International HIV Sidelines Gay Men

posted: 07/03/2011

Every two years the world’s biggest HIV conference faces criticism for sidelining the needs of gay men, sex workers, transgender people, and injecting drug users. The International AIDS Society conference visited Vienna in 2010, around 25,000 people attended, but it still grossly under-represented four groups most at risk for HIV infection.

A detailed study by the Global Forum on MSM & HIV (MSMGF), confirms the long-held suspicions and criticism of this neglect, and calls for change.

The International AIDS Society may be part of the problem, but it can solve it.

Shame of stigma and discrimination
Stigma and discrimination against marginalised and unpopular groups affected by HIV is unprofessional and brings shame on the International AIDS Society.

The 2010 conference programme seriously neglected key needs. There is little exclusive time and exposure given to the four groups, and the four groups are often ignored even in general studies.  

• Only 6.6% of the abstracts of studies were only concerned with gay and bi men / MSM, 5.7% targeted only people who use drugs, 3.5% looked only at sex workers, and 0.6% solely considered transgender people.
• Only 3.8% of ordinary conference sessions exclusively focused on gay and bi men / MSM, 5.1% on IDU people, 2.5% on sex workers and 0% on transgender people.
• Just 3.7% of all workshops exclusively focused on gay and bi men / MSM, 6.4% on people who use drugs, and 0% on sex workers and 0% on transgender people.
• Out of over 4,500 abstracts sent in for selection and publicity, only 558 even mentioned MSM, only 442 mentioned IDU, just 338 mentioned sex workers, and a bare 134 mentioned transgender people.
• Only 2.6% of all sessions in the entire conference programme exclusively focused on MSM, 4.5% exclusively focused on IDU, 3.0% on sex workers and 1.1% on transgender people.

The percentage of all sessions at the conference exclusively focused on the four marginalised groups was 2.6% for MSM, 1.1% for transgender people, 3% for sex workers and 4.5% for people who use drugs.

Research shows these four populations are at higher risk for HIV than the general population in nearly every country where reliable data exist.

Compare tiny conference gestures with actual needs

• MSM represent more than a quarter of HIV infections in Latin America and the Caribbean
• People who inject drugs are more than half of HIV infections in Eastern Europe
• Up to half of all sex workers across Sub-Saharan Africa have HIV
• Transgender people in El Salvador, Indonesia and India have HIV rates as high as 25%, 35%, and 42% respectively.

"Abysmal representation reinforces discrimination and invisibility"

“While the International AIDS Society turns a blind eye, HIV rates among these populations continue to climb around the world,” said Dr. George Ayala, Executive Officer of the MSMGF.

“The IAC is the world’s most important opportunity for international exchange and collaboration on HIV and AIDS. Such abysmal representation of most-at-risk groups only serves to reinforce the invisibility, discrimination and disregard that drive the epidemic among these communities.”

“Ostensibly, the IAC offers chances for local healthcare providers to learn ways to improve their services, provides channels for advocates to engage in dialogue with powerful decision-makers, and creates opportunities for community members to shape global funding and research agendas,” said Dr. Mohan Sundararaj, Policy Associate at the MSMGF. “This really is a phenomenal platform, but how useful can it be when those who need it most are locked out?”

Calls for change
The report recommends steps to make the Conference programme fairer, based on the numbers of people affected . These include involving the communities affected in the conference planning.

“The International AIDS Conference has unparalleled potential to impact the global AIDS epidemic,” said Dr. Ayala. “It is incumbent upon the organizers to ensure that the IAC becomes a vehicle for change, shifting the global landscape so that funding, research and programs are directed to those who need them most. Right now it’s part of the problem.”

Source The Global Forum on MSM & HIV

Read the full report Coverage of Four Key Populations at the 2010 International AIDS Conference: Implications for Leadership and Accountability in the Global AIDS Response February 2011

The Global Forum on MSM & HIV (MSMGF) is an expanding network of AIDS organizations, MSM networks, and advocates committed to ensuring robust coverage of and equitable access to effective HIV prevention, care, treatment, and support services tailored to the needs of gay men and other MSM. Guided by a Steering Committee of 20 members from 18 countries situated mainly in the Global South, and with administrative and fiscal support from AIDS Project Los Angeles (APLA), the MSMGF works to promote MSM health and human rights worldwide through advocacy, information exchange, knowledge production, networking, and capacity building.

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

Guide to Safer Sex Advice

posted: 01/03/2011

The British HIV Association has produced draft guidance for STI clinics on offering Safer Sex Advice for the UK. They are inviting comments on their draft Guidelines.

The Safer Sex Advice guidelines recommend behaviour change interventions, what safer sex advice to give people at risk of STIs, and advising people living with HIV and people at greater risk of HIV infection.

The guidance is also useful for GPs and HIV care services when offering Safer Sex Advice.
 

Comment on Safer Sex Advice Guidance

Comments deadline is 31 May 2011 - comment through this webpage

Safer Sex Advice Guidance for the UK

Gay, Positive, Herpes and LGV

posted: 25/02/2011

Gay men living with HIV who have herpes may find symptoms flare up worse and last longer. Preventive treatment can help prevent herpes flare ups.

Herpes also makes it much easier to pass on HIV (and other STIs) because it raises your viral load, and the blisters contain HIV and provide a way in and out for HIV.
 

Herpes leaflet for gay men

As well as that herpes leafte for gay men, there’s also a new detailed briefing about herpes for sexual health and HIV professionals from Sigma Research, produced for CHAPS, England's gay men's HIV prevention and sexuial health partnership.

LGV
LGV (lymphogranuloma venereum) is a much more uncommon sexually transmitted infection and, like herpes, it's one that gay men living with HIV are more likely to get. It’s caused by varieties of chlamydia bacteria.

LGV caused ulcers, like herpes and syphilis do, and these surface wounds are always a route in and out for HIV.

Having LGV also increases your HIV viral load and that makes passing on HIV more likely.

LGV leaflet for gay men

THT have more information about herpes, LGV and other STIs, on their new website for people living with HIV, My HIV

HIV and Sex Booklet

posted: 10/02/2011

The booklet HIV and Sex  for people living with HIV is now updated for 2011 by NAM. It's in three parts. The booklet has three parts.

• HIV, sex and the law
• How might you feel about sex after an HIV diagnosis?
• Dealing with sexual problems
• Relationships with an HIV-negative partner  

• Anal sex
• Vaginal sex
• Oral sex
• Other sexual activities
• Condoms
• Undetectable viral load and infectiousness
• Reinfection
• Using anti-HIV drugs to prevent infection – PEP and PrEP
• Contraception, conception and pregnancy

• Sexual health check-ups
• Sexually transmitted infections

You can download HIV and Sex free here

You can read the booklet online here