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

HIV-positive men who are on treatment and have undetectable viral load do not transmit HIV to their partners.

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PARIS, FRANCE – HIV-positive men who are on treatment and have undetectable viral load do not transmit HIV to their partners. This is according to new study – titled “Opposites Attract” – from the Kirby Institute at the University of New South Wales (UNSW) in Australia, and presented at the International Aids Society (IAS) Conference on HIV Science in Paris, France.

For this study, 358 serodiscordant gay male couples (where one has HIV and the other does not) from Thailand, Brazil and Australia were regularly tested from 2012 to 2016. For that period, the researchers recorded 16,889 acts of condomless anal sex, and none of those acts resulted in the transmission of HIV.

“Our research adds to the evidence from a small number of other international studies of heterosexual and homosexual couples and means that we can say, with confidence, that effectively treated HIV blocks transmission in couples of differing HIV status,” said Andrew Grulich, the study’s chief investigator and a professor at the Kirby Institute.

Already, an earlier PARTNER study found that HIV-positive people on effective HIV treatment that fully suppresses their virus cannot transmit their infection through sex.

Both the “Opposites Attract” and the PARTNER studies also found that if the HIV-positive partner is on successful treatment, even having another sexually transmitted infection (STI) does not increase the risk of HIV being transmitted. In “Opposites Attract”, participants had an STI during 6% of anal sex acts; while in the PARTNER study, 17.5% of participants had an STI at some point in the study.

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Sexual positions also did not matter even though when viral load is not suppressed, transmission is 10-20 times more likely if the HIV-positive partner is the insertive one (i.e. “top”). In “Opposites Attract”, the HIV-positive partner was “top” over a third of the time.

Three men actually became infected with HIV during the “Opposites Attract” study. However, genetic analysis showed that these infections came from a partner outside the main relationship who was not virally suppressed.

The results of “Opposites Attract” strengthen the “U=U” (Undetectable=Untransmittable) campaign of the Prevention Access Campaign, whose consensus statement was signed by the International AIDS Society (IAS) and NAM, organizers of the conference in Paris.

For Kevin Robert Frost, CEO of amfAR, one of the organizations that funded the study, these results are “extremely encouraging and underscore the need to get people tested and onto treatment immediately if they are HIV positive,” he said in a statement released to the media. “This important breakthrough underscores yet again how investments in HIV research yield invaluable dividends in the global response to HIV.”

REFERENCE
Bavinton B et al. (presenter Grulich A). HIV treatment prevents HIV transmission in male serodiscordant couples in Australia, Thailand and Brazil. 9th International AIDS Society Conference on HIV Science, Paris, abstract no TUAC0506LB, July 2017.

POZ

13 countries from APAC plan scale-up of PrEP and HIV self-testing; challenges remain

Most countries in the region do not have policies in place to implement PrEP or HIV self-testing at scale.  However, a handful of countries are taking the lead and have included these innovative interventions into their national HIV strategies.

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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”.

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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.

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POZ

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.

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Image used for illustration purpose only; photo by lucas clarysse from Unsplash.com

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.”

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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.”

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POZ

‘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.

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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 editor@outragemag.com, or call (+63) 9287854244 and (+63) 9157972229.

Photo used for illustration purpose only; by Jason Schjerven from Unsplash.com

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.

@pozzieblue: The HIV-positive OFW

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.

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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.

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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.

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POZ

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.

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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.

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“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.

READ:  HIV prevention efforts still need to be significantly stepped up

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Roadmap for speedy development of HIV vaccine announced

As scientific discoveries lead to promising new approaches to HIV vaccine development, and with several large-scale vaccine efficacy studies underway, a new strategy takes a fresh look at the major challenges confronting the HIV vaccine paradigm.

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Photo by Sara Bakhshi from Unsplash.com

The Global HIV Vaccine Enterprise, hosted by the International AIDS Society (IAS), launched a five-year strategy to accelerate the development of an effective vaccine to prevent HIV infection. The new Global HIV Vaccine Enterprise Strategic Plan (2018-2023) was unveiled at the opening of HIV Research for Prevention (HIVR4P 2018), the world’s only scientific conference dedicated exclusively to biomedical HIV prevention, in Madrid, Spain.

“This strategy presents an opportunity to address some of the most significant challenges in HIV vaccine development today,” IAS President Anton Pozniak said.

