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Over one third of people would ‘swipe left’ on a dating app to reject someone with HIV and on effective treatment

On dating apps, over one third (35%) of people would reject someone living with HIV and even if the person is on effective treatment. This is largely because of outdated beliefs, considering that science has proven that people living with HIV who are on effective treatment cannot pass the virus onto sexual partners.

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Stigma and discrimination against people living with HIV is still truly alive.

Over one third (35%) of people would “swipe left” on a dating app to reject someone living with HIV and even if the person is on effective treatment. In gay dating app Tinder, swiping left means outright rejection of the person.

This is according to HIV and sexual health charity Terrence Higgins Trust, basing on a YouGov research that explored people’s attitudes towards sex, relationships and HIV to reveals a shocking level of stigma steeped in a severe lack of understanding of HIV transmission.

A further third (31%) “don’t know” which way they’d swipe, while a final third (30%) said they “wouldn’t” swipe left, implying that they’d give the person a chance.

When presented with the statement ‘I would feel comfortable kissing someone living with HIV on effective treatment’, almost one in two (43%) disagreed with the statement.

Almost one in five (17%) said they weren’t sure, while just over a third (35%) agreed that they would.

Regardless of treatment, HIV cannot be passed on through kissing.

Because Undetectable = Untransmittable

When asked about condomless sex, just 10% of those asked agreed that they’d be comfortable having “unprotected” sex with someone living with HIV and on effective treatment.

Over three quarters of respondents (77%) disagreed with this.

Science has proven that people living with HIV who are on effective treatment cannot pass the virus onto sexual partners, regardless of whether they use a condom or not.

HIV+ men with undetectable viral load do not transmit HIV to their partners, says new study

In the PARTNER study, considered were 58,000 instances of sex between an HIV positive person on effective treatment and a partner without HIV, and there were zero cases of HIV transmission.

READ:  Vacc for PLHIVs

Apparently, most people are unaware of this, and many still don’t believe it when it’s explained.

When given the statement “people on effective HIV treatment can’t pass the virus on”, over half of respondents (55%) said it was false.

Over one third (33%) said they were unsure, while just one in ten (10%) believed it was true.

According to Ian Green, chief executive at Terrence Higgins Trust, ‘It’s so important to get this message out to as many people as possible. We hear on a near daily basis how out of date beliefs about how HIV is passed on are negatively affecting the lives and mental health of people with HIV, and it urgently needs to change.”

Green added that “amazing medical progress has been made, but knowledge of HIV quite clearly hasn’t kept up with that progress. Effective treatment means HIV shouldn’t be a barrier to anyone doing anything they want to and that includes having a fulfilling relationship and sex life. We all have a role to play in this and it’s high time for everyone to stop doubting the science and accept the realities of HIV as that’s the best way to tackle the abhorrent stigma that still surrounds the virus. It’s truly devastating to hear that so many wouldn’t swipe right for or even kiss someone living with HIV who’s on effective treatment. We’ve known for three decades that HIV can’t be passed on through day-to-day contact and that includes kissing.”

READ:  Tricia Cabrera: A Dabawenya's positive life

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Let science inform application of law in criminal cases related to HIV, according to experts

Prosecutions of people living with HIV for acts that pose no risk of HIV exposure or transmission prompt scientists to issue a statement urging the criminal justice system to use science when considering prosecution of HIV non-disclosure, exposure or transmission.

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A group of 20 leading HIV scientists from around the world have issued a scientific consensus statement urging governments and people working in the legal and justice systems to pay close attention to the significant advances in HIV science to ensure that science informs the application of criminal law in cases related to HIV.

“Science has greatly advanced in recent years which has been critical in allowing countries to make evidence informed decisions in their HIV programming,” said Michel Sidibé, executive director of UNAIDS. “With all the new scientific advances now available we need to continue to use science as evidence to deliver justice. No one should face criminalization because of a lack of information or understanding by the justice system about the risks of HIV transmission.”

The expert group of scientists, convened by UNAIDS, the International Association of Providers of Care (IAPAC) and the International AIDS Society, warn that an overly broad and inappropriate application of criminal law against people living with HIV remains a serious concern across the globe. Around 73 countries have laws that criminalize HIV non-disclosure, exposure or transmission, and 39 countries have applied other criminal law provisions in similar cases.

