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EU project maps how HIV crosses borders
Up to 30% of HIV-positive gay men diagnosed
in Europe have become HIV positive outside their own country or HIV has been
passed on by someone visiting from abroad, a new European study has found.
Many heterosexual people in the study were themselves from immigrant
communities. Despite this, they were less than half as likely to have been
infected by someone diagnosed in another country, or by someone whose infection
was connected to someone diagnosed in another country.
The SPREAD study genetically analysed HIV from samples from 4260 newly diagnosed
people in 25 European countries. It found that, in 1330 cases, the virus was
more than 98% genetically similar to another virus in the samples, forming a
so-called ‘cluster’. For viruses to be this similar, people in the cluster must
have either been infected by someone else in the cluster or by a close
intermediary. There were 457 clusters, the largest containing 28 people;
two-thirds of clusters were pairs.
In 17% of clusters, the people in the cluster came from more than one
country; 26% of people who were in a cluster came from an international one.
Thirty-one per cent of gay men came from an international cluster but only 14%
of heterosexuals. People infected less than a year ago were also more likely to
be in a cluster of diagnoses from more than one country.
Comment: It’s important to note that SPREAD excludes some
European countries (notably the UK
and cannot say anything about the origin of infections unlinked to clusters.
Phylogenetic testing cannot tell us who infected whom. However, it does show
who is connected in a network of infection, and this study shows that a
surprisingly high proportion of gay men are connected to someone diagnosed in
another country. In contrast, it shows that heterosexual people from high-prevalence
countries are much less likely than might be expected to be in cross-border
networks; this may indicate that few immigrants diagnosed abroad pass on HIV to
anyone in their new host country, or that if they do, it is overwhelmingly
likely to be someone in their own community.
Global gay survey: blackmail, stigma and poverty blight lives and health
A global survey of approximately 5000 gay
men and men who have sex with men (MSM) in 165 different countries has found
that only a minority has easy access to HIV prevention and treatment.
The 2012 Global Men’s Health and Rights Study, co-ordinated by the
Global Forum for MSM and HIV, found that the lower the income of their country,
the less easy MSM found it to access condoms, lubricants and, if they had HIV,
treatment. Overall, 37% of gay men said they could easily access condoms
without restrictions and 25% lubes. Eighteen per cent of respondents said they
had HIV. Of those, 50% had unrestricted access to HIV treatment in high-income
countries, but only 14% in low-income countries (this may exclude some people
who had access to condoms, treatment and lubes but with barriers such as having
to pay). Access to HIV testing was lower in middle-income countries than
Access to HIV resources of all kinds was lower in countries with higher
perceived rates of homophobia, and stigma from healthcare providers was
especially associated with poor access to condoms.
Being ‘out’ as gay was a mixed blessing: belonging to a community
support organisation was associated with better access to HIV resources, but
being publicly gay or having experienced negative consequences of it were
associated with poorer access to lubes and HIV testing.
Young men under 30 had poorer access to all categories of HIV resources
than older men; young men were 50% more likely to report not knowing their HIV
status. Young men on HIV treatment were much less likely to know their viral
load or to have an undetectable viral load if they did know it.
The survey was supplemented in Africa by interviews with 71 men in Kenya, Nigeria
and South Africa.
These revealed that one of the biggest burdens they had to deal with was not so
much violence as blackmail and extortion, which were a common consequence of
being gay. Negative reactions from healthcare staff were also common.
Comment: The comments from the focus groups in this
survey are especially worth reading. One striking finding is how blackmail,
often by other gay men, is one of the most common problems MSM have to deal
with in countries where homosexuality is still illegal, as it was before
decriminalisation in the US and Europe. Similarly, the finding that being out
as gay restricts access to prevention services may reflect that, in strongly
homophobic countries, ‘passing as straight’ is still a necessary strategy to
avoid bad treatment. The higher rate of HIV testing in poor countries may
reflect the success of HIV testing programmes or simply that low-income
countries tend to have more HIV.
Many Dutch men with HIV take viral load into account in condom decisions
A community survey of HIV-positive gay men
in the Netherlands has found that, of the 68% who said they had had unprotected
anal sex since their diagnosis, nearly two-thirds (63%) said they had
considered their viral load as a factor when deciding whether or not to use a
condom. This represents 41% of all the men asked, including those
who did not have unprotected anal sex.
The survey was conducted among gay men with HIV who form part of a
community consultation panel in the Netherlands. In total, 177 men who
had an undetectable viral load completed the survey and are included in the
The survey split the men’s answers into whether a respondent’s most
recent partner was a casual or regular partner and whether he was known to have
HIV or not.
Respondents took viral load into account with both HIV-positive and
(potentially) HIV-negative partners in making the decision on
whether or not to have unprotected sex. With HIV-positive partners, they
were more likely to do so if they were with a regular partner.
With partners who also had HIV, viral load was likely to be openly
discussed as part of a general discussion on whether or not to use condoms.
Conversely, with negative or unknown partners, few people disclosed status and
even fewer talked about their viral load openly; instead it was part of an
internal process of risk calculation the men went through.
Comment: This study doesn’t explore what “taking viral
load into consideration” actually means. Because its respondents were part of a
community panel, they may be more informed about viral suppression and risk
than the average person with HIV, so results may not be generalisable. It
confirms, as so many studies have done, that HIV-positive men find it very
difficult to disclose to new partners and go through a unilateral ‘risk
assessment’ exercise when making decisions about sex with partners of unknown
status. In terms of the law, this might not be enough to exonerate them legally
in legal systems where HIV disclosure to partners is mandatory, though it might
be a valid plea against exposure where it is not.
Getting viral load as low as possible may pay prevention dividends
A low-level but detectable viral load in the
blood of gay men taking antiretroviral therapy (ART) is strongly predictive of
low but detectable levels of HIV also being found in the semen, a Californian
study has found.
More than one-in-three gay men on ART with viral loads between 50 and
500 copies/ml in their blood also had detectable virus in their semen, at a
mean level of 126 copies/ml.
In contrast only one-in-17 men with blood viral loads below 50 copies/ml
had detectable seminal HIV.
Another factor independently associated with detectable HIV in the semen
was active infection with two viruses of the herpes family: cytomegalovirus (CMV) and Epstein Barr
virus (EBV). Men with high levels of these viruses in their semen were
respectively 4.5 and six times more likely to also have detectable HIV in their
semen. CMV and EBV are very common and normally asymptomatic.
There was no relationship between detectable HIV in the semen and
duration or type of ART or self-reported adherence (which was high in this
group). Perhaps surprisingly, there was also no relationship to bacterial STIs
such as gonorrhoea or chlamydia, although these were relatively uncommon in
Comment: We don’t know how infectious someone with a
seminal viral load of 126 copies/ml really is – probably not very. However,
this study does suggest that blood plasma viral load when someone is taking ART
is a good surrogate for seminal viral load, and getting it as low as possible
will improve the efficacy of ART as prevention as well as treatment. There is
little research into treating chronic CMV or EBV infection, though giving drugs
against the related genital herpes virus (HSV2) has so far not resulted in
reducing HIV transmission between serodiscordant couples.
Steroid injectors: an under-studied HIV risk group
A study presented at the British HIV
Association conference last month has uncovered a
previously almost completely unresearched group of people at risk of HIV and
hepatitis B and C – male bodybuilders who inject steroids or growth hormone to
The study recruited 395 men and found that
six (1.5%) were HIV positive – ten times the prevalence of HIV in the general
UK population. In addition, 5.5% had hepatitis C infection and 8.8%
had evidence of past or current infection with hepatitis B.
This group has only ever been the subject of three studies ever before,
Dr Vivian Hope of Public Health England
told the conference. In the one previous study conducted in the UK, no one was
found with HIV.
The men were recruited via needle and syringe exchanges so may not be
typical of the steroid-injecting population. Their average age was 28 and they
were almost all (97%) heterosexual. Twenty per cent had had at least five
female sexual partners in the last year and 8% had had at least ten; only one in five always used
a condom. Five per cent had ever injected a psychoactive drug such as heroin,
methamphetamine or cocaine.
Nine per cent reported ever sharing a needle, syringe or vial (steroid
hormones come ready-mixed in vials and are injected into muscles rather than
Three of the six HIV infections were in the 13 men who had sex with men
involved in the study, and they had probably acquired it sexually.
Comment: As the presenter said at the time, these results
need to be interpreted with caution as male steroid users may have other risks
that raise their risk of HIV above the general population. However, it is of
some concern that HIV has been found in this group when a study 20 years ago
found none. At the very least, it indicates that doctors and health advisers
may need to be aware of steroid injection as an HIV and hepatitis risk factor
in men without any other apparent risk factors. Given that, despite quite high
levels of sexual activity, only one in six had gone for a sexual health check-up
in the last year, these are exactly the type of people that may ‘slip through
the net’ and be diagnosed with HIV very late.
