IRMA - Rectal Microbicide Advocacy: risk

Showing posts with label risk. Show all posts

Tuesday, August 14, 2012

Translating clinical efficacy into public health effectiveness

via Citizen News Service, by Bobby Ramakant

At the recently concluded XIX International AIDS Conference (AIDS 2012), not only the decibels went up on ending AIDS but also sane voices were heard demanding a well-costed and thought-through strategy on how to end AIDS. One of the strategies that will complement a comprehensive HIV prevention, treatment, care and support plan to end AIDS is preventing HIV transmission. In this context, we need to look beyond the Phase III trials in HIV prevention research so that if the product being tested is proved to be effective, we have the means and well-thought plan to make it available for those people in need, without delay.

The HIV prevention research is certainly going ahead with rectal microbicides phase II efficacy clinical trials (MTN017) about to begin in four countries (US, Thailand, South Africa and Peru), US FDA's approval to use 'Truvada' as pre-exposure prophylaxis (PrEP) for HIV prevention, vaginal microbicides research and HIV vaccine science progressing ahead, treatment as prevention (TasP) getting a buy-in as never before, among other positive developments that give us hope.

Read the rest.

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*Join IRMA's robust, highly-active. moderated, global listserv addressing rectal microbicide research and advocacy as well as other interesting new HIV prevention technologies by contacting us at rectalmicro@gmail.com. Joining our listserv automatically makes you a member of IRMA - a network of more than 1,100 advocates, scientists, policy makers and funders from all over the world.

*Please look for us on Facebook: www.facebook.com/InternationalRectalMicrobicideAdvocates, and you can follow us on Twitter: @rectalmicro.

*Also, please note that shared news items from other sources posted on this blog do not necessarily mean IRMA has taken any position on the article's content.
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Friday, August 10, 2012

Most young Thai MSM define as heterosexual, even if they mainly have sex with men

via aidsmap, by Gus Cairns

A large, randomised sample of 21-year-old Thai men, presented at the 19th International AIDS Conference in Washington recently, has found that by far the largest risk factor for HIV infection is gay identity. Contrary to the oft-quoted saying “it’s not who you are, but what you do,” actual male/male sexual behaviour, while still an important risk factor, was not as strongly associated with being HIV positive as gay identity.

The survey was conducted among over 35,000 army conscripts from all parts of Thailand. All 21-year old Thai men enter a lottery at the age of 21 for conscription into the Thai army and of these half a million young men, 60,00 to 100,000, in any year, are conscripted, twice a year in May and October.

This survey thus constituted a truly randomised, cross-sectional survey of the 21-year-old men who were inducted into the Thai army in May 2011. It was conducted no more than two weeks after induction and therefore serving in the army had no influence on the results. Men from all provinces in Thailand were included and from both urban and rural areas.

The survey found that 7% of respondents had had sex with another man (MSM) but that only 1.1% only had sex with men.

Read the rest.

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*Join IRMA's robust, highly-active. moderated, global listserv addressing rectal microbicide research and advocacy as well as other interesting new HIV prevention technologies by contacting us at rectalmicro@gmail.com. Joining our listserv automatically makes you a member of IRMA - a network of more than 1,100 advocates, scientists, policy makers and funders from all over the world.

*Please look for us on Facebook: www.facebook.com/InternationalRectalMicrobicideAdvocates, and you can follow us on Twitter: @rectalmicro.