“Many of these laws do not take into account measures that reduce HIV transmissibility, including condom use, and were enacted well before the preventive benefit of antiretroviral therapy or pre-exposure prophylaxis was fully characterized,” said José M. Zuniga, IAPAC President and Chief Executive Officer. “Most people living with HIV who know their status take steps to prevent transmitting HIV to others. Laws that specifically criminalize HIV non-disclosure, exposure, or transmission thus primarily exacerbate HIV-related stigma and decrease HIV service uptake.”

READ:  On using phased-out medication

Most prosecutions have occurred based on perceived risk of HIV transmission through sexual activity. Some have also occurred for biting, spitting or even scratching. Prosecutions, and convictions, have often been influenced by a lack of knowledge or appreciation of scientific evidence regarding the possibility of transmission of the virus. In many instances, they have been influenced by deep-rooted stigma and fear associated with HIV, which still exists despite the huge advances in HIV treatment and prevention.

“We support this globally relevant expert consensus statement, for which we have been long-time advocates,” said HIV Justice Network’s Senior Policy Analyst Sally Cameron, on behalf of the Steering Committee of HIV Justice Worldwide, a global civil society coalition campaigning to end unjust prosecutions. “HIV criminalization is a growing global phenomenon that unfairly targets people living with HIV through criminal prosecutions and harsh penalties. This welcome statement makes the case that our current understanding of HIV science, alongside key human rights and legal principles, does not support this miscarriage of justice.”

The peer-reviewed consensus statement, endorsed by 70 additional scientists from around the world, was released today in the Journal of the International AIDS Society. It describes scientific evidence on the possibility of HIV transmission under various circumstances, the long-term impact of HIV infection and the means of proving HIV transmission so that it is better understood in criminal law contexts.

Based on a detailed analysis of the best available scientific evidence on HIV transmission and treatment effectiveness, the statement notes that there is no possibility of HIV transmission through saliva as a result of biting or spitting, even where saliva contains small quantities of blood. There is no to negligible possibility of HIV transmission where a condom is used correctly during sex, or where a partner living with HIV has an undetectable viral load.

READ:  Rainbow History Captured

In addition, effective antiretroviral therapy, low viral load, the use of pre-exposure prophylaxis (antiretroviral drugs taken by an HIV-negative person before a possible exposure), or post-exposure prophylaxis (antiretroviral medicines taken after a possible exposure) all significantly reduce the possibility of HIV transmission.

International guidance on HIV in the context of the criminal law recommends that “proof of causation, in relation to HIV transmission, should always be based on evidence derived from a number of relevant sources, including medical records, rigorous scientific methods and sexual history” (Ending overly broad criminalization of HIV non-disclosure, exposure and transmission: critical scientific, medical and legal considerations).

The experts recommend strongly that more caution be exercised when considering criminal prosecution, including careful appraisal of current scientific evidence on HIV risk and harms. The consensus statement is expected to help policymakers, prosecutors and courts be guided by the best available science and thereby avoid the misuse of the criminal law, as is currently happening in many countries worldwide.

Read the full Expert Consensus Statement on the Science of HIV in the Context of Criminal Law.

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From the Editor

3 Reasons why TasP and U=U won’t happen soon in the Philippines…

Treatment is available for people with HIV. And if a PLHIV gets treatment, he does not need to die from AIDS-related complications, and he’ll reduce his viral load so he can’t transmit HIV to others. But in the Philippines, among the common reasons why TasP is NOT working is because of the failures of the service providers themselves.

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Fact: Treatment is available for people living with HIV.
And if someone with HIV gets treatment, he/she does not need to die from AIDS-related complications.
And if someone also gets treatment, the antiretroviral treatment (ART) he/she uses reduces the HIV viral load in his/her blood, semen, vaginal fluid and rectal fluid to “undetectable level”. And get this: Evidence shows that individuals on effective antiretroviral treatment (ART) with an undetectable viral load cannot transmit HIV to others.

“Lor”, one of the HIV-positive people Outrage Magazine met in Mindanao, who lamented how he was not informed of “what to now do after I tested HIV-positive”.
Eventually, without being able to access treatment, he passed away from AIDS-related complications.

