections around PrEP: Questions, concerns, and suggestions for next steps

by Keith R. Green, MSW (Co-Chair Elect, Chicago Black Gay Men’s Caucus)

As Project Director of the only U.S.-specific acceptability and feasibility pre-exposure prophylaxis (PrEP) trial in adolescents ages 18-24 - Project PrEPare - I must qualify the following statements by saying that my views are my own. They do not in any way reflect the thoughts or beliefs of the Adolescent Trials Network for HIV/AIDS Interventions (ATN), my current employer. My views on this topic are mine alone and, as a Black man who is sexually intimate with other men (diagnosed with HIV as an adolescent), they come from a very personal place.

Formalities aside, I should start by saying that I am very excited about the data that has come forth from the National Institutes of Health’s Pre-Exposure Prophylaxis Initiative (iPrEx). This international research study showed that the antiretroviral drug Truvada, when offered as a component of a comprehensive prevention package that includes condoms, counseling, and regular HIV/STI screening, was associated with a 44% reduction in HIV infections in participants who took it compared to those who took placebo. Additionally, a nearly 73 percent reduction in infections was seen in participants who took the study drug more than 90 percent of the time. I perceive PrEP to be a much needed weapon in our arsenal against the havoc that HIV is wreaking on gay, bisexual, and same gender loving communities, and this data demonstrating such a significant degree of efficacy fills me with hope.

I also very much appreciated the opinion piece that Dr. Kevin Fenton (Director of the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention at the Centers for Disease Control and Prevention) wrote for CNNOpinion, outlining some of the cautions around this potential prevention option. I completely agree with him. This is just one study testing this intervention, and many unanswered questions remain, particularly with respect to what this data means for the populations most impacted by the epidemic in the United States.

Though the NIH iPrEX dataset is relatively large in numbers (2499 participants in total), U.S. men who have sex with men (MSM) are terribly underrepresented. In fact, less that 10 percent (less than 250 people) of the sample was from two U.S. cities combined (San Francisco and Boston). I have not seen the racial/ethnic background of the U.S. cohort—however, I think that it’s safe to say that the numbers get even smaller as it relates to people of color and young people of color in particular.

That said, the way that this data has been represented in the U.S. media is deeply disturbing. And the fact that the U.S. Centers for Disease Control and Prevention (CDC) immediately issued a fact sheet regarding the implications of this data, complete with incomplete guidelines for use and considerations for roll out, without a clear research agenda around these objectives, is downright scary. (I want to reiterate that I appreciate Dr. Fenton’s opinion piece, but it came nearly a week after the fact sheet. I understand the intent behind both, but from what I’ve read, a caution statement released on the same day as the data would have been much more in order than a fact sheet.)

One of the key messages from the NIH study is that adherence to the PrEP regimen is paramount to its success at combating the virus. I admit that I do not know a whole lot about the cultural variances around adherence (in Lima, Peru compared to Brooklyn, New York, per se), but I do know that African Americans, particularly those here in Chicago where I live, have a very rocky relationship with antiretrovirals. Recent surveillance data issued from the Chicago Department of Public Health found that only about 43 percent of African American MSM who knew their HIV status at the time of that survey were engaged in care that involves antiretrovirals. The reasons behind this are not clear, but anecdotally, we can speculate about them. Primarily, I believe, it has to do with our fragile history with the healthcare system, and the lack of trust that we have developed as a result. A lack of trust that all Americans can probably relate to, considering the abundance of malpractice suits and recalled prescription drugs that abound in our country.

That said, many critical concerns come to mind when I think about how the use of Truvada as PrEP could play out in the real world, particularly for the populations most impacted by the epidemic in this country at this time. Rocky relationships with antiretrovirals have equated to decreased engagement with them among African American gay, bisexual men, and same gender loving men. 

Truvada is one of the most widely prescribed antiretrovials (mostly due to its convenient dosing schedule and its presence in Atripla – the once-daily ‘miracle pill’). Therefore, considering the troubled relationship that African American MSM in Chicago have with antiretrovirals in general, is it possible that there are increased levels of resistance to Truvada among HIV positive men in the community? And, if so, could it be possible that an African American gay, bisexual, or same gender loving man who decided to take Truvada as PrEP (as a primary prevention with or without other proven prevention options), is at greater risk of being exposed to virus that is resistant to Truvada, leaving him not as protected as he believes he is? And, if he becomes infected and is infectious until he is diagnosed, is there not potential for him to pass on more resistant virus to others in the process?

I need to be clear that I understand that these concerns could be generalized to other populations. Much of this could be true for gay, white men or men from Lima, Peru, and that’s my whole point. We don’t have enough information to make any assumptions, really!

There are so many critical questions that must be answered before we allow those seeking to avoid contracting HIV to become convinced of the safety and efficacy of Truvada as PrEP:
•    Will African American MSM take PrEP as it must be taken in order for it to work? (Which includes taking it as a component of a comprehensive prevention package that includes condoms, counseling, and regular HIV/STI screening?
•    Does the general public understand that PrEP must be combined with other safe sex practices to derive the greatest protection from HIV?
•    Are we communicating, completely and honestly, the full range of risks involved with PrEP? Or do we really understand the full range of risks, particularly as it relates to resistance and how the potential for it varies from population to population?
•    What are the long-term effects associated with taking antiretrovirals preventatively?
•    Are we communicating effectively the fact that PrEP is not the ticket to a free ride on the “Sex Express”? (Condoms and other proven prevention strategies MUST be used)
•    Are we still advocating for regular HIV/STI screening and the power of knowing one’s status?

