For first time, over half of people with HIV taking meds

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For first time, over half of people with HIV taking meds

LONDON -- For the first time in the global AIDS epidemic that has spanned four decades and killed 35 million people, more than half of all those infected with HIV are on drugs to treat the virus, the United Nations said in a report released Thursday.

AIDS deaths are also now close to half of what they were in 2005, according to the U.N. AIDS agency, although those figures are based on estimates and not actual counts from countries.

Experts applauded the progress, but questioned if the billions spent in the past two decades should have brought more impressive results. The U.N. report was released in Paris where an AIDS meeting begins this weekend.

"When you think about the money that's been spent on AIDS, it could have been better," said Sophie Harman, a senior lecturer in global health politics at Queen Mary University in London.

She said more resources might have gone to strengthening health systems in poor countries.

"The real test will come in five to 10 years once the funding goes down," Harman said, warning that some countries might not be able to sustain the U.N.-funded AIDS programs on their own.

The Trump administration has proposed a 31 percent cut in contributions to the U.N. starting in October.

According to the report, about 19.5 million people with HIV were taking AIDS drugs in 2016, compared to 17.1 million the previous year.

UNAIDS also said there were about 36.7 million people with HIV in 2016, up slightly from 36.1 million the year before.

In the report's introduction, Michel Sidibe, UNAIDS' executive director, said more and more countries are starting treatment as early as possible, in line with scientific findings that the approach keeps people healthy and helps prevent new infections. Studies show that people whose virus is under control are far less likely to pass it on to an uninfected sex partner.

"Our quest to end AIDS has only just begun," he wrote.

The report notes that about three-quarters of pregnant women with HIV, the virus that causes AIDS, now have access to medicines to prevent them from passing it to their babies. It also said five hard-hit African countries now provide lifelong AIDS drugs to 95 percent of pregnant and breast-feeding women with the virus.

"For more than 35 years, the world has grappled with an AIDS epidemic that has claimed an estimated 35 million lives," the report said. "Today, the United Nations General Assembly has a shared vision to consign AIDS to the history books."

The death toll from AIDS has dropped dramatically in recent years as the wide availability of affordable, life-saving drugs has made the illness a manageable disease. But Harman said that "Ending AIDS" - the report's title - was unrealistic.

"I can see why they do it, because it's bold and no one would ever disagree with the idea of ending AIDS, but I think we should be pragmatic," she said. "I don't think we will ever eliminate AIDS, so it's possible this will give people the wrong idea."

© 2017 The Associated Press. All Rights Reserved. This material may not be published, broadcast, rewritten, or redistributed.

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Path to end HIV could be within reach for United States in next decade

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Path to end HIV could be within reach for United States in next decade

The United States could be on track within the next decade to see significant steps towards ending the HIV epidemic in this country, suggests new research from the Johns Hopkins Bloomberg School of Public Health and Brigham and Women's Hospital.

The researchers say their findings reveal that, with adequate commitment, a path exists to eliminate domestic HIV infection through the achievement of critical milestones -- specifically, the reduction of annual new infections to 21,000 by 2020 and to 12,000 by 2025. They say that if these goals were met, 2025 could be the turning point for the epidemic, when HIV prevalence, or the total number of people living with HIV in the United States, would start to decline. The report is published May 15 online in the American Journal of Preventive Medicine.

"While these targets are ambitious, they could be achieved with an intensified and sustained national commitment over the next decade," says study co-author David Holtgrave, PhD, chair of the Department of Health, Behavior and Society at the Bloomberg School. "It's critical to note that the key to ending the HIV epidemic domestically lies in our collective willingness as a country to invest the necessary resources in HIV diagnostic, prevention and treatment programs."

For their study, the researchers used HIV surveillance data published by the Centers for Disease Control and Prevention (CDC) for the years 2010 to 2013 to project yearly estimates for several key indicators -- the number of new infections occurring annually, the number of people living with HIV in the United States, and the mortality rate -- for 2014 through 2025.

The researchers used these projections to forecast the potential trajectory of the epidemic if the United States were to achieve certain benchmarks set by the National HIV/AIDS Strategy (NHAS), which was first released by President Obama in 2010 and updated in 2015 with targets to be met by 2020. The NHAS targets for 2020 include a"90/90/90" goal, which proposes that by 2020, 90 percent of people living with HIV will know their HIV status; 90 percent of people diagnosed with HIV will receive sustained, quality HIV care; and 90 percent of people on antiretroviral therapy (ART) will achieve viral suppression, or an undetectable level of virus in the blood. For their projection of the potential course of the epidemic from 2020 to 2025, the researchers proposed a "95/95/95" goal and assessed achievement of the NHAS targets at 95 percent levels by 2025.

Their analysis revealed that if the NHAS targets -- "90/90/90" for 2020 and "95/95/95" for 2025 -- were achieved, the number of new HIV infections in the United States would drop from 39,000 in 2013 to approximately 20,000 in 2020, or a 46 percent decrease, and to about 12,000 in 2025, a nearly 70 percent reduction. Additionally, the total number of deaths among people living with HIV would decline from 16,500 in 2013 to approximately 12,522 in 2025, a 24 percent decrease, and the mortality rate would drop from 1,494 deaths per 100,000 people living with HIV in 2013 to around 1,025 in 2025, a 31 percent decrease.

"If the United States were to reduce the number of new HIV infections to 12,000 by 2025, this would mark an important inflection point in the HIV epidemic in this country," says study leader Robert Bonacci, MD, MPH, a resident physician in the Department of Medicine at Brigham and Women's Hospital. "It would be the first year that the number of new infections drops below the simultaneously decreasing number of deaths among people living with HIV. This is critical, because if new infections decline faster than the number of deaths, the total number of people living with HIV in the United States would begin to decrease, meaning the United States would be on course to end the epidemic."

Advancements in antiretroviral therapy (ART) -- the lifesaving drugs that reduce HIV transmission by lowering the level of virus in the blood -- mean that HIV can now be a manageable chronic disease. In the United States, the average life expectancy for people living with HIV continues to increase toward that of the general population. Yet, of the more than one million people living with HIV, many lack access to ART.

Additionally, certain populations -- particularly gay men, young people, transgender people, black and Hispanic Americans and those who live in southern states -- continue to be disproportionately affected, and the overall progress has not been felt equally across all communities.

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A GOP Health Care Plan May Ruin Our Best Chance At Ending HIV And AIDS

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A GOP Health Care Plan May Ruin Our Best Chance At Ending HIV And AIDS

Truvada, a drug that prevents HIV infection, is poised to have a major effect, if we can keep giving coverage to the people who need it most.

Before the pharmacist retrieves my prescription, she leans in and whispers: “Just so you know, it’s $1,300.” This happens almost every time, so I already have at the ready my coupon card from the drug’s manufacturer.

The card provides me with $3,600 in co-pays, or about three months worth of medicine, but now I’ve run out. I’m only on the hook for $80, after which I’ll hit my $7,150 health insurance deductible for the year. Then, until January, each monthly prescription will be free for me. I swipe my credit card.

Between the manufacturer-provided discounts and my private health insurance, I can afford Truvada, which blocks HIV transmission, and, most likely, I’ll be able to continue my regimen even if the Affordable Care Act is repealed. But, that won’t be the case for thousands of other at-risk people who could potentially lose coverage, meaning we may miss the best chance we’ve ever had to end the AIDS epidemic.

“Universally available PrEP and treatment could end the HIV epidemic,” said Dr. Robert Grant, an AIDS clinician and researcher at the University of California, San Francisco. However, the implementation still needs some work.

