Let's Talk About Sex - A Sexual Health Workshop

posted: 17/02/2012

This evening workshop aims takes place at GHT on Wednesday 14th March from 5 p.m. until 9 p.m.

The workshop aims to explore what sexual health means to you, learn more about how to look after your sexual health and is a chance to ask those questions that you have always wanted the answers to!

Food will be provided, and although there will not be a crèche, we may be able to support childcare.

To confirm a place, please email Nathan on or call us on 0161 274 499.

Treatment Protects Partners

posted: 13/05/2011

There’s been a lot of publicity in the last day or so about HIV treatment helping stop the spread of HIV. 96% of HIV transmissions among couples are blocked by early treatment of the partner with HIV, was the headline result from a multinational study.

The results were so striking that the study was stopped three years early and everyone with HIV who was not already on HIV treatment was immediately offered HIV treatment.

The results show that treating people living with HIV is at least as good as using condoms to prevent HIV transmission.
 

Universal access to treatment goal
This treatment for prevention success offers an extra reason for pushing the world to achieve the internationally agreed World Health Organisation goal of universal access to HIV treatment, prevention and care. The goal was to reach universal access by 2010, but better late than never. Millennium Development Goal 6 includes halting and beginning to reverse the spread of HIV/AIDS by 2015.
 

Gay men too?
The study included hardly any gay couples (only 3% were gay), so the results don’t prove a 96% reduction in transmission in gay couples. Other evidence already strongly suggests gay men living with HIV on successful treatment are also much less likely to transmit HIV, but probably not by the same amount. (Anal sex is riskier than vaginal sex for passing on HIV, gay men tend to have more partners than heterosexual couples, and other sexually transmitted infections also raise the risks).
 

What they found
The study began in 2005 of 1763 couples where one partner has HIV and the other did not (97% were heterosexual couples). They wanted to find out whether HIV treatment prevented the uninfected partner from getting HIV. It was an international study at 13 sites in Botswana, Brazil, India, Kenya, Malawi, S Africa, Thailand, USA (only one couple were from the USA), and Zimbabwe.
 

They split the couples in half randomly and half the partners with HIV immediately started HIV treatment (with CD4 counts higher than normal for starting treatment at between 350 and 550). The other half of positive partners only started treatment when their CD4 count fell to 250 or less, or they developed an AIDS defining illness.
 

• 39 (2.2%) of the negative partners out of 1763 got HIV
• Up to 11 of the 39 got HIV from someone else, not their partner in the study
• 28 (1.5%) got HIV from their partner in the study, and all but one of those were infected by positive partners who were in the delayed treatment half of the study.

That result was so stark they stopped the study and offered immediate treatment to everyone with HIV not already on treatment because the prevention effect of early treatment was so clear. Early treatment also prevented partners from getting tuberculosis (TB) with only 3 of the people treated early getting TB, compared with 17 of those treated after their CD4 count fell below 250. There were slightly more deaths among the deferred treatment group, but the difference was not statistically significant.
 

You can read the report from the US National Institute of Allergy and Infectious Diseases here  and their Q&A page about the study here
 

Aidsmap’s report

Answers in Untested Mystery

posted: 12/04/2011

HIV experts in England are puzzled why some people using STI clinics refuse HIV tests. We know for sure that some of those refusing HIV tests do have HIV (from using blood from samples given for syphilis tests and after the syphilis test is done and the blood sample is made completely anonymous, it can be tested for HIV).

The 2009 results from doing this show that 2.4% of gay and bisexual men and 0.25% of heterosexuals tested for syphilis came to the sexual health clinic with undiagnosed HIV.

But only 63% of these people agreed to a HIV test at the STI clinic - much lower than the average rate of HIV testing for people using STI clinics.

Why are so many people who have ‘undiagnosed’ HIV, refusing HIV tests?

One quarter must already know they have HIV - they are taking HIV treatment !

Some useful answers to the testing mystery have now emerged. Now we know that around a quarter of people with ‘undiagnosed’ must know they have HIV, because blood tests prove they are taking HIV treatment. These and other results, given at the British HIV Association conference in Bournemouth last week, are the first clear evidence of some answers to the ‘undiagnosed’ mystery.
 

Slightly more heterosexual women and men (32% for both men and women) than gay men (24%) are using a different clinic for STI checks than for their HIV treatment. Experts thought gay men with HIV were more likely to go elsewhere for HIV checks than heterosexuals. Experts don’t always guess right. Some people with HIV have told community organisations and patient advocates that one reason they go elsewhere for testing is to avoid unwanted, intrusive or judgemental discussion of their sexual behaviour by their own HIV clinic.
 

The results means

• 9 in 100 of the gay and bisexual men who said yes to a syphilis test but no to a HIV test have HIV. At least 2 of those 9 are on treatment but didn’t tell the STI clinic they have HIV
• 8 in 1000 of the heterosexual women and men similarly are HIV positive. At least 2 of those 8 are on treatment but did not tell the STI clinic they have HIV.
   

These findings will make little difference to national estimates of how much undiagnosed HIV there is in the country.
 

Why do gay men who don’t yet know they have HIV refuse HIV tests?
Another small study given to last weeks conference looked at why some gay men refuse HIV tests. Researchers gave an anonymous questionnaire to 19 men who didn’t want to be tested, even though they had had anal sex without condoms and have, either never been tested, or had taken anal sex risks since their last HIV test.

The men could tick more than one reason.
 

15 of the 19 men said they believed they were at low risk of HIV infection [2 of the 19 men knew their partner has HIV]

• 14 said they were emotionally unprepared for a positive result
• 4 said they don’t like giving a blood [but nonetheless gave this to have the syphilis test]
• 4 also mentioned prosecutions for HIV transmission
• 4 said they were planning to test 'next month'
• 3 mentioned worries about the confidentiality of the HIV test result.

