1 in 6 Gay Men Recently Infected

posted: 26/07/2010

One in six gay men having a HIV positive test in the UK became HIV positive within the past six months. This is the first result from a new system tracking trends in recent HIV infections in the UK.
 

The Health Protection Agency devised a formula (an algorithm) and method for tracking recent HIV infections. Knowing how many people were recently infected is helpful for working out what is actually happening in the UK HIV epidemic.

The number of recent infections matters because people who are recently infected are far more infectious than at any other time.
 

Tracking recent infections
The new formula and tracking method, called either the Recent Infection Testing Algorithm (RITA) or Serological Testing Algorithm for Recent HIV Seroconversion (STARHS), measures the amounts of certain antibody markers. These amounts change depending on how long ago the HIV infection took place. Amounts below a certain level mean the infection was recent (approximately within the last six months).
 

The RITA / STARHS method is not exact enough to tell an individual when they became HIV positive, because we all vary in how our immune system responds to HIV, but the method is good enough to give rough timings, which is all we need to track what is happening with the epidemic.
The work on this tracking system began in 2008, when the Health Protection Agency rolled-out STARHS as part of the routine public health monitoring of all newly diagnosed HIV infections in the country.
 

Results
The data presented the International AIDS 2010 conference in Vienna that has just ended, came from samples of 2099 people, who broadly represent, demographically and geographically, people newly diagnosed in the UK. The samples were collected between February 2009 and May 2010.
 

Gay and bi men results

Amongst gay and bisexual men, 16.1% of diagnoses were judged to be recent – within the past six months – one in six. There wasn’t any difference between gay and bi men of different ages.
 

Heterosexual results

Among heterosexuals, 6.2% men and 6.8% women were recently infected. This is just one in sixteen heterosexuals being infected within six months of their positive test.
 

There appears to be a trend for recent infections to be more commonly identified in younger heterosexual women (probably due to antenatal testing), but the age variations were not statistically significant. Curiously, in women aged 50 or over, there was a relatively high proportion of recent infections, but this is based on a small number of cases and could be due to chance. But it fits with another recent report from the HPA at the Vienna International AIDS Conference - many long-term heterosexual relationships break up when people are in their 50s, and women, no longer needing contraception, may neglect to consider the need for safer sex - condoms - to protect against STIs such as HIV.

Recently infected heterosexuals were largely people born in the UK. Heterosexual people born in Africa tend to have infection diagnosed later, the majority becoming HIV positive before migration to the UK.
 

Source

Reference: Lattimore S et al. Surveillance of recently acquired HIV infections among newly diagnosed individuals in the UK. Eighteenth International AIDS Conference, Vienna, abstract FRAX01001, 2010.
 

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

Positively Women Changes

posted: 09/06/2010

Positively Women, based in London, has changed both its name and the focus of its work. As their website says "On 6 June, Positively Women entered a new and exciting chapter in its life. Following a major strategic review and process of consultation with service users and stakeholders we have extended our remit to reach both men and women living with HIV.

Positively UK retains its core ethos of peer support, with people living with HIV developing and delivering services. Our peer support services for women remain along with Positively Women magazine, and these now sit alongside services for men and young people."

About the changes

After 23 years, Positively Women has entered a new and exciting chapter of its life. In June 2010 following a major review of strategy, and consultation with service users and stakeholders they have decided to serve both men and women living with HIV.

It will retain its core ethos of peer support, with people living with HIV developing and delivering services. Peer support services for women will remain, alongside resources such as the Positively Women magazine. They will build on their strengths and provide peer support to new groups, notably men and young people. They are saying 'we are here to support people living with HIV across the UK'. That explains the change of name to Positively UK.

New Vision - A society where HIV and related health conditions are free from stigma and discrimination
New Mission - Positively UK champions the rights of people living with HIV and related health conditions

What they will do 

• Providing specialist and peer support, advocacy and information
• Campaigning against discrimination
• Promoting positive attitudes and equitable access to health
• Increasing involvement, voice and visibility

Ambition - To provide peer led support to all people living with HIV in the UK by 2020.
 

