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VANCOUVER — The Globe and Mail
PublishedMonday, Jul. 14 2014, 8:35 PM EDT
The number of new HIV diagnoses in British Columbia has steadily declined in the past decade – but not for gay and bisexual men, who have shown no meaningful decreases and accounted for nearly two-thirds of new cases in 2012, according to a new report from B.C.’s provincial health officer.
Perry Kendall released the report, co-authored with Mark Gilbert from the B.C. Centre for Disease Control, on Monday, noting a complex interaction of societal and structural drivers has resulted in gay and bisexual men carrying a disproportionate burden of HIV in B.C. These include individual factors such as sexual behaviour and HIV testing, as well as outside factors such as stigma, marginalization, poor social supports and other systemic challenges to HIV prevention.
“While there has been considerable advancement in understanding and treating HIV, and related successes in reducing HIV incidence overall in B.C., existing programs and initiatives have not resulted in meaningful reductions in HIV incidence among gay and bisexual men since the early 2000s,” the report stated.
“This exposure group currently makes up the largest number and proportion of new HIV diagnoses in B.C. Renewing HIV prevention in B.C. requires working with gay and bisexual men to address the many drivers of the epidemic and making meaningful improvements in HIV prevention within this important exposure group.”
A lack of appropriate health care is one significant factor. The report noted gay and bisexual men face challenges in accessing appropriate and culturally sensitive health care; in 2011, 14 per cent of gay and bisexual men stopped seeing their health-care providers “because of his or her negative attitude toward their sexual orientation.” That same year, the online Sex Now survey found such men who were “out” to their care providers ranged from just 36.6 per cent (in North Fraser and Northern B.C.) to 84.8 per cent (in Vancouver’s West End).
While B.C. now offers highly active antiretroviral therapy (HAART) – a treatment that can totally suppress a viral load, reducing the risk of transmission to zero – Dr. Kendall noted that some doctors have difficulty recognizing the acute phase of HIV infections. This is when viral loads, and risk of transmission, are very high.
“This is why it’s for us to look at developing optimal times for routine testing and treatment in populations with a higher burden of illness,” said Dr. Kendall, who presented the report at a news conference on Monday.
The report also noted that while gay and bisexual men made up 57 per cent of new HIV infections in B.C. in 2011, only 10 per cent of Canadian health research grants went to prevention for that demographic.
Patricia Daly, chief medical health officer and vice-president of public health for Vancouver Coastal Health, lauded Vancouver’s routine HIV testing for sexually active adults, announced as part of B.C.’s larger STOP HIV/AIDS project, and said she hopes to see the program expanded.
“We have found that routine testing has picked up more new HIV cases – including among gay and bisexual men – than any other testing strategy, including targeted testing [high-risk patients],” Dr. Daly said. This strategy has picked up infections doctors and patients might have otherwise missed due to a perception of being low-risk.
“By simply routinely testing every adult patient as part of good health care, we are far more likely to pick up undiagnosed HIV infections than by only target-testing high-risk patients,” Dr. Daly said. “We have already found that that strategy has paid dividends in Vancouver. We hope to see it roll out in the rest of the province.”
Geneva (AFP) – HIV infections are rising among gay men in many parts of the world, the World Health Organization warned Friday, urging all men who have sex with men to take antiretroviral drugs to prevent infection.
Infection rates are rising again among men who have sex with men — the group at the epicentre of AIDS pandemic when it first emerged 33 years ago, he told reporters in Geneva.
While images of skeletal men dying of AIDS in the 1980s pushed the world to act, a younger generation that has grown up among new treatments that make it possible to live with HIV are less focused on the disease, he suggested.
Today, this group is 19 times more likely than the general population to be infected by HIV, Hirnschall said.
In Bangkok for instance, the incidence of HIV among men who have sex with men stands at 5.7 percent, compared to less than 1.0 percent for the overall population, he said.
In its new recommendations for combatting the HIV/AIDS pandemic, published Friday, the UN health agency therefore for the first time “strongly recommends men who have sex with men consider taking antiretroviral medicines as an additional method of preventing HIV infection”.
US authorities made the same recommendation in May.
Taking pre-exposure prophylaxis medication, for instance as a single daily pill combining two antiretrovirals, in addition to using condoms, has been estimated to cut HIV incidence among such men by 20-25 percent, WHO said, stressing that this could avert “up to one million new infections among this group over 10 years”.
The new guidelines also focus on other high-risk groups, pointing out that men who have sex with men, transgender people, prisoners, people who inject drugs and sex workers together account for about half of all new HIV infections worldwide.
- Putting overall progress at risk -
At the same time, they are often the very groups who have least access to healthcare services, with criminalisation and stigma often dissuading them from seeking help even when it is available.
When people fear seeking health care services it “will inevitably lead to more infections in those communities,” Rachel Baggaley, of the WHO’s HIV department, told reporters.
Globally, transgender women and injecting drug users, for instance, are around 50 times more likely than the general population to contract HIV, while sex workers have a 14-fold higher chance of getting infected, WHO said.
The world has overall been making great strides in tackling HIV, with the number of new infections plunging by a third between 2001 and 2012, when 2.3 million people contracted the virus.
And by the end of 2013, some 13 million people with HIV were receiving antiretroviral treatment, dramatically reducing the number of people dying from AIDS.
