Expanded access to ART has the potential to avert millions of AIDS orphans in Africa

Via aidsmap, by Michael Carter

Universal adult access to antiretroviral therapy compared to current roll-out could prevent over 4 million more children being orphaned because of HIV in the sub-Saharan African countries hardest hit by AIDS, according to published in the online journal AIDS Research and Therapy.


“Results from this study highlight the positive impact that expanded ART [antiretroviral therapy] may have in sub-Saharan countries already burdened with high numbers of AIDS orphans,” comment the investigators. They add, “we found that achieving universal ART uptake among adults may avert over 4 million maternal, paternal and double AIDS orphans over the next 10 years.”

It is estimated that 11.6 million children in sub-Saharan Africa have already lost one or both parents because of HIV. Orphans have greater material, physical, health-related and psychological need, and there is also evidence that they have higher levels of HIV-related risk behaviour. Moreover, HIV-infected orphans often delay accessing essential care and have poor rates of adherence to HIV therapy.

Antiretroviral therapy has significantly reduced rates of HIV-related illness and death. At the end of 2008, it was estimated that 44% of eligible patients in sub-Saharan Africa were receiving HIV 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.]

UGANDA: IDP's hit by ARV shortages, poor HIV care in the north

Via PlusNews

Internally displaced people in northern Uganda face a difficult choice - whether to return to their ancestral villages or stay in camps hoping for better access to healthcare, as antiretroviral (ARV) drugs are in short supply.

"Going back to the village to me means committing suicide because the village health centres do not provide us ARVs - they are constantly out of drugs," said Bosco Opiro of Pabbo, a former IDP camp in Amuru District.

Opiro said his village of Lalem, also in Amuru, had no health centre; he and other HIV-positive people in the camp have chosen to remain in Pabbo and continue to collect their ARVs from the health centre in town rather than go back to Lalem.

The UN Office for the Coordination of Humanitarian Affairs has reported a lack of basic services, including healthcare, in areas of return.

Patrick Odong, the district health officer for Amuru District, told IRIN/PlusNews one of the major problems with HIV management both in the camps and in towns was the irregular supply of drugs by the National Medical Stores.

However, Zainab Akol, AIDS programme manager in the Ministry of Health, said the fault often lay with the districts.

"The main problem is that these people wait until everything is finished in their stores and then they place their order [with the National Medical Stores]," she said. "Right now we have stocks at the medical stores so if they don't order, it causes supply problems for the patients."

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.]

HIV/AIDS: Five Ways to reduce women's vulnerability to HIV/AIDS



Via PlusNews

Women and girls across the globe continue to be disproportionately affected by the AIDS pandemic. HIV is the leading cause of death and disease among women of reproductive age worldwide.

IRIN/PlusNews presents five important ways to reduce women's vulnerability to HIV:

Education: According to UNAIDS, illiterate women are four times more likely to believe there is no way to prevent HIV infection, while in Africa and Latin America, girls with higher levels of education tend to delay first sexual experience and are more likely to insist their partner use a condom.

Access to reproductive health services: In many developing countries, women have very limited access to vital reproductive health services. A combination of biological and social factors means women are more vulnerable to sexually transmitted infections (STIs), which, if left untreated, increase their vulnerability to HIV.

Ending gender violence: One in three women has been beaten, experienced sexual violence or otherwise abused in their lifetime, according to the UN; one in five will be a victim of rape or attempted rape. More often than not, the perpetrators are known to the women.

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.]

Changing HIV Risk Behaviors

Via The Forum for Collaborative HIV Research

Background: Previous studies have suggested that initial reductions in risk behavior after HIV diagnosis are not sustained. We investigated how seroadaptive tactics, including fewer total partners, serodiscordant partners, and “risk partnerships” (defined as insertive unprotected anal intercourse with an HIV– or partners unknown status), adopted by HIV+ men who have sex with men (MSM) influence HIV transmission risk over time.

Methods: MSM with acute/recent (<6 months) HIV infection were enrolled from 1998 to 2010 into the OPTIONS cohort. During 2009 to 2010, at every 3-month interval, subjects completed computer-assisted self-interviews detailing risk behavior in the prior 3 months.

To assess the relationship between transmission risk and time, we categorized individuals as being in the pre-diagnosis, post-diagnosis (as long as 6 months post-diagnosis), or later follow-up period based on their first interview. We calculated the mean number of partnerships for each category. Trends over time were assessed in subsets of individuals with data at multiple time points using linear regression.

Results: In 504 interviews, 237 MSM contributed data: 52 (10.3%) interviews assessed behavior pre-diagnosis, 65 (12.9%) post-diagnosis, and 387 (76.8%) in follow-up. The mean number of sexual partners per 3 months was significantly higher pre-diagnosis (12.2) than post-diagnosis (3.8) and follow-up (7.5) periods.

