The Man Who Had HIV and Now Does Not

Via New York Magazine, by Tina Rosenberg

Four years ago, Timothy Brown underwent an innovative procedure. Since then, test after test has found absolutely no trace of the virus in his body. The bigger miracle, though, is how his case has experts again believing they just might find a cure for AIDS.

AIDS is a disease of staggering numbers, of tragically recursive devastation. Since the first diagnosis, 30 years ago this June 5, HIV has infected more than 60 million people, around 30 million of whom have died. For another 5 million, anti-retroviral therapy has made their infection a manageable though still chronic condition. Until four years ago, Timothy Brown was one of those people.


Brown is a 45-year-old translator of German who lives in San Francisco. He is of medium height and very skinny, with thinning brown hair. He found out he had HIV in 1995. He had not been tested for the virus in half a decade, but that year a former partner turned up positive. “You’ve probably got only two years to live,” the former partner told him when Brown got his results.

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.]

The Vatican and AIDS: Symposium Includes Pro-Condom Advocates (Updated)

by Aldona Martinka

May 31, 2011 - UPDATE:

Unfortunately, this weekend's symposium at the Vatican did not fulfill hopes that the Catholic Church might adopt a more comprehensive approach to HIV prevention. In fact, the Church's long-held, misguided beliefs that condoms actually hurt HIV prevention continue to be supported. Dr. Sidibe quoted the Pope's book, but the response was tired and dimissive, rather than cooperative. Citing AIDS statistics from African nations, speakers noted that governments encouraging abstinence rather than handing out condoms had higher success rates in stemming the tide.

The Catholic Church continues its commitment to humanitarian efforts, including HIV/AIDS prevention and treatment. Using Church-approved methods, faith-based organizations will continue to provide care to countless victims of the epidemic, but without a commitment from the Vatican to accept and work with scientific and public health advancements, the global fight against AIDS will never be unified. If there is a constant battle behind the scenes between prevention methods with religious approval like abstinence, and methods not approved by the religious leaders like condoms, then mixed messages and funding battles will serve as yet another obstacle to eradication.


May 27, 2011 - Traditional Catholic doctrine forbids the use of artificial forms of birth control, including the condom. But what if the condom is being used as a way to prevent infection rather than a birth control method?

Last November, Pope Benedict XVI made waves in Catholic and public health communities when he stated that when used "in the intention of reducing the risk of infection,” condoms could actually represent a step in the right moral direction. Since then his comments have been analyzed and re-analyzed, defended and dismissed, by in support of every possible viewpoint on condom use. This leaves many confused over whether condoms are still considered to contradict the teachings of the church, and whether this has opened the door for a less strict policy from the Vatican and other religious leaders in favor of global health.

Pope Benedict XVI, however, also stated a little over a week ago that the fight against AIDS “cannot be overcome through the distribution of condoms, which even aggravates the problems.” This position is maintained by many leaders across the world in the church and religious organizations, even to the point of completely denying science in favor of supporting the official stance, to the detriment of local and global public health goals in the fight against the epidemic.

Changes in religious leaders’ views on condom use have potentially far-reaching effects: from sex education, to the work of faith-based organizations in AIDS relief (which get billions of dollars in federal aid each year), to a shift in public health practices in hard-hit conservative countries. So while the Vatican’s official stance is still that condoms are immoral, the pope’s comment that they might be a step in a moral direction in some cases unprecedented and has implications that may someday alter what has until now been a battle pitting conservative religious doctrine against progressive attempts to change the way the AIDS epidemic is faced.

Today and tomorrow the Vatican is hosting a symposium on preventing HIV and caring for those affected by the virus. Notably, this symposium includes the executive director of UNAIDS, Dr. Michel Sidibe, and other know advocates for condom distribution as part of a prevention plan. Perhaps this symposium, following on the heels of the new UN strategy for the upcoming years, will represent another step in the right direction of a more united fight against AIDS.

[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.]

What the UN Can Learn from Gay Activism

via The Bay Area Reporter, by George Ayala

Many gay men and women have a deep and complicated relationship with the concept of omission. The choice to leave out information about our sexual orientation can be a useful strategy when faced with the potential for an awkward, painful, or violent situation. It placates sensitivities, prevents discord, and in some cases it saves our lives. However, it also preserves the status quo.

