Microbicide Trials Network Statement on Decision to Discontinue Use of Oral Tenofovir Tablets in VOICE, a Major HIV Prevention Study in Women

via Microbicide Trials Network

VOICE, an HIV prevention trial evaluating two antiretroviral (ARV)-based approaches for preventing the sexual transmission of HIV in women – daily use of one of two different ARV tablets or of a vaginal gel – will be dropping one of the oral tablets from the study. The decision to discontinue use of tenofovir tablets in VOICE comes after a routine review of study data concluded that the trial will not be able to demonstrate that tenofovir tablets are effective in preventing HIV in the women enrolled in the trial. VOICE will continue to test the safety and effectiveness of the other oral tablet, Truvada®, a combination of tenofovir and emtricitabine, and of the vaginal gel formulation of tenofovir.

Importantly, the review, which was conducted by the National Institute of Allergy and Infectious Diseases (NIAID)’s independent Prevention Trials Data and Safety Monitoring Board (DSMB), identified no safety concerns with any of the products being studied in VOICE.

VOICE – Vaginal and Oral Interventions to Control the Epidemic – involves 5,029 women at 15 trial sites in Uganda, South Africa and Zimbabwe. The trial is being conducted by the Microbicide Trials Network (MTN), an HIV/AIDS clinical trials network funded by the National Institute for Allergy and Infectious Diseases with co-funding from the Eunice Kennedy Shriver Institute for Child Health and Human Development and the National Institute of Mental Health, all components of the U.S. National Institutes of Health.

The study was designed with five study groups: tenofovir gel, an inactive placebo gel, oral tenofovir, oral Truvada and an inactive placebo tablet. The women in each group (about 1,000) are asked to take their assigned study product daily. VOICE is the only trial evaluating the daily use of an ARV tablet – an approach called oral pre-exposure prophylaxis, or PrEP – and a vaginal gel in the same study. This design is important for determining how each product works compared to its control (placebo gel or placebo tablet) and which approach women prefer.

On September 16, 2011, the NIAID Prevention Trials DSMB reviewed VOICE study data for the period between Sept. 9, 2009, when the study began, and July 1, 2011. Based on this interim review, the DSMB determined that it was not possible to show whether oral tenofovir tablets were any better than a placebo for preventing HIV in the women assigned to that study group. The DSMB therefore recommended that the women randomized to the oral tenofovir tablet group discontinue their use of the study product. This recommendation does not apply to the women in the groups using either the tenofovir gel or oral Truvada tablets, or the corresponding placebos; the DSMB recommended that these four study groups continue in VOICE.
 
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[If an item is not written by an IRMA member, it should not be construed that IRMA has taken a position on the article's content, whether in support or in opposition.]

Zimbabwe lawmaker advocates once-a-month sex to curb AIDS

Via Associated Press.

A Zimbabwean lawmaker has called on scientists to develop a chemical to dull men's libido and enable them to have sex once a month to curb the spread of HIV/AIDS, a state daily reported.

Senator Sithembile Mlotshwa told the upper house of parliament that scientists should "look into the issue of trying to inject men with a substance that will make them lose appetite..." during a debate on access to HIV/AIDS treatment.

"I want to contribute by saying all the other avenues have been looked into and the only avenue left is for us parliamentarians to decide or suggest reducing the appetite of men and their insatiable greed for women."

Zimbabwe is one of the countries worst affected by the HIV/AIDS pandemic although the rate of infection has gone down.

Extra-marital relationships are among the drivers spreading the pandemic.

[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.]

New Light Shed on Male Sex Work

Via PlusNews.

Commercial sex work, dominated by a focus on women, could be redefined as new research launched today in Nairobi, Kenya, sheds light on the complicated HIV prevention needs of what may be Africa’s most deeply underground group at high risk of HIV - male sex workers.

The report co-authored by the United Nations Development Programme (UNDP) and South Africa's Sex Workers Education and Advocacy Taskforce (SWEAT) seeks to better understand the social contexts, sexual practices and risks, including that of HIV, among these men.

The professional debut of many of the 70 male sex workers surveyed in Kenya, Namibia, South Africa, Uganda and Zimbabwe was often prompted by the family rejecting the men’s sexual orientation; for others, it was a way to survive in a foreign country.

Men reported being at risk of HIV in many ways, including the unavailability of speciality health services, the premium clients placed on unprotected sex, violence and the lure of substance abuse. Although the work often placed them at risk of substance and physical abuse as well as HIV infection, the researchers found that it also provided the men with a sense of freedom and empowerment.

The report cautions that mitigating these risks may require specialised HIV prevention services unlike those targeted at female commercial sex workers or men who have sex with men (MSM).

