Pregnancy HIV Risks for Men and Women

posted: 17/01/2011

A new study shows that a man's risk of getting HIV from a woman partner doubles when she is pregnant. Other studies have told us that women are more likely to get HIV from men when the woman is pregnant. This is the first study showing that a woman being pregnant raises men’s risk of getting HIV from her.

The results come from the Partners in Prevention HSV/HIV Transmission Study, of 3,210 couples, where one partner has HIV and the other partner does not, in seven African countries.

Pregnancy and HIV infections

61 women got HIV during the two year study period and 28% of these women were pregnant; 57 men got HIV during the two years of the study while 21% of these men's partners were pregnant.

Analysing these results showed that pregnancy roughly doubles the HIV risk for both sexes, but other factors, such as sexual behaviour, makes a difference for some women and men.

Among men, uncircumcised men, and men who did not use condoms, are much more likely to get HIV when their partner is pregnant.

Pregnancy changes biology
One of the study investigators, Dr Nelly Mugo, of the Kenyatta National Hospital and University of Nairobi, and of the University of Washington in Seattle, suggests that biological changes during pregnancy might explain higher female-to-male HIV transmission during pregnancy.

Men should take HIV tests at antenatal clinics along with their partner

The increased risk of HIV infection for men when their partner is pregnant emphasises the need for men to join their women partners and get tested for HIV at antenatal visits.
 

These study results were presented at the International Micobicides Conference, Pittsburg, USA.

Source

HIV and Gay European Migrants

posted: 06/01/2011

Gay men from Central and Eastern Europe who now live in the UK are at risk of HIV and other sexually transmitted infections, according to a new study.
 

Around one in four of the men surveyed said they had unprotected anal sex with a casual partner of a different or unknown HIV status, and 15% of men reported being paid for sex. The risks faced by gay and bi men from central and eastern European countries are broadly no worse nor better than the risks run by British men. But the men need culturally appropriate HIV and STI information.
 

The study looked at what happened after the ten central and eastern European states joined the European Union in 2004. Joining the EU gave people the right to live and work in the UK. The men were from the Czech Republic, Cyprus, Estonia, Hungary, Latvia, Lithuania, Malta, Poland, Slovakia and Slovenia. Most (80%) of those surveyed live in London.
 

Online recruits
Using the internet cruising sites gaydar and gayromeo, the investigators recruited 691 men. They answered in-depth on-line questionnaires. The men had a mean age of 29 years, most were working and 54% had a degree. The majority (83%) have lived in the UK for over a year and mainly live in the capital.
 

Risks taken
There is a high level of risk behaviour raising the chances of HIV transmission.

• 13% were paid for sex in the UK, with 22% having a history of being paid for sex
• 37% said they recently used recreational drugs
• 31% have had a sexually transmitted infection
• 62% had ten or more sexual partners in the past year
• 23% had unprotected anal sex that involved a risk of HIV transmission.

But HIV testing rates were high, with 79% stating that they had ever tested, and 64% said they had tested since arriving in the UK. British men could learn something helpful about taking regular (at least annual) HIV tests, from some of these European men.
 

HIV is less common than for British men
Prevalence of HIV was 5%, much lower than prevalence among UK gay men, which some studies have suggested is as high as 12% in London, and 1 in 10 in Manchester.  Most of the men diagnosed with HIV, were diagnosed in the UK (78%).
 

Britons' bad example? Risky behaviour rises after arrival
The longer men lived in the UK, the more likely they were to report risky sex. Levels of drug use are higher after men have been here a year, and partner numbers also rise.
 

Condomless risks
Unprotected sex with casual partners of an unknown or different HIV status was linked significantly with being HIV-positive, or untested, recreational drug use, and being paid for sex in the UK.
 

“CEE (Central and Eastern European) MSM (Men who have Sex with Men) are at significant risk of the acquisition and transmission of HIV,” write the investigators, who emphasise the UK’s “duty of care to ensure that MSM from CEE countries are aware of their sexual health services in the UK and are able to access them.” They call for HIV prevention materials to be tailored to meet the needs of these men.

“Our findings suggest that CEE MSM report comparable levels of risk to those in the general MSM population in London and the UK,” comment the investigators, “interventions aimed at MSM should be accessible to CEE MSM.”

Source with reference

Risks and HIV Status

posted: 26/10/2010

Gay men using London gyms are revealing more about choosing their partners and taking risks with anal sex. The latest annual sex risk survey of gay men at London gyms has appeared. 36% of the 648 men taking part in 2008 had anal sex without condoms in the previous year. Condomless anal sex is becoming more common, but this headline “masks a more complex picture,” which varies with HIV status, the researchers say.
 

Same HIV status or different status: more risks
Men are now having more sex without condoms with partners who have the same HIV status, than with men whose HIV status is different or unknown to them. But there are also more men reporting sex without condoms with a main partner whose HIV status is unknown or different.
 

