Viral Load Does Not Equal Value

Ensuring health equity for all people living with HIV

First published on February 18, 2019 and written by Charles Stephens for Poz.com

In 2018, I was invited by writer, blogger and HIV advocate Mark S. King to co-facilitate a discussion at the United States Conference on AIDS related to Undetectable Equals Untransmittable (U=U). Titled “Are We Shaming Those Who Are Detectable?” the workshop examined the struggles and barriers around treatment and care for people living with HIV.

The session was an extraordinary learning experience. Questions raised during the session, and the ideas that we discussed, have inspired me to think through the current challenges and opportunities for ensuring health equity in our communities.

How to support and affirm people living with HIV who are not virally suppressed was one of the key issues that emerged. Viral suppression, or being undetectable, not only keeps people who are living with HIV healthy, but it also means they cannot transmit the virus sexually.

However, according to the Centers for Disease Control and Prevention (CDC), in 2015, an estimated 1.1 million U.S. adults and adolescents were living with HIV but only 51 percent of them had achieved viral suppression. Further CDC data showed that in 2014, about 471,500 African Americans were living with HIV but only 43 percent of them had a suppressed viral load.

Considering the profound advances in HIV treatment and medicine, many of us are left wondering why so many members of our community struggle with viral suppression. To contend with this issue and fight the epidemic, we must confront structural barriers and address stigma. What’s more, we must imagine new ways to provide community support beyond offering only clinical solutions.

Not Just Pills, but Power

Public narratives—stories told and spread throughout a culture to describe, explain and provide meaning to experiences—are often rooted in myths and fictions perpetuated by the dominant culture to maintain social order. 

No matter how many times, for example, the racist and sexist caricature of the “welfare queen” is refuted, the notion that Black people take advantage of the “system” for personal gain persists.

These narratives rob low-income Black people of public empathy, absolve American institutions that sustain Black poverty of any responsibility and justify efforts and actions to reduce the social safety net that protects vulnerable Americans.  

A pervasive myth concerning the HIV epidemic is that individual behavior rather than structural inequality is the root cause of the disproportionate impact of HIV on the lives of members of vulnerable communities.

Leisha McKinley-Beach, founder of Leisha.org and a national HIV prevention consultant, echoes this point: “We tend to blame the person instead of looking at our infrastructure or systems that support these negative outcomes. If we continue to focus on HIV, we [won’t] end the epidemic. HIV is the outcome of cultural and social issues that affect the entire person.”

Institutions must also have the capacity and resources to serve and connect to communities in need, particularly communities already affected by structural violence, such as people of color, cisgender and transgender women, undocumented folks, the queer community and people experiencing economic distress. If HIV organizations are unable to provide quality services, then how can people living with HIV be expected to access health care? More specifically, how can individuals become undetectable if their AIDS service organization can’t help them get meds?

In an interview with TheBody.com, Martin Walker, director of HIV programs at Planned Parenthood of the Rocky Mountains, shares his journey: “I think it’s a bigger systematic problem, right? We’ve got all these grassroots organizations trying to do a lot of things, and they’re getting overrun by the number of people that they are trying to serve. And so things like making phone calls back from the voicemail, or checking the voicemail, or cleaning the voicemail out, that sort of gets lost in the shuffle when you are a small grassroots organization.”

Recognizing institutional and structural barriers does not mean completely ignoring the role of individual actions or personal agency. Walker acknowledges: “I want people to know that my being detectable is not just the system—it’s also me.” He knows that sometimes you have to be your own advocate. “Folks need to just keep calling, keep trying to access the system, be the squeaky wheel. Get back to that old ’80s-style advocacy that we used to do.” 

McKinley-Beach concurs: “Although I am not downplaying the accountability and responsibility of each individual, even in the midst of making decisions that could yield positive outcomes, people are still faced with these other barriers that exist and prevent such an event from occurring.” 

The late poet and essayist Essex Hemphill sums it up best in his epic poem “Vital Signs”: “Some of the T cells I am without are not here through my own fault. I didn’t lose all of them foolishly, and I didn’t lose all of them erotically. Some of the missing T cells were lost to racism, a well-known transmittable disease.”

Hemphill continues: “Some were lost to poverty because there was no money to do something about the plumbing before the pipes burst and the room flooded. Homophobia killed quite a few, but so did my rage and my pointed furies, so did the wars at home and the wars within, so did the drugs I took to remain calm, cool, collected.”

To address the structural barriers that impede treatment access, the HIV movement must employ an anti-oppression/racial justice lens. To this end, it is particularly critical to recognize how HIV affects Black communities.

McKinley-Beach suggests, “We don’t end HIV in America without ending it in Black America, and we don’t end it in Black America under the current trajectory.”

The late HIV advocate Mario Cooper, in his prophetic essay “Get Your Black Up!,” calls on the Black community to engage in direct-action organizing. Visionary movement leadership, rooted in an intersectional analysis, is the ground upon which our politics and policies must be built. To comprehend why people struggle to become virally suppressed, we must confront health care, but we must also confront race.

Weaponizing Culture

Though it may be tempting to reduce stigma to interpersonal interactions, doing so ignores the truth that stigma is as much systemic as it is singular. Stigma is a kind of psychological warfare that robs oppressed people of their human dignity; it also constitutes a stealth effort to control them. This is, in part, how stigma makes its way into laws. HIV criminalization is a stunning example of this process, and it illustrates how people with a detectable viral load are set up to be further stigmatized and shamed.

In a POZ blog post titled “Prevention vs. Prosecution: Creating a Viral Underclass,” Sero Project executive director and POZ founder Sean Strub illustrates how HIV stigma, reinforced by the power of the law, creates a viral underclass: “This viral underclass is a result of HIV criminalization, when people who have tested positive for HIV experience punishment, or a more extreme punishment, as well as a presumption of guilt or wrongdoing in a host of settings and for a host of practices that are, for those who have not tested positive for HIV, unremarkable.”

Strub continues: “When the government statutorily stigmatizes, it is a collective statement of the society. It says this group is ‘less than.’ It sets an example for communities, encouraging stigmatization and discrimination. And it is wrong.” 

In the health care narrative writ large—played out in service delivery, blogs, forums, workshops, research and social media—being detectable can make folks the object of blame.

In other words, as Venita Ray, deputy director of Positive Women’s Network–USA, puts it: “Because HIV is a racial justice issue, we must not deny that inequities exist that increase the vulnerability of Black folks to acquiring HIV and prevents us from accessing culturally appropriate care. That means we have folks who are not able to achieve undetectability for a number of reasons. It is not their fault. We must not blame or shame folks for acquiring HIV or having a detectable viral load. We cannot and must not leave anybody behind.”

From Continuum of Care to Continuum of Justice 

The dominant framework for how we care for people living with HIV must be examined not only through a continuum of clinical care but also through a continuum of community care and justice. Who are we leaving out and how do we bring them in? How are we supporting our community members? Do we not have any obligation to ensure that our friends and loved ones are engaged in health and wellness in a way that’s comfortable for them?

Too often, we fail to show empathy and compassion for the marginalized among us. Rather than see the system and its institutions for what they are—the sources of our challenges—we view the marginalized as accountable for their own oppression. This lets institutions off the hook. Worse, it paints marginalized people as being responsible for the conditions forced on them by the dominant culture. 

Monte J. Wolfe, artistic director of arts, education and outreach organization Brave Soul Collective, says: “I think one of the most important things to consider when talking about those of us living with HIV, particularly people of color, is for us to be as compassionate as humanly possible, taking into consideration that none of us really truly knows what it’s like ‘on the other side of HIV’ until we’re faced with having to deal with the very intricate parts of such a complicated issue.”

Fighting Back

We must fight back with messaging. One of the most effective and historic counter-narratives to HIV stigma has been the U=U movement. U=U advances a message that successfully battles stigma and transforms the lives and experiences of people living with HIV.

Perhaps U=U could be a model for how we as a community can better support people living with HIV who have a detectable viral load. The proper messaging would let them know they, too, are worthy of celebration; they, too, are worthy of affirmation and should absolutely be loved, supported and valued. 

We must also fight back with organizing and activism. Much of HIV movement history is rooted in confrontation—with government, health care institutions, pharmaceutical companies and more. So if health care departments and AIDS service organizations continue to be hostile to vulnerable communities or put up barriers to care, then we must consider direct actions targeting them.

We need to make more funding available for community organization and political education in the HIV movement. Such investment by the philanthropic community must actively engage and partner with networks of people living with HIV, particularly those led by people of color, in order to guide programmatic approaches. As a movement, we must continue to advance an analysis that centers racial justice in our policy prioritization.

A discussion about the clinical experiences of marginalized communities—notably those whose HIV remains detectable—necessitates addressing trauma. Trauma-informed care practices could go a long way in making health care delivery more responsive to the various experiences and needs of people living with HIV and supporting them in remaining connected to care. We must demand that HIV clinicians be trained in trauma-informed care. 

We, as individuals, must also not forget the collective trauma endured by the survivors of our movement. We must remember those who came before us, know their stories and honor their memories with our efforts. Our movement’s history offers lessons we can integrate into our current efforts.

The immense challenges we confront cannot be overstated. Years and years of hard-won battles for rights and resources, which, even with our best efforts, never completely addressed all our needs, are being plundered by a conservative regime that has expressed a deep hostility toward those of us in the margins. The health of our communities is at stake.