The proportion of reported partners who were HIV– or of unknown status was 0.80 pre-diagnosis, 0.24 post-diagnosis, and 0.62 in follow-up. Mean “risk partnerships” per 3 months was 2.80 pre-diagnosis, but was significantly lower in both post-diagnosis (0.09) and follow-up (0.20) groups.

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

Kenya: Testing the Integration of HIV and public healthcare

Via PlusNews

HIV could lose its "special status" in Kenya's health system if a new pilot programme integrating HIV care and public healthcare proves successful.

Traditionally, public hospitals in Kenya have a "comprehensive care clinic" (CCC) dedicated to people living with HIV; under the new system, these would no longer exist.

For more than six months, the Ministry of Health and its partners have been piloting the move in Western Province; senior government officials say it will not reduce the focus on HIV, but will ease pressure on an already overburdened and understaffed health system.

"Integrating HIV treatment with other outpatient services doesn't mean it has become less important; it only means maximizing on space and reducing the burden on healthcare personnel and to help increase focus on other equally important diseases like malaria," said Ibrahim Mohamed, head of the National AIDS and Sexually transmitted infections Control Programme, NASCOP.

Joshua Omoro likes the new system, stating, "I have come today to pick my [antiretroviral] medicine but nobody can know; people are just guessing what I might be suffering from just like I am also just guessing for other people," he said. "It puts you at ease... before when you went to a specific room, people just knew you had HIV."

"It is not only reducing stigma but is also easing the staff shortages that had been experienced earlier when too much focus was placed on HIV/AIDS," said Beatrice Misoga, HIV/AIDS integration officer for US government-supported AIDS, Population and Health Integrated Assistance II (APHIA II) in Western Kenya.

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

AFRICA: Need for systematic HIV drug resistance testing

 via PlusNews

HIV is a tough enough diagnosis, but when one contracts a strain of HIV resistant to some life-prolonging medicines, treatment options are limited. A new study has found that transmitted HIV drug resistance may be on the rise in Africa, and the authors warn that unless resistance surveillance is increased, the continent's treatment programmes could suffer.

The study, led by the International AIDS Vaccine Initiative (IAVI) in five African countries, found that the prevalence of transmitted drug resistance in Rwanda, Uganda and Zambia was considerably higher than previously reported. Of 408 people studied in Kenya, Rwanda, South Africa, Uganda and Zambia, 19 had transmitted resistance mutations. Resistance prevalence rose considerably during the study in Zambia and remained high throughout the study in Entebbe (Uganda).

"The message to take away from this study is the urgent need for regular drug resistance surveillance, which we currently do not have," said Omu Anzala, head of the Kenya AIDS Vaccine Initiative. "If we can see transmitted resistance in such a small study then there could be much more going around."

"We saw what has happened with malaria over the years, with resistance developing against several drugs. We need to move quickly to ensure governments are aware and are implementing drug resistance surveillance to prevent the same thing happening with ARVs," he added.

In 2009 Kenya launched a five-year national plan on HIV drug resistance, prevention, monitoring and surveillance.

A separate study in 2010 by PharmAccess African Studies to Evaluate Resistance (PASER), a project of the PharmAccess Foundation, a Dutch health NGO, found that nearly 6 percent of patients about to start HIV treatment for the first time already had resistance to standard first-line ART.

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

VIDEO: Melvin and his sister: A gay Kenyan's struggle to survive

via guardian.co.uk

As discrimination against homosexuals in Africa reaches a new murderous peak, Guardian Films travels to Mombasa, Kenya, to hear from a male prostitute who risks his life to support his younger sister.



[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.]

Debate PrEP based on facts

Via Ebar, by Dr. Robert Grant

A robust public debate is under way about the potential use of anti-HIV drugs to prevent HIV infection (also known as pre-exposure prophylaxis or PrEP). Our study, called iPrEx, provided the first conclusive evidence that the daily use of PrEP with the FDA-approved HIV treatment Truvada can significantly reduce HIV infection risk in gay, bisexual, and other men who have sex with men and transgender women, when delivered as part of a comprehensive package of prevention services, including condoms.

Recently, a private health care provider has begun a paid advertising campaign urging the FDA not to even consider approving the use of PrEP – charging, among other things, that MSM will stop using condoms if PrEP is permitted. The pros and cons of PrEP use should be vigorously debated – but that debate should be based on facts, rather than the assumption that MSM will not act to protect themselves and others from infection. Here are the facts about the iPrEX study:

The protection provided by PrEP and condoms together could have a substantial impact in reducing new HIV infections among MSM worldwide.

A diverse group of 2,499 HIV-negative MSM and transgender women on four continents with a range of sexual practices participated in iPrEx. All participants received a comprehensive package of HIV prevention services. Half also received Truvada, while the other half received a placebo (blank pill). Neither the study participants nor the investigators knew which pill they received during the study.