In 2012, when the Food and Drug Administration approved Truvada for the prevention of HIV, a treatment also called pre-exposure prophylaxis (PrEP), it seemed like a watershed moment. The pill is taken once a day, has comparatively mild side effects, requires only routine blood tests, and is up to 99 percent effective. Public health officials in major U.S. cities, such as New York and San Francisco, embraced Truvada, which is more effective than condoms and also an option for IV drug users, who now account for 10 percent of all new HIV infections.

The major barrier then — and now — is the $1,300-a-month price tag.

Currently, only 125,000 people are on PrEP in the United States, the majority of whom are white men living in cities — a troubling disparity considering that, during the past decade, overall HIV infection rates have fallen by 20 percent but risen, during this same period, by almost a quarter for black and Latino men who have sex with men, populations that are also disproportionately uninsured and on Medicaid. Likewise, because of a combination of stigma and inaccessibility, rural communities are also lagging behind.

Though small in absolute terms, the number of PrEP users has grown more than 13 percent since the end of 2016, thanks in part to new advertising campaigns from the drug’s manufacturer, Gilead.  

Moreover, the benefits extend beyond greater protection from HIV. Truvada is “a wonderful gateway drug to primary care,” according to Grant.

When someone comes in for an HIV test, Cody Shafer, the PrEP coordinator for Iowa’s Department of Public Health, directs him to a patient navigator who specializes in ACA enrollment and assists him during the 20-minute wait for results. Shafer says it’s the first time that many of his patients have had insurance, which allows them to access a host of preventive services, such as programs to quit smoking, treat substance abuse and combat diabetes risks.

What’s more, to maintain their PrEP prescriptions, each recipient must get tested for HIV every three months, four times as frequently as other men who have sex with men, according to Grant’s experience as a clinician and data from the Centers for Disease Control and Prevention. This infrequent testing helps explain why 1 in 8 HIV-positive people in the U.S. is unaware of their status.

But, these secondary benefits may soon disappear.

Though it’s unclear how (or if) the ACA will be repealed, the plan passed by the House this month would certainly lead to fewer insured Americans and, by extension, fewer patients able to afford PrEP. Gilead offers that $3,600 co-pay discount to patients with insurance and a full subsidy to those without, but that assistance will be insufficient.

“To qualify for those programs, you need to have a motivated physician who’s willing to fill out the forms. If you don’t have insurance, you won’t have a physician,” Grant said.

And, Gilead also doesn’t cover lab fees, which, for my latest visit, would have cost me $615.81.

The dangerous practice some users engage in

When patients are unable to access Truvada through official channels, they find other means. Shafer told me he’s already seen men in Iowa who drop down to four doses a week to conserve pills, HIV-positive patients who ask for early refills to share or sell, and PrEP users who continue to fill prescriptions even after they’ve stopped engaging in risky behavior.

“They want to have extra on hand to help out friends and partners who lose coverage,” he said.

Considering the drug’s effectiveness and ease of use, it’s understandable that patients will choose to have some protection over none. However, the greatest risk of PrEP is contracting HIV and then taking Truvada, which is also used to treat the disease, and that potentially leading to mutations that make patients resistant to an entire class of antiretrovirals.

To make matters worse, HIV can lie dormant and asymptomatic in the body for years, and at-home tests can miss an infection as far back as a month. Newly infected patients are the most contagious vectors, and without any symptoms to slow them down, they can spread the disease with astonishing quickness. (Some of the first men to die of AIDS reported more than 2,500 lifetime partners.)

A missed opportunity

Republicans’ health care reform proposal comes at a precipitous time for the AIDS epidemic. Current treatments are effective enough that HIV becomes nearly undetectable in the blood, but antiretrovirals don’t come cheaply. The CDC estimates that the lifetime cost of treatment is $379,000, and allowing insurers to discriminate based on pre-existing conditions would, of course, be catastrophic for HIV-positive patients, 30 percent of whom are already uninsured.

Echoing Shafer, Dr. Michael Ohl, an infectious disease specialist at the University of Iowa, says that these patients may sell their Truvada to make ends meet, which will raise their viral load — and their chances of transmission.

By all accounts, I’m fortunate: for being young, healthy and without any pre-existing conditions and for being well-equipped to navigate bureaucracies, able to afford health insurance, and now in a monogamous relationship. If the ACA is repealed, however, others won’t be so lucky, which could jeopardize the last three decades of progress in combating the epidemic.

CORRECTION: An earlier version of this post misstated the amount of the Gilead co-pay discount. It’s $3,600.

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10 Mistakes People with HIV Make

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10 Mistakes People with HIV Make

Sidestep Complications

You can live a long, productive life with HIV. But it’s important to learn all you can about the condition and how to care for yourself. By avoiding the following mistakes, you can sidestep complications and improve your quality of life. READ MORE

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HIV Infection Associated With Elevated Cardiovascular Disease Risk

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HIV Infection Associated With Elevated Cardiovascular Disease Risk

HIV-related comorbidities, including cardiovascular disease (CVD), have assumed a higher profile given the efficacy of antiretroviral therapy (ART). With the increased survival of persons living with HIV, several factors raise the risk for CVD, including the high rate of conventional CVD risk factors,1-8 the presence of HIV-related inflammatory and immunological processes,8,9 and metabolic dysregulations (eg dyslipidemia and insulin resistance) possibly associated with ART.10-12

Accordingly, CVD risk assessment has assumed a more prominent role in the management of HIV-infected persons, particularly those receiving ART. This assessment, however, needs to account for the distinctive factors affecting CVD risk in this population. The standard Framingham model for global CVD risk may not provide the most accurate assessment of the odds of cardiovascular events in HIV-infected persons. As a consequence, a modified predictive model derived from the Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) study, which considers CD4 cell counts and administration of ART in addition to standard risk factors, has been developed (http://www.cphiv.dk/Tools) to alert clinicians to CVD risk in HIV-infected persons requiring more aggressive CVD risk-mitigation interventions.13 READ MORE

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UNDER NEW BILL HAVING UNPROTECTED SEX WITHOUT DISCLOSING HIV-POSITIVE STATUS WILL NO LONGER BE A FELONY

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UNDER NEW BILL HAVING UNPROTECTED SEX WITHOUT DISCLOSING HIV-POSITIVE STATUS WILL NO LONGER BE A FELONY

A new bill in California proposes to reduce the punishment for having unprotected sex without disclosing one's HIV-positive status from a felony to a misdemeanor.

The bill is proposed as an effort to reduce the stigma attached to being HIV positive, and would also apply to people who donate to blood or semen banks without disclosing their HIV or AIDS status.

"HIV-related stigma is one of our main obstacles to reducing and ultimately eliminating infections," Democratic state Senator Scott Wiener said. "When you criminalize HIV or stigmatize people who have HIV it encourages people not to get tested, to stay in the shadows, not to be open about their status, not to seek treatment."

According to the Williams Institute at the UCLA School of Law, between 1988 and June 2014, there were 357 convictions in California for such crimes. Felony convictions for failing to disclose HIV status can result in sentences of up to seven years in prison.

A majority of convictions occur in relation to prostitution, where soliciting someone for sex while HIV-positive resulted in a felony, even if the two people never had sex.

The legislators who created the bill believe the current law puts an unfair burden on HIV-positive people.

"These laws are absolutely discriminatory. No other serious infectious disease is treated this way. HIV was signaled out," Wiener said.

