Survey reveals gaps in HIV programming for MSM

Via PlusNews.

A new global survey of more than 5,000 men who have sex with men (MSM) reveals a marginalized group of people with little access to basic HIV prevention tools such as condoms and few means to learn about HIV.

Conducted by the Global Forum on MSM & HIV between 24 June and 17 August 2010, the survey sought to highlight key gaps in global efforts to provide MSM with evidence-informed HIV prevention services. More than 1,000 of the study participants - drawn from all over the world - were health workers; 22 percent reported being HIV-positive.

The authors recommend expanding access to HIV prevention services for MSM across the globe, more focus on promoting awareness of emerging HIV prevention interventions and more robust and sustained stigma-reduction efforts. Some of the major findings of the survey include:

Access to health services - Fifty-three percent of participants said they could easily access testing for sexually transmitted infections, while 51 percent said they had easy access to HIV counseling; 47 percent found STI treatment easily accessible.

Just 36 percent of MSM surveyed reported having easy access to HIV treatment, while 27 percent said it was available but difficult to access, was not available or had never heard of HIV treatment.

Access to HIV prevention - Free condoms were easily accessible only to 44 percent of participants, while just 29 percent could obtain lubricant.

Just 30 percent of participants reported easy access to each of the basic HIV prevention services, including behavioural HIV/AIDS interventions, HIV education materials, mental health services, free or low-cost medical care, media campaigns focused on reducing HIV, and laws/policies to ensure access to HIV prevention.

Just 25 percent said they had access to sex education.

Stigma - Africa reported the highest levels of stigma and external homophobia, followed by the Middle East, Asia-Pacific, Central/South America and the Caribbean, which all reported similar levels of stigma. Australia and New Zealand reported the lowest levels of stigma and external homophobia.

MSM from Africa and the Asia-Pacific region reported the highest levels of internalized homophobia.

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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.]

Intensive and targeted PEP counselling leads to less risky sex afterwards, fewer HIV infections

Via AIDSMap, by Roger Pebody.

Researchers in San Francisco wished to measure the impact of providing risk reduction counselling to people taking post-exposure prophylaxis (PEP) to prevent HIV infection. They measured changes in sexual behaviour one year later.

They randomised 457 people receiving PEP to either receive two sessions of standard counselling, or an enhanced programme of five counselling sessions.

The standard counselling intervention consisted of two sessions of 20 to 30 minutes each, individually tailored on the basis of social cognitive theory, motivational interviewing, and coping effectiveness training. In the first session, the counsellor and participant explored the details and context of the risk exposure and developed a written risk reduction plan. At the second session a week later, the baseline HIV test result was given. The participant was asked about risk behaviour in the past week and the effectiveness of the risk reduction plan, which was adjusted if necessary.

People receiving the enhanced intervention received the same two sessions, as well as three further sessions, during which difficulties in implementing the plan were explored, contextual factors (such as particular places or emotions) that led to high or low risk behaviour were identified and an increasingly personal risk reduction plan was developed. (A detailed protocol for the five sessions is freely available on the journal’s website).

Adherence counselling was also separately provided on three occasions.

Almost all participants were men, and PEP had commonly been prescribed after unprotected anal sex (80.1%), unprotected vaginal sex (7.5%) or oral sex to ejaculation (5.9%) in the previous 72 hours. Four out of ten people receiving PEP knew that their partner was HIV-positive.

To assess the impact of the two styles of counselling, the behaviour of participants was assessed at the time of taking PEP and one year later.

When the data for all participants were analysed together, the extra intervention appeared to provide a modest benefit, but perhaps one that could not justify the cost of its provision.

The study’s primary outcome was change in the number of unprotected anal or vaginal sex acts. In the six months before taking PEP, participants had had unprotected sex an average of 5.5 times. In people who received two counselling sessions, this dropped by a mean of 1.8, while those getting the extra sessions had 2.3 fewer unprotected sex acts.

The results are more interesting if we only look at those individuals who were taking more sexual risks to begin with. A fifth of the participants had had unprotected sex four or more times in the six months before taking PEP, and the extra counselling had much more impact in this group.

In terms of the primary outcome, those with higher risk receiving the standard two sessions had a reduction in 7.0 unprotected sexual acts, whereas in those getting the extra sessions the average reduction was 13.2 acts.

Whereas 31.5% of higher-risk individuals receiving the standard intervention felt the need to come back for a second course of PEP within a year, this was case in 17.1% of those receiving five sessions.

And most importantly, fewer people were HIV-positive one year later. Among those with higher risk who received two sessions, 12.3% seroconverted. In those who received five sessions, 2.4% did so. (These infections are likely to be due to risk behaviour in the months after taking PEP, not the failure of PEP to prevent infection).

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

Kenya: Counselling, not alarm device, had best effect on ART adherence

Via aidsmap, by Carole Leach-Lemens

Patients in Nairobi, Kenya getting intensive early adherence counselling when starting antiretroviral therapy were 29% less likely to have poor adherence and 59% less likely to have virological failure compared to those getting no counselling Michael H Chung and colleagues reported in a randomised, controlled trial published in the March issue of PLoS Medicine.

The positive effects of counselling on adherence were seen immediately after starting antiretroviral therapy and maintained throughout the18 month follow-up period. Use of an alarm device had no effect on adherence or virological outcomes. Public health concerns that scale-up of antiretroviral treatment in sub-Saharan Africa would lead to poor adherence and widespread drug resistance have been proven wrong, note the authors.

The authors conclude “as antiretroviral treatment clinics expand to meet an increasing demand for HIV care in sub-Saharan Africa, adherence counselling should be implemented to decrease the development of treatment failure and spread of resistant HIV.”

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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.]