Men in both study groups reduced their risk behaviors and increased their condom use – demonstrating that MSM can use PrEP and condoms together. PrEP does not protect against other sexually transmitted infections and should never be considered as a substitute for condom use or other safer sex precautions.

Much more work lies ahead to determine whether PrEP can help stop HIV infections in other populations, such as heterosexuals and injection drug users, to better understand possible side effects of PrEP, to support consistent pill use among people who want to use it, and to ensure that PrEP is seen as one element of an HIV prevention strategy that includes regular condom use.

Additional studies are also under way to test whether other anti-HIV medicines (including pills, gels, and other formulations) are safe and effective for HIV prevention.

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.]

K24TV - The price of protection in Kenya is too high

[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/AIDS: UNAIDS, activists urge countries to get clever with TRIPS

Via PlusNews

UNAIDS has released a new policy brief to help countries make intellectual property rights work for them, amid growing concern that an impending free trade agreement between the European Union (EU) and India could threaten the world's supply of generic antiretroviral (ARV) drugs.


The World Trade Organization's Trade Related Aspects of Intellectual Property Rights (TRIPS) allows countries to override patents - for public health purposes - by issuing "compulsory licenses" that enable the generic manufacture of drugs still under patent.

The UNAIDS brief, published on 15 March, noted that few developing countries had exercised this right and cited a lack of capacity to deal with the complicated legal paperwork required. Nevertheless, the flexibility afforded by TRIPS has brought increased competition, helping to lower the cost of first-line generic ARVs by as much as 99 percent in the last decade.

Recent changes in World Health Organization (WHO) HIV treatment guidelines substituted stavudine, a cheaper ARV, for tenofovir, a more expensive one, making it even more important for countries to take advantage of TRIPS to keep treatment costs low and extend coverage.

The UNAIDS paper - co-authored by UNAIDS, WHO and the United Nations Development Programme (UNDP) - aims to help countries improve their access to generic ARVs by using TRIPS. It also provides successful case studies from countries like Thailand, Brazil and Rwanda, which have used TRIPS to negotiate lower ARV prices, and recommends that governments adapt their national legislative frameworks and develop a domestic pharmaceutical production capability.

African activists speak out

According to UNITAID, an international facility for purchasing ARVs, India manufacturers most of the generic ARVs used in low-and middle-income countries, but African activists maintain that ongoing free trade talks between the EU and India will limit access to these drugs.

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.]

High prevelance of anal pre-cancerous lesions in men with HIV

Via Aidsmap, by Michael Carter



Prevalence and incidence of high-grade pre-cancerous anal lesions in HIV-positive men who are taking antiretroviral therapy are high, Canadian investigators report in the online edition of Clinical Infectious Diseases. A low nadir CD4 cell count and infection with HPV types 16 and 18 were associated with an increased risk of developing high-grade pre-cancerous anal lesions (AIN-2, 3). The investigators hope that their findings will help identify patients who have a higher risk of HPV-associated anal disease.

Rates of HIV-related opportunistic infections have fallen significantly since the introduction of antiretroviral therapy.

However, the incidence of anal cancer is increasing.

Most of the information about the risk factors for this disease in HIV-positive gay men was obtained during the era before effective antiretroviral therapy became available. These include high-grade pre-cancerous lesions, infection with HPV 16 and 18, multiple HPV infections and CD4 cell count.

Investigators from the Canadian Human Immunodeficiency and Papilloma Virus Research Group (HIPVIRG) wanted to establish a comprehensive understanding of the risk factors for progression to AIN 2 and 3. They also wished to see if treatment with anti-HIV drugs had any impact on disease progression.

A total of 247 men who were taking or about to initiate antiretroviral therapy were recruited to the study between 2002 and 2005. The patients had swabs to see if they had anal HPV infection, and if present further tests were conducted to determine whether strains associated with anal cancer were present.

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

Circumcision Does Not Protect MSM of Peru and US From HIV

via International AIDS Society, by Mark Mascolini

Circumcision did not protect men who have sex with men (MSM) from acquiring HIV infection, according to an analysis of more than 1800 men in Peru and the United States. The findings confirm results of earlier studies. Three randomized trials in Africa showed that circumcision does lower the risk of HIV infection in heterosexual men.

This analysis involved 1824 MSM, 1362 (75%) of them from Peru and 462 (25%) from the United States. All men were negative for HIV and positive for herpes simplex virus type 2 (HSV-2). They were enrolled in a randomized placebo-controlled trial of HSV-2 suppression to prevent HIV infection. That study found treating HSV-2 did not lower the risk of HSV-2 acquisition.

All study participants were assessed for circumcision status at enrollment and were tested for HIV every 3 months for up to 18 months. Researchers determined partner-specific sexual behavior for up to the last 3 partners during the previous 3 months.