"Current state law related to those living with HIV is unfair because it is based on the fear and ignorance of a bygone era," Assemblymen Todd Gloria, who cowrote the bill, said. "With this legislation, California takes an important step to update our laws to reflect the medical advances which no longer make a positive diagnosis equal to a death sentence."

The lawmakers also noted that under the current law, people can be charged with a felony for failing to disclose status even if they are under a treatment regimen that virally suppresses the infection, making it unlikely that it would be passed on to sexual partners. Treatment for the disease, including reducing and even blocking transmission, has vastly improved since rates first sky-rocketed in the 1980s.

LGBTQ rights groups like Equality California, the Los Angeles LGBT Center and the Sex Workers Outreach Project are in favor of the bill, as it would reduce the overwhelming stigma around HIV/AIDS and halt overreaching punishments on those with HIV-positive status.

Rick Zbur, the executive director of Equality California, said, "These laws impose felony penalties and harsh prison sentences on people who have engaged in activities that do not risk transmission and do not endanger public health in any way."

Republican state Senator Jeff Stone, one of the opponents of the bill, said, "HIV/AIDS remains a deadly disease. Existing law provides accountability of those engaging in unprotected, risky behavior that endangers the life of another."

Republican Senator Joel Anderson agreed, saying, "While we have come a long way with AIDS, you still have to take drugs for the rest of your life. You still have to bear the burden of the costs of the health care."

Anderson said he would add other diseases to the list whose intentional spreading results in a felony conviction in order to eliminate the inherent discrimination in the law. "I get that this is the only disease that is treated that way, but I think any disease that you inflict on somebody against their will that permanently changes them should be a felony," he said.

"Because they are so disrespectful of the people they are willing to engage in a sexual act with and risk their life, that is the reason why they need to go to prison," Anderson added. "They can't be trusted in society as a responsible person."

Catherin Hanssens, the executive director of The Center for HIV Law and Policy and a supporter of the bill, says that while most people agree that a person should be upfront about their HIV status, lack of disclosure shouldn't be met with such a harsh penalty.

"There is a very important difference between what people should do, or even may have an ethical duty to do, and what they should be prosecuted as a serious felon for not doing," she said.

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HIV is still deadly; willingly exposing someone to it ought to remain a felony

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HIV is still deadly; willingly exposing someone to it ought to remain a felony

To the editor: The primary purpose of the California law making it a felony to knowingly expose someone to HIV is to discourage evil and criminal behavior and to protect the innocent. (“Having unprotected sex without telling partner about HIV-positive status no longer would be a felony under new bill,” March 17)

Let’s be clear: HIV is still a death sentence. Yes, science has done a remarkable job of extending life spans, but HIV-positive people still can expect to die years before the uninfected. And the drugs have their own issues and side effects. Don’t ask about cost. There is still no cure — you’ve got it for life. READ MORE

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Charlie Sheen says other Hollywood stars are HIV positive: 'I know who they are'

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Charlie Sheen says other Hollywood stars are HIV positive: 'I know who they are'

CHECK OUT VIDEO:

Charlie Sheen told “The Kyle and Jackie O Show” on Wednesday that he knows of other celebrities who are HIV positive but won’t speak out.

Host Jackie O asked him, “Do you think there are more people in Hollywood that have HIV that wouldn't dare come out and say it like you did?”

Sheen replied, “There are, and I know who they are, but I will take that to my grave.”

The 51-year-old revealed in 2015 that he was HIV positive. During his chat with Kyle and Jackie O, he also blasted his ex-“Two and a Half Men” co-star Jenny McCarthy for comments she made about her contact with him on set after he revealed his HIV status.

He said McCarthy spoke too soon when he “came out with the HIV s--t”.

“ ... She’s like, ‘I kissed him! I touched him!’ And I was like, ‘B--ch! Your math sucks, I didn’t have it then!’”

During Wednesday’s interview, Sheen also raved about the “miracle drug” he is on to keep him healthy.

He said as a result he is “safer” than many people in Hollywood who are having sex.

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Why Fewer Babies Are Being Born With HIV

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Why Fewer Babies Are Being Born With HIV

BY: Alice Park 

Researchers have seen big progress in reducing HIV transmission from mother to child, according to the latest data compiled by the Centers for Disease Control and Prevention (CDC). In a report published in JAMA Pediatrics, scientists found that in 2013, 69 babies were born with the virus in the U.S., compared to 216 in 2002.

Efforts to prevent the transmission of HIV from mother to child during pregnancy are starting to pay off, as TIME detailed in a recent feature about stopping the spread to infants. Part of that is due to higher rates of HIV testing among women. About half of the women who gave birth to HIV-positive newborns were diagnosed with HIV before getting pregnant in the years from 2010-2013. Only about 38% of mothers knew their status before pregnancy in the years from 2002-2005. This suggests that more women are getting tested for HIV, which doctors say is a critical step in reducing transmission. Expectant moms who know their status can start anti-HIV drug treatments, which can keep their virus at extremely low levels. Moms on proper treatment only have a 1-2% chance of passing on HIV to their babies. READ MORE

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National Native American HIV/AIDS Awareness Day

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National Native American HIV/AIDS Awareness Day

Get tested, and get involved in HIV prevention, care, and treatment. March 20, 2016, is National Native HIV/AIDS Awareness Day (NNHAAD). This day is an opportunity for Native people across the United States to learn about HIV/AIDS, encourage HIV counseling and testing in Native communities, and help decrease the stigma associated with HIV/AIDS. On March 20, we recognize the impact of HIV/AIDS on American Indians, Alaska Natives, and Native Hawaiians (collectively referred to as Native people) through the observance of National Native HIV/AIDS Awareness Day. This national observance, now in its 10th year, is sponsored by a coalition of partners who provide assistance to Native organizations, tribes, state health departments, and other organizations serving Native populations. Observed annually on the spring equinox, NNHAAD is a national community mobilization effort designed to encourage American Indians, Alaska Natives, and Native Hawaiians across the United States and territorial areas to get educated, get tested, and get involved in HIV prevention, care, and treatment. This year's theme is Hear Indigenous Voices. HIV in Native Communities in the United States Of the estimated 44,073 new HIV diagnoses in the United States in 2014, one percent (222) were among AI/AN. Of those, 77% were men, and 22% were women. Of the estimated 170 HIV diagnoses among AI/AN men in 2014, most (84%, 142) were among gay and bisexual men. From 2005 to 2014, the number of new HIV diagnoses increased 19% among AI/AN overall and 63% among AI/AN gay and bisexual men.1 Poverty and high rates of sexually transmitted diseases (STDs) contribute to the challenges. The stigma associated with gay relationships and HIV, barriers to mental health care, and high rates of alcohol and drug abuse, STDs, and poverty all increase the risk of HIV in Native communities and create obstacles to HIV prevention and treatment. Native communities are working to overcome these barriers by increasing HIV/AIDS awareness, encouraging HIV testing, and promoting entry into medical care. CDC is working with communities to share stories, build awareness, and reduce the toll of HIV, for example: "Sharon's Story" is part of the CDC HIV Treatment Works campaign. A member of the Penobscot Nation, Sharon has been living with HIV since 2003, and she is a voice to those with HIV in her community. "Shana's Story" and "Tommy's Story" are included in Let's Stop HIV Together. This campaign shows HIV-positive individuals alongside someone important in their lives to demonstrate how HIV affects people from all walks of life. Public service announcement for Doing It, CDC's HIV testing campaign, features Native participants encouraging others to make HIV testing a routine part of their healthcare. CDC recommends that all adults and adolescents get tested for HIV at least once as a routine part of medical care while those at increased risk should get an HIV test at least every year. HIV testing is vital and sexually active gay and bisexual men might benefit from HIV testing every 3 to 6 months. Women should also get an HIV test each time they are pregnant. What Can You Do? Visit the CDC HIV/AIDS website to learn: The risk factors for getting HIV High-risk behaviors How to practice safer methods to prevent HIV infection Get tested for HIV and encourage others to do the same. To find a testing site near you, call 1-800-CDC-INFO (232-4636), go to GetTested, or text your ZIP code to KNOW IT (566948). Home testing kits are available online or at a pharmacy. You may also find a testing location by visiting your local IHS Tribal or Urban facility, or through Indian Health Service. Talk about HIV prevention with family, friends, and colleagues and on social media When posting on Facebook, Twitter, or other social media, please use the hashtag #NNHAAD Sponsor an event. Additional materials are available from the official National Native HIV/AIDS Awareness Day website (NNHAAD.org), Materials include posters, save the date cards, fact sheets, an NNHAAD tool kit, and public service announcements (PSAs). This year the celebrity PSAs are by Stefan Lessard of the Dave Matthews Band and Becky Hobbs, fifth granddaughter of Nancy Ward, Beloved Woman. 