Testing Advantages well known

Most of the men know the advantages of HIV testing

• 16 said testing could give peace of mind
• 16 said testing allows treatment to start at the best time.

Testing worries rule

But all the gay men listed the disadvantages to them of HIV testing.

• 17 said testing was stressful
• 8 were worried about having to tell a boyfriend if they were positive
• 7 were concerned about the insurance and mortgage implications.

Unready for positive result, testing stress, in denial about risks

So most of these gay men didn’t feel emotionally ready to deal with a positive result, and find HIV testing stressful.

• Most thought their HIV risk was low, despite having taken enough risks to have got HIV and needing to visit an STI clinic.

The study authors suggest investigating ways of overcoming gay men’s resistance to testing at STI clinics.
 

Source 
Reference – the free conference abstracts - read O13 & P152

Fresh Gay Men’s HIV Prevention

posted: 16/03/2011

HIV prevention work for gay and bi men in England has been freshened up in the latest edition of Making it Count. Making it Count is the HIV prevention framework used in England by gay men’s and other HIV prevention organisations.
 

Making it Count first appeared in 1998 and the new edition describes how to do HIV prevention and education with gay and bisexual men. It’s been totally rewritten and is available here. It's produced by the CHAPS gay men's HIV prevention and sexual health partnership.

George House Trust is not part of CHAPS but we play a lively and active role. At the CHAPS conference last week we made two conference presentations based on our experience of the sexual health and HIV support needs of HIV+ gay and bi men.

George House Trust also made detailed comments and suggestions for improving the latest Making It Count.

Risky Choices

The new edition of Making It Count considers the various choices facing men who have sex with men that make a difference to HIV transmission, and puts more emphasis on what motivates and drives men in making these critical decisions on sexual risks.

Making It Count brings education and empowerment together in HIV prevention, in a way that values and respects gay and bi men, including men with HIV. It includes using social norms to influence men’s sexual behaviour.

Best Sex with Least Harm
Making It Count aims to promote the best sex with the least harm among gay men and bisexual men.

Making It Count Briefing Sheets

Making It Count Briefing Sheets are also available. These are handy summaries of the evidence on important HIV prevention and sexual health issues.

Making It Count Briefing Sheets already available are 

• Using fear in HIV prevention
• Herpes
• LGV
• Gonorrhoea, chlamydia and non-gonococcal urethritis (NGU)
• Hepatitis C
• Social marketing.

Future Briefings will soon be added for

• Poppers
• Microbicides
• PEP
• Undiagnosed HIV infection.

Making It Count Briefing Sheets

Making It Count from Sigma Research

Treating to Prevent HIV

posted: 03/03/2011

Could people who do not have HIV use HIV treatment drugs (PrEP) to stop themselves from getting HIV? The detailed results just out for gay and bi men are better than the early findings. This means PrEP could be approved for use in the USA by the end of the 2011.

Last year, the first results from a study of gay and bisexual men appeared. Taking PrEP cuts gay and bi men’s risk of getting HIV. But there were worries because many of the men did not take all the tablets. Some men got HIV.

HIV infection
Much better updated results were announced at the CROI conference in Boston, USA, that has just ended.

In the different places where the trial took place, including South Africa, the taking of PrEP (HIV drugs to prevent HIV infection) varied a lot.

Gay and bi men in the two USA cities (Boston and San Francisco) of the international iPrEx study of tenofovir/FTC (Truvada) had near-perfect HIV-prevention drug taking, compared with 50% tablet taking at the other sites.
 

And the men taking the greatest sexual risks for HIV, by having unprotected receptive anal sex, were taking the prevention treatment better than men taking less HIV risks – which is good to know.
 

USA approval within a year?
Lead investigator Bob Grant announced that the US Food and Drug Administration (FDA) had agreed that the trial results were good enough for the FDA to consider allowing the use of Truvada to prevent HIV. PrEP, as a result, might be approved in the USA by the end of this year.
 

First USA Guidelines for gay men published

Interim Guidance: Pre-exposure Prophylaxis for the Prevention of HIV Infection in Men Who Have Sex with Men from USA Centers for Disease Control and Prevention. 

2500 men and the results

There were almost 2500 men in this trial and 130 of them got HIV by the end. Like most drug trials men were randomly split into two groups and told they would either get Truvada, or a dummy pill, but no-one would know who was taking what, until the end. The men were therefore warned they should still use condoms, because half were using the dummy pill.
 

48 of the men who got HIV took the Truvada and 82 of the men who were taking the dummy pills, a HIV infection rate of 2.6% a year. Another 10 other men have HIV, but they already had the symptoms of HIV infection when they joined the study.
 

This means that the final ‘how well does it work’ rate in the ‘modified intent to treat’ analysis, (this leaves out the 10 men who started the study with HIV, and ignores things like different rates of tablet-taking and the men’s level of sexual risk-taking), was 42%.
 

PrEP worked better when men were over 25 (56%), among men who took more than 9 out of 10 of the tablets (68%), and among the men who were circumcised (76%).
 

Would PrEP be cost effective? 

Other new studies have now looked at the value for money of treating people to prevent HIV in South Africa. The answer is mixed. 

It is usually cheaper to treat the person with HIV than treating one or more HIV negative people with PrEP. Treating the person with HIV should reduce their viral load so it becomes undetectable and their chance of passing on HIV then becomes very small. In mixed status couples, that may be enough protection for many. But PrEP would help protect negative partners who have unsafe sex outside the main relationship and who don't use condoms.  

Source and more details