This is why treatment as prevention (TasP) is important.
So important, in fact, that the World Health Organization (WHO) guidelines call for “test and treat” strategies to “initiate all people diagnosed with HIV on ART as soon as possible after diagnosis as a way to decrease community viral load and reduce the rate of new HIV infections”.

But in the Philippines, among the common reasons why TasP is NOT working is because of the failures of the service providers themselves.
Testing is picking up, yes. But even now, not even half of PLHIVs access ART.
But so many of the after-test services continue to be lacking.

Here are three (of the many) reasons why I think TasP and U=U won’t happen soon in the Philippines:

READ:  NCCP's message on World AIDS Day 2016: 'God's love encompasses all'

1. After people get tested, no one really knows what to do next.
In the past three days, I have been speaking with three people whose HIV rapid test results were “reactive”. Soon after the tests, they were basically “dumped” by their “counselors”/service providers. These three were basically left on their own – and, as two of them said, “ni walang flyer na binigay para sana alam ko man lang ano na ang gagawin ko (no flyer was even given so I would at least be guided on what to do next).”
You’d expect more from the center where they got tested, too – both are satellite treatment hubs of one of the country’s major treatment hubs; and one is (in)famous for its extremely well-funded “efforts” to supposedly stop the spread of HIV in the Philippines.
The way I see it: Centers without after-testing support should NOT exist.
Because I said this before, and let me say this again: “You can’t just test people and then – after finding out they’re reactive/positive – ‘dump’ them to become somebody else’s problem. Because if/when you do, your concept of service provision is too limited, and as such, you’re actually part of the problem you claim to be dealing with…”

2. Baseline tests are NOT covered by PhilHealth.
In the Philippines, the treatment, care and support (TCS) received by most people living with HIV (PLHIVs) are covered by the Philippine Health Insurance Corporation’s (PhilHealth) Outpatient HIV/AIDS Treatment (OHAT) Package. Specifically, to those who are enrolled in PhilHealth, P30,000 is allocated per PLHIV per year, or P7,500 every quarter.
The 2010 circular that guided the implementation of the OHAT specifically stated that “covered items under this benefit are drugs and medicines, laboratory examinations including Cluster Difference 4 (CD4) level determination test and test for monitoring of anti-retroviral drugs (ARV) toxicity and professional fees of providers.”
The revised OHAT Package released last June 2015 stated that “covered items under this benefit are drugs and medications, laboratory examinations based on the specific treatment guideline including Cluster of Differentiation 4 (CD4) level determination test, viral load (if warranted), and test for monitoring anti-retroviral (ARV) drugs toxicity and professional fees of providers.”
Meaning: baseline tests are NOT covered by the OHAT package.
In 2015, Outrage Magazine interviewed Dr. Rosanna Ditangco, research chief at The Research Institute for Tropical-AIDS Research Group (RITM-ARG), a treatment hub located in Alabang. She lamented that management issues come to play in the delivery of treatment, care and support (TCS) services to PLHIVs.
For instance, “the OHAT Package does NOT cover baseline tests yet”, including such baseline laboratory tests as CBC, chest x-ray, PPD and blood chemistry (i.e. lipid profile, BUN, Creatinine, FBS), and CD4 count.
Let’s call this out already: This policy is – in a word – idiotic.
You need ARVs to treat HIV. You can ONLY get ARVs if you get your baseline tests done. If you have no money to pay for these baseline tests, then say goodbye to ARVs. Sans ARVs, you’re as good as dead.

3. Many medical practitioners in HIV advocacy continue to not know much about… HIV. Or even if they do, they continue to be sources of HIV-related discrimination.
One of the (aforementioned) guys who only recently got tested for HIV told me that – when the attending doctor was informed that his CD4 count is 60 – he was sarcastically told: “Ha, good luck!”.
I saw for myself how one nurse told a PLHIV “not to have sex anymore, ever. Para di na kayo dumami (So your number won’t grow).”
Try bringing up U=U in the country, and among the staunchest deniers are those working in HIV advocacy. I remember one of them tell me before: “Magkakalat pa (You’re giving them excuse to spread HIV)!”.
I also know of doctors who won’t even touch people they suspect to have HIV – due to disgust or fear or whatever, I can only surmise…

READ:  HIV+ men with undetectable viral load do not transmit HIV to their partners, says new study

There are other issues, of course (from slow government response to wrong priorities to fund mismanagement to profiteering).