The new strategy evaluates current opportunities, challenges and obstacles in HIV vaccine research and development and recommends a series of steps to:

  • Propel the vaccine pipeline by strengthening strategies to align, amplify and accelerate development of candidate vaccines
  • Prepare for success by tackling priorities essential to clarifying the roadmap for future access to a vaccine
  • Expand resources and engagement by enlisting a diverse community of partners to support and contribute to the field.

The new strategic plan was developed through an IAS-led consultation involving HIV vaccine research and funding stakeholders, the Enterprise Strategic Advisory Group and the IAS Governing Council. The plan advances the ongoing partnership between the IAS, the world’s largest association of HIV professionals, and the Global HIV Vaccine Enterprise, which promotes coordination, collaboration and resource mobilization to accelerate HIV vaccine development.

“While the HIV vaccine landscape offers greater scientific promise than ever before, the field also faces real challenges in terms of aligning scientific priorities, developing the smartest and most effective research studies, maintaining funding and engaging and maximizing the contributions of all global stakeholders in the search for a vaccine,” Pozniak added.

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“The new strategy builds on more than a decade of work by the Global HIV Vaccine Enterprise to identify critical gaps in systems and knowledge, promote collaboration and address one of the greatest scientific challenges of our time.”

As scientific discoveries lead to promising new approaches to HIV vaccine development, and with several large-scale vaccine efficacy studies underway, the new strategy takes a fresh look at the major challenges confronting the HIV vaccine paradigm. Among these are:

  • The increasing complexity of conducting vaccine efficacy trials as more biomedical HIV prevention options become available
  • The need to address critical gaps in scientific knowledge about immune responses to HIV
  • Stagnant funding and the need to increase government and industry commitment and investment to meet emerging vaccine research opportunities
  • Uncertainty about regulatory and access pathways for a successful vaccine.

To address these challenges and others, the IAS/Enterprise plan proposes a series of near-term activities to address critical, of-the-moment challenges, along with longer-term goals and guideposts to measure achievements and guide adjustments in the strategy as the field evolves. The plan’s activities will be sequenced strategically and guided by annual implementation plans – with detailed activities, timelines and deliverables.

“This plan captures the promise and challenges of a unique and exciting moment in HIV vaccine development and offers a roadmap for action to bring us closer to the end of this epidemic,” President of the South African Research Council Glenda Grey said.

“With the support, expertise and convening power of IAS, this new strategic plan will build on the Enterprise’s longstanding role as a both a neutral convener and facilitator of collaboration in the HIV vaccine field and propel realizing our shared vision to develop a safe, effective and globally available HIV vaccine.”

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Health & Wellness

Trans youth lack access to trans-affirming care, which may put them at risk for HIV

One-quarter of youth were less inclined to discuss GSM (gender and sexual minority) identity and sexual health with their primary care providers due to concern that their provider would disclose this information to parents.

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Photo by Mercedes Mehling from Unsplash.com

Many trans youth lack access to trans affirming care, which may put them at risk for HIV. This is according to a study that explored trans youth’s perceptions regarding encounters with primary care providers (PCPs) related to gender and sexual minority (GSM) identity and sexual health.

In “Perceived Barriers to HIV Prevention Services for Transgender Youth”, which appeared in LGBT Health, C.B. Fisher, A.L. Fried, M. Desmond, K. Macapagal and B. Mustanski engaged youth aged 14-21 (N = 228; 45% trans masculine, 41% trans feminine, 14% gender nonbinary) and asked them to complete a survey on GSM identity disclosure and acceptance, gender-affirming services, sexual health attitudes and behaviors, and interactions with PCPs involving GSM identity and concerns about stigma and confidentiality.

A factor analysis yielded three scales: GSM Stigma, Confidentiality Concerns, and GSM-Sexual Health Information. Items from the GSM Stigma scale showed that nearly half of respondents had not disclosed their GSM identity to their PCP due to concern about an unaccepting PCP. One-quarter of youth were less inclined to discuss GSM identity and sexual health with their PCP due to concern that their provider would disclose this information to parents; these concerns were greater among adolescents <18 and those not out to parents about their gender identity. Only 25% felt their PCP was helpful about GSM-specific sexual health issues. Youth who were out to parents about their gender identity and had received gender-affirming hormone therapy were more likely to report receiving GSM-specific sexual health information.

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For the researchers, “trans youth may not discuss their GSM identity or sexual health with PCPs because they anticipate GSM stigma and fear being ‘outed’ to parents.” And so “PCPs should receive transgender-inclusive training to adequately address youths’ sexual health needs and privacy concerns.”

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