Mapping Pathways is a multi-national project to develop and nurture a research-driven, community-led global understanding of the emerging evidence base around the adoption of antiretroviral-based prevention strategies to end the HIV/AIDS epidemic. The evidence base is more than results from clinical trials - it must include stakeholder and community perspectives as well.

26 April 2012

The Affordable Care Act's Impact on People Living With HIV

via Associated Press, by David Crary

hervotes-blog-carnival-what-health-care-reform-means-to-women.jpgFor many HIV-positive Americans, and those who advocate on their behalf, these are days of anxious waiting as the Supreme Court ponders President Barack Obama's health care overhaul.

This loose-knit community — made up of activists, health professionals and an estimated 1.2 million people living with HIV — has invested high hopes in the Affordable Care Act, anticipating that it could dramatically improve access to lifesaving care and treatment. The act is now in limbo as the high court deliberates on its constitutionality, notably its requirement that most Americans obtain health insurance. A ruling could come in June.

"The HIV treatment community sees the act as a critical step in our fight against the AIDS epidemic," said Scott Schoettes of Lambda Legal, a national gay-rights advocacy group. "People have been counting on it, making plans based on its implementation, so for it to be pulled out from under their feet at this point would be a tremendous loss."

Among its many provisions, the health care law has two major benefits for HIV-positive people: It expands Medicaid so that those with low incomes can get earlier access to treatment, and it eliminates limits on pre-existing conditions that have prevented many people with HIV from obtaining private insurance.

Under current policies, low-income HIV-positive people often do not qualify for Medicaid if they are not yet sick enough to be classified as disabled.

In the view of advocacy groups, this creates a cruel Catch 22 — at a stage when they are still active and productive, these people can't afford the antiretroviral treatments that could help them stay that way. Only when their condition worsens are they able to qualify for Medicaid and get treatment that might have prevented the deterioration.

Read the Rest.

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

25 April 2012

The Obama Adminstration Explains Unspent HIV/AIDS Funding

via The Global Post, by John Donnelly

Obama AIDS DayThe Obama administration has set extraordinarily high goals in its fight against AIDS around the world. Secretary of State Hillary Rodham Clinton said late last year that an “AIDS-free generation” is possible. And President Obama promised last December that the number of US-supported AIDS patients on treatment would rise to 6 million by the end of next year, up from the current 4 million.

So why did the administration submit a fiscal year 2013 budget that called for a $550 million reduction — an 11 percent cut — in its global AIDS program?

GlobalPost put that question to the Obama administration several weeks ago and US officials responded, saying that the government didn’t need more money because there has been nearly $1.5 billion stuck in the pipeline for 18 months or more.

In an interview with GlobalPost, Ambassador Eric Goosby, global AIDS coordinator, explained that $1.46 billion designated to fight AIDS hasn’t been used because of inefficient bureaucracies; major reductions in the cost of AIDS treatment; delays due to long negotiations on realigning programs with recipient country priorities; and a slowdown in a few countries because the AIDS problem was much smaller than originally estimated.

“What we’re doing is defining what money is available, and what’s left are our resources that we will put back into AIDS-free generation type activities — things that will not require continued year funding, could be a one-time funding effort,” Goosby said.

Read the Rest.

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

24 April 2012

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

via, 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.

Read the Rest.

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

PrEP Evaluated on Possible Cost Issues that May Rise

via, by Ed Silverman

Late last year, Gilead Sciences took a widely anticipated and controversial step by seeking FDA approval to market its Truvada HIV pill to prevent infection, which is also known as pre-exposure prophylaxis or PrEP. The move was both welcomed and criticized by AIDS activists, reflecting a spectrum of views on making a preventive pill available on a large-scale basis.

To some, FDA approval would offer needed assistance in containing HIV and possibly clarify the extent to which such preventive measures are useful. To others, FDA approval raises the specter of creating a form of resistance to HIV due to widespread use, which would undermine effectiveness for existing Truvada patients and, therefore, diminish prevention efforts. In particular, critics worry people without HIV who take a preventive pill may engage in risky behavior.