Get tested, and get involved in HIV prevention, care, and treatment.

March 20, 2016, is National Native HIV/AIDS Awareness Day (NNHAAD). This day is an opportunity for Native people across the United States to learn about HIV/AIDS, encourage HIV counseling and testing in Native communities, and help decrease the stigma associated with HIV/AIDS.

On March 20, we recognize the impact of HIV/AIDS on American Indians, Alaska Natives, and Native Hawaiians (collectively referred to as Native people) through the observance of National Native HIV/AIDS Awareness Day. This national observance, now in its 10th year, is sponsored by a coalition of partners who provide assistance to Native organizations, tribes, state health departments, and other organizations serving Native populations.

Observed annually on the spring equinox, NNHAAD is a national community mobilization effort designed to encourage American Indians, Alaska Natives, and Native Hawaiians across the United States and territorial areas to get educated, get tested, and get involved in HIV prevention, care, and treatment. This year's theme is Hear Indigenous Voices.

HIV in Native Communities in the United States

Of the estimated 44,073 new HIV diagnoses in the United States in 2014, one percent (222) were among AI/AN. Of those, 77% were men, and 22% were women. Of the estimated 170 HIV diagnoses among AI/AN men in 2014, most (84%, 142) were among gay and bisexual men. From 2005 to 2014, the number of new HIV diagnoses increased 19% among AI/AN overall and 63% among AI/AN gay and bisexual men.1

Poverty and high rates of sexually transmitted diseases (STDs) contribute to the challenges. The stigma associated with gay relationships and HIV, barriers to mental health care, and high rates of alcohol and drug abuse, STDs, and poverty all increase the risk of HIV in Native communities and create obstacles to HIV prevention and treatment.

Native communities are working to overcome these barriers by increasing HIV/AIDS awareness, encouraging HIV testing, and promoting entry into medical care. CDC is working with communities to share stories, build awareness, and reduce the toll of HIV, for example:

"Sharon's Story" is part of the CDC HIV Treatment Works campaign. A member of the Penobscot Nation, Sharon has been living with HIV since 2003, and she is a voice to those with HIV in her community.

"Shana's Story" and "Tommy's Story" are included in Let's Stop HIV Together. This campaign shows HIV-positive individuals alongside someone important in their lives to demonstrate how HIV affects people from all walks of life.

Public service announcement for Doing It, CDC's HIV testing campaign, features Native participants encouraging others to make HIV testing a routine part of their healthcare.

CDC recommends that all adults and adolescents get tested for HIV at least once as a routine part of medical care while those at increased risk should get an HIV test at least every year. HIV testing is vital and sexually active gay and bisexual men might benefit from HIV testing every 3 to 6 months. Women should also get an HIV test each time they are pregnant.

What Can You Do?

Visit the CDC HIV/AIDS website to learn:

The risk factors for getting HIV

High-risk behaviors

How to practice safer methods to prevent HIV infection

Get tested for HIV and encourage others to do the same. To find a testing site near you, call 1-800-CDC-INFO (232-4636), go to GetTested, or text your ZIP code to KNOW IT (566948). Home testing kits are available online or at a pharmacy. You may also find a testing location by visiting your local IHS Tribal or Urban facility, or through Indian Health Service.

Talk about HIV prevention with family, friends, and colleagues and on social media

When posting on Facebook, Twitter, or other social media, please use the hashtag #NNHAAD

Sponsor an event.

Additional materials are available from the official National Native HIV/AIDS Awareness Day website (NNHAAD.org), Materials include posters, save the date cards, fact sheets, an NNHAAD tool kit, and public service announcements (PSAs). This year the celebrity PSAs are by Stefan Lessard of the Dave Matthews Band and Becky Hobbs, fifth granddaughter of Nancy Ward, Beloved Woman

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National Women & Girls HIV Awareness Day

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National Women & Girls HIV Awareness Day

National Women and Girls HIV/AIDS Awareness Day (NWGHAAD) is March 10. Learn how HIV affects women and girls in the United States and how women can protect themselves. HIV remains a significant health issue for women and adolescent girls, with more than 280,000 women living with HIV in the United States. In 2014, an estimated 8,328 women aged 13 and older were diagnosed with HIV. The majority of these diagnoses can be attributed to heterosexual sex. Black/African American* and Hispanic/Latina** women continue to be disproportionately affected by HIV. Among all US women in 2014, Black women accounted for 62% of new HIV diagnoses but only 13% of the female population. Hispanic/Latina women accounted for 16% of new diagnoses but only 15% of the female population. Whites accounted for 18% of new diagnoses and 64% of the female population. Nevertheless, we are making progress in the fight against HIV among women. From 2005 to 2014, new HIV diagnoses declined 40% among all women and even more (42%) among black women. And for black women newly diagnosed with HIV, the percentage linked to HIV medical care increased 48% from 2012 to 2014. The National HIV/AIDS Strategy has set goals to reduce new HIV infections even more. One goal is to make sure more people diagnosed with HIV achieve viral suppression (keeping their virus under control and at a level that greatly lowers their risk of transmitting HIV to a partner). Another focus is to increase the use of daily medicines to prevent HIV, called pre-exposure prophylaxis (PrEP). If we reach the US targets for testing and treatment and expand the use of PrEP, we could prevent an estimated 185,000 new HIV infections by 2020—a 70 percent decrease in new infections among the population as a whole. Everyone has a role to play in helping us get there. What Can Women Do? Start talking. Learn the facts about HIV, and share this lifesaving information with your family, friends, and community. Let's Stop HIV Together, part of Act Against AIDS, has many resources for raising awareness about HIV and includes many video testimonials from people living with HIV. Start Doing It – getting tested for HIV. Knowing your HIV status gives you powerful information to help keep you and your partner healthy. If you are pregnant or planning to become pregnant, get an HIV test as soon as possible. To find a testing site near you, visit Get Tested, text your ZIP code to KNOWIT (566948), or call 1-800-CDC-INFO (232-4636). You can also use a home testing kit available in drugstores or online. Learn more about HIV testing. Protect yourself and your partner. Today, more tools than ever are available to prevent HIV. You can Use condoms the right way every time you have sex. Learn the right way to use a male condom. Choose less risky sexual behaviors. Limit your number of sexual partners. Never share needles. Talk to your doctor about pre-exposure prophylaxis (PrEP), taking medicine daily to prevent HIV infection, if you are at very high risk for HIV. Talk to your doctor about post-exposure prophylaxis (PEP) if you think you may have been exposed to HIV within the last 3 days through sex, sharing needles and works, or a sexual assault. Get treated. If you are HIV-positive, start medical care and begin taking medicines to treat HIV, called antiretroviral therapy (ART), as soon as possible. If taken the right way every day, these medicines reduce the amount of HIV (viral load) in the blood and elsewhere in the body to very low levels, called viral suppression. They can even reduce the viral load to such a low level that it is undetectable. Being virally suppressed or having an undetectable viral load is good for an HIV-positive person's overall health. It also greatly reduces the chance of transmitting the virus to a partner. If you are pregnant, taking HIV medicines throughout your pregnancy can greatly lower the HIV risk for your baby. Learn more about how you can live well with HIV. You can learn more about how to protect yourself and your partners and get information tailored to meet your needs from CDC's new HIV Risk Reduction Tool (BETA). * Referred to as black in this feature. ** Hispanics/Latinas can be of any race.

