Treatment and Prevention: Interview w/Uganda's Dr. Patrick Ndase

via The Observer, by Shifa Mwesigye

Excerpt:

"Uganda has participated just like several other African countries; [in research] you must go where infection is happening. The majority of HIV research in the early stages happened in Uganda because Uganda was heavily infested with the virus. As you remember we had prevalence rates of above 20% and then we had the so called Uganda success story after the zero grazing campaign.

"At the time, the countries in southern Africa which largely [depend on] tourism were silent on HIV infection. Now the countries that are laden with infection are Swaziland, Botswana, Zimbabwe, Zambia and South Africa. So majority of HIV prevention research is not happening in Uganda anymore. In fact it is difficult to get someone who wants to do HIV research to come to Uganda."

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.]

When addressing the challenge of changing behavior, it's "easy to blame the victim"

via Huffington Post, by Simon McCormack

When addressing the challenge of changing behavior, Marjorie Hill says it's easy to blame the victim.

"There's always a tendency to look at the person and say, 'why don't you just stop smoking or eating red meat or start exercising?'" The Gay Men's Health Crisis CEO and HuffPost blogger says.

But when it comes to dealing with HIV and AIDS, Hill says, it's more complicated.

"We think that personal responsibility is important and we certainly encourage it," she said. "But when you look at the numbers and understand the epidemiology, the most common factor that those 33 million people who have the disease share is poverty. Poverty doesn't transmit HIV, but certainly being in a situation where someone has less access to information, resources, education and power -- those are factors that influence HIV."

That's what GMHC, the world’s first provider of HIV and AIDS prevention, care and advocacy, works to change, Hill 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.]

IRMA's next teleconference: Yes, Africa Needs Rectal Microbicides - 9/27

Yes, Africa Needs Rectal Microbicides
Tuesday, September 27, 2011, 10:00 EDT

(click here to determine the time in your area)

Please join IRMA and AVAC with our special guest Dr. Salim Abdool Karim (Slim.)

Slim is a clinical infectious diseases epidemiologist whose main current research interests are in microbicides and vaccines to prevent HIV infection and implementing antiretroviral therapy in resource constrained settings. He is Pro Vice- Chancellor (Research) at the University of KwaZulu-Natal in Durban, South Africa and is also Professor of Clinical Epidemiology at the Mailman School of Public Health at Columbia University and Adjunct Professor of Medicine at the Weill Medical College of Cornell University. He is Director of CAPRISA - Centre for the AIDS Programme of Research in South Africa.

Slim did a fantastic presentation at the Microbicides 2010 called "Does Africa Need a Rectal Microbicide" and the data he shared revealed the answer to be a resounding "YES!" He will be doing an updated version of this presentation on our call.

Additionally, IRMA's Jim Pickett will discuss Project ARM - Africa for Rectal Microbicides. Project ARM is hosting a 2-day strategy meeting at the ICASA 2011 conference in Ethiopia this December. The 40 invited participants and speakers will be working on crafting an African-specific agenda for rectal microbicide advocacy and research that ensures Africa remains on the rectal microbicide map, and that all Africans who need rectal microbicides have access to them when they become available.

Click here to RSVP. Check back here in advance of the call for presentation slides. An audio recording of the call will be made available shortly after its completion.


[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 Experts Create the Roadmap for Providing PrEP to Uninfected Individuals to Reduce the Risk of HIV Infection

Press release via Forum for Collaborative HIV Research

To stem the estimated 2.6 million new HIV infections that occur worldwide each year, more than 200 representatives from the scientific and HIV/AIDS communities took an important step in assessing the safety and public health implications of providing antiretroviral drugs to uninfected men and women exposed to HIV through sexual contact – a strategy called pre-exposure prophylaxis, or PrEP.

Assembling August 19 at an open public meeting and interactive webcast convened by the Forum for Collaborative HIV Research, these researchers, HIV/AIDS advocates, members of industry and representatives from National Institutes of Health, the Centers for Disease Control and Prevention (CDC), Food and Drug Administration (FDA) and state public health departments applied the findings from a number of large trials to discuss a roadmap for FDA and CDC to develop guidance on the safe use of PrEP in otherwise healthy individuals at high risk of acquiring HIV. Held with the encouragement of FDA, this meeting has important implications for medical practice in the U.S. because recent data strongly support the efficacy of antiretroviral intervention for this purpose.

Although FDA has not yet approved PrEP to reduce HIV acquisition in uninfected individuals, one form of PrEP recently studied for use in healthy men or in couples where one partner is HIV positive –a daily pill containing tenofovir plus emtricitabine (TDF/FTC) – is FDA-approved for the treatment of HIV infection. In women, studies have also demonstrated the efficacy of prophylactic treatment with tenofovir applied as a vaginal gel.

“We now have findings from large studies that support a conclusion that PrEP is effective in gay and bisexual men, who represent more than half of new HIV infections in the U.S., and now, there is evidence that PrEP may reduce HIV infection in heterosexual men and women, the population hardest hit by HIV worldwide,” said Jur Strobos, MD, Deputy Director of the Forum. “We must however, apply these promising data to develop workable strategies that mitigate risk that may be associated with the prophylactic use of antiretrovirals. These include both medical and socio-behavioral risk. We must ensure that people at greatest risk for acquiring HIV receive a comprehensive package of prevention services, including regular HIV testing, condom provision, risk reduction counseling and management of other sexually transmitted infections. The purpose of our meeting was to help identify what the components of a complete package should be.”

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.]

HPV Vaccine Protects Women Against Anal Infection

via Medpage Today

A vaccine against human papillomavirus (HPV) protects women against two strains of the virus that causes anal cancer, researchers reported.

The vaccine (Cervarix) against HPV strains 16 and 18 offered "strong protection" against anal infection in a study whose main goal was to assess the efficacy of vaccination against cervical infection and pre-cancerous lesions, according to Aimée Kreimer, PhD, of the National Cancer Institute, and colleagues.