*Also, please note that shared news items from other sources posted on this blog do not necessarily mean IRMA has taken any position on the article's content.
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Thursday, August 9, 2012

Interim Guidance for Clinicians Considering the Use of Preexposure Prophylaxis for the Prevention of HIV Infection in Heterosexually Active Adults

via Morbidity and Mortality Weekly Report

In the United States, an estimated 48,100 new human immunodeficiency virus (HIV) infections occurred in 2009 (1). Of these, 27% were in heterosexual men and women who did not inject drugs, and 64% were in men who have sex with men (MSM), including 3% in MSM who inject drugs. In January 2011, following publication of evidence of safety and efficacy of daily oral tenofovir disoproxil fumarate 300 mg (TDF)/emtricitabine 200 mg (FTC) (Truvada, Gilead Sciences) as antiretroviral preexposure prophylaxis (PrEP) to reduce the risk for HIV acquisition among MSM in the iPrEx trial, CDC issued interim guidance to make available information and important initial cautions on the use of PrEP in this population.

Those recommendations remain valid for MSM, including MSM who also have sex with women (2). Since January 2011, data from studies of PrEP among heterosexual men and women have become available, and on July 16, 2012, the Food and Drug Administration (FDA) approved a label indication for reduction of risk for sexual acquisition of HIV infection among adults, including both heterosexuals and MSM.* This interim guidance includes consideration of the new information and addresses pregnancy and safety issues for heterosexually active adults at very high risk for sexual HIV acquisition that were not discussed in the previous interim guidance for the use of PrEP in MSM.

Read the rest.

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*Join IRMA's robust, highly-active. moderated, global listserv addressing rectal microbicide research and advocacy as well as other interesting new HIV prevention technologies by contacting us at rectalmicro@gmail.com. Joining our listserv automatically makes you a member of IRMA - a network of more than 1,100 advocates, scientists, policy makers and funders from all over the world.

*Please look for us on Facebook: www.facebook.com/InternationalRectalMicrobicideAdvocates, and you can follow us on Twitter: @rectalmicro.

*Also, please note that shared news items from other sources posted on this blog do not necessarily mean IRMA has taken any position on the article's content.
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Tuesday, July 31, 2012

Legal barriers and stereotypes block care services for same sex couples

[Citizen News Service and IRMA are collaborating to amplify rectal microbicide research and advocacy, as well as IRMA-led initiatives, throughout AIDS 2012, and after.]

via Citizen News Service, by Jittima Jantanamalaka

Despite alarming HIV rates amongst the men who have sex with men (MSM) and transgender people, many countries, community leaders, media and society at large continue to hold discriminating stereotypes against them. "Punitive laws will drive MSM and transgender populations underground" rightly said Aradhana Johri of Department of AIDS Control, Government of India. In US alone, according to the Centers for Disease Control and Prevention (CDC) report, although Black American MSM people represent only 13 percent of the US population but they account for about 44 percent of the new HIV infections particularly among those aged 13 -19.

Unless we protect the rights of same sex couples to live a life of dignity, and discourage those who are judgemental about their same sex behaviour, not only we will fail to reduce stigma and discrimination associated with HIV and same sex behaviour, but also fuel homophobia and negative perceptions about HIV testing. People will continue to choose to hide their high-risk behaviour and not seek counseling and testing for HIV and other sexually transmitted infections (STIs).

Thursday, July 26, 2012

Anti-HIV rectal microbicide research moves ahead

[Citizen News Service and IRMA are collaborating to amplify rectal microbicide research and advocacy, as well as IRMA-led initiatives, throughout AIDS 2012.]

via Citizens News Service, by Bobby Ramakant

It is indeed promising to note the momentum rectal microbicides research and development has attained, more so when there is a global call to end AIDS at the XIX International AIDS Conference (AIDS 2012). Turning the tide of HIV is not possible unless we have safe and effective HIV prevention options for women and men who practice anal sex. Just before the AIDS 2012 opened in Washington DC, the researchers at Microbicide Trial Network (MTN), University of Pittsburgh, USA, got a green signal to go ahead with a major rectal microbicide clinical trial.

According to Jim Pickett, Chair of International Rectal Microbicides Advocates (IRMA) and Director (Advocacy), AIDS Foundation of Chicago: Rectal microbicides are products currently under research – that could take the form of gels or lubricants – being developed and tested to reduce a person’s risk of HIV or other sexually transmitted infections from anal sex. The risk of becoming infected with HIV during unprotected anal sex is 10 to 20 times greater than unprotected vaginal sex because the rectal lining is only one-cell thick, the virus can more easily reach immune cells to infect.