7 B.S. (or at least half-truths) you hear about HIV in the Philippines

And so here’s another fact: Unless these are dealt with, expect for the worst to come.

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UNAIDS calls for bold leadership to tackle prevention crisis

Around 1.8 million people became newly infected with HIV in 2017 and around 50 countries experienced a rise in new HIV infections as HIV prevention services are not being provided on an adequate scale or with sufficient intensity.

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Photo by Tim Marshall from Unsplash.com

UNAIDS is urging countries to take bold action to address the HIV prevention crisis. Around 1.8 million people became newly infected with HIV in 2017 and around 50 countries experienced a rise in new HIV infections as HIV prevention services are not being provided on an adequate scale or with sufficient intensity.

“Health is a human rights imperative and we are deeply concerned about the lack of political commitment and the failure to invest in proven HIV programmes, particularly for young people and key populations,” said Michel Sidibé, executive director of UNAIDS. “If countries think they can treat their way out of their epidemics, they are dangerously mistaken.”

UNAIDS’ report, Miles to go: closing gaps, breaking barriers, righting injustices, shows that 47% of new HIV infections globally are among key populations. Although combination HIV prevention approaches work for key populations, including harm reduction, pre-exposure prophylaxis (PrEP), social care and condoms, many countries are unwilling to invest in approaches viewed as culturally or religiously inappropriate, unpopular or counter to the bad laws that may exist in a particular country.

HIV prevalence can be high as up to 70% among sex workers in some southern African countries; however, about three quarters of countries reporting to UNAIDS criminalize some aspect of sex work and sex workers report that condoms are often confiscated by the police.

In eastern Europe and central Asia, one third of all new HIV infections are among people who inject drugs; however, 87% of countries reporting to UNAIDS criminalize drug use or possession of drugs, driving people underground and out of reach of HIV services. Many countries do not make sterile injecting equipment and opioid substitution therapy widely available, which is a huge barrier to efforts to bring down new HIV infections among this population and their partners.

READ:  On using phased-out medication

Gay men and other men who have sex with men accounted for around 57% of new HIV infections in western and central Europe and North America in 2017 and an estimated 41% of new infections in Latin America. However, globally, access to HIV services for men who have sex with men is still being blocked by bad laws. Of 100 countries reporting to UNAIDS, at least 44 had laws specifically criminalizing same-sex sexual intercourse. The death penalty applied in two countries.

“If countries don’t provide comprehensive sexuality education, condoms, harm reduction or pre-exposure prophylaxis for key populations, this will ultimately translate into more new HIV infections, higher future treatment costs and a higher burden for health-care budgets and systems,” said Sidibé.

Countries that have invested are seeing results. In Finland’s capital, Helsinki, for example, scale-up of harm reduction and HIV testing and treatment services led to a steep drop in new HIV infections and high rates of viral suppression among people who inject drugs. The number new HIV diagnoses in this key population decreased from more than 60 in 1999 to almost zero in 2014.

In San Francisco in the US, PrEP was added to programs that include HIV testing, rapid linkages to antiretroviral therapy and boosting support for retention in care. Between 2013 and the end of 2016, there was a 43% decrease in new HIV diagnoses in the city, a decline that is being attributed to both quicker achievement of viral suppression among people who test HIV-positive and to increased uptake of PrEP.

READ:  IBM Philippines becomes 1st ASEAN IBM unit to provide LGBTQ domestic partner benefits

Women and girls also need access to HIV prevention. In 2017, around 6500 women and girls were infected with HIV every week. Limited access to education, a lack of economic autonomy and a lack of decision-making power, including over their own health, expose them to intimate partner violence, limit their ability to practice safer sex and limit their ability to benefit from HIV and sexual and reproductive health services, making them more vulnerable to HIV infection.

Women and girls must have the knowledge and power to protect themselves against HIV in safe and enabling environments and must be able to access services that meet their needs. This requires countries to reform discriminatory laws that perpetuate inequality and develop and enforce laws that promote gender equality.

Young people also need age-appropriate youth-friendly health services. More than two thirds of countries reporting to UNAIDS require parental consent for a child under 18 years to access HIV testing, and more than half require consent for HIV treatment.

