LGBTQ Discrimination Undermining HIV Prevention in Guatemala

via IPS News, by Danilo Valladares

Lesbian, gay, bisexual, and transgender people "face discrimination in health centres due to homophobia and transphobia, and do not receive treatment tailored to our needs. That's why we still represent the largest number of cases of HIV," Valdez told IPS.

Among men who have sex with men in the country, 7.6 percent were HIV-positive in 2010, according to the study "Intensificación de las acciones de prevención y atención integral en VIH y sida en grupos vulnerables y áreas prioritarias de Guatemala" (The Intensification of Preventive Actions and Integral Attention to HIV/AIDS in Vulnerable Groups and Priority Areas of Guatemala), carried out by World Vision.

However, other organisations put the prevalence of HIV/AIDS among sexual minorities much higher.

A total of 22,647 cases of HIV/AIDS were officially reported in Guatemala between 1984 and 2010, according to the ministry of health and social assistance, although NGOs say that figure would grow considerably if it included the unregistered cases.

Meanwhile, the Pan-American Health Organisation (PAHO) estimates that more than 65,000 people in this Central American country of 14 million people are living with the disease, many of them without even knowing it.

Valdez said the country has taken "few steps" for preventing the spread of HIV among vulnerable groups.

But one of the advances made was the opening of five clinics catering to members of sexual minorities.

"This kind of service should be available in all hospitals, in order to eliminate homophobia, which is the biggest hurdle we face," he said.

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.]

Using Conjoint Analysis to Measure the Acceptability of Rectal Microbicides Among Men Who Have Sex with Men in Four South American Cities

via Pubmed.gov, by Kinsler JJ, Cunningham WE, Nureña CR, Nadjat-Haiem C, Grinsztejn B, Casapia M, Montoya-Herrera O, Sánchez J, Galea JT.

Abstract

Conjoint Analysis (CJA), a statistical market-based technique that assesses the value consumers place on product characteristics, may be used to predict acceptability of hypothetical products. Rectal Microbicides (RM)-substances that would prevent HIV infection during receptive anal intercourse-will require acceptability data from potential users in multiple settings to inform the development process by providing valuable information on desirable product characteristics and issues surrounding potential barriers to product use. This study applied CJA to explore the acceptability of eight different hypothetical RM among 128 MSM in Lima and Iquitos, Peru; Guayaquil, Ecuador; and Rio de Janeiro, Brazil. Overall RM acceptability was highest in Guayaquil and lowest in Rio. Product effectiveness had the greatest impact on acceptability in all four cities, but the impact of other product characteristics varied by city. This study demonstrates that MSM from the same region but from different cities place different values on RM characteristics that could impact uptake of an actual RM. Understanding specific consumer preferences is crucial during RM product development, clinical trials and eventual product dissemination.



[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 ALC Presents on PrEP and Rectal Microbicides for Lima's Gay Community

by Steve Miralles

On May 11th, IRMA ALC (América Latina y el Caribe), based at Epicentro Gay Men’s Community Center in Lima, Peru, hosted a presentation on PrEP and rectal microbicides.

More than 15 men attended the presentation that was facilitated by IRMA-ALC leaders Steve Miralles and Jerome Galea.

The 15 community members included doctors, lawyers, psychologists and others participated in an open discussion/dialogue about these HIV prevention interventions under investigation and information was shared on the current state of the field of rectal microbicides and the inclusion of Lima in a RM study hopefully in 2012. 

Also, the results of the PrEP study (iPrEx) which took place in Lima was discussed along with the study’s results and how PrEP could change the HIV panorama.

Participants received IRMA's Spanish edition of the report “From Promise to Product” (De la Promesa al Producto: Avanzando en la Investigación y Promoción de los Microbicidas Rectales) AVAC fact sheets on iPrEx and other information and resources available in Spanish thanks to the IRMA-ALC team.

Now underway is the preparation of a radio program about rectal microbicides and iPrex to be aired in July on Epicentro's weekly program Espacio Común and an article for the next edition of Epicentro's magazine La Antena.

Visit IRMA ALC on Facebook. And check out the IRMA ALC page on the IRMA website to see some of those Spanish resources.

Also available in Spanish are IRMA's documents on lube safety:

Safety of lubricants for rectal use: A fact sheet for HIV educators and advocates

Safety of lubricants for rectal use: Questions & Answers for HIV educators and advocates

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

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

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

Click here to access the full paper.

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

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

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

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

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

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

*Read AIDSmeds coverage of this study here.


