People from 13 countries across Asia and the Pacific gathered in Bangkok, Thailand to develop road maps to implement and expand pre-exposure prophylaxis (PrEP) and HIV self-testing in the region.
PrEP reduces the risk of acquiring HIV by more than 90 percent, and HIV self-testing can significantly increase the number of people who find out their status, particularly among those at highest risk and least reached by existing services. This means that adequate use of these products is set to revolutionize HIV prevention across Asia and the Pacific. In China, Indonesia, Malaysia, Pakistan and the Philippines for example, infections among men that have sex with men (MSM) continue to rise, and HIV prevalence has hit 25.8 percent in Indonesia and 21.6 percent in Malaysia. MSM could make up at least half of all new HIV infections in Asia by 2020.
But most countries in the region do not have policies in place to implement PrEP or HIV self-testing at scale.
Also, while a handful of countries are taking the lead and have included innovative interventions into their national HIV strategies, more countries have challenges re PrEP access that remains extremely limited to the well-off; while self-testing is not even discussed yet. This includes the Philippines, where PrEP access is deemed elitist; and self-testing is basically non-existent.
“The numbers say it all. We cannot stop new HIV infections in men who have sex with men and other key populations if we stick to business as usual,” said Eamonn Murphy, UNAIDS Regional Director for Asia and the Pacific. “PrEP answers an unmet need and expands the prevention options for people at substantial risk of HIV. We need to scale up PrEP as an additional effective HIV prevention intervention”.
According to Rachel Baggaley, WHO’s coordinator of HIV testing and prevention, WHO first recommended HIV self-testing in 2016; and 59 countries now have policies. However, only 28 are implementing.
“HIV self-testing needs to become more widely available, affordable and accessible to reach the 90-90-90 targets. WHO has also recommended PrEP since 2015. If we are going to scale up PrEP, if we are going to reach levels of coverage that translate into public health impact, we need to engage and support key populations to deliver PrEP in Asia,” she concluded.
Participants discussed roadblocks to scale-up, including lack of political commitment, investments, national guidance; as well as stigma and discrimination towards key populations. They also emphasized the need to integrate PrEP and HIV self-testing into national programs, work with the private sector, and to further involve communities to increase demand and improve service delivery.
The meeting was coordinated by Unitaid, UNAIDS, and WHO. Attendees included representatives from Ministries of Health, country and regional partners and networks working on PrEP and HIV self-testing, civil society representatives from Bangladesh, Cambodia, China, Indonesia, India, Lao PDR, Malaysia, Myanmar, Pakistan, Papua New Guinea, Philippines, Thailand and Viet Nam, WHO and UNAIDS country and regional HIV focal points and representatives from civil society including APCOM and APTN as well as other partners such as PEPFAR, CDC, FHI360 and the Global Fund for AIDS, TB and Malaria.
Outrage Magazine reached out to the organizers of the Bangkok gathering to ascertain: 1) who the countries representatives are; 2) how they intend to do the scale-up; and 3) if they have a timeline for the scale-up.
No responses have been received to date.
Phl now has 32 new HIV cases per day
From January 1984 to October 2018, the Philippines already had a total of 60,207 HIV cases. It is worth noting that 9,605 of that number was reported from January to October 2018 alone.
October highlighted the continuing disturbing worsening HIV situation in the Philippines, with an estimated 32 new HIV cases now happening in the country every day. For October, there were 1,072 new HIV cases reported to the HIV/AIDS & ART Registry of the Philippines (HARP).
It was in September when this number (i.e. 32 new HIV cases per day) was first reported. Prior to that, the country “only” had 31 new HIV cases reported daily, though even this figure was already considered high compared to figures from past years. In 2009, the country only had two new HIV cases per day. By 2015, the number increased to 22; and in the early part of 2018, the number was 31.
From January 1984 (when the first HIV case was reported in the country) to October 2018 (when the latest figures were belatedly – as usual – released by the HARP), the Philippines already had a total of 60,207 HIV cases. It is worth noting that 9,605 of that number was reported from January to October 2018 alone.
MALES IN FOCUS
Those newly infected continue to be male – in October, of the 1,072 newly infected, 1,016 (95%) were male. The median age was 28 years old (age range: 2 – 67 years old). Half of the cases (50%, 537) were 25-34 years old and 29% (306) were 15-24 years old at the time of testing.
