Rectal Microbicides Seen As Key in Preventing New HIV transmissions

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

via Citizen News Service, by Chief K.Masimba Biriwasha

Unprotected anal sex has long been regarded as a key driver of HIV transmission in many parts of the world, especially among men who have sex with men. In many contexts, the practice is surrounded with stigma and discrimination which is a key barrier to developing protective measures, and largely pushes affected populations to go underground far from the reach of public health services as well as HIV prevention tools.

There is a growing recognition that to turn the AIDS tide and avoid uneccessary deaths, there is a need to develop new HIV prevention tools such as rectal microbicides for women, men, and transgender individuals around the world who engage in anal intercourse.

Read the rest.

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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.]

Casual Sexual Encounters Among Gay Men: Familiarity, Trust and Unprotected Anal Intercourse

Iryna B. Zablotska1, Andrew E. Grulich, John De Wit and Garrett Prestage

Published online: 8 April 2010

Abstract:

Familiarity with and a history of prior sex with casual partners is associated with unprotected anal intercourse and may increase the risk of HIV transmission among gay men. Using data from the Sydney Gay Community Periodic Survey 2007, we explored the relationship between familiarity and unprotected anal intercourse with the last casual partner (UAI-LC). 51% of the men knew their last casual partner and 49% had previously had sex with him. Men were more inclined to engage in UAI-LC if they had previously had sex with this partner. HIV-negative men were more likely to have UAI-LC with a more familiar partner independent of his serostatus. Familiarity with and a previous history of sex between casual partners may result in a false sense of trust and may increase the risk of HIV transmission. HIV prevention services should address this issue and develop programs to improve men’s skills in negotiating safer sex.

Anal cells appear to be the major HIV risk factor

via GayNZ.com

The risk of anal transmission of HIV appears to be more associated with the presence and concentration of vulnerable cells than to low level physical damage associated with anal sex, according to information presented to a sexual health conference at the weekend.

Anal sex, sexually transmitted infections among gay men, and biological infection risk factors were hot topics at the 21st NZ Sexual Health Society conference which convened in Paihia.

Read the rest.  

Unprotected sex between HIV-infected partners keeps immune responses activated

Crabb, Charlene

AIDS. 23(11):N7, July 17, 2009.

HIV acts as a ‘natural immunogen’, keeping anti-HIV-1 immune responses boosted in HIV-infected male couples who have unprotected sex, say University of California San Francisco researchers [original article from UCSF researchers: PLoS Pathog 2008; 4:e1000185].

Until now, little has been reported on the consequences of continued exposure to HIV in people who are already infected. But serosorting, the practice of identifying sexual partners based on their HIV status, is a growing trend. It often leads to unprotected sex between HIV infected individuals, which poses the risk of acquiring a drug-resistant strain of the virus.

To shed light on the immunological consequences of continued exposure to HIV, Christian Willberg and colleagues studied 49 men, from a San Francisco prospective cohort of couples in long-term relationships, who were suppressing their virus below the detection level (50RNAcopies/ml) with HAART. Twenty-nine men had partners whose virus was also in check due to antiviral therapy, whereas 20 men had viremic partners whose viral loads were more than 90 000RNAcopies/ml.

Using enzyme-linked immunosorbent spot (ELISPOT) assay to compare HIV-1-specific T-cell responses between the two groups, the researchers found significantly stronger (P¼0.001) responses against HIV-1 protease, reverse transcriptase, and integrase peptides in the men with viremic partners. The magnitude of their responses correlated with a greater frequency of unprotected sex, and in particular with the frequency of exposure through receptive (versus insertive) anal sex. No similar correlations were found in the men with nonviremic partners.

‘Rather than losing responses because their own virus has been suppressed by antiviral therapy,’ explains Willberg, ‘we found that the men are maintaining a response because they are constantly being exposed to their partner’s virus.’

That the amount of exposure drives the boosted HIV-1- specific immune responses was also illustrated in three individuals from the viremic partner group whose T-cell responses dropped significantly a year later. Two had partners who started antiretroviral therapy and were suppressing their viral loads. The third had reduced his exposure. (Seven individuals from the viremic partner group had blood samples available froma 1-year followup.)

The researchers note that superinfection is the most likely mechanism to maintain or boost the HIV-1 immune responses. However, HIV-1 sequencing of all participants in the study found no evidence of superinfection at the systemic level in which a new virus overgrows the existing strain. Willberg, who is now at Oxford University, cautions that the study’s phylogenetic analysis does not rule out localized superinfections in the gut, most likely the rectum.

Furthermore, no one knows whether maintaining a high T-cell response is good or bad. Willberg says that keeping an active HIV-1 immune response might help control viral rebound in a person when antiviral therapy fails for some reason, or it could indicate a compartmentalized superinfection and the increased risk of acquiring a drug-resistant strain. ‘It could be a double-edged sword,’ he says.