Tag Archives: prevention

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.

6 Major Reasons We Need to Rethink HIV Prevention

Many HIV prevention campaigns rely on appealing to our emotions, but are not taking a good look at the HIV research and information available. Read on to see why we should rethink HIV prevention.

60 Percent of young people with HIV do not know their status
According to the Centers for Disease Control (CDC), 60 percent of young individuals have no idea that they have HIV. Some men and women who are HIV negative think that it is too big of a risk to be with someone who discloses that they are HIV positive, yet they might go on to have sex with someone who believes they’re HIV negative, but hasn’t been tested to verify. Those undiagnosed carry a higher viral load than those who are aware of their status and on treatment.

91 percent of new HIV transmission happen by those who are not diagnosed or haven’t been treated
This statistic comes from a new study released by JAMA Internal Medicine. In 2009, there were more than 1.1 million people living with HIV; of these people 207,600 were undiagnosed and 519,414 knew they were HIV positive, but were not receiving medical care. In comparison to those who were undiagnosed, those who knew about their status, yet not receiving medical care were 19 percent less likely to transmit the virus.

6 Major Reasons We Need to Rethink HIV Prevention

Those who are HIV positive and receiving antiretroviral therapy (ART) who have achieved an undetectable viral load are 96 percent less likely to spread HIV
There hasn’t been a reported case of anyone living with the virus with an undetectable viral load who has transmitted the virus.

Truvada has been shown to reduce HIV transmission by 96 – 99 percent, when used daily
One new study also shows when PrEP is used as needed (a user taking Truvada 2-24 hours before sex and one pill 24 and 48 hours after) has shown to be 86 percent effective in preventing HIV. With all that’s available–TasP, PrEP and condom use, there seems to be much less of a reason to fear sex with someone with someone of opposite HIV status. Be open and honest with your partner.

Three out of 10 in the US have their virus under control
The care continuum, which is also known as the HIV treatment cascade, showed that even though 86 percent of people living with HIV were diagnosed, only 30 percent of them had  an undetectable viral load. The majority of those living with HIV know they have it, but are either too scared or unable to do what is needed to control it.

You can expect to live an additional 51 years if you’re newly diagnosed in your 20’s
That is, if you enter proper treatment. This is roughly the same number of years as a person without HIV would live. Many need only take one pill each day to manage HIV. Of course, there are mental and emotional health issues to treat as well.

Study Shows Truvada Cuts HIV Spread 86%

A recent UK trial shows that a pill taken by men who have sex with men (MSM) on a daily basis, can protect them from HIV infection. Experts are saying that the drug called “Truvada” offers hope that the spread of HIV will be reversed. Truvada can be taken daily, as a regular part of the routine for MSM. The National Health Service (NHS) will be looking at the results to consider whether it is cost effective for men who risk infection.

Truvada was approved in the FDA in the US in 2012 and is available through Medicaid and many private health insurance plans. It was the first pill approved by the FDA to be taken daily to help prevent HIV and is already used extensively here in the US.

Proud (Pre-exposure Option for reducing HIV in the UK: immediate or Deferred (the  name of the study) shows that Truvada decreased infections in MSM by 86 percent. Experts in the study were thrilled, particularly because the study was conducted in “real world” circumstances. The participants were allowed to take (or not take) the pills as they wished. Proud has entered the scene following a line of other trials, with a greater rate of success than all of them.

Study Shows Truvada Cuts HIV Spread 86%

The 545 men involved in the trial were deemed to be at a high risk for HIV through sexual health clinics; the median of partners the men had was 10 within the past 90 days. Fifty percent of the men were given Truvada immediately, while the other half received the drug after one year. Three HIV infections occurred among the men who were given the drug immediately and 19 among the men who didn’t receive the drug.

These results are very encouraging. Richard Gilson, principal investigator for the Proud study thinks the drug “appeared to be an important and practical solution” for high risk men who were willing to take it on a regular basis. He believes the next step should be cost-benefit analysis from the trial. Gilson said, “I shall be surprised if it is not cost-effective at the usual threshold they apply, at least for individuals with this high-risk profile.”

This important study proves that pre-exposure prophylaxis (PrEP) can prevent HIV infection and has been tested in real life circumstances. It is a significant form of defense against HIV.

