Tag Archives: AIDS

Mental Health’s Influence on HIV Prevention

The HIV epidemic has changed a lot within the past 20 years, and still yet, continued high risk behaviors have remained the same.  Contributing factors to these behaviors include a lack of power or oppression, marginalization, sexual abuse, sexual compulsivity, low self esteem, depression, and loneliness.  These are not issues that can be fixed quickly.  Addressing these issues requires effort and time and may extend beyond the capabilities of many HIV programs for prevention.

An important thing learned from HIV prevention research is one size doesn’t fit all. Programs require different components that address the various different needs of clients.  Increased access to syringes for people who inject drugs, and condoms to those who have sex are necessary to win the battle against HIV.  Skill building and increasing knowledge about HIV are good methods for prevention, but they don’t work for everyone.  For most, the obstacles related to behavior changes involves dealing with mental health problems.

What people experience and what they do have effects on their mental health. Substance abuse and use (even when the drugs are not abused), marginalization, poverty, and discrimination are all serious factors that can have a big impact on one’s mental health and can place some people at a higher risk for contracting an HIV infection.

Mental Health's Influence on HIV Prevention

Do Issues with Mental Health Affect HIV Risk?

Yes. When someone decides to engage in a risky drug or sexual act, it doesn’t always occur due a consciously made decision.  Instead, these decisions are sometimes based on an attempt to get satisfaction for another need related to a mental health condition. For example:

  • Low self-esteem: For many men who have sex with other men (MSM), internalized homophobia and low self-esteem can impact their risk of of contracting HIV.  Internalized homophobia is a feeling which results in a person having a lack of self-acceptance, feeling unhappy, or self-condemnation for being gay.  In one study, it showed that men who did test positive for HIV were the ones that were in fact the ones that experienced internalized homophobia.  These men seemed to spend less time with others who lived the same lifestyle, and they also showed less satisfaction in their relationships.
  • Male to female transgender persons, also known as MTFs, identify depression, rejection, feelings of isolation, and low self esteem as barriers to risk of HIV reduction.  Many MTFs state that they take part in unprotected sex because it verifies their identity and helps boost their self esteem.
  • Post traumatic stress disorder:  People who are diagnosed with PTSD seem to partake in high-risk sexual behaviors.  One study showed that 59% of the women who were HIV positive had full PTSD due to traumas, such as rape, assault, or witnessing a murder. Non-violent traumas including serious accidents, loss or children, or homelessness.  Still yet, these women were not being treated for PTSD.  A national study performed on veterans found that substance abusers who had PTSD were more than 12 times as likely to be HIV infected than those veterans who were not suffering from PTSD or substance abuse.
  • Depression and anxiety: Those suffering from depression and anxiety are more likely to take part in high- risk sexual activities, such as substance abuse, including injection drug use, prostitution and choosing a high-risk partner.  A study following city youths for over a several year time period found that the change in risk behaviors wasn’t associated with access to information, counseling or knowing someone had AIDS.

What can be done?

As you can clearly see, mental health conditions by far increase risky sexual behaviors.  In order to address mental health issues, it is important that a person visit an individual therapist or counselor, as well as a physician to be put on appropriate medication(s). It’s also important for such people to have access to structural and community level programs that address mental health needs and HIV.

Individuals with HIV Age 14 Years Faster, According to Study

A diagnosis of HIV is no longer the death sentence it used to be; we’ve come a long way. However, there is a new study that was published in PLOS One that shows that although HIV positive individuals are typically living longer, they may be aging more quickly than expected. The study shows that those with HIV are at a greater risk of age-related diseases including kidney disease, frailty, osteoporosis, neurocognitive disease and some cancers.

Researchers are not pointing to the medications used to treat HIV as being the reason for faster aging; they think it’s HIV itself and that it speeds the process by 14 years.  Scientists from the Multi-Center AIDS Cohort Study and the UCLA AIDS Institute and Center for AIDS Research looked at whether HIV induced epigenetic changes that are age-related, meaning those changes to the DNA that do not change the genetic code, lead to changes in expression of genes. These types of transitions are triggered by the aging process itself or environmental factors.