European HIV prevention webinars – an HIV cure
As part of its European HIV prevention work, NAM is
collaborating with AVAC to provide a series
of webinars (conference calls with accompanying slides) to train and inform
prevention advocates and anyone interested in the newest developments in HIV
The fifth webinar is entitled:
Cure research: The facts and
Recently several stories have appeared in national
newspapers and magazines over-optimistically predicting that HIV may be curable soon. It is timely therefore
that the fifth webinar in our series will look at recent
developments in the area of cure research.
Time and date: 2pm UK time (BST),
Tuesday 11 June (3pm CEST)
To register for the webinar and get phone numbers and
joining instructions click this link:
As usual, the presentations will be followed by a
question and answer session with our expert speakers. Questions can be submitted in advance to firstname.lastname@example.org. The webinar will be 90 minutes long and chaired by
Rebekah Webb of AVAC.
Other recent news headlines
Data from two
national sex surveys in the United States show that gay and bisexual men (men
who have sex with men, or MSM) reported significantly fewer sexual partners in
the previous year in a survey conducted between 2006 and 2010 than they did in
one conducted in 2002. This decline was consistent across most ethnicities and
age groups, but was particularly marked, and statistically significant, in men
aged under 24. In contrast, the proportion who reported having condomless anal
sex at least once in the previous year did not change between surveys.
In a blow to
HIV vaccine development, the US National Institute of Allergy and Infectious
Diseases (NIAID) announced on
25 April that it was discontinuing the HVTN 505 HIV
vaccine trial. This
trial started in July 2009 and involved 2504 volunteers. Since the successful
conclusion of the RV144 vaccine
trial in September
2009, HVTN 505 has been the only ongoing HIV vaccine trial large enough to be a
true test of vaccine efficacy. The trial’s data and safety monitoring board
(DSMB) found that the vaccine regimen was neither preventing HIV infection nor reducing
viral load among vaccine recipients who acquired HIV. There were actually more HIV infections in volunteers receiving vaccine
than placebo, but this difference was not statistically significant and could be
due to chance.
Oral infection with human papillomavirus (HPV) is common among gay
men, Dutch investigators report. Prevalence was especially high among
HIV-positive gay men, who were also more likely to be infected with the strains
of HPV associated with a high risk of cancers of the head and neck. In a study
of 767 gay men, 40% of samples taken from them had oral HPV infections.
Prevalence differed by HIV status and was significantly higher among the men
with HIV (57 vs 27%).
Taking HIV pre-exposure prophylaxis (PrEP) did not lead to increased
levels of sexual risk behaviour among gay men taking part in the
second study of PrEP ever completed, a 400-member safety trial that took
place in San Francisco, Atlanta and Boston between 2005 and 2007. The average
number of sexual partners in the previous three months fell from 7.25 to 5.7
during the trial and the number of partners of HIV-positive or unknown status
from 4.2 to 3.3. In this trial, half the participants received PrEP immediately
and half nine months later; the falls in partner numbers were similar in the
immediate- and delayed-PrEP arms.
Editors' picks from other sources
from Science Daily
A team of NIH scientists has developed a new tool to identify broadly neutralizing antibodies (bNAbs) capable of preventing infection by the
majority of HIV strains found around the globe, an advance that could
help speed HIV vaccine development.
Contrary to some hysterically hyped headlines this past week, HIV is not on the verge of being cured in the next three months, nor have scientists found an effective vaccine. The truth is that a hopeful compound to force HIV out of hiding is under study, and the results should be known in the near future. Unfortunately, however, even if researchers hit a home run with this drug, it won't likely be a cure by itself and we will
still be waiting for the day that we have a vaccine or other types of immune therapy to help the body kill any remaining infected cells.
from Gay News Network
Already in use in the USA – and becoming a major part of the fight
against HIV in sub-Saharan Africa – home-based testing has the potential to
revolutionise the way gay men are tested. Debate rages around the psychological
impact of discovering you may be positive without the support of a medical
professional and the implications for the testing of potential partners – once
you get them home. However, in places like Kenya, home-based testing has become
the major weapon in the government’s fight to have 80 per cent of all Kenyans
knowing their HIV status by the end of 2013 and in stopping the spread of the
is room for optimism in the overall progress of the global education
sector's response to HIV, says a new in-depth study of 39 countries
around the world. However, a worrying degree of stagnation in some areas
still exists and much more needs to be done if the sector is to fulfil
its critical role in helping to intensify HIV prevention.
from The Atlantic
the "next-generation condom" initiative, Bill Gates is acknowledging
that the practical reasons people don't use condoms warrant honest