The protection was higher in women who did not have HPV infection when they were first given the vaccine, Kreimer and colleagues reported online in The Lancet Oncology.

Anal cancer is rare in women, with an annual incidence of about 1.5 per 100,000, but rates are rising, the researchers noted. The rate is higher than for men in general, but markedly lower than for men who have sex with men or those with HIV.

Most anal cancers are caused by HPV, with strains 16 and 18 responsible for up to 80% of cases, Kreimer and colleagues noted.

They tested the vaccine against anal infection in a subgroup of young adult women, ages 18 through 25, who enrolled in a community-based randomized trial of cervical vaccine efficacy in Costa Rica.

The 6,352 participants who came for the final blinded study visit, four years after their first of three vaccine shots, were asked to give an anal sample, and 4,210 did so, with a median follow-up of 48.1 months.

The researchers analyzed anal infection in the whole cohort and also in a subgroup of women who had been negative for HPV DNA and antibodies at the start of the trial. Patient characteristics in both groups were well-balanced, the researchers reported, including the proportions who got the vaccine and those who were in the control group, given hepatitis A vaccine.

Kreimer and colleagues found...

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.]

You are Invited - IRMA Teleconference - Lube Access - A Global Challenge

Lube Access - A Global Challenge
Monday, August 29, 2011, 1200 EDT
(click here to determine the time in your area)

Please join IRMA, AVAC and partners from PSI, Johns Hopkins, and the Global Forum on MSM and HIV as we discuss lube access in the global context - highlighting the needs, gaps, and challenges, as well as efforts underway to address them.

Click here to RSVP. Check back here in advance of the call for presentation slides. An audio recording of the call will be made available shortly after its completion.

The call's proposed agenda is as follows:

• Welcome and introduction
• Stefan Baral (Johns Hopkins): Lube access in Africa among MSM
• Beth Skorochod (PSI): PSI's work as a distributor of SRHR commodities, specifically lube distribution in developing countries
• Pato Hebert (MSMGF): Lube-related information from the 2010 MSMGF global survey on HIV prevention and social norms
• Jim Pickett (IRMA): The importance of addressing lube access now to prepare for eventual rectal microbicide access
• Q&A, Discussion

Click here to RSVP.

[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.]

My Summer with IRMA

By Aldona Martinka, IRMA Intern

Today is my last day at the AIDS Foundation of Chicago, where I had the pleasure of interning this summer. I am one of the last summer interns remaining, and the empty intern “sweatshop” surrounds me. I had the opportunity to work with AFC and IRMA, as well as with Mapping Pathways and Project CRYSP for the summer at this desk, facing a window with blinds that are always closed. The closed blinds never bothered me, though, because whenever I was at my desk my eyes were fixed on my computer screen. I know that statement does little to separate me from the rest of my generation, but there is a good reason that I did not often look away from my work: I was fascinated.

I joke with my friends that I read about sex all day for work, but it’s true. In my work with HIV, and especially in my work with IRMA, I am constantly exposed to sex. My days are spent absorbing information about it: clinical studies showing the effectiveness of antiretroviral-based prevention methods, laws that criminalize and stigmatize high-risk groups, public health efforts in deeply-affected areas, or even sexual advice for HIV-positive people looking for love in modern America. Not only that, but for IRMA much of my reading was about the sexual act that is perhaps the most taboo, anal sex, because of the high risk of transmission and the sociocultural issues surrounding it. For a shy girl from a Catholic family this was a lot to take in. I quickly adjusted, though, and as my internship comes to a close I can discuss lubricant distribution in the rectum with a straight face and a confident smile. Though initially kind of shocking, I learned so much in these past several months, and what I learned has crystallized so much for me.

I learned that there are more HIV prevention tools even than there were 4 years ago when I took sex ed in high school. Rectal and vaginal microbicides, PrEP, and treatment as prevention represent real methods of preventing HIV that should be added to condoms as tools in the global prevention toolbox. Not only are they effective enough to warrant more exploration and consideration, but they provide protection in the wide variety of cases where condoms are a less desirable option, or not an option at all. With these prevention methods sex workers, wives in patriarchal societies, members of sero-discordant couples, and many other at-risk people can be protected that may not want to or be able to use condoms for a variety of reasons.

I learned just how inextricably HIV/AIDS is linked to my other passion: human rights. I learned about how government and cultural views toward sex workers, women, and LGBT people affects everything from the availability of condoms to the accessibility of treatment, and can create many difficulties in between. I also learned about the criminalization and stigmatization of HIV-positive individuals, something which surprised and horrified me, and how the continuation of these only obstructs public health efforts.

I learned so much, but I learned one last thing of personal significance to me. I was chattering excitedly at my father about the internship portion of my upcoming semester abroad in India, and how I hoped to work with an organization there that fights HIV. He asked if I wanted to look at other internships as well, to broaden my areas of knowledge in public health. While answering that question, I realized that everything I’ve learned in this internship, all of the related issues and exciting science, had led me to this seemingly unexceptional question. “No,” I said, “I want to continue to work with HIV.” Everything about it, the human right issues, the new advances in prevention and treatment, and my personal experiences with advocacy work, have captured my attention and drawn me to the fight against AIDS. I hope to continue in the field of HIV prevention and advocacy, and my time at the AIDS Foundation of Chicago with IRMA has provided me with invaluable experience. Thank you to all of the IRMA community for allowing me this opportunity. With a bit of luck and a lot of hard work, hopefully someday no one will have to go without a way to prevent HIV, for any reason.

[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.]

‘Confront legal and policy barriers to HIV’: Sub-Saharan Africa Regional Dialogue on HIV and the Law

Via UNAIDS.