Individuals with HIV Age 14 Years Faster, According to Study

One of the study’s senior authors, Beth Jamieson, professor of medicine in the division of hematology/oncology at the David Geffen School of Medicine at UCLA, director of the UCLA Flow Cytometry Core said, “While we were surprised by the number of epigenetic changes that were significantly associated with both aging and HIV-infection, we were most surprised that the data suggests HIV-infection can accelerate aging-related epigenetic changes by 13.7 to 14.7 years.”  There is published data and anecdotal evidence that lines up with this number. It suggests that treated HIV positive adults may develop age-related diseases, about a decade sooner than those who are uninfected.

The study looked at 96 samples of white blood cells from both young and old HIV patients before they began Antiretroviral Therapy (ART). DNA was then extracted and looked at for changes. When studied, there was a lot of overlap when the pattern of changes was compared to the pattern connected with aging. After extrapolating the biological ages of the HIV positive patients, researchers found that the patients were 14 years older than their actual age on both a cellular and physiological level.

Researchers say that this data suggests that HIV speeds up some aspects of the aging process, and there are common mechanisms found in both HIV-related aging and general aging. They consider the results of the study to be an important start in the attempt to find therapeutic approaches to mitigate the effects of HIV and aging.

Gay Men “Serosort” to Prevent Contracting HIV

One study in Seattle showed that approximately 40 % of men who are HIV negative make sure to only have sex with others who share their serostatus in order to attempt to prevent contracting the virus. A similar German study found that 10 percent of HIV positive gay men believe they are noninfectious if they have a viral load that is undetectable. Both studies’s results were presented at the Conference on Retroviruses and Opportunistic Infections (CROI) in Boston.

In Seattle, two different questionnaires that included 1902 gay men accessing an HIV/ STI clinic between February and August of 2013,  were conducted by researchers.  The first one asked questions about their recent sexual behavior.  For example, the HIV status of their partners, what role they played during sex, whether they use condoms, and other topics were brought up. The second questionnaire asked about what they did to reduce their risk of HIV.

Both questionnaires were completed by a total of 964 people, including 835 (87%) who were HIV negative and 129 (13%) who were HIV positive. Forty-two percent of HIV negative men were strict serosorters; they reported to only have sex with other HIV negative men (with or without a condom). Thirty-nine percent of these men said this was a deliberate strategy. A total of 6.5% practiced condom serosorting, which means they only  reported  having sex without a condom with other HIV negative men. 5.2% said this was deliberate. Lastly, 7.1 % were seropositioning, which means they only had condomless sex if they were the top, no matter their partner’s HIV status; 6.5% said this was a strategy.

Gay Men "Serosort" to Prevent Contracting HIV

Thirty-two percent of HIV positive men were strict serosorters, 25% of them doing this deliberately. Eleven percent engaged in condom serosorting and 10% in seropositioning.

In the German study presented at CROI, researchers asked 269 gay men who were HIV positive about whether they thought they could infect somebody if they had a viral load that was undetectable.  Ten percent of this group thought they were noninfectious, with a fully suppressed virus and they held this belief when making choices about sex.  Of these viral sorters, 57.5 %  reported condomless sex,  compared with 36% of men who were not viral sorters. Nineteen percent of the viral sorters said that recently they told someone about their status, while 22 % had not discussed HIV recently at all.  On these two counts, the respective figures for the rest of the men were 42% and 44%.

An HIV Cure is Still a Long Way Away

Though HIV treatment today is better than at any time in the past, challenges remain.

We have antiretroviral therapy (ART) today which can help HIV patients lead a normal life. But this requires lifelong care. What’s more ARTs are expensive and compliance with the drug remains an issue for many patients. Besides medications that can control the virus, the case of the “Berlin Man” or Timothy Brown encourages researchers. In 2007 Brown went for leukemia treatment. He received a transplant of hematopoietic stem cells. These are all the cells associated with blood. But the donor these cells came from had a rare genetic disorder, which proved to make Mr. Brown HIV resistant. To date there is no sign of HIV in Brown’s body. He no longer has to take antiretroviral drugs. Despite this, there are still many challenges in curing HIV.  In fact, the task is more complex than researchers first imagined.