Univariate analysis revealed no significant association between circumcision and HIV acquisition (relative risk [RR] 0.84, 95% confidence interval [CI] 0.50 to 1.42). Multivariate analysis that assumed a linear relationship between the proportion of insertive sex acts and effect of circumcision on HIV acquisition found that the interaction between circumcision and the proportion of insertive acts was not significant in lowering HIV risk (P = 0.11).

A third analysis that divided men into those who had fewer than 60 insertive acts with recent partners and those who had 60 or more partners determined that circumcision reduced the risk of HIV acquisition 69% (RR 0.31), but that association was not statistically significant (95% CI 0.06 to 1.51) among men who repeated at least 60% of insertive acts with recent male partners.

The researchers conclude that “circumcision does not have a significant protective effect against HIV acquisition among MSM from Peru and US.” However, they suggest “there may be reduced risk for men who are primarily insertive with their male partners” and they call for further investigation of this association.

Source: Jorge Sánchez, Victor G. Sal y Rosas, James P. Hughes, Jared M. Baeten, Jonathan Fuchs, Susan P. Buchbinder, Beryl A. Koblin, Martín Casapia, Abner Ortiz, Connie Celum. Male circumcision and risk of HIV acquisition among MSM. AIDS. 2011; 25: 519-529.

Click here for the study abstract.

[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: Stigma keeps Asian population from accessing HIV services

via PlusNews

When 20-year-old Jenna,* a Kenyan of Asian descent, told her family two years ago she had tested positive for HIV, they forced her to terminate her pregnancy, forbad her to seek treatment and kept her locked in the house because of the shame she had brought on the family.

She did, however, go against their will and obtained life-prolonging antiretroviral medication at hospital. She now lives with another family who have taken her in and accepted her status.

"When I insisted on seeking treatment, my family chased me away," Jenna told IRIN/PlusNews. "For them it was good if I died slowly rather than shame them by seeking treatment and giving people an opportunity to know my status."

The Kenya National Bureau of Statistics estimates there are about 120,000 Kenyans of Asian - largely South Asian – origin, mainly living in the three major cities of Nairobi, Mombasa and Kisumu.

According to Anwar Ali Sharif, 36, the only Asian member of the National Empowerment of People Living with HIV/AIDS of Kenya (NEPHAK), stigma is the biggest impediment to Kenyan Asians accessing HIV/AIDS services.

"There is a lot of stigma among Kenyans of Asian origin. Many people who are HIV-positive are locked in the house because it is feared they will shame the family if it is known they are HIV-positive," he said.

He noted that while wealthy Asians could afford to visit private health facilities where no one need know their status, the stigma of visiting the clearly marked comprehensive HIV care clinics in public hospitals kept poorer Asians away from treatment.

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.]
 

2011 National LGBTI Health Summit Calls for Abstracts

Indiana University Health Bloomington and the Local Steering committee of the National LGBTI Health Summit are proud to announce our call for abstracts. The call for abstracts ends April 15th, 2011. Abstracts may be submitted at www.nationallgbtihealthsummit.com

We invite you to spend a few days in Bloomington working intensively with colleagues from all over the nation and world who are grappling with similar challenges, and engage in deep thinking and extended discussion about innovative programming related to the theme of "LGBTI Health: At the Crossroads." We welcome presentations from diverse health care disciplines, community members, and anyone with a vested interest in addressing LGBTI health discrepancies. Based on the content of the abstracts accepted for workshop presentations, the workshop will be organized into tracks.

Workshop tracks/themes may include:

• Mental health care
• Health disparities by age
• Health disparities by race or ethnicity
• Health disparities by sex or gender
• Health disparities by sexual orientation
• Substance abuse
• Policy/Health care reform
• HIV/AIDS
• And more.

The 2011 National LGBTI Health Summit will be held in Bloomington, Indiana on July 16-19, 2011 at the Indiana Memorial Union on the campus of Indiana University. We would like to invite all members of the LGBTI Community and their allies to join us in beautiful, Bloomington, Indiana.


[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.]

 

Ethiopia's five-year plan to halve new HIV infections

via Afrique en ligne

Ethiopia's government has come up with an ambitious plan to halve new HIV infections, quadruple its annual condom distribution and put 85 percent of people who need life-prolonging HIV medication on treatment within five years. An estimated 1.2 million Ethiopians are HIV-positive. According to the government, the country's national prevalence is 2.4 percent, with stark differences between urban HIV prevalence, which stands at about 7.7 percent and rural levels of under 1 percent...

... The country's HIV plan aims to be comprehensive, but glaringly absent from its HIV strategies is any programming specifically for men who have sex with men (MSM), who generally fall into "most at-risk" populations.

According to Israel Tadesse, a lawyer at Addis Ababa city municipality, Ethiopia's criminal code imposes prison terms of 3-12 months on people found having sex with members of the same sex. Fear of legal repercussions is often a hindrance for gay people seeking HIV prevention and treatment services.