Tuesday, July 24, 2012

AIDS 2012: The Latest on Rectal Microbicides

via San Francisco AIDS Foundation

What if a lube could help prevent HIV infection during sex? Microbicide researchers and advocates are hoping to answer that question and create a new HIV prevention tool—and a sexy one at that, if rectal microbicides advocate Jim Pickett has his way.

A microbicide is a chemical agent (such as a drug) that could be formulated as a gel, lubricant, douche, or enema and applied vaginally or rectally to reduce the risk of HIV infection during sex. One benefit of using a microbicide is that it puts the HIV-fighting drug exactly where the virus is entering the body during sex. Another is that it would offer an unobtrusive and even pleasure-enhancing HIV prevention option for people who are unable or unwilling to consistently use condoms, as well as for mixed-HIV-status couples trying to have a child.

Thursday, July 12, 2012

HIV and the Law

via the Commission on HIV and the Law

The end of the global AIDS epidemic is within our reach. This will only be possible if science and action are accompanied by a tangible commitment to respecting human dignity and ending injustice.

Law prohibits or permits specific behaviours, and in so doing, it shapes politics, economics and society. The law can be a human good that makes a material diff erence in people’s lives. It is therefore not surprising that law has the power to bridge the gap between vulnerability and resilience to HIV.

We came together as a group of individuals from diverse backgrounds, experiences and continents to examine the role of the law in effective HIV responses. What we share is our abiding commitment to public health and social justice. We have listened with humility to hundreds of accounts describing the eff ects of law on HIV. In many instances, we have been overwhelmed by how archaic, insensitive laws are violating human rights, challenging rational public health responses and eroding social fabric. At other times, we have been moved by those who demonstrate courage and conviction to protect those most vulnerable in
our societies.

Many would say that the law can be complex and challenging and is best left alone. Our experience during this Commission has shown us a very diff erent perspective. We have been encouraged by how frank and constructive dialogue on controversial issues can sometimes quickly lead to progressive law reform, the eff ective defence of legislation or better enforcement of existing laws. Even in environments where formal legal change is a slow and arduous process, we have witnessed countries taking action to strengthen access to justice and challenge stigma and discrimination.

Click here for the full report.

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*Join IRMA's robust, highly-active. moderated, global listserv addressing rectal microbicide research and advocacy as well as other interesting new HIV prevention technologies by contacting us at rectalmicro@gmail.com. Joining our listserv automatically makes you a member of IRMA - a network of more than 1,100 advocates, scientists, policy makers and funders from all over the world.

*Please look for us on Facebook: www.facebook.com/InternationalRectalMicrobicideAdvocates, and you can follow us on Twitter: @rectalmicro.

*Also, please note that shared news items from other sources posted on this blog do not necessarily mean IRMA has taken any position on the article's content.
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Friday, June 15, 2012

Age at First Anal Sex and HIV/STI Vulnerability among Gay Men in Australia

via bmj.com, by Anthony Lyons

ABSTRACT

Objectives To determine whether there is a link between age at first anal intercourse (AFAI) and gay men's HIV/sexually transmissible infection (STI) vulnerability, including tendencies to engage in higher risk sexual behaviour.

Methods A nationwide cross-sectional survey was conducted online involving 845 Australian gay men born between 1944 and 1993.

Results Median AFAI fell from 35 years for men born between 1944 and 1953 to 18 years for men born between 1984 and 1993. Of those who reported having had anal intercourse (N=822), HIV-positive men were found to be significantly younger on average when they first had anal intercourse compared with HIV-negative men (18.5 vs 21.3 years, p<0.001). Men with a history of other STIs were also significantly younger. Engaging in higher risk sexual behaviour is a likely factor, with AFAI generally younger among men who reported >10 sexual partners in the past year (p<0.001) and who engaged in group sex (p<0.001), receptive anal intercourse (p=0.008) or were drug or alcohol affected (p=0.06) during their most recent sexual encounter.