1 in 3 taking risks but more choose same HIV status partners
The first study, in 1998, found 24% of men had unprotected anal intercourse in the previous three months. By 2008 this was up to 36%. But in both the two latest surveys (2005 and 2008), more men report having unprotected sex with men of the same HIV status as themselves (“sero-sorting”) than with men of unknown, assumed or different HIV status. In 2008 21% reported condomless anal sex with men of the same status and 16% reported this with men of unknown, assumed or different status.
 

Some positive men choosing positive
Among HIV-positive men in 2008, 14% sero-sorted (chose a partner who is also HIV+) their casual partners. 10% of the HIV-positive men have a main partner who also has HIV.
 

Negative men rarely choose casual partners by HIV status
Among men who reported that their last HIV test was negative, less than 2% chose casual partners who are also HIV negative. However 21% had unprotected sex with a main partner whose last HIV test was also negative. The proportion of supposed HIV negative men reporting condomless sex with men who also last tested HIV negative has risen to 21% since 1998, when 12% reported it.
 

Test together or just talk?
The researchers are worried about how HIV-negative men decide their main partner is also HIV negative. While four in ten men took the HIV test together, the others only talked about their status. This is not good enough, because the longer the time since the last test and the risks taken since that test mean the test result may now be wrong.
 

Men’s relationship risks
Men’s main relationships seem to be where more risks are now being taken, although the numbers are low. There have been significant increases in the numbers of men reporting having unprotected sex with a main partner of unknown, assumed or different HIV status between 2005 and 2008.
 

Positive men risks
Among HIV positive men, 2.5% reported having unprotected sex with a main partner of unknown, assumed or different HIV status in 2005, and it was 8.1% in 2008. For about half the positive men, in fact their partner’s HIV status was known to be HIV-negative.
 

A significant proportion of HIV-positive men (19%) report unprotected sex with casual partners of an unknown or assumed HIV status, although this has fallen a lot compared with the earlier surveys.
 

Negative men risks down
Fewer than 6% of HIV-negative men report unprotected sex with casual partners of an unknown or assumed HIV status, the lowest level in these gym surveys. The researchers comment: “This is an encouraging trend and is likely to reflect consistent and sustained health promotion campaigns targeting gay men.”
 

Summing up, the researchers say that their data “suggest that main partners may have become an important source of HIV risk among London’s gay men.” They recommend that more health promotion campaigns should focus on HIV risk within relationships and on HIV testing among couples.
 

Source with reference details

Oral Sex and HIV

posted: 10/09/2010

The gay men’s sex survey sometimes tells us surprising things, but the news that almost all gay and bisexual men have oral sex - 99% - was no surprise at all. With HIV, what do men need to know?
 

What about HIV?
How risky is oral sex for men with HIV? How risky is it for positive men’s partners?

There’s a lot of confusion about this – at all our newly diagnosed courses this causes big discussions and lots of questions.
 

Doctors and researchers aren't sure exactly how many people get HIV from oral sex. Some think hardly anybody ever gets HIV from oral sex, but others think 3 out of every 100 HIV+ people got HIV through oral sex. A review of all the oral sex studies in late 2008 worked out that the risk of getting from oral sex was very low, but the risk isn't zero.

Whatever the oral sex risk, it is always much safer than anal or vaginal sex without a condom.
 

How risky is oral sex?
The likelihood that HIV is passed on from an HIV-positive person to an HIV-negative person during oral sex depends on

• whether a man with HIV sucks, or gets sucked
• the viral load of the man with HIV 
• the dental health of the man sucking
• if the man sucking has a sore mouth, or throat, oral cuts, sores or abrasions 
• if either man has a Sexually Transmitted Infection (STI).

Having a high viral load in the blood usually means that the viral load is also high in the semen, and that makes HIV easier to pass on during sex. Although having an undetectable viral load in the blood usually means there is an undetectable viral load in the semen, this isn't always true. And untreated sexually transmitted infections (including infections without symptoms), cause viral load in semen to increase.

But all in all, if you have an undetectable viral load, the chances of passing on HIV are very low in oral sex.
 

Oral sex is never risk free. It’s also easy to pass on and get some other sexually transmitted infections, such as syphilis, herpes and gonorrhoea.

Oral studies
A number of studies looked at the risks of HIV transmission from oral sex.

• One American study reported that of 122 gay men with HIV, 8% reported oral sex as their only risk activity. But this study is not really trusted. It is based on very few men and some of the men who first of all said oral sex was the only risk they took later on admitted they had anal sex without condoms.
• Another study of over 100 couples didn’t find any cases of oral transmission of HIV over a ten year period, where one partner was HIV-positive and the other HIV-negative.
• Another study from the USA found the risk to be effectively zero, but didn't exclude the possibility of there being a risk.
• Other researchers in 2008 pooled the results from all the oral studies and found that the risk was very low, but not zero.
   

We are unlikely to ever have an exact answer: the best we can say is low risk, but not no risk.
 

When is oral sex more risky?
It is important to put oral sex HIV transmission risks in perspective.