Based on where those who tested HIV-positive originated, one third (32%, 343) were from the National Capital Region (NCR). Region 4A (17%, 187 cases), Region 3 (11%, 121), Region 7 (8%, 82), and Region 6 (7%, 76), round off the top five regions with the most number of newly diagnosed cases for the month, together accounting for 75% of the total.
Sexual contact remains the main mode of transmission (97%, 1,044). Among this, 86% were males who have sex with males (MSM). Other modes of transmission were needle sharing among injecting drug users (1%, 15) and vertical (formerly, mother-to-child) transmission (<1%, 2). There were 11 cases that had no data on mode of transmission.
Among the newly diagnosed females in October, eight were pregnant at the time of diagnosis. Five cases were from NCR and one case each from Regions 3, 4A and 7.
In October, there were 831 patients who were initiated on antiretroviral therapy (ART). This is close to the figure registered in September, when 804 patients were initiated on ART. To date, a total of 32,324 people living with HIV (PLHIV) are on ART as of October; and this figure is still only a few thousand over the total number (60,207) of those who reported to have HIV in the country.
FOCUS ON THE YOUNG
Those getting infected continue to be also younger.
In October, 306 (29%) cases were among youth 15-24 years old; 94% were male. Almost all (98%, 300) were infected through sexual contact (31 male-female sex, 197 male-male sex, 72 sex with both males and females). There were six cases that had no data on mode of transmission.
There were also 41 newly diagnosed adolescents 10-19 years old in October. Almost all (95%) were infected through sexual contact (3 male-female sex, 31 male-male sex, and 5 had sex with both males and females); two had no data on mode of transmission. There were two newly diagnosed child less than 10 years old, and both were infected through mother-to-child transmission.
OFWs IN FOCUS
Even among overseas Filipino workers who tested HIV-positive, more were infected from male-to-male sexual contact.
Eighty-one people who worked overseas within the past five years of diagnosis, whether on land or at sea, were diagnosed HIV-positive in October. They comprise 8% of the total newly diagnosed cases for the month. Among them, 89% (72) were male. Almost all were infected through sexual contact (27 male-female sex, 32 male-male sex, and 21 sex with both males and females). The ages of male OFWs ranged from 23 to 55 years (median: 32 years). More than half (57%) of the cases belonged to the 25-34 year age group. Among the female OFWs diagnosed in October 2018, four cases were from the age groups 25-34 and 35-49; and one case was from 50 years old & older age group. The age range among diagnosed female OFWs were 28 to 61 years (median: 35 years).
ENGAGEMENT IN TRANSACTIONAL SEX
In October 2018, 14% (147) of the newly diagnosed engaged in transactional sex. Ninety-five percent (140) were male and aged from 20 to 64 years old (median: 30 years). More than half of the males (57%, 80) reported paying for sex only, 31% (43) reported accepting payment for sex only and 12% (17) engaged in both. Among the female cases who engaged in transactional sex, majority (71%, 5) were reported accepting payment in exchange for sex and 29% (2) reported paying for sex only.
Reporting on people who engage in transactional sex – or those who reported that they either pay for sex, regularly accept payment for sex, or do both – was only included in the HARP starting December 2012.
PREGNANT AND HIV-POZ
In October 2018, eight newly diagnosed cases were reported to be pregnant. Five were from NCR and one each from Regions 3, 4A and 7. The age of diagnosis ranged from 19 to 34 (median age: 23).
Reporting of pregnancy status at the time of testing was included in the HARP from the year 2011.
DEATHS AMONG PEOPLE WITH HIV
In October 2018, there were 30 reported deaths due to any cause among people with HIV. Ninety-seven percent (29) were males. One case (4%) was less than 15, four cases (13%) were 15-24, 12 cases (40%) were from 25-34, 10 cases (33%) were from 35-49, and three cases (10%) were 50 years and older age group. Almost all of the cases were reported to have acquired the infection through sexual contact (97%) (3 through male-female sex, 19 through male-male sex, and seven through sex with both males and females); while one case (3%) was infected through vertical transmission.
The 30 deaths are lower than the number reported in August, with reached 159 HIV-related deaths. But the figures are still believed to be be higher because of under- or non-reporting.
Interventions needed to reach older adults and ethnic minorities to address HIV testing, beliefs
Many barriers already prevent people from getting tested for HIV. But researchers now argue that interventions are urgently needed to also reach older adults and ethnic minorities to address HIV testing and beliefs.
As it is, many barriers already prevent people from getting tested for HIV, including lack of knowledge, competing priorities during medical visits, and stigma associated with the test on the part of both the patient and provider. But researchers now argue that interventions are urgently needed to also reach older adults and ethnic minorities to address HIV testing and beliefs.
