Rise in Over 50s HIV Infections

posted: 21/07/2010

People over 50 are as much at risk from unsafe sex as younger people, the UK’s Health Protection Agency (HPA) has just warned. Today it revealed evidence, at the International AIDS Conference in Vienna, that the number of people over 50 who are catching HIV has more than doubled in seven years.
 

In 2000 there were just 299 new HIV infections among the over-50s, according to the HPA. But in 2007 there were 710 people infected.
 

Gay and bi men are the majority infected when older, but white heterosexual men infected abroad - typically in Thailand - are another significant group of older men who are diagnosed.

Late diagnosis common
Half of those diagnosed when over 50 were diagnosed late. Younger people are much less likely to be diagnosed late. Late diagnosis is bad news when you are older - during the eight year study period three quarters of the deaths among people aged 50 and over occurred within one year of the diagnosis, with half of those diagnosed late. Unfortunately, late diagnosis with HIV reduces people's life expectancy and quality of life. If treatment is started late it cannot undo all the unnoticed damage already caused by HIV.

Some people diagnosed after 50 were infected when they were younger. After some early symptoms (such as flu-like symptoms with a rash), many people after HIV infection remain apparently fit, healthy and continue to feel well, without suspecting they have HIV, for as long as 10 years.

Most are recently infected by risky sex
But half of the over-50s diagnosed had recently been infected, through taking chances without condoms.

Getting away with risks in your earlier years doesn't mean that luck will continue.

Letting down your guard just because you are older can still catch anyone out. We often hear older people say, rather sheepishly, 'I should have known better'.
 

Keep on testing - and condoms
"This highlights the importance of HIV testing, whatever your age," said Ruth Smith, a senior HIV scientist at the HPA's Centre for Infections. "We must continually reinforce the safe sex message – using a condom with all new or casual partners is the surest way to ensure people do not become infected with a serious sexually transmitted infection such as HIV."
 

Her co-author, Dr Valerie Delpech, head of HIV surveillance at the HPA, said people in the older age group needed to be aware that they were just as much at risk as young people if they had unsafe sex.
 

"Although adults aged 50 and over account for just 8% of all new HIV diagnoses, the fact that cases have more than doubled in recent years serves as a timely reminder that anybody is at risk of HIV infection if they do not use protection and practise safe sex," she said.
 

More information from HPA

Source
 

HIV Microbicide Success

posted: 20/07/2010

A vaginal microbicide gel containing the anti-HIV drug tenofovir (Viread) reduces the risk to women of HIV infection by 39%, results of a study show. This is the most hopeful news in the years long search for something that women can use to protect themselves from HIV risk. There was a recent flurry of hope about another microbicide which showed some signs of working but further study showed it wasn't good enough.

Women who used this new gel more reliably, during four out of the last five times they had had sex saw their risk of HIV infection reduced by 54%. The microbicide also had another useful sexual health benefit, halving the risk of infection with genital herpes.
 

Other reports about this microbicide explain that women must apply the gel 12 hours before sex and once again as soon afterwards as possible.

There is more work to be done before this microbicide can supplied publicly, but this was a top-notch scientific study, a randomised, placebo-controlled trial – called CAPRISA 004 – in South Africa. 889 HIV-negative women were randomly divided into two groups, one was given the tenofovir-containing gel and the other group was also given gel that looked exactly like the first but without any tenofovir in it. No-one (neither women nor the clinic staff) knew who was getting what. Both groups of women got advice about safer sex and free condoms. The women were monitored for two and a half years.
 

Results from the study will be officially presented to the AIDS 2010 conference in Vienna today, but they have already generated a lot of excitement.
“This is an important day,” said Yasmin Halima, director of the Global Campaign for Microbicides. “We now have evidence that a vaginal gel can help prevent HIV. This is good news for women, good news for the field and a good day for science.”
 

Next Steps

To stimulate and prioritise rapid action, WHO and UNAIDS announced that they will convene an expert consultation in August with women’s health and HIV prevention advocates, scientists, microbicide research teams and product developers, and public health experts to discuss the next steps with the product.

A webcast of this session and interviews are available on the Kaiser Family Foundation website

More information from NAM/aidsmap.com

Image - Prof. Quarraisha Abdool Karim, Associate Scientific Director of CAPRISA, explains how to use an applicator with gel       from blogs.timeslive.co.za

Africans HIV Prevention in England

posted: 23/06/2010

HIV prevention among black Africans in England describes the major prevention challenges and highlights the actions that are needed and details the sexual health needs of Africans in England. It’s a useful briefing paper with helpful information on where to find more information and guidance. It is one of a series of briefings from the Race Equality Foundation.

