`Test and Treat` HIV Prevention

posted: 19/03/2010

Treating everyone to halt the HIV epidemic in the worst-affected countries may not be the best way to use HIV treatment for HIV prevention, according to mathematical modelling by London’s Imperial College Infectious Disease Epidemiology group. Nor is universal treatment and annual testing always needed to make deep cuts in new infections, they find.

Reports of their computer modelling of ‘test and treat’ prevention, showed how much sexual behaviour affects how well universal testing and treatment works in preventing HIV. It has been claimed that universal testing and treatment could virtually eliminate HIV epidemic in countries like South Africa within 20 years.

Best: Test every 4 years, and treat 80% of people
The researchers showed that treating 80% of those with CD4 counts below 350, and getting everyone to take an HIV test every four to five years, could be the most cost-efficient strategy for reducing new infections.

Computer models and the real world
The Imperial College computer model follows another attempt to work out how well testing and treating works as a means of HIV prevention, from the World Health Organisation (WHO). The earlier WHO model showed that new HIV infections could be eliminated by 2030 in countries like South Africa, if universal annual testing was introduced, and people who are diagnosed then immediately start treatment.

There’s been a lot of interest and debate – how sure can we be that treating most people would cut HIV in the highest prevalence countries? Would the computer predictions work in the real world?

Sexual behaviour makes a big difference
Imperial’s computer model of the epidemic is different from the WHO model. Imperial looked at how differences in people's sexual behaviour affects how well treatment and testing works. Imperial also looked at the effects of changing how often people are retested for HIV, and how starting treatments at different CD4 levels would affect the future pattern of the epidemic.

Imperial’s results broadly confirm the results of the WHO model. Testing and treatment in `hyper-endemic` countries would have a profound impact on new HIV infections.

However, the model showed that results would be highly dependent on the character of the local epidemic. If people with large numbers of sexual partners have sex with people who have very few partners, new infections would be reduced by 85%, but would not be eliminated.

If there is not much sexual contact between people at high-risk and those at low-risk, testing people every two years would be necessary to bring down new HIV infections by 90%. But where there is much more sexual mixing, testing would need to be much more frequent; we might have to diagnose every person with HIV within one month of their infection to cut total transmissions by the same 90%.

95% cut in infections
New infections might be reduced by 95%, if 80% of the population were to be tested every three to four years, and started treatment at a CD4 count around 400.

Only in the worst situations, where new infections have failed to fall despite years of prevention efforts, would more frequent testing be cost-efficient. In the worst situations testing 80% of people every two to three years and starting treatment even earlier (above CD4 of 450) would give the best results.

Test and treat success varies
“It is likely that the `test and treat` approach is much better suited to some populations and poorly suited to others,” they conclude. “There are diminishing returns for increasing testing frequencies to once-per-year levels. Failing to achieve sufficiently high coverage levels or failing to test frequently enough could just lead to a dramatic spiralling of treatment costs.”

Reductions in incidence of 85% - 95% would take around 30 years to achieve, so in the short term, treatment costs would rise.

They speculate that targeting particular population groups or locations for testing, such as truck drivers or beer halls, might prove particularly effective. However targeting raises serious worries over the human rights risks in `test and treat` strategies.

Prevention Models and the Real World
In the latest issue (March 2010) of HIV Treatment Update,  Gus Cairn’s lead article gives the example of San Francisco. Here 85.5% of people with HIV are diagnosed (in England it is far lower – only around 75% are diagnosed); 78% of these attend clinics; 90% of these take HIV treatment; of those taking HIV treatment, 72% have an undetectable viral load.

As Gus says: ‘Do the sums: even with such high testing and coverage rates, only 43% of San Franciscans with HIV have an undetectable viral load. Treatment as prevention will need to be truly universal to work.’

Source with reference

Condom Adverts on TV

posted: 17/03/2010

Changes to the rules about TV condom advertising 'may help fight HIV' say HIV charities. The Broadcast Committee of Advertising Practice has just announced that condom advertising will be allowed on TV before the current 9pm adult watershed. Condom adverts will now be allowed at any time, but will not be permitted around programmes aimed at children under ten. Condom adverts will also have to comply with strict rules on taste, decency and socially responsible advertising.

Campaign success

The move was recommended by the government's Independent Advisory Group on Sexual Health and HIV, which said that advertising the contraceptive method on television would help cut HIV, STIs and unwanted teenage pregnancies.

