| || |
One-in-five US gay men don’t test for HIV while in a relationship
A fifth of gay men whose last HIV test was
negative and who are in a relationship with a male partner have not had an HIV
test in their present relationship, US researchers have found.
recruited 275 HIV-negative male couples via Facebook. It found that 21% said
they tested for HIV every three to six months, 29% had an annual test, 30%
tested only when they thought one of them might have taken a risk, and the
other 20% had not tested for HIV while in their current relationship.
Men who had
not tested for HIV were – not unexpectedly – more likely to be in a new
relationship but were also more likely to be young and of lower educational
attainment. They were less likely to have negotiated an agreement about sex
outside the relationship and more likely to say they were faithful and trusted
their partner to be. Conversely, men who tested frequently were older, less
trusting, more likely to have an open relationship or to have had recent
‘extramarital’ sex and more likely to have an agreement with their partner
about their relationship’s sexual boundaries.
who don’t test may be right to trust their partners but, as the researchers
say, “additional research is warranted to further explore how concepts of trust affected...gay couples’ HIV testing
Comment: Given that HIV
testing rates are still lower in the UK
and in most other European countries than they are in the US, especially
for frequent testing, the percentage of gay men in a primary relationship who don’t
test is likely to be a higher figure here. The authors say that the Centers for Disease Control, as a result of this study, should recommend more strongly than ever that that all sexually active gay men should test for HIV regularly, regardless of whether they think they are at risk of it in their current relationship.
Intravenous AZT still useful to stop HIV if women giving birth have high viral load
A large French study of over 11,000 women
with HIV has concluded that intravenous AZT, which until recently has been
recommended for all HIV-positive women giving birth to prevent mother-to-child
transmission (MTCT), has helped to bring down the overall MTCT rate.
But it made no difference for the majority of mothers who had a well-controlled
viral load (400 copies/ml or less). It also made no difference if the baby was
given two- or three-drug ART regimens as post-exposure prophylaxis (PEP) after birth.
MTCT rate for the entire time period of the 13-year study (1997-2010) was 7.5%
without intravenous AZT, and 2.9% with it.
there were no transmissions from any woman with a viral load below 400
copies/ml who did not receive intravenous AZT. In fact, there were 42
transmissions (0.6%) from women who did
receive intravenous AZT. This is because the guidelines did not stop
recommending intravenous AZT until July 2010, so the vast majority of women in
the study received it.
women with virological failure who had caesarean sections were five times more
likely to pass on HIV (9.5%) if they did not have intravenous AZT than if they
did (1.8%). The survey therefore generally supports dropping intravenous AZT
from guidelines for the prevention of MTCT but shows that there may still be a
role for it where women have virological failure or present very late. In
addition, because there were still too few women not given intravenous AZT to make a
reliable recommendation, the researchers support its use in cases of
complicated delivery such as emergency caesareans.
Comment: This large study provides useful evidence for case management of women who are diagnosed late in pregnancy but should not
obscure the fact that the biggest contributor to reducing MTCT is to offer
antiretroviral therapy to all pregnant women and to ensure virological
Few HIV-negative gay men stick to one role, but they do attempt to ‘seroposition’
A US study, one of the first in that country
to examine which sex role gay men prefer in anal sex, has found that HIV-negative
men who are ‘versatile’, taking both insertive and receptive roles, have
considerably more unprotected sex than men who stick to one role.
found that 63% of gay men were versatile, 17% exclusively ‘top’ (insertive) and
10% exclusively ‘bottom’ (receptive). The other 10% did not have anal sex.
These figures are similar to UK
figures from the Gay Men’s Sex Survey of 2008, which found that 56% of respondents were
versatile, 18% top, 15% bottom and 11% did not have anal sex.
researchers comment that versatile men were more likely to pass on HIV than
single-role men – because they are more likely to acquire it through receptive
sex and then transmit it through insertive sex. This may be one reason why HIV
incidence is so much higher in gay men than in heterosexual people, even more than one would
expect from the relatively greater efficiency of anal sex in transmitting HIV.
also found, as some others have done, that younger men are more likely to take
the receptive role than older men; this is also a pattern that facilitates HIV
transmission, as seen in studies of
The study did
find that many gay men attempt to reduce the risk of HIV transmission by
‘seropositioning’. When the HIV-negative men in the survey had sex with a man
they knew to have HIV, they were 2.3 times more likely to be exclusively
insertive and 1.5 times more likely when they did not know their partner’s HIV
Comment: This study
interestingly confirms what other studies have found, but it is difficult to
derive a public health message from it, as HIV-negative gay men are unlikely to
switch roles immediately following diagnosis any more than they already do. HIV-negative
gay men already seem to be aware that it is safer to be ‘top’ with an HIV-positive or unknown-status partner. The study did find that such
‘seropositioning’ became less common in longer-term relationships, so the
advice that partners should make no decisions about dropping condoms before
both getting tested needs to be reinforced. See ‘One in five US gay men don’t test
while in a relationship’ above.
