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Preparing for National HIV Testing Week
second National HIV Testing Week will run from Friday 22 to Friday 29 November
2013, promoting testing amongst the country’s most at-risk populations – gay men
and African people.
briefing document explains the rationale behind National HIV Testing Week,
as well as how you can get involved and support the event in your area. The
briefing describes what is being produced to support the event, including the
next phase of HIV Prevention England’s It
Starts With Me campaign.
To support engagement with different stakeholders, separate
briefing documents have been created for clinicians,
faith leaders and Muslim
All organisations in HIV and sexual health, including
clinics, community and statutory bodies, are invited to get involved by setting
up their own activities.
Who will take PrEP?
pre-exposure prophylaxis (PrEP) is adopted and proves to be an effective HIV
prevention method depends crucially on people’s subjective assessment of
whether they are at risk of HIV, and their cultural and moral beliefs about
whether they should take it, a London conference recently heard.
Screening tools to identify people who would benefit from
PrEP may need to be developed, as people are not always very good at estimating
their own risk. For
example, one study showed that one-in-seven gay men considered themselves at
increased risk of HIV infection, while an ‘objective’ assessment used by
researchers found that three-quarters of the men were at increased risk.
Taking PrEP each day requires people to anticipate that they
will need extra protection from HIV, but with condoms frequently presented as
being 100% effective and with non-condom use highly stigmatised in certain
contexts, acknowledging that risk may be challenging for some individuals.
Perceptions of PrEP may change over time and with experience.
Doctors in San Francisco report that people taking PrEP perceive advantages
including decreased anxiety about transmission, increased communication and
disclosure to partners, more intimacy and trust, greater sexual pleasure, and an
increased sense of self-efficacy. Disadvantages included feeling stigmatised because
of PrEP’s associations with HIV or with risky sex, and negative attitudes from
some healthcare workers.
An international conference on vaccine research took place
this month, and scientists
were remarkably optimistic about the prospects for eventual development of a
vaccine. In particular there was excitement about
a vaccine studied in monkeys which uses a common virus called cytomegalovirus (CMV)
as the vehicle for delivering inactive proteins from the monkey equivalent of
HIV. This vaccine did not prevent
infection, but almost half of vaccinated monkeys controlled the infection or
cleared it altogether.
A vaccine which showed a modest protective effect in a human
study in Thailand
is now being tested in larger trials to see if the level of protection can be
improved. If this vaccine, RV144, proves
effective in these trials, it might be licensed for use in some populations by
2022. To be put forward for marketing approval, trials would have to show that
the vaccine was safe and that it reduced the risk of infection by at least 50%.
Further clinical trials of vaccines will be needed to
develop vaccines with higher levels of protection. In fact, two vaccine trials
being conducted by Imperial College London are currently looking for potential
participants. In the first trial, three different vaccines that have all been
previously tested will be given in combination, by injection on two different
schedules. The other trial tests different ways of delivering a previously studied
Trial participants need to be HIV negative, aged between 18
and 45, and fit a number of other criteria. For more details, visit the ‘Help
Make History’ website.
Diagnosing acute HIV infection
in Vancouver, Canada, have demonstrated that a large increase in the diagnosis
of acute (very recent) HIV infection can be achieved.
The clinicians began using pooled RNA (viral load) tests
alongside traditional tests. These tests are used when screening blood donors
and can identify infections sooner than antibody or p24 tests.
They also ran two social marketing campaigns, raising
awareness of new testing technologies, the increased risk of HIV transmission
during acute infection and the importance of testing when beginning a new
relationship. The campaigns did not focus
on describing seroconversion symptoms.
The policy change resulted in a significant increase in the
number of men diagnosed with acute infection. The researchers believe the
campaigns played a role in encouraging men to test more frequently.
The new testing policy was only implemented in clinics which
diagnose large numbers of gay men, and was particularly effective in one
community-based clinic – this site diagnosed one third of the acute infections
The research highlights an approach which may reduce rates
undiagnosed acute infection. This is vital as viral loads are exceptionally
high during the first few weeks of infection and individuals may be continuing
with the risk behaviour which led them to acquire HIV in the first place. After
diagnosis, prevention interventions such as partner notification and immediate
antiretroviral therapy can be offered.
new models of female condoms are being introduced and it is hoped that the
wider choice may encourage policy makers and health providers to improve the
availability of female condoms, giving women more options.
The first model of female condom, the Femidom, was introduced in 1993, replaced in 2007 by an improved
version that is softer and less noisy. Other manufacturers have now developed
several alternative versions that have varying features, shapes, materials and
degrees of lubrication.
A study comparing four different models found that each had
a low rate of failures such as the device breaking or slipping out of the
vagina, or the penis being inserted between the condom and the vaginal wall.
The models were also highly rated by the women using them, in terms of their
feel and ease of use.
All four models have received the European Union’s CE mark
(i.e. they meet EU safety, health and environmental requirements), so could be
used in the UK.