With such compelling reasons to bite our tongues, many of us choose silence as homophobia takes its toll around us. Lips sealed and hands tied, we watch in quiet pain as abuses are inflicted on our more visible kin. We become unwitting accomplices to those who wish to erase us. Realizing the effects of our own inaction, more and more of us have come to feel that this path of least resistance is not worth the violence and injustice it allows – and we speak up.

As the world prepares for the upcoming United Nations High Level Meeting on AIDS, taking place June 8-10 in New York, country missions at the UN are faced with a strikingly similar dilemma. With HIV rates among gay men skyrocketing across the globe, UN member states must decide how to present men who have sex with men in the meeting's final outcome document. They can appease anti-gay forces by omitting MSM entirely, or they can write MSM into their policies explicitly, no matter how polarizing the issue may be.

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.]

No superinfections among HIV-positive gay men in Amsterdam reporting risky sex

via Aidsmap, by Michael Carter


HIV superinfection appears to be extremely rare, a Dutch study published in the June 1st edition of the Journal of Infectious Diseases suggests.

The study is one of the few attempts to use ongoing virological monitoring and behavioural data to establish the likely incidence of superinfection, albeit in a small cohort, and points to the neglect of a question that remains important for giving advice on HIV prevention strategies that might encourage the practice of serosorting - sex with partners of the same HIV status.

Researchers monitored 15 HIV-positive gay men for evidence of superinfection for an average of almost six years. All the men either reported unprotected anal sex, or had a history of sexually transmitted infections. Despite this risk, no cases of superinfection were detected.

“With no putative case of HIV-1 superinfection detected in 15 individuals over a total of 88.3 PY [per years], we observed a low incidence rate of HIV-1 superinfection (incidence rate: 0 per 100 PY, 95% CI: 0.42),” write the investigators.

However, they do not regard their results as definitive and call for further research into this matter. In particular, they speculate that the level of risk of the men in their study may not have been high enough to lead to superinfection.

Intensive case finding has identified approximately 50 cases of confirmed HIV superinfection (infection with a second strain of 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.]

WHO Announces New HIV Strategy for 2011-2015

by Aldona Martinka

According to a news release from the United Nations’ website, the five year strategy that the World Health Organization announced yesterday could prevent as many as 4.2 million new HIV infections and save as many as 2 million lives.

The strategy for the coming years focuses on four strategic directions: “To optimize HIV prevention, diagnosis, treatment and care outcomes”, “to leverage broader health outcomes through HIV responses”, “to build strong and sustainable health systems “, and “to address inequalities and advance human rights.” Within these directions there are many exciting goals, such as reducing stigmatization of those with HIV/AIDS, promoting human rights where abuses are barriers to getting tested and/or treated, and driving the development of new preventative interventions.

The strategy specifically mentions PrEP, ARV therapy as prevention, and microbicides as potentially effective new interventions, and plans to guide countries in implementing these programs when the results of evaluations become widely available.

This strategy, unanimously adopted by the Sixty-Fourth World Health Assembly, will serve as a guide for the actions of the WHO and for governments worldwide in facing the AIDS crisis in the first half of the second decade of the new millennium.

Read the full strategy here, or get more information 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.]

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.

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.]

IRMA lube safety presentation gets some love

IRMA recently teemed up with the Global Forum on MSM and HIV to present on one of our key issues - lube safety "Are Lubes Safe for Rectal Use? What MSM Need to Know."

IRMA Secretary and resident lube expert Marc-André LeBlanc did the honors, and if we must say so ourselves, did them quite well. And we're not the only ones saying so.

The webinar was attended by over 60 people from all over the world and was even covered on a number of websites.

About.com/sexuality says: "I've sung the praises of IRMA, the International Rectal Microbicide Advocates in the past, and wanted to pass along an interesting resource. It is primarily intended for people who work with men who have sex with men (that's what the MSM above stands for, in case you're more of a media person and were wondering why the mainstream media needs to know about rectal lubes in the first place), but may be of interest to sex educators, lube lovers, or anyone with a nerd's love of information."