In Sub-Saharan Africa, the region most heavily affected by HIV, legal, policy and social barriers, including stigma, discrimination, gender inequality and the criminalization of key populations at higher risk of HIV infection, continue to make people vulnerable to HIV and hamper the ability of individuals, communities and states to respond to the epidemic. This was the conclusion of the Regional Dialogue for sub-Saharan Africa, part of the Global Commission on HIV and the Law, held at the beginning of August in Pretoria, South Africa.

No taboo should be left unchallenged

A significant breakthrough came from the pledge of participants to highlight and discuss all aspects of the legal environment relating to HIV, including laws and practices related to stigma and discrimination, access to affordable treatment, children and adolescents, women’s rights and gender-based violence.

“This regional dialogue is a great opportunity for us, as Africans, to confront the difficult issues including discriminatory and punitive laws that target sex workers and men who have sex with men, and other populations vulnerable to HIV,” said Bience Gawanas, African Union Commissioner for Social Affairs.

The criminalization of drug use, sex work and same-sex sexual relations was also confronted by the participants in a bid to challenge all taboos. This is remarkable as recent punitive legal and policy developments in a number of countries in sub-Saharan Africa relating to the situation of members of key populations has raised concerns about the readiness of stakeholders in the region to confront this issue. Some 31 countries in the region criminalize sex work, and same-sex sexual relations constitute a criminal offence in at least 30 countries.

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.]

IRMA and AIDS Leaders Press Feds for Action on Promising New Prevention Tool

Just months after an AIDS drug demonstrated reasonable efficacy in preventing HIV infection in controlled clinical trials, seven leading AIDS organizations are urging the U.S. government to act quickly to determine if the results could translate to the real world.   Today, at an HIV prevention meeting hosted by the U.S. Centers for Disease Control and Prevention (CDC), the coalition of AIDS advocates called on officials from the U.S. Department of Health and Human Services (HHS) to address the shortage of funding and coordination around a new prevention approach known as pre-exposure prophylaxis (PrEP).

“HIV estimates released by the CDC two weeks ago—showing that new HIV infections have risen nearly 50 percent in young black gay men since 2006—make it clear that the status quo is failing to keep the epidemic in check,” said David Evans, director of research advocacy at Project Inform. “PrEP could be one of the more promising new options we have to offer young HIV-negative gay men at the highest risk of infection in the U.S., but until we expand PrEP programs in real-world settings we won’t be able to translate the trial results into public health impact.”

PrEP involves HIV-negative people taking antiretroviral medication before exposure to the virus to prevent infection.  Three clinical trials have demonstrated that when used consistently, PrEP is both safe and effective at preventing HIV infection, but it’s unknown if and how results apply outside of clinical trials.  Activists are urging the U.S. government to move quickly to fund and coordinate demonstration projects to evaluate PrEP in the real word and determine the best ways to use it.

“We are at a pivotal moment in HIV prevention, and what happens next hinges on a swift, coordinated effort to understand how PrEP can be used effectively by people at highest risk for infection,” said Dr. Judy Auerbach, vice president of research and evaluation at San Francisco AIDS Foundation.  “If we do too little, or the demonstration projects aren’t properly designed, there’s a real danger that we could lose the promise of one of the most important scientific breakthroughs in HIV prevention.”

Two PrEP demonstration projects are near launch, and others are under discussion, but funding remains uncertain and participating medical providers and institutions are not being coordinated. The groups issuing the call to action request that HHS respond rapidly to ensure that coordination takes place and that the projects with the highest likelihood of answering key research questions are fully funded.  These questions include the feasibility, desirability, uptake, and effectiveness of PrEP in different settings, among others.

“We cannot be content with budget constraints and calls to do more with less,” said Mitchell Warren, AVAC executive director. “Science has given us new ways to potentially significantly blunt the epidemic in the U.S. and around the world. We have an obligation to push to find the best ways to use antiretroviral drugs as prevention – both for HIV-positive people to reduce their risk of passing on HIV to others and for HIV-negative people to protect themselves. The U.S. government and other funders must move quickly to ensure the availability of resources for the essential next steps for PrEP, including demonstration projects and continued research.”

The call to action was issued by Project Inform, along with the AIDS Foundation of Chicago, AIDS United, amfAR: the Foundation for AIDS Research, AVAC: Global Advocacy for HIV Prevention, the Black AIDS Institute, the International Rectal Microbicide Advocates, National Alliance of State & Territorial AIDS Directors, the National Minority AIDS Council and the San Francisco AIDS Foundation.  It’s accompanied by a report called “PrEP: Roadmap to the Real World,” in which advocates detail key questions to be answered in demonstration projects.



[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-prevention strategy carries risks

Via Nature News, by Erika Check Hayden.

When the US Food and Drug Administration approved Viagra in 1998, officials never considered one possible side effect of the drug: higher rates of sexually transmitted diseases among men who, thanks to Viagra, would become more sexually active. A powerful tool in the fight against HIV is raising similar questions about the possibility of unintended public-health consequences if drugs are approved for use in healthy people and cause them to alter their behaviour.

Several studies in the past year have reported that the very drugs used to treat people with HIV can also stop healthy people from becoming infected (see table). But people taking the drugs may adopt riskier behaviours because they feel protected — a phenomenon known as 'risk disinhibition' — undermining the benefit of the drugs and potentially infecting others. Moreover, those who become infected while taking the preventive regimen might develop drug-resistant viruses that they could then transmit to others. "You have this wonderful scientific breakthrough," says Kevin Frost, chief executive of the Foundation for AIDS Research in New York City. "But what are the practical implications?"