National Women and Girls HIV/AIDS Awareness Day (NWGHAAD) is March 10. Learn how HIV affects women and girls in the United States and how women can protect themselves.

HIV remains a significant health issue for women and adolescent girls, with more than 280,000 women living with HIV in the United States. In 2014, an estimated 8,328 women aged 13 and older were diagnosed with HIV. The majority of these diagnoses can be attributed to heterosexual sex.

Black/African American* and Hispanic/Latina** women continue to be disproportionately affected by HIV. Among all US women in 2014,

Black women accounted for 62% of new HIV diagnoses but only 13% of the female population.

Hispanic/Latina women accounted for 16% of new diagnoses but only 15% of the female population.

Whites accounted for 18% of new diagnoses and 64% of the female population.

Nevertheless, we are making progress in the fight against HIV among women. From 2005 to 2014, new HIV diagnoses declined 40% among all women and even more (42%) among black women. And for black women newly diagnosed with HIV, the percentage linked to HIV medical care increased 48% from 2012 to 2014.

The National HIV/AIDS Strategy has set goals to reduce new HIV infections even more. One goal is to make sure more people diagnosed with HIV achieve viral suppression (keeping their virus under control and at a level that greatly lowers their risk of transmitting HIV to a partner). Another focus is to increase the use of daily medicines to prevent HIV, called pre-exposure prophylaxis (PrEP). If we reach the US targets for testing and treatment and expand the use of PrEP, we could prevent an estimated 185,000 new HIV infections by 2020—a 70 percent decrease in new infections among the population as a whole. Everyone has a role to play in helping us get there.

What Can Women Do?

Start talking. Learn the facts about HIV, and share this lifesaving information with your family, friends, and community. Let's Stop HIV Together, part of Act Against AIDS, has many resources for raising awareness about HIV and includes many video testimonials from people living with HIV.

Start Doing It – getting tested for HIV. Knowing your HIV status gives you powerful information to help keep you and your partner healthy. If you are pregnant or planning to become pregnant, get an HIV test as soon as possible.

To find a testing site near you, visit Get Tested, text your ZIP code to KNOWIT (566948), or call 1-800-CDC-INFO (232-4636). You can also use a home testing kit available in drugstores or online.

Learn more about HIV testing.

Protect yourself and your partner. Today, more tools than ever are available to prevent HIV. You can

Use condoms the right way every time you have sex. Learn the right way to use a male condom.

Choose less risky sexual behaviors.

Limit your number of sexual partners.

Never share needles.

Talk to your doctor about pre-exposure prophylaxis (PrEP), taking medicine daily to prevent HIV infection, if you are at very high risk for HIV.

Talk to your doctor about post-exposure prophylaxis (PEP) if you think you may have been exposed to HIV within the last 3 days through sex, sharing needles and works, or a sexual assault.

Get treated. If you are HIV-positive, start medical care and begin taking medicines to treat HIV, called antiretroviral therapy (ART), as soon as possible. If taken the right way every day, these medicines reduce the amount of HIV (viral load) in the blood and elsewhere in the body to very low levels, called viral suppression. They can even reduce the viral load to such a low level that it is undetectable. Being virally suppressed or having an undetectable viral load is good for an HIV-positive person's overall health. It also greatly reduces the chance of transmitting the virus to a partner. If you are pregnant, taking HIV medicines throughout your pregnancy can greatly lower the HIV risk for your baby. Learn more about how you can live well with HIV.

You can learn more about how to protect yourself and your partners and get information tailored to meet your needs from CDC's new HIV Risk Reduction Tool (BETA).

* Referred to as black in this feature.
** Hispanics/Latinas can be of any race.

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Women at the centre: WHO issues new guidance on the sexual and reproductive health and rights of women living with HIV

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Women at the centre: WHO issues new guidance on the sexual and reproductive health and rights of women living with HIV

21 February 2017 A woman-centred approach to healthcare is one that consciously adopts the perspectives of women, their families and communities. This means that health services see women as active participants in, as well as beneficiaries of, trusted health systems that respond to women’s needs, rights and preferences in humane and holistic ways. 

Such an approach to healthcare is crucial when working to safeguard the sexual and reproductive health and rights of women living with HIV. In 2015, there were an estimated 17.8 million women aged 15 and older living with HIV in 2015, constituting 51 percent of all adults living with HIV. 

HIV is not only driven by gender inequality, but also further entrenches inequalities, leaving girls and women more vulnerable to its impact. Girls and women often do not have equal access to health services and information and can also face additional negative health impacts as a result of living with HIV – including stigma, shame, violence and abuse.

Unique new guideline

WHO has today launched the Consolidated guideline on sexual and reproductive health and rights of women living with HIV, which takes a woman-centred approach throughout to effectively address and represent the needs of girls and women, as well as those of their families and communities. 

Manjulaa Narasimhan, Scientist at WHO comments ,“Supporting evidence based recommendations and building an enabling environment will help advance the health and well-being of women living with HIV in all their diversity.”

Taking this approach, the process adopted for the development of the guidelines was unique in its meaningful engagement of communities of women living with HIV.

Guiding principles 

In taking a woman-centred approach, the new WHO guideline are founded upon the guiding principles of human rights and gender equality:

  • Human rights: An integrated approach to health and human rights lies at the heart of ensuring the dignity and well-being of women living with HIV. This includes, but is not limited to, the right to the highest attainable standard of health; the right to life and physical integrity, including freedom from violence; the right to equality and non-discrimination on the basis of sex; and the right to freedom from torture or cruel, inhuman or degrading treatment. The right to SRH is an integral part of the right to health, enshrined in article 12 of the International Covenant on Economic, Social and Cultural Rights.
  • Gender equality: The promotion of gender equality is central to the achievement of SRHR of all women, including women living with HIV in all their diversity. This means recognizing and taking into account how unequal power in women’s intimate relationships, harmful gender norms and women’s lack of access to and control over resources affect their access to and experiences with health services.

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Better depression care could improve outcomes for HIV treatment programmes

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Better depression care could improve outcomes for HIV treatment programmes

Roger Pebody

Published: 21 February 2017

Improved management of depression and other mental health disorders has the potential to improve the outcomes of HIV treatment programmes, Pamela Collins of the National Institute of Mental Health told the Conference on Retroviruses and Opportunistic Infections (CROI 2017) in Seattle last week. Mental health treatment should be integrated into HIV services in resource-limited settings, she said.

