New South Wales Gay HIV Rate Drops by One Third After PrEP Scale-Up

This is according to the world’s first study to conduct an analysis of PrEP’s apparent effect on the HIV rate on a public-health level.

March 14, 2018  By Benjamin Ryan reposted from Poz.com 

This dramatic shift occurred after the province’s HIV diagnosis rate had held essentially steady during the preceding years. The recent period researchers factored into their analysis saw only relatively modest increases in the HIV population’s viral suppression rate. So treatment as prevention is not likely the primary driver of the considerable change in the HIV rate. (If HIV is fully suppressed with antiretroviral (ARV) treatment it effectively cannot transmit.)

“Really, the main thing that changed by far during this period was PrEP,” said Andrew Grulich, PhD, an HIV epidemiologist at the Kirby Institute at the University of New South Wales in Sydney, who presented findings from the study at the 2018 Conference on Retroviruses and Opportunistic Infections (CROI) in Boston.

Andrew Grulich speaks at CROI 2018 in Boston.

Andrew Grulich speaks at CROI 2018 in Boston.Benjamin Ryan

Seeking to conduct the world’s first analysis of PrEP’s wide-scale effect on a population’s HIV rate, researchers secured funding from the New South Wales Ministry of Health to start 3,700 people on PrEP beginning in March 2016. The target population included adults who were at a high and ongoing risk for HIV according to local guidelines. Those who had compromised kidney function (an eGFR test result below 60) were excluded.

Those receiving PrEP were scheduled to receive a baseline-screening visit, a one-month follow-up visit and screening visits every three months thereafter.

Demand for PrEP proved considerable: 3,700 people started PrEP within eight months of the study’s launch. Consequently, the investigators behind the study were able to convince the local government to give them greater financial backing; by the end of 12 months, 7,621 individuals had received PrEP.

Of the first 3,700 people, 8 percent were 18 to 24 years old, 36.7 percent were 25 to 34 years old, 29.3 percent were 35 to 44 years old and 26 percent were 45 years old or older. A total of 99.4 percent of the overall group was male, 95.5 percent identified as gay and 4 percent identified as bisexual. A total of 47.1 percent received PrEP from a public sexual health clinic, 48.6 percent from a private general practice and 4.4 percent from a hospital.

Eighty percent of new HIV cases are among MSM in New South Wales, so PrEP was well positioned to make a major dent in the state’s HIV rate given its rapid uptake among this population.

A total of 3,602 people (97.4 percent) received at least one follow-up HIV test during the study. This population was included in one of the key parts of the final analysis.

The study authors looked at a so-called medication possession ratio over 12 months among the individuals receiving PrEP, specifically the estimated percentage of a year’s supply of Truvada that individuals obtained during their first year after initially receiving the drug. The median possession ratio was 97.8 percent, meaning that more than half of those receiving Truvada received almost an entire year’s worth. Seventy percent of the study population received 80 percent of a 12-month supply of the drug, while 14 percent received 50 to 79 percent, 13 percent received 10 to 49 percent and 3 percent received less than 10 percent of a year’s supply within 12 months of first receiving PrEP.

During a cumulative 3,927 years of follow-up among those 3,602 people, two of them tested positive for HIV. One individual was given PrEP but never started it, and the other took no Truvada for months before contracting the virus.

Consequently, the researchers concluded that the study population contracted HIV at the very low rate of five cases per 100,000 cumulative years of life.

The investigators looked at the HIV rate among MSM in New South Wales according to state surveillance from March 2015 through February 2016, the 12-month period before the study began recruiting people, and compared that rate to the one seen during the 12-month period after the study enrolled its first 3,700 people, November 2016 through October 2017.

By the end of this time, the study had recruited 7,621 to start on PrEP.

During the initial 12-month period and the latter 12-month period, MSM in New South Wales saw a respective 149 and 102 diagnoses of HIV that were deemed to be infections MSM had contracted within 12 months. These two periods saw a respective 295 and 211 total HIV diagnoses among MSM, including both recent and more long-term infections. That meant that among MSM in this province, diagnoses of recent HIV infections dropped by 32 percent and all HIV diagnoses fell by 25 percent.