And the Bilerico Project gave the issue some attention as well. While the blogger on Bilerico is a little confused about what IRMA has contributed to the field of lube safety (we DID the internet survey on lube use, we DID NOT actually test specific lubes in the lab, that is for our scientist friends) - we very much appreciate the coverage. It helps get the word out and that is what's most important.

Full Presentation: Are Lubes Safe for Rectal Use? What MSM Need to Know (or download a pdf of the slides 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.]

KENYA: Protest as government grapples with HIV funding shortages

via PlusNews

Hundreds of Kenyan AIDS activists held a protest on 18 May in the capital, Nairobi to demand that the government meet its commitment to increase annual health and HIV funding.

"The Minister of Finance promised an annual budgetary allocation increase of 10 percent to health and HIV - we demand that this promise be kept," Davis Njuguna, an AIDS activist with the National Empowerment of People living with HIV/AIDS in Kenya (NEPHAK), told IRIN/PlusNews during the rally. "We cannot pledge to end AIDS without increasing funding to it. Access to HIV treatment is a right and we are not accepting lip service any more."

Marching along Nairobi's busy Thika Road, protesters waved posters urging Finance Minister Uhuru Kenyatta and US President Barack Obama - who pledged during his presidential campaign to provide US$50 billion to fight HIV globally by 2013 - to keep their promises. Other placards read, "You Talk, You Talk, We Die!" and "Broken Promises Kill!"

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.]

CDC Provides Recommendations for Zombie Apocalypse

via The Seattle Times

Pity poor Tom Skinner, a top spokesman for the Centers for Disease Control and Prevention (CDC) who has been valiantly trying to interest reporters in a new study in the agency's Morbidity and Mortality Weekly Report trumpeting "10 Great Public Health Achievements."

Unfortunately for Skinner, over at his agency's public-health blog, his colleagues were posting something that really got to the beating heart of morbidity and mortality: the first official CDC instructions on coping with a zombie apocalypse.

Yes, that's right. With a straight face, the normally staid health agency had posted a primer on how to prepare for an invasion of the brain-eating undead.

"So what do you need before zombies ... or hurricanes or pandemics, for example, actually happen?" the post said. "First of all, you should have an emergency kit in your house. This includes things like water, food and other supplies to get you through the first couple of days before you can locate a zombie-free refugee camp."

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.]

Uganda Gay Death Bill May Return

via Mambaonline.com

Uganda's Anti-Homosexuality Bill and HIV Prevention and Control Bill are likely to be carried over to the new session of parliament, despite international and local pressure.

David Bahati, the Member of Parliament who introduced the Anti-Homosexuality Bill (2009), said he fully intended to re-introduce the bill into the next session. The new parliament began on 19 May.

"The closure of this parliament is just pressing on the pause button," he said. "I'm committed to the fight against behaviour and promotion of behaviour that is going to destroy the future of our children."

Men who have sex with men (MSM) are considered by the Uganda AIDS Commission to be a "most at-risk population", but because homosexual acts are illegal, there are no policies or services targeting HIV interventions towards them. AIDS activists say the bill would only drive an already stigmatised population further underground, leaving them even more vulnerable to HIV.

MSM are often referred to as a "bridging" population for HIV to the general population, given that many also have sex with women. According to a 2010 survey of 303 MSM in the capital Kampala by the US Centres for Disease Control, 78 percent had had sex with women while 31 percent had been married.

The study also found HIV prevalence among participants was 13.7 percent, significantly higher than the city's average rate of 8.5 percent; knowledge of the risks of HIV was also low.


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.]

Vietnam: Gay rights group tackles insensitive medical care

Doctors believed, for example, that becoming a homosexual was a fashion statement. They teased gay patients, and criticised anal sex despite training on gay issues, the survey revealed.

via VietNamNet

Nguyen Thanh Trung (not his real name), a gay man who lives in Ha Noi, was very upset by the way doctors discriminated against him when he was undergoing an anal health test in one of the city's many health clinics.

"The doctor told me to my face that having sex with men is not a natural act and asked me why I did it," Trung recalled.

"I was so upset that I left the clinic and will never return," he said.


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.]