Never have we—LGBTQ folks, people of color, poor and working-class people, all communities most affected by HIV—enjoyed the luxury of passive despair; we have always had to fight for everything. Now is not different. We need a movement that leaves no one behind, regardless of viral load. We must protect all our community members.


TAF as Effective as TDF in Cisgender Women, With Fewer Side Effects

Another important article From TheBodyPRO
By Martha Kempner

Initial data gathered from seven separate studies found tenofovir alafenamide (TAF) is just as effective as tenofovir disoproxil fumarate (Viread, TDF), with fewer side effects to the kidneys and bones, when used in cisgender women. These results, presented this week at the Conference on Retroviruses and Opportunistic Infections (CROI 2019) in Seattle, are similar to those found in cisgender men.

TDF was approved for use in patients with HIV in 2001 and for use in those with hepatitis B in 2008. The drug was highly successful and became a staple of most HIV treatment regimens, but was known to cause kidney toxicity and loss of bone density in some patients. In 2015, the Food and Drug Administration (FDA) approved the tenofovir prodrug TAF, which can be effective in smaller quantities relative to the original.

TAF is now included in a number of commonly used antiretroviral combination pills, most notably bictegravir/emtricitabine/TAF (Biktarvy) and emtricitabine/TAF (Descovy), which are among the list of first-line drugs currently recommended in U.S. first-line HIV treatment guidelines. For the most part, research has shown that TAF is equally effective as TDF with fewer negative side effects. But, as researcher Melanie Thompson, M.D., with AIDS Research Consortium of Atlanta pointed out in her presentation, the majority of participants in these studies were men.Advertisement

Though women make up 52% of adults living with HIV worldwide, they are often underrepresented in clinical trials, and health care providers are forced to assume that women will have the same results as men. For this analysis, an all-women team of researchers looked at seven studies that included a total of 779 cisgender women. Two of the studies (representing 260 of the women) were of individuals who were treatment-naive. The other five studies (representing 519 women) were conducted among virally suppressed individuals who were switching from a TDF regimen to TAF.

The data show that the two tenofovir treatments have similar efficacy rates. At 96 weeks, the FDA snapshot showed 86% viral suppression for women on TAF and 85% for those on TDF. This is close to what research has found in men — 87% viral suppression on TAF and 85% on TDF.

The reporting of adverse effects was also similar among women taking TDF and TAF. The most common side effects for treatment-naive women on both drugs included nausea, swelling of the throat and nasal passages, headache, upper respiratory infection, diarrhea, joint swelling and pain, dizziness, and back pain. Again, this was similar to the common side effects found in men on both medications.

The differences between the two drugs were most evident when it came to kidney toxicity. The analysis looked at two biomarkers that could indicate kidney injury and found that both were lower in women taking TAF than in those on TDF. Moreover, no women on TAF developed proximal renal tubular dysfunction, which is known to happen on TDF. The researchers referred to the lower adverse renal effects as a “highly treatment significant difference” between the two drugs.

The researchers also looked at adverse effects related to bone density. Women who started treatment with TAF had less bone mineral density decline than those who started on TDF. And, women who switched from TDF to TAF had improvements in bone mineral density. These were similar to the results found in men.

The analysis of the pooled data suggests that women have similar experiences with tenofovir to those of men. The researchers conclude that starting therapy with TAF or switching to TAF has significant safety advantages for women, while offering the same amount of viral suppression as treatment with TDF. Melanie Thompson ended her presentation by saying that “the other finding from this analysis is that it is both feasible and awesome to work with an all-female research team.”

Martha Kempner is a freelance writer, consultant, and sexual health expert.

National Women Living with HIV Day

Women and HIV

Originally from The Well Project and also featured on Thebody.com this is a great summary of that state of play for women with HIV around the world.

Table of Contents

A Look at the Numbers

More than 35 years have passed since the first diagnosis of AIDS (Acquired Immune Deficiency Syndrome) in the US. While there were a handful of women among the first cases, AIDS was thought to mostly affect gay men. However, as the years passed, women have emerged as another group hard hit by the HIV/AIDS epidemic. Globally, women living with HIV account for half of all people living with HIV, and in many countries, women living with HIV outnumber men living with HIV. Across the globe, transgender women (transwomen) are affected by HIV to a much greater degree than other groups. The proportion of transwomen living with HIV is estimated to be 49 times higher than the proportion of people living with HIV in the general adult population.

In the US

In 2016, almost one in five new HIV diagnosis in the US were among women. African-American women are especially affected. African-American adolescent and adult women made up only 13 percent of the US female population and accounted for more than six of every ten new HIV cases among women in 2016. Latinas made up 17 percent of the US female population and accounted for 16 percent of all new HIV cases among women. For African-American women, the rate of HIV diagnosis was 16 times that of white women in the US. For Latinas, it was more than three times that of white women.Advertisement

Though not often talked about, American Indian/Alaskan Native communities experience the third-highest HIV rate of any racial group in the US. And while Asian/Pacific Islander communities may not be as heavily impacted by HIV, cultural factors may leave women in these communities vulnerable to acquiring HIV or make it harder for them to connect to HIV care. For more information on these factors, see our fact sheet on HIV among US women of different races or ethnicities.

Between 2011 and 2015, the number of new HIV diagnoses among all women dropped 16 percent. Although African-American women and Latinas continue to be disproportionately affected by the epidemic, new HIV diagnoses have declined among women of color, as well.

HIV affects both younger and older women. In fact, the rate of HIV diagnoses in older women has been rising recently; in 2013, women aged 45 and older accounted for 37 percent of new HIV diagnoses – more than twice the proportion of women 13 to 24 years old (14 percent).

Globally

The World Health Organization (WHO) estimates that almost 18 million adults living with HIV in 2014 were women. Although women account for approximately half of all people living with HIV worldwide, the percentage of women who are living with HIV varies widely among countries. Estimates suggest that one in three people living with HIV in the United Kingdom are women; almost four out of ten people living with HIV in India are women; and almost six in ten people living with HIV in sub-Saharan Africa are women. The Joint United Nations Programme on HIV/AIDS (UNAIDS) reports that only 21 percent of teen girls (ages 15 to 19) worldwide know enough about HIV to help them stay HIV-negative.

Transgender women: Across the globe, transwomen are affected by HIV to a much greater degree than other groups. It is estimated that the proportion of transwomen living with HIV is 49 times higher than in the general adult population. This is true whether transwomen are living in low-, middle-, or high-resource countries. Worldwide, 19 out of 100 transwomen in a given population will be living with HIV. For more information, see our fact sheet on Transwomen Living with HIV.

Older women: The number of older women living with HIV has been rising, not only because the rate of older women who have newly acquired HIV has increased, but because more women living with HIV are living longer, healthier lives and are aging with HIV. Older women deal with two stigmas – that of living with HIV, a disease spread through sexual contact or drug use, and that of being older. As a result, many older women are first diagnosed with HIV at a later stage of infection, when their immune systems are quite weakened.

Transmission

Heterosexual sex (sex between a male and female) is the most common way of getting HIV (or mode of transmission) among women in the US. During heterosexual sex, HIV is passed almost twice as easily from men to women as from women to men. More than eight out of every ten women living with HIV in the US get the virus through sex with a man living with HIV. Heterosexual sex is also the main source of HIV transmission for women in many other countries in Africa, South America, and Western Europe.

Sharing HIV-contaminated syringes for injecting drugs is another common mode of transmission.

Is HIV Different for Men and Women?

Until recently, little research had been done on women and HIV. While many questions remain unanswered, available information shows that HIV affects men and women differently in some ways:

  • When women are first diagnosed, they tend to have lower viral loads (amount of HIV in the blood) compared to men who are newly diagnosed
  • Women generally have lower CD4 cell counts than men with similar viral loads
  • Women are most often diagnosed when pregnant, considering becoming pregnant, or hospitalized with acute (initial) illness
  • Women are more likely than men to develop bacterial pneumonia
  • Women have higher rates of herpes infection than men
  • Women get thrush (a yeast infection) in their throats more often than men
  • Men are eight times more likely than women to develop Kaposi’s sarcoma or KS (a cancer-like disease caused by a herpes virus)

Women tend to be diagnosed with HIV later in their disease than men and fewer women than men are getting HIV treatment. Women may delay getting medical care and treatment and choose not to disclose their HIV status for several reasons, including:

  • Limited access to health care due to lack of insurance and/or transportation
  • Unstable housing
  • Fear of violence in the home (domestic violence)
  • Other responsibilities, such as child care or caring for a sick family member
  • The stigma associated with HIV
  • Problems with substance abuse or addiction
  • Depression
  • Lack of financial resources and/or social support
  • Mistrust of health care providers and/or the medical system
  • Taking care of everyone but themselves and not putting themselves first

Numerous studies have shown that, if a person living with HIV is taking HIV drugs and their viral load has reached undetectable levels (not enough HIV in their bloodstream for a test to measure), that person cannot transmit HIV to a sexual partner who is HIV-negative. This is true for men as well as women, but there is still more research needed into how this exciting development affects women in particular – especially when it comes to breastfeeding children, or the often unfair power dynamics women experience in their relationships. For more information, please see our fact sheet Undetectable Equals Untransmittable: Building Hope and Ending HIV Stigma.

Treatment in Women Living with HIV: Effectiveness, Side Effects, and Drug Interactions

HIV treatment studies (clinical trials) have traditionally included very few of women. As a result, most information on the effectiveness and safety of HIV drugs comes from research done in men. This under-representation of women in studies is slowly beginning to change. For more information on how The Well Project is working to improve research for women living with HIV, please visit our page on the Women’s Research Initiative on HIV/AIDS.