"There is anecdotal belief that the number of MSM is increasing but we don't have any credible or official study or data," HAPCO's Yibeltal said. "Ethiopia is no island to the global state of things so I am sure in the near future it will be a threat. Therefore, necessary intervention should be implemented but the problem so far is a hidden agenda."


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.]

High HIV risk behavior among men who have sex with men in Kigali, Rwanda: making the case for supportive prevention policy

AIDS Care. 2011 Apr;23(4):449-55.

Chapman J, Koleros A, Delmont Y, Pegurri E, Gahire R, Binagwaho A.

Futures Group International, Washington, DC, USA.

Abstract

Rwanda has responded strongly to HIV/AIDS, but prevention among men who have sex with men (MSM) has not yet been addressed due to a strong cultural resistance to homosexuality, and a lack of data showing the public health value of attending to the sexual health needs of this group. We conducted an exploratory study on HIV risk among MSM in Kigali using snowball sampling involving peer leaders. The 99 respondents were demographically, socially, and sexually diverse. Respondents reported relatively high numbers of male and female partners, and considerable HIV risk behaviors including commercial sex with men and women, low condom use during anal and vaginal sex, and high mobility. Many respondents reported verbal and/or physical abuse due to their sexuality. This first study of MSM in Rwanda has brought attention to a previously neglected HIV risk group and their potential driving role in the Rwandan epidemic, demonstrating the need for sensitive and targeted interventions.

[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.]

So, what about this "magic pill" that can prevent HIV?!

[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.]

Slate: Why are bisexual women more likely to have tried anal sex?

via Slate.com, by William Saletan

Have you heard the latest report on Americans' sex habits? The study, Sexual Behavior, Sexual Attraction, and Sexual Identity in the United States, comes from the National Survey of Family Growth, the country's most respected periodic sex survey. Media reports about the study have noted what seems to be a resurgence of virginity. But the data also show something more surprising: Compared with women who are totally straight, women who are slightly bisexual are more likely to have tried various sex acts with men. In fact, compared with totally straight women, women who are fully bisexual or lesbian are more likely to have tried anal sex.

Why?

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.]

Gilead’s High Bar for AIDS Drugs Means New Development Withers

via Bloomberg, by Michelle Fay Cortez

Gilead Sciences Inc., the world’s biggest AIDS-drug maker, revolutionized treatment and helped forge a $15 billion market with a single daily pill attacking the virus with three medicines at once.

Now, Foster City, California-based Gilead and rivals Merck & Co. and Bristol-Myers Squibb Co. are victims of that success. Three decades after the discovery of the virus that causes AIDS, there are 31 drugs on the market that have helped turn HIV from a death sentence into a manageable disease in the developed world. Only six were approved after 2004.

“The bar for bringing on a drug in HIV has gotten higher,” said George Hanna, vice president of virology for U.S. medical and HIV early development at Bristol-Myers, based in New York. “You can no longer bring to market a drug you’re going to have to take three times a day. All of a sudden, we’re seeing a lot less in the pipeline.”

Medicines created over the years have become safer, more effective, have attacked the virus in new ways and have eliminated the need for as many as 20 pills a day. As drugmakers struggle to top that achievement, millions of HIV patients face the possibility of the virus becoming fatal again if it shifts shape inside cells to outsmart existing therapies.

HIV has been a formidable foe for drug designers, mutating around chemical hurdles placed in its way. The attack begins when the virus attaches to a cell surface receptor and uses a protein to force its way inside. Most existing families of drugs stop HIV from hijacking proteins to enter cells or block its ability to copy itself once inside.


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.]

Human Rights Watch: US: Mississippi Policies Fuel HIV Epidemic

State’s Approaches Impede Access to Information, Prevention, Treatment

via Human Right Watch

Thousands of Mississippians are at risk for HIV, and many who are infected are denied lifesaving measures and treatment because of counterproductive state laws and policies, Human Rights Watch said in a report released March 9. Mississippi has resisted effective approaches to HIV prevention and treatment and instead supported policies that promote stigma and discrimination, fueling one of the nation's highest AIDS rates, Human Rights Watch said.

The 59-page report, "Rights at Risk: State Response to HIV in Mississippi," documents the harmful impact of Mississippi's policies on state residents, including people living with HIV and those at high risk of contracting it. Mississippi refuses to provide complete, accurate information about HIV prevention to students and threatens criminal penalties for failing to disclose one's HIV status to sexual partners. At the same time, Mississippi provides little or no funding for HIV prevention, housing, transportation, or prescription drug programs for people living with HIV, and the state fails to take full advantage of federal subsidies to bolster these programs. In Mississippi, half of people testing positive for the virus are not receiving treatment, a rate comparable to that in Botswana, Ethiopia, and Rwanda.

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.]

Kenya: How discrimination is a barrier to good health

via guardian.co.uk

Complex issues, such as health and poverty, are often best illustrated by following individuals and showing how the issues affect their lives. That is why the Guardian is producing a series of films about some of the global issues that feature in Christian Aid's manifesto for change, Poverty Over.