Acceptability of pre-exposure prophylaxis as an HIV prevention strategy: barriers and facilitators to pre-exposure prophylaxis uptake among at-risk Peruvian populations

IRMA Steering Committee member Jerome T. Galea is lead author of this fascinating paper. Here he provides an overview of the study.

Click here to access the full paper.

"The study examined pre-exposure prophylaxis acceptability (PrEP) among female sex workers, male-to-female transgendered persons and men who have sex with men in Lima, Peru.  Focus groups explored social issues associated with PrEP acceptability and Conjoint Analysis – a consumer research market technique – assessed the preferences participants had with regards to eight hypothetical PrEP “scenarios”.  This was the first study of it's kind to apply this technique.

"Each scenario was made up of the same characteristics but differed slightly (for example, higher cost versus lower cost; daily dosing versus non-daily dosing; some side effects versus no side effects, and so on).  Participants had to rank the scenarios in order of preference taking into account all of the product’s chacteristics, and in doing so expressed the value they placed on the various characteristics.  Focus groups helped to explain the reasons behind the preferences made.

"There were some unexpected findings. For example, cost trumped effectiveness; a low-out-of pocket cost had the single greatest impact on PrEP acceptability. While we expected cost to be an important factor we were surprised that it was more important than the ability of the product to actually prevent HIV infection. 

"Another surprise was that in the focus groups we learned that participants preferred that PrEP be dispensed in health centers as opposed to pharmacies. This surprised us as we hypothesized that pharmacies would provide faster, easier and more widespread access, but participants cited privacy concerns with PrEP being dispensed by pharmacies.

"The next step is to replicate this sort of research to more populations at risk in different settings. We have learned that the existence of an effective product does not guarantee its use (recent studies on the female condom, for example, highlight the challenges of understanding the needs and perceptions of the target user and also the necessity of dispelling myths that often arise when new products are introduced). 

"We cannot generalize our findings to all persons at risk for HIV, in Peru or elsewhere, but do propose it as a model for future exploration of the topic now that oral PrEP has been shown to work but has not yet been scaled up for widespread use."

*Read AIDSmeds coverage of this 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.]

NEWS ROUNDUP: Early HIV Treatment Can Reduce Transmission Risk By 96%, Study Results Show

via Kaiser Family Foundation


Results from a multicountry clinical trial, sponsored by the National Institute for Allergy and Infectious Diseases (NIAID), show that HIV-positive people who take combination antiretroviral therapy (ART) can reduce the risk of transmitting the virus to their HIV-negative partners by 96 percent, U.S. researchers announced on Thursday "[i]n what is being hailed as a breakthrough in HIV prevention," the Los Angeles Times reports (Maugh, 5/13).

The randomized controlled trial, run by the HIV Prevention Trials Network and named HPTN 052, was meant to run another four years, but an interim analysis by an independent monitoring group prompted NIAID to halt the trial and release the results, ScienceInsider writes. The study, conducted since 2005 at 13 sites in nine countries, recruited 1,763 couples, 97 percent of whom were heterosexual, in which one partner was HIV-positive at enrollment. None of the HIV-positive partners had taken ART, and their CD4 cell counts, a measure of the immune system's health, were between 350 to 550. "Half the participants received immediate treatment, and the other half did not start [therapy] until their CD4 count dropped to 250 or they developed an AIDS-related symptom, according to ScienceInsider (Cohen, 5/12).

Analysis "identified 39 new cases of HIV among the previously uninfected partners. In 28 of these cases, genetic analysis confirmed that one partner had infected the other. Of these 28 infections, 27 – or 96 percent – occurred among couples in which the HIV-infected partner did not start antiretroviral therapy immediately," HealthDay/U.S. News reports (Reinberg, 5/12). The couples were all counseled on safe sex practices, given free condoms and provided treatment for sexually transmitted infections, BBC News adds (Gallagher, 5/12).

"This new finding convincingly demonstrates that treating the infected individual – and doing so sooner rather than later – can have a major impact on reducing HIV transmission," NIAID Director Anthony Fauci said in a statement (5/12).