Existing research has found little difference in the effectiveness of HIV treatment for women and men. Women living with HIV who begin treatment as recommended to do as well as men living with HIV. Although treatment seems to work as well in women as in men, the side effects may differ:

  • Rashes: Women living with HIV are more likely than men to experience skin rashes from HIV drugs.
  • Liver problems: Women are more likely to experience liver problems as a side effect of certain HIV drugs. In fact, women with a CD4 count above 250 are warned against starting a drug combination with Viramune (nevirapine) because of the risk of dangerous liver problems.
  • Body shape changes: Some studies have found that women living with HIV experience different types of body shape changes than men. Women may experience more fat gain in their breasts and waists.
  • Weak bones: It is known that women in general are at increased risk of developing osteoporosis (weak bones) after menopause, but studies have also shown that living with HIV increases a person’s risk of weaker bones. This means both men and women living with HIV are at higher risk of osteoporosis. However, the risk for bone weakness in women living with HIV is three times higher than it is for men living with HIV.

Differences in side effects between men and women may be due to interactions between HIV treatment and female hormones. They may also be the result of women’s smaller physical size. Standard doses of drugs are usually based on research in men.

Women living with HIV do need to be careful about drug interactions. Certain HIV drugs can affect the levels of other drugs in the body. For example, several HIV drugs can affect the levels of birth control pills and change how effective those pills are at preventing pregnancy.

It is important for women living with HIV to be treated by health care providers who have experience in treating women with HIV. Tell your health care provider about all your medical conditions and any medications you are taking. If you experience side effects from your HIV drugs, be sure to ask your health care provider for help.

Gynecological Issues in Women Living with HIV

Certain gynecological (GYN) conditions are more common, more serious, and/or more difficult to treat in women living with HIV than in HIV-negative women:

Although little conclusive research is available on HIV and menstruation (periods), many women living with HIV report abnormal menstrual periods. Some bleed much more than usual while others stop menstruating altogether.

Human papillomavirus (HPV) is a sexually transmitted infection that causes 99 percent of cervical cancer and can also cause genital warts. Women living with HIV are more likely to be infected with HPV than HIV-negative women. Women living with HIV are also less likely to clear, or get rid of HPV, than HIV-negative women. Women living with HIV, especially those with advanced HIV disease (lower CD4 counts), are more likely to develop dysplasia (abnormal cervical cells) as a result of HPV.

Dysplasia means abnormal cells on the cervix (the opening of the womb). It is often more severe and difficult to treat in women living with HIV than in HIV-negative women. Untreated dysplasia can lead to cervical cancer, a life-threatening illness.

It is important to find HPV early and get treatment to prevent health problems. Regular cervical screening tests are a good way to check for HPV. An abnormal cervical screening test can indicate inflammation, infection, dysplasia, or cancer in the cervix.

The US National Institutes of Health (NIH) guideline recommends that:

  • women living with HIV have a complete gynecological examination, including a cervical screening test (e.g., Pap test), when they are first diagnosed with HIV – within one year of starting to be sexually active, for women with other modes of transmission (such as acquiring HIV ar birth or through injection drug use)
  • if the initial test is normal, women living with HIV have another cervical screening test 12 months later
  • if three tests in a row are normal, then screening is recommended every three years
  • women with abnormal tests or dysplasia should receive further testing – the type of test will differ depending on the result.

For more information, see our fact sheet on Caring for a Woman’s Body: What Every Woman Should Know about the Care and Prevention of GYN Problems.

There are also three effective HPV vaccines. Since the introduction of the HPV vaccines in the US in 2006, the number of teen girls who have HPV has dropped by more than half. It is important for young people to get vaccinated before they have sex (before they have been exposed to HPV), since people who are already infected with HPV are not protected by the vaccines. There are many strains of HPV, however, so even women with one strain of HPV will benefit from the vaccine, since they will be protected against other strains. The vaccine was found to be safe and effective in women living with HIV. For more information, see our fact sheet on HPV.

Pregnancy and HIV

With the advances in HIV care and treatment, many women are living longer, healthier lives with HIV. As they think about the future, some of these women are deciding to have the babies they always wanted. Women living with HIV who want to become pregnant should discuss their plans with a health care provider who is very experienced in treating women with HIV. For more information, see our fact sheet on Getting Pregnant.

The good news is that advances in HIV treatment have also greatly reduced the chances that a mother will pass HIV on to her child (mother-to-child transmission). If the mother takes appropriate medical precautions, the rate of transmission can be reduced to fewer than one in 100 births. In addition, studies in the US have shown that being pregnant will not make HIV progress faster in the mother. For more information, see our fact sheet on Pregnancy and HIV.

In Conclusion

The number of women living with HIV is growing. It is important that you get tested regularly and do your best to be aware of your risk for HIV. In many countries, including the US, testing for HIV is part of routine health screening and preventive care.

If you test negative, you can take steps to stay that way. If you test positive, you can take steps to stay healthy and prevent passing the virus on to others, including during pregnancy. And while there is no cure yet, many women are living longer and stronger lives with HIV thanks to effective care and treatment.

More research is needed to determine how HIV progresses in women and how HIV drugs affect women’s bodies. However, it does seem that HIV drugs benefit women as much as men. By taking advantage of good health care and treatment as soon as you can, you greatly increase your chances of living a longer and healthier life for you and your loved ones.

Nicotine metabolised at a faster rate among HIV-positive smokers – implications for quitting smoking

This article is reprinted from www.aidsmap.com by Michael Carter and was published on  18 February 2019

HIV-positive smokers metabolise nicotine at a significantly higher rate than HIV-negative individuals, investigators from the United States report in the online edition of AIDS. The finding could explain why people with HIV have more difficulty quitting smoking than their HIV-negative peers. A second study involving the same HIV-positive smokers and published in the Journal of Acquired Immune Deficiency Syndromes showed that a higher nicotine metabolism ratio (NMR) was associated with symptoms of anxiety and treatment with efavirenz.

The researchers say their findings have important implications for the use of smoking cessation medication by individuals with HIV, and that more intensive therapy with varenicline (Chantix and Champix, an oral prescription medication), rather than nicotine replacement patches, is warranted.

“The mean NMR of this sample resembles levels reported among those with opioid dependence,” comment the authors. “Although the nature of the relationship between NMR and HIV is uncertain, these results suggest that the nicotine patch would have limited therapeutic benefit for most smokers with HIV, which has been reported, and that varenicline would be more beneficial.”

People with HIV are more likely to smoke and have more difficulty quitting than individuals in the general population. Smoking-related diseases are now a leading cause of serious illness and death among people with HIV and supporting smoking cessation should be part of routine HIV care.

The rate at which the body metabolises nicotine could explain why people with HIV are more likely to become smokers and find it harder to stop. Nicotine is metabolised by the body using the CYP2A6 liver enzyme. Research has shown that people with reduced CYP2A6 function (slow nicotine metabolisers) smoke fewer cigarettes, are less dependent on nicotine and are more likely to succeed in quitting smoking. NMR is a widely used measure of CYP2A6 function.

Investigators from the University of Pittsburgh hypothesised that smoking behaviours in people with HIV were influenced by NMR. They therefore designed an observational study comparing NMR between 131 HIV-positive smokers and 199 closely matched HIV-negative smokers.

Data were collected on factors known to impact on NMR, including sex, race, gender and body mass index (BMI).

Most of the participants were male (70-74%), African American (72-79%) and were living on an annual income below $35,000.

Almost all the HIV-positive participants were taking antiretroviral therapy (ART). Eighty per cent had an undetectable viral load and the average CD4 cell count was 714 cells/mm3.

The individuals with HIV smoked significantly fewer cigarettes daily than the matched population (13 vs 15, p = 0.003). Despite this, mean NMR was significantly higher in the people with HIV than the HIV-negative individuals (0.47 vs 0.39, p < 0.001).

Participants were divided into four groups according to NMR speed: people living with HIV were twice as likely as HIV-negative individuals to be placed in the fourth quartile, the fastest metabolisers (35% vs 17%).

“These findings suggest that HIV-infected smokers metabolize nicotine faster than HIV-uninfected smokers, even after controlling for relevant demographic and behavioral factors,” write the authors. “Understanding the mechanisms that contribute to faster nicotine metabolism among PLWH [people living with HIV] is necessary to understand tobacco’s role in undermining clinical outcomes in HIV, and identifying novel therapeutic interventions.”

The second study examined whether there were any specific characteristics associated with a higher NMR in the 131 HIV-positive people.

The investigators collected demographic data, information on CD4 cell count and viral load, CD4 cell count, ART type and adherence and symptoms of anxiety and depression. Breath carbon monoxide was also evaluated.

The initial analysis showed that race, symptoms of anxiety and depression, greater smoking intensity, breath carbon monoxide and therapy with efavirenz were all associated with higher NMR values.

After taking into account known potential confounders, a higher NMR remained associated with smoking more cigarettes per day (p = 0.050), higher levels of symptoms of anxiety (p = 0.054), and therapy with efavirenz (p = 0.003). Treatment with efavirenz accounted for 5% of the variance in NMR.

“Taking efavirenz was associated with higher NMR, rather than lower NMR as expected for a drug interaction (efavirenz would be predicted to inhibit CYP2A6), which needs to be understood further,” comment the authors. “This suggests that efavirenz therapy should be considered when addressing tobacco use among PLWH.”