An HIV Cure is Still a Long Way Away

Though scientists are able to halt the virus’s replication, it continues to be able to hide out in the body, in what are known as HIV reservoirs. It can attach its DNA to a cell’s genome, and continue on in long living cells, such as CD4+T cells found within the immune system. One recent study suggests that the HIV virus can be kicked out of their hiding places and neutralized. Another study found a way to snip HIV’s DNA out of a cell’s genome.

A recent John Hopkins University study found that these latent reservoirs are 60 times more prevalent than previously thought.  ARTs are not only a method of controlling the virus but also preventing it. Many health experts say ARTs should be more widespread to prevent the virus, particularly amongst at-risk populations. Now that researchers understand the challenges they face more clearing in locating HIV reservoirs, extracting the virus and it’s DNA, they can now develop better methods and someday a cure.

New Aggressive HIV Strain Discovered in Cuba

An aggressive, new strain of HIV has been discovered in Cuba.

One which has the ability to develop into AIDS within three years of infection. There is worry that this particular strain’s accelerated progression is so rapid that antiviral treatment may come too late, according to researchers. This study was prompted by the fact that Cuban doctors were reporting an ‘increasing trend’ of AIDS cases that were rapidly progressing.

Without any form of treatment, it usually takes HIV approximately 5 to 10 years to advance to AIDS. This happens more quickly if a patient has an already suppressed immune system. In the case of patients in the study in Cuba, there was a significantly faster advancement. The study found that within three years, patients with the mutated strain developed AIDS. It is often the differences in patients pre-existing immune system differences, not the subtype of HIV, that plays a role in AIDS development. Yet, it was obvious in this study that the specific type of HIV played a major role in the quick advancement.

New Aggressive HIV Strain Discovered in Cuba

When the researchers took a closer look, they found that the patients with quick advancing HIV were linked by their variant type of HIV. This new variant-HIV was discovered to be a new recombinant subtype made up of subtypes A, D, and G. It has been named CRF19. One researcher in the study, Prof. Anne-Mieke Vandamme of Belgium University-Leuven, explained how this variant accelerates the AIDS process:

“There are two types of co-receptors that HIV can use: CCR5 or CXCR4. And, in the normal progression of the HIV to AIDS it often happens that the virus switches co-receptor. It almost always starts with using CCR5 and then it switches to CXCR4 after many years. And once it switches the progression to AIDS goes very fast”.

The inclusion of subtype D may be a key in the CRF19 strain’s aggressiveness, according to researchers. Subtype D has an enzyme that allows HIV to produce in higher numbers and uses proteins that it takes from other subtypes, in new virus particles.

ART soon after HIV Infection Lowers AIDS Outcome

Researchers studying military service members and their beneficiaries found that those who started antiretroviral therapy (ART) shortly after HIV transmission were 50% less likely to develop AIDS.

They were also more likely to see their CD4+ T-cells return to normal levels. CD4+ T-cells are immune system sentries that guard the body against infection. Researchers reported other immune system benefits as well as more active T-cells, improved immune response to pathogens and a better response to vaccinations, particularly for hepatitis-B.

A 2013 study found that a normal T-cell count is considered over 800 cells per cubic millimeter. Researchers found two things favored a positive response by the immune system, if ART was started within the first year of infection and if the patient’s T-cell count was at 500 cells per cubic millimeter or above.

ART soon after HIV Infection Lowers AIDS Outcome

Researchers at the School of Medicine at The University of Texas Health Science Center, in conjunction with the Veterans Affairs (VA) Research Center for AIDS, the VA Center for Personalized Medicine and the Uniformed Services University of Health Sciences, conducted the study. The results were published in JAMA Internal Medicine. The data from 1,100 service members from all branches of the military and their beneficiaries who had contracted HIV was utilized.

Professor of medicine, microbiology/immunology and biochemistry in the UT School of Medicine Sunil K. Ahuja, M.D. led the study. He said that the immune system is best reconstructed when ART is administered soon after infection, regardless of the CD4+T-cell count.  Since the drug cocktail administered today is so potent, it can easily stifle HIV right from the beginning.

A targeted public health strategy including periodic testing, particularly for those who are at high risk and administration of ART soon after infection should help stem the spread of HIV and give those infected a better chance at a normal life.