Diabetes, cardiovascular disease, cancers, lung disease and other non-communicable diseases have an increasing impact on the health and quality of life of people living with HIV. Health services in low- and middle-income countries have been slow to implement programmes to prevent, screen for and treat these diseases, but a number of projects have shown that this work can be integrated with HIV care.

Dr Collins noted that mental health disorders are now considered alongside non-communicable diseases in the third Sustainable Development Goal. But she said that whereas other non-communicable diseases increasingly affect people as they get older, the greatest burden of mental health problems falls in adolescence and young adulthood. Around three-quarters of mental health disorders have begun by the age of 24. 

A global meta-analysis showed that 18% of people had experienced a mental health disorder in the previous year and 29% had done so in their lifetime (23% in low- and middle-income countries, 32% in high-income countries). However, few people receive the treatment they need, especially in resource-limited settings.

Mental health disorders commonly occur in people living with chronic health conditions (including HIV). The evidence from a range of conditions, such as diabetes, asthma and arthritis, is that having untreated depression as well as another health condition is associated with being less able to function and having poorer health status.

Depression is the most common mental health co-morbidity experienced by people living with HIV. In sub-Saharan Africa, the average prevalence of depression in people living with HIV is around 8% (similar to that seen in general population samples in the region), but can be much higher in some groups.

Depression is more commonly experienced by women, older people, those who are unemployed, people with low CD4 cell counts and people with more physical symptoms. People who have experienced childhood trauma or negative life events, and those with less social support are more likely to be depressed.

The relationship between mental health disorders and HIV works in both directions, Collins said. Mental disorders can be a risk factor or increase vulnerability to HIV infection. At the same time, people may experience depression or anxiety as they adjust to a diagnosis or live with a chronic illness. Moreover, neuropsychiatric effects of the virus can in some cases lead to cognitive changes or dementia.

Providing HIV medical care and antiretroviral treatment specifically is in itself associated with improvements in mental health, due to the improvements in physical health which it brings. Nonetheless, a number of cases of depression persist, requiring intervention above and beyond the provision of antiretroviral therapy.

Moreover, around 15% of adults and 26% of adolescents living with HIV cite feeling depressed or overwhelmed as a barrier to HIV treatment adherence. A meta-analysis of studies mostly conducted in the United States suggested that treating depression can improve adherence to antiretroviral therapy. When the interventions specifically targeted depression (rather than treating it as a secondary objective), results were better. Furthermore, the greatest impact was seen in patients with a low CD4 cell count or moderate to severe depression symptoms, or when treatments of a longer duration were used.

A recent prospective cohort study from Tanzania found that 58% of women beginning HIV treatment had symptoms consistent with depression, with around a third mentioning each of the following – loss of sexual interest, low energy, worrying too much and blaming themselves. One in six women said they sometimes felt like ending their life. 

Depression was associated with mortality in this study. Two years after beginning HIV treatment, 6.6% of women with depression symptoms and 3.7% of other women had died. After adjustment for other factors, women with depression symptoms were twice as likely to have died. 

One of the challenges of addressing mental health is the dearth of mental health workers in many settings. There is one mental health worker per 100,000 people in low-income countries, compared to 52 workers per 100,000 people in high-income countries.

Task shifting is therefore key. In a recently published randomised controlled trial, lay health workers in Zimbabwe were trained and supervised to provide individual problem-solving therapy. Those who received the intervention (42% of whom had HIV) had fewer depression symptoms after six months. The evidence base for task shifting in mental health in resource-limited settings has grown considerably in recent years, Collins said. 

To give another example, a small pilot study in Cameroon used depression care managers, a non-physician role that can be fulfilled by nurses or social workers after training. Working within HIV clinical services, they provided support to an HIV clinician, giving advice on depressive symptoms and the use of antidepressant medication, based on a treatment algorithm.

After four months, nearly all participants had a considerable improvement in their depressive illness. The intervention also appeared to have an impact on HIV outcomes, including CD4 cell count, viral load, symptoms and adherence.

In Uganda, a group support psychotherapy intervention for people with HIV, using problem-solving and cognitive-behavioural approaches, reduced depression symptoms. Support groups exist in many settings, Collins said, but can be enhanced by adding evidence-based interventions for depression.

Integrating care for mental disorders and HIV is feasible, she said. This means making the screening and treatment of mental disorders a normative part of HIV care. Consensus needs to be achieved on who delivers services – nurses, adherence counsellors, community health workers, peers or other groups. People seeking services, healthcare providers, managers and policymakers need to be involved in decision making about service integration, she said.

Reference

Collins P Minimizing morbidity: integrating care for depression and HIV in low-resource settings.Conference on Retroviruses and Opportunistic Infections (CROI 2017), Seattle, presentation 153, 2017.

View the abstract on the conference website.

View a webcast of this presentation on the conference website.

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STI rates in PrEP users very high, but evidence that PrEP increases them is inconclusive

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STI rates in PrEP users very high, but evidence that PrEP increases them is inconclusive

A study of pre-exposure prophylaxis (PrEP) users presented at the Conference on Retroviruses and Opportunistic Infections (CROI 2017) last week in Seattle, showed that PrEP users had very high rates of sexually transmitted infection (STI) diagnosis – in the order of 20 times higher than among HIV-negative gay men in the general population.

There was also an increase in STI diagnoses from a time point a year before they sought PrEP to the date they started it. And the percentage of men reporting never using condoms for anal sex somewhat increased while they were on PrEP, though never exceeding 10% of all PrEP users.

The evidence that STIs increased further while people were on PrEP was, however, a lot more ambiguous. Chlamydia cases increased from starting PrEP to nine months after starting it. On the other hand, syphilis diagnoses fell over the same time period while gonorrhoea diagnoses stayed at the same rate. The only STI which increased during PrEP was urethral gonorrhoea. But that was only seen in a small number of individuals.

In a symposium, Professor Matthew Golden, who runs King County’s STI and HIV programme, told the conference that some other studies such as the Kaiser Permanente PrEP programme in northern California showed that STI rates increased after PrEP was started. Others, such as the PROUD study, provided little evidence of this.

The problem in proving that PrEP has any causal relationship to STIs is that STIs among gay men were, in general, rising well before PrEP, and also that PrEP usually involves regular testing for HIV and STIs. Since many STIs are asymptomatic and self-limiting, more tests will result in more diagnoses.

The study

To investigate the relationship between PrEP use and STIs, Golden and colleagues looked at condom use and STI diagnoses in gay men enrolling in the King County programme between September 2014 and June 2016. He looked at condom use reported by participants at the time they started PrEP and three, six and nine months after initiation. For STIs, he looked at the proportion of people who had STI diagnoses one year before they started PrEP, at the time they started PrEP, and during the time they were on PrEP.

The criteria for starting PrEP in the programme were being a man (including transgender) or transgender woman who had sex with men and who reported rectal gonorrhoea, early syphilis, methamphetamine or nitrites (poppers) use, or sex work in the year before asking for PrEP; or, alternatively, that they were anyone with an HIV-positive partner who was not on treatment, not virally suppressed, or within their first eight months of viral suppression. Although these criteria could have included heterosexuals in practice all the cohort were men who have sex with men.

A total of 218 men started PrEP and completed baseline behavioural questionnaires but only 108 completed follow-up to nine months. This was a young cohort on average (average age 30.6) and ethnicity reflected the racial makeup of Washington State; 53% were non-Hispanic white, 22% Hispanic, 10% Asian or Pacific Islander, 9% African American, 2% Native American and 4% other ethnicity.