Breaking down the decline in the rate of recent infections among MSM in New South Wales by age, the investigators found that those 18 to 24 years old saw a 9.5 percent decline (21 cases before, 19 after), those 25 to 34 years old saw a 22 percent decline (58 cases before, 45 after), those 35 to 44 years old saw a 44 percent decline (39 cases before, 22 after) and those 45 years old and older saw a 48 percent decline (31 cases before, 16 after).

While the decline in the recent infection rate among those born in Australia or another high-income, English-speaking country dropped by a respective 49 percent (78 cases before, 40 after) and 33 percent (12 cases before, 8 after), the rate for those born in Asia dropped only 21 percent (42 cases before and 33 after) and the rate for those born in other nations actually increased by 24 percent (17 cases before, 21 after).

National Women Living with HIV Day!

Get tested, know your status

07 Mar 2018 – reproduced from NAPWHA

Once again, March 9 commemorates the National Day of Women Living with HIV in Australia. Initiated by the National Network of Women Living with HIV — otherwise known as the Femfatales — the annual day of awareness was conceived due to concerns that Australian women are too often unaware about the risks and realities of HIV. “We wanted to start conversations so that all women have an opportunity to increase their knowledge and awareness about HIV,” said Femfatales Chair, Kath Leane.

Now into its third year, the national day continues to grow and is observed by local events held all around Australia. The key message this year is Get Tested, Know Your Status to encourage and empower women to take control of their own health by getting tested for HIV.

There are currently around 3,000 women living with HIV in Australia. Yet women are often not considered to be at risk of acquiring HIV. As a result, they are less likely to test for the virus. We need to change this by normalising the testing procedure and thereby reducing the stigma around HIV.

Having an HIV test should be something women include as part of their regular sexual health check-up. The more women test for HIV, the more we will be able to diagnose and treat women appropriately, address the gaps in testing, and tailor the experience to suit women.

It is vital that the barriers and gaps in testing for women around HIV are recognised so that women are not left behind. Nearly half of heterosexual people diagnosed with HIV in 2017 had a late diagnosis, which means they were likely to have acquired HIV at least four years before the positive result — and had been unaware of their status all that time. Being diagnosed late can result in serious health challenges due to a compromised immune system.

It is hoped that the National Day of Women Living with HIV in Australia will help not only raise the profile of women with HIV, and help reduce stigma, but also — importantly — encourage women to test. “In 2018, Femfatales is advocating the importance of knowing your own HIV status, which requires having an HIV test and taking charge of your sexual health,” said Leane. “This is the aim of this special day.”

What is AIDS Survivor Syndrome?

This article was originally published on BETA and something that I think we need to be having more discussion on here in Australia.  It was first published on , by Emily Land, 

Last November, long-term survivors in San Francisco—and other interested community members—gathered to hear Ron Stall, PhD, from the University of Pittsburgh, present his research on AIDS Survivor Syndrome.

Organized by Tez Anderson, the director of the San Francisco nonprofit “Let’s Kick ASS” [AIDS Survivor Syndrome], the community forum offered a chance for long-term survivors to learn about a condition theorized to affect some people who have lived through the worst days of the AIDS epidemic.

Vince Crisostomo

Vince Crisostomo

 

“HIV is a very specific trauma,” explained Vince Crisostomo, the manager of the Elizabeth Taylor 50-Plus Network at San Francisco AIDS Foundation. “Some people compare living through the epidemic as living through the Holocaust, or being in a war.”

During the community forum, Stall explained that what differentiates AIDS Survivor Syndrome from something like post-traumatic stress disorder (PTSD) is the length of time a person can be affected.

Anderson, for example, was diagnosed in 1987, and watched hundreds of friends and lovers pass away before effective HIV therapies were developed. His own health suffered, and every few years his doctors would tell him he didn’t have much more time to live. After living to see the roll-out of protease inhibitors and modern-day HAART in the 1990s, Anderson said the trauma of HIV started to take on a slightly different tenor.