Brandon Brown, an HIV researcher at the University of California, Riverside’s School of Medicine, is the lead author of “Indicators of self-reported human immunodeficiency virus risk and differences in willingness to get tested by age and ethnicity: An observational study”, which was published in the journal Medicine.
The researchers argued that “not much is known, however, about what impact age and ethnicity have on HIV testing.”
Brown and colleagues explored data on self-reported HIV risk and willingness to be tested. They focused on age and ethnicity in the Coachella Valley in the US using the 2014 Get Tested Coachella Valley Community Survey. The team collected data from nearly 1,000 participants related to demographics, sexual history, HIV testing history, thoughts on who should get tested, and future preferences for HIV testing.
“We found stigma, education, provider recommendations, risk perceptions, and cost are among major factors contributing to accepting HIV testing and intention to receive HIV testing,” Brown said.
The study also found:
- Most untested participants did not believe they are at risk.
- Men were more likely than women to have been tested.
- Significantly fewer participants aged 50 or older said they are at risk of HIV compared to participants younger than 50.
- Participants aged 50 or older were less likely to be tested for HIV compared to participants between the ages of 25 to 49.
- Compared to younger participants, significantly fewer participants aged 50 years or older accepted HIV testing when it was offered by a health care provider.
- Older adults tend to underestimate their HIV risk and severely delay HIV testing or forgo testing altogether.
- Older adults are more likely than younger adults to be diagnosed with HIV later in the disease course.
- Many participants claimed they would get tested if their health care provider offered testing.
“Our recommendations to health care providers are that they talk directly with their patients during clinical visits about HIV prevention and HIV risk, and that they routinely offer HIV screening as part of primary care,” Brown said.
Brown added that interventions are needed to “debunk beliefs among physicians that older adults are not sexually active, and beliefs among older adults that only others are at risk of HIV.”
‘Life for a poz is an ongoing struggle. Face it.’ – @pozzieblue
Contributing writer @pozzieblue tested HIV-positive in July 2013, while working as a nurse in the Middle East. He now writes how life has been after he was detained and then deported.
This is part of “More than a Number”, which Outrage Magazine launched on March 1, 2013 to give a human face to those infected and affected by the Human Immunodeficiency Virus (HIV) and Acquired Immunodeficiency Syndrome (AIDS) in the Philippines, what it considers as “an attempt to tell the stories of those whose lives have been touched by HIV and AIDS”.
More information about (or – for that matter – to be included in) “More than a Number”, email email@example.com, or call (+63) 9287854244 and (+63) 9157972229.
BACKGROUND: While working as a nurse in Abu Dhabi, United Arab Emirates, @pozzieblue tested HIV-positive in July 2013. He was placed in an isolated facility in the middle of a desert, and then deported to the Philippines. Months after trying to get his life back together, he shared his story to Outrage Magazine in November 2013. This is a new contributed article from him, sharing how life has changed for him after he tested HIV-positive; and the lessons he hopes others like him learns from life.
After being detained and deported, life was not easy. I felt I’ve went back to zero. I grieved a lot, and sometimes I thought I’ve reached the acceptance phase but the anger and sadness fluctuates every now and then. There was even a time that I went to RITM from my hometown by myself, and I was still struggling from my pneumonia and ARV allergic reaction. I needed to go back to my hub so I could refill my new ARV. I was on MRT train when I felt I was fainting so I’ve decided to sat on the floor to gain my strength and to avoid falling. It felt so terrible and lonely because as a nurse who used to take care different people, nobody cared to approach and ask me if I’m okay.
This is the reason why I realized that I need to focus on one of the most important aspect of my life, my health. Later on, I discovered twitter. I am grateful because this social media became a great support system to me because the of the fellow poz who have their account there. They have been very encouraging to my PLHIV journey, so I’m truly thankful to them. In fact, I have found some of my true best friends.They were there in supporting me in different ways, specially to my mental health.
When my health became stable, I started working from different fields. I hopped from the BPO industry, teaching International students and doing online jobs. I was upset because it was hard to start a clean slate. Maybe because deep in my heart, I hold this faith that there is still another world waiting for me, but this virus in my blood inhibits me, as well as the trauma I’ve had. Then I promised myself that my life will not end this way and just like the long-time drama anthology says “Ikaw ang bida ng buhay mo.”