The proportion of men saying they never used condoms for anal sex was higher in men on PrEP than before they started, though there was no evidence for an increase during time on PrEP. The increases were relatively slight and largely in single percentages but were statistically significant.

The proportion saying they had never used condoms in the previous three months was 6% at baseline and 10% three months after starting PrEP, though it declined to 8% at nine months.

The proportion saying specifically they never used condoms for receptive sex was 2% at baseline and 4% while on PrEP for HIV-positive partners, and 4% at baseline and 8% while on PrEP for HIV-negative partners. There was also an increase in never using condoms in insertive sex with HIV-positive partners, from 2% at baseline to 6% while on PrEP. Condom use did not change significantly with partners of unknown HIV status.

STI diagnoses increased significantly from a year before starting PrEP to the time PrEP was started. In the three months ending a year before PrEP start, 6.5% of participants were diagnosed with chlamydia, 10.2% with gonorrhoea and also 10.2% with early or early-latent syphilis. When tested at the start of PrEP the proportion diagnosed with chlamydia was 16%, nearly three times the rate, and 20.4% with gonorrhoea, twice the rate. Syphilis increased slightly to 12%.

Rectal chlamydia increased from 4.6% to 14.8% and rectal gonorrhoea increased from 9.3% to 13.9%.

All this may show, however, is that people at high STI risk tend to seek PrEP, and that comprehensive testing picks up more STIs than ad hoc testing.

The evidence that STIs increased during PrEP is more ambiguous. Chlamydia and particularly rectal chlamydia diagnoses did increase further, from 16% to 22%, and from 15% to 19%, respectively.

On the other hand, diagnoses of gonorrhoea and rectal gonorrhoea stayed at the same rate of around 20% and around 14% respectively. And early and early-latent syphilis decreased, from 12% to 7%.

It may be relevant that diagnoses of chlamydia, the STI most likely to be asymptomatic, increased the most. So Golden and colleagues picked out two STIs that were generally not asymptomatic in order to try and factor out increases due to the detection of asymptomatic cases. The results were contradictory. The proportion of men diagnosed with urethral gonorrhoea, which is nearly always symptomatic, increased from 0.9% at baseline to 5.6% on PrEP. One the other hand, diagnoses of primary and secondary syphilis, excluding early latent syphilis, i.e. only syphilis in which symptoms are usually seen, declined both before and on PrEP, from 9.3% a year before baseline, to 7.4% at baseline, to 3.7% while on PrEP.

It is very difficult to make any generalisations from these figures. The increase in urethral gonorrhoea is suggestive, but this was only a small study where the 0.9% of men with urethral gonorrhoea at PrEP initiation represents two individuals and the 5.6% at nine months represents six.

The STI rates in PrEP users were certainly high: rates of all three STIs were almost exactly 20 times what they were in the general HIV-negative gay population, and rectal STIs were 30 times more common – for instance, the general gay-population diagnosis rate of rectal gonorrhoea was 0.9%, versus 26% in PrEP users.

Mathematical model finds STI rates should fall with widespread PrEP coverage

A mathematical modelling study also presented at CROI found that if PrEP became widespread among gay men in the US, STI diagnoses would rise in the first year, but would fall thereafter. If the testing interval was once every six months, for instance, all-STI incidence in gay men would fall from about 5.4% a year after starting a PrEP programme to 4% three years after starting it and less than 2% ten years after starting it. 

This was based on an assumption of high coverage – that 40% of gay men take PrEP – and as long as every STI gets treatment. STI incidence would remain unchanged rather than fall if only 50% got treated. However, these net benefits of PrEP are calculated on the basis of condom use in gay men on PrEP falling by 40% – they would be even greater if condom use did not fall.

There was no support for the hypothesis that PrEP could cause STI increases by themselves: in this model, even zero condom use under PrEP could not transform the STI rates seen in the general gay population into the ones seen in PrEP users. This backs up the idea that people seeking PrEP already know they are at high risk and don’t think that risk will change by itself.

References

Montaño MA et al. Changes in sexual behaviour and STI diagnoses among MSM using PrEP in Seattle, WA. Conference on Retroviruses and Opportunistic Infections (CROI 2017), Seattle, abstract 979, 2017. 

View the abstract on the conference website.

Download the poster from the conference website.

Jenness SM et al. STI incidence among MSM following HIV preexposure prophylaxis: a modelling study. Conference on Retroviruses and Opportunistic Infections (CROI 2017), Seattle, abstract 1034, 2017. 

View the abstract on the conference website.

Download the poster from the conference website.

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Five HIV patients left "virus-free" with no need for daily drugs in early vaccine trails

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Five HIV patients left "virus-free" with no need for daily drugs in early vaccine trails

A new vaccine-based treatment for HIV has succeeded in suppressing the virus in five patients, raising hopes further research could help prevent Aids without the need for daily drugs.Researchers combined two innovative HIV vaccines with a drug usually used to treat cancer in the trial, conducted over three years at the IrsiCaixa Aids Research Institute in Barcelona.

After receiving the treatment, the virus was undetectable in five out of 24 participants and its spread was stopped by their immune systems, reported the New Scientist. One of them has been drug-free for seven months.

Around 18 million people – half of all those living with HIV around the world – take ART to slow the progression of the infection, according to the UN. But these drugs are expensive and can cause unpleasant side effects. Patients have to remember to take them every day, sometimes over their entire lives. Mitchell Warren, executive director of the Aids Vaccine Advocacy Coalition (Avac), said the study had been carried out on a small scale but its findings were “interesting and important”. “Long-term systems that don’t require daily pill taking could really help accelerate getting 37 million people with HIV undetectable and not infectious – that would be a great opportunity to turn the tide on the epidemic,” he told The Independent.

Mr Warren said this was an example of a therapeutic vaccine, for people already infected with the disease, as opposed to preventative immunisation for diseases such as polio or mumps and measles. “The idea of a therapeutic vaccine that could provide ongoing control of the virus without having to take a pill every day would be a huge advance,” he said.

Dr Mothe and her team gave the patients, all recently diagnosed with HIV, two vaccines designed to stimulate the production of white blood cells which can recognise and destroy cells that have been infected by the virus. The trial participants continued to take ART for three years, while the researchers monitored their immune responses. Then 15 of the participants received a booster dose of one of the vaccines and a cancer drug called romidepsin, which has been shown to ‘flush out’ the HIV virus from tissues where it can lie dormant. The virus quickly returned and began to spread again in 10 of these patients, who resumed taking ART, but five of them have been free of the virus with no need to take daily drugs for a number of weeks, and in one case for seven months.

In 2015, providing ART to patients in low to middle-income countries cost $19 billion (£15 billion), according to the New Scientist, meaning huge savings could be possible if further research is successful. More than 100,000 people are living with HIV in the UK, according to the Terrence Higgins Trust.

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Can this pill end the AIDS epidemic?

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Can this pill end the AIDS epidemic?

(CNN)Charlie Ferrusi is a 23-year-old gay man with a winning smile and an easygoing manner. In May, he completed a master's degree in public health and recently began a job at the New York State Department of Health AIDS Institute

Ferrusi said he is HIV-negative and would like to stay that way. He's the kind of person that could be taking Truvada, a once-a-day pill that is nearly as effective as condoms in preventing HIV, the virus that causes AIDS. Some doctors and politicians have hailed the antiretroviral drug, known as PrEP, as a key to ending the AIDS epidemic. 