“Progress is however uneven,” Hirnschall said, warning that failing to address the still sky-high HIV incidence among certain groups was putting the overall battle against the deadly disease at risk.
Most countries focus the lion’s share of their attention on fighting HIV infections among the general populations, paying relatively little attention to the most high-risk groups.
This is especially true in sub-Saharan Africa, which is home to 71 percent of the some 35.3 million people worldwide living with HIV, the expert said.
Hirnschall stressed that tackling infections among the most at risk should be a general concern.
“None of these people live in isolation,” he said, pointing out that “sex workers and their clients have husbands, wives and partners. Some inject drugs. Many have children.”
Decriminalising and destigmatising these groups would greatly help bring down HIV infections among them, WHO said.
Promoting condom use, wide-spread voluntary HIV testing, treating at-risk individuals with antiretrovirals, voluntary male circumcision and needle exchange programmes figure among the other WHO recommendations for battling the disease.
Gay men who discuss HIV status with sexual partners are less likely to acquire HIV
Aidsmap reports on research which points to factors which lead to reduced risk of transmission.
This article by Roger Pebody first appeared on aidsmap.com here.
A case-control study, examining the sexual behaviour of German gay men receiving HIV-negative and HIV-positive test results, identified two key factors which distinguish the groups – consistent condom use with casual partners and discussing HIV status with partners.
The results, recently published in BMC Public Health, lend some support to the idea of serosorting (choosing a partner who has the same HIV status), but only when HIV status is ascertained through a clear and unambiguous conversation. Men who didn’t use condoms because they assumed their partner was HIV negative had a greater risk of acquiring HIV than other men.
This was a case-control study – in other words, an observational study in which a group of people with an infection (called ‘cases’) are compared with a group of people without the infection (called ‘controls’). The past events and behaviour of the two groups are compared in order to help us understand the risk factors for acquiring the infection.
Cases were gay men who attended one of a variety of HIV testing facilities in Germany, were diagnosed with HIV and who were determined to have acquired their HIV infection within the previous five months (based on a Recent Infection Testing Algorithm or RITA). Controls were gay men who took an HIV test and received a negative result, matched to the cases on the basis of their age and country of birth.
Information about the sexual behaviour of cases and controls was collected before receiving HIV test results.
Data were collected between 2008 and 2010. There were 105 cases and 105 controls, who had an average age of 34 years. Nine out of ten were born in Germany and they were generally well educated.
There were numerous variables for which no differences were observed between cases and controls:
However some behavioural factors did distinguish cases (men who acquired HIV) from controls (men who did not) in the first analysis.
More cases (22 men) than controls (10 men) reported having been in a relationship of less than six months duration, and cases were also less likely to be in a relationship lasting more than a year. This points to the risks of HIV transmission during the early stages of romantic relationships.
While equal numbers of cases and controls had only had one sexual partner in the past six months (14 men in each group), average partner numbers were higher for cases (mean 11.8 partners, median 5) than controls (mean 6.6, median 4).
Whereas 60 cases reported having unprotected anal intercourse with a partner of unknown HIV status, this was only reported by 36 controls. There was a marked difference in terms of having unprotected receptive anal intercourse with a partner of unknown status (reported by 43 cases and 18 controls). Cases were also more likely to report inconsistent condom use outside of a primary relationship, with partners met online and with acquaintances.
Moreover, cases were less likely to report ‘always being safe’ with non-primary partners – in other words, consistent condom use or no anal sex. This was reported by 9 cases and 30 controls.
As can be seen only a minority of participants – including the controls – reported consistent condom use. When asked why condoms hadn’t been used on the last occasion of unprotected sex, many responses did not differ between cases and controls. For example, men in both groups said that they hoped nothing would happen, that condoms would have disturbed the mood, or that condoms caused erection problems.
However not using a condom because the respondent had assumed his partner was HIV negative was reported by more cases (25 men) than controls (8 men). Furthermore, while relatively few men said that they didn’t use condoms because they had talked to their partner about HIV status, this was reported much less frequently by cases (3 men) than controls (16 men).
The key results come from the multivariable analysis, which uses statistical techniques to identify the most important factors associated with HIV infection. Only two variables remained statistically significant. Demonstrating the continued relevance of consistent condom use, men who reported ‘always being safe’ were less likely to be diagnosed with HIV (odds ratio 0.23, 95% confidence interval 0.08 – 0.62).
In addition, men who did not use condoms having previously talked to their partner about HIV status were less likely to be diagnosed with HIV (odds ratio, 0.18, 95% confidence interval 0.05 – 0.71).
“One of the key findings was that having an explicit conversation about HIV serostatus before sexual activity reduces the risk of acquiring HIV,” conclude the researchers. “This might be attributable to the mode of serostatus communication: namely a direct and explicit conversation might be protective, whereas other ways of serosorting, such as relying on online profiles, or guessing/assuming HIV status based on appearance, might be much less effective.”
Santos-Hövener C et al. Conversation about Serostatus decreases risk of acquiring HIV: results from a case control study comparing MSM with recent HIV infection and HIV negative controls. BMC Public Health 14:453, 2014. (Full text available freely available here).
Watch a short documentary explaining the events that led up to the AIDS crisis. “The Fight Continues” examines prejudice and homophobia — topics as relevant now as they were in 1981 when the AIDS crisis began in the US. Created by the Director and Executive Producer of the HBO film The Normal Heart, Ryan Murphy.
New campaign from the CDC!