Clearing up Some Myths about HIV

Myths about HIV are all too common, especially in connection with the LGBT community. It’s important to keep in mind that the myths and facts here are written in the context of the United States.  The circumstances and realities are different in other countries.

HIV is a gay person’s disease

HIV is not a disease that only LGBT individuals acquire.  Unfortunately, rates of infection are higher in the LGBT community. Labeling it as a “gay” disease is a damaging stereotype and not medically true.

Contracting HIV is a death sentence

HIV is a serious and chronic medical illness, but not a death sentence.  Currently, there are a lot of advances in HIV treatment and it’s possible to live a fulfilling, healthy and long life.  Those living with HIV who take their medication as directed can reduce the risk of passing the virus by up to 96 percent.

I don’t have to worry about HIV

Many individuals are at risk for HIV, even from new infections that are occurring in higher rates in communities.  HIV is very treatable and people are living better with it, but it’s still extremely important to practice safe sex.  Communication with potential sexual partners is crucial, too.

It is possible to tell that someone has HIV by looking at them

This is untrue.  There is no way.  In fact, some people have HIV for over 10 years, never showing any symptoms or signs.  For this reason, it is incredibly important to be honest and communicate with potential sex partners.

HIV testing only needs to be done once every year

This is not enough for some people, especially those who have a lot of high-risk sex and/or use injection drugs.  The center for disease control recommends testing every three to six months. And, it sometimes takes up to three months for HIV to appear in many tests.

Clearing up Some Myths about HIV

If my relationship is monogamous, I don’t need to get tested

Recent estimates indicate that 68 percent of new HIV infections among bisexual and gay men occurred when they were in a monogamous relationship.  Make sure to speak with your partner about your sexual health.

It’s impossible to stay HIV negative if you have sex with someone who’s HIV positive

This is not true. There are actually many “mixed-status” couples (one with HIV, one without) who have healthy, lifelong sexual relationships without ever transmitting HIV.  Those with HIV are stigmatised and it’s assumed that no one should be with them sexually.  This is medically untrue.  One can also reduce their risk of HIV with pre-exposure prophylaxis (PrEP).

HIV is irrelevant to those who are HIV negative

It doesn’t have to be and really isn’t.  You can be an ally, educator and supporter of those who are HIV positive.  It’s very relevant!

 

Berlin Patient Rids Self of HIV, Researchers Attempt to Discover How

According to a new study, researchers are closer to figuring out how Timothy Ray Brown, the only human cured of HIV, beat the virus.

There’s not a definite answer provided by the study, but it does rule out one explanation. Brown is one of the most studied cases in the history of the HIV epidemic. He learned that he had developed acute myeloid leukemia, in 2006, after living with the virus for 11 years and controlling his infection with antiretroviral (ARV) drugs. The leukemia does not have any known connection to HIV treatment or infection.

The next year Brown, who was living in Berlin at the time, received the first of two bone marrow transplants, after chemotherapy failed. He stopped taking his ARVs. Usually when an HIV infected person stops taking their ARVs, the level of HIV increases rapidly, within weeks. But researchers kept track of Brown’s blood over the past 7 years and have found only trace amounts of the viral genetic material that cannot replicate.

"Berlin Patient" Rids Self of HIV, Researchers Attempt to Discover How

There are different factors that are possible, according to today’s researchers, that could have rid Brown’s body of HIV, either independently or in combination: The process of conditioning in which Brown’s immune system was destroyed with chemotherapy and whole body irradiation in order to prepare him for the bone marrow transplant. His oncologist, Gero Hütter, who at the time was with the Free University of Berlin, thought he might help rid Brown’s body of HIV as well as cure leukemia.  Hütter found a donor who had an unusual mutation in a gene that cripples a key receptor on white blood cells the virus uses to start an infection.

Another possibility is that Brown’s immune system attacked remnants of his old one that housed HIV-infected cells. This is a process known as graft-versus-host disease.

An unusual monkey experiment was designed to test these possibilities in a new study led by immunologist Guido Silvestri of Emory University in Atlanta. The study leaves open the chance that the graft-versus-host disease played a central part in Brown’s cure, even though it showed that conditioning itself will not likely eliminate an HIV infection. Unlike two of Daniel Kuritzkes’s (not connected to the research) patients, and Brown, transplanted monkeys in the experiment received their own stem cells that didn’t prompt a graft-versus-host response.