Conclusions There appears to be a strong link between AFAI and infection with HIV/STIs, as well as tendencies to engage in higher risk sexual behaviour. While further research is needed to understand this link, these findings highlight a need for sexuality education aimed at gay-identified youth to ensure their sexual debut does not lead to poorer sexual health outcomes.

Tuesday, May 29, 2012

FDA Hearing on Truvada as PrEP - Watch the Webcast!

On May 10, 2012 the FDA Antiviral Drug Advisory Committee strongly recommended that emtricitabine/tenofovir disoproxil fumarate (TDF/FTC or Truvada) be approved for use as pre-exposure prophylaxis (PrEP) among sexually active adult men and women – particularly gay men and other MSM, serodiscordant heterosexual couples, and other individuals at high risk. It is likely the FDA will follow the committee’s recommendations and issue a new prevention indication for the use of Truvada by mid June.

Watch the recorded webcast here.

Check out the slide presentations here.

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*Join IRMA's robust, highly-active. moderated, global listserv addressing rectal microbicide research and advocacy as well as other interesting new HIV prevention technologies by contacting us at rectalmicro@gmail.com. Joining our listserv automatically makes you a member of IRMA - a network of more than 1,100 advocates, scientists, policy makers and funders from all over the world. *Please look for us on Facebook: www.facebook.com/InternationalRectalMicrobicideAdvocates, and you can follow us on Twitter: @rectalmicro.

*Also, please note that shared news items from other sources posted on this blog do not necessarily mean IRMA has taken any position on the article's content.

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Tuesday, February 28, 2012

Will high risk MSM use over the counter HIV tests?

via Journal of Sex Research, by Alex Carballo-Diégueza, Timothy Frascaa, Curtis Dolezala & Ivan Balana

Abstract

The Food and Drug Administration may license OraQuick™, a rapid HIV test, for over-the-counter (OTC) sale. This study investigated whether HIV-uninfected, non-monogamous, gay and bisexual men who never or rarely use condoms would use the test with partners as a harm-reduction approach. Sixty participants responded to two computer-assisted self-interviews, underwent an in-depth interview, and chose whether to test themselves with OraQuick. Over 80% of the men said they would use the kit to test sexual partners or themselves if it became available OTC. Most participants understood that antibody tests have a window period in which the virus is undetectable, yet saw advantages to using the test to screen partners; 74% tested themselves in our offices. Participants offered several possible strategies to introduce the home-test idea to partners, frequently endorsed mutual testing, and highlighted that home testing could stimulate greater honesty in serostatus disclosure. Participants drew distinctions between testing regular versus occasional partners. Non-monogamous men who have sex with men, who never or rarely use condoms, may nevertheless seek to avoid HIV. Technologies that do not interfere with sexual pleasure are likely to be used when available. Studies are needed to evaluate the advantages and disadvantages of using OTC rapid HIV tests as one additional harm-reduction tool.

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.]

Wednesday, February 15, 2012

Increased risk of anal cancer for all groups with HIV, not just MSM

via Aidsmap, by Michael Carter

Gay men are not the only group of HIV-positive patients who have an increased risk of anal cancer, according to North American research published in the online edition of Clinical Infectious Diseases. The researchers found that incidence of the cancer was also significantly higher in non-gay HIV-positive men as well as HIV-positive women when compared to individuals in the general population.

“We confirmed that HIV-infected MSM [men who have sex with men] experienced the greatest risk of anal cancer,” write the authors. “We also found that both HIV-infected other men and women had substantially higher rates than HIV-uninfected men and women, and that HIV-infected other men and women had similar rates.” They believe that their findings may have implications for anal cancer screening strategies.