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

Dignity Denied: Violation of the Rights of HIV-Positive Women

From the Center for Reproductive Rights

More women than ever before are living with HIV around the world, and too many of them suffer cruel reproductive rights violations. The Center's newest fact-finding report, Dignity Denied: Violations of the Rights of HIV-Positive Women in Chilean Health Facilities, reveals the extent of the problem through the stories of 27 HIV-positive women in Chile.

As our report makes clear, Chilean women living with HIV are routinely denied care, verbally abused, given misleading or inaccurate health information, and pressured to agree to sterilization—or sterilized without their consent. Of the sixteen women we interviewed who were sterilized, only four said that they made a fully informed and voluntary choice to have the procedure.

Their testimonies echo that of our client Francisca*, an HIV-positive Chilean woman who was sterilized without her consent during a Cesarean section. The Center and our Chilean partner Vivo Positivo filed a case on behalf of Francisca, F.S. v. Chile, at the Inter-American Commission on Human Rights in February 2009.

Read the rest

Read the full report

IRMA ALC announces "Acceptability of Rectal Microbicides (RM): Barriers and facilitators of RM use among MSM in 4 South American Cities"

English:

IRMA-ALC (America Latina y el Caribe) founding members Jerome Galea (UCLA Program in Public Health, Latin America); Jórge Sánchez (INMENSA - Peru), Orlando Montoya (Equidad – Ecuador) and Beatriz Grinsztejn (Fiocruz – Brazil) are excited to announce funding received from the UCLA AIDS Institute and the UCLA Center for AIDS Research for a new project entitled, “Acceptability of Rectal Microbicides (RM): Barriers and facilitators of RM use among men who have sex with men in 4 South American Cities.”

This study will be the first of its kind to systematically explore RM in the region among diverse populations including both gay and non-gay identified men who have sex with men, sex workers and transgendered persons. The study will take place in Lima and Iquitos Peru; Guayaquil, Ecuador; and Rio de Janeiro, Brazil and will involve key-informant interviews, one-on-one in depth interviews, focus groups and conjoint analysis (a quantitative method that helps to understand consumer preferences) to assess the acceptability of using RM and willingness to participate in and feasibility of future RM clinical trials.

The project will also examine culture-specific customs, beliefs, and stigma related to anal sex. In all up to 256 people will participate.

Galea said, “We hope that the data collected in this study will provide the foundation for a future, larger research agenda leading to the development of RM clinical trials in the region, as well as expanded acceptability studies, specifically with respect to RM delivery devices which will be critical in preparing for adequate roll-out and dissemination of RM.

en español:

Los miembros fundadores de IRMA-LAC, Jerome Galea (Programa de Salud Pública de la UCLA en América Latina), Jorge Sánchez (INMENSA – Perú), Orlando Montoya (Equidad - Ecuador) y Beatriz Grinsztejn (Fiocruz - Brasil) se complacen en anunciar el financiamiento recibido del Instituto de Sida de la UCLA y el Centro para la Investigación en Sida de la UCLA para un nuevo proyecto titulado “Aceptabilidad de los Microbicidas Rectales (MR): Barreras y Facilitadores para el Uso de MR entre Hombres que Tienen Sexo con Hombres en 4 Ciudades de Sudamérica”.

Este estudio será el primero en su tipo en explorar sistemáticamente el uso de MR en la Región en diversas poblaciones, incluyendo a hombres que tienen sexo con hombres con y sin identidad gay, trabajadores sexuales y personas transgénero. El estudio será realizado en Lima e Iquitos, Perú; Guayaquil, Ecuador; y Río de Janeiro, Brasil, e incluirá entrevistas con informantes clave, entrevistas en profundidad, grupos focales y un análisis conjunto (que involucra el empleo de un método cuantitativo que ayudará a entender las preferencias de los usuarios), para evaluar la aceptabilidad del uso de MR, la viabilidad de futuros ensayos clínicos de MR, y la voluntad de las personas para participar en ellos.

El proyecto examinará también las costumbres específicas a la cultura, creencias y estigma relacionado con el sexo anal. En total, participarán hasta 256 personas.

Al respecto, Galea señaló: “Esperamos que los datos recolectados en este estudio sienten las bases para una agenda de investigación posterior de mayor envergadura, que conduzca al desarrollo de ensayos clínicos de MR en la Región, así como a estudios de aceptabilidad mayores, específicamente sobre los dispositivos de aplicación de MR, estudios que serán cruciales en la preparación de la implementación y diseminación de los MR.