Reference

Ashare RL et al. Differences in the rate of nicotine metabolism among smokers with and without HIV. AIDS, online edition, DOI: 10.1097/QAD.0000000000002127, 2019

Schnoll RA et al. Rate of nicotine metabolism and tobacco use among persons with HIV: implications for treatment and research. J Acquir Immune Defic Syndr, 80: e36-40, 2019.

The Road Ahead for HIV Cure Research

Today, with better understanding of the complex task at hand, cure researchers are investigating multiple avenues and taking the long view.  This article comes from Benjamin Ryan and was first presented online in Poz.com on January 7, 2019

Cure research and the potential for a cure is still front and centre in many of our lives and this article talks about the road ahead and some of the setbacks that have been suffered along the way.


HIV cure researchers received some disappointing news at the July 2018 International AIDS Conference in Amsterdam. Two studies in particular offered a sobering lesson on how extraordinarily complex developing a safe and effective cure for the virus will likely be.

As conference attendees learned, researchers behind a randomized trial of an HIV cure method, the largest such study to date, recently found that their efforts failed to reduce viral DNA in human participants. The trial, called RIVER, tested the “kick and kill” strategy that seeks to roust latently infected immune cells from their slumber and then kill them off. Standard HIV medications—antiretrovirals, or ARVs—work only against cells that harbor actively replicating virus. These resting infected cells are a chief component of what is known as the viral reservoir, and it’s the stubborn persistence of this reservoir that frustrates cure efforts.

In a second study presented at the conference, an antibody treatment that had shown promise in monkeys failed to prompt what is known as posttreatment control of the virus after HIV-positive humans interrupted their ARV therapy.

As scientists in this field recalibrate their expectations, the use of the term “cure” as a goal for their research is declining. Instead, investigators may seek to induce posttreatment control of HIV, or viral remission, in which a particular therapy would not eradicate the virus from the body but rather suppress HIV over an extended period without the need for long-term ARV treatment.

Nevertheless, the overall field is generally still referred to as HIV cure research.

Taking the pulse of her fellow HIV cure researchers, Sharon R. Lewin, MD, PhD, director of The Peter Doherty Institute for Infection and Immunity at the University of Melbourne in Australia, says, “If anything, there was probably more optimism four years ago because we had tried fewer things. We now know that curing HIV is definitely not an easy task.”

Looking on the bright side, Lewin points to other promising recent cure studies conducted in primates, noting, “We definitely have been able to cure a few monkeys. That’s exciting.”

But as the antibody study presented at the Amsterdam conference indicated, disappointing outcomes among humans might follow success in primate research.

“The preclinical studies have universally shown more favorable outcomes than human studies,” says Jintanat Ananworanich, MD, PhD, who in her capacity as the associate director for therapeutics research at the U.S. Military HIV Research Program directs research in the HIV cure field. “Although no strategies have resulted in remission in clinical trials thus far, tremendous knowledge on HIV persistence and immune responses has been generated. This is important to informing future trials.”

Concerns about recent setbacks notwithstanding, Lewin remains optimistic about the future of HIV cure research. “Science can also take dramatic turns with significant discoveries too,” she says. “So you never know what may change the field dramatically.”

Lewin is the lead author of a literature review recently published in The Lancet HIV, “Barriers and Strategies to Achieve a Cure for HIV,” in which she and her three coauthors offer a comprehensive summary of the impressive number of avenues researchers are pursuing in their quest for a cure, or something close to it. Below, POZ looks at the main takeaways from their paper. We also explore a few HIV cure studies published more recently.

***

Lewin and her colleagues note that the only person ever cured of HIV remains Timothy Ray Brown. As a component of his treatment for leukemia, Brown received stem cell transplants a decade ago from a donor with a genetic mutation that confers natural resistance to the virus—the surface of the donor’s immune cells lacked the CCR5 coreceptor to which most HIV attaches in order to infect the cells. As far as researchers can tell, Brown benefited from a sterilizing cure. There is no evidence in his body of any virus with the capacity to replicate, and his viral load has never rebounded. (Today, Brown actually takes Truvada [tenofovir disoproxil fumarate/emtricitabine] as pre-exposure prophylaxis [PrEP] to ensure he does not contract HIV again.)

Otherwise, in the realm of posttreatment control of HIV, quite a few people with the virus have been able to suppress their viral load for long stretches, sometimes for years, after interrupting standard ARV treatment. A recently published paper found that those who began ARVs very soon after contracting the virus are more likely to achieve such a prolonged state of viral remission after eventually going off their meds. It is likely that beginning on ARVs so promptly after infection keeps the viral reservoir relatively small, thus reducing the likelihood of latently infected cells springing to life at any given moment following a treatment interruption.

One of the most famous cases of such posttreatment control is that of the African child who was treated for HIV for less than a year after birth and, by the time the child’s case was reported in 2017, had spent over eight years in a state of viral remission. In 2015, news surfaced that an 18-year-old French individual had spent 12 years off ARVs and still controlled the virus. Then, of course, there was the 2013 case of “the Mississippi Child”—met with great fanfare—who spent a couple of years off ARVs during her very young life but ultimately, and disappointingly, experienced a viral rebound at 4 years old.

According to Lewin, scientists’ increasingly enriched comprehension of the posttreatment-control phenomenon has actually made designing HIV cure studies more difficult. Now researchers must take into account that some study participants might achieve control of their virus, even if for a short time, without the benefit of an investigative cure therapy, thus making it more challenging to prove that a cure treatment was the cause of viral remission or a delayed viral rebound after the interruption of ARV treatment.

***

Not only do latently infected immune cells evade ARV treatment, but also for every million such cells, perhaps only 60 harbor virus that can actually replicate; the rest contain defective virus. So finding those resting cells capable of waking up and repopulating the body with new virus in the absence of ARV treatment can be akin to finding a needle in a haystack. The immune system itself wastes considerable energy going after cells infected with dud copies of the virus.

In another of the myriad ways HIV has evolved to help ensure it sustains a lifelong infection, latently infected cells have the ability to clone themselves. Perhaps more than half of the viral reservoir cells in some people living with the virus are clones.

The matter of whether HIV continues to replicate at low levels in the face of effective ARV treatment has been the source of significant controversy in the cure field. A study presented at the 2018 Conference on Retroviruses and Opportunistic Infections in Boston found no evidence of such ongoing replication in the lymph nodes, calling into question the notable contrasting findings of a 2016 paper.

***

The lack of precise tests for measuring the viral reservoir remains a considerable obstacle for HIV researchers, both in determining the challenge they face in their quest to vanquish an infection and in assessing how well they did. Currently, scientists in the field must rely on rather crude metrics, such as changes in the overall presence of viral DNA or RNA in the blood, to gauge how a particular treatment affects the size of the reservoir. (HIV carries its genetic code in RNA, which is copied to DNA during infection of a cell.) Such metrics can underestimate the population of infected cells because most virus hides in tissues, not blood.

Scientists may also try to measure success by determining whether an HIV cure treatment is associated with a delay in viral rebound after an interruption of ARV therapy and whether such a treatment is associated with a particular level of control of the virus in the absence of standard ARV therapy for the virus.

If only scientists could identify a specific biomarker, such as a particular protein, that could predict the likelihood of a delay to viral rebound or control of the virus after a treatment interruption. Then, study participants might be spared the burden of interrupting their ARVs, a common requirement in HIV cure study designs. Asking people to stop standard HIV treatment raises ethical questions and may discourage people living with the virus from entering cure trials. That said, multiple studies have indicated that treatment interruptions in cure studies are safe.

Lewin argues that such a tidy biomarker would likely attract greater investment in the field from pharmaceutical companies. (Global funding for public sector HIV cure research increased from $88 million in 2012 to $289 million in 2017, with the lion’s share coming from the National Institutes of Health.) Such for-profit companies prefer study designs boasting a level of simplicity that will help an investigational treatment pass muster with regulatory bodies like the Food and Drug Administration. They also prefer efficient investments for their research and development dollars. So their researchers favor clearly delineated, objective means of measuring success in clinical trials of experimental agents.

Case in point: The recent discovery of a biomarker that can predict whether an individual will achieve a functional cure of hepatitis B virus (HBV) gave rise to a surge of interest from the pharmaceutical industry in researching curative therapies for HBV.

Investment in Cure Research chart

Source: “Global Investment in HIV Cure Research and Development in 2017”

Investment in Cure Research chart

Source: “Global Investment in HIV Cure Research and Development in 2017”

Avenues of Research:

Stem cell transplants

Clinicians are still trying to replicate the success of Timothy Brown’s HIV cure with similar strategies. In recent years, a number of other individuals with cancer have received stem cell transplants from donors who also have the genetic mutation related to the CCR5 coreceptor that confers resistance to the virus. One of the six such individuals whose cases have been published in scientific literature experienced a viral rebound; the other five ultimately died as a result of complications following their stem cell transplant or from their underlying cancer.

In other cases of people living with HIV who received a stem cell transplant but from a donor who lacked the CCR5-related genetic mutation, the stem cell transplant did delay the time to viral rebound by 3 to 10 months after the individuals stopped ARVs.

However, the high fatality rate following transplantation highlights how impractical, not to mention unethical, this method of attempting to cure HIV is for anyone not already facing a high risk of death due to cancer.