 

 

http://www.theguardian.com/society/2015/feb/24/daily-pill-truvada-cuts-spread-of-hiv-by-86-study-shows

Ethical Implementation of PrEP for MSM is Vital

The World Health Organization (WHO) recently recommended pre-exposure prophylaxis for men who have sex with men (MSM).  This is a monumental step towards eliminating the HIV epidemic.  Certain ethical matters must be addressed to ensure the best execution of this recommendation, such as confidentiality, privacy and stigma.  Of course, anything that would aid in eradicating HIV is extremely important, but so far discussions regarding the possible barriers, ethically and where implementation is concerned, have not been properly addressed.

The resolute recommendation: “among men who have sex with men, pre-exposure prophylaxis (PrEP) is recommended as an additional HIV prevention choice.”, goes further than a conditional recommendation in 2012 which looked at  serodiscordant relations.  The new recommendation acknowledges potential obstacles to implementation and tries to take the proven benefits of PrEP into consideration for balance.  This is of vital importance for a population that is at high risk for HIV infection.

Ethical Implementation of PrEP for MSM is Vital

Stigma towards the MSM population and those with HIV is not new.  But, the PrEP debate has served to intensify the discussion as emtricitabine/tenofovir disoproxil fumarate (Truvada) serves as a catalyst for the talk surrounding stigma within the community affected by the recommendation,  as well as the public health and medical communities.  For example, the term “Truvada whore” has been coined by some individuals in the MSM community, which assumes that those using PrEP want to do so in order to participate in risky sex.  This is unfortunate and misinformed stigma.  Those who choose to use PrEP are making a responsible and personal decision about their health.  Following a similar line of illogic, it would be just as rational to assume that someone using a birth control pill was doing so in order to engage in high-risk sex.

It is crucial for health care providers to make a commitment to put a stop to stigma surrounding HIV care and put an end to HIV exceptionalism.  It is also of critical importance that we refrain from generalizing the MSM population as being a high-risk community, instead focusing on the individual.  There are many limitations to implementing the WHO recommendation  to consider and steps to be taken which include:

  • The development (or continuation) of tools to prevent HIV in MSM who are unaware of exposure risks (and who haven’t disclosed their sexual practices to their doctor)
  • Significant concerns related to confidentiality in the MSM and/or HIV positive populations.
  • Medical professionals providing PrEP need to be mindful of the surroundings in the exam rooms to ensure the strictest confidentiality.
  • Office staff should be keenly knowledgeable of Health Insurance Portability and Accountability Act (HIPAA) considerations when discussing information on the phone and otherwise.
  • Doctors need to obtain permission to discuss health matters in front of family and/or partners.

PrEP, as a concept, has been around for decades, but it has taken over a decade to generate clinical evidence to support the use of a particular regimen for an at risk population, and years to disseminate when determined.

Antibiotic Resistant Gonorrhea Rates Drop

Once feared to be the next modern scourge, the Centers for Disease Control and Prevention reported that adherence to new federal guidelines has seen treatment resistant gonorrhea rates decrease significantly in recent years.

The descent started in 2011 according to the federal agency. But the most precipitous drop occurred between 2012 and 2013. One reason for the plunge according to officials is more awareness of drug-resistant gonorrhea among the gay and men who have sex with men communities. But more aggressive treatment and the removal of the antibiotic gonorrhea was becoming resistant to, supplanted by one that can take it out, dealt the heaviest blows.

The disease is also declining in the UK according to a blog associated with the British Medical Journal. Still, both the BMJ and the CDC warn that gonorrhea could resurge and become a serious threat to public health. The disease has eventually become resistant to every drug thrown at it, thus far.

Antibiotic Resistant Gonorrhea Rates Drop

Gonorrhea is among the most common sexually transmitted infections around the globe. But in first world countries, only about one out of every 500-1,000 people are infected, each year. For MSM however the rate is much higher. Symptoms include pain along with a discharge in both men and women. However, some don’t experience any symptoms at all. 50% of women who have any for instance, and so don’t know they have it. Gonorrhea can infect the anus and the throat as well as the penis and vagina.

Originally, gonorrhea was treated with penicillin. Once it became resistant, other classes of antibiotics were used. Next came tetracycline followed by fluoroquinolone. Today, the last resort medication is cephalosporin. In the U.S. between 2006 and 2010 the rate of antibiotic resistant gonorrhea jumped from under 0.1% to 1.4%. This updating of guidelines has now set the trend in the right direction.

Drug Therapy Soon After Contracting HIV Improves Outcomes

 

A new study shows that U.S. service members and beneficiaries who acquired HIV and were treated with antiretroviral therapy (ART) soon after contraction were 50% less likely to develop AIDS. They also had a better chance at a resurgence of CD4+T-cells, the immune system’s defense against pathogens. The results of this study were published in JAMA Internal Medicine.