Thanks to improvements in HIV treatment and care the prognosis of many HIV-positive patients is now near normal. However, HIV-positive patients appear more likely to develop certain malignancies, including anal cancer, compared to their HIV-negative peers.

Understanding the incidence of anal cancer in the different populations affected by HIV can help develop strategies to prevent the cancer.

Therefore investigators from the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) analysed findings from 13 US and Canadian studies. Their aims was to determine incidence of anal cancer in HIV-positive patients, who were divided into three categories – MSM, other men and women.

Rates of anal cancer in these HIV-positive patients were compared to those observed in HIV-negative men and women. Analyses were also conducted to see if there were temporal trends in anal cancer incidence, and if any specific risk factors for the malignancy in HIV-positive patients could be identified.

A total of 34,000 HIV-positive patients (55% MSM, 19% other men, 26% women) and 110,000 HIV-negative controls (90% men) were included in the study.

Data gathered between 1996 (the year effective HIV therapy first became available) and 2007 were examined by the investigators.

Incidence of anal cancer in MSM was 131 per 100,000 patient years. Among HIV-positive other men incidence of the malignancy was 46 per 100,000 years, and incidence in HIV-positive women was 30 per 100,000 person years. Incidence was therefore significantly higher in HIV-positive MSM compared to other men (p < 0.01). However, incidence rates for HIV-positive other men and women did not differ significantly.

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.]

Tuesday, January 31, 2012

Identifying at-risk populations to enroll and maintain in HIV prevention trials

via PubMed, by Price MA, Rida W, Mwangome M, Mutua G, Middelkoop K, Roux S, Okuku HS, Bekker LG, Anzala O, Ngugi E, Stevens G, Chetty P, Amornkul

"Finding, enrolling, and retaining risk populations for HIV prevention trials is challenging in Africa. African MSM are not frequently engaged for research, have high HIV incidence, need urgent risk reduction counseling, and may represent a suitable population for future HIV prevention trials."

Objective

To identify and describe populations at risk for HIV in 3 clinical research centers in Kenya and South Africa.

Design

Prospective cohort study.

Methods

Volunteers reporting recent sexual activity, multiple partners, transactional sex, sex with an HIV-positive partner, or, if male, sex with men (MSM; in Kenya only) were enrolled. Sexually active minors were enrolled in South Africa only. Risk behavior, HIV testing, and clinical data were obtained at follow-up visits.

Results

From 2005 to 2008, 3023 volunteers were screened, 2113 enrolled, and 1834 contributed data on HIV incidence. MSM had the highest HIV incidence rate of 6.8 cases per 100 person-years [95% confidence interval (CI): 4.9 to 9.2] followed by women in Kilifi and Cape Town (2.7 cases per 100 person-years, 95% CI: 1.7 to 4.2). No seroconversions were observed in Nairobi women or men in Nairobi or Cape Town who were not MSM. In 327 MSM, predictors of HIV acquisition included report of genital ulcer (Hazard Ratio: 4.5, 95% CI: 1.7 to 11.6), not completing secondary school education (HR: 3.4, 95% CI: 1.6 to 7.2) and reporting receptive anal intercourse (HR: 8.2, 95% CI: 2.7 to 25.0). Paying for sex was inversely associated with HIV infection (HR: 0.2, 95% CI: 0.04 to 0.8). 279 (13.0%) volunteers did not return after the first visit; subsequent attrition rates ranged from 10.4 to 21.8 volunteers per 100 person-years across clinical research centers.

Conclusions

Finding, enrolling, and retaining risk populations for HIV prevention trials is challenging in Africa. African MSM are not frequently engaged for research, have high HIV incidence, need urgent risk reduction counseling, and may represent a suitable population for future HIV prevention trials.

[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.]

