Studies Show that PrEP is an Acceptable HIV Prevention Strategy in UK's Gay Population

via AIDSmap.com, by Roger Pebody

Pre-exposure prophylaxis (PrEP) would be an acceptable HIV prevention strategy for large numbers of gay, bisexual and other men who have sex with men in major UK cities, according to two studies presented to the British HIV Association (BHIVA) conference in Birmingham this week.

The conference also heard details of a small pilot PrEP study, likely to start recruiting later this year.

A cross-sectional survey of 842 HIV-negative gay and bisexual men, recruited at bars, clubs and saunas in London, suggested that half the respondents would be interested in taking PrEP.

Respondents were given information about pre-exposure prophylaxis and asked: “If PrEP were available, how likely is it that you would take a pill (oral dose) on a daily basis to prevent HIV infection?”.

Half said yes, with 16% saying they were likely to take PrEP and 34% saying they were very likely to. Men interested in PrEP were slightly more likely to be under the age of 35 (AOR adjusted odds ratio 1.58), have attended a sexual health clinic in the past year (AOR 1.59) and to have previously taken post-exposure prophylaxis (PEP) (AOR 1.96). After statistical adjustment, various measures of risky sex were no longer associated with interest in PrEP.

In this survey, 17 men (2.1% of those answering the question) said that they had previously taken antiretroviral drugs to reduce their risk of HIV infection.

Secondly, clinicians at the Manchester Centre for Sexual Health surveyed HIV-negative men attending their service who reported unprotected receptive anal intercourse. Of the 121 men who responded, 36% said they would be “very willing” to take PrEP while only 14% said they would not take the treatment. Daily dosing was perceived as a better option by four fifths of respondents – just one fifth would prefer taking a dose before sexual activity.

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[Content that is linked from other sources is for informational purposes and should not construe a Mapping Pathways position.]

FDA, Gilead And HIV Prevention-In-A-Pill?

via Pharmalot, by Ed Silverman


The debate over whether the FDA should approve an existing AIDS medication for preventing the spread of HIV has ratcheted up as more than a dozen advocacy groups are urging the agency to accelerate its review process and not wait for data about heterosexuals. The move comes just one month after one prominent advocacy group urged the FDA not to approve Truvada, which is sold by Gilead Sciences, for prevention, or as pre-exposure prophylaxis, for any group.

In a letter to the FDA and Gilead, the groups say that approval is needed as soon as possible in order to provide protection to gay and bisexual men and transgender women. And they cited data from a study released last November that found that men and transgender women who have sex with men and received a daily dose of Truvada, along with condoms and safe sex counseling, had an average of 42 percent fewer HIV infections than those who received only condoms and counseling (read here).

In fact, three PrEP trials have shown evidence that using Truvada or Gilead’s Viread, which is a component of Truvada, reduced the risk of infections. The other trials examined use by heterosexual men and women, and a so-called partners trial that looked at couples in which one partner is HIV-negative and the other is HIV-positive.But the advoacy groups complain that before results of the heterosexual study were released, the FDA and Gilead were believed to be ready to proceed with a review of PrEP for men who have sex with men, or MSM. And to them, delay means more infections.

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[Content that is linked from other sources is for informational purposes and should not construe a Mapping Pathways position.]

PrEP acceptable to gay men and few report that it would change their risk behaviour

via aidsmap, by Michael Carter.

Approximately 50% of gay men said they were likely to use pre-exposure prophylaxis (PrEP), but few reported that it would lead to a change in their risk behaviour, according to data presented to the International AIDS Society conference in Rome.

Nevertheless, the investigators were concerned that even minor increases in rates of unprotected anal sex could offset the benefits of pre-exposure prophylaxis.

The IPrEX study showed that PrEP significantly reduced the risk of infection with HIV for gay and bisexual men. Overall, men who took PrEP had their risk of HIV reduced by 44%. If adherence was high, the risk was reduced by 73%.

“PrEP offers much promise as the first biomedical intervention to have success in at-risk men who have sex with men,” comment the researchers.

They therefore undertook further analysis to see how likely the men who participated in the study were to use PrEP and if its availability would change their HIV risk behaviour.

They undertook a survey in December 2010, immediately following the release of the IPrEX results, using Facebook and Black Gay Chat to recruit participants. A total of 1155 gay and other men who have sex with men were recruited to the study.

Participants completed a questionnaire about their knowledge and willingness to use PrEP; perceptions of the risk of HIV infection from unprotected anal sex with or without PrEP; perceptions of sexual pleasure; and perception of likelihood to experience sexual pleasure with or without a condom and with or without PrEP.