A related issue, of course, is cost. Truvada carries a price of $26 a day, or roughly $10,000 a year, which may inhibit widespread usage. However, a new study suggests there is, indeed, value. Prescribing Truvada to men who have sex with men in the US would cost $495 billion over 20 years, but targeting only those at highest risk would lower costs to $85 billion, according to the study published in The Annals of Internal Medicine (here is the abstract).

Over the next two decades, the researchers calculated a total of 490,000 new infections if prevention is not undertaken, but if 20 percent of gay men take the pill daily, there would be nearly 63,000 fewer infections. And if just 20 percent of high-risk men took the drug, 41,000 new infections would be prevented over 20 years at a cost of about $16.6 billion.

“Promoting PrEP to all men who have sex with men could be prohibitively expensive,” Jessie Juusola, a PhD candidate in management science and engineering in the Stanford School of Engineering and first author of the study, says in a statement. “Adopting it for men who have sex with men at high risk of acquiring HIV, however, is an investment with good value that does not break the bank.”

Read the Rest.

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

23 April 2012

Adherence – the key to success?

Original content from the Mapping Pathways blog team

A recent Mapping Pathways post talked about how the Partners PrEP study helped some couples work through their relationship problems – these couples saw the trial as a way to save their strained marriages. A key finding from the trial was the high level of adherence observed amongst the participants. The HIV-negative partner would remind the HIV-positive partner to take medication on time, replenish pill supplies, and keep follow-up appointments with counselors.

Adherence was also a key issue that came up at the Conference on Retroviruses and Opportunistic Infections (CROI) held recently in Seattle, Washington. Adherence is critical to interpreting the results in any trial, since a study pill, if not taken as directed, can make a highly effective pill appear ineffective.

A case in point is the FEM-PrEP study that involved 2,056 HIV-negative women in South Africa, Kenya and Tanzania who were randomly assigned to take either a daily Truvada pill or a placebo pill. However, the trial was stopped in April 2011 due to “futility” when an interim analysis discovered both trials arms having near-identical HIV infection rates. There were 33 HIV infections in women taking Truvada and 35 in women taking placebo.

While the participants in the study stated that they took their pills 95% of the time, drug levels found in the blood of women assigned to the Truvada study wing indicated that less than 50% of the women had actually taken the drug in the last 12 days.

In contrast, the Partners PrEP study, which enrolled 4,758 seriodiscordant (one partner HIV-negative and the other HIV-positive) couples in Kenya and Uganda, indicated adherence to medication at almost 97%. 

Why was there such a drastic difference in the levels of adherence in the two trials? Investigators suggested that the differences in population between the two studies could be one reason. The Partners PrEP study involved couples who defined themselves as being in long-term, stable relationships, which was one of the pre-requisites for lasting through the two-year-long trial.

On the other hand, the women recruited for the FEM-PrEP study were much younger and there was no such requirement of being in a stable relationship. Initial qualitative surveys indicated these women did not believe themselves to be at a high risk of HIV, despite high incidence in the community around them. 

In short, the Partners PrEP study had in-built adherence motivators, in the form of committed partners, many of who participated in the whole process and actively helped their companions adhere to pill intake.

Could similar intrinsic motivators have improved the rate of adherence to medication in the FEM-PrEP study? And could similar subtle motivators be incorporated in other studies to improve the rates of adherence?

“Adherence is the word on everyone’s lips and minds these days – at CROI, at M2012, among trial designers, program implementers and advocates,” says Jim Pickett, Director of Prevention Advocacy and Gay Men's Health at the AIDS Foundation of Chicago and a Mapping Pathways member.

Stay tuned to the Mapping Pathways blog for more interesting posts on the important issue of adherence.

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

20 April 2012

New Project Initiative Involving PrEP Research Throughout California

via California HIV/AIDS Research Program

In April 2012, the California HIV/AIDS Research Program (CHRP) of the University of California awarded grants totaling $11.8 million to three collaborative teams of investigators to test a potential HIV prevention medication among high-risk HIV-uninfected persons in several communities throughout California. The studies also will examine new strategies to engage and retain HIV-infected persons in care and treatment. Both of these strategies are expected to help curb the HIV epidemic in California.