Researchers also found an increased ability for the immune system to respond to pathogens, and reduced T-cell activation in those who quickly received ART. These factors can significantly influence the course of HIV.

800 CD4+T-cells per cubic millimeter was defined as a normal count in a 2013 New England Journal of Medicine report. Healthcare providers often wait until an infected person possesses a T-cell count of 500 cells per cubic millimeter before beginning therapy. But this research suggests beginning ART immediately gives the best outcomes. Health data regarding the treatment and outcomes for 1,100 service members and beneficiaries from all branches of the armed forces were utilized for this study.

Drug Therapy Soon After Contracting HIV Improves Outcomes

This was a collaborative study which included researchers at the Veterans Affairs Research Center for AIDS and HIV-1 Infection, the VA Center for Personalized Medicine at the South Texas Veterans Health Care System, and The University of Texas Health Science Center at San Antonio. Professor of medicine, microbiology/immunology, and biochemistry at the UT Health Science Center, Sunil K. Ahuja, M.D., was the lead author in this study. He said:

“The immune system can be reconstituted most effectively and durably if ART is initiated quickly after infection…While the practice has been to generally defer ART till CD4+ counts decline to less than 500 cells per cubic millimeter, our results suggest that any delay in ART even in people maintaining higher levels of CD4+ counts impairs their ability to subsequently normalize CD4+ T-cell counts.”

Those who began ART within 12 months of infection had the best outcomes. Testing for sexually active adults should occur at least once per lifetime. Those who are single should be tested once per year. Anyone in a high risk group should get tested once every three months. These are men who have sex with men, intravenous drug users, transsexuals, and sex workers. The faster treatment is administered, the better the chance of living a normal life.

HIV Prevention with PrEP

The late ‘90s was a turning point for our understanding of HIV and AIDS. In 1996 we saw the introduction of antiretroviral therapy, known as ART, the medication that suppresses the virus’ ability to circulate in the body. This meant that people who tested positive for HIV were no longer facing a terminal illness, but a manageable one.

Another discovery came with ART: people who are on ART and control the virus to the point that there is no evidence of the virus in their blood are nearly incapable of transmitting the virus to others. This led to the idea of providing at risk individuals with treatment as prevention. Pre-exposure Prophlyaxis, known as PrEP.

The only FDA approved medication that is used for PrEP is Truvada. PrEP entails HIV negative individuals taking the Truvada anti-viral medication to prevent infection. While studies show that PrEP is an effective method of preventing the spread of HIV, there are many arguments against its use.

HIV Prevention with PrEPAn initial concern was that PrEP would create a false sense of security and cause an increased rate of risky behavior, such as a greater number of sexual partners or increased unprotected sexual encounters. There has yet to be any evidence to prove this to be a valid concern. We should also remember that, not long ago, similar arguments were being used against women’s birth control and that has since proven to have greater benefits than risks.

Similarly, many argue that, because PrEP is only effective if taken properly, it also causes a false sense of security as not everyone is diligent enough in taking medications in an efficient manner. While this is valid, birth control pills face the same issue, but stand as evidence that the overwhelming majority is more responsible than not in their pill taking habits.

PrEP is an amazing breakthrough and can prove to be groundbreaking in the fight against the HIV epidemic. As long as studies are showing it’s effectiveness, it should be a method that is promoted, not debated and shunned. As with the birth control pill and many other medications, opposition comes from our fears. The more research and studies that are published, the greater our chances of moving away from fear-based biases and embracing methods of healthy, happy living.

HIV and AIDS among Youth and Young Adults

Youth and young adults between the ages of 13 and 24 in the United States are among the highest risk groups of being infected with HIV. The CDC reports that the greatest number of new HIV infections within this age group are among gay and bisexual males, with African-American and Latino males who have sex with other men being at even greater risk.

Why is this population increasingly at risk? There are a myriad of reasons, including a lack of sexual education and information promoting abstinence and delaying initial sexual encounters. These groups are also among the highest populations suffering from substance abuse, homelessness, and sexually transmitted infections.

HIV and AIDS among Youth and Young AdultsLooking at global numbers, a young person becomes HIV-positive every 30 seconds. Studies have shown that the majority of youth and young adults in the U.S. are not afraid of contracting HIV, which equates to low testing rates and low rates of condom use. While there are an increasing number of HIV and AIDS awareness promotion programs, youth advocacy, and health counseling, the data translates to a dire need for greater outreach efforts.