Young gay men catch HPV early in sexual history, but vaccine could still help
A study that followed young gay men for a
year found that infection with at least one variety of the human papillomavirus
(HPV) was almost more likely than not for those who had at least one anal sex
partner over the year.
found that fewer than one in five who did not already have the strains of HPV
associated with a higher risk of cancer (HPV 16 and 18) caught them during the
year and that none of the men studied had all four types of HPV that Gardasil, the vaccine currently used in
the UK, protects against.
researchers say their study reinforces the importance of vaccinating young gay
men before they become sexually active. “But”, they add, “the fact that most
young men who have sex with men (YMSM) appeared to remain susceptible to at
least some HPV types included in the vaccine show that catch-up immunisation
programmes do offer YMSM some benefit.”
study, of 94 gay men aged between 16 and 30 (median age 21), 70% had anal HPV
infection detected at some point, with 28% having HPV 16, the most common and
virulent cancer-causing type. Among men who did not already have HPV at
baseline, annual incidence was 47% – in other words there was a roughly 50/50
chance of them getting at least one strain of HPV within a year. However,
annual incidence of HPV 16 or 18 was only 18% (this compares with an annual
incidence of 7% for type 16 alone in young women in the first vaccine efficacy trials).
A recent study in older gay men, which we reported on in July’s HIV
prevention news: Europe bulletin, found that while 30% had HPV 16, only 5% were acquiring new
infections per year, so older gay men might benefit too.
Comment: This study not only
adds to the strong evidence that boys as well as girls should receive Gardasil before they start having sex, it also suggests that, because HPV
subtypes can be eliminated by the immune system but then re-acquired, the
vaccine might be useful for gay men
at any age, especially those with HIV who are much more likely to develop the
lengthy HPV infections that can end up as anal cancer.
PrEP acceptable to Kenyan gay men and sex workers, but stigma and gossip may be barriers
A qualitative study gauging the
acceptability of Truvada pre-exposure
prophylaxis (PrEP) in 66 Kenyan men who have sex with men (MSM) and five female
sex workers found that adherence was high (83%) in those who took a daily pill
and that participants were highly motivated to continue taking PREP, even
though some experienced initial side-effects.
who were randomised to an intermittent PrEP regimen, however (taking doses
every Monday and Friday and also two hours after sex), only had 55% adherence,
with the main difficulty being the post-sex dose, which only 23% of
participants managed to take. Participants pointed out that sex often happened
in the context of drink and drugs and they too often fell asleep afterwards to
take the post-sex dose.
also found that the biggest barrier to PrEP acceptability was the fear that
others would assume they had HIV if they saw them taking PrEP – a fear that was
borne out on some occasions, with one participant blaming PrEP for the break-up
of his marriage and another taking his wife to have an HIV test with him to
prove he did not have HIV. Participants suggested that Truvada for PrEP could be formulated to look clearly different from
the Truvada used for treatment.
Comment: This study confirms
that, as has been found in other studies, the barriers to taking PrEP are
largely social. On the other hand, it also shows that this extremely high-risk
study population – mainly MSM who often did sex work with men and also had sex
with women and were married – were happy to consider the idea of PrEP and in
some cases even believed that, by removing the fear of HIV, it also enhanced the
experience of sex.
Other recent news headlines
study of prescriptions of Truvada for
pre-exposure prophylaxis (PrEP) given out by doctors in the US has found that
PrEP recipients were more likely to live in the southern states, and were more
likely to be young and female, than people taking Truvada as treatment for HIV. About 2000 individuals, excluding
ones taking part in clinical trials, have so far been prescribed PrEP in the US
experience violence from their male partner are less likely to use condoms or
diaphragms, an international team of investigators report in the online edition
of the Journal of Acquired Immune Deficiency Syndromes. Intimate partner
violence increased the risk of condom non-use by up to 47% and non-use of
diaphragms by a quarter.
messaging did not help reduce early resumption of sex after male circumcision
(MC) in a large randomised, controlled trial conducted at twelve sites in
Nyanza province, Kenya.