A series of interviews with male sex workers at a five-country workshop in Johannesburg, South Africa, and country visits to Kenya and Namibia has produced a significant addition to the paucity of data on male sex workers, according to Paul Boyce, a UNDP researcher.

While data on MSM from Malawi, Namibia and Botswana indicated that about 17 percent were HIV positive - almost twice the national prevalence rates of their respective countries - not much has been written on the specific HIV risks of male sex workers, which may be higher than those of MSM.

While male sex workers reported working at a range of venues, including Namibian truck stops and Zimbabwean mines, most of the available information on male sex work has come from those operating in the sex tourism hot spot of Mombasa, Kenya, with limited data from a 2009 study in South Africa that showed male sex workers were twice as likely to engage in anal sex than MSM who were not selling sex.


Not necessarily the same old risks:

Unprotected receptive anal sex carries almost 20 times the HIV risk associated with unprotected vaginal sex.

Interviewees told researchers that the unavailability of water-based lubricant, which reduces the risk of condoms breaking during anal sex, and the higher financial reward of unprotected anal sex, made consistent condom use difficult.

Some clients forced unprotected intercourse on sex workers, while others admitted to practicing unsafe sex due to the disinhibition often brought about by the drug and alcohol abuse that is reportedly part of the social scene in sex work. Drugs and alcohol also helped the men mentally cope with the omnipresent risks of this lifestyle, including police harassment.

South African male sex workers said substance abuse - not HIV infection - was the greatest threat to their health.

Those who tried to access health services for HIV testing and treatment, or the diagnosis of sexually transmitted infections (STIs), reported being ridiculed and stigmatized by health workers, even in countries like Kenya, where the Ministry of Health has introduced new guidelines on MSM and sex work, and health and HIV.

"[At the] government hospital, the nurses just [stand] in front of everyone and shout out loud to the people waiting for assistance: 'If you have HIV, go to room nine, TB room 12, STD [sexually transmitted disease] room 8,'" said one man quoted in the report.

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.]

LGBT Africans Face Blackmail and Extortion on a Regular Basis

via International Gay and Lesbian Human Rights Commission

Antiquated laws against same-sex sexual activity as well as deeply ingrained social stigma result in the all-too-frequent targeting of lesbian, gay, bisexual and transgender (LGBT) people in Africa for blackmail and extortion, said the International Gay and Lesbian Human Rights Commission (IGLHRC) in a report launched today.

The report, Nowhere to Turn: Blackmail and Extortion of LGBT People in Sub-Saharan Africa, illustrates how LGBT Africans are made doubly vulnerable by the criminalization of homosexuality and the often-violent stigmatization they face if their sexuality is revealed. Based onresearch from 2007 to the present, the volume features articles and research by leading African activists and academics on the prevalence, severity and impact of these human rights violations on LGBT people in Cameroon, Ghana, Malawi, Nigeria, and Zimbabwe.

"The tragic reality is that blackmail and extortion are part of the daily lives of many LGBT Africans who are isolated and made vulnerable by homophobic laws and social stigma," says IGLHRC's Executive Director, Cary Alan Johnson. "The responsibility clearly lies with governments to address these crimes and the underlying social and legal vulnerability of LGBT people."

The report's authors vividly depict the isolation, humiliation and manipulation to which LGBT people are subjected by blackmailers and extortionists and describe the threats of exposure, theft, assault, and rape, that can damage and even destroy the lives of victims. Vulnerability to these crimes is faced on a regular basis and families and communities are not safe havens. For example, according to research conducted in Cameroon and featured in the report, "the bulk of blackmail and extortion attempts were committed by other members of the community - 33.9% by neighbors, 11.8% by family members, 11.5% by classmates, and 14.1% by homosexual friends. Police were often complicit in this - either by ignoring or dismissing it or, in 11.5% of cases, directly perpetrating it."

Nowhere to Turn explores the role the State plays in these crimes by ignoring blackmail and extortion carried out by police and other officials by failing to prosecute blackmailers, and by charging LGBT victims under sodomy laws when they do find the courage to report blackmail to the authorities.

IGLHRC urges States to take concrete steps to reduce the incidence of these crimes by decriminalizing same-sex sexual activity, educating officials and communities about blackmail laws, and ensuring that all people are able to access judicial mechanisms without prejudice.

A PDF version of Nowhere to Turn is available here. To obtain a hard copy of the volume, email iglhrc@iglhrc.org

[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.]

Differences in HIV-1 prevalence not linked to sexual behavior, study finds

via Journal of the International AIDS Society, by Mapingure et al.

A new study concludes that higher HIV-1 prevalence among pregnant women in Zimbabwe compared with Tanzania cannot be explained by differences in risky sexual behaviour.

