How healthcare can prepare for My Health Record roll-out


Article by Proofpoint APJ vice president Tim Bentley

  • An important article when you consider whether or not to sign up for My Health Record 21 Jan 19

Australians have until January 31 to decide if they will opt out of a nationwide My Health Record initiative designed to ensure healthcare providers have instant online access to important patient information.

At the same time, cybercrime is the fastest growing crime in the world, and Australia’s healthcare sector is the continent’s biggest target according to a July report from the Australian Information Commissioner.

While Australian healthcare cybersecurity teams are in a constant fight to defend patient information from cybercriminals, there are three important steps healthcare providers can take to proactively secure their systems from online compromise.

Train healthcare staff to spot cyberattacks that target them.

Cybercriminals have shifted methods from attacking network infrastructure to attacking users directly to break into systems and access patient information.

While facilities can eliminate most legacy threats at the network perimeter, targeted attacks can circumvent the most sophisticated security software to exploit well-intentioned employees.

All it takes is one well-crafted email and a single click to lose critical patient information.

IT and senior management must work together to develop a robust cybersecurity awareness training program for every employee to undergo.

As it stands, approximately 3 in 4 (73.5%) healthcare organisations provide cybersecurity awareness training for end users, but only half of those trainings occur annually.

While this may satisfy regulatory requirements, it isn’t optimal for memory retention and doesn’t adequately keep pace with today’s rapidly evolving threat landscape.

Continuous awareness training aimed at the most targeted people within an organisation needs to be prioritised.

In addition, using real-world simulations within these trainings will also help staff members recognise attacks that they are likely to encounter across email, cloud apps, and social media.

Secure your email channel – cybercriminals’ attack vector of choice.
To address today’s attacks, healthcare organisations must practice the “ounce of prevention is worth a pound of cure” model by deploying a multi-layered approach to network defences.

Today’s fast-moving, people-centred attacks are immune to conventional signature and reputation-based defences.

In addition to firewalls and other perimeter security, a dedicated email security application must also be in place, removing employees from the equation whenever possible.

One of the most effective weapons in an attacker’s arsenal is business email compromise (BEC) or email fraud, which is the ability to disguise malicious emails, making them appear to come from a trusted source – often a CEO or CFO.

BEC uses social engineering tactics to fool victims into wiring funds, sending patient information, or divulging login credentials to someone the employee perceives is an authority figure.

Email fraud attempts are widespread in this industry and phishing attacks are at an all-time high. Healthcare employees are especially vulnerable to email-based attacks due to the high volume of personal health information they access, their frequent email communication with patients, time constraints in acute care settings, and highly publicised ransoms being paid by clinics and hospitals.

There has been a significant uptick in email fraud attacks aimed at clinical staff, business associates, and even patients – basically anyone who can access medical records.

Proofpoint’s research has shown that cybercriminals are especially targeting pharmacy directors, who control drug access, and chief nursing officers, along with any employee who can legitimately access all patient records.

These attacks are tailor-made for the recipients, often including specific references to the individual gleaned from researching their social media accounts.

This research is done with the goal of getting their attention and increasing the likelihood of ‘open rates.’

Rounding out this Pandora’s box of vulnerability is the fact that many medical facilities have complex supply chains running multiple clinical systems and security applications – many of them outdated.

One additional important component of an effective email security strategy is to deploy email authentication protocols such as DMARC and lookalike domain defences.

These technologies stop many attacks that use your trusted brand to trick employees, partners, vendors, and patients.

Our research shows that 1 in 5 emails purported to be from a healthcare organisation in 2017 was fraudulent.

Furthermore, of three billion emails using the domain of a known healthcare brand, about 8.3% of these were in fact from sources that were either unauthorised or malicious.

Deploy CASB to get visibility into the cloud apps, services, and add-ons your employees use.
You can’t defend against what you don’t know.

As more and more organisations rely on cloud-based solutions to conduct global operations, enterprise security teams must have clear visibility into the third-party applications running within their environments (Microsoft Office 365, Google G Suite, Box and others) and appropriately secure them.

Best practice calls for organisations to deploy a cloud access security broker (CASB) solution that combines user-specific risk indicators with cross-channel threat intelligence to analyse user behaviour and detect anomalies in third-party apps.

Without this, healthcare providers don’t know when users and patient data are at risk.

CASB solutions allow IT administrators to deploy tools to detect unsafe files and content, credential theft, data loss, third-party data access, and abuse by cloud scripting apps.

Healthcare cyber attacks can have serious, if not fatal consequences, and Australians are looking to trust healthcare providers with their information.

It’s essential that security teams have the proper technology to quickly remediate risk while proactively educating the healthcare workforce to detect and quarantine today’s online threats.

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.

Treatments Forum 2018

We invite you to join us for the next Treatments forum to be held at the Backlot in West Perth. RSVP is essential.

The WA AIDS Council Treatments Forum is an event where WA HIV sector professionals
present and discuss new treatments, clinical developments, research and current issues.

Arrival is 6pm for a 7pm commencement. Food and drinks will be served on arrival.
Due to seating limitations this event is for PLHIV only.

Please RSVP to Alli at the WA AIDS Council on 9482 0000
or email apaterson@waaids.com Monday November 5th by 2018

Event – Treatments Forum

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.

My Health Record

AFAO have just released a Consumer fact Sheet about My health record, telling you about what it is and how it can be of use to you.

You can find it here – My Health Record Fact Sheet

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.”

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

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

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

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

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

Andrew Grulich speaks at CROI 2018 in Boston.

Andrew Grulich speaks at CROI 2018 in Boston.Benjamin Ryan

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

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

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

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

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

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

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

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

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

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

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

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

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

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

National Women Living with HIV Day!

Get tested, know your status

07 Mar 2018 – reproduced from NAPWHA

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

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

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

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

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

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

What is AIDS Survivor Syndrome?

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

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

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

Vince Crisostomo

Vince Crisostomo

 

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

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

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

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

Ron Stall, PhD

Ron Stall, PhD

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

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

The research on AIDS Survivor Syndrome

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

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

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

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

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

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

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

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

Dusty Araujo

Dusty Araujo

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

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

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

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

 

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