If you and your partners are having anal sex without condoms, first do something about reducing your anal sex risks, because the risks of HIV transmission during anal sex are so very much higher than in oral sex. Using condoms during anal sex will make far more difference in reducing the risk of passing on HIV, than trying to reduce the already small risk from oral sex.
 

Think of oral sex like being a safe car driver – an accident is always possible, but unlikely.

Think of anal sex like speeding and drink driving – an accident is quite likely. To reduce the chance of passing on (or getting HIV), using condoms makes sense, like it makes sense to stop drink driving and speeding. Using condoms reliably during anal sex is what we should really try to do better.
 

How can you reduce oral risks?
If you do want to cut the HIV risks during oral sex, there are several ways. Some of these are more acceptable than others, so make your own risk decisions. Many of these steps will also cut the risk of other sexually transmitted infections:

• You may decide the risks with oral sex are low enough to carry on as before
• You may prefer not to have oral sex because you do not want to take even a tiny risk
• You may decide to have oral sex with fewer men at a time, and in total
• You may decide to have oral sex using a condom
• Men with HIV may decide only to suck, as this is far less likely to pass on HIV than sucking
• Men who don't have HIV may decide only to be sucked, as being sucked by a positive man is far less likely to pass on HIV 
• Men with HIV may decide not to cum in a partner’s mouth. There is a theoretical risk of getting another HIV strain, or drug resistant HIV, if you let another man with HIV come in your mouth. 
• You may decide to have less vigorous oral sex, and not to deep throat
• HIV negative men should look after their teeth and mouths. The risk of HIV transmission increases if a HIV negative man sucking has bleeding gums, ulcers, cuts or sores in his mouth. He should not brush his teeth or floss before sucking, because that makes the gums more open to HIV
• Get regular sexual health checks. Sexually transmitted infections raise the risk of passing on HIV to a negative partner. For HIV negative men, sexually transmitted infections raise the risk of getting HIV.

Source 1

Source 2

Some Lubes Raise Risks

posted: 27/05/2010

Gay and Bi men have been advised for many years to use a water or silicone-based lube for anal sex. A  new research study helps men and women who have anal sex to choose the lubes that are safer and work well - like Wet Platinum .

The results suggest people should avoid  the ones like KY Jelly that seem to increase the risk of sexually tranmsitted infections (STIs).

This new study has caused a stir at the International Microbicides Conference, underway in Pittsburg, USA.
 

STI risks rise with some lubes

Some lubes increase the risk of getting a bacterial sexually transmitted infection (STI), like gonorrhoea, chlamydia or syphilis. Almost twice as many people using certain lubes (12%) were diagnosed with rectal gonorrhoea, chlamydia or syphilis, compared with 5% of those who didn’t use a lubricant.
 

Even when the researchers took into account things like the number of partners, frequency of sex, and condom use, they found that the use of certain lubes was associated with a three times bigger rise in rectal STIs.
 

Lubricants are not regulated like medicines: they are ‘medical devices’ and do not have strict safety testing. Many include things that are ‘not friendly’ to the cells lining the rectum. KY Jelly, for example, contains the disinfectant clorhexidine.
 

Keep using lube – but change your brand?
People should continue to use lube for anal sex. Without lube there’s a good chance of discomfort, pain, soreness, bleeding, and tissue damage in the anus and rectum – and this makes it much easier for HIV and STIs to be passed on.

People in this study used various kinds of lubricant: 67% had used a water-based one such as KY Jelly, 28% a silicone-based lubricant, 17% an oil-based lubricant such as Crisco, and 6% used a numbing lubricant to deaden feelings.
 

Choose lubes carefully
The researchers recommend choosing lubricant carefully. More research is needed to assess the risks with each of those commonly used.
 

Better Choice

The study found that a silicone-based lube, Wet Platinum,  and a vaginal water-based lube, PRé, did not damage the cells.
 

Best Avoided

Other studies have shown KY Jelly can kill friendly bacteria in the vagina, and this and several similar water-based lubricants damaged the cell lining of the rectum. Another study tested six lubricants that can be bought over the counter in the USA. They studied the physical properties of each.

Four lubricants Astroglide, KY Jelly, ID Glide and Elbow Grease did risky things to rectums. They are strongly hyperosmolar. This means they suck water out of the cells lining the rectum into the rectum and they also strip off the protective epithelium (lining) of the rectum. Astroglide caused almost as much damage as nonoxynol-9, the spermicide that increases the risk of HIV infection.
 

These lubes were also tested on ‘friendly’ bacteria that are part of the normal vaginal flora. Astroglide killed off one species of Lactobacillus, and KY Jelly, which contains the disinfectant clorhexidine, killed all species.

PRÉ  (limited UK availability) and Wet Platinum   caused relatively little damage and seem a better choice.

There is an urgent need to conduct further research into sexual lubes, to distinguish between harmful and harmless ones, and it looks like it is time to have stricter safety checks before allowing sexual lubes to be sold.
 

Source