While most countries have significantly scaled up their HIV treatment programs, some to the extent of reaching 80% of people living with HIV with antiretroviral therapy, the HIV prevention benefits of treatment that countries had hoped to achieve are not yet being realized. People are are not being diagnosed and treated soon enough, allowing transmissions to occur before they start treatment or if treatment is interrupted.

Botswana, for example, has nearly reached its 90–90–90* targets, as 86% of people living with HIV know their HIV status, 84% of people who know their status are on antiretroviral therapy and 81% of people on antiretroviral therapy are virally suppressed. However, new HIV infections have failed to see any declines since 2010.

READ:  LoVeChild: ‘Always protect and love yourself first’

To address the HIV prevention crisis and increase political commitment for HIV prevention, a Global HIV Prevention Coalition of United Nations Member States, donors, civil society organizations and implementers was established in 2017 that includes the 25 highest HIV burden countries.
The overarching goal of the Global HIV Prevention Coalition is to strengthen and sustain political commitment for primary HIV prevention by setting a common agenda—the HIV Prevention 2020 Road Map—among key policy-makers, funders and program implementers to accelerate progress towards reducing new HIV infections by 75% by 2020.

On 23 July 2018, the Global HIV Prevention Coalition came together at an event at the International AIDS Conference in Amsterdam, Netherlands, to discuss the urgency for scaling up HIV prevention, share progress made and address persisting challenges, including policy barriers and inadequate financing for HIV prevention.

The Global HIV Prevention Coalition recently launched its first progress report, Implementation of the HIV Prevention 2020 Road Map, which shows that while initial progress has been made, more efforts are needed to move from political commitment to strong actions on the ground.

90% of people living with HIV know their HIV status, 90% of people who know their status are receiving antiretroviral treatment and 90% of people on treatment have suppressed viral loads.

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Donor cuts could threaten global progress on HIV, new researches warn

A report issued by the Kaiser Family Foundation and UNAIDS found that eight of 14 donor governments reduced their spending on global HIV efforts in 2017. Overall, donor government funding for HIV increased from 2016 to 2017, following two years of declines. Also, mismanagement of funds is a big problem, such as in the Philippines.

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Photo by Freddie Collins from Unsplash.com

If donor government funding for HIV continues to fall, nearly two decades of progress against the disease will be in jeopardy, according to new researches.

Using newly available data, a study from researchers at the Institute for Health Metrics and Evaluation and the Harvard T.H. Chan School of Public Health showed that cuts to development assistance for HIV could do serious harm in hard-hit countries, which continue to rely greatly on this aid.

“If donors falter in their support for HIV, the consequences could be devastating,” said Linda-Gail Bekker, president of the International AIDS Society and International Chair of AIDS 2018. “Smart investments are curbing the spread of HIV and saving both money and lives. Now is not the time to stall or pull back.”

A report issued by the Kaiser Family Foundation and UNAIDS found that eight of 14 donor governments reduced their spending on global HIV efforts in 2017. Overall, donor government funding for HIV increased from 2016 to 2017, following two years of declines. However, this increase was largely due to a shift in timing of US support, and is not expected to last.

To date, there has been limited data on whether the downward trend in development assistance for HIV threatens global progress against the disease.

To address this and other research questions, a study presented by Annie Haakenstad of the Harvard T.H. Chan School of Public Health estimated HIV expenditures by source and function in 188 countries from 2000 to 2015. The results showed that of the $48 billion spent on HIV in 2015, about 62% came from domestic spending by governments and about 30% came from development assistance. In countries with high HIV prevalence, however, nearly 80% of spending came from development assistance.

READ:  HIV+ men with undetectable viral load do not transmit HIV to their partners, says new study

The study concluded that development assistance remains a major portion of spending on critical HIV prevention and treatment program, especially in the hardest-hit countries. The study team urged high-prevalence countries that rely on international aid to plan strategically to ensure that declines in external financing do not threaten progress towards an AIDS-free generation.

A study presented by Deepak Mattur of UNAIDS provided new insight on trends in domestic HIV spending, based on an analysis of data from 112 low- and middle-income countries.

The study found that, overall, domestic public spending on HIV in these countries increased by 60% from 2006 to 2016. In low-income countries, it increased from $121 million to $256 million; in lower-middle income countries, from $231 million to $980 million; and in upper-middle income countries, from $2.4 billion to about $6.9 billion.