Researchers will mull over these issues on 19 August at a meeting convened by the Forum for Collaborative HIV Research in Washington DC. The questions have become more urgent since January, when the drug firm Gilead of Foster City, California, announced that it plans this year to ask the Food and Drug Administration (FDA) to approve its HIV drug Truvada for use in healthy people — in what is known as pre-exposure prophylaxis, or PrEP. Truvada, which contains the antiretroviral drugs tenofovir and emtricitabine, has been used in many of the PrEP trials. In the three clinical trials that have reported benefits for PrEP so far, once-a-day pills have cut a person's risk of acquiring HIV by between 44% and 73%, a variation that is due primarily to differences in how strictly patients stuck to the daily regimen. Although the need for PrEP is greatest in poor countries, approval in the United States could greatly expand the market for Truvada, which generated US$2.65 billion in sales last year.

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.]

Early ARV Treatment Will Save Lives in South Africa

Via All Africa.

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

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

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

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

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

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

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

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

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

Read the rest here.

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

SWAZILAND: HIV prevalence among factory workers "50 percent"

Via PlusNews.

A new government study has found that more than half of workers in Swaziland’s garment industry are living with HIV, and officials are realizing that the once-hailed promise of manufacturing employment has become a financial and medical nightmare for tens of thousands of Swazi women.

“HIV prevalence among factory workers is 50.3 percent,” said Nhlanhla Nhlabatsi, an epidemiologist with the Ministry of Health. Nhlabatsi presented the data last week as preliminary findings for Swaziland’s first Behaviour Sentinel Surveillance Report to be released in its entirety later in the year.

About 30,000 Swazis, mostly women, are employed in garment factories financed by Taiwanese investors and operated by managers from mainland China.

The survey also found that most factory workers were well informed about HIV/AIDS, and 90 percent of workers interviewed were aware of the female condom and other methods of preventing HIV.

Government officials will now begin investigating the gap between knowledge of HIV/AIDS prevention and workers’ susceptibility to HIV. The prevalence rate for textile industry employees is significantly higher than the 26 percent rate among sexually active adult Swazis.

“Women comprise the largest number of workers at the garment industry plants. They work long hours at wages so low some of them are known to turn to prostitution to support themselves and their families,” said Alicia Simelane, an HIV testing and counselling officer at the Matsapha Industrial Estate, where Swaziland’s industry is concentrated outside the commercial hub of Manzini.

The link between “sweatshop” wages and the risk of HIV has been known for years, but the statistical impact of the risk is only becoming apparent now.

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.]

Criminalizing HIV Transmission Will Only Spread the Problem

Via the Vancouver Sun, by Peter McKnight.

It sounds like the synopsis of a B-movie: Thanks to the long arm of the law, the world is once again safe from The Attack of the Killer HIV-people.

Safe from Johnson Aziga, the Ontario man who had sex with more than a dozen women without informing them of his HIV-positive status. Several of the women contracted HIV, including two who subsequently died, which led to Aziga being declared a dangerous offender and handed an indeterminate sentence earlier this week.

And safe from the 17-year-old Edmonton girl who was charged this week with two counts of aggravated sexual assault after allegedly having sex with two men without informing them of her HIV-positive status. The girl had been the subject of an urgent police bulletin, which led to the worldwide publication of her name, picture and health status. Aside from painting a rather ghoulish picture of people living with HIV, such unusual cases inevitably send the message that the best way to handle HIV-non-disclosure is through the criminal law.

Police forces across the country seem to have got the message, given the increase in the number and severity of charges laid for HIV-non-disclosure in recent years. Well over 100 HIV-positive people across Canada - and at least 14 in B.C. - have now been charged with offences ranging from assault to first-degree murder.

Courts, too, have been enthusiastic in prosecuting cases of non-disclosure, with defendants receiving everything from suspended sentences to, in Aziga's case, an indeterminate and potentially lifelong sentence of imprisonment.

This enthusiasm for criminal prosecution exists despite - or perhaps because of - uncertainty about the disclosure obligations of HIV-positive people. The Supreme Court of Canada has held that individuals are under a legal duty to reveal their HIV-positive status before engaging in sex that poses a "significant risk" of HIV transmission, but what constitutes a significant risk remains unclear.

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 Maheswar Satpathy - A Friendly Rectal Microbicide Advocate

"IRMA develops means and strategies for organizing advocates on this area of research and practice by pooling in people from all paths of life, and does offer a very sound platform for sharing views, opinions, and informing key stakeholders in the prevention-focused research and practice." - Maheswar Satpathy, Sydney, Australia

Maheswar Satpathy is originally from Bhubaneswar, Orissa in India. He now lives in Sydney, Australia. He is a trained clinical neuropsychologist, but his interests are broad, including HIV/AIDS prevention and health promotion. At present he is working towards his PhD in Health, Sexuality & Culture at the National Centre in HIV Social Research at the University of New South Wales (UNSW) on a prestigious AusAID's Australian Leadership Awards Scholarship. He is extremely involved in public health, devoting his time to national and international organizations across the globe.

Maheswar was introduced to IRMA by colleague and friend Jim Pickett. He was encouraged to advocate for more innovative bio-medical prevention strategies along with the psycho-social ones he has researched. He believes that rectal microbicides should be emphasized as an important method of prevention which can act as a catalyst in preventing diseases like HIV, and several other health risks like HPV and other sexually transmitted infections.

He is excited to act as an advocate for rectal microbicides and to teach the usage patterns, newer emerging technologies in developing but emerging countries like India, which has the 2nd highest population in the world. He plans to work on health planning programs for effective dissemination, contact key groups for outreach, and lobby for translational bio-medical research in the Indian research centers and universities.

A busy man, whatever free time Maheswar has is spent in reading more books of psychology and literature, advocating for human rights and health issues among the LGBTQI population, and networking among the Civil Society Organizations both in India and Australia.

Read about other friendly rectal microbicides advocates. Newly featured advocates include Daniel Nuñez, Amy Stapleford Jackson, Luis Fernando Galarza, Vanessa Marquez, and Mark Hubbard.

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.]

New Report Shows Major AIDS Funders Fail to Track Investments for Gay Men and Transgender People

Via MSMGF.

A new report indicates that most major bilateral, multilateral and private philanthropic funders that focus on HIV do not consistently track their investments targeting men who have sex with men (MSM) and transgender people. Produced by the Global Forum on MSM & HIV (MSMGF), the report also examines tracking of domestic government funding dedicated to these populations in all UN Member States, revealing that only 25% these countries recorded levels of HIV prevention spending for MSM in 2010 and no country tracked spending for transgender people.

“With overwhelming evidence for the need to prioritize MSM and transgender people in the global fight against AIDS, it is shocking that so few funders actually know how much money they are spending on these populations,” said Dr. George Ayala, Executive Officer of the MSMGF. “Funders often talk about the importance of investing in key affected populations, but budgets offer a clear reflection of what their priorities actually are. HIV investments must be accounted for in order to ensure that MSM and transgender people are getting the support they need.”

In the few countries that did track HIV prevention spending for MSM, the report indicates expenditures fell far below the amount required to achieve universal access. According to country reports made to the United Nations in 2010, an average of 2% of national HIV prevention budgets was dedicated to MSM in the 42 low- and middle-income countries that tracked spending for this population – $15.8 million in total. Nearly 75% of that sum came exclusively from international sources, highlighting the role of bilateral, multilateral and large private philanthropic funding in service provision for MSM in low- and middle-income countries.

The report follows a number of recent publications arguing in favor of targeted investments for most-at-risk populations like MSM and transgender people. In June of this year, the World Bank issued a report demonstrating that increased access to HIV prevention and treatment for MSM can change the trajectory of a national epidemic. That same month, the Lancet published a new global HIV investment framework that emphasizes the importance of targeted investments for key affected populations.

“After 30 years of diffused investment, the world is realizing that a focused approach is the only one that will work,” said Dr. Ayala. “It is time for funders to reflect that in their budgets and track their investments by population. Donor agencies must communicate and coordinate to ensure adequate coverage without duplication, and we must all aim for a higher level of accountability to the people we serve.”

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 Daniel Julio Eduardo Nuñez - A Friendly Rectal Microbicide Advocate

"If we create a circle of people around you that at least know a word or two about rectal microbicides I believe the work is done, because everyone has his own circle, so the knowledge in one way or another will flow." - Daniel Julio Eduardo Nuñez, Lima, Peru

Daniel Nuñez is studying law. While working towards his law degree he began working at Epicentro with his local gay community. It is at Epicentro that Daniel met an IRMA member (Epicentro is the headquarters for IRMA-ALC, IRMA's South American sister) and, anxious to find out more about rectal microbicides, immediately sought more information. He was quickly inspired to spread the word about IRMA and its goals.

Daniel realizes that rectal microbicides are important "because we are humans and not robots, we don't necessarily act following a program and sometimes we do things that don't correspond to safe sexual behavior". Because of this he works to make many prevention options available to everyone.

He urges every IRMA advocate and anyone interested in microbicides or HIV prevention at all to discuss options and knowledge with family and friends. With each person able to talk openly and knowledgeably about AIDS and HIV prevention, Daniel hopes that the topic will become less taboo and more can be done in the fight against AIDS.

In his free time Daniel provides freelance tech support, but he enjoys it so it doesn't feel like work. He also enjoys watching TV programs from the United States such as A Game of Thrones, his current favorite show.

Read about other friendly rectal microbicides advocates. Newly featured advocates include Luis Fernando Galarza, Amy Stapleford Jackson, Maheswar Satpathy, Vanessa Marquez, and Mark Hubbard.

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.]

Gay Men: PrEP Acceptable and Unlikely to Change Risk Behaviour

Via AIDSMap, by Michael Carter.

Approximately 50% of gay men said they were likely to use pre-exposure prophylaxis (PrEP), but few reported that it would lead to a change in their risk behaviour, according to data presented to the International AIDS Society conference in Rome.

Nevertheless, the investigators were concerned that even minor increases in rates of unprotected anal sex could offset the benefits of pre-exposure prophylaxis.

The IPrEX study showed that PrEP significantly reduced the risk of infection with HIV for gay and bisexual men. Overall, men who took PrEP had their risk of HIV reduced by 44%. If adherence was high, the risk was reduced by 73%.

“PrEP offers much promise as the first biomedical intervention to have success in at-risk men who have sex with men,” comment the researchers.

They therefore undertook further analysis to see how likely the men who participated in the study were to use PrEP and if its availability would change their HIV risk behaviour.

They undertook a survey in December 2010, immediately following the release of the IPrEX results, using Facebook and Black Gay Chat to recruit participants. A total of 1155 gay and other men who have sex with men were recruited to the study.

Participants completed a questionnaire about their knowledge and willingness to use PrEP; perceptions of the risk of HIV infection from unprotected anal sex with or without PrEP; perceptions of sexual pleasure; and perception of likelihood to experience sexual pleasure with or without a condom and with or without PrEP.

The men had an average age of 33 years, 75% were white, and 51% reported unprotected anal sex at least once in the last twelve months.

Only a third of men had heard of PrEP before the release of the study results. Just under half of individuals reported that they were “very” or “extremely” likely to use PrEP.

Unprotected anal sex without a condom was widely considered to involve a high risk of HIV.

The availability of PrEP did not alter the perception of the risk associated with HIV in the majority of men, regardless of whether they were the insertive (75%) or receptive (60%) partner in anal sex.

Three-quarters of men stated that the 44% efficacy of PrEP in the IPrEX study would not affect their use of condoms. However, 7% reported that they would use condoms less frequently.

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 Amy Stapleford Jackson - A Friendly Rectal Microbicide Advocate

"IRMA has gathered together people who are doing great work in the fields of sexual health, scientific research, medicine, HIV prevention, and microbicide advocacy and by pooling these resources is making important strides advocating for safe, effective rectal microbicides." - Amy Stapleford Jackson, Chapel Hill, USA

Amy is a many-talented and busy advocate. Among several projects, she works with a scientist to develop novel formulations for user-friendly, safe sexual lubricants which could someday also deliver microbicides. She also serves as the Sexuality Education Coordinator at the Sinclair Institute.

Her current pet project is an informative venture: "the creation of a table of information about common lubricant ingredients…so that there's an easy resource from which folks can learn what scientists know and don't know about the ingredients in their lubes." She became interested in IRMA's work after she shared her lube findings with some rectal microbicide advocates, and was excited to be asked to join IRMA's Lubricant Safety Working Group and IRMA.

Amy feels IRMA's work is especially important because of the dialogue it encourages and nurtures between people of disparate fields with a common interest. "Microbicides are a natural extension of what people already do: use lubrication during sex," she says: "If a microbicide could be found which would be safe and non-toxic for the user and would also reduce transmission rates for HIV (and hopefully other STIs), people will have an amazing tool for reducing sexual risk while also increasing sexual health and pleasure."

In her advocacy work Amy hopes to spread her knowledge and enthusiasm with sexual health professionals and consumers, with the goal of making lubes safer, more pleasurable, and someday a vessel for microbicides.

Much of Amy's free time is spent invested in her projects, but when she isn't working Amy enjoys Sudoku, audio books, and savoring good food and wine.

Read about other friendly rectal microbicides advocates. Newly featured advocates include Daniel Nuñez, Luis Fernando Galarza, Maheswar Satpathy, Vanessa Marquez, and Mark Hubbard.

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.]

How do you douche?

TOOT TOOT HEY BEEP BEEP!

IRMA has teamed up with UCLA on another survey - this one on the very exciting and super relevant topic of rectal douching and enemas.

The survey is now available in English.

IRMA and researchers at the University of California, Los Angeles (UCLA) School of Public Health are conducting a brief survey to help us better understand the types of products people use rectally for anal sex including lubricants and enemas or douches.

We are trying to gain a better understanding of rectal practices and behaviors that may affect the risk for sexually transmitted infections among people who practice anal intercourse. We hope you will fill out this brief anonymous survey (estimated time to complete: less than 15 minutes).

Spanish, French, Portuguese, Chinese and Russian versions of the survey are in the works now. Watch this space - we will let you know when they are ready.

In the meantime, please take the survey in English if appropriate, and share this link widely. Thanks!





[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.]

Petition for informed debate about PrEP. HIV+ gay and bi men, please SIGN BELOW!

The release of data from the iPrEx study of pre-exposure prophylaxis (PrEP) for HIV prevention in gay and bisexual men and transgender women has led to a good deal of debate about whether and how PrEP should be used.

Unfortunately, some of that debate has been fueled by misrepresentations of the study data and, perhaps more alarmingly, by groundless assertions that gay/bi men and other men who have sex with men (MSM) will misuse PrEP, spread drug resistance and act without regard to their health or the health of others if PrEP is made available. A paid ad campaign by the AIDS Healthcare Foundation running in gay papers across the country has contributed to spreading false ideas both about PrEP and about the commitment of gay/bi men to care for themselves and others. We reject those false assertions and want a full and factual discussion of the pros and cons of PrEP in our community.

Recently, two additional studies, Partners PrEP and the CDC's TDF2 study have confirmed the safety and efficacy of PrEP, this time in heterosexual women and men.

A small group of HIV positive gay/bi men who are committed to promoting safer sex and the open exchange of accurate information are circulating the following letter to help clarify the facts about PrEP, open up community discussion and make clear our belief that we are entitled to respect, accurate information and new HIV prevention tools.

This sign on letter is part of a broad array of advocacy activities being undertaken by the national PrEP Committee. Members of the PrEP Committee include individuals from a host of organizations working on PrEP and other new prevention technologies who meet regularly by phone and email to share information and strategize.

For allies who are not HIV+ gay/bi men, you can learn more about this work and how to participateby sending an email to Jim Pickett at jpickett@aidschicago.org.

We encourage HIV+ gay/bi men who are allied in the fight against AIDS to help us clear the record about PrEP by signing on to this letter.

Read the letter and add your support 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 Vanessa Marquez - A Friendly Rectal Microbicide Advocate

"Thank the universe for organizations such as IRMA and individuals who are willing to inform and educate the population at large about the heavily stigmatized topic of anal sex. Without their efforts the possibility of rectal microbicides being readily accepted as a prevention method may not be possible. We must continue to lay the foundation for such important work that could save the lives of millions." - Vanessa Marquez, Boston, USA

Vanessa Marquez, a Clinical Research Nurse at The Fenway Institute in Boston is a proud advocate for rectal microbicides among many other HIV prevention methods. She was born in New York to parents who emigrated from Latin America and was raised in New Orleans, Louisiana.

Vanessa became interested in HIV prevention after volunteering as a massage therapist at an HIV alternative therapies clinic in San Francisco, CA. She got involved with IRMA through her work with the Microbicide Trials Network. She feels very fortunate to have found her dream job immediately after graduating nursing school, and is excited about the possibilities of continuing to advocate for important prevention methods like rectal microbicides.

She believes that rectal microbicides provide a very important other option for HIV prevention. Her work on the iPrEx study has led her to understand that "the more options individuals have, the more likely it is that they will use these prevention technologies".

In her advocacy work she meets with clients each week for microbicide study visits, presents information on anal sex through a skit of her creation called "The Shameless Plug." Vanessa feels that the destigmatization of anal sex and health will lead to more conversations with medical providers, which will hopefully lead to more options like rectal microbicides.

Vanessa, who speaks fluent Spanish, enjoys reading, attending classical music concerts, learning new languages, volunteering in community events, traveling, and being with her family in her free time.