Two of the collaborative teams of investigators will offer PrEP (pre-exposure prophylaxis with antiretroviral drugs) to high-risk uninfected men who have sex with men (MSM) and to transgender women (male to female transgendered persons) located in Los Angeles, San Diego, and Long Beach over the next four years. These investigators also will assess the implementation of TLC+ (testing and linkage to care plus treatment), a strategy to locate, engage, and retain HIV-infected persons in care and start them on life-saving treatment for their HIV infection

A third grantee consortium will not fully implement PrEP or TLC+ at the present time, but will instead plan and pilot PrEP/TLC+ implementation strategies for young MSM of color located in Oakland, Richmond, Berkeley, and other East Bay Area locations.

PrEP involves the provision of antiretroviral drugs and risk reduction counseling to high risk uninfected persons to prevent future HIV infection among those who potentially may be exposed to the virus. Previous international research trials have shown that PrEP has been very effective in preventing new HIV infections among MSM and selected other risk populations, but only when taken as prescribed in addition to ongoing risk reduction counseling. Recent studies have suggested that the mixed results found for some populations may be due to a lack of consistent adherence to the medication, leading to suboptimal or ineffective levels of drug in the body. In addition, other studies have suggested that identification and rapid institution of antiretroviral therapy for people infected with HIV not only improves survival of those treated, but also lowers the level of HIV virus in the community and might ultimately reduce HIV transmission rates.

This will be the largest PrEP/TLC+ demonstration project initiative in the U.S., and will be the first to test PrEP in several communities throughout California. In these demonstration projects in California, PrEP will be delivered as part of a comprehensive prevention package including risk reduction counseling, sexually transmitted infection screening, and other components. Daily Tenofovir/FTC (Truvada®, a tenofovir/emtricitabine two-drug combination pill manufactured and distributed by Gilead Sciences, Inc. of Foster City, CA) based PrEP will be offered to eligible uninfected high-risk men who have sex with men, as well as to transgender women. Gilead Sciences will provide the drug product (brand name Truvada®) to support these studies. The studies will adhere to safety and implementation guidelines issued by the Centers for Disease Control and Prevention.

Read the Rest.

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

19 April 2012

A More Broad Integrative HIV Prevention Conference Is Planned for the Future

via, by Gus Cairns

ASHM Australasian HIV/AIDS Conference 2011The International Microbicides Conference held in Sydney this week will be the last of its kind, delegates were told in a closing plenary today.

From 2014 onwards, it is planned, a single biennial conference on all aspects of HIV prevention will be held.

Globally, the two largest funders of HIV prevention research are the US National Institutes of Health's Office of AIDS Research and the Bill and Melinda Gates Foundation. Gina Brown of the Office of AIDS Research and Stephen Becker of the Gates Foundation shared the podium to make a joint speech outlining the reasons for no longer funding separate conferences, and instead convening a programme committee to plan a biennial global HIV prevention conference.

They said they were proposing an "integrative prevention meeting" in recognition of the fact that no one HIV prevention method is likely to end the epidemic and that different methods can be synergistic. Stephen Becker said that the demand for a more integrated approach to HIV prevention “was being voiced from the ground up", by community advocates and NGOs, as well as by donors who wished to see more efficiency and less duplication of effort within the field.

Cross-cutting dialogue between specialists pursuing different areas is more likely to generate combinations of prevention approaches than individual approaches being pursued in neighbouring research 'silos', Becker added.

There was duplication of effort in some areas. Much of the animal-model and mucosal-immunity work being done in the HIV prevention technologies underlay HIV vaccine development as much as it did microbicide development. he said. And, he added, the social and behavioural research that underpinned prevention technology research by helping to understand which populations need what HIV prevention methods formed the same backdrop, whether what was being developed was a vaccine, a microbicide or the roll-out of a circumcision programme.