Why change the name after 23 years?
Positively Women has spent a year reviewing its strategy and future. The whole country faces a period of significant change and less public funding for services. Councils and the NHS are expected to reduce the number of contracts, and will favour general support organisations rather than specialists. Providing services specifically women, meant Positively Women would be vulnerable. It has already lost some funding because of this.
 

Gap for Peer Support

There is a lack of organisations providing peer led work - services led by people with HIV . Continuing to provide peer services to women, and extending this to men, meets a need and helps fill this gap. Changing the name reflects this.

Why Positively UK?
They have kept the word ‘Positively’ as the organisation remains committed to supporting people living with HIV. It also acknowledges and keeps a link to the past. Adding ‘UK’ makes it clear to people using services, to funders and others that the organisation is open to everyone living with HIV, across the country.
Replacing ‘Women’ in the name was a difficult decision and they realise many people will feel a sense of loss that the organisation is no longer called Positively Women. The name Positively Women  is close to many people’s hearts and is an assurance of dedicated services for women. They will keep the Positively Women brand for all their women’s services and have designed a new Positively Women logo.
This was developed with a design company Intertype who have helped before with their publications design including Positively Women magazine. Intertype came up with a series of designs for the new logo. Staff, volunteers and trustees were consulted and the new design was the most popular. People felt this was friendly and accessible. The designers did not charge and Positively UK designed and built their own new website.
 

Services for Women

Positively UK will have six strands of work. A main strand will continue to be Positively Women. Women still encounter gender and health inequalities, and women living with HIV have specific needs in their role as mothers and carers. Positively UK will continue to provide one-to-one and group peer support for women; women accessing services will still receive support from another positive woman.

Their current London support groups will remain women only and we will continue support for lesbian, bisexual and transgender women. Positively Women magazine will also remain women focused.

Positively UK will also continue to support the development of the national network of women living with HIV, PozFem-UK. They are also committed to new women’s services and over the next year are developing a project to support women through pregnancy and ante-natal care.
 

Services for Men Services for men will be developed under the accompanying strand of Positively Men.
 

Other services They already host Str8 Talk, a self-facilitating group for heterosexual men and women; and their Parenting and Caribbean groups are already open for men to attend. Additional peer support services are being developed for men and they are already recruiting and training male volunteers to be peer mentors providing one-to-one support, alongside female volunteers; in the meantime their London services are open to men.
 

Positively Youth
In early 2010 they ran a pilot project looking at the needs of young people living with HIV as they make the transition from adolescence to adulthood and paediatric to adult HIV services. They are looking for funding to implement a new programme for young people living with HIV, working in partnership with the 900 clinic at St Mary’s Hospital, in London.
 

Positively Health
Their prevention activities have focused upon the African communities as part of the Department of Health’s NAHIP programme. They aim to continue this and build on this to extending work in the community and with people living with HIV, and into HIV testing.
 

Positively Policy
The organisation remains committed to developing and supporting the involvement of people living with HIV in shaping policy, practice and services. PozFem-UK, the national network of women living with HIV, will continue to be developed and they are committed to developing a wider network to support all people living with HIV in consultations and policy responses.
 

Positively Information
Their website is their largest information tool for wider the public and people living with HIV. It's been redesigned along with the change of name.

Positively Women magazine

Positively Women magazine  continues to be the only magazine for women living with HIV written by women living with HIV. They are developing new materials to support other aspects of our work such as information for women around pregnancy and resources for young people.
 

Their new website - Positively UK

PozFem-UK website

Their questions and answers document about the changes - the information above comes from this.

