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.

About 1 in 10 have Hepatitis C

posted: 15/02/2011

9% of people living with HIV in the UK also have hepatitis C, the Journal of Viral Hepatitis tells us, which is low compared with other countries.  “In comparison with other large cohort studies, the overall HCV [hepatitis C virus] prevalence of 8.9% in the UK…is low,” comment the investigators.

9% means there are about 6,000 people who are diagnosed with both HIV and hepatitis C in the UK.

But 13,000 more people with HIV still haven't been checked for hepatitis C.

George House Trust analysis suggests that the true UK rate of hepatitis C among people with HIV is probably 11%, not 9%.

As a result, 2% of UK HIV clinic patients receive substandard care - we estimate there are around 1300 people with hepatitis C that is ignored by their HIV clinic, simply because the clinic hasn't checked for it, despite guidance advising hepatitis C checks since 2004.

Are you curious why the hepatitis C rate is lower in the UK among people with HIV? Here, most drug injectors (the main group of people who get hepatitis C) do not have HIV.

Early in the epidemic, England did the right thing, by introducing harm reduction for injecting drug users - like providing clean needles and syringes to reduce onward HIV transmissions. 

Countries which delayed doing this have higher rates of HIV now among injecting drug users. We are sorry to say that Scotland is one of the countries with higher rates of hepatitis C among people with HIV.

1 in 10, or even 1 in 9?

The level of hepatitis C must be above 9%, because about 20% of UK people with HIV have never been tested for hepatitis C, despite clear UK guidance to test everyone with HIV for this once a year. 

The 20% of people untested for hepatitis C by clinics would, if tested, probably add another 2% to the total, meaning the actual rate of hepatitis C among the UK HIV+ population is about 11%.  

Liver disease harm means hepatitis C matters

Liver disease caused by hepatitis C is a major cause of illness and death among people with HIV. What was uncertain was

• how common hepatitis C is among people with HIV in the UK now,
• whether people were being checked every year for hepatitis C following the guidelines, and
• how well treatment works when people have both HIV and hepatitis C.
   

So, the study used anonymous information about 31,765 people using ten HIV clinics between 1996 and 2007, from the UK Collaborative HIV Cohort (UK CHIC).
 

1 in 5 seen at HIV clinics in 2007 were untested

The proportion of patients screened for the virus increased from 9% in 1996 to 80% in 2007. 
 

“There has been a clear instruction that all HIV-positive patients should be screened since at least 2004,” write the investigators. Nevertheless, “20% of patients under follow-up in 2007 had not apparently ever been tested. The latest BHIVA [British HIV Association] guidelines recommend screening all HIV-positive patients at diagnosis, with annual repeat testing in those who are negative.”
 

Although injecting drug use (IDU) is very closely linked with having hepatitis C, only half (50%) the people with a history of injecting drug use were known to have had a hepatitis C test.

Gay men with HIV were most likely to have had a hepatitis C test (74%), followed by heterosexual men and women (63%), then IDU (50%). The investigators think more drug injectors have been tested than the 50% they found, perhaps at services for drug users.

George House Trust commentary

In 2009, 65,319 HIV-infected individuals (of all ages) were seen for HIV care in the UK, so the 2% who clinics are not treating for hepatitis C means about 1300 people are being neglected with worryingly substandard care. 

• Clinics admit they don't know the hepatitis C status of half the people with HIV infected through injecting drug use. From this study we know that 84% are very likely to have hepatitis C.
• Clinics don't know the hepatitis C status of 26% of gay men, the next most at risk group. We know from this study that 7% of these men probably have hepatitis C.

The failure to screen 20% of HIV clinic patients for hepatitis C harms people's health and can seriously shorten life. Hepatitis C causes permanent liver damage.

Anyone with hepatitis C and HIV needs careful health monitoring for both conditions and the coordination of treatment and care.

This isn't happening for half the people infected through IDU and about one third of gay men, the other main group at risk.

The 9% of people with HIV in the UK this study found to have hepatitis C, compares with just 0.44% among the general UK population.
 

Hepatitis C and how people got HIV
The rate of hepatitis C varies with how people got infected with HIV. 84% of the people who got HIV as an injecting drug user have hepatitis C, and the next largest group is gay men – but just 7% of HIV positive gay men also have hepatitis C.
 

Gay men injecting more?
However, the investigators suggest that some hepatitis C infections in gay men may be due to injecting drug use, which is “underreported by some MSM [men who have sex with men], sufficient to place them at risk of HCV infection … underreporting of IDU as a risk for HCV transmission in MSM may also affect other cohorts.”
 

