Rise in Over 50s HIV Infections

posted: 21/07/2010

People over 50 are as much at risk from unsafe sex as younger people, the UK’s Health Protection Agency (HPA) has just warned. Today it revealed evidence, at the International AIDS Conference in Vienna, that the number of people over 50 who are catching HIV has more than doubled in seven years.
 

In 2000 there were just 299 new HIV infections among the over-50s, according to the HPA. But in 2007 there were 710 people infected.
 

Gay and bi men are the majority infected when older, but white heterosexual men infected abroad - typically in Thailand - are another significant group of older men who are diagnosed.

Late diagnosis common
Half of those diagnosed when over 50 were diagnosed late. Younger people are much less likely to be diagnosed late. Late diagnosis is bad news when you are older - during the eight year study period three quarters of the deaths among people aged 50 and over occurred within one year of the diagnosis, with half of those diagnosed late. Unfortunately, late diagnosis with HIV reduces people's life expectancy and quality of life. If treatment is started late it cannot undo all the unnoticed damage already caused by HIV.

Some people diagnosed after 50 were infected when they were younger. After some early symptoms (such as flu-like symptoms with a rash), many people after HIV infection remain apparently fit, healthy and continue to feel well, without suspecting they have HIV, for as long as 10 years.

Most are recently infected by risky sex
But half of the over-50s diagnosed had recently been infected, through taking chances without condoms.

Getting away with risks in your earlier years doesn't mean that luck will continue.

Letting down your guard just because you are older can still catch anyone out. We often hear older people say, rather sheepishly, 'I should have known better'.
 

Keep on testing - and condoms
"This highlights the importance of HIV testing, whatever your age," said Ruth Smith, a senior HIV scientist at the HPA's Centre for Infections. "We must continually reinforce the safe sex message – using a condom with all new or casual partners is the surest way to ensure people do not become infected with a serious sexually transmitted infection such as HIV."
 

Her co-author, Dr Valerie Delpech, head of HIV surveillance at the HPA, said people in the older age group needed to be aware that they were just as much at risk as young people if they had unsafe sex.
 

"Although adults aged 50 and over account for just 8% of all new HIV diagnoses, the fact that cases have more than doubled in recent years serves as a timely reminder that anybody is at risk of HIV infection if they do not use protection and practise safe sex," she said.
 

More information from HPA

Source
 

Teens' Unplanned Pregnancies

posted: 04/05/2010

Around one in seven adolescent females with HIV became pregnant, according to a recent check at UK HIV clinics. Most of the pregnancies were unplanned and a quarter were ended. Although there were problems with adherence to HIV treatments medication among many of the young women, none of the women transmitted HIV to their baby.

These pregnancies highlight the need for sexual health education for young people who acquired HIV from mother-to-child transmission in the 1980s and 1990s. To help health professionals with this work, the HIV in Young People Network (HYPNET) and the Children’s HIV Association (CHIVA) have just produced a draft guide for managing the sexual and reproductive health of HIV+ adolescents.

19 clinics responded to a survey of all mother-to-baby infected young women aged twelve or over. There were 172 young women, and 27 young women had a total of 36 pregnancies.

Of the 36 pregnancies:

• 75% were unplanned
• 86% involved regular partners
• 39% of partners were not aware of the woman’s HIV status
• 25% of the pregnancies were terminated
• 14% ended in miscarriage
• 50% resulted in a live birth and
• 11% were still pregnant at the time of the report.

Most mothers had detectable HIV

Of the 18 live births, 89% of the mothers were on combination therapy at the time of delivery.
In only 8 (44%) of the live births did the mother have an undetectable viral load of <50 copies/ml before delivery. 80% of mothers had poor adherence to treatment during pregnancy, with two being given Directly Observed Therapy (DOT).

One third of the babies were premature and five required neonatal intensive care. Three had a low birth weight. No congenital anomalies were reported. No cases of HIV transmission were recorded.

Two-thirds of the young mothers were reported as having complex social needs, with one quarter of their babies requiring foster care.

Draft guidelines

The first ever guidance for managing the sexual and reproductive health of HIV-positive adolescents has been produced. The document makes it clear that, even if the issue is not raised by the young person, then paediatricians should take responsibility for covering sexual health education and needs during consultations, with the process starting well before sexual maturity is reached. The guidance states that HIV-positive adolescents require the same sexual health information as their HIV-negative peers, as well as further help on applying it while living with HIV.

Topics which need to be discussed include preventing the transmission of HIV and other sexually transmitted infections; contraception; symptoms and treatment of sexually transmitted infections; vaccinations; HIV disclosure; post-exposure prophylaxis; conception options and fertility issues; pregnancy and avoiding mother-to-child transmission; options if there is an unplanned pregnancy; sexual exploitation and sexual violence; sexual difficulties; psychological support for negotiating safe sex, self-assertion, bullying or other issues.