Its key messages are that

• Black Africans in England have the highest rates of heterosexually acquired HIV. Black Africans are about 1% of the population, but have nearly half of new HIV diagnoses. Many of these infections occurred abroad, but a rising proportion happen here.
• The majority of black Africans in England are tested for HIV very late; this makes onward HIV transmission much more likely. Most, particularly men, are diagnosed at such a late stage that treatment does not work as well as it should. This cuts the quality and length of life.
• There are many more same-sex relationships than reported among black Africans in England. Often men have relationships with both women and men.
• The sexual health of black African communities is worsened by many socio-economic factors.
• There are many unmet sexual health and social needs among black Africans living in England, making people far more vulnerable to HIV.

It concludes with a shopping list of the main unmet needs that require action. These include

• Late HIV testing and undiagnosed HIV are serious issues. All myths and misconceptions about testing and treatment need challenging to encourage testing. More information about the available services, and more support to encourage their use are needed, particularly to reach men and new migrants. There need to be good referral systems within and between organisations.
• Prevention interventions and information should target people with lower education, and young black Africans. People, including late teenagers, lack basic information concerning condom access and use and negotiating safer sex, for example. Interventions should target heterosexual men and men who may have sex with men.
• Educating men especially about consistent condom use is critical because many women are vulnerable to HIV infection due to socio-economic factors, lacking the power or authority to safely insist on condom use. Positive women often face the same problem with negotiating in safety for condom use to avoid onward transmission. Condom distribution, including of female condoms (femidoms), needs to be intensified to improve condom accessibility.
• People diagnosed with HIV should be involved in the development and implementation of interventions (sometimes called ‘positive prevention’), because people with HIV have a key part to play in halting onward transmission and reducing HIV-related stigma and discrimination. However, ‘positive prevention’ needs to respect human rights and dignity, incorporate shared responsibility and avoid reinforcing HIV stigma and discrimination.
• Service providers working with Africans should be aware of HIV trends in the countries of origin of their service users, and the local prevalence data in England, in order to plan and target their interventions appropriately. NW England annual district level detailed HIV statistics
• The majority of black Africans are involved in various religious faiths, making religious leaders key contacts for reaching wider audiences. Interventions should be sensitive to faith issues. Many religious leaders would benefit from training in HIV issues.
• Service providers should recognise that there are many more same-sex relationships among black Africans than reported, and tailor their services appropriately. Providers should not assume having same gender sexual relationships has much or any connection with the gay and bisexual sexual identities familiar in England. However services should also seek out Africans who do have gay or bisexual identities. Whatever the sexual identity a person has, it is same sex behaviour that gives rise to significantly higher HIV transmission risk and unmet sexual health needs than with exclusively heterosexual black Africans.
• There is a need for continuous information, education and communication on HIV and sexual health, targeting not just black Africans but also the general population, in order to reduce stigma and discrimination, which undermine the impact of current interventions. Tightly targeted interventions risk increasing HIV stigma among and directed towards black Africans.
• GPs (family doctors) can play a leading role in HIV diagnosis among black African communities. This needs handling with sensitivity. 

HIV prevention among black Africans in England

UK HIV Prevention for Africans

posted: 22/06/2010

‘Testing is the only way you can tell if you are infected with HIV’ is the message of the new HIV campaign by the African HIV Policy Network. The campaign theme TALK and TEST aims to signpost Africans wanting to talk about HIV testing or about living with HIV, to the free and confidential African HIV information helpline: 0800 0967 500 – Monday to Friday, 10am – 6pm.
 

They are keen for people to visit the African HIV information website Do-It-Right for facts and figures about HIV, to find out more about HIV testing, and take part in the Life Check interactive HIV information quiz. This hopes to offer a fun way to find out more about everything from the basics of HIV, to taking HIV treatments.
 

Untested worries
TALK and TEST is based on results from the latest Bass Line survey of 2,500 Africans living in England. Bass Line found that almost 40% of African people living in England have never tested for HIV, and among the untested, 1 in 10 feel too afraid to test because of fear about having HIV.
Another one-in-eight want to test for HIV but did not know where to go for an HIV test.
 

