Gay, Positive, Herpes and LGV

posted: 25/02/2011

Gay men living with HIV who have herpes may find symptoms flare up worse and last longer. Preventive treatment can help prevent herpes flare ups.

Herpes also makes it much easier to pass on HIV (and other STIs) because it raises your viral load, and the blisters contain HIV and provide a way in and out for HIV.
 

Herpes leaflet for gay men

As well as that herpes leafte for gay men, there’s also a new detailed briefing about herpes for sexual health and HIV professionals from Sigma Research, produced for CHAPS, England's gay men's HIV prevention and sexuial health partnership.

LGV
LGV (lymphogranuloma venereum) is a much more uncommon sexually transmitted infection and, like herpes, it's one that gay men living with HIV are more likely to get. It’s caused by varieties of chlamydia bacteria.

LGV caused ulcers, like herpes and syphilis do, and these surface wounds are always a route in and out for HIV.

Having LGV also increases your HIV viral load and that makes passing on HIV more likely.

LGV leaflet for gay men

THT have more information about herpes, LGV and other STIs, on their new website for people living with HIV, My HIV

USA Prevention Treatment Gay Guidelines

posted: 08/02/2011

The first guidelines for HIV negative gay and bisexual men wanting to reduce the risk of getting HIV by using the anti-HIV drug Truvada have appeared.

Taking HIV treatment drug(s) before sex is called pre-exposure prophylaxis (PrEP) and it is not guaranteed to work.

Just two months after the first positive results showed that Truvada can sometimes help, this ‘interim guidance’ has very quickly appeared.
 

The USA public health body, the Centers for Disease Control (CDC), were worried that unofficial, poor use of Truvada and bad habits would grow up if they didn’t put out some guidelines quickly.
 

Prescriptions with detailed support
In the guidelines prescriptions should only be given for 90 days at a time, with HIV testing, adherence counselling, sexually transmitted infection check-ups, sexual risk counselling and condoms provided before new prescriptions are issued.
 

Only if HIV risk ‘substantial’ and continuing
The guidelines state that PrEP should only be provided for men who have sex with men, specifically those who are “at substantial, ongoing, high risk for acquiring HIV infection”.
Pre-exposure prophylaxis involves HIV-negative people taking antiretroviral medications in order to reduce their risk of acquiring HIV. In November, a study conducted with gay and bisexual men in six countries showed that daily use of the two drugs tenofovir and FTC (combined in one pill as Truvada) reduced the risk of infection by 44%.
 

However many of the gay and bisexual men participating in the trial did not take the pills each day, as prescribed. In men who did take the drugs consistently, results seemed to be much better. In men with very poor adherence, results were worse.

However extensive analysis of the adherence data from the trial has not yet been completed, nor have the trial results been replicated in other settings.
 

The CDC only supports using Truvada when it is used almost exactly like it was in the trial. That is why they are limiting its use now gay and bisexual men at high risk of getting HIV.
 

Truvada indicators
The guidance gives quite a broad indication of which men PrEP may be suitable for, citing only lack of condom use in combination with “frequent partner change or concurrent partners in a geographic setting with high HIV prevalence” as examples.
 

Truvada only
The CDC says that antiretrovirals other than Truvada should not be used for PrEP and that the same daily dosing schedule that was employed in the trial must be followed. Therefore, ‘intermittent’ dosing (i.e., before or after sex) is not endorsed.
 

Adherence and continuing prevention support
Moreover adherence support must be a “routine component of any PrEP program”. It should be provided before PrEP is issued, and then at least every 90 days.
 

Similarly, PrEP should only be delivered “as part of a comprehensive set of prevention services” that includes risk-reduction counselling, ready access to condoms and the diagnosis and treatment of sexually transmitted infections. These activities should take place each 90 days, before a new prescription is issued.
 

HIV test first
Before PrEP is provided, clinicians must also check that the patient is HIV-negative. If he has any signs or symptoms that may be linked to HIV seroconversion, RNA testing is recommended. He must also be screened for sexually transmitted infections and hepatitis B, and have his kidney function assessed (Truvada can sometimes harm the kidneys).
 

Other tests for side-effects are required after three months and then annually. Any serious adverse events should be reported to the Food & Drug Administration (FDA).
Cost will be a central concern. In the USA medical insurance companies are unlikely to pay for this prevention use of Truvada but if men have the cash USA doctors can prescribe it. A month’s supply costs around $1000, and USA patients would also have to pay for counselling, side-effects monitoring and doctors appointments.
 

Source

Smith DK et al. Interim Guidance: Pre-exposure Prophylaxis for the Prevention of HIV Infection in Men Who Have Sex with Men. Morbidity and Mortality Weekly Report 60: 65-68, 2010.