From the abstract:

Substantial heterogeneity in HIV prevalence has been observed within sub-Saharan Africa. It is not clear which factors can explain these differences. Our aim was to identify risk factors that could explain the large differences in HIV-1 prevalence among pregnant women in Harare, Zimbabwe, and Moshi, Tanzania.

Cross-sectional data from a two-centre study that enrolled pregnant women in Harare (N = 691) and Moshi (N = 2654) was used. Consenting women were interviewed about their socio-demographic background and sexual behaviour, and tested for presence of sexually transmitted infections and reproductive tract infections. Prevalence distribution of risk factors for HIV acquisition and spread were compared between the two areas.

The prevalence of HIV-1 among pregnant women was 26% in Zimbabwe and 7% in Tanzania. The HIV prevalence in both countries rises constantly with age up to the 25-30 year age group. After that, it continues to rise among Zimbabwean women, while it drops for Tanzanian women. Risky sexual behaviour was more prominent among Tanzanians than Zimbabweans. Mobility and such infections as HSV-2, trichomoniasis and bacterial vaginosis were more prevalent among Zimbabweans than Tanzanians. Reported male partner circumcision rates between the two countries were widely different, but the effect of male circumcision on HIV prevalence was not apparent within the populations.

Read the 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.]

Alarming Drop in Condom Use Following HIV Prevention Trial in Zimbabwe

via IRIN PlusNews

When researchers returned to Zimbabwe several months after the end of a trial involving condom and diaphragm use, they were disappointed to find that condom use - which had risen to 86 percent during the trial - had reduced significantly.

"What happens after trials has always remained very much a mystery, and today, with biomedical prevention that has proved to be partly efficacious, such as the microbicide gel from the CAPRISA trial [which found that a vaginal gel containing tenofovir, an antiretroviral (ARV) drug, was 39 percent effective at reducing women's risk of contracting HIV during sex], it would be interesting to see what happens after the trial," Ariane van der Straten, lead author of a recent study on the issue, told IRIN/PlusNews.

"We were disappointed to see that all the effort and intense counselling provided to participants didn't seem to have a long-lasting effect - in effect, condom use went back to enrolment levels."

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

Positive Feedback from Anti-HIV Gel Research

From The Standard, by Kudzai Chimhangwa

The success of tests into the effectiveness of anti-HIV gels to be used by women before engaging in sex has presented Zimbabwe with another chance of further reducing the rapid transmission of the virus. According to various presentations made at a feedback workshop organised by the United Nations Population Fund (UNFPA) and the National Aids Council (NAC) on Friday, the research on the gels has brought a lot of hope. One of the gels is based on the anti-retroviral (ARV) drug Tenofovir and recent research carried out in South Africa showed that it reduces transmission of Aids to women if used before sex.

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Prisoners To Get Condoms in Zimbabwe?

From NewsDay, by Owen Gagare

Inmates in Zimbabwe's filthy prisons could soon be receiving condoms while in incarceration to prevent the spread of HIV, NewsDay has established. According to proposals by the Ministry of Health and Child Welfare and World Health Organisation (WHO), prisoners could soon benefit from initiatives to curb the spread of the deadly scourge.

The director of the Aids and TB programme, Owen Mugurungi, told journalists attending a workshop whose theme was "Understanding multiple concurrent partnerships and male circumcision" in Kadoma that his ministry was working with the Justice ministry to address health challenges in the country's prisons. He said there had been realisation that there was rampant homosexuality in the penitentaries and upon release the likelihood to affect spouses and girlfriends was high.

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Zimbabwe aims to circumcise 80% of young men in drive against HIV

Via The Guardian, by Sarah Boseley

A big effort is under way to circumcise 80% of young men in Zimbabwe after a study four years ago found that the operation reduced the chance of contracting HIV by 60%.

Yet the procedure is still not widely available across sub-Saharan Africa, where HIV prevalence is high, the International Aids Conference in Vienna was told today.

In Zimbabwe, Population Services International (PSI) is working with the government to try to get mass circumcision underway, using a "conveyor belt" strategy that allows doctors and nurses to move rapidly from one patient to another, operating on 10 instead of three patients an hour. The goal is to circumcise at least 80% of all young men between 15 and 29 – a total of 1.2 million.

For the full story, click here.

Zimbabwe - No room for gay rights in new constitution

via Radio VOP

Didymus Mutasa, a powerful figure in President Robert Mugabe’s Zanu PF political party, said his party will see to it that homosexuality is outlawed in the new constitution and that stiff penalties will be put in place for those who engage in the practice.

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Researchers: Zimbabwe's crisis driving HIV decline

by Michelle Faul, Associated Press

CAPE TOWN, South Africa — Fewer Zimbabweans are getting infected with AIDS, and researchers speculate it's due in part to a battered economy that's leaving men short of money to be sugar daddies and keep mistresses.