Ford Hickson, the leading researcher on Bass Line, said: “Many African people in England would test for HIV if they knew where to go for a test. However, influencing testing in other Africans requires increasing their perception of risk from HIV infection, and increasing their understanding of the benefits of testing and the potential harm associated with not knowing their HIV status.
The vast majority know that
• HIV is a virus that can be passed during sexual intercourse
• that HIV cannot be passed through everyday contact
• that there is a medical test that can show whether someone is infected.”

Jabulani Chwaula – National African HIV Prevention Programme Manager says “Those who lack social power turn out to be those with the greatest need for skills and confidence to help them avoid getting or passing on HIV. Resolving this means paying attention to treatment access, stigma, discrimination, and immigration policy.”
Free and confidential African HIV information helpline: 0800 0967 500 – Monday to Friday, 10am – 6pm.
African HIV information website Do It Right
African HIV Policy Network 020 7017 8910
e-mail
NAHIP website
 

Treatment for Prevention

posted: 04/06/2010

"The strongest evidence to date" shows that HIV treatments can be used to prevent the passing on of HIV, reports the medical journal The Lancet. Treating HIV-positive heterosexual people in one recent African study reduced the risk of HIV transmission to their sexual partners by 92 percent. That is as good or better than condoms in cutting the risk of HIV transmission.

HIV transmission risks
More than 3,400 heterosexual couples, in which one partner had HIV and the other did not, in seven African countries (Botswana, Kenya, Rwanda, South Africa, Tanzania, Uganda and Zambia), were in the study.
 

"At the beginning of the study, the HIV-infected members had high CD4 counts and were not on antiretroviral treatment. Couples were provided with counselling and prevention services, followed for up to two years, with regular CD4 measurements and ART [Anti-Retroviral Therapy = HIV treatments] referrals made when they became eligible for ART".
 

After treatment of HIV positive partners: one infection
349 of the partners living with HIV in this study began taking HIV treatments. While 103 partners became HIV positive during the study, only one caught HIV after their partner with HIV started taking HIV treatments.
 

Deborah Donnell of the Vaccine and Infectious Disease Institute in Seattle, Washington state, USA, who was the study’s leading author, said HIV treatments cut the HIV Viral Load to low levels, making people far less infectious. 70% of the partners taking HIV treatments in this study saw their Viral Load fall to very low levels. A randomized trial has now begun to check this reduction in HIV transmission between partners continues.
 

"While awaiting those results, our study indicates that initiation of antiretroviral therapy may have a significant public health benefit as well as clinical advantages for the individuals being treated," Donnell said in a statement.
 

Test and Treat Prospects
This supports earlier research that suggested “the spread of HIV in hard-hit African nations could be cut by 95 percent in a decade, if all those infected started taking medicines immediately. That so-called test-and-treat theory has been disputed in other mathematical models that say those projections are based on flawed assumptions".
 

Warnings
The authors, like many clinicians, are worried that people with HIV will treat this news as permission to give up condoms. One of several critical requirements is avoiding sexually transmitted infections (STI). If either partner has an STI, that raises the risks of HIV being passed on. Many STIs show no symptoms. This study was of heterosexual couples – and HIV transmission risks for men who have sex with men are rather higher than for heterosexual couples.
 

"Although the 92% reduction in HIV-1 transmission that we report is highly encouraging, on an individual basis, counselling is needed to reinforce understanding that potential for HIV-1 transmission to partners remains after ART initiation," write the authors of the study. "This cohort received frequent counselling during 3-monthly follow-up, and we noted no evidence of behavioural risk disinhibition after ART initiation."
 

Test and Treat?

The authors conclude: "As countries strategise for optimum use of resources to expand ART provision beyond individuals with low CD4 cell counts, targeting of treatment to those with high plasma HIV-1 concentrations could be a cost-effective strategy to achieve maximum population-level reductions in HIV-1 transmission, as a step toward universal ART provision to all patients with HIV-1".
 

"We should not wait for the results of further models, observational studies, or the ongoing couple-based prevention trial before engaging in population-based trials of test-and-treat," the authors of a Lancet comment say. "Prevention of new infections would be the main goal but individual-level benefits can also be expected; to be evaluated against initially increased costs to the health-care system. Indeed, today's results argue powerfully for a new generation of research on HIV prevention at the population level with the best possible scientific methodology, including cluster-randomised trials".
 

Source 
Other research 
Lancet
Lancet editorial
University of Washington press release 
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