Gene therapy

Seeking safer alternatives to cancer-treatment-based stem cell transplants, researchers are experimenting with gene-editing techniques that alter the DNA of an individual’s immune cells. In particular, the scientists will try to deactivate the gene that gives rise to the CCR5 coreceptor, thus robbing HIV of a means of latching onto immune cells. The modified cells are then grown outside the body and ultimately reinfused into the person’s body. The aim is to spawn a population of immune cells that are resistant to infection. As the field of gene editing rapidly evolves, it is hoped that new, even more cutting-edge technology will facilitate progress on the HIV cure front.

“Kick and kill”

The method of waking up latently infected cells (the “kick” part) and then finishing them off (the “kill” part) has yielded some notably disappointing results of late, including those of the RIVER study that was presented at the July conference in Amsterdam. Researchers pursuing this strategy have looked to various cancer drugs known as HDAC inhibitors as the kick element; but thus far, they have not been able to show such drugs can actually diminish reservoir cells.

Lewin remains cautiously optimistic about further research into these medications, noting that the RIVER trial used a less advanced and relatively weak kick agent. Recent, more preliminary studies that have examined other kick agents, such as so-called TLR agonists, have shown far greater promise.

On this front, Gilead Sciences is investigating a drug known as GS-9620 that has shown positive results in primate research.

Latency silencing: “block and lock”

Effectively the opposite of the kick and kill strategy, the “block and lock” method, also known as latency silencing, is based on the presumption that if rooting out and killing all the latently infected cells in the body is too challenging, keeping them in a silent state indefinitely may be a viable alternative. A recent study conducted in mice sought to inhibit a viral protein known as tat that acts as an on-off switch for viral replication in cells. The study successfully reduced the amount of HIV RNA expressed in tissue biopsies taken from the animals, and it delayed viral rebound after the interruption of ARV treatment.

Enhancing the immune system

Researchers are investigating whether vaccines can be used to prompt the body to better control the virus.

Scientists have also invested considerable energy into studying so-called broadly neutralizing antibodies, which are natural antibodies that boast the capacity to combat a wide array of HIV strains. Research has indicated that some of these antibodies are associated with a delay in viral rebound after an ARV treatment interruption. Recently, scientists have gone high-tech by synthesizing three such antibodies into one “trispecific” antibody—a kind of all-in-one triple combination therapy—that has already shown promise in its use as pre-exposure prophylaxis (PrEP) among primates.

Modulating the immune system

Scientists are seeking to manipulate proteins that redirect the traffic of immune-fighting cells. One such example is an antibody called vedolizumab that targets a protein on the surface of CD4 cells and stops these cells from moving into the gut, where HIV focuses much of its assault on the immune system. An initial study in monkeys reported two years ago provided hope for progress in this area of research, but scientists recently repeated the study and found that the antibody had a null impact on the second go-round. Preliminary results in humans also showed that vedolizumab did not affect the time to viral rebound after individuals interrupted their ARV treatment.

Looking to the future

In all likelihood, a successful HIV cure, or posttreatment control, strategy will rely upon a combination approach based on a number of the methods currently under investigation or those yet to be imagined.

“It is clear that achieving HIV remission will not be easy and that one should not expect any single intervention to help people get to remission,” says Jintanat Ananworanich. “We are taking small steps in discovery science.”

Any successful method will need to be safe, effective and—if it is to make a significant dent in the global epidemic—scalable. An HIV cure therapy that is extraordinarily expensive thanks to, for example, the highly involved and complex process required to provide personally tailored genetic editing of an individual’s immune cells, will have little to offer poorer nations—in particular those in sub-Saharan Africa—where the need is greatest.

Curative hepatitis C virus (HCV) treatment, for example, costs tens of thousands of dollars in the United States, which has led insurers to restrict coverage of the medications. The actual cost to manufacture such medications, however, is relatively low, which allows for a steep sliding scale elsewhere around the world.

The future of HIV cure science is also up against the phenomenal success of ARV treatment, which has set a high bar for any alternative means of suppressing the virus. The life expectancy of those on ARVs is approaching normal. What’s more, the risk of transmitting HIV is effectively zero for those who maintain a fully suppressed viral load.

However, such benefits don’t speak to the psychic costs of living with a highly stigmatized lifelong infection or how a cure therapy may alleviate such burdens. Then there are the extreme difficulty and expense of getting the global population on lifelong ARV treatment. Also, even well-treated HIV is associated with an increased risk of numerous health conditions, such as cardiovascular disease and cognitive decline.

Some form of HIV cure could help address these problems. However, as HIV drug development continues to progress and long-acting injectable treatments, or even very long-lasting implants, become the standard of care, emerging HIV cure treatments may cease to offer the freedom from daily medications as an advantage over standard ARV therapy. (Or perhaps by then, long-acting antibody treatments will be the norm.)

Furthermore, if someone is in a state of posttreatment control of the virus, what reassurances will there be that the virus will remain dormant indefinitely and won’t suddenly surge back and make an individual unwittingly infectious? How frequently will people benefiting from viral remission need viral load monitoring?

These pressing questions, along with HIV’s extraordinary complexity, likely make for a long and winding scientific road ahead. But thanks to the increasing funds backing such research and a growing army of top-tier scientists doggedly pursuing a cure, the future will hopefully prove bright with new developments.

Still, this field isn’t simply concerned with a binary outcome of finding the holy grail of a cure or otherwise failing to do so. Success will likely prove incremental, with scientists eventually discovering new means of further mitigating HIV’s long-term harms, further transforming a once surely fatal infection into an increasingly innocuous presence in the body and around the world.

 

Even When Well Treated, HIV Is Linked to Advanced Aging

Researchers analyzed 10 biomarkers associated with biological aging among a group of HIV-positive and -negative Europeans.

This article is a reprint from POZ.com  from January 17, 2019  By Benjamin Ryan

Publishing their findings in the journal AIDS, researchers from the ComorBidity in Relation to AIDS (COBRA) study analyzed 134 people with HIV and 79 HIV-negative people with similar sociodemographic and lifestyle factors. The participants were recruited in Amsterdam (these were at least 45 years old) and London (these were at least 50 years old).

All the HIV-positive individuals were on antiretrovirals and had had a fully suppressed viral load for at least 12 months.

The researchers also studied samples from 35 blood donors selected from the Dutch national blood bank in Amsterdam. They were matched with the HIV-positive and -negative individuals from the COBRA study according to age and had all tested negative for HIV, hepatitis B and C viruses (HBV/HCV), syphilis and human T-lymphotropic virus 1 and 2 (HTLV).

The investigators tested the participants for 10 biomarkers that previous research has indicated are associated with biological, as opposed to chronological, aging.

Among the COBRA study members, biological age was greater than chronological age by an average of 13.2 years among those with HIV and 5.5 years among those without the virus. For the blood donors, biological age was an average of 7.0 years lower than chronological age.

After adjusting the data for various factors, including HIV status, the study authors found that the following factors were significantly associated with a greater average biological age compared with chronological age: chronic HBV, 10.05 years; total anti-cytomegalovirus (CMV) IgG antibody levels, 1.83 years per 10-fold increase; and CD8 cell count, 0.44 years per 100-cell increase.

After adjusting for chronic HBV infection status, total anti-CMV IgG antibody levels and CD8 levels, the analysis indicated that the HIV-positive COBRA participants had a greater discrepancy between biological and chronological age compared with their HIV-negative counterparts (4.5 years on average) and with the blood donors (19.0 years on average).

After conducting another analysis in which they adjusted the data for various factors, the study authors found that HIV-related factors associated with a greater biological age compared with chronological age included: cumulative exposure to the antiretroviral Invirase (saquinavir), 1.17 years per year of exposure; a lowest-ever (nadir) CD4 count of less than 300, 3.0 years; chronic HBV, 7.35 years; and total anti-CMV IgG antibody level, 1.86 years per 10-fold increase.

AIDS 2018 told the story of a global health crisis

This important article comes from Devex.com and puts the International AIDS Conference into perspective.

AMSTERDAM — The fight to end HIV/AIDS was given a boost by a star-studded week of presentations, panel sessions and the occasional protest at this year’s International AIDS Conference in Amsterdam. However, tensions within the community remain, and with few new funding pledges announced, there are questions about how to translate strong rhetoric into action.

Some 16,000 stakeholders from more than 160 countries gathered in the Dutch capital last week for AIDS 2018, the conference’s 22nd edition and one of the biggest events in the global health calendar, featuring sessions on the latest HIV science, policy, and practice.

The week-long event was awash with celebrities including Elton JohnCharlize Theron, and the United Kingdom’s Prince Harry, as well as former United States President Bill Clinton, who gave the keynote speech at the closing plenary. The heads of the world’s major health donors, notably U.S. President’s Emergency Plan for AIDS Relief, the Global Fund to Fight, AIDS, Tuberculosis and MalariaWorld Health Organization and Joint United Nations Programme on HIV/AIDS were also in attendance.

Held under the theme of “Breaking Barriers, Building Bridges,” the real story of this year’s conference was the growing realization that the HIV/AIDS epidemic is in crisis, with 1.8 million new infections in 2017. There are also alarming spikes in new HIV cases among key groups including adolescent girls in sub-Saharan Africa and drug users in eastern Europe and parts of Asia, according to recent figures from UNAIDS. At the same time, development assistance for HIV dropped $3 billion between 2012 and 2017, according to a study by the Institute for Health Metrics and Evaluation.