Wednesday, January 25, 2012

PrEP: Attitudes and Acceptance Among Potential User Groups

via PLoS One, by Andreas B. Eisingerich, Ana Wheelock, Gabriela B. Gomez, Geoffrey P. Garnett, Mark R. Dybul, Peter K. Piot

Background

The use of antiviral medications by HIV negative people to prevent acquisition of HIV or pre-exposure prophylaxis (PrEP) has shown promising results in recent trials. To understand the potential impact of PrEP for HIV prevention, in addition to efficacy data, we need to understand both the acceptability of PrEP among members of potential user groups and the factors likely to determine uptake.

Methods and findings

Surveys of willingness to use PrEP products were conducted with 1,790 members of potential user groups (FSWs, MSM, IDUs, SDCs and young women) in seven countries: Peru, Ukraine, India, Kenya, Botswana, Uganda and South Africa. Analyses of variance were used to assess levels of acceptance across different user groups and countries. Conjoint analysis was used to examine the attitudes and preferences towards hypothetical and known attributes of PrEP programs and medications. Overall, members of potential user groups were willing to consider taking PrEP (61% reported that they would definitely use PrEP). Current results demonstrate that key user groups in different countries perceived PrEP as giving them new possibilities in their lives and would consider using it as soon as it becomes available. These results were maintained when subjects were reminded of potential side effects, the need to combine condom use with PrEP, and for regular HIV testing. Across populations, route of administration was considered the most important attribute of the presented alternatives.

Conclusions

Despite multiple conceivable barriers, there was a general willingness to adopt PrEP in key populations, which suggests that if efficacious and affordable, it could be a useful tool in HIV prevention. There would be a willingness to experience inconvenience and expense at the levels included in the survey. The results suggest that delivery in a long lasting injection would be a good target in drug development

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.]

Monday, January 23, 2012

Reasons behind high risk behaviors in Chinese MSM

via BMC Public Health, by Guanzhi Chen, Yang Li, Beichuan Zhang, Zengzhao Yu, Xiufang Li, Lixin Wang, Ziming Yu

Background

Men who have sex with men (MSM) have become a high-risk group of HIV infection in China. To date, little is known regarding the behavioral, social and psychological characteristics in Chinese MSM, which makes the implementation of preventive and therapeutic strategies for this high-risk subpopulation of people extremely difficult.

Methods

A total of 714 questionnaires were retrieved from the database of a Chinese government-sponsored National Key Research Project titled "Risk Analysis and Strategic Prevention of HIV Transmission from MSM to the General Population in China". The respondents were categorized into a high-risk group and a control group. Their behavioral, social and psychological characteristics were comparatively analyzed.

Results

Of the 714 MSM analyzed, 59 (8.26%) had high-risk homosexual behaviors. This sub-group of MSM had a higher in-marriage rate, a higher monthly income, heavier alcohol consumption and more serious problems with sexual abuse in childhood, intentional suicide attempts and mistaken assumption on condom's role in protecting HIV infection, as compared with the control group (P < 0.05). In contrast, the two groups did not differ significantly the sexual orientation, level of education, types of profession, drug use, condom use and experience of social stigma and discrimination (P > 0.05). A vast majority of the individuals in both behavior categories expressed support of legally protected gay clubs as well as gay marriage legislation in China. There was a strong correlation between high-risk behaviors and sexual abuse in childhood, alcohol drinking, income level and a mistaken belief in perfect HIV protection through the use of condoms.

Conclusions

MSM with and without high-risk homosexual behaviors have different social and psychological characteristics, which should be taken into account when implementing behavioral and therapeutic interventions aimed at preventing HIV/AIDS transmission among MSM as well as from MSM to the general population in China.

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.]

Wednesday, January 4, 2012

USAID Technical Brief: Human Rights Considerations in Addressing HIV Among MSM

via USAID, by AIDSTAR-One Project

Just as I was very proud to say the obvious more than 15 years ago in Beijing—that human rights are women’s rights and women’s rights are human rights—let me say today that human rights are gay rights and gay rights are human rights.