I tried enriching my neurons by finishing my Master’s Degree and improving my English skill. I was spending my earnings in different classes and dealing my thesis. During that time, I was also rekindling my relationship to God. There was a time that I felt He left me, but I realized that during those lowest lows of my life, he was there all through out, but I couldn’t see him because I was blinded with frustration, anger and regrets.
After going through with my Master and passing my English test. I’ve received an information from another PLHIV that he knows a nurse who was accepted to work in UK to practice his profession, despite being a poz. That simple online conversation ignited a hope in my heart. Hence, I started applying for an overseas job again. I can still remember how much worry it caused me whenever I needed to disclose my HIV status to my prospective employers but I’m grateful that they don’t mind it.
To make the story short, I’m now in UK and I just passed my final exam to become a Registered Nurse here few weeks ago. It wasn’t an easy journey, but with perseverance, good health and divine intervention; I was able to fulfill this dream. I remember what Pope Francis said, “When you lose the capacity to dream, you lose the capacity to love, and the energy to love is lost.” This is my new mantra now.
To all my fellow PLHIV out there: life may seem to be a continuous struggle but continue learning and enriching yourself. Ask for help if you think you need one. Pain and sorrow is subjective. I may not know what you are going through but I sincerely wish everyone well.
Study links individual HPV types to HIV infection
Persons with any HPV type, more than one HPV type, or high-risk HPV are more likely to test HIV positive.
Individual types of the human papillomavirus (HPV) that are specifically linked to HIV infection have – for the first time – been identified.
In a study published in the journal PLOS ONE, a person with any HPV type, more than one HPV type, or high-risk HPV is more likely to acquire HIV. The study found the following HPV types are linked to HIV: HPV16, 18, 31, 33, 35, 52, 58.
“Although most studies have shown a general link between HPV and HIV co-infection, our findings illustrate the strong relationship between individual HPV types and HIV infection,” said Brandon Brown, an HIV researcher and associate professor in the UCR School of Medicine and lead author of the study. “Some HPV types are more linked to cancer and others to warts. This further illustrates the potential utility of HPV vaccine for men who have sex with men and trans women, not only for HPV prevention but also possibly for HIV prevention.”
Brown, a member of UCR’s Center for Healthy Communities, was joined in the study by Logan Marg of UCR; Segundo Leon at Socios En Salud, Lima, Peru; Cynthia Chen and Junice Ng Yi Siu of the National University of Singapore; Gino Calvo and Hugo Sanchez of Epicentro Salud, Lima, Peru; and Jerome T. Galea of the University of South Florida.
Previous research has shown that HPV, in general, was linked to HIV infection, but the new research team looked at infection with 37 HPV types and found that individual types are linked, “which is more specific than saying HPV is linked.”
The study investigated the relationship between HPV types and incident HIV infection among men who have sex with men (MSM) and transgender women in Lima, Peru. There were 600 participants recruited at a local community-based health center, bars, clubs, volleyball courts, and via social media. The researchers started with two groups, one with genital warts and one without, and followed participants over two years to see who contracted HIV. Of the 571 participants who completed at least two study visits, 73 acquired HIV in two years – a 6% HIV incidence rate.
Brown has been working in Peru for more than 10 years and has conducted preliminary work on HPV vaccine acceptability in MSM. In his previous work with female sex workers, he found that the HPV vaccine still provided protection to high-risk groups.
According to Brown, the results of the study are “absolutely applicable beyond Peru, and synergize with recent results of studies outside Peru.”
“The fact that our study took place in Peru is irrelevant,” Brown said. “It was simply convenient to do it there with our strong community connections and a high interest in this research.”
Regarding prevention and treatment, Brown recommends the HPV vaccine, widely provided to everyone, regardless of sex, gender, or sexual orientation, before sexual debut, as well as genital wart treatment.
“Even if the vaccine is not provided before sexual debut, there can be strong benefit if given at any time to prevent HPV-associated disease and also HIV,” he said. “We know that HPV is the most common STI, and we know that HPV vaccine works to prevent chronic HPV infection. What we need now is to implement the vaccine in a better way.”
Study stresses negligible risk of transmitting HIV during sex when viral load is suppressed
Stressing U=U with a new research stating that there is a negligible risk of transmitting HIV during sex when a person living with HIV is on antiretroviral therapy and maintains a viral load under a specific threshold.