“At the end of the day that might be an important component,” Silvestri said. He also believed it might help if the reservoir size was reduced to treat monkeys with ARVs for longer than a few months. He hopes to conduct experiments with monkeys that test different variables that would include transplanting the animals with viral-resistant blood cells that act like the ones Brown received.

Steven Deeks, a researcher and clinician at the University of California who has treated and worked with Brown, is confident the team will find an answer. “The best scientific studies raise as many questions as answers,” said Deeks

 

Gay Men’s Health & Healthcare Providers

Have you ever had a healthcare provider who didn’t understand you?

Maybe you just didn’t feel comfortable with him, or maybe she was outright rude. Either way, having an open relationship with your physician is extremely important. Aside from the fact that you don’t want to work with someone looking down their nose at you, being able to raise concerns and discuss health issues openly and honestly is a major contributor to your long-term health.

As a gay man, there are a couple of issues that are particularly important to discuss with your healthcare provider.

Gay Men's Health & Healthcare Providers

#1 HIV/AIDS

Men who have sex with men are at disproportionately high risk for contracting HIV, in addition to other sexually transmitted infections. Many infections may not initially show symptoms so following up regularly for check-ups and discussing your sexual practices with your physician may end up making all the difference in the long run. Many healthcare providers are also able to provide you with other resources and referrals – when it comes to your doctor, it’s always good to talk!

#2 HPV

The serious effects of HPV have only recently hit the forefront of health news. HPV has many strains, but it is mostly known for being the virus that causes genital warts. Genital warts are generally easy to treat, your healthcare provider can prescribe a removal cream, or, if needed, laser treatment. The concern with HPV isn’t the genital warts as much as it is cancer. Unfortunately, there aren’t many other symptoms of HPV to warn you, but the virus is now being linked to increased levels of anal and oral cancer. Oral sex can transmit HPV to the mouth and throat, causing problems in the long run. The virus is also transmitted through anal sex, possibly causing anal cancer. While this is difficult to test in men, keep up to date with your check ups.

If you are a sexually active man, find a healthcare provider that you are comfortable with and check in regularly. Reach out to a professional today!

HIV Becoming Less Virulent, Lowering Risk of AIDS

Usually, the evolution of a disease spells bad news, but recent changes have made it more difficult for the virus to overwhelm the body and develop into AIDS, according to a new study.

Researchers concluded that widespread access to antiretroviral drugs has caused the virus to become less “virulent.” This was a joint effort by researchers from many countries around the world Japan, South Africa, Canada, and America. Scientists from Microsoft and Harvard University took part. The study appeared in in the journal Proceedings of the National Academy of Sciences.

Research was conducted in Botswana and South Africa, two of the countries hard hit by the epidemic. Over 2,000 infected women from these countries were selected for the study. The first leg looked at HIV-immune system interaction. It was here that researchers determined that the virus is becoming less virulent.

HIV Becoming Less Virulent, Lowering Risk of AIDSInvestigators looked closely at the participants human leukocyte antigens (HLA), a specific protein found in the blood. These help the body determine which proteins are from pathogens and which come from normal human cells. Those who have the gene HLA-B*57 are known to have a special genetic “protection.” The gene slows the spread of HIV by making it more difficult for the virus to replicate.

The authors of this study illustrated that gene adaptations are “driving down the virulence of transmitted HIV and is thereby contributing to HIV elimination.”

The second leg of the study investigated the impact ARVs are having on the epidemic, which they found to be significant. Oxford University professor Phillip Goulde, lead researcher on this study said, “This research highlights the fact that HIV adaptation to the most effective immune responses we can make against it comes at a significant cost to its ability to replicate. Anything we can do to increase the pressure on HIV in this way may allow scientists to reduce the destructive power of HIV over time.”

Head of Infection and Immunobiology at the Wellcome Trust Dr. Mike Turner said, “The widespread use of ART is an important step towards the control of HIV. This research is a good example of how further research into HIV and drug resistance can help scientists to eliminate HIV.”