Almost all regions increased their domestic HIV resources. For example, in the Asia Pacific region, resources increased by 132%, and in Eastern and Southern Africa, resources increased by 57%. The lowest increase, 33%, was in Eastern Europe and Central Asia. The study also found that domestic public spending on HIV has a significant positive relationship with the GDP per capita of a country, coverage of antiretroviral therapy, and HIV prevalence.

The study concluded that sustained increases in domestic public spending will be critical for ending AIDS as a global public health threat by 2030.

A study presented by John Stover of Avenir Health in Glastonbury, US, investigated how well the current allocation of resources for HIV is optimized for cost effectiveness in 55 low- and middle-income countries that account for about 90% of all new infections.

READ:  IBM Philippines becomes 1st ASEAN IBM unit to provide LGBTQ domestic partner benefits

The study found that cost effectiveness varies widely across countries and interventions. Antiretroviral treatment dominates cost per death and disability adjusted life years averted, and also ranks high in cost effectiveness for infections averted.

The most cost-effective prevention interventions were generally voluntary medical male circumcision, prevention of mother-to-child HIV transmission, outreach to sex workers and condom promotion. These programmes currently receive about 14% of direct intervention funding, which is about two-thirds of the need. The most cost-effective programmes are in East and Southern Africa, where HIV incidence is high and costs are generally low.

The authors concluded that resources for HIV prevention and treatment are generally targeted appropriately, but more focused allocation of resources could improve cost effectiveness by about a quarter. Resource allocations should be continually assessed because cost  effectiveness can change significantly as HIV incidence patterns change.

This is perhaps worth stressing since with the budget cuts, mismanagement of funds is also a big problem, such as in the Philippines.

7 B.S. (or at least half-truths) you hear about HIV in the Philippines

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Chance of HIV-positive person with undetectable viral load transmitting the virus to a sex partner is scientifically zero

The PARTNER 2 study found no transmissions between gay couples where the HIV-positive partner had a viral load under 200 copies/ml – even though there were nearly 77,000 acts of condomless sex between them.

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Confirmed and needs to be stressed: The chance of any HIV-positive person with an undetectable viral load transmitting the virus to a sexual partner is scientifically equivalent to zero.

This is according to researchers who released at #AIDS2018 the final results from the PARTNER study. Results originally announced in 2014 from the first phase, PARTNER 1, already indicated that “Undetectable equals Untransmittable” (U=U). But while the first study was lauded in tackling vaginal sex, the statistical certainty of the result did not convince everyone, particularly in the case of gay men, or those who engage in anal sex.

But now, PARTNER 2, the second phase, only recruited gay couples. The PARTNER study recruited HIV serodifferent couples (one partner positive, one negative) at 75 clinical sites in 14 European countries. They tested the HIV-negative partners every six to 12 months for HIV, and tested viral load in the HIV-positive partners. Both partners also completed behavioral surveys. In cases of HIV infection in the negative partners, their HIV was genetically analyzed to see if it came from their regular partner.

And the results indicate “a precise rate of within-couple transmission of zero” for gay men as well as for heterosexuals.

The study found no transmissions between gay couples where the HIV-positive partner had a viral load under 200 copies/ml – even though there were nearly 77,000 acts of condomless sex between them.

PARTNER is not the only study about viral load and infectiousness. Last year, the Opposites Attract study also found no transmissions in nearly 17,000 acts of condomless anal sex between serodifferent gay male partners. This means that no transmission has been seen in about 126,000 occasions of sex, if this study is combined with PARTNER 1 and 2.

READ:  NCCP's message on World AIDS Day 2016: 'God's love encompasses all'

While this is good news overall in the fight against HIV, related issues continue to plague HIV-related efforts, particularly in countries like the Philippines.

Why aren’t we talking about ‘undetectable = untransmittable’ in the Philippines?

For instance, aside from the overall silence on U=U (undetectable = untransmittable), use of anti-retroviral therapy (ART) continue to be low. As of May 2016, when the country already had 34,158 total reported cases of HIV infection, Filipinos living with HIV who are on anti-retroviral therapy (i.e. those who are taking meds) only numbered 14,356.

The antiretroviral medicines in use in the Philippines also continue to be limited, with some already phased out in developed countries.