Unsurprisingly (when most gay men in the UK are white and most injecting users are also white and male), most people with both HIV and hepatitis C are men (80%), white (82%), with the median age at 37.
 

Treatment working
4% of the 10,000 patients starting HIV treatment after 2000 also had hepatitis C. Overall, 91% reached an undetectable viral load, which is as good as for people with only HIV. 
 

Ask for hepatitis test when your next bloods are taken

Jason Warriner, clinical director of Terrence Higgins Trust said: “It’s concerning that almost 13,000 people living with HIV could have Hepatitis C without knowing it because they haven’t been routinely checked for the infection.

It’s not just people who use drugs intravenously who’re at risk of Hepatitis C, the infection can also be passed on during sex, so we’re encouraging anyone who is HIV positive and hasn’t been tested for Hepatitis C to ask their health practitioner for a check the next time they’re getting their routine blood tests.” 

More information on hepatitis C and HIV

• Information booklet from aidsmap.com / NAM
• Information booklet from i-Base

Reducing the risk of getting hepatitis C

People injecting drugs can protect themselves and others from hepatitis C by using drugs more safely.

Gay men’s risk of getting hepatitis C sexually seems to come from unprotected anal sex, group sex, drug use and fisting. Sharing sex toys and lubricants also appear to be risky. Using condoms for anal sex, and gloves for fisting provide protection. Information on risk reduction for gay men.

Source with reference and weblink

further material : demand screening

Europe, HIV and Hepatitis C

posted: 15/12/2010

Recommendations for treating acute hepatitis C infection in people with HIV in Europe have just been published in AIDS. The new European recommendations deal with detecting and treating hepatitis C and these follow the UK's own guide, written in 2010.

What they mean by ‘acute’ is recently infected, within the last 6 months.

Hepatitis C abroad (and at home)

Roughly a third of HIV-positive people in Europe also have hepatitis C. Few people in England have both HIV and hepatitis C because we introduced harm reduction (like clean needles and syringes) for injecting drug users, in the early years of HIV. In NW England only 2% of people with HIV were infected through injecting drug use.
 

However recently sexually transmitted hepatitis C among HIV-positive gay men has become a problem. So in spring this year doctors, researchers and activists met in Paris to develop guidelines for managing early-stage hepatitis C infection.
 

Their recommendations are about

• Defining acute hepatitis C infection
• Screening for hepatitis C
• Risk reduction advice
• Natural history
• Treatment during acute infection.
   

Acute hepatitis C means the first six months after infection with the virus. Many people do not develop symptoms when they first contract hepatitis C, and delayed antibody responses are found in some people with HIV.

Testing points

People with HIV should be tested for hepatitis C. Screening recommendations from Europe are to test everyone newly diagnosed with HIV for hepatitis C, and HIV-positive gay men should have checks at least annually.
 

HIV, gay men and hepatitis C

It is still not clear exactly how hepatitis C is being sexually transmitted between HIV-positive gay men. European hepatitis C sex-risk reduction advice is to discuss fisting, recreational drug use, group sex, use of sex toys, unprotected sex, traumatic sex, sharing injecting equipment, and risks from blood-to-blood contact.
 

Treat or natural recovery

Some people naturally get rid of hepatitis C infection without any treatment. But most people with HIV will need hepatitis C treatment. Up to 40% of HIV-positive people may naturally get rid of their early-stage hepatitis C infection.
 

Treatment for hepatitis C works better for people with HIV when started early, within the first year.
 

2010 UK Hepatitis C and HIV treatment guidelines

Source with reference for the European guidelines

Image 2009 European HIV treatment guidelines, from European AIDS Clinical Society

More Hepatitis C and HIV

posted: 22/06/2010

Hepatitis C in the UK: 2009 report is the latest update on the hep C virus from the Health Protection Agency. Figures from this yearly report show that laboratory reporting of newly diagnosed hepatitis C infections in England increased in 2008 by 6% compared to 2007, with 8,196 new cases reported in 2008.

Hepatitis C is rising among among people living with HIV, particularly gay men. Among gay men living with HIV hep C is sexually transmitted. Hep C has serious health impacts, shortens life expectancy and is harder to treat for people with HIV. Hep C treatment takes at least 6 months and has unpleasant side effects, and the success rate is much better when it is treated at an early stage. The largest number of people with and at risk of hep C howeer are injecting drug users.

Hepatitis C in the UK 2009 report and slide set
More news and information on Hepatits C and gay men living with HIV

1 in 73 Injecting Drug Users have HIV
The Health Protection Agency (HPA) has also published 'Shooting up: infections among injecting drug users in the United Kingdom 2008. An update: 2009’.