Gina Brown said that a world HIV prevention conference planning committee would be convened immediately, comprising experts from all fields including social sciences and community advocacy. In common with the international microbicides conferences, which have been held biennially since 2002, the last of the the annual AIDS Vaccine conferences, which started in 2000, will be held in 2013 in Barcelona. Other prevention conferences, such as next week's second international Treatment as Prevention Workshop in Vancouver, will also no longer receive funding as separate events.

Read the Rest.

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

Congratulations to Bob Grant for Making it Into Time's 100 Most Influential People!

via Time Magazine, by Kenneth Cole

When the history of the AIDS epidemic is written, I hope there will be a chapter on Dr. Robert Grant, a professor of medicine at the University of California, San Francisco, and at the Gladstone Institute of Virology and Immunology. Through one landmark study in November 2010, Dr. Grant, 52, changed the way AIDS researchers think about preventing HIV transmission. He and his team showed that gay, HIV-negative men could radically lower their risk of contracting HIV from their sexual partners by taking a combination antiretroviral drug already used to treat people living with the virus.

Later studies showed that this technique could work to prevent HIV transmission among heterosexual men and women too. This not only saves lives but provides a model that could one day halt new infections everywhere. We are in debt to Dr. Grant, who has shown us another way to curb an epidemic that has already claimed 30 million lives.

See it here.

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

The Effectiveness of ARV's Used for HIV Prevention

via AIDSmeds, by Tim Horn

While studies exploring the effectiveness of antiretroviral (ARV) therapy for HIV prevention purposes have generally yielded encouraging results, a group of researchers at the University of North Carolina at Chapel Hill suggest that the way forward is not entirely clear and that additional research is needed, particularly in understanding the combined benefits of biomedical and behavioral interventions in specific at-risk communities.  

“Recent research developments in [pre-exposure prophylaxis, or PrEP] and [treatment of people living with HIV to curtail HIV transmission] provide a unique opportunity to highlight areas of advancement that have galvanized changes in HIV treatment and prevention, and to highlight topic areas that remain undecided and controversial,” write Myron Cohen, MD, and his colleagues in an editorial published ahead of print by the journal AIDS.

The paper reviews much of the scientific research that has contributed to our current understanding of ARV treatment as prevention, including pharmacologic and observational studies, ecological evaluations and various modeling and empirical data. And despite the completion of several sound clinical trials—also summarized by Cohen and his colleagues and reviewed here—gaps in knowledge remain.

The Limits of HPTN 052

Building on the results of cohort and mathematical modeling studies, the HIV Prevention Trials Network began a randomized clinical trial, called study 052 (HPTN 052), to confirm a prevention effect from ARV therapy. While the study is ongoing, its Data Safety and Monitoring Board recommended nearly a year ago that the interim results be made publicly available.

As previously reviewed by AIDSmeds, the trial demonstrated a 96 percent reduction in HIV transmission among monogomous heterosexual HIV-serodiscordant couples in which the HIV-positive partner was started on ARV therapy, compared with couples in which the positive partner had not started HIV treatment.

Read the rest.

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

18 April 2012

PRESENTATION: Expanding the Evidence Base for ARV Prevention Strategies: Community Perspectives from India, South Africa, and the United States

Mapping Pathways presented this oral abstract - see below for PowerPoint and abstract - at Microbicides 2012 in Sydney, Australia on 17 April, 2012.

Background: Several clinical trials have reported efficacy of three different ARV-based prevention strategies including vaginal microbicides (CAPRISA 004), PrEP (iPrEx, Partners PrEP, TDF 2), and HIV treatment (HPTN 052). Statistically significant P-values and strong confidence intervals are not sufficient for countries to make decisions on the potential deployment of any ARV-based prevention strategy. Stakeholder inputs from community, research, policy and governmental spheres are critical for mapping pathways to sound, evidence-based decision making.

Methods: Community organizations in India, South Africa and the United States collaborated with RAND to solicit community opinions and concerns regarding ARV-based prevention strategies through an online survey and individual interviews. The online survey ran for six months and was open to anyone interested in ARV-based prