Rectal Sexually Transmitted Infections and Lubricant Use

via Sexually Transmitted Diseases, by Pamina M. Gorbach, DrPH, Robert E. Weiss, PhD, Edward Fuchs, PA-C, Robin A. Jeffries, MS, Marjan Hezerah, PhD, Stephen Brown, MD, Alen Voskanian, MD, Edward Robbie, MPH, Peter Anton, MD, and Ross D. Cranston, MD

Background

Use of lubricant products is extremely common during receptive anal intercourse (RAI) yet has not been assessed as a risk for acquisition of sexually transmitted infections (STIs).

Methods

Between 2006 and 2008, a rectal health and behavior study was conducted in Baltimore and Los Angeles as part of the University of California, Los Angeles Microbicide Development Program (NIAID IPCP# #0606414). Participants completed questionnaires, and rectal swabs were tested for Neisseria gonorrhoeae and Chlamydia trachomatis with the Aptima Combo 2 assay, and blood was tested for syphilis (for RPR and TPHA with titer) and HIV. Of those reporting lubricant use and RAI, STI results were available for 380 participants. Univariate and multivariate regressions assessed associations of lubricant use in the past month during RAI with prevalent STIs.

Results

Consistent lubricant use during RAI in the past month was reported by 36% (137/380) of participants. Consistent past month lubricant users had a higher prevalence of STI than inconsistent users (9.5% vs. 2.9%; P 0.006). In a multivariable logistic regression model, testing positive for STI was associated with consistent use of lubricant during RAI in the past month (adjusted odds ratio: 2.98 95% confidence interval: 1.09, 8.15) after controlling for age, gender, study location, HIV status, and numbers of RAI partners in the past month.

Conclusions

Findings suggest some lubricant products may increase vulnerability to STIs. Because of wide use of lubricants and their potential as carrier vehicles for microbicides, further research is essential to clarify if lubricant use poses a public health risk.
 
Read the full 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.]

Age as a Risk "Marker" for MSM

via JAIDS, by Potterat, John J BA; Brewer, Devon D PhD

Hurt and colleagues observed that primary HIV infection (PHI) in men who have sex with men (MSM) was associated with selecting older sex partners. Specifically, MSM with PHI (median age, 24.5 years) tended to choose partners 5 years older (median, 29.8 years) compared with uninfected MSM who were much closer in age (22.5 years; partners, 23.9 years). This result is not surprising, because older MSM are more likely to be infected. In Colorado Springs, for example, rigorously sought, community-wide sexually transmitted disease/HIV surveillance data show that whereas chlamydia is an infection of the late teens and early 20s, and gonorrhea of the early to mid-20s, the average age for HIV seroconversion is late 20s (median, 27 years; mean, 27.8 years), an average age approaching that of older partners of men with PHI in Hurt and colleagues' study.

What is remarkable is Hurt and colleagues' and Coburn and Blower's interpretation of the observed association between partner age disparity and PHI. They mislabel sex with an older man as a risk factor for HIV and correspondingly call for prevention messages to be refocused on this behavior. Sex with an older MSM cannot be a risk factor for HIV infection, although it is a risk marker. The fact that the age of sex partners remained an independent correlate of recent HIV infection in Hurt and colleagues' multivariate model reflects mismeasurement of exposure to HIV. It appears objective data on partners' HIV statuses were unavailable for 90% (18 of 20) of men with PHI and 46% (25 of 54) of uninfected men. It is unclear whether all such partners were classified as “serostatus unknown” (and thus regarded as having exposed participants to HIV) or their serostatuses were estimated from participants' perceptions (the authors did not describe such procedures). In the former scenario, uninfected men's exposure to HIV may be overestimated. In the latter scenario, men with PHI may have incorrectly perceived infected partners as uninfected or not reported partners during the period when they acquired infection because the authors collected data on the three most recent partners only.

Other characteristics of partners can also serve as markers of HIV risk in MSM such as race and injection drug use. The social contexts in which MSM form sexual partnerships may be even better indicators of HIV risk. Although local data on risk markers might inform ancillary prevention messages, the educational focus in MSM should remain on avoiding the most direct risk factors-anal (especially receptive) intercourse without a condom and sex between serodiscordant men-as their own data clearly show.


[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.]

Risk factors for HIV vary between African cities, need tailored responses

Via AIDSMap, by Carole Leach-Lemens.

A comparative study in three large cities in southern Africa has found big differences in risk factors for acquisition of HIV infection, emphasising the importance of locally tailored HIV prevention strategies and up-to-date information on local risk factors.

The study looked at behavioural risk factors associated with acquiring HIV infection in 5000 sexually active women in Harare, Durban and Johannesburg who took part in a large trial of an HIV prevention method based on use of the diaphgram.

Sue Napierala Mavedsnege and colleagues report the findings of their prospective cohort analysis in the advance online edition of the Journal of Acquired Immune Deficiency Syndromes.

A total of 309 incident HIV infections were identified. Durban reported the highest incidence rate, followed by Johannesburg and then Harare (6.75 per 100 person years, 95% CI: 5.74-7.93; 3.33 per 100 person years, 95% CI: 2.51-4.44; 2.72 per 100 person years CI: 2.26-3.26, respectively).

Having more than one partner in the last three months was the only common factor associated with HIV incidence.

The majority of the estimated 35 million people living with HIV live in sub-Saharan Africa where 70% of all new infections occur. Women represent over 60% of all infections. Southern Africa, with the highest regional prevalence, reflects different phases of the epidemic.

In Zimbabwe, with an estimated prevalence of 14.3%, the epidemic began early, peaked in 1998 with a subsequent decline in incidence and prevalence.

From 1990-1998 South Africa had an exponential increase followed by a moderate increase until 2004 when apparent stabilisation began. In 2008 estimated provincial prevalence rates ranged from 5.3% to 25.8%.

In Gauteng province, with Johannesburg its largest city, prevalence appears to have peaked in 2002 at 20.3% and declined to 15.2% in 2008. In contrast, Kwa Zulu Natal province where Durban is the largest city, estimated prevalence rose from 15.7% in 2002 to 25.8% in 2008.

While cross-sectional studies looking at risk factors associated with HIV have taken place in Zimbabwe and South Africa, few have looked at risk factors for HIV incidence in women. A better understanding of these factors within local contexts will help develop targeted interventions so reducing transmission.

The authors looked at factors associated with differences of HIV incidence among women in Harare, Johannesburg and Durban enrolled between September 2003 and September 2005 in the Methods for Improvement of Reproductive Health (MIRA) study, a randomised clinical trial to look at the effect of the diaphragm plus lubricant gel for the prevention of HIV. The intervention did not reduce HIV incidence.

The authors undertook a prospective cohort analysis of trial participants who were followed for a median of 21 months (12-24 months).

Socio-demographic, biological and behavioural data were collected at baseline and at quarterly visits. Testing for HIV and STIs were conducted at each quarterly visit.

Each location had distinct characteristics as well as different patterns of individual risk factors.

In Harare women were more likely to live with their partner, be employed and not use alcohol or drugs but more likely to wipe inside their vagina. While they had a later sexual debut and fewer partners than in Durban or Johannesburg there was more transactional sex (for money, food, drugs or shelter) within the last three months.

Early sexual debut was more common in Durban, while in Johannesburg consumption of alcohol within the last three months, multiple sexual partners and sex under the influence of drugs or alcohol were more likely.

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.]

KENYA: Rural MSM Too Afraid to Access HIV Health Services

Via PlusNews.

Discriminatory laws and a largely homophobic society mean that men who have sex with men (MSM) in Kenya generally find it difficult to access HIV-related information and health services, but rural MSM have an especially hard time.

When Kibet Kipsowen*, 30, a cattle keeper in Kenya’s Rift Valley Province, and his partner have sex, they use the oil-based jelly he applies when milking his cows; he’s never heard of a water-based lubricant, let alone used one. “Milking jelly is the only lubricant I have known for the last four years,” he told IRIN/PlusNews at his home in the village of Lanjuera.

Health practitioners discourage the use of oil-based lubricants for anal sex, as the oil degrades condoms, increasing the likelihood that they will break. Studies have found that most African MSM use oil-based lubricants, heightening their risk of contracting HIV.

According to a 2008 Modes of Transmission study conducted by UNAIDS and the government, MSM and prisoners account for 15.2 percent of new HIV infections in Kenya annually.

Kipsowen and his partner have been an item for a few years now, but dare not let anyone in their village know they are a couple. “Even people who have ‘normal’ sex do not speak about it - I can never reveal my sexuality or else I would risk being an outcast, or even be killed,” he said.

The only other person in the village who knows about his sexuality is Soita Wellapondi, a local nurse and social worker, and that’s only because Kipsowen visited her when he developed a sexually transmitted infection.

“At that time I had a lot of wounds in my anus; I felt so much pain that I thought I would die, yet I could not even confide to my own mother, brother or sister, and I could not visit a health centre,” he said.

He knew that by confiding in Wellapondi he risked his secret being revealed to the community, but he felt she was his only chance of accessing health care. “I bought him some antibiotics and pain killers; it was absolutely impossible to convince him to visit a health centre, even one far away where he is not known,” said Wellapondi.

Local health workers have very little experience and no training in dealing with MSM. A clinical officer at the Mogotio health centre near Lanjuera says he has only ever had one MSM client.

Even people who have 'normal' sex do not speak about it - I can never reveal my sexuality or else I would risk being an outcast or even be killed“He came here for treatment of injuries resulting from anal sex, and was advised to come for further treatment but he never came back,” said the clinical officer, who declined to be named.

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.]

HIV Envelope Discovery Could Reveal New Vaccine Targets

Via hivandhepatitis.com

An international study headed by a UC Davis scientist describes how a component of a potential HIV vaccine opens like a flower, undergoing one of the most dramatic protein rearrangements yet observed in nature.

The finding could reveal new targets for vaccines to prevent HIV infection and AIDS. A paper describing the work was published online this week in the journal Proceedings of the National Academy of Sciences.

In the new study, researchers from the U.S., Sweden and France explored the structure and behavior of the HIV envelope protein complex, which could potentially serve as a component of a vaccine aimed at eliciting the human immune system to generate antibodies against HIV.

"By opening up these less exposed regions, we might be able to raise more broadly cross-reactive antibodies to HIV," said R. Holland Cheng, professor of molecular and cellular biology at UC Davis and senior author of the study.

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.]

Traditional Leaders challenged to actively participate in the fight against HIV

Via Safaids.net

Traditional leaders from southern Africa have been challenged to play an active role in the fight against HIV for the region to achieve zero new infections, zero discrimination and zero AIDS related deaths.

This was said by the Executive Director of SAfAIDS, Mrs Lois Chingandu at the Regional Traditional Leadership Rock Indaba-50 x 15 Prevention Movement being held in Johannesburg from 12-14 April 2011.

Mrs Chingandu challenged traditional leaders to move from being actors where they are often invited to officially open HIV events and be actively involved in the fight against the epidemic.

Excerpt:

“As chiefs, you must tell yourself that I want zero new infections in my village. This can only happen if you know the epidemic, start to openly talk about sex and encourage your community members to go for HIV tests. This should start with you.....We found that the African epidemic had something to do with our culture. As much as we love our culture, it is important for our culture to protect us. We found some practices that were not protecting us but putting us at risk, for example wife inheritance. We are therefore working with traditional leaders to find ways of how we can practice our culture, without exposing ourselves to HIV infection”.

She stressed the importance for traditional leaders to model the behaviours they are promoting as they can’t encourage others to change their behaviour whilst they are having multiple partners.


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.]

African Girls Getting World Bank Cash Deters Sex With 'Sugar Daddies'

Via Bloomberg, by Simon Clark

Young women in sub-Saharan Africa have HIV infection rates up to three times higher than their male peers, largely because of relationships with older "sugar daddies" who give them money in exchange for sex.

The phenomenon contributes significantly to HIV's spread, said Ester Etkin of loveLife, South Africa's largest anti-AIDS group.

A World Bank study in Malawi examined cash incentives among approximately 3,800 females ages 13-22. One group received roughly $10 a month and payment for school fees if they regularly attended class, while the control received no incentives. HIV infection rates at 18-month follow-up were 60 percent lower among girls who were given cash: 1.2 percent, compared with 3 percent. The study also showed a delay in the start of sexual activity among beneficiaries and a decline in the number of partners among those who were sexually active.

Though the study's results are being assessed by a peer-reviewed journal, plans are underway to repeat the experiment elsewhere in Africa, said Mayra Buvinic, director of gender and development at the World Bank. "The potential could be huge to reduce HIV rates in teenage girls," she said.

But some experts question whether cash payouts are an appropriate strategy. "We could end up creating an environment of dependency that cannot be sustained," warned Peter Lamptey, a Family Health International physician practicing in Ghana. "Paying people to influence their sexual behavior won't solve the wider problems of abuse, esteem, neglect and inequality that cause them to get HIV," said Sophie Harman, a senior lecturer at London's City University who has studied World Bank AIDS policies.

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.]

PrEP: A Possible Approval Like No Other

Via Poz, by Tim Horn

The AIDS Healthcare Foundation began a paid advertisement campaign urging Gilead Sciences to refrain from seeking approval from the U.S. Food and Drug Administration for Truvada for use of the combination tablet as HIV prevention, in an approach known as pre-exposure prophylaxis, or PrEP.

The ads were met by an outcry from the community. One prominent organization, the HIV Prevention Justice Alliance, issued a sign-on letter , dated March 16, urging the FDA "to examine the study results of PrEP rather than playing to speculation and fear."

While I agree that PrEP should be considered as an option in the HIV prevention toolkit and would ultimately support an effort by Gilead to expand Truvada's labeling to include PrEP--should the company petition the FDA for approval--I am also of the mind that a green light from the FDA should not be met with the rush-to-treatment that typically follows approval of a drug.

Given how little we know about the safe application of PrEP in a real-world setting--read: outside of a clinical trial--not to mention the expense of a comprehensive prevention program that includes PrEP, I think more feasibility studies need to take place before we consider a widespread HIV prevention program involving PrEP.

Here's what we do know: PrEP is effective in one population of at-risk individuals: men who have sex with men (MSM). The iPrEx clinical trial, sponsored by the National Institute of Allergy and Infection Diseases (NIAID) of the U.S. National Institutes of Health (NIH) and co-funded by the Bill & Melinda Gates Foundation, involved a large sample size (approximately 2,500) of MSMs. The study, which had sound design and statistical analysis, proved Truvada use resulted in significantly fewer infections compared with those using a placebo.

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.]

New recommendations to reach 2015 goals for AIDS response

Via unaids.org

Thirty years into the AIDS epidemic, investments in the AIDS response are yielding results, according to a new report released today by United Nations Secretary-General Ban Ki-moon.

Titled Uniting for universal access: towards zero new HIV infections, zero discrimination and zero AIDS-related deaths, the report highlights that the global rate of new HIV infections is declining, treatment access is expanding and the world has made significant strides in reducing HIV transmission from mother to child.

Between 2001 and 2009, the rate of new HIV infections in 33 countries—including 22 in sub-Saharan Africa—fell by at least 25%. By the end of 2010, more than 6 million people were on antiretroviral treatment in low- and middle-income countries. And for the first time, in 2009, global coverage of services to prevent mother-to-child transmission of HIV exceeded 50%.
 
“World leaders have a unique opportunity at this critical moment to evaluate achievements and gaps in the global AIDS response,” said Secretary-General Ban Ki-moon at the press briefing in the Kenyan capital. “We must take bold decisions that will dramatically transform the AIDS response and help us move towards an HIV-free generation.”  
 