A newer study found – and backed – the already-established fact that there is a negligible risk of transmitting HIV during sex when a person living with HIV is on antiretroviral therapy and maintains a viral load under a specific threshold. In “Risk of sexual transmission of human immunodeficiency virus with antiretroviral therapy, suppressed viral load and condom use: a systematic review”, published in CMAJ (Canadian Medical Association Journal), the Public Health Agency of Canada conducted a systematic review that relied on 11 studies and one previously published review to determine the absolute risk of HIV transmission when preventive measures are in place.
“Our findings show that there is a negligible risk of sexually transmitting HIV when an HIV-positive sex partner adheres to antiretroviral therapy and maintains a suppressed viral load of less than 200 copies/mL on consecutive measurements every four to six months. The risk of sexual HIV transmission is low when an HIV-positive sex partner is taking antiretroviral therapy without a suppressed viral load of less than 200 copies/mL, condoms are used or both,” the researchers – which included Rachel Rodin from the Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada – stated.
The findings are of particular relevance, according to the researchers, in the drafting of laws.
In Canada, for instance, based on the findings of this study, as well as relevant case law and other factors, the Department of Justice Canada concluded that “the criminal law should not apply to people living with HIV who maintain a suppressed viral load of less than 200 copies/mL.”
Justice Canada also concluded that the criminal law should generally not apply to those who use condoms, among others.
Previous studies found that antiretroviral therapy and condoms can reduce HIV transmission. This study includes evidence from newer studies that have influenced clinical practice and could affect criminal law.
PrEP is safe and effective for widespread use, research shows
Worldwide, there are only 300,000 people estimated to be taking PrEP. This is far too small a number to prevent 1.8 million new HIV infections.
New research shows that pre-exposure prophylaxis (PrEP) could be given to millions of people worldwide with no increased risk of safety issues during treatment.
PrEP is a combination of two drugs that people can take before sex to prevent HIV infection. Existing evidence shows that people who take tenofovir disoproxil fumarate (TDF) and emtricitabine (FTC) as PrEP have a 90% lower chance of being infected with HIV than people not taking it.
However, widespread use of TDF/FTC can be justified only if its preventative benefits outweigh potential risks of safety issues. These new results, presented today, show that PrEP is safe to use.
The researchers undertook a meta-analysis of 13 randomized trials with 15,678 participants. People at risk of HIV infection were given either TDF/FTC as PrEP or no treatment (the control, or placebo). There was no significant difference in risk of high grade or serious adverse events comparing PrEP with control. The risk of serious adverse events was almost the same for both groups: 9.4% for those on PrEP and 10.1% for those on placebo. There was also no significant difference in risk of renal or bone adverse outcomes. The risk of bone fractures was 3.7% on PrEP versus 3.3% on no treatment. The risk of significant renal dysfunction was 0.1% on PrEP and 0.1% for no treatment.
“In 2016, there were 1.8 million new HIV infections worldwide and the same number again in 2017,” International AIDS Society President Anton Pozniak said. “Across a range of studies, men who have sex with men have one in 30 chance of contracting HIV in a year. Other particularly vulnerable populations’, such as people who inject drugs or sex workers, have a one in 50 chance of being infected with HIV.
“Worldwide, there are only 300,000 people estimated to be taking PrEP. This is far too small a number to prevent 1.8 million new HIV infections. Clearly, to have a significant effect on the HIV epidemic, we need to scale up PrEP to reach tens of millions of people worldwide.”
Other PrEP modalities, such as long-acting injectable drugs and antibodies, are being tested in order to offer more choices of how PrEP could be taken.
“Globally, there is a new HIV infection every 18 seconds,” study co-author Dr Andrew Hill, from Liverpool University, said. “Every person newly infected will then need to be treated for life, and could transmit HIV to others. We need radical changes in our prevention strategy to cut new HIV infections down to zero.”
The most widely used PrEP, a combination of TDF and FTC, costs only £40 per year to make. A generic TDF/FTC course is available in the UK for £300 per year and £50 in sub-Saharan Africa. With recent legal rulings, low-cost, generic PrEP is becoming more available. This provides an opportunity, with the decreasing costs making it increasingly feasible to provide PrEP to millions of people at risk of HIV worldwide.
“The World Health Organization updated its official guidelines in 2015 to include the use of PrEP as a prevention method,” Dr. Pozniak commented. “The data is clear and it’s time to globally implement this recommendation.”
These results are supported by another recent analysis, which showed no difference in adverse events between TDF/FTC and a combination of tenofovir alafenamide (TAF) and FTC when taken for treatment with an additional antiviral drug.