All the same, this is considered a significant stride, with science unequivocally backing the scientific view helmed in 2008 by Dr. Pietro Vernazza who spearheaded the scientific view that viral suppression means HIV cannot be passed via a statement in the Bulletin of Swiss Medicine.

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POZ

Time is running out to reach the 2020 HIV targets – UNAIDS

New HIV infections are rising in around 50 countries, AIDS-related deaths are not falling fast enough and flat resources are threatening success. Half of all new HIV infections are among key populations and their partners, who are still not getting the services they need.

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UNAIDS is issuing countries with a stark wake-up call. In a new report, UNAIDS warns that the global response to HIV is at a precarious point. At the halfway point to the 2020 targets, the report, Miles to go—closing gaps, breaking barriers, righting injustices, warns that the pace of progress is not matching global ambition. It calls for immediate action to put the world on course to reach critical 2020 targets.

Photo used for illustration purpose only. Photo by Vittore Buzzi from Unsplash.com.

“We are sounding the alarm,” said Michel Sidibé, executive director of UNAIDS. “Entire regions are falling behind, the huge gains we made for children are not being sustained, women are still most affected, resources are still not matching political commitments and key populations continue to be ignored. All these elements are halting progress and urgently need to be addressed head-on.”

HIV prevention crisis

Global new HIV infections have declined by just 18% in the past seven years, from 2.2 million in 2010 to 1.8 million in 2017. Although this is nearly half the number of new infections compared to the peak in 1996 (3.4 million), the decline is not quick enough to reach the target of fewer than 500 000 by 2020.
The reduction in new HIV infections has been strongest in the region most affected by HIV, eastern and southern Africa, where new HIV infections have been reduced by 30% since 2010. However, new HIV infections are rising in around 50 countries. In eastern Europe and central Asia the annual number of new HIV infections has doubled, and new HIV infections have increased by more than a quarter in the Middle East and North Africa over the past 20 years.

Treatment scale-up should not be taken for granted

Due to the impact of antiretroviral therapy roll-out, the number of AIDS-related deaths is the lowest this century (940 000), having dropped below 1 million for the first time in 2016. Yet, the current pace of decline is not fast enough to reach the 2020 target of fewer than 500 000 AIDS-related deaths.
In just one year, an additional 2.3 million people were newly accessing treatment. This is the largest annual increase to date, bringing the total number of people on treatment to 21.7 million. Almost 60% of the 36.9 million people living with HIV were on treatment in 2017, an important achievement, but to reach the 30 million target there needs to be an annual increase of 2.8 million people, and there are indications that the rate of scale-up is slowing down.

READ:  UN HRC identifies LGBT rights violations in Phl

West and central Africa lagging behind

Just 26% of children and 41% of adults living with HIV had access to treatment in western and central Africa in 2017, compared to 59% of children and 66% of adults in eastern and southern Africa. Since 2010, AIDS-related deaths have fallen by 24% in western and central Africa, compared to a 42% decline in eastern and southern Africa.

Nigeria has more than half (51%) of the HIV burden in the region and there has been little progress in reducing new HIV infections in recent years. New HIV infections declined by only 5% (9000) in seven years (from 179 000 to 170 000) and only one in three people living with HIV is on treatment (33%), although HIV treatment coverage has increased from just 24% two years ago.

Progress for children has slowed

The report shows that the gains made for children are not being sustained. New HIV infections among children have declined by only 8% in the past two years, only half (52%) of all children living with HIV are getting treatment and 110 000 children died of AIDS-related illnesses in 2017. Although 80% of pregnant women living with HIV had access to antiretroviral medicines to prevent transmission of HIV to their child in 2017, an unacceptable 180 000 children acquired HIV during birth or breastfeeding—far away from the target of fewer than 40 000 by the end of 2018.

“One child becoming infected with HIV or one child dying of AIDS is one too many,” said Mr Sidibé. “Ending the AIDS epidemic is not a foregone conclusion and the world needs to heed this wake-up call and kick-start an acceleration plan to reach the targets.”

Key populations account for almost half of all new HIV infections worldwide

The report also shows that key populations are not being considered enough in HIV programming. Key populations and their sexual partners account for 47% of new HIV infections worldwide and 97% of new HIV infections in eastern Europe and central Asia, where one third of new HIV infections are among people who inject drugs.