"You go into a panic that wouldn't be there if I was on PrEP," Ferrusi said. "I'm having a good time and being a good person -- and that comes with a risk sometimes. If I can eliminate those risks by taking PrEP, I think it would be a good idea."

    Still, like many others, Ferrusi is grappling with a decision to take the drug as a preventive. When taken as prescribed, PrEP can prevent more than 90% of sexually transmitted HIV infections. So why aren't people jumping on the bandwagon? 

    The end of 'condom culture'?

    The Food and Drug Administration approved Truvada in 2004 for treating HIV infections. In 2012, it was approved as the first -- and still, only -- drug for pre-exposure prophylaxis, or PrEP. It works by establishing a presence of the drug in the cells that HIV targets for infection; the virus can't produce a genetic code, so it can't replicate and cause an infection.

    Men who have sex with men account for more than half of the 1.2 million people living with HIV in the United States

    "People at high risk who should be offered PrEP include about 1 in 4 sexually active gay and bisexual men, 1 in 5 people who inject drugs and 1 in 200 sexually active heterosexual adults," according to the Centers for Disease Control and Prevention.

    But not everyone is applauding the pill as a major advancement in the fight against HIV and AIDS.

    No one, at least publicly, is advocating for using PrEP without condoms. Still, it erodes the "condom culture," said AIDS Healthcare Foundation President Michael Weinstein, who is among PrEP's most prominent critics.

    "If people take this drug, they're not going to use condoms. Let's just be real about it," Weinstein said.

    "The reality is that condoms are 98% effective. So if people use condoms, they don't need to take this pill."

    Weinstein said it might be the best choice for people who refuse to use condoms. But for many people, taking the pill as prescribed could be a challenge. Without insurance, the drug can run about $1,500 per month. Many insurance plans, as well as Medicaid, cover it, and the drug's maker, Gilead Sciences, offers assistance for people who can't afford the cost.

    "The record of people taking pills for every disease is bad," Weinstein said. "I know that personally when I've had to take an antibiotic for 10 days, I'm sure I'm taking it the way I'm supposed to be, and yet I wind up with a bunch of pills in the bottle at the end."

    Another PrEP opponent is longtime activist Larry Kramer, who has been HIV-positive since the late 1980s and takes antiretroviral drugs as treatment. He declined to talk with CNN for this report, but in a 2014 interview with The New York Times, Kramer said of its side effects, "Anybody who voluntarily takes an antiretroviral every day has got to have rocks in their heads." 

    Side effects of Truvada include gastrointestinal issues, fatigue, headaches and mild itching or skin rash. Some Truvada patients have experienced kidney and liver problems. For that reason, anyone taking the medication to prevent infection must have their blood tested every three months to ensure proper kidney and liver function and to make sure they remain HIV-negative. If someone manages to contract HIV while on PrEP, he or she must switch to a different treatment regimen, so he or she won't build up a resistance to the medication.

    "There's something, to me, cowardly about taking Truvada instead of using a condom," Kramer told the Times. "You're taking a drug that is poison to you, and it has lessened your energy to fight, to get involved, to do anything."

    Changing the psychology of sex

    Others say the effects of PrEP extend beyond preventing HIV. It can "revolutionize the psychology of the HIV epidemic," said Sarit Golub, a Hunter College professor who has been studying the psychological effects of PrEP for years

    Golub said her research indicates 40% to 60% of gay men report thinking about HIV while they're having sex all or most of the time. She calls that a "psychological tragedy." Her PrEP patients report significant decreases in anxiety, depression and stress, she said.

    "What PrEP is able to do is separate the act of prevention of HIV from the act of sexual intimacy," Golub said. "And to me, I think that is one of the tremendous powers of PrEP for individuals and for us as a broader community."

    Dr. Demetre Daskalakis, assistant commissioner of the Bureau of HIV/AIDS Prevention and Control for the New York City Department of Health and Mental Hygiene, said that PrEP has the power to change anxiety levels about sex.

    "For men who have sex with men and who are of a certain age, there has never been a time that they've had sex without having to be very, very worried about HIV constantly," said Daskalakis, who played an integral role in the FDA's approval of Truvada for PrEP. 

    "You can plan ahead by saying, 'You know, something is going on in my surroundings that is putting me at risk for HIV, so I'm going to take this really, frankly, brave step in taking a medicine every day to prevent HIV infection.' So it's not really in the heat of the moment, or 'I have to put a condom on right now' or 'Where is my condom?' It just gives you the level of security to acknowledge that risks happen and that some people have risk patterns."

    PrEP, Daskalakis said, is not a "forever intervention." It might appeal to someone in the months after a breakup with a longtime, monogamous partner, after a move to a new place or after the discovery of an interest in higher-risk sex acts. It isn't immediate either. It takes seven days to build up the full level of protection of the drug in the immune system, and Daskalakis recommends patients continue taking the prescription for 28 days after the risk has subsided.

    For individuals who find themselves in a panic after having unsafe sex or after a condom breaks, Daskalakis recommends PEP -- post-exposure prophylaxis.

    Whereas PrEP is an antiretroviral administered consistently, PEP is prescribed as soon as possible (within 72 hours) following a sexual encounter, and the medication must be taken for 28 days.

    PrEP's social stigma

    Truvada has only been on the market as a preventive drug for a few years, but some liken the debate around it to a better-known drug: birth control, when it first went on the market for contraception in the 1960s.

    Birth control protects against unwanted pregnancy but does not protect against sexually transmitted infections, including HIV. While Truvada does protect against HIV, it does not protect against other sexually transmitted infections.

    Some PrEP studies have shown spikes in the rates of syphilis, gonorrhea and chlamydia among the drug's users, while other studies have not. 

    The AIDS Healthcare Foundation's Weinstein sometimes refers to PrEP as a "party drug," one he believes is taken mostly by people who want to have unprotected sex.

    Daskalakis disagrees. "I'm feeling like I live somewhere in the '60s, talking about contraception and sometimes I can imagine deleting the word 'HIV' and saying 'unwanted pregnancy,' " he said. "I think there is a lot of what's called 'slut shaming' in the Truvada story, but it's the exact analogy of what happened in the '60s with birth control. I mean, we've been living 30 years with the dogma that says the only way to be safe -- to prevent HIV infection -- is using condoms or abstinence."

    Both Daskalakis and Golub said the majority of the PrEP users they counsel are responsible men who have sex with men. Like Ferrusi, they want an added safety net if they choose to have sex with someone whose status is unknown or who is HIV-positive.

    "Our ultimate tagline is that we need to customize people's prevention for what is appropriate for their lifestyle," Daskalakis said, whether that means condoms or PrEP.

    Last summer, New York Gov. Andrew Cuomo outlined a three-point plan to move the state closer to the end of its AIDS epidemic. The goal: dramatically reduce the number of new HIV infections by 2020 and achieve the first-ever decrease in HIV prevalence in New York since the beginning of the crisis in the '80s.

    The plan calls for identifying people who are positive and undiagnosed, keeping people in care so they remain healthy and prevent further transmission -- and facilitating access to PrEP for those at high risk.

    Although Ferrusi hasn't taken the drug yet, that plan -- Ending the AIDS Epidemic -- is the campaign on which he now works. He doesn't feel any stigma attached to the drug, he said, and he'll consider taking it in the future.

    "I'd be very surprised in myself if I didn't go on PrEP within the next year," he said. "I think everything is there, the research is there. I've had friends who use it, and they've had good experiences."

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