The first film – on sexuality-based discrimination, human rights and HIV in Kenya – is available to view here on the Guardian's Christian Aid website from Monday. Same-sex relationships are illegal in the country, but prejudice and fear about them go far deeper than that. This film shows how hatred has a negative impact on the health of gay people in Kenya.

Anti-gay feeling is common in Kenya. Some politicians, religious leaders and sections of the media have stirred up this hatred. In November last year, for instance, the prime minister, Raila Odinga, called for a nationwide crackdown on gay people. Odinga ordered the police to arrest anyone found having sex with someone of the same gender and said that the country's constitution made it clear that homosexual activity was not to be tolerated.

This has obvious implications for men who have sex with other men, as they are often unable to access care if they become infected with HIV. Clinics that are known to treat gay men are threatened, medical practitioners may be unwilling to help them, they are often isolated and unable to access any kind of information. Many of these men are married, and risk infecting their wives with HIV.

The red-light areas of large cities in Kenya also show that, despite the rhetoric, there is a thriving gay sex industry. Many of the male sex workers have been thrown out of their family homes for their sexuality; they report that they are often compelled by clients to have sex without condoms.

Yet a growing gay community, and some inspiring gay rights and HIV activists, are doing their best to ensure that more people in Kenya are made aware of safer sex, condoms are made available, and prejudice against men who have sex with other men is addressed.

To find out more, view the film online from Monday, March 14. The site also has other interesting content that will engage, outrage, inspire and inform you, including Thursday webchats (1pm-2pm) when you can post questions for Christian Aid advisers. Additional films will be uploaded every week.

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.]

Is treatment really reducing infections?

via Aidsmap, by Gus Cairns

Moupali Das of the San Francisco Department of Public Health presented evidence to show that the city’s intensive testing and treatment policy was beginning to result in a declining HIV infection rate there. Similar evidence was presented from the province of British Columbia in Canada.

The evidence presented still leaves some questions unanswered, however.

• Is the reduction in viral load in the HIV-positive population (the 'community viral load' or CVL) really the cause of the decreased level of diagnoses seen in San Francisco in the last few years, or is it due to the success of prevention campaigns and reductions in risky behaviour?
  
• Do reduced diagnoses really indicate reduced incidence of infection?
  
• Is reducing the average viral load of diagnosed people a good indicator of the average infectiousness of people with HIV in the community – or do high viral loads in the minority who remain undiagnosed make this an unreliable indicator?

The answers to these questions are crucial as the future direction of HIV prevention policy may depend on them, in particular whether to concentrate on suppressing viral load or on behaviour change as the mainspring of prevention.

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.]

Kenya: Anal sex - "the modern way" - lies, and HIV

via IRIN PlusNews

For 10 years Amina Hassan*, 37, trusted her husband and had a happy married life in Nakuru, in Rift Valley Province, western Kenya. Even if her religion allowed him to marry other wives, he had always assured her that she was enough, and he would have no reason to marry anyone else. But she told IRIN/PlusNews that life changed when her husband went to work in the port city of Mombasa and he returned a different man.

"I got married in 1994 at the age of 20 to a man who was five years older than me. Every time we talked, he assured me of his love for me and his commitment to making me happy all the time. He said he was faithful to me even though as a truck driver he travelled for long distances and many days.

"In return, I remained faithful to him, I would miss him when he travelled but kept off the temptations of having another partner. He had rented a house for us in Bondeni, Nakuru, and I made sure no man, even a relative, visited in his absence, lest speculations start spreading around.

"In January 2004 he told me he would be working around the costal town of Mombasa for three weeks but... he did not return as promised and told me on the phone that he would take a little longer, as he had been assigned more work.

"When he came back in July the same year, it was a joyous moment for me and our children. But unlike before, the joy did not last over the night.

"He had never before asked to have anal sex with me, but on that particular night he demanded that it had to be done 'the modern way'. When I resisted, he threatened to leave me, saying I and the children would soon die from starvation as he would no longer provide for us.

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.]

CROI 2011: Rectal Microbicides to Prevent HIV Infection in Heterosexual Populations in High-prevalence Settings

Poster from CROI 2011

Dobromir Dimitrov*1, M-C Boily2, S Abdool Karim3, and B Mâsse1,4
Fred Hutchinson Cancer Res Ctr, Seattle, WA, US; 2Imperial Coll London, UK; 3Univ of KwaZulu-Natal, Durban, South Africa; and 4Univ of Montreal, Canada


Background:
The role of anal intercourse in the overall heterosexual HIV epidemic remains unclear. However, it may be an important risk factor because the considerably higher risk of HIV infection during unprotected receptive anal intercourse compared to vaginal intercourse. Anal intercourse is widely practiced by heterosexuals in many countries; in Tanzania, 6% of sexually active school pupils reported anal intercourse at their first sexual experience. In Cape Town, 10 to 14% of the study participants reported engaging in anal intercourse over the last 3 months. Different mathematical modeling studies have assessed the potential impact of a vaginal microbicide in heterosexual populations and of a rectal microbicide for homosexuals. However, none have assessed the potential impact of a rectal microbicide in heterosexual population. Our study aims to compare the potential impact of rectal, vaginal, and bi-compartment (i.e. applied vaginally and protective during vaginal and anal intercourse) microbicides to prevent HIV acquisition and transmission in heterosexual populations.