Key findings of the update include: transmission of HIV and hepatitis C infection through injecting drug use remains higher than in the late 1990s - overall, around two-fifths of injecting drug users are now infected with hepatitis C, and about one in 73 with HIV.
 
 

Foil for Injectors

posted: 28/09/2009

'Harm Reduction' is the name given to anything that reduces health risks. For years injecting drug users have been provided with clean needles and syringes and this has helped keep the number of people with HIV from injecting drug use in Manchester and the rest of NW England low. Just 2% of HIV infections in the region came through injecting drugs, 118 people. This is far less than in Scotland and many other countries in Europe.

Now there are moves to provide aluminium foil as an alternative - the foil is used for smoking heroin and this is safer than sharing and using needles and syringes.

Drug treatment experts say that inhaling heroin instead of injecting reduces a user's risk of contracting HIV and Hepatitis C. A drug user heats a blob of heroin on the foil and smokes the fumes - which is called "chasing the dragon".

drugs paraphernalia and police

The Advisory Council on the Misuse of Drugs (ACMD) is examining whether the law should be changed to allow Britain's 300,000 problem drug users to receive foil as a way of protecting their health. Since last year, the ACMD's 31 members, who advise the Home Office, have been considering whether section 9A of the Misuse of Drugs act, governing "paraphernalia" or equipment used in the consumption of illicit substances, should be amended to allow the UK's network of needle exchanges to supply foil. At present, it prohibits the supply of "articles to be used for the preparation or consumption of illicit drugs".

Foil ban criticised

Critics say the ban endangers users' health because most drug workers are too afraid of being prosecuted to risk giving out something that many see as a sensible harm-reduction measure. An estimated 100 of England's 1,300 needle exchanges already defy the law by providing foil. Some have even had tacit support in the form of "letters of comfort" from their local police force, such as Avon and Somerset, which emphasises that it does not see the pursuit of section 9A as a priority.

The ACMD's technical committee has held two private evidence-gathering sessions on the subject with with Jamie Bridge of the International Harm Reduction Association, which backs legalisation, and drugs treatment researchers Neil Hunt and Rachael Pizzey. It is due to hear on 29 October from veteran Dutch drugs worker John-Peter Kools, who has issued foil in the Netherlands. Both Holland and Spain issue foil through needle exchanges without any major problems.

The full ACMD is to debate the issue in November and is expected to suggest setting up a pilot study on the effects of foil provision. It hopes to advise ministers of its views soon – possibly before the end of the year – on whether the law should be changed. Bridge said: "Smoking drugs is by no means safe, but is a great deal safer than injecting drugs – which is particularly associated with overdose, blood-borne viruses, drug-related litter, greater dependency, abscesses and vein damage.

police edging closer to foil acceptance

"The law has unintentionally put us in a strange position whereby we can give someone clean needles to inject with, but we face arrest for giving them aluminium foil to smoke with. Providing foil in this way is such a common-sense approach – with huge potential benefits and little opposition or potential costs – that we hope the law will change soon." Significantly, the Association of Chief Police Officers, which represents the country's most senior officers, is neutral on whether the law should be amended. But it would support a change if the ACMD recommended such a move on public health grounds, sources told the Observer.

Harry Shapiro of Drugscope, which represents 800 drug projects, said: "It's important to do everything possible to discourage Britain's 300,000 problem drug users from injecting their drugs, and we should allow injecting heroin users to be provided with foil as part of a harm-reduction programme. As the law now stands users' health is being compromised and it would be better if section 9A was repealed."

But James Brokenshire, the Conservative shadow home affairs minister, said: "I'm cautious about these sort of moves, which progress harm reduction rather than focus on getting people drug-free. In recent years there has been insufficient focus on getting people off drugs and too much on just maintaining people on drugs through methadone and other measures.

"I would need to be swayed that there are clear and compelling public health arguments to make such a change [in the law]. I want to promote abstinence-based rehabilitation. There needs to be a greater emphasis in getting people off their drug habit rather than maintaining their addiction."

Paul Hayes, the chief executive of the NHS's National Treatment Agency, which funds drug treatment, said: "Any way of using heroin is dangerous and likely to lead to addiction. However, injecting the drug is far more dangerous than other means of ingestion, such as smoking. Currently, the provision of foil is not legal. The NTA cannot advise drug treatment services to follow a course of action which is illegal and could have adverse consequences for provider services."
 

Source

Legalise It - former Chief Constable Tom Lloyd writes about legalising all recreational drugs instead of continuing the failing 'war on drugs'