The New York Times notes that though the trial was "relatively large," there are limitations to interpreting the results for other populations, like men who have sex with men, because nearly all "of the couples in the trial, who lived in Botswana, Brazil, India, Kenya, Malawi, South Africa, Thailand, the United States and Zimbabwe, were heterosexual" (McNeil, 5/12).

Treating HIV-positive participants early also improved other health outcomes, the Los Angeles Times reports, noting that the results showed 17 cases of disseminated tuberculosis (TB) among those whose treatment was deferred compared with three cases among the treatment group (5/13). According to Bloomberg News, researchers will continue to monitor study participants to determine whether treatment benefits persist (Cortez/Bennett, 5/13).

Treatment As Prevention

"Until now, antiretroviral therapy was known to improve the health of people infected with human immunodeficiency virus, but this is the first study to show a solid impact on preventing transmission to an HIV-negative partner," Agence France-Presse reports (Sheridan, 5/12).

Though the preliminary results "are likely to end, or at least diminish, a bitter feud within the AIDS world over how much funding should go to treatment versus prevention," funding "will be a major obstacle," the Wall Street Journal writes. With more than five million HIV-positive people on treatment at the end of 2009, and another 10 million in need of the drugs based on international treatment guidelines, UNAIDS has estimated a treatment funding shortfall of more than $7.5 billion, the Wall Street Journal notes (Schoofs/McKay, 5/12).

Observational studies have shown a benefit to early HIV treatment, leading UNAIDS last year to adopt "as its goal" a "test and treat" policy that "encourages doctors to start people on treatment as soon as they test positive for HIV," the New York Times states. Still, "[f]or lack of money, clinics in Africa are turning away patients who are not just infected but close to death. And in some American states where money provided by the Ryan White Care Act has run out, poor uninsured people are on waiting lists," the newspaper adds (5/12).

UNAIDS Executive Director Michel Sidibe said, "This breakthrough is a serious game changer and will drive the prevention revolution forward. It makes HIV treatment a new priority prevention option," adding, "Now we need to make sure that couples have the option to choose treatment for prevention and have access to it," according to Reuters (Steenhuysen, 5/12). Sidibe said "he hopes the new results will compel pharmaceutical companies to lower the price of ARVs as the demand for the drugs expands," that "new partnerships will form to advocate for increased funding and that the findings will be prominently discussed next month at the United Nations High Level Meeting on AIDS in New York City," ScienceInsider reports (5/12).


[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.]

ARVs Dramatically Reduce Risk of Passing HIV to Healthy Partners

via Health Behavior News Service, by Glenda Fauntleroy

When one partner in a couple is infected with HIV and the other is not, treatment with antiretroviral drugs can dramatically lower the chances of the infected partner passing along the disease to his or her mate, a new evidence review finds.

Patients with HIV receive a combination of drugs is given as part of antiretroviral therapy (ART) to stop progression of the disease. The new review discovered that when patients with HIV are on ART, their partners had more than a five-fold lower risk of getting the virus than in couples without treatment.

“We weren’t particularly surprised having followed this literature for awhile,” said reviewer George Rutherford of Global Health Sciences at the University of California, San Francisco. “The magnitude of the effect was somewhat surprising, though.”

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 Caribbean: State-Sponsored Homophobia Helps Spread HIV

via Open Society, by David Scamell

A few weeks ago, civil society groups and human rights activists from across the Caribbean met with officials from UNAIDS, UNDP, and various national governments to talk about the impact that laws have on the HIV epidemic in the region. The meeting was the second regional dialogue of the UNDP Global Commission on HIV & Law, and was held in a region where a number of governments continue to use the law to persecute sexual and gender minorities.

According to the 2010 report from the International Lesbian and Gay Association, State-Sponsored Homophobia, 11 of the 13 Caribbean states criminalize sex between men. Under the continuous threat of imprisonment and police abuse, as well as discrimination from other citizens and even family members, gays and other men who have sex with men (MSM) in these countries are often driven away from the health and social services that they need. The same services, such as access to condoms and voluntary HIV testing and counseling, which are crucial in the fight against HIV.

Unsurprisingly, HIV among MSM is a relatively hidden but increasing problem for the Caribbean. In a region where the general adult HIV prevalence is second only to sub-Saharan Africa, at one percent of the population, infection among MSM is disproportionately high. For example, one in three MSM in Jamaica and one in five in Trinidad and Tobago are living with HIV.