The men had an average age of 33 years, 75% were white, and 51% reported unprotected anal sex at least once in the last twelve months.

Only a third of men had heard of PrEP before the release of the study results. Just under half of individuals reported that they were “very” or “extremely” likely to use PrEP.

Unprotected anal sex without a condom was widely considered to involve a high risk of HIV.

The availability of PrEP did not alter the perception of the risk associated with HIV in the majority of men, regardless of whether they were the insertive (75%) or receptive (60%) partner in anal sex.

Three-quarters of men stated that the 44% efficacy of PrEP in the IPrEX study would not affect their use of condoms. However, 7% reported that they would use condoms less frequently.

Read the rest here.

[Content that is linked from other sources is for informational purposes and should not construe a Mapping Pathways position.]

HIV Prevention and LGBT Communities: Syndemics, Resilience, and Real Change

How can justice be better served for the lesbian, gay, bisexual and/or transgender (LGBT) community? This remains one of the biggest questions in the US – the last few months have seen a country-wide discussion on this issue, sparked off by what is being called an “epidemic” of suicides by gay teenagers.[1] “People are talking about the important ways through which the US, in the coming generation, can begin to honor the rights of LGBT communities – I believe, in time, that would reduce the incidence of HIV infection,” says Julie Davids, Director of National Advocacy and Mobilization at the AIDS Foundation of Chicago and Coordinator at the HIV Prevention Justice Alliance.

There is strong data on the “syndemics” phenomenon[2] (synchronous epidemics) in the lives of gay men. Gay men often face violence, abuse, marginalization and rejection by parents, friends and peers – there is compelling data that these conditions make them far more vulnerable later in life to substance use and abuse, intimate partner violence, and contracting HIV. The syndemics discussion has also led to an increasing focus on the idea of resilience. Says Julie, “Although HIV is very widespread among gay men, the majority of gay men are not HIV positive – what helps them remain HIV negative? As someone who believes very strongly in the idea of gay and queer liberation, I believe that members of LGBT communities create resilience, have innovative ways of living and of structuring families and lives that can be extended to broader society for better health outcomes and happier lives.”

There is a concerted effort to steer prevention efforts away from an earlier reliance on fear tactics and a vocabulary based on vulnerability. The gay men’s health movement and their allies in the HIV/AIDS community are increasingly emphasizing resilience and trying to create a scale of measuring this quality in the lives of gay men – and hopefully extend this to other communities as well. “There are a number of programs – like Project CRYSP, Lifelube, the Gay Men’s Health Crisis, and the Gay Men's Health Summit – that confront the conditions that drive the syndemic among gay men and build resilience and resourcefulness in gay communities[3]. Other projects doing fantastic work in this field include the Gay City Health Project in Seattle, Magnet in San Francisco, and William Way in Philadelphia,” says Jim Pickett, Director of Prevention Advocacy and Gay Men's Health at the AIDS Foundation of Chicago, chair of IRMA, and a member of the Mapping Pathways team. In fact, Jim recently checked in with Dr. Ron Stall, an expert in gay men’s health, to get his views on syndemics and the HIV/AIDS epidemic among gay youth and adults, as well as the idea of resilience. You can read the eye-opening interview here.

The approach to HIV prevention could also benefit from elements of asset-based community development: focusing on the assets of a community, the skills and experiences that are available, can help illuminate the path forward and create sustainable solutions.

“We can’t do it all on our own though,” says Julie, “so it’s important to continue to push for government policies that honor the human rights of all people – specially now that there is a focus on the impact of bullying of LGBT people. We need to made sure doesn’t just end up contributing to mass imprisonment – another social driver of HIV in our country. Creating merely a punitive system doesn’t really solve the problem – it just results in more imprisonment, thus exacerbating health issues like HIV. Many people who are bullies have been bullied themselves. We need policies and mechanisms to increase parental acceptance of gay and gender variant children, strengthen communities to support all their LGBT members rather than rejecting them, and help people proactively stand up to bullying. Addressing the root causes will bring about real, long-term change.”

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[1] To know more, take a look at The New York Times’ “Coming Out” project, which captures compelling first-person accounts by gay teenagers.

[2] Syndemics: A set of linked health problems involving two or more health conditions, interacting synergistically, and contributing to excess burden of disease in a population. Learn more about the syndemic among gay men that drive the HIV/AIDS epidemic by accessing Ron Stall’s presentation here.

[3] Take a look at Jim Pickett’s presentation on this here.

[Content that is linked from other sources is for informational purposes and should not construe a Mapping Pathways position.]