How to work with young people with HIV

The guidance explores some of the issue involved in delivering sexual health work with this age group. Sexual health services for young people should be confidential (without disclosure to a parent or guardian), provided that the young person is assessed as being ‘Gillick competent’ (has the maturity to make their own decisions and to understand the implications of them). For under 16s, Gillick competence needs to be assessed at each clinical visit as it can change over time.

The guidance notes that adolescents value consultations that are non-judgemental, give them correct information and which maintain confidentiality. Professionals are encouraged to use simple language, check understanding and not overload adolescents with too much information. They should not make assumptions about whether the young person is sexually active or what their sexuality is.

The draft guidance is open for comments and feedback until May 28.

Source with references

Cheaper Female Condoms

posted: 17/04/2009

A cheaper, more user-friendly female condom could have a vastly bigger impact in the global fight against HIV. Female condoms are important - at present they are the only woman-controlled means of protection against HIV. The first female condom was introduced in 1993.

Yet despite promotion by the United Nations and others, female condom use is still tiny, although women are more likely to become heterosexually infected than men.

The USA's Food and Drug Administration approved FC2, a new version of the female condom produced by the Chicago-based Female Health Co.

About 35 million female condoms were distributed worldwide last year, but that compares to more than 10 billion male condoms, which are far cheaper, familiar and a bit easier to use. However, many men refuse to use condoms, putting women at risk.

Made from cheaper material

Though the new female condom looks like the one we already have - a soft, transparent sheath with flexible inner and outer rings - the FC2 is made from synthetic rubber rather than polyurethane, making it cheaper to produce.

Quiet to use

Mary Ann Leeper, of Female Health Co. said the FC2 also is less noisy during use. People complained the original squeaked during use, which is embarrassing.

The developing world price for the current female condom is about $1 each and the cost of the FC2 is one-third less, and may fall if production rises, enabling health organizations to distribute many millions more than at present.

For now, the price will be about US$0.60c (mass-distributed male condoms cost very much less, $0.06c each. This price difference is still huge and a major issue in the developing world. If your income is $1 a day you are not able to buy these, but might conceivably manage to buy male condoms at 4 cents. However if demand rises FC2 production costs should fall and the price halve to about 25 cents.

The Female Health Co. distributed 14 million of the new FC2s last year along with 21 million of the original. The FDA announcement was welcomed by HIV prevention advocates because it means the U.S. Agency for International Development (USAID), one of the largest global providers of condoms, can now distribute them.

"If presented in the right way, many women do like it," Hoffman said. "To find these people and help them and train them, you need systematic programming, which costs money."

Resistance is less of a problem in some developing nations. The U.N. Population Fund, government agencies and nonprofits are aggressively promoting female condoms in places such as Brazil, Ghana, Zimbabwe and South Africa.

Zimbabwean and Ghanaian Women's Demands

Women's groups in Zimbabwe collected more than 30,000 signatures demanding access to the female condom. In Ghana, nonprofits say more than 10,000 people have attended training programs that teach women how to insert female condoms — they require careful instruction to be used properly — and how to negotiate with their male partners.

"The mindset is changing, but there are still a lot of challenges," said Bidia Deperthes, the Population Fund's HIV technical adviser for condoms. "Accessibility is still minimal. There's a huge demand, and we're not meeting it."

50 million target

Deperthes hopes that with FDA approval of the FC2, the number of female condoms distributed globally could climb to 50 million this year. If the numbers keep rising, she said, the cost to public-sector distributors for each FC2 could drop as low as 25 cents.

Women friendly

Another challenge is a stigma associated with the female condom in some places because prostitutes are among those deemed to benefit most from using it. On the other hand, advocates of the female condom say it has invaluable safe-sex potential for married women whose husbands are unfaithful and shun male condoms.

Serra Sippel, executive director of the Center for Health and Gender Equity in Washington, said FDA approval of the FC2 is a key step toward "putting the power of prevention in women's hands." But she bemoaned the product's limited over-the-counter availability.

"We'd love to see the profile raised, to have commercials about it and normalize it so people aren't embarrassed," she said.

The female condom's advocates stress that it will never be the "magic bullet" that by itself turns the tide in fighting AIDS. But, they say, it should be a bigger part of the arsenal.

"It's not going to be the one answer," Hoffman said. "But it's got a lot more to contribute than it has to date."

Other women's prevention

Efforts are being made to develope vaccines and microbicides that will also put women in a far better position to protect themselves, but results are disappointing and there have been many failures so far.

Source