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.]

IGLHRC Shocked at Possible Passage of Ugandan Anti-Homosexuality Bill; Rights Protections for All Ugandans Precarious

Press Release via IGLHRC

Contacts:

Cary Alan Johnson, Executive Director, IGLHRC (New York)
Tel: (347) 515 0330; Email: cjohnson@iglhrc.org

(New York, 6 May 2011) The International Gay and Lesbian Human Rights Commission is deeply concerned at reports that the now infamous Anti-Homosexuality Bill in Uganda may be passed by that country's Parliament. The Bill, first introduced in October 2009, was ostensibly "shelved" by Uganda's president Yoweri Museveni following an international outcry. However, public hearings on the Bill took place today in the Legal and Parliamentary Affairs Committee. The remaining stages of the legislative process – namely second and third readings of the bill and presidential adoption – could be completed within the remaining week of the current parliamentary session.

"We are shocked that after more than 2 years of engagement with the government of Uganda about the Anti-Homosexuality Bill, this heinous piece of legislation may still become law," said Cary Alan Johnson, IGLHRC Executive Director. "Governments, world religious and political leaders, and HIV prevention experts have all appealed to Ugandan parliamentarians to put their distaste and fear of LGBT people aside and use their better judgment for the good of the country."

The Bill reaffirms existing penalties for consensual same-sex relationships, and criminalizes the "promotion of homosexuality" and failure to report homosexual activity. The Parliamentary Committee itself has said that the provisions of the Bill are redundant and unnecessary. Most controversially, the Bill would punish "aggravated homosexuality" – including activity by "serial offenders" or those who are HIV positive – with the death penalty. To IGLHRC's knowledge, the provisions related to the death penalty remain part of the Bill, despite statements by the Bill's author that these would be removed. The Bill not only violates multiple protections guaranteed by the Constitution of Uganda, but also contravenes the African Charter on Human and People's Rights, the International Covenant on Civil and Political Rights (ICCPR), and other international human rights treaties to which Uganda is a party.

"There can be no reason to pass this Bill other than to take the attention of Ugandans – and the rest of the world – away from the fact that Uganda is slipping into political chaos," stated Johnson. "Clearly the issue of homosexuality is being used to deflect attention from the crackdown on democracy and freedom of speech that has led to at least 5 deaths, more than 100 injuries, and hundreds of arrests in the last month. IGLHRC stands firm with all the people of Uganda as they struggle to maintain their freedom and dignity."

See our previous work on Uganda

For more information, visit Uganda's Civil Society Coalition on Human Rights and Constitutional Law website



[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.]

Slide Presentations from MTN's 2011 Annual Meeting

The 2011 Annual Meeting of the Microbicide Trials Network was held in Washington, DC this past March.

Very informative plenary presentations occurred on the two main days of the meeting. The MTN and all the presenters have graciously provided access to their slide sets. Below are links to each of them. Please take advantage of this great set of resources.

Presentations from Plenary Sessions on Monday, March 28, 2011
DIEFFENBACH: Challenges and Opportunities in HIV Prevention
FENTON: Enhancing HIV/STI Prevention for MSM in the United States
HILLIER: Welcome and MTN State of the Network
HUMES: Engaging African American MSM in Research
MCGOWAN: MTN Response to the US Domestic Agenda
MGODI: Where are we going after effectiveness studies?
MILLETT: The U.S. National HIV/AIDS Strategy
STANTON: Update on the Status of USAID’s HIV/AIDS Microbicides Program
Presentations from Plenary Sessions on Tuesday, March 29, 2011
BANGSBERG: PREP Adherence Measurement
CELUM: Adherence & Effectiveness: Lessons from CAPRISA 004, iPrEx & Partners PrEP (& HSV-HIV Trials)
GORBACH: Integration of Behavioral Science in the MTN
HENDRIX: MTN-001Phase 2 Adherence and Pharmacokinetic Study of Oral and Vaginal Preparationsof Tenofovir
HILLIER: MTN Annual Meeting Awards and Closing Remarks
MCGOWAN: Microbicides 2012
ROMANO: The Microbicide Pipeline:A Critical Review

[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 Drug Shuts Down Precancerous HPV-Infected Cells

via AIDSmeds

The antiretroviral (ARV) drug lopinavir (found in Kaletra) is able to kill cervical cells infected with the human papillomavirus (HPV)—cells that can go on to become cancerous—according to a study published online May 5 in the journal Antiviral Therapy.