“The right to health for all is non-negotiable,” said Sidibé. “Sex workers, gay men and other men who have sex with men, prisoners, migrants, refugees and transgender people are more affected by HIV but are still being left out from HIV programs. More investments are needed in reaching these key populations.”

READ:  Because AIDS is far from over…

Half of all sex workers in Eswatini, Lesotho, Malawi, South Africa and Zimbabwe are living with HIV. The risk of acquiring HIV is 13 times higher for female sex workers, 27 times higher among men who have sex with men, 23 times higher among people who inject drugs and 12 times higher for transgender women.

“Communities are echoing UNAIDS’ call,” said Vincent Pelletier, positive leader and executive director of Coalition PLUS. “We need universal access to adapted prevention services, and protection from discrimination. We call upon world leaders to match commitments with funding, in both donor and implementing countries.”

Stigma and discrimination persists

Discrimination by health-care workers, law enforcement, teachers, employers, parents, religious leaders and community members is preventing young people, people living with HIV and key populations from accessing HIV prevention, treatment and other sexual and reproductive health services.

Across 19 countries, one in five people living with HIV responding to surveys reported being denied health care and one in five people living with HIV avoided visiting a health facility for fear of stigma or discrimination related to their HIV status. In five of 13 countries with available data, more than 40% of people said they think that children living with HIV should not be able to attend school with children who are HIV-negative.

New agenda needed to stop violence against women

In 2017, around 58% of all new HIV infections among adults more than 15 years old were among women and 6600 young women between the ages of 15 and 24 years became infected with HIV every week. Increased vulnerability to HIV has been linked to violence. More than one in three women worldwide have experienced physical or sexual violence, often at the hands of their intimate partners.

“Inequality, a lack of empowerment and violence against women are human rights violations and are continuing to fuel new HIV infections,” said Sidibé. “We must not let up in our efforts to address and root out harassment, abuse and violence, whether at home, in the community or in the workplace.”

90–90–90 can and must be achieved

There has been progress towards the 90–90–90 targets. Three quarters (75%) of all people living with HIV now know their HIV status; of the people who know their status, 79% were accessing treatment in 2017, and of the people accessing treatment, 81% had suppressed viral loads.

Six countries, Botswana, Cambodia, Denmark, Eswatini, Namibia and the Netherlands, have already reached the 90–90–90 targets and seven more countries are on track. The largest gap is in the first 90; in western and central Africa, for example, only 48% of people living with HIV know their status.

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A big year for the response to tuberculosis

There have been gains in treating and diagnosing HIV among people with tuberculosis (TB)—around nine out of 10 people with TB who are diagnosed with HIV are on treatment. However, TB is still the biggest killer of people living with HIV and three out of five people starting HIV treatment are not screened, tested or treated for TB. The United Nations High-Level Meeting on Tuberculosis in September 2018 is an opportunity to bolster momentum around reaching the TB/HIV targets.

The cost of inaction

Around US$ 20.6 billion was available for the AIDS response in 2017—a rise of 8% since 2016 and 80% of the 2020 target set by the United Nations General Assembly. However, there were no significant new commitments and as a result the one-year rise in resources is unlikely to continue. Achieving the 2020 targets will only be possible if investments from both donor and domestic sources increase.

Ways forward

From townships in southern Africa to remote villages in the Amazon to mega-cities in Asia, the dozens of innovations contained within the pages of the report show that collaboration between health systems and individual communities can successfully reduce stigma and discrimination and deliver services to the vast majority of the people who need them the most.

These approaches continue to drive the solutions needed to achieve the 2020 targets. When combination HIV prevention—including condoms and voluntary medical male circumcision—is pursued at scale, population-level declines in new HIV infections are achieved. Oral pre-exposure prophylaxis (PrEP) is having an impact, particularly among key populations. Offering HIV testing and counseling to family members and the sexual partners of people diagnosed with HIV has significantly improved testing access.

Eastern and southern Africa has seen significant domestic and international investments coupled with strong political commitment and community engagement and is showing significant progress in achieving the 2020 targets.

“For every challenge there is a solution,” said Sidibé. “It is the responsibility of political leaders, national governments and the international community to make sufficient financial investments and establish the legal and policy environments needed to bring the work of innovators to the global scale. Doing so will create the momentum needed to reach the targets by 2020.”

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