The best way to prevent infection with HIV is abstinence. Secondly, reducing the number of sexual partners, avoiding unprotected sexual encounters, and being tested regularly are the most important steps you can take to prevent infection or spreading the virus. More than half of the percentage of youth infected with HIV/AIDS were not aware that they had the virus.

While many young adults are not concerned with contracting HIV, a large number are still in denial of the increasing risk of contracting and spreading the virus. Even if you think you are not at risk, it is recommended that you get tested regularly. Speak to a professional today, there are a number free test sites available as well as youth programs and counseling services .

Is “Undetectable” Becoming a Thing?

The results of the partner study known as HTPN 052 really have people talking. Although further research must be conducted, the study shows the use of Antiviral Treatments/Therapy (like PrEP) can successfully reduce the spread of the HIV by at least 96%. Not one case of the virus has been reportedly transmitted by people receiving treatment with an undetectable viral load.

This brings an interesting questions regarding sexuality: is an undetectable status as safe as uninfected, or will this study bring false hope that essentially causes an outbreak of the virus?

The answer to both of these questions is complicated. Again, not one case where a partner had an undetectable viral load has shown to spread HIV, but the research is still young. The Partner study comes with a number of warnings, emphasizing what it has really found about undetectable viral loads. Regardless of infection status, researchers still recommend using protection.

Is "Undetectable" Becoming a Thing?The bottom line is the safest way to have sex is to take as many precautions as possible. “The most common response I get from disbelievers is that positive men use ‘undetectable’ as a way of getting people to sleep with them without a condom. Positive men don’t want to transmit the virus to someone who is negative just as much as a negative person doesn’t want to become positive,” says Tyler Curry, editor for the new group HIV Equal.

What we need to remember is that condom-less sex occurs regularly with men who have sex with men outside of marriage. This proves what many experts have been saying for some time: new infections usually spread from people that are unaware, undiagnosed and are not receiving treatment. This goes beyond sexual preference, being true for both hetero and homosexual individuals.

The more time spent on this study, the more conclusive the results will be. Scientists claim that with current research, they won’t be able to finalize until roughly 2017. Still, the facts the study presents are still facts; the maximum possible risk of transmission thus far for same-sex couples is 4%, with the risk being greater for the receptive partner and when ejaculation occurs. These numbers may not make a difference to skeptics, but the hope it breeds for people who have put themselves in risky situations is remarkable.

Curry notes that it all boils down to trust, awareness and communication between partners. Couples that discuss their status are more likely to take preventative measures and stop the spread. The same can also be said of those who get tested; they know their status, so it is easier for them to take action. PrEP is improving the quality of life for those infected, allowing them normal sex lives and relieving many of the stresses associated with HIV.

Undetectable or not the world is becoming a better place, we just need to do our part to get it there. “As far as dating goes, I don’t need to convince someone else that they are safe to date me because I am undetectable,” says Curry. “I give them the facts and they either accept them or they do not. Either way, I know what it means to be undetectable and I know that I am safe from ever transmitting the virus so long as I stay compliant.”

Talk About It: Gay Men That Discuss HIV Less Likely to Develop It!

Talk About It: Gay Men That Discuss HIV Less Likely to Develop It!A recent German study published in BMC Public health found that gay men who discuss HIV before sex were less likely to contract the virus. The study also found that HIV transmission usually occurs within the first six month of new relationships. 105 men, recently diagnosed, were studied and compared to 105 HIV negative contemporaries. All of the data collected was acquired between 2008 through 2010 and finalized not too long ago.

What the investigation discovered was that those who developed HIV were 3.9 times more likely than the negative control group to be in a relationship lasting less then 6 months. Other comparisons between the two groups showed those that recently became HIV positive were 3 times more likely to report condomless intercourse with strangers whose HIV status they were unaware of, 2.5 times more likely to report lower rates of condom use with partners outside of a primary relation, and 4.5 times more likely to report not using a condom with men they met via the internet.

The World Health Organization Says Discrimination May Increase Spread of HIVEssentially the investigation found no difference between either group in regard toward their frequency of screening, whether they were in a monogamous relation, their knowledge of how the disease spreads, or condomless intercourse between partners assumed to be positive.

As mentioned before, scientists have concluded discussing the virus prior to intercourse has shown to reduce contraction. Discussing HIV status before sex statistically reduced the risk by 80 percent when comparing those who tested positive versus those who did not. Futhermore, condom use was shown to lower contraction frequency by 77 percent. This research is evidence of the benefits of open discussions about HIV, especially in new relationships. Don’t be afraid to ask; it could save your life.