–Hillary Clinton, U.S. Secretary of State (U.S. Department of State 2010)

Introduction
Men who have sex with men (MSM) face a disproportionate share of the HIV epidemic throughout the world (Baral et al. 2007; Cáceres et al. 2008), and in low- and middle-income countries bear a greater burden of the epidemic relative to the general population. In many countries, the HIV risk to MSM is exacerbated by social, cultural, and political factors. These include cultural biases against MSM, limited access to information and services, low national investments in health, and legal, institutional, or social barriers, including negative bias among providers, that make it difficult for MSM to negotiate safe sex or obtain adequate services for preventing and treating HIV and other sexually transmitted infections (STIs). This situation is compounded by adverse human rights environments— for example, in settings where same-gender sexual relationships are illegal—where MSM may fail to seek treatment because doing so may lead to harassment, refusal of services, arrest, or violence.

Yet international consensus and recommendations— including the 2011 United Nations (UN) Political Declaration on HIV/AIDS, to which the United States was a signatory—recognize the vulnerability of MSM to HIV and endorse national and international efforts to include MSM in HIV programming and address discriminatory laws and practices that keep this group from obtaining services. In keeping with this consensus,the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) has issued guidance on developing comprehensive programming to reduce HIV among MSM.

This AIDSTAR-One technical brief provides a systematic global review and synthesis of practical approaches, program examples, and resources to support human rights as a core element of HIV programming for MSM. The brief complements and is aligned with other global and regional publications that have relevance to human rights, health programming, HIV, and MSM.(1) This document gives an overview of U.S. policies on and commitments to MSM and human rights, and outlines recommended approaches, including program examples in various countries, for linking health and human rights to address HIV among MSM. It also offers a synthesis of questions for developing and monitoring HIV programs for MSM, and a list of program resources.

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.]

Wednesday, December 21, 2011

Ongoing risk behaviour likely cause of high HIV incidence rate among gay men treated with PEP

via Aidsmap, by Michael Carter

HIV incidence is high among gay men who use post-exposure prophylaxis (PEP), investigators from Amsterdam report in the online edition of AIDS.

Overall, users of PEP were almost four times more likely to become infected with HIV than gay men who did not use the therapy.

There was no evidence that PEP failure was the cause. The investigators believe this is because PEP users continued to put themselves risk of HIV after completing their treatment.

“Our study showed a high incidence of HIV among MSM [men who have sex with men] who used PEP, an indication of ongoing risk behaviour,” write the investigators. “This implies that PEP alone for this group is not sufficient to prevent HIV infection, and a combination of other more comprehensive preventative strategies is needed.”

HIV post-exposure prophylaxis is a four-week course of combination antiretroviral therapy, prescribed after an encounter with body fluids possibly infected with HIV.

It is estimated that the treatment can reduce the risk of infection by up to 81%.

Gay men are the group most likely to request PEP after a possible sexual exposure to HIV. Australian research has shown that gay men who used PEP continued to be at risk of HIV after completing their treatment.

Therefore, Dutch investigators compared HIV incidence among gay men prescribed PEP in Amsterdam between 2000 and 2009, and compared this to the rate of new infections seen over the same period among gay men enrolled in the Amsterdam Cohort Study.

A total of 355 men who received 395 PEP prescriptions were included in study. The majority of individuals took one course of PEP, but approximately 10% of men were provided with multiple prescriptions (two to four).

Adherence rates were high, with 94% of men completing their therapy. HIV status was monitored three and six months after baseline.

Eleven PEP users seroconverted. Two men tested HIV-positive at their three-month follow-up appointment; one individual who did not attend for his three month appointment was diagnosed at month six; and the remaining eight men were HIV-negative at month three, but were HIV-positive at month six.

This provided an HIV incidence of 6.4 per 100 person years among the individuals treatment with PEP.

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.]