“The feel is definitely less congratulatory than past conferences and more sobering,” Rachel Baggaley, coordinator for HIV prevention and testing at WHO, told Devex, but added that it was good to see the community responding with force. The activist spirit which has defined the fight against AIDS in the past was never far away, she noted, with many sessions interrupted by campaigners.

“It is very positive to see the AIDS movement hasn’t gone away … I went feeling rather down and have come away challenged and inspired; there’s a lot of things we must do and a lot of people who continue to take this [AIDS agenda] forward,” she said.

One protest challenged the leadership of the U.N.’s dedicated AIDS agency, UNAIDS, with more than 20 female campaigners interrupting Executive Director Michel Sidibé — who has been criticized for his response to a sexual harassment scandal — during his address on stage at the opening plenary. Sidibé insists he has made changes and has resisted calls to step down, but his presence was a source of controversy.

In terms of funding, the conference saw the launch of the new $1.2 billion MenStar coalition to expand HIV services for men and boys, and £6 million ($7.87 million) in new funding from the U.K. government for grassroots HIV groups, provided through the Robert Carr Fund. The real test, however, will be next year’s Global Fund replenishment in France.

The key now will be turning the strong rhetoric and passion seen throughout AIDS 2018 into action on the ground, according to youth HIV activist Mercy Ngulube.

“We are all going to build bridges this week … but where is your bridge going to lead us? Don’t let your bridge be a bridge to nowhere,” she said during the opening plenary.

Key messages from the week were:

1. Target key populations

Attendees agreed that, without drastic change, the world will see global HIV targets missed and a possible resurgence of the epidemic. But Peter Piot, founding executive director of UNAIDS and now director of the London School of Hygiene and Tropical Medicine, warned the targets themselves could leave key populations even further behind.

Speaking on Thursday, Piot reminded the audience that the 90-90-90 targets set by UNAIDS in 2014 will miss 27 percent of HIV patients. The framework calls for countries to get 90 percent of people living with HIV diagnosed; 90 percent of those diagnosed to be accessing treatment; and 90 percent of people on treatment to have suppressed viral loads by 2020.

“The 90-90-90 targets are actually 90-81-73,” he said, adding that “what the future of the epidemic is going to be determined by is the 10-10-10” — those not hit by the targets.

The 10-10-10 is likely to be made up of key populations including sex workers, men who have sex with men, LGBTI groups, people who inject drugs, and young people — all of whom are less likely to access HIV services due to social stigma, discrimination, criminalization, and other barriers, Piot said. These groups currently account for 47 percent of people with new infections, according to UNAIDS data.

Reaching these key populations was high on the agenda last week. Dudu Dlamini, a campaigner for sex workers’ health and rights who was awarded the Prudence Mabele prize for HIV activism during the conference, spoke to Devex about the need to decriminalize sex work in order to remove barriers to HIV services for sex workers.

Leading HIV scientists also put out a statement in the Journal of the International AIDS Society about laws that criminalize people with HIV for not disclosing their status and for exposing or transmitting the disease. Such laws, which exist in 68 countries, “have not always been guided by the best available scientific and medical evidence,” it said, and when used inappropriately can reinforce stigma and undermine efforts to fight the disease.

2. Prevention pay off

With new infections standing at 1.8 million last year, the recent UNAIDS report describes a “prevention crisis.” Traditionally, prevention has received only a tiny proportion of HIV funding, with the bulk going toward treatment. But there was a new buzz around the prevention agenda at this year’s event, in part driven by excitement around oral pre-exposure prophylaxis, or PrEP, which can prevent HIV infection among those at high risk. The antiretroviral medication has been successfully rolled out in North America, western Europe, and Australia, and has been shown to help reduce new infections among men who have sex with men.

is a highly effective modality of prevention that should be paid for by the health system. No doubt.” – @NIAIDNews Director Anthony S. Fauci
WHO’s Baggaley said PrEP had “energized the prevention agenda.” However, questions remain about the feasibility of rolling it out in low-income countries, and about its efficacy for women.

“There is a prevention crisis and we need to find better ways of addressing it,” said Christine Stegling, executive director of the International HIV/AIDS Alliance. But while PrEP is a promising tool, a full approach to prevention needs to include a range of methods, combined with interventions that tackle human rights issues and gender inequality, she said.

3. A youth bulge

It was impossible to miss the strong youth presence at this year’s AIDS conference, which organizers said had a larger number of young people attending than ever before, and featured dozens of youth-focused events. This is linked to a growing recognition that adolescents face a disproportionately high risk of becoming infected with HIV, especially in Africa where the population is set to rapidly increase, and where new infection rates are on the rise among young people.

Ugandan youth advocate Brian Ahimbisibwe, a volunteer ambassador for the Elizabeth Glaser Pediatric AIDS Foundation, said: “Without the youth, the future of all these conferences, and more importantly [of] services and programs, [is] compromised.”

However, 28-year-old Tikhala Itaye, co-founder of women’s rights group Her Liberty in Malawi, said the youth voice had not been fully integrated and that young people were still being “talked at” during many of the sessions, as opposed to being listened to.

“There’s now acceptance that young people need to be at the center … they do have the demographic weight and power to influence issues around HIV,” she said, but “you still find the different youth events happening in different rooms … Why aren’t we all coming together as one to build the bridges and have a global voice?”

Signs at the 22nd International AIDS Conference in Amsterdam, The Netherlands. Photo by: Marcus Rose / IAS

4. The need for integration

A number of sessions talked about the need to integrate HIV programming, which has traditionally been siloed due to having its own funding streams, into broader health care. This was a key message of The Lancet Commission report on strengthening the HIV response published ahead of the conference, and was also the message delivered by WHO director-general Tedros Adhanom Ghebreyesus during the opening plenary.

“We have not truly helped a child if we treat her for HIV, but do not vaccinate her against measles. We have not truly helped a gay man if we give him PrEP but leave his depression untreated … Universal health coverage means ensuring all people have access to all the services they need, for all diseases and conditions,” he said.

Baggaley said integrating HIV into the broader health agenda posed both “an opportunity and also a challenge and risk for those populations most marginalized,” explaining that key populations currently served by externally funded nonstate health services could see their assistance diminished under UHC if the country in question did not believe UHC includes key populations or had punitive laws against gay men or sex workers, for example.

There was much discussion around the need to combine HIV and tuberculosis efforts, especially in the run up to the first U.N. high-level TB event in September. TB is the number one killer of people with HIV, who are up to 50 times more likely to develop it, according to WHO.

Speaking in between interruptions from the crowd, former U.S. President Clinton highlighted the need to address HIV and TB in tandem during the closing plenary and called on world leaders, notably India which has the highest TB burden, to attend the upcoming U.N. TB meeting.

“If you think … anyone ..that we can possibly bring the developing world to where we want it to be by abandoning the fight against HIV/AIDS and the collateral struggle against TB, you need to think again,” he said.

New findings from the Sustainable East Africa Research in Community Health program, presented during the conference, showed positive results from a community-based program which combined HIV testing and treatment with other diseases including TB, diabetes, and hypertension. The findings of a three-year randomized controlled trial in Kenya and Uganda showed that communities receiving testing and care for HIV alongside related conditions saw nearly 60 percent fewer new TB cases among HIV-infected people and that hypertension control improved by 26 percent.

5. Medical developments

Concerns about GlaxoSmithKline’s so-called “wonder drug” dolutegravir, which a study recently suggested might be linked to serious birth defects among children in Botswana, sparked debate amongst conference goers about whether potential mothers should be prescribed the drug.

WHO already advises that women of childbearing age wishing to take the antiretroviral have access to effective contraception, and will be re-evaluating its guidance as new evidence emerges, Baggaley told Devex. But there are concerns the agency could introduce blanket restrictions for women of childbearing age, which would force them to take other antiretroviral drugs that have worse side effects. The controversy could also lead to delays in the rollout of other forms of the drug, such as a pediatric version.

The conference also featured new data from the APPROACH study, which is evaluating the safety of several different HIV vaccines currently undergoing clinical trials in the U.S., East Africa, South Africa, and Thailand — but researchers admitted a vaccine will take years to develop.

6. The Trump effect

The shadow of U.S. President Donald Trump’s beefed-up “global gag rule,” otherwise known as the Mexico City Policy, loomed large over the conference, and a number of sessions discussed how it is negatively affecting HIV programs. Unlike previous iterations of the policy — which restricts U.S. funding to non-U.S. organizations that offer services related to abortion — Trump’s version is applied to almost all U.S. global health assistance, including PEPFAR.

Santos Simione from AMODEFA, an NGO that offers sexual health and HIV services in Mozambique, said his organization had lost U.S. funding due to the gag rule and was forced to close half of its youth clinics, which offered sexual and reproductive health services alongside HIV testing, counseling, and antiretroviral therapy.

“We could not provide condoms … testing … we just stopped everything,” Simione said.

Participants also spoke of a chilling effect, whereby organizations have stopped offering services that may not actually be prohibited under the rule, and raised concerns about PEPFAR’s staying power within a hostile Trump administration.

Meanwhile, there was heated debate about arrangements for the next conference, which the International AIDS Society has said will take place in San Francisco, California, in 2020. The decision has been met with fierce opposition and threats to boycott the event from AIDS campaigners who say many key population groups affected by HIV will have difficulties attending due to strict immigration policies. In 2009, former U.S. President Barack Obama lifted a restriction banning people with HIV from entering the country, but sex workers and people who use drugs still face legal challenges entering.