Methods:
Risk equations were used to determine under which conditions a rectal microbicide could be as useful as a vaginal microbicide. A transmission dynamic model was used to assess the population-level impact of the different microbicides in a variety of intervention scenarios and high HIV prevalence settings and to predict the fractions of new HIV infections prevented over fixed time periods.

Results:
Without anal intercourse, a 50% efficacious vaginal microbicide used by 100% of females prevents about 10% and 25% of all new male and female HIV infections over 10 years if adherence is 30% and 75%, respectively. These 10-year infection preventions are reduced by 32% in populations with 10% frequency of receptive anal intercourse, assuming 4-fold increase in transmission risk per receptive anal intercourse (RRRAI). A rectal microbicide could be as effective as a vaginal microbicide in populations with anal intercourse rates ranging from 5% to 20% across a range on RRRAI, assuming similar efficacy and frequency of use of both products. A rectal microbicide has less impact than a vaginal microbicide in populations with <5% anal intercourse, unless it is used more often or is more efficacious than a vaginal microbicide. The 10-year infections prevented of bi-compartment microbicide is 2-fold larger than vaginal microbicide in populations with 10% anal intercourse if RRRAI = 10- and ~6-fold larger than rectal microbicide, in populations with 5% anal intercourse if RRRAI = 4.

Conclusions:
Both rectal microbicide and bi-compartmental microbicide are necessary prevention tools for heterosexual populations engaging, relatively frequently (~10% of sex acts), in anal 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.]

New Report: World’s Premier AIDS Event Neglects Populations Most at Risk for HIV

 via Global Forum on MSM and HIV

Independent assessment indicates severe underrepresentation of gay men, transgender people, sex workers and people who use drugs at the biennial International AIDS Conference

A new report indicates that the International AIDS Conference (IAC), a biennial event convened by the International AIDS Society (IAS) that has become the world’s premier gathering for people working in the field of HIV, suffers from gross underrepresentation of populations most at risk for HIV infection, including men who have sex with men (MSM), transgender people, sex workers and people who use drugs.  The independent audit, conducted by the Global Forum on MSM & HIV (MSMGF), confirms suspicions long-held by activist groups and calls for a comprehensive review of IAC governing structures.

Produced in response to growing concern among community groups that the IAC has repeatedly neglected these key populations, the report focuses on program content at the most recent IAC, held in Vienna, Austria in July 2010.  The analysis reveals that the percentage of all sessions at the conference exclusively focused on these groups was limited to 2.6% for MSM, 1.1% for transgender people, 3% for sex workers and 4.5% for people who use drugs.

“While the International AIDS Society turns a blind eye, HIV rates among these populations continue to climb around the world,” said Dr. George Ayala, Executive Officer of the MSMGF.  “The IAC is the world’s most important opportunity for international exchange and collaboration on HIV and AIDS.  Such abysmal representation of most-at-risk groups only serves to reinforce the invisibility, discrimination and disregard that drive the epidemic among these communities.”

Research has shown that these four populations are at higher risk for HIV infection than the general population in nearly every country context where reliable data exist.  MSM represent more than a quarter of HIV infections in Latin America and the Caribbean, people who inject drugs account for more than half of HIV infections in Eastern Europe,  and sex workers across Sub-Saharan Africa experience HIV prevalence rates of up to 50%.  Infection rates among transgender people in El Salvador, Indonesia and India are as high as 25%, 35%, and 42% respectively. 

The IAC takes place in a different city every two years, gathering tens of thousands of experts and advocates from around the world to share the field’s most recent developments and engage in strategic collaboration.  The most recent conference hosted an estimated 25,000 people.

“Ostensibly, the IAC offers chances for local healthcare providers to learn ways to improve their services, provides channels for advocates to engage in dialogue with powerful decision-makers, and creates opportunities for community members to shape global funding and research agendas,” said Dr. Mohan Sundararaj, Policy Associate at the MSMGF.  “This really is a phenomenal platform, but how useful can it be when those who need it most are locked out?”

The report recommends a number of steps to bring the IAC’s program coverage of these key populations up to a level proportionate to their epidemiological burden.  Among these recommendations are efforts to ensure transparent processes for abstract review and program design, the development of targeted support to authors developing abstracts focused on key populations, and open representation of civil society on the committees responsible for developing conference programs.