Read about other friendly rectal microbicides advocates. Newly featured advocates include Daniel Nuñez, Amy Stapleford Jackson, Maheswar Satpathy, Luis Fernando Galarza, and Mark Hubbard.

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.]

Project ARM: John Shaw Memorial Scholarship Call for Application

Project ARM—Africa for Rectal Microbicides—is a long-term, sustained project which aims to develop community capacity around rectal microbicide advocacy in order to ensure broad participation in research activities and well-informed community input into the development of an African rectal microbicide agenda. The end goal is enhanced rectal microbicide advocacy in Africa as well as the planning and implementation of rectal microbicide trials on the continent. Project ARM is coordinated by International Rectal Microbicide Advocates (IRMA). First year funding for Project ARM has been secured from the United States National Institutes of Health – Office of AIDS Research and the New Venture Fund. AVAC is also partnering with IRMA on this initiative.

Project ARM evolved from discussions initiated by IRMA through its listserv, and from input received from African advocates and partners at two informal meetings held in conjunction with the Microbicides 2010 (Pittsburgh) and AIDS 2010 (Vienna) conferences. A working group was formed following the Microbicides 2010 meeting, and has guided this process ever since. There are now 60 working group members including advocates and community members, researchers, funders and policy-makers from 10 African countries, as well as a few key international partners.

In order to develop an African rectal microbicide agenda that articulates research, advocacy and community mobilisation strategies, IRMA is hosting a working meeting on 2-3 December 2011 in Addis Ababa as part of Project ARM. This invite-only meeting is taking place prior to the 16th International Conference on AIDS and STIs in Africa (ICASA, December 4–8), and is considered an official satellite session.

PLEASE NOTE: This is a working meeting—not a workshop, nor a conference.

The objectives of the December working meeting are:

• To promote a common understanding of how rectal microbicide (RM) research and advocacy is proceeding, the potential role that African RM research and advocacy could play, and the various African contexts within which RMs would be introduced.
• To enhance the capacity of African community advocates to participate in RM agenda-setting, research and mobilisation efforts.
• To stimulate strategies for African community mobilization around RMs; to put RMs on the research agenda in Africa; and, to develop an African RM research agenda that is part of a global RM research agenda.

AIMS OF THE SCHOLARSHIP PROGRAMME 

1. To strengthen research literacy and advocacy capacity amongst IRMA membership in Africa
2. To promote and enhance the role and standing of IRMA within the microbicide community in Africa
3. To facilitate the involvement of well-informed and active members of the African research and advocacy communities in the development of an African rectal microbicides agenda
4. To ensure diversity in participation at the meeting, including from researchers and community members, women and men, gay men and other men who have sex with men, people living with HIV, and different regions of Africa

We are covering the travel costs of more than 30 of the 40 meeting participants—most of which are Africans—including speakers, organisers, invited guests, and key partners. This includes an additional 12 scholarships for Africans through this call for applications.

For more information, please send an email to rectalmicro@gmail.com.

[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 Mark Hubbard - A Friendly Rectal Microbicide Advocate

"The work we do is difficult, complex, challenging, and nuanced. If we recognize that upfront, we do better at avoiding frustration and conflict." - Mark Hubbard, Nashville, USA

Mark Hubbard is an independent community organizer, advocate, educator and activist. He was introduced to IRMA when he produced a community forum on microbicides that featured Jim Pickett.

Mark is excited to be a part of rectal microbicide advocacy. He believes IRMA serves the community in a number of ways: It educates the community about HIV/AIDS prevention broadly and new prevention technologies research more specifically, it highlights the disparity between vaginal and rectal microbicide research, and it provides context for rectal microbicide advocacy work. "Our best efforts at developing biomedical or behavioral interventions will be futile if we fail to work within a framework of understanding regarding affected communities' cultural contexts and legacies," he says.

The role of rectal transmission in the pandemic is profoundly clear, and for this reason Mark hopes to bring rectal microbicide research to the forefront of HIV prevention technologies. He has produced educational events that attracted a broad, diverse audience in a format that encourages real dialogue. Even in his personal life he "just never stops talking about the issues."

Mark loves to watch movies in his free time – particularly classics and independent films. He also loves being outdoors; taking walks in nature keeps him happy and healthy. He "definitely got the 'gay Broadway' gene" and enjoys musical theater culture as well.

Read about other friendly rectal microbicides advocates. Newly featured advocates include Daniel Nuñez, Amy Stapleford Jackson, Maheswar Satpathy, Vanessa Marquez, and Luis Fernando Galarza.

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.]

Meet Luis Fernando Galarza - A Friendly Rectal Microbicide Advocate

"We need more choices to fight against HIV."

- Luis Fernando Galarza, Guayaquil, Ecuador

Luis works with Fundación Ecuatoriana Equidad, a non-governmental organization in Ecuador that works for human rights, and the health and social welfare of the GLBTI Community. Equidad is collaborating on the new iPrEx OLE trial (the open-label extension of the original iPrEx study), and Luis is the site study coordinator for Guayaquil.

He said of the project: "This trial and the great staff behind it has been for me the best opportunity I had to learn all I know so far about the serious and important clinical research world." He also offers counseling services related to HIV testing and risk reduction.

Luis was introduced to IRMA by a colleague in Lima, Peru - Steve Miralles of IRMA-ALC, IRMA's South American sister which is working to expand rectal microbicide and PrEP advocacy in the region. He is collaborating with IRMA-ALC, and is very excited about the possibilities in rectal microbicides, because "the alarming numbers of new HIV Infections around the world are telling us that new prevention strategies and technologies are extremely necessary, and rectal microbicides could be an excellent option."

In his free time, Luis enjoys being with his friends, family and partner. When alone he loves to garden, with his flowers and his two dogs to keep him company.

Read about other friendly rectal microbicides advocates. Newly featured advocates include Daniel Nuñez, Amy Stapleford Jackson, Maheswar Satpathy, Vanessa Marquez, and Mark Hubbard.