Deborah Jack, the chief executive of NAT (National AIDS Trust), said: "It is good news that the ban of advertising condoms on television before 9pm has been lifted. Condoms are the most effective way of protecting against HIV transmission when having sex. Over 7,000 people were diagnosed with HIV in 2008 so increasing education about safer sex is important. It makes sense that condom adverts will be allowed to be shown in the early evening at the same time as soaps, such as Hollyoaks, which include storylines about sexual relationships and HIV.”

Carl Burnell, chief executive at GMFA, the gay men’s health charity, added: “This shouldn’t just be about reducing pregnancies. Condom-use is a central sexual health and HIV prevention message and needs to reach those most in need, particularly gay men. In that respect, we welcome the relaxing of the rules. However, commercial adverts promoting brands aren’t enough. Of more importance is making sure men receive the information and support they need to protect themselves and their partners.”

"Prevention is better than cure when dealing with sexually transmitted infections or unplanned pregnancies. Relaxing the watershed is another positive step in getting safe sex messages to the public," said Baroness Gould, chairwoman of the Independent Advisory Group on Sexual Health and HIV.

However the welcome is not universal - the Church of England said it was "especially disappointing to see a relaxation of the rules on targeting condom advertising at under-16s". A spokesman said: "The Church supports the sensitive use of media to offer unbiased and authoritative information to young people, but educational and commercial objectives should not be muddled."

Other changes

Other changes will see tougher action on television adverts which promote violent video games or products which make spurious claims about being environmentally friendly.

This new advertising code - and the earlier condom adverts - will appear on TV screens after September 1st.

Image - blog with 41 creative condom adverts

Source and Source2

Positive Men’s Sex Rights

posted: 09/03/2010

Calls to improve the sexual health of gay and bisexual men living with HIV across England were made at the national gay men’s sexual health conference that has just ended in Sheffield. George House Trust put up a strong case for improving the sexual health support provided for all men living with HIV.
 

Top experts
The conference heard from four George House Trust experts, including young gay Positive Speaker Craig, who came out about having HIV to thousands at the Manchester Pride Candlelit Vigil. In five out of the six conference sessions, our experts led the way. The conference heard that meeting the sexual health needs of gay and bisexual men living with HIV is critical, about positive prevention (involving positive men in reducing onward HIV transmission), calls for widespread campaigns to stop HIV stigma among gay men, and for the greater use of positive speakers to challenge stigma and empower men living with HIV.
 

And positive men too
We’ve been campaigning about these for years. Our efforts are paying off, but improving things across the whole country is slow because we can only persuade and encourage other organisations to do the right thing. At last, CHAPS has now added supporting men living with HIV to the national strategy for gay and bisexual men’s HIV prevention.
 

Status check
With LGF, who are part of CHAPS, we produced our Update Your Status campaign encouraging undiagnosed gay and bisexual men to test regularly for HIV. Testing and diagnosis helps improve the sexual health of men who do turn out to have HIV and cuts the number of gay men diagnosed with HIV too late for the men to get the best out of their HIV treatment.
 

Positive prevention pioneers
In the next couple of months we will hold an national symposium in Manchester for experts in Positive Prevention with gay and bisexual men with HIV. This will start work on the first national CHAPS programme for gay men’s positive prevention.
 

Positive prevention was neglected because the national strategy aimed instead at undiagnosed men. This left out the many positive men who are passionate about reducing HIV transmission. George House Trust wants men with HIV involved in developing the resources, knowledge and skills to maximize sexual health and cut HIV transmission.
 

Work in some countries on positive prevention is well ahead of the UK – for instance Canada already has its national Poz Prevention strategy and has produced a booklet for HIV+ gay men and Ireland has its own booklet.
 

Face to face and working behind the scenes
Most of George House Trust’s efforts directly support people living with HIV. What is not so well known is our important behind the scenes work. This backstage work aims to cut the number of people becoming HIV positive and working for better services to meet the changing needs of people living with HIV across the country. It’s not so glamorous and it often takes time to show results, but work like this is essential to prevent even more gay and bisexual men from needing services in the first place, as well as improving the lives of men who do have HIV.
 

Our behind the scenes work is a form of long term indirect prevention - taking steps to stop even more people becoming HIV positive. Everyone who gets HIV potentially requires a life time of support from services such as ours.
 

NW Gay HIV Stigma and Risks

posted: 04/01/2010

The NW England results of the annual Gay Men’s Sex Survey are now out. ‘Vital Statistics 2008’ gives us the latest information on the prevention needs of gay and bisexual men in the UK and our region.