Presenting a study of the infection rate among pregnant women at a major international AIDS conference in South Africa this week, Dr. Michael Silverman said the prevalence of the virus that causes AIDS fell from 23 percent in 2001 to 11 percent at the end of 2008. His study was based on tests of 18,746 women at a prenatal clinic in rural Zimbabwe over that period.

Silverman, a Canadian infectious disease expert, works at Howard Hospital in Zimbabwe, where the women were tested.

Silverman said he concluded that "a lot of the effect (of the decline in HIV infections) is from the collapsing economy." AIDS experts have long noted that the richest countries in Africa are also those with the highest infection rates.

"You can't pay the sex worker if you have no currency," he said. "It's hard to have a concurrent relationship if you're always in earshot of your spouse, because you can't afford to travel. Because of the economic collapse, people are forced to stay home, like being in quarantine."

Getting accurate AIDS numbers in Africa, however, has been notoriously difficult since researchers are often forced to guess from imperfect indicators like HIV incidence in pregnant women, instead of counting actual numbers of HIV patients.

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Gays and lesbians demand recognition - Zimbabwe Times

Zimbabwe’s reclusive homosexual community has demanded that its rights be recognised and enshrined in the new Constitution currently being drafted.“The purpose of a Constitution is to protect vulnerable and marginalised minorities,” the Gays and Lesbians Association of Zimbabwe, GALZ, said in a statement to The Zimbabwe Times. “Most gay and lesbian people in Zimbabwe live in fear and are driven underground. This is blatant discrimination against a group of people whose only difference from the majority is in who they are attracted to sexually.

“And homosexuals do not choose to be homosexual just as heterosexuals do not choose to be heterosexual. Choosing to be gay or lesbian in Zimbabwe would be lunacy given the levels of disapproval shown by many elements of society.”

The most vocal opponent of the homosexual community has been Zimbabwe’s aging head of state. President Mugabe described homosexuals as “worse than dogs and pigs” about a decade ago when they attempted to assert their rights and highlight widespread homophobia in the country.

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Obrian Nyamucherera - a friendly rectal microbicide advocate

Obrian Nyamucherera
Harare, Zimbabwe

Obrian is an IRMA advocate from Harare, Zimbabwe where he serves as the national coordinator of Partners Zimbabwe, a partnership of six Zimbabwean HIV/AIDS organizations. These organisations have come together to promote information, dialogue and advocacy on HIV/tuberculosis issues in Zimbabwe, and Obrian coordinates all of their respective activities.

He came to know about IRMA through a friend who is a fellow HIV activist and an admirer of IRMA’s advocacy strategies. She advised Obrian to subscribe to the listserv, and he has been an active member ever since.

In Obrian’s perspective, rectal microbicides are an important priority among new HIV prevention technologies because very little has been done or said about them in Southern Africa - even though they have the potential to save lives. He believes that more research needs to be done on them because of the need for a complete arsenal of tools to fight the transmission of HIV.

“We will never reach a stage where we will sit back and say we have done enough, so we have to broaden the base of HIV prevention technologies!”

Obrian is an advocate to be admired, as he has taken much personal initiative for promoting microbicides in a region of the world where resources are lacking. In Zimbabwe and the surrounding countries, he acknowledges that little information on rectal microbicides is available. As a result, he takes every opportunity he can through workshops, reports, and other means to advocate for more information dissemination regarding microbicides and to push for more feasibility studies

When he is not hard at work advocating for rectal microbicides, he loves to watch soccer and spend time with his family.

Read more bios of Friendly Rectal Microbicide Advocates here, on the IRMA site.

How gay Zimbabweans are fighting HIV

"You're the first caller I've had for a few days now," Samuel Matsikure tells me from the GALZ health centre in Harare. The telephone lines in the city are working again after a 24-hour break in service, but despite the continuing poor line, Matsikure speaks in a bright, calm tone that belies his circumstances. "People are struggling with transport costs and things being so expensive, so they can't come and see us." He's talking about some of the one in five Zimbabweans that are living with HIV-Aids and of those who seek to avoid infection. In a country with few jobs, scarce food and inflation upwards of 100,000 percent, even the cost of a bus ride can be a barrier to seeking help.

Economics, however, is not the only obstacle to seeking help for HIV-Aids in Zimbabwe. Despite an estimated 1.8 million people in the country living with HIV-Aids, stigma remains not only a significant obstacle to accessing treatment, but also a powerful force for dividing families and propagating conflict within communities. For the community served by Matsikure and his team at GALZ, however, stigma has always run deep. When Robert Mugabe threatened legal action against "sexual perverts" that he considered "lower than cats and dogs" in 1995, he was talking about GALZ's community – the Gays and Lesbians of Zimbabwe.

Read the rest of this article in The Guardian (UK).