“I started getting this creeping notion in the back of my mind that, ‘I may become an old person with HIV,’ which brought a new set of anxieties,” he said. “I didn’t plan for being old.”

Ron Stall, PhD

Ron Stall, PhD

Stall said the term “AIDS Survivor Syndrome” is used to describe the constellation of physical, psychological and emotional symptoms that a person (either HIV-negative or HIV-positive) may experience after living through intense grief and trauma during the years of the AIDS epidemic and after.

Symptoms may include: depression, uncertainty about the future, suicidality, feelings of panic from growing older, social isolation and social withdrawal, survivor’s guilt, and more. Read the full list of symptoms and Anderson’s explanation of AIDS Survivor Syndrome.

The research on AIDS Survivor Syndrome

Stall, using data from the Multicenter AIDS Cohort Study (MACS), has been studying AIDS Survivor Syndrome and how it affects people who have lived through the HIV epidemic. Started in 1983, the MACS is a study of more than 7,000 of men who have sex with men (both HIV-negative and HIV-positive) who complete twice-yearly health and behavioral assessments to study the health effects of HIV infection. Stall reported that as of 2013, the average age of people in the study was 56, and roughly half of the men (49%) were living with HIV.

More than a quarter (27%) of men surveyed in the study had lost more than 10 people close to them to AIDS. 35% of men reported that they “still grieve” for these lost people, 7% of men reported that they “still deeply grieve,” and 3% reported that they “grieve these losses nearly every day.” About half (49%) agreed with the statement that “Because of the HIV epidemic, I never thought I would live as long as I have.”

To assess AIDS Survivor Syndrome, Stall’s research team asked participants about symptoms they theorized constitute AIDS Survivor Syndrome, including depression, isolation, anxiety, difficulty sleeping, feelings of despair for the future, nightmares, emotional numbness, strong feelings of anger, and feeling threatened.

Half of the men in the cohort had none of these symptoms, while the rest reported experiencing one to all nine of these symptoms at some point over the last six months. Nearly a quarter of men (22%) reported experiencing three or more symptoms “fairly frequently.”

“Most of us are doing OK, or very well, but there is a small cluster of guys who probably really do need some kind of help in dealing with the long-term effects of the epidemic,” said Stall.

Stall’s research team tested the statistical “clusterness” of symptoms as a way to see how well they “hung together” as part of a related syndrome. (Stall explained that for a condition to be characterized as a “syndrome,” signs and symptoms would need to occur together.) All of the symptoms, except nightmares and trouble sleeping, were statistically linked.

Interestingly, said Stall, people in the study who were HIV-negative seemed to be as affected as men living with HIV.

“The [HIV] negative men are also suffering significantly from repercussions of the epidemic, it would appear,” said Stall. “I immediately thought of a friend of mine, that I was close to in San Francisco, who wears a chain around his neck with two wedding rings. He has buried two partners.”

Dusty Araujo

Dusty Araujo

“People who are HIV-negative, who lived through the AIDS epidemic may have survivors guilt,” said Dusty Araujo, a coordinator for the Elizabeth Taylor 50-Plus Network. “They maybe were in the trenches, too—caring for friends and watching them die. They were marching, protesting, and trying to create change. Some people who are HIV-negative went through the same struggles, so for them to find community and support is important, too.”

Crisostomo and Araujo said that it was not surprising to hear that such a large percentage of people in the Multicenter AIDS Cohort Study studied by Stall experienced symptoms including depression, anxiety, isolation, and fear.

“Although people may or may not identify with the ‘AIDS Survivor Syndrome’ term, these symptoms are present in our community. People may experience things like depression and isolation as they age—whether or not they were impacted by the AIDS epidemic,” said Araujo.

“This is the rationale for the Elizabeth Taylor 50-Plus Network and other community programs that benefit long-term survivors,” said Crisostomo. “We bring people together and build community. People have an opportunity to get out of their houses, engage with each other, connect to services, volunteer in the community, and learn from each other. All of those things can help people if they are experiencing things like isolation, depression, and loneliness.”