It also tells us some useful things about HIV stigma across the region, the numbers of men who have never taken a HIV test, and about the numbers who take significant HIV risks.
 

Blackpool – gay hotspot missing
There had to be 20 or more men in a NHS district (Manchester, Liverpool etc) fill in a survey for results from that district to appear in this report.  Unfortunately the gay hotspot of Blackpool only had 17 men fill in the survey, so we can’t say much about gay and bisexual men’s needs there.

Stigma and rejecting men with HIV
This survey asked questions about what undiagnosed men say they would do if a potential sex partner told them he had HIV. Would they change their mind and turn down sex, have sex but be extra careful, have sex just as they planned, or do something else?
 

Men who said they’d reject positive men are showing strong signs of HIV stigma and discrimination. Across NW England half the men said they would reject any HIV positive man for sex. This really discourages diagnosed men from talking and telling any sex partners about HIV.
Things look best for positive men in Manchester and Stockport, but not much better – in Manchester 39% of undiagnosed men say they would reject any positive man for sex.
 

Are George House Trust’s anti-stigma campaigns at Pride helping to cut stigma by rejection locally? It’s difficult to say – in next door Salford the rejection rate is higher – with rejection by almost half the men, like the regional average. HIV rejection is worst of all in Cumbria and Sefton (Merseyside) at 61%, and 56% of undiagnosed men would reject any positive man in Liverpool. [See 19 in the report].

Mixed HIV status relationships
The number of men who have regular partners of a different HIV status is another way of trying to measure how much HIV stigma is about. Sadly it is almost impossible to reach a clear answer from the survey report. In Manchester around 1 in 10 do have a regular partner of a different HIV status. Another 1 in 4 have a partner of the same HIV status, which could be where both men are HIV positive, or both are HIV negative – we just don’t know.

Another 1 in 10 have a regular partner and the man has no idea whether they have the same HIV status or not – a recipe for risking HIV transmission. [See 10 in the report].

Testing or not?
Last year the Health Protection Agency advised that the amount of HIV in Manchester, Salford and Blackpool meant special measures to increase HIV testing are needed and that gay and bisexual men living there should test at least once a year.
 

1 in 5 gay and bisexual men in Manchester have still not tested, ever. Almost as many didn’t test last year but have tested at least once before.

However 28% of Manchester men in the survey have tested HIV positive. That does NOT mean 28% of gay men in Manchester have HIV – just that more men with HIV took part in the survey. A previous study shows the real HIV rate on the scene in the city is about 1 in 10. [See 13 in the report]
 

Risk taking evidence
When men were asked how they rated their chances of passing on or picking up HIV in the next year, 6% think HIV transmission is very or quite likely for them within 12 months.

77% think it is very or quite unlikely, which just shows how many men really are deluding themselves. 63% had also told the survey they had at least one partner with whom they had unprotected sex that year. And 1 in 10 Manchester men reported they had 5 or more partners a year with whom they had anal sex without condoms. [See 14 and 16 in report].
 

We thank all the men who completed either a booklet or the website survey that George House Trust promoted.

NW England 2008 ‘Vital Statistics’ report

Survey questions
UK and English regions reports (including for past years)

Older People and HIV

posted: 04/01/2010

HIV among older people is coming to attention more and more. More people are living longer with HIV, especially because of effective HIV treatments, and more older people are being diagnosed with HIV - often at a late stage of infection - and other older people are at more risk of HIV.

We've now added some useful 'Older' links to the website to pull together some of the available information, to help interested individuals, service providers and policy makers to act. Most of these materials are from North America, mostly the USA. We will add UK and other European links as useful information becomes available.

If you search our website for key words like 'older' you will find relevant news from the UK as well as other information.

UK organisations - HIV and older people's - are now working on HIV service development for older people. For example in NW England, George House Trust is meeting with Manchester Public Health Development Services to help develop the sexual health strategy for older people.

HIV and older people in NW England

By the middle of 2009, NW England had 950 people diagnosed with HIV over 50. 950 people is 17% of all people diagnosed with HIV in the region. In ten years time this number and the proportion will have very rapidly grown, probably by well over 2000, because there are almost that many people in their 40s already diagnosed with HIV in the region. 

Most of the 950 people diagnosed with HIV in the region are gay and bisexual men - 60%. Most of the rest of diagnosed people over 50 are heterosexual men and women (34% - with around 2:1 of them being men).

image source - a USA leaflet