 

New Sexual Health Strategy

posted: 21/01/2011

There will, at last, be a new Sexual Health Strategy for England this year. Public Health Minister, Anne Milton, agreed it is time to replace the HIV and sexual health strategy, which was drawn up in 2001.
 

David Cairns MP, Chair of the All Party Parliamentary Group on HIV & AIDS, shamed English health ministers into action, by making an unfavourable comparison with Scotland, who have a more recent Sexual Health plan.

The All Party Parliamentary Group, and others, repeatedly pushed the Government for a new English strategy.

Finally at a debate on World AIDS Day in Westminster Hall, the Public Health Minister announced there will be a new strategy for England. Anne Milton confirmed it would be more than just a ‘position paper.’
 

“HIV has changed enormously in the last decade. It is now a long-term health condition, not a death sentence, and there are far more people now living with the virus. We’ve been arguing for a new strategy to reflect those changes and I am very pleased that the Government has decided to draw one up this year,” said David Cairns MP, chair of the All Party Parliamentary Group.
 

Remember this?

The 2001 English strategy aimed to:

• reduce the transmission of HIV and STIs
• reduce the prevalence of undiagnosed HIV and STIs
• reduce unintended pregnancy rates
• improve health and social care for people living with HIV
• reduce the stigma associated with HIV and STIs.

To do this the 2001 English Strategy said about HIV, that it would :

• provide clear information about avoiding STIs, including HIV
• increase HIV testing [testing is up]
• ensure there is a sound evidence base of what works in HIV/STI prevention
• set a target to reduce the number of new HIV infections [this target was hopelessly missed]
• develop managed networks for HIV and sexual health services [we have 3 NW networks]
• set a target to reduce the number with undiagnosed HIV [now at last, but we had to wait until 2011]
• ensure earlier access to HIV treatment [This is still a major problem, England has a high level of late HIV diagnosis]
• set standards for treatment, support and social care of people living with HIV [where are the standards for social care support? but we do have excellent standards for treatment]
• prioritise researching good practice in sexual health and HIV

On other sexual health issues the 2001 plan was to 

• evaluate more integrated sexual health services
• screen for Chlamydia
• stress open access to GUM services and more urgent appointments
• ensure a range of contraceptive services are provided
• address the patchy abortion service
• increase hepatitis B vaccinations
• set standards for treating STIs
• train and develop the sexual health workforce
   

Manchester HIV Training

posted: 19/01/2011

Dates and details of all the training courses on HIV, sexual health, drugs and alcohol for the next year are now listed and can be booked with Manchester Public Health Service.

HIV courses

• Positive Interventions : HIV & Sexual Health Awareness

2 Day course, for frontline workers, in April, July, November, January (2012), February and March

• Positive Plus : Advanced HIV Awareness

1 Day Course for frontline workers - you need to have done their HIV introduction course Back to Basics, or have a good knowledge of HIV. In May, November

• Back to Basics : An introduction to HIV and Sexual Health Awareness

1 Day Course, for frontline workers, in June, October, November, and March (2012)

• Rather have a cup of tea : Over 50’s, sexual health and HIV

1 Day Course for frontline staff working with people over 50, in August

Other Manchester sexual health, drink and drug courses

• Crushes to Hot Flushes : Women and Sexual Health (women only course)
• Getting the Measure of it : Basic alcohol awareness
• Alcohol and Dependency : Women and alcohol
• It’s a Man’s World : Working with boys and young men
• ‘It’s not an issue’ : Sexual health, sex and relationships for people with learning difficulties
• Reducing Drug Related Deaths : Overdose Management
• Living the High Life (Part 1) : Drug Awareness
• Living the High Life (Part 2) : Advanced drugs awareness
• No Girls Allowed : Men and sexual health (men only course)
• People, Pins and Prevention : Safer injection training
• The Jury’s Out : Harm Reduction
• The Sleeping Giant Awakes! : Hepatitis C
• Who ate all the P.I.E.S : ‘An Introduction to Performance and Image Enhancing Drugs’
• Call the Cops : ‘The essential guide to Legal and illegal 'Legal Highs'
• Curry & Rice : The Ultimate Take Away [about the high risks of speedballing: using heroin and crack together]

Manchester Public Health Service sexual health training booklet with application form

Sexual Health and Harm Reduction Training Administrator: Kellie McGuire
MPHDS
Mauldeth House
Mauldeth Road West
Chorlton
Manchester
M21 7RL
0161 882 2301

 

Other Manchester Public Health training booklets

• Mental Health and Well Being, contact
• Physical Activity, Health Eating & Cancer Prevention, contact
• Stop Smoking, contact

Manchester Public Health Development Service

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