HPV is one of the most widely spread viruses in the world. Transmitted through sexual contact, some strains cause genital warts, while others can cause cells to mutate and become cancerous, thereby leading to cervical cancer, anal cancer, penile cancer and cancers of the head and neck.

Though there is now a vaccine against several strains of HPV, it can only prevent HPV. It doesn’t protect someone already infected from developing cancer. Also, HIV-positive women have much higher rates of cervical cancer than women without HIV, and cervical cancer is a leading cause of death in both HIV-positive and HIV-negative women in resource poor countries.

In announcing the new findings, the study’s senior author—Ian Hampson, PhD, from the University of Manchester in England—noted that he and his colleagues were the first to document that lopinavir could be toxic to HPV, as reported in a fall 2006 issue of Antiviral Therapy.

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.]

Check it out: Condom Effectiveness Dossier

via Global Forum on MSM and HIV, by Michael Reece

Dear Colleagues:

Over the past year, leaders from multiple sexual health organizations in the U.S. have teamed together to create what is called the “Condom Effectiveness Dossier.”  The Dossier is a review of the scientific evidence for the effectiveness of condoms----designed to be used by educators and policy makers when faced with questions about condom manufacturing, condom efficacy, etc.  The full Dossier includes a slide set with over 100 slides dedicated to what scientists know about condoms and their effectiveness, and also includes several videos (e.g., of the condom testing process) that can be used by faculty and other educators during lectures and other presentations.

Our goal is to make this Dossier available as widely as possible.  The full folder of the Dossier can be downloaded at the link below.  I think this is one of the most comprehensive collections of information that supports the work that we do to encourage condom use and condom education.

Michael

The Condom Effectiveness Dossier can be downloaded here.

PASSWORD:  12345678


Michael Reece, Ph.D., MPH
Director, Center for Sexual Health Promotion
Associate Professor, School of Health, Physical Education & Recreation
Indiana University

Source.

[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.]

Factors Influencing the Emergence and Spread of HIV Drug Resistance Arising from Rollout of Antiretroviral Pre-Exposure Prophylaxis (PrEP)

via PLoS One, by Abbas UL, Hood G, Wetzel AW, Mellors JW

Abstract

Background

The potential for emergence and spread of HIV drug resistance from rollout of antiretroviral (ARV) pre-exposure prophylaxis (PrEP) is an important public health concern. We investigated determinants of HIV drug resistance prevalence after PrEP implementation through mathematical modeling.

Methodology

A model incorporating heterogeneity in age, gender, sexual activity, HIV infection status, stage of disease, PrEP coverage/discontinuation, and HIV drug susceptibility, was designed to simulate the impact of PrEP on HIV prevention and drug resistance in a sub-Saharan epidemic.

Principal Findings

Analyses suggest that the prevalence of HIV drug resistance is influenced most by the extent and duration of inadvertent PrEP use in individuals already infected with HIV. Other key factors affecting drug resistance prevalence include the persistence time of transmitted resistance and the duration of inadvertent PrEP use in individuals who become infected on PrEP. From uncertainty analysis, the median overall prevalence of drug resistance at 10 years was predicted to be 9.2% (interquartile range 6.9%–12.2%). An optimistic scenario of 75% PrEP efficacy, 60% coverage of the susceptible population, and 5% inadvertent PrEP use predicts a rise in HIV drug resistance prevalence to only 2.5% after 10 years. By contrast, in a pessimistic scenario of 25% PrEP efficacy, 15% population coverage, and 25% inadvertent PrEP use, resistance prevalence increased to over 40%.

Conclusions

Inadvertent PrEP use in previously-infected individuals is the major determinant of HIV drug resistance prevalence arising from PrEP. Both the rate and duration of inadvertent PrEP use are key factors. PrEP rollout programs should include routine monitoring of HIV infection status to limit the spread of drug resistance.