However, the study did confirm a number of key risk factors for resumption of
sexual activity prior to wound healing, and also identified that men who
resumed sex before the end of the recommended period of abstinence were more
likely to have unprotected sex when they did so.
campaign promoting condom use and sexual health check-ups to gay and other men
who have sex with men in Scotland was recalled by 60% of the target group, but
there is no evidence that it had an impact on risky sexual behaviour. While researchers
did find that men with medium and high levels of exposure to the campaign were
more likely to test for HIV, it is difficult to show whether the campaign
caused this or men who tested more often were more likely to notice the
A qualitative study in three cities in Peru and
Ecuador has found that most gay men and transgender women asked thought that a
rectal microbicide formulated as a douche, rather than as a gel or lubricant,
might offer additional safety or efficacy. However, participants doubted the
practicality of such a formulation for use in sex away from home. The researchers also discovered that
some participants were already using a variety of homemade douching preparations
before anal sex, some of them potentially hazardous.
Editors' picks from other sources
from Eurekalert Medicine & Health
vaccine candidate developed by researchers at Oregon Health & Science
University appears to
have the ability to completely clear an AIDS-causing virus from the body. The
promising vaccine candidate is being developed at OHSU's Vaccine and Gene Therapy
Institute. The research results were published online today by the journal Nature.
See also this BBC report.
from Western University press release
A phase I clinical trial (SAV CT 01) of the first and only preventive HIV
vaccine based on a genetically modified killed whole virus (SAV001-H) has been
successfully completed with no adverse effects in all participants. Whole-virus
vaccines were seen as potentially dangerous but this phase 1 trial may clear
the way to further research into this approach, which could generate a broader
immune response than other HIV vaccine candidates.
Chronicle of an HIV Witch Hunt” is a 53-minute film that documents a 'witch hunt' that targeted HIV-positive
women in Athens.
During the run-up to a tense parliamentary election, and at a time of national austerity
and concern about rising HIV rates, the Greek health ministry took the decision
to round up, force test and publicly name, shame and prosecute a group of HIV-positive
women. The film examines the psychological impact of the stigma
forced on the prosecuted women and their families. At the same time, the
documentary sets out to deconstruct the social causes and political motives
that led to the operation.
from HIV Justice Network
The HIV Justice Network has released a new
documentary, More Harm than Good: How
overly broad HIV criminalisation is hurting public health, which had its
world premiere at the US Conference on AIDS in New Orleans on September 10th. Despite strong recommendations against overly broad
use of the criminal law by UNAIDS
and the Global
Commission on HIV and the Law,
the latest report from the Global Network of People Living with HIV and the HIV
Justice Network highlights that new laws continue to be proposed and enacted, and more
prosecutions are taking place than ever before
Researchers found that specially created Facebook social
media groups helped encourage men who have sex with men to reach out for
information about testing themselves at home for HIV. They
randomly assigned the participants to two different types of groups. One type
was led by people who sent information on HIV prevention and testing through
Facebook to their members. The other type was led by people who sent their
members information on maintaining a healthy lifestyle. Of the 57 men in the
HIV prevention groups, 25 requested at-home HIV tests and nine of those tests
were returned. In the healthy-living group, only 11 of the 55 men requested HIV
tests, with only two being returned.
See also this piece
for a critique of this study.
Free webinar: HIV prevention in people who inject drugs
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 prevention technology.
webinar is on HIV prevention in people who inject drugs (PWID), with a focus on
90-minute webinar will, it is planned, examine the epidemiology of HIV and TB
in PWID in eastern Europe; harm reduction policy, including needle exchange,
opiate substitution therapy and PrEP; HIV treatment access for PWID in eastern
Europe; and national programmes for PWID and how stigma works within them.
presentations will be followed by a question and answer session with our expert
speakers. The webinar will be conducted in English and chaired by Rebekah Webb
Because October is a busy month for conferences, the webinar will be
conducted later in the month than usual, at 2pm UK
time (GMT), 3pm European time (CET) on either Tuesday 22 or Thursday 24
October. Watch for more details on aidsmap or the AVAC website.