Tuesday, December 20, 2011

Beliefs associated with unprotected sex are changing among gay men in Australia

via Aidsmap, by Roger Pebody

A study of Australian gay men examining unprotected sex and the beliefs that are associated with it has found that the concept of ‘treatments optimism’ needs to be unpacked. While some men do think that having HIV is less serious than it used to be, there is more of an association between unprotected sex and men believing that treatments have made HIV-positive people less infectious.

But writing in the journal Sexually Transmitted Diseases, the researchers warn that the relationships between information, beliefs and behaviour are not straightforward, with individuals managing risk, desire and pleasure in complex ways.

Soon after the advent of combination therapy, commentators began to explain unprotected sex in gay and bisexual men in terms of ‘treatments optimism’ – the theory that reductions in illness and death had caused men to be less concerned about HIV infection, and so more willing to have unprotected sex. While a number of studies have confirmed an association between beliefs characteristic of treatments optimism and risk behaviour, it is unlikely that such beliefs – held by a minority of men – are sufficient to explain rising infection rates in gay men.

Moreover, there has always been controversy over whether treatment optimism leads to unprotected anal sex, or whether it is a way in which men rationalise their sexual behaviour, after the event.

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.]

Tuesday, November 22, 2011

MSM living in hostile social environments more likely to have negative feelings about sexuality, less likely to test for HIV

via aidsmap, by Roger Pebody

The largest ever international study of the sexual health of men who have sex with men (MSM), which recruited men from across the European continent, has found clear links between the social environment men live in and their own internal acceptance of their sexuality. Furthermore, men with 'internalised homonegativity' were much less likely to test for HIV.

These European results are to some extent confirmed by a study from the United States, which found that men living in states that are hostile to gay issues were more likely to have internalised homonegativity than men living in more tolerant states. However the American researchers found that the relationship between men's feelings about their sexuality and unprotected sex was quite weak.

Preliminary results from both studies were presented to the Future of European Prevention among MSM (FEMP) conference in Stockholm last week.

While the term 'homophobia' is probably better known than 'homonegativity', a number of researchers prefer the latter as it does not suggest that negative attitudes to homosexuality and homosexuals are fundamentally driven by fear. Public expressions of homonegativity may include discriminatory laws, personal rejection by family and friends, violent attacks in public spaces, disapproval from religious authorities and hostile newspaper articles.

When gay, bisexual and other men who have sex with men have negative or ambivalent feelings about their own sexuality, this is termed 'internalised homonegativity'. It has been defined as "the gay person's direction of negative social attitudes toward the self, leading to a devaluation of the self and poor self-regard".

While it may seem obvious that negative social environments can create negative psychological states, the link between social factors at a country level and men's internalised homonegativity has not been clearly demonstrated before.

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.]

Thursday, October 20, 2011

What HIV-Positive MSM Want from Sexual Risk Reduction Interventions: Findings from a Qualitative Study

via pubmed.gov, by Vanable PA, Carey MP, Brown JL, Littlewood RA, Bostwick R, Blair D

Abstract

To facilitate the development of a tailored intervention that meets the needs of HIV-positive men who have sex with men (HIV-positive MSM), we conducted formative research with 52 HIV-positive MSM. We sought to (a) identify major barriers to consistent condom use, (b) characterize their interest in sexual risk reduction interventions, and (c) elicit feedback regarding optimal intervention format. Men identified several key barriers to consistent condom use, including treatment optimism, lessened support for safer sex in the broader gay community, challenges communicating with partners, and concerns about stigmatization following serostatus disclosure. Many men expressed an interest in health promotion programming, but did not want to participate in an intervention focusing exclusively on safer sex. Instead, they preferred a supportive group intervention that addresses other coping challenges as well as sexual risk reduction. Study results reveal important considerations for the development of appealing and efficacious risk reduction interventions for HIV-positive MSM.

[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.]

Sunday, August 14, 2011

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.]

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