It is my sincere hope that the HIV/AIDS advocacy community will raise its voice LOUDLY to these concerns, and that the powers that be at the CDC, NIH, and other research institutions will explore the warnings and thoughtfully design research studies with strong behavioral and clinical outcomes that have these questions in mind. The future of HIV prevention in our country is dependent upon it. 

*** A community forum to discuss the iPrEX data and its potential impact on the future directon of Project PrEPare will take place in the Michael Leppen Theater at the Center on Halsted, 3656 N. Halsted, on Wednesday, December 15th 2010 from 6:30-8:30pm. The discussion will be co-facilitated by Jim Pickett, Director of Advocacy for the AIDS Foundation of Chicago and Chair of the International Rectal Microbicide Advocates.


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USAID Meeting on Microbicides

Over the past year, new technologies have been proven including a microbicide gel that could help prevent HIV transmission in women. On November 29th, 2010, USAID Administrator Raj Shah convened a high-level meeting of global health professionals, experts, and policy makers at USAID headquarter.




Related:

Goosby, Emanuel Address Progress, Potential Roadblocks Ahead For Introduction Of Microbicides In Developing Countries



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The 411 on microbicides

via ONE, by Todd Summers

There’s exciting news coming from researchers working on HIV prevention technologies about a gel that women can use that reduces significantly their risk of acquiring HIV from vaginal intercourse. Called a microbicide, it’s particularly exciting because it offers women more control over HIV prevention –- and this is important because AIDS impacts girls and women disproportionately (I blogged about this earlier, but it’s so exciting, I’m doing it again!)

Yesterday, I had a chance to attend a workshop at the US Agency for International Development hosted by its administrator Dr. Raj Shah (disclosure: I worked with Raj at the Gates Foundation and he’s a friend). USAID helped finance the microbicide study in South Africa that generated these results, and yesterday’s workshop was to come up with an action plan to get it approved by regulatory agencies and into the hands of women that need it.

It was smart to get this planning underway, as there are too many examples of good health technologies that go unused. It was also exciting for those attending, most of whom had been working in various ways for years to get to this point. Indeed, the first generation of microbicides didn’t work, and this second generation, now using AIDS drugs, was probably the last chance to keep the research going.

Raj started off the conference by sharing his trademark optimism: “I’m incredibly enthusiastic about today!” he exclaimed, noting that this research finding “changes the fundamental equation of how we address HIV around the world.” At the same time, he made clear what we all know, that “AIDS prevention requires a broad range of tools…all of which have some roll to play.”

Put simply, this is a great additional tool, especially for women, but it’s no silver bullet. Microbicides don’t protect from all infections, and will only work for women who can access it, afford it and use it every time they have intercourse -– all of which are significant challenges. There’s also a lot of work needed to get products necessary to regulatory approval in the donor world and in the affected countries, and to come up with strategies for integrating microbicides into broader HIV prevention strategies.

Raj urged the group to take a market-based approach, using lessons from the business world to look carefully at what’s needed to get the product out quickly and widely. Sometimes the public health world can learn a lesson from the business world, and this is one of those moments.

Also providing introductory remarks was Ambassador Melanne Verveer, a senior adviser to Secretary Clinton on gender issues (she worked with former First Lady Clinton in promoting US efforts on global HIV back in the late 1990s). She provided a sober reminder that HIV risk for women was about more than just the virus. Lack of economic opportunity and inadequate education, combined with longstanding cultural degradation, put women and girls at heightened risk for HIV –- and may very well inhibit their access to microbicides. So, she urged that planning for accelerating uptake of microbicides take these broader systemic challenges into account, and committed to full support from Secretary Clinton in that effort.

There’s lots of work ahead, and additional microbicides being studied, so expect to hear more from us on this. I’m particularly excited about microbicides that use impregnated rings that can stay inserted for long periods of time and therefore don’t require use of gels each time there’s a potential exposure. I also hope that work can begin to look at potential applications for rectal microbicides, which can protect women and men. Hats off to the researchers, the donors, and especially the women that volunteered to be part of the study!

Source.

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Walking 26km for a condom in Kenya

via PlusNews

“Condoms are good and I use them with girls - they have taught us how to use them… but here in the rural area there is a problem because we walk very far to get the condoms,” said Lemeo Ntalel, a 21-year-old Maasai moran – warrior – in rural Narok, in Kenya’s Rift Valley.

“At times you want to use one and you don’t have it near so you just do it with a girl without it; it is hard to tell a girl ‘wait for me I am going to get a condom’, because she will lose interest and go.” 

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.]

Launch of online MSM sensitivity training for Africa

Today marks the launch of the launch of the MARPS Africa website

This facility provides online training for health care workers, advocates and researchers in Africa around issues affecting key populations.

Currently, a MSM sensitivity training course is available. This course was developed by the Desmond Tutu HIV Foundation in collaboration with Wellcome-KEMRI Kilifi and other international contributors.

In the future this site will provide online tools and trainings for around topics relevant to the needs of MSM, transgender, IDU Sex Workers and other key populations in Africa.

[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: HIV prevention drugs raise more questions than answers

via PlusNews

Excerpt:

Finding a way to eventually put research into practice was not only necessary but also a moral obligation, Rees noted.

“I’d ask why we’re doing these studies in these countries at all if we’re not going to implement any of these interventions,” Rees said. “I find that unethical.” 

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.]

World AIDS Day 2010 Universal Access & Human Rights - A Global Health Community Statement

 [IRMA is a signatory on this statement]

Open publication - Free publishing - More IRMA

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