Read the full text.


[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 PrEP Explained: Critical Prevention Opportunity

via AIDS Treatment News, by John S. James

This is a superb description of the iPrEx trial, with a smart analysis of it's implications. A must-read.

Excerpt:

Why did so many of the study participants not take the Truvada?

No one knows for sure at this time. But something unusual and unexpected happened in this study. This clinical trial took place at 11 sites in 6 countries -- with two of the 11 sites in the United States (Boston and San Francisco -- with 113 U.S. participants on Truvada, 114 on placebo). And adherence at the U.S. sites was much better than at the non-U.S. sites -- 97% among all the U.S. participants, considered extremely good, compared to far less overall. The "44% effective" headline just averages these very different situations.

We know of three theories about this difference: (1) The U.S. participants were about 10 years older on the average (though this would hardly explain the huge adherence differences observed); (2) Many of the non-U.S. participants were living at home and probably not “out” to their families, so they would have needed to conceal their participation in the study, making adherence difficult; or (3) Boston and San Francisco have excellent HIV treatment access, perhaps the best in the U.S., while in many countries most people with HIV are dying with no treatment at all. So trial participants may have given or sold their pills to someone with immediate need.

We think that the latter is most likely.

Whatever the reason, the excellent U.S. adherence shows that people can use the drug properly for prevention. And in the future, patients will know that they are getting the active drug (not a placebo), and that it has been proven to work -- both of which should boost adherence. Researchers need to find out what went wrong at some of the sites, and learn how fix it.

But the bottom line is that we do have proof of principle that Truvada prophylaxis can work in high-risk gay men, and prevent close to 100% of the HIV infections that would otherwise occur.

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.]

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.

Read the rest.






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

A comparison of condom use errors and problems for heterosexual anal and vaginal intercourse

via International Journal of STD and AIDS

Abstract

Condom use errors and problems were compared for anal and vaginal intercourse among a convenience sample of heterosexual men aged 18–66 years (n = 757). Men completed an online questionnaire for the last male condom use event for penile–anal (10.4%) or penile–vaginal (89.6%) intercourse. The prevalence of condom use errors and problems was similar regardless of intercourse type with a few exceptions; those reporting anal intercourse were significantly more likely to report using water-based (P < 0.001) and oil-based (P = 0.037) lubricant and to remove condoms before sex was finished (P < 0.001). The large majority of the sample (93.8%) reported at least one of the nine errors assessed and almost half (46.2%) reported at least one of the seven problems, indicating that many adults may need assistance with these issues. Condom use promotion programmes designed for heterosexual adults are needed that address condom use errors and problems for penile–anal as well as penile–vaginal intercourse.

[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.]

Description of a Pilot Anal Pap Smear Screening Program Among Individuals Attending a Veteran's Affairs HIV Clinic

via AIDS Patient Care and STDs

Isabella Rosa-Cunha, Vincent A. DeGennaro, Rene Hartmann, Clara Milikowski, Andres Irizarry, Brenda Heitman, Orlando Gómez-Marín, Gordon M. Dickinson. AIDS Patient Care and STDs. April 2011, 25(4): 213-219. doi:10.1089/apc.2010.0233.

Abstract

Despite the higher risk of anal cancer among HIV-infected individuals currently there are no national or international guidelines for anal dysplasia screening. We assessed acceptance and feasibility of screening for anal intraepithelial neoplasia (AIN), the rate of abnormalities, and relationship between the presence of AIN and a history of receptive anal intercourse. Eighty-two percent of HIV-patients approached during routine clinic visit agreed to participate in the study with anal Pap smear collection; 53% had abnormal cytology results and among those undergoing high-resolution anoscopy with biopsy, 55% had high-grade AIN, including 2 cases of carcinoma in situ. Anal cytology was well accepted and it was feasible to be incorporated into HIV primary care practice. Abnormal cytology was not significantly associated with history of anal intercourse (p = 0.767). The high rate of abnormal results reinforces the need for further evaluation of the role of systematic anal Pap smear screening for HIV patients.

Read the whole 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.]