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.]

Why So Anal about Pleasure?

Via EmpowHer, by Hannah Cutts.

Whether you are a committed fan, a non-subscriber, or have been considering engaging in anal play, I believe it is a subject that women should make an effort to include in their sexual awareness and conversations, even if only to expand their education on the female body and become resources for friends/family members who may have questions about the behavior.

According to the Center for Disease Control and Prevention’s National Survey of Family Growth, anal sex between heterosexual partners has been on the rise over the past decade. In 1992, 20.4 percent of women reported engaging in anal sex with a male partner, while in 2005, 32.6 percent indicated they include anal in part of their heterosexual repertoire (New York Magazine, 2006). While anal sex has historically been associated with gay couples, it is clear that people who enjoy sex with the opposite gender have adopted the practice, perhaps finally realizing what they have been missing out on. It is time for women—straight, gay and anywhere in between—to get the facts on anal play and what makes it worthwhile.

The bottom line is, like your vagina, your anus is packed with sensitive nerve endings that feel great when touched or stimulated. Although experimenting with this somewhat fragile opening is not necessarily a stand-alone endeavor (it requires some foreplay and careful lubrication), gentle exploration of the anus is a tremendous complement to other pleasure-giving (think cunnilingus). By slowly introducing the stimulation of this third hole into your sexual repertoire one step (or to be more accurate, one finger) at a time, you are opening yourself up to sensations that you won’t feel with vaginal-only penetration. Many sources suggest you begin simply with a massage of the anal opening, an action that carries almost no risk and allows both partners to get comfortable with the touch.

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.]

Why the CIA's Vaccine Ruse Is A Setback for Global Health

Via TIME, by Emily Rauhala.

Last week, the Guardian broke the news that in the run-up to the raid on Osama bin Laden's compound, the CIA used a vaccination campaign as a ruse to get DNA evidence from the al-Qaeda leader's kids. With help from a Pakistani doctor, Shakil Afridi, they set up clinics in two neighborhoods, delivering doses of the Hepatitis B vaccine to local children. The revelation drew a quick and angry response from health experts. Medecins Sans Frontieres called the operation "a dangerous abuse of medical care." In the Washington Post, Orin Levine and Laurie Garrett warned that the CIA's "reckless tactics could have catastrophic consequences."

Indeed, they may. Here are three reasons why this is bad news for public health:

1. Broken Trust

When people don't trust medical personnel, they're less likely to participate in legitimate public health campaigns. Eight years ago, rumors spread that an anti-polio campaign in Nigeria was an American plot to sterilize Muslim girls, causing many families to refuse the vaccine. The subsequent outbreak spread to eight countries.

Read the rest here.

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

The crazy things they say: politicians and HIV

Via PlusNews.

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

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

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

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

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

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

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

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

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

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

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

Read the rest here.

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

Study - Addressing Social Drivers of HIV/AIDS for the Long-Term Response: Conceptual and methodological Considerations

Via MSMGF.

A key component of the shift from an emergency to a long-term response to AIDS is a change in focus from HIV prevention interventions focused on individuals to a comprehensive strategy in which social/structural approaches are core elements. Such approaches aim to modify social conditions by addressing key drivers of HIV vulnerability that affect the ability of individuals to protect themselves and others from HIV. The development and implementation of evidence-based social/structural interventions have been hampered by both scientific and political obstacles that have not been fully explored or redressed. This paper provides a framework, examples, and some guidance for how to conceptualise, operationalise, measure, and evaluate complex social/structural approaches to HIV prevention to help situate them more concretely in a long-term strategy to end AIDS.

Conclusion:

After nearly 30 years of the HIV/AIDS pandemic, there have been woefully few examples of truly successful HIV prevention initiatives conceived and implemented by national policy makers and programme planners. To ensure measurable HIV prevention success by 2031, the 50th anniversary of the epidemic, it will be necessary to move beyond the limited, individualistic, urgency-based approaches of the past. Shifting from an emergency framework and mounting a long-term response to AIDS requires new approaches that engage with underlying social-structural drivers of patterns of practices that influence vulnerability and facilitate the spread of HIV, as part of comprehensive, strategic programming (or ‘combination prevention’).

Patterns of behaviour and practices arise from combinations of drivers, operating in specific social, economic, and political contexts. As such, no single causal pathway can be drawn from a social driver to a set of practices or behaviours; rather, a range of potential outcomes may arise. Making causal inference about correlations between social drivers and HIV burden involves identifying ‘sociologically plausible’ pathways drawn from extant social science and epidemiological data. Engaging with social drivers requires methods and approaches beyond traditional conceptualisations that seek to identify and intervene on single, causal determinants or universal mechanisms of influence. HIV prevention researchers and advocates should reject and resist over-simplified language for social drivers. Statements that particular social-structural factors ‘do’ or ‘do not’ lead to HIV transmission are almost always too simplistic; language should shift to discussing how, in what circumstances, and for whom particular combinations of factors contribute to HIV vulnerability (or, conversely, resilience). In order to be rigorous, design of HIV prevention programmes and interventions aiming to address social-structural factors should:

• Begin with an assessment of the social and structural factors that may be
• increasing HIV vulnerability in targeted populations and settings.
• Identify (hypothesise) sociologically plausible causal chains between distal structural factors and specific individual or group practices.
• Identify levels of possible influence, in line with the HIV prevention programme’s or intervention’s scope and aim.
• Articulate any assumptions about such influences and aims including potential expected and unexpected consequences of the programme or intervention (including other social impacts).
• Build in evaluation mechanisms that are both feasible and appropriate to the aim, level, scope and method of the programme or intervention as a way to enable validation of assumptions, investigation of the mechanisms by which structures affect risk and vulnerability, and appropriate assessment of outcomes and impact.

Find the whole 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.]