Rise in HIV rates among Asian-born gay men prompts call for more services

While rates of new HIV cases are falling in Australia, there’s been a sharp increase in diagnoses among Asian-born gay men.

Jimmy Chen had never been to a gay club until he moved to Australia from Taiwan three years ago.

But a short-term relationship with a man changed his life last year.

After undergoing a routine three-monthly sexual health status check, the 24-year-old was diagnosed with HIV.

SBS News

SBS News

“At the beginning, I just felt empty and also I feel like I don’t have any emotion going on in my mind,” he told SBS News.

While far fewer Australian-born men are being diagnosed with HIV, new diagnoses for gay men born in Southeast Asia, living in Australia, rose sharply between 2014 and 2016.

There was also an increase among Northeast Asian-born men.

Data from New South Wales shows the alarming trend is continuing.

There were 29 per cent more new cases among overseas-born gay men in the first quarter of this year, compared to the previous five years.

SBS News

SBS News

At the same time, the number of Australian-born gay men newly diagnosed fell 63 per cent.

CEO of the AIDS Council of New South Wales (ACON), Nicolas Parkhill, says criminalisation of homosexuality in migrants’ home countries, such as Indonesia, could be in part to blame.

“You’re going to have a very different perspective I think about accessing health care, particularly to get a HIV test or talk about sexual health for fear of privacy, for fear of some sort of reprimand,”

The HIV-prevention drug PREP is now cheaply available for most Australians, but uptake of the game-changing medication is lower among Asian gay men.

CEO of the AIDS Council of New South Wales (ACON), Nicolas Parkhill

CEO of the AIDS Council of New South Wales (ACON), Nicolas Parkhill.
SBS News

Mr Parkhill says that’s because a lot of international students or people on working holidays do not have access to Medicare.

“We’re really keen to work with certainly all governments on what might be an access scheme for people who we certainly know are high risk, certainly know can’t afford or can’t get access to things like PREP or treatment for people we know so that coverage is really, really targeted.”

The organisation is also trialling an education program targeting Chinese gay men.

Tim Chen explains the program is conducted in Mandarin.

“It has a Chinese name ‘Tong shi yao ling yao’, it’s a six-week-long structured workshop and each week has a different topic, like coming out, identity, sexual health, relationships, and getting involved in the communities in the last session.”

Tim Chen

Tim Chen.
SBS News

It’s one of a range of programs targeting Asian gay men with the aim of increasing the use of prevention strategies, such as condoms and PREP.

ACON hopes to adapt the program to target other Asian ethnicities.

Those that have already contracted HIV could become a key part of the strategy.

Jimmy Chen used to worry about how others would react to his diagnosis.

“At the beginning, I felt what if I tell them my HIV status they might turn away from me. What if I tell my partner, they won’t accept me anymore. And what if just being a stranger next to me and you know I’m HIV positive you might feel uncomfortable… that’s why I feel scared.

But he’s no longer afraid.

“This is a just a thing, a virus living in my body. But it doesn’t change my personality, I’m still who I am.”

Jimmy Chen

Jimmy Chen.

HIV-NEGATIVE GAY MEN UNCOMFORTABLE RELYING ON AN UNDETECTABLE VIRAL LOAD TO PREVENT HIV

Much more confidence in PrEP

Australian HIV-negative gay men express far more confidence in pre-exposure prophylaxis (PrEP) than an undetectable viral load in preventing HIV, with only 18% agreeing that “a person with an undetectable viral load cannot pass on HIV” and 6% feeling comfortable having condomless sex with an HIV-positive partner who had an undetectable viral load, according to a pair of articles recently published in Sexually Transmitted Infections and AIDS & Behavior.

Confidence in the efficacy of PrEP was much higher.

Researchers from the Burnet Institute conducted an online survey with gay and bisexual men living in Melbourne and other parts of the state of Victoria. It included a series of questions to gauge men’s knowledge of and attitudes towards condoms, an undetectable viral load and PrEP.

Australia has a long history of promoting condom use and regular HIV testing in gay men. More recently, there has also been high-profile support for treatment as prevention and PrEP. Around the time the survey was conducted in August and September 2016, a PrEP demonstration project was scaling up in Victoria. Several Australian campaigns promoting the benefits of HIV treatment had already been run, but the international “Undetectable = Untransmittable” campaign had not yet taken off.

Half the survey participants were between the ages of 25 and 40; most identified as gay; and 20% were born outside Australia. A third reported condomless sex with a casual partner in the past six months, and half with a regular partner.

The survey was completed by 844 people, but men with diagnosed HIV were excluded from the following analyses. The data on comfort having condomless sex come from 771 HIV-negative or untested men, including 83 PrEP users (12% of the men). The data on perceptions of effectiveness come from a smaller group of 462 survey respondents who answered all relevant questions and were not using PrEP. (The researchers did not report on responses from PrEP users for these questions.)

Perceptions of effectiveness

Although this analysis excluded current PrEP users, the majority of respondents expressed confidence in PrEP’s effectiveness: 78% agreed that “PrEP is effective in preventing HIV infection” and 65% agreed that “An HIV-negative person who is on PrEP is unlikely to get HIV”. Respondents also agreed that PrEP users were “being responsible” (74%) and were “protecting themselves” (84%).

In contrast, 18% agreed that “A person with an undetectable viral load cannot pass on HIV”. A similar statement, with less definitive language was not much more popular – 20% agreed that “An HIV-positive person on treatment is unlikely to transmit the virus”.

Despite this scepticism, other findings showed that respondents were aware that HIV treatment has a prevention impact – 37% agreed that “If more HIV-positive men have an undetectable viral load, then I’m less likely to get HIV” and 82% agreed that “HIV-positive people should go on treatment to protect their partners”.

Moreover, taking treatment soon after diagnosis appears to have become a community norm – 84% agreed that “People should start treatment as soon as they are diagnosed”, while statements suggesting that people should delay until they are completely ready or until treatment is absolutely necessary were supported by fewer than 10%.

This cohort of HIV-negative men generally rejected relying on their partners using antiretrovirals in order to be protected from HIV. They suggested that their personal sexual strategies would not change in response – 16% agreed that “If more men are on PrEP, I would feel like I don’t need to use condoms to avoid getting HIV”. Similarly, 12% agreed that “Because of PrEP and HIV treatments, I’m less likely to ask my partners about their HIV status”.

Comfort having condomless sex

Men were asked, “How comfortable would you be having anal sex without a condom with casual partners in the following scenarios?” and were asked to respond for a number of partner types. There were important differences between the responses of PrEP users and non-users.

The 668 men who were not taking PrEP were generally uncomfortable with the idea of having condomless sex – only 7% said they would be comfortable doing so with ‘any casual partner’, 5% with a casual partner of unknown HIV status and 3% with an casual partner who was HIV positive.

It made little difference if the HIV-positive partner had an undetectable viral load – 6% would feel comfortable having sex with him.

Men appeared to be more comfortable serosorting, although this can be a risky strategy for HIV-negative men as there is always the possibility that a partner has recently acquired HIV but has not yet been diagnosed. Among men not using PrEP, 31% said they would be comfortable having condomless sex with a casual partner described as HIV negative. If the same man was taking PrEP, fewer men (23%) would be comfortable having condomless sex with him, perhaps reflecting a perception of PrEP users as risk takers.

The 83 respondents who were using PrEP were more comfortable with the idea of having condomless sex, but comfort levels were not particularly high.

PrEP users were most likely to feel comfortable having condomless sex with other HIV-negative PrEP users (72%) and HIV-negative partners not taking PrEP (64%).

The proportion who would feel comfortable having condomless sex with an HIV-positive partner (29%) was lower than for a partner of unknown HIV status (34%) or ‘any casual partner’ (40%).

And less than half of current PrEP users would be comfortable having condomless sex with an HIV-positive partner with an undetectable viral load (48%), although the respondent would be protected by two extremely effective prevention methods.

Conclusions

“While gay and bisexual men are highly supportive of pre-exposure prophylaxis, there remains some scepticism towards HIV treatment when used for prevention,” sum up the authors. “Increasing community understanding of treatment as prevention is needed to optimise treatment-based HIV prevention strategies.”

“In general, HIV-negative and untested gay and bisexual men indicated that they remained more comfortable negotiating condomless sex based on knowledge of HIV status, rather than PrEP or undetectable viral load.”

Many men continue to rely on serosorting: “HIV-negative men tend to perceive all sex with HIV-positive partners as potentially risky, regardless of condom use, HIV treatment or viral load.”

Some commentators have suggested that PrEP and understanding of undetectable viral loads could help reduce HIV stigma and the fear of partners living with HIV. However, PrEP users’ relatively high levels of discomfort with the idea of condomless sex with HIV-positive partners suggest that these hopes may be over-stated, the authors comment.

By Roger Pebody

References

Wilkinson AL et al. Measuring and understanding the attitudes of Australian gay and bisexual men towards biomedical HIV prevention using cross-sectional data and factor analyses. Sexually Transmitted Infections 94: 309-314, 2018. (Abstract.)

Holt M et al. Comfort Relying on HIV Pre-exposure Prophylaxis and Treatment as Prevention for Condomless Sex: Results of an Online Survey of Australian Gay and Bisexual Men. AIDS & Behavior, online ahead of print, 2018. (Abstract.)

Reprinted from the ETAG article published 6/6/18

By 2030, Top Cancers Among People With HIV Expected to Be Prostate and Lung

Declining rates are expected for Kaposi sarcoma, non–Hodgkin lymphoma, cervical and lung cancer and Hodgkin lymphoma, among others.

This story is taken from a recent article by Benjamin Ryan on Poz.com

May 8, 2018 

Publishing their findings in the Annals of Internal Medicine, researchers analyzed data from the National Cancer Institute’s HIV/AIDS Cancer Match study, modeling cancer diagnosis rates during 2000 to 2012 to make projections about how rates will change from 2013 to 2030.

The U.S. HIV population is steadily aging, thanks to effective antiretroviral treatment. In 2006, an estimated 27 percent of the population was age 50 or older, a proportion that increased to 45 percent in 2014. Between 2010 and 2030, the proportion of the population age 65 and older is expected to increase from 8.5 percent to 21.4 percent, while the proportion that is age 45 to 64 is expected to increase from 39.4 percent to 47.7 percent.

Between 2000 and 2012, the 463,300 HIV-positive adults in the HIV/AIDS Cancer Match Study were diagnosed with 23,907 cancers. During this period, the annual diagnosis rates (known as incidence) declined for Kaposi sarcoma (KS), non–Hodgkin lymphoma (NHL), cervical cancer, anal cancer (among men who have sex with men), lung cancer, Hodgkin lymphoma and other cancers among all age types. Colon cancer incidence decreased among those age 65 and older. Meanwhile, prostate cancer incidence increased among men ages 35 to 64.

Overall, cancer incidence among the U.S. HIV population is expected to decline through the next decade.

Among three AIDS-defining cancers, the estimated numbers of diagnoses seen in the U.S. HIV population in 2010 and projected to occur in 2020 and 2030, respectively, according to the study authors’ analysis were: 8,150, 7,490 and 6,690 diagnoses of NHL; 1,490, 750 and 450 diagnoses of KS; and 120, 50 and 30 diagnoses of cervical cancer.

As for non-AIDS-defining cancers, the respective numbers of diagnoses seen in 2010 and projected to occur in 2020 and 2030 were: 5,420, 6,150 and 5,980 diagnoses of lung cancer; 830, 910 and 1,030 diagnoses of prostate cancer; 750, 1,340, 1,590 diagnoses of anal cancer; 360, 460 and 480 diagnoses of liver cancer; 300, 200 and 120 diagnoses of Hodgkin lymphoma; 250, 320 and 340 diagnoses of oral cavity/pharyngeal cancer; 220, 260 and 260 diagnoses of breast cancer; 220, 230 and 200 diagnoses of colon cancer; and 1,910, 1,880 and 1,510 diagnoses of other types of cancers.

The study authors concluded that their findings stress the importance of expanding access to HIV treatment and cancer prevention, screening and treatment.

Nearly all Australians with HIV can’t transmit the virus — but can its stigma be broken?

As we continue to see improvements in our health we still battle on a daily basis with stigma…

By the time he was 25, Ed Moreno was preparing to die.

He imagined a painful and undignified end — a fate he saw other gay men suffer.

He was diagnosed with human immunodeficiency virus (HIV) in 1990.

“They gave me five years to live,” he said.

“AIDS was killing people in a very ugly way … [there were] disfigurements, painful deaths.”

It was around the height of the AIDS epidemic that was terrifying the world.

Back then AIDS (acquired immunodeficiency syndrome) and its precursor, HIV, were effectively a death sentence. “Telling my parents was probably the hardest thing I’ve ever had to do,” Mr Moreno said.

Mr Moreno resigned himself to the “numbing” thought he would be lucky to reach 30, but his sights were set on going “out with a bang”.

The American moved from his home town of Santa Fe to Miami to party away what remained of his relatively short life.

“I decided I was going to live large,” he said.

The anti-retroviral revolution

However, by the mid-1990s, major medical advances meant that AIDS was no longer a death sentence: it was a chronic condition which could be managed with multiple anti-retroviral drugs.

Mr Moreno started treatment, which at the time involved a complicated cocktail of medications with painful side effects.

Still it wasn’t until 2003, more than a decade after his diagnosis, that he contemplated one day experiencing old age.

“It took me a long time to realise I wasn’t actually going to die,” he said.

“It’s kind of feel like I lost those 13 years.”

Living under the dark cloud

In recent years, HIV treatment has been simplified down to a pill a day.

It is now shown that with effective and sustained treatment, the virus cannot be detected by standard blood tests or transmitted during sex.

More than 26,000 Australians were living with HIV in 2016, according to the Kirby Institute at the University of New South Wales.

Of them, more than 90 per cent had an undetectable viral load.

“A person living with HIV like myself, takes my medication every day,” said Nic Holas from The Institute of Many.

“That one pill stops HIV in its tracks, it stops the virus replicating.”

The organisation is behind a new push to end HIV stigma.

The U=U campaign — which stands for “undetectable equals untransmittable” — involves Mr Moreno and four others sharing their HIV experiences.

Mr Moreno is now 53 and calls Melbourne home. He personally knows the impact of outdated views on HIV.

“I had an experience not too long ago of someone wanting to keep my cutlery and cups separate,” he said.

The gap between science and perception extends to those with the virus, Mr Holas added.

“We’ve been living under a very dark cloud of HIV for many decades,” he said.

“HIV positive people hear it [the U=U message] and [say], ‘Oh, but what if?'”

Mr Holas stressed the U=U campaign was grounded in strong scientific research.

“Some of the greatest scientific minds in the field, at an international level, have endorsed the U=U statement,” Mr Holas said.

“There is effectively zero risk of transmission, so don’t worry about it.”

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.”

 

U=U

U=U Forum march 8th 2018
Undetectable Equals Untransmittable
Loton Park Tennis Club 6:30PM

This is an opportunity to have your U=U questions answered by Bruce Richman, a community leader who has had an unprecedented impact on the global HIV response.

Hosted by TIM’s Nic Holas. One of TIM’s taglines is “welcome to HIV in the 21st century” and this speaking tour is a great chance to get updated on where things are at.

The event is open to all people who would like to engage in the Undetectable Equals Untransmittable conversation.

See the flyer for details and RSVP to Alli Paterson at apaterson@waaids.com or call 9482 0000

Flyer – U=U MARCH 2018

Targeting positive men won’t end HIV

Some very interesting and not surprising observations that I thought were worth reminding and sharing with people.
Words by Ian Howley | @IanHowley 

Photo: © Shutterstock.com


I’ve been working in sexual health since 2010 and I’ve seen it all.

I’ve seen how the lack of basic sex education can affect people. I’ve seen how low poor self-esteem can impact someone’s judgement to look after their sexual health. But of all I’ve seen, it’s fear that is having the biggest impact on HIV prevention by creating stigma associated with HIV.

Fear is the worst emotion of them all. Fear makes us afraid of things we shouldn’t find scary. When people are afraid they tend to back off, put up walls, criticise or lash out. Some won’t even believe the facts that are put in front of them. Fear in our community is stopping people from opening up and preventing communication with gay men living with HIV. Fear is leading to a battle within our community on apps and in social settings.

People with HIV are called ‘dirty’, ‘sluts’, ‘bad people’ because luck went against them and they caught the virus. Fear creates a space for targeted hate. Many times HIV-negative people hit out at people living with HIV because they are scared of the virus. But this can have severe health problems for people living with HIV. It’s been found that men living with HIV are likely to have mental health issues because of their status, with some dying by suicide. Four in ten suicides occurred in the first year after diagnosis. During this time, men’s suicide rate was five times that of the general population. This is totally unacceptable.

Over the last several years, GMFA and other sexual health organisations have worked really hard to make sure we reached out to people and help break down the fear associated with the virus. But unfortunately, fear also sells. And in a world where clicks are more important than improving society we are seeing how years of hard work can be destroyed with just one headline. And it’s so frustrating. I know what some of you are already thinking: “Isn’t fear a good thing sometimes, as it keeps us in check?” or thinking that stigma or having a fear of HIV-positive people will stop people from becoming positive.

Well I’m here today to tell you that you are wrong. Recently, Public Health England released statistics that show that about 13% of people who are living with HIV don’t know they have the virus. Those 13% think they are HIV-negative. They are also accounting for around 80% of new HIV infections. So it’s mainly people who don’t know they have HIV, who will tell you they are HIV-negative, who are spreading the virus. If you’re being treated successfully, you cannot pass on HIV.

Here’s something you need to know. People living with HIV and on successful treatment cannot pass on the virus. When someone is diagnosed as HIV-positive, their viral load (that’s the amount of HIV in their system) tends to be very high. Once they are put on HIV medication, the medication works to decrease the amount of HIV in their body and very soon their viral load will become so low that they will become HIV-undetectable, meaning there is so little HIV in their system they cannot pass on the virus. In the last year or so you may have seen this message being pushed quite a bit by sexual health organisations. It’s been proven by science.

The PARTNER study recorded sexual acts between mixed HIV status people and found that no-one passed on the virus. But yet, because of the fear people have we still have people not believing science. I’ve heard many times: “It’s not worth the risk”. But we must continue moving forward with this message. Fear can hold us back but education and awareness will move us forward. We must continue to work to dispel the ignorance that ‘s surrounding HIV, increase people’s knowledge of testing, treatment as prevention, PrEP and condoms, while breaking down the social barriers that are caused by fear and HIV stigma. Only by increasing our knowledge of HIV and how it’s transmitted, can we really make an effort to stop HIV stigma in our community.

Someone’s unfounded fear might just be stopping them from being with someone truly amazing.


This article was originally published in the i Newspaper.