One of the key barriers to more widespread use of female condoms in the UK has been the
absence of programmes to promote and distribute them.
Interventions which encourage heterosexual people to find a
condom which suits them (in terms of size, shape and material) need to raise
awareness of female condom options.
progressing on new ways to deliver antiretroviral (ARV) drugs in order to
prevent infection. Whereas the drugs may be taken as tablets (pre-exposure
prophylaxis or PrEP), it’s also possible to provide the drugs as a cream or a
gel (a microbicide). And new studies have highlighted the possibility of
providing antiretroviral drugs in a vaginal ring.
flexible vaginal rings are already used to deliver hormonal contraceptives. An
important advantage is that they only need to be inserted once a month, which
makes adherence much easier.
ongoing into a variety of different rings. In particular, two phase III randomised control
assessing the efficacy of a monthly ring containing the non-nucleoside reverse
transcriptase inhibitor dapivirine. Earlier-stage research is looking into rings which provide both an antiretroviral and
results were released from an animal
study showing that
a vaginal ring containing tenofovir protects against infection, including when
hormonal contraception was also used.
Also, a study with American women showed that the rings were easy to
use, with four-in-five women saying that they would use them if they were
Another future possibility is an
monthly or every three months.
Gay men’s risk profiles
study from Montreal, Canada, suggests that HIV-negative gay men adopt many
different strategies of varying effectiveness to regulate their risk of HIV
infection. Individuals employed various combinations of condom use, serosorting,
viral sorting, negotiated safety, HIV testing and post-exposure prophylaxis (PEP).
analysis identified five different ‘risk profiles’, some of which put men at
higher risk of infection than others. For example, around half the men fell
into one profile in which individuals had relatively few partners and high
rates of condom use, and mostly avoided partners known to have HIV.
another group rarely had sex with known HIV-positive partners, but frequently
had unprotected sex with partners of unknown HIV status, so had a high risk of
being exposed to HIV.
Men in a
third group reported having more partners and more sex with men known to have
HIV. They appeared to pay attention to their partner’s viral load, using
condoms if it was detectable, and sometimes having unprotected sex if it was
undetectable. But they risked HIV infection by also having unprotected sex with
partners of unknown HIV status.
researchers said that prevention messages and the approaches taken by health
professionals need to take account of this diversity – one size does not fit
Other recent news headlines
There has been considerable publicity in the gay, scientific
and general media recently about so-called ‘slamming’ or ‘slam parties’,
defined as group sex parties where gay men take drugs such as methamphetamine
or mephedrone, often by injection, in order to facilitate prolonged sexual
activity. Needless to say, these reports have created considerable alarm about
the possibility of a new gay subculture that may amplify the spread of HIV and
hepatitis C, and anecdotally, the large majority of gay men attending support
services for drug users in London
now report injecting.
Late diagnosis of HIV remains a serious problem across Europe, results of a large study published in PLOS Medicine show. The research
involved approximately 85,000 people diagnosed with HIV between 2000 and 2011
in 35 European countries. Overall, 54% of patients were diagnosed late and a
third presented very late. There was a fall in the proportion of people being
diagnosed late, but in 2010/11 over half of patients were still presenting for
care with a CD4 cell low enough to warrant immediate antiretroviral therapy.
half of HIV-positive people in the United States are not receiving
prevention counselling as part of their routine care, results of a study
published in the online edition of AIDS
show. “We found that less than half our clinic-based sample reported receiving
individual-level HIV/STD prevention counseling from healthcare providers,”
comment the authors. “Exposure to individual-level prevention counseling from
prevention program workers and to small group interventions was even lower.” The
investigators believe their findings highlight “missed prevention
Editors' picks from other sources
from National AIDS Trust
expensive overhaul of the way all patients will access the NHS is being
proposed despite the Department of Health acknowledging that they do
not know the
scale of the problem of ‘health tourism’, or even how many migrants are
being charged under the current system.
from New Yorker (blog)
of PrEP has been slow. According to Dawn Smith of the CDC at least
half a million Americans are good candidates for PrEP – meaning that they
are at high risk for contracting HIV through sexual activity – yet only
a few thousand Americans are receiving the treatment.
from Incidence 0
community awareness, late and superficial institutional support, and
cost-effectiveness issues paint a bleak future for pre-exposure prophylaxis (PrEP) in the UK.
from NICE press release
of thousands of people across England and Wales inject drugs like
heroin and anabolic steroids each year, with others turning to botulinum
toxin products or other cosmetic injections like tanning agents. Now,
the National Institute for Health and Care Excellence (NICE) is updating
its guidance on how best to provide needle and syringe programmes to
encourage people who use these drugs to access other health services and
prevent the spread of bloodborne diseases like HIV and hepatitis C. A
consultation has begun on the provisional update so organisations can
have their say.
Major studies support circumcision as prevention in Africa but a small yet vocal group argues the science is flawed.