“The International AIDS Conference has unparalleled potential to impact the global AIDS epidemic,” said Dr. Ayala.  “It is incumbent upon the organizers to ensure that the IAC becomes a vehicle for change, shifting the global landscape so that funding, research and programs are directed to those who need them most.  Right now it’s part of the problem.”

[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.]

Forecasters agree PrEP/microbicides could cut HIV infections in South Africa

via Aidsmap, by Gus Cairns

Several presentations at the Eighteenth Conference on Retroviruses and Opportunistic Infections this week used mathematical modelling to forecast the impact of adopting oral pre-exposure prophlyaxis (PrEP) or a topical microbicide in a high-prevalence country, added to HIV treatment or on its own. Three used South Africa as a model, while one analysed how PrEP might affect a serodiscordant couple.

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.]

Giving HIV a Poor Reception: New AIDS Treatment Tinkers with Immune Cell Genes

via Scientific American, by Bob Roehr

Researchers have found new ways to interfere with a co-receptor important to HIV infection, and the outcomes so far are encouraging.

A novel treatment for HIV could involve changing the genes in a person's immune cells and, ultimately, in his or her stem cells, as well. It might even lead to a cure for that deadly disease. Promising advances in that direction were presented here Monday at the 18th Conference on Retroviruses and Opportunistic Infections.



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.]

Q and A: Moving PrEP from Promising Trial Result to Practical, Public Health Prevention Intervention?

by Julie Davids, AIDS Foundation of Chicago, HIV Prevention Justice Alliance and IRMA member

As noted in these pages and press reports worldwide, the iPrex trial found that daily use of truvada protected gay men, other MSM and trangender women from HIV infection.

Updated data presented at this week's Conference on Retroviruses and Opportunistic Infections (CROI) showed the trial results held true through 144 weeks - nearly three years - and that the key challenge seems to be adherence. Those who took the drug most or all of the time (about 1/2 of the people in the study) had high rates of protection - over 90%. But because the other half took little or no drug at all (as confirmed by blood tests), the overal efficacy rate among trial participants was 44%.

After a long day at the conference, an eager crew of conference-goers - including researchers, people with HIV, White House officials and press - joined local community members here in Boston on Tuesday night in the auditorium of Fenway Community Health for ARV-Based Prevention: A Community & Research Forum on Recent Results and What Happens Next, sponsored by AVAC and Fenway.

At the end of the formal presentations, I asked the panelists (on behalf of the HIV Prevention Justice Alliance)

"What are one to three next steps that are vital to making PrEP [pre-exposure prophylaxis] effective at the community or public health level, rather than just a boutique intervention for a few individuals?"

I captured the responses, which cover a wide range of issues and strategies, and wanted to share them with you. Panelists, in order of response, were:

- Morenike Ukpong, New HIV Vaccines and Microbicide Advocacy Society, Nigeria
- Kevin Cranston, Massachusetts Bureau of Infectious Disease
- Cate Hankins, UNAIDS
- Salim Abdool Karim, CAPRISA
- Jared Baeten, University of Washington and Partners PrEP
- Robert Grant, Gladstone Institute of Virology and Immunology
- Jim Rooney, Gilead Sciences
- Mark Hubbard, Tennessee Association of People With AIDS



Q and A: Moving PrEP from Promising Trial Result to Practical, Public Health Prevention Intervention? from HIV Prevention Justice Alliance on Vimeo.

High-Impact Prevention: New Approach to the Science and Practice of HIV Prevention in the United States?

by Julie Davids, AIDS Foundation of Chicago, HIV Prevention Justice Alliance and IRMA member

This week at the Conference on Retroviruses and Opportunistic Infections (CROI) in Boston, researchers and clinicians from around the world met to share and discuss HIV research.

The opening plenary on Monday was delivered by Jonathan Mermin, Director of the Division of HIV/AIDS (pictured). Titled The Science and Practice of HIV Prevention in the US, the 30 minute presentation outlined Mermin's vision of a new approach called high-impact prevention (HIP). I caught up with Mermin the following day, and asked him to talk about his speech, explaining what HIP is all about.

If this quick video grabs your interest, you can view Mermin's full presentations and slides right here - and you can look around that conference site for more webcasts of important sessions. I'll be blogging about other conference matters of interest to HIV prevention justice advocates in the coming days, including some thoughts on high-impact prevention, pre-exposure prophylaxis, racial disparities in infection, and other matters...



[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.]

Pittsburgh's Dynamic Rectal Duo

IRMA Scientific Vice Chair Ian McGowan and his research/life partner, Ross Cranston (also a member of the IRMA Steering Committee) are featured in CUE Pittsburgh this month. They talk about our favorite topic - rectal microbicides - and a trial taking place right in Pittsburgh that gay men can get involved in.

The article, below, starts on Page 17. Use the arrows on both sides of the magazine to "flip" pages forward and back.

[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.]