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HIV Incidence

HIV incidence among gay and bisexual men shows no meaningful decrease

VANCOUVER — The Globe and Mail


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.

“We are seeing exploding epidemics,” warned Gottfried Hirnschall, who heads WHO’s HIV department.

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.


Campground Testing

Once again Men4Men is pleased to offer anonymous HIV testing at Cedars Gay Campground this summer!

Our of the clinic and into the bush. No appointment required and you get the result in seconds.

Men4Men & The AIDS Network wish you a safe and happy

World Pride 2014!

Research Roundup

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.

Gay men who discuss HIV status with sexual partners are less likely to acquire HIV

This article by Roger Pebody first appeared on 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:

  • Education.
  • Knowledge of HIV transmission risks during different sexual acts.
  • Recent HIV testing.
  • Recent diagnosis of a sexually transmitted infection.
  • Being single.
  • Inconsistent condom use in a primary relationship.

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).

The beginning of an important conversation in our community

The Fight Continues

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!


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