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
 
 

Crunch Time for Microbicides

posted: 25/05/2010

Professor Robin Shattock, director of the microbicide research at at St George’s Hospital in London, warned the opening session of Microbicides 2010 Conference in Pittsburgh, USA that “we stand at a critical time point in microbicide development. There is a recognised need to prioritise and accelerate efficacy testing in clinical trials,” before funders lose interest in microbicides.
 

Since all the first attempts at non-ARV-based microbicides have failed, there are now just three possible microbicides being studied.
 

Three possible microbicides left
 

• The first is CAPRISA in South Africa, a phase 2b trial of tenofovir gel - expect results in July at the Vienna International AIDS Conference 
• VOICE, a phase 3 trial testing tenofovir gel and tenofovir and tenofovir/FTC PrEP, is recruiting now with results next year. 
• The long-awaited IPM009 trial of dapivirine in a vaginal ring and/or gel is not due to start till 2012.

Microbicides once were the best new hope for prevention, but now what is called ‘pre-exposure prophylaxis’ – giving HIV drugs to people who do not have HIV to prevent HIV infection - is pulling ahead. There are now more ‘pre-exposure prophylaxis’ trials underway or planned than the three trials we have for microbicides.
However, microbicides still look far more hopeful than attempting to make a workable HIV vaccine.
 

Microbicide possibilities
There are now 13 different compounds that might work if used in microbicides being tried out, and more than 20 studies. The compounds that might be used for microbicides range from drugs as familiar as tenofovir, to ones as exotic as nucleocaspid protein inhibitors, and broadly neutralising antibodies. These have all been shown to block HIV infection in monkeys.
 

Next steps – and some of the problems
“Biological plausibility for microbicides has never been stronger,” he said. “But how can this knowledge bridge to better human trials?”

• One problem is making sure any drug reaches the place it needs to, in the right amount, and in a state which will work. We need better ways of measuring these things in people. People are already working on solving this.

Real life practicalities

• An even bigger problem is designing microbicides that will work in the real world. Doctors and researchers usually describe this as an adherence problem – making sure people use the microbicides properly. But if the instructions are unreasonable and don’t fit with real life needs and situations, any unreasonable instructions will be ignored. We learnt that many women simply find it impossible to re-apply a microbicide, when they have sex more than once a night. We learnt this from the Carraguard trial which failed two years ago precisely because this turns out to be a real life requirement.

Professor Shattock told the conference that we need better formulations to maximise adherence. New ways of monitoring adherence would also be needed to measure how well the new microbicides work in real life. Vaginal rings, like those used for contraception, that supply a constant level of drugs, would be one way to overcome this 'adherence' problem.
 

• Microbicides which use a combination of two of three drugs also look a good prospect for investigation.

Money is the key
The challenge now, Shattock told a press conference, is not developing more possible things that might work as a microbicide – there were plenty of those – but finding the money to start trials.
 

Anti-HIV drug microbicides cheaper
You need very little of a HIV drug in a microbicide for it to work – far less than you need when treating someone with HIV. That makes using the same drugs in microbicides relatively cheap compared with the cost of treating someone after infection. A single maraviroc tablet has enough of the drug for up to 20 doses if it is used as a microbicide. “But,” he added, “Without success or even an indication of success soon it will be impossible to sustain the funding for microbicides.”
 

Nono Eland of the South African Treatment Action Campaign, speaking after Shattock, commented that “if we fail on prevention, we will lose the progress we’ve made on treatment,” because funders will be unwilling to provide ever-expanding funding for an uncontainable disease.
 

Waiting women

We seem to have reached a critical moment for the future of microbicides. Microbicides need money now if we are ever to have any that will work. Microbicides are a gender issue. Women's need for an independent form of protection must be taken seriously.
 

Women are still waiting for any type of HIV prevention that will work when men won’t use condoms or it is too risky to suggest this to men. Microbicides are one of the best hopes we have for offering HIV prevention to women.

Source
Shattock R. State of the ART for microbicides. Opening plenary, Microbicides 2010 Conference, Pittsburgh. Presentation #1. 2010.