“Thirty years into the epidemic, it is imperative for us to re-energise the response today for success in the years ahead,” said UNAIDS Executive Director Michel Sidibé, who joined Mr Ban for the launch of the report. “Gains in HIV prevention and antiretroviral treatment are significant, but we need to do more to stop people from becoming infected—an HIV prevention revolution is needed now more than ever.”

Mobilizing for impact  In the report there are five recommendations made by the UN Secretary-General to strengthen the AIDS response:

• Harness the energy of young people for an HIV prevention revolution;
• Revitalize the push towards achieving universal access to HIV prevention, treatment, care and support by 2015; 
• Work with countries to make HIV programmes more cost effective, efficient and sustainable;
• Promote the health, human rights and dignity of women and girls; and Ensure mutual accountability in the AIDS response to translate commitments into action.

Read the full report

[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 Africa ready for PrEP?

Via Incidence0.org, by Adebisi Ademola Alimi

One of the biggest breakthrough in HIV clinical research, since the outbreak of the epidemic 30 years ago, is the recent success in a clinical trial of a new HIV prevention approach based on the daily use of the antiretroviral drug Truvada by HIV negative person to prevent HIV transmission (Called PrEP, for Pre-Exposure Prophylaxis).

The results of the iPrEX trial raised hope but also many questions and concerns as showed by the ensuing debate about what the next step should be. Divergences culminated with the Aids Health Foundation (AHF) petitioning the FDA not to consider Gilead’s request for a licence to use Truvada for the prevention of HIV infection and a joint counter response by a number of HIV advocacy organisations.

But for me as an advocate and an African living in Europe, the most important thing on my mind is “Will Africa be able to access PrEP?” Providing ARV to HIV negative people in Africa needs to be considered in light of the challenge of accessing treatment in Africa, where more than 50% of HIV positive people in the world live (UNAIDS report).

Even if PrEP drugs become available, what are the mechanisms in place to ensure that it will not be tribalized in a continent where there are some indications that access to ARVs is based on political and ethnical loyalty and where there are evidences of bribery at the delivery point, misused of funds and a non-negligible ARVs black market leading to ARVs being dispensed to increasing numbers of patients at the periphery of the health system. One has to be skeptical about the PrEP implementation process in this context.

Read the full article

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

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.]

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.

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.]

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.]

CDC Factsheet: HIV and AIDS in the United States

A new factsheet from the CDC estimates that more than one million people are living with HIV in the United States. One in five (21%) of those people living with HIV is unaware of their infection. Despite increases in the total number of people living with HIV in the United States in recent years, the annual number of new HIV infections has remained relatively stable. However, new infections continue at far too high a level, with an estimated 56,300 Americans becoming infected with HIV each year.

HIV Incidence and Prevalence, United States, 1977-2006

For more click here.

Unprotected Anal Intercourse and Sexually Transmitted Diseases in High-Risk Heterosexual Women

via American Journal of Public Health


Objectives. We examined the association between unprotected anal intercourse and sexually transmitted diseases (STDs) among heterosexual women.

Methods. In 2006 through 2007, women were recruited from high-risk areas in New York City through respondent-driven sampling as part of the National HIV Behavioral Surveillance study. We used multiple logistic regression to determine the relationship between unprotected anal intercourse and HIV infection and past-year STD diagnosis.

Results. Of the 436 women studied, 38% had unprotected anal intercourse in the past year. Unprotected anal intercourse was more likely among those who were aged 30 to 39 years, were homeless, were frequent drug or binge alcohol users, had an incarcerated sexual partner, had sexual partners with whom they exchanged sex for money or drugs, or had more than 5 sexual partners in the past year. In the logistic regression, women who had unprotected anal intercourse were 2.6 times as likely as women who had only unprotected vaginal intercourse and 4.2 times as likely as women who had neither unprotected anal nor unprotected vaginal intercourse to report an STD diagnosis. We found no significant association between unprotected anal intercourse andHIV infection.

Conclusions. Increased screening for history of unprotected anal intercourse and, for those who report recent unprotected anal intercourse, counseling and testing for HIV and STDs would likely reduce STD infections.

For the full study click here.