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

Hear Results of Euro Sex Survey

posted: 27/04/2011

Come and find out the results from the biggest every survey of gay men's sex lives. In summer 2010 over 1650 men from North-West England (800+ in Greater Manchester), took part in the online European gay men’s sex survey. 180,000 gay and bi men across Europe joined in – the world’s biggest survey of gay men's sex lives and life.

Find out what’s going on
On Tuesday 31 May in the early evening, at LGF in the heart of Manchester’s gay village, you can find out

• A bit about this Europe-wide survey
• Find out what’s going on across Europe
• See how the UK compares with other countries
• Find out how NW England measures up to other UK regions
   

Over about two hours there will be a mix of Presentations, Question and Answers, and Group Discussions.
 

Welcome to all interested in gay men's sexlives and HIV prevention needs

It’s open to everyone interested – people from the gay community, people interested in HIV prevention for men who have sex with men, people providing or commissioning health and social services, gay community organisation staff and volunteers, clinic and social services staff, gay businesses, helpline and switchboard workers, gay youth groups, …..
 

Book your seat by Friday 20 May
Refreshments and nibbles provided, and it’s free – you just need to book so there’ll be enough room, nibbles and refreshments for all
There’s a simple booking form HERE you email back to Shaun at LGF 
All he needs to know is your name and an email address and tell him you want to come to the GMSS Seminar on 31 May. If you work for an organisation he would like to know your organisation's name and your work email.

When and where

The evening is on Tuesday 31st May, it starts at 5.30pm and ends 7.30pm
Lesbian & Gay Foundation, 5 Richmond Street, Manchester, M1 3HF
 

Survey Results for anyone who wants to do some homework and ask smarter questions, here are the results for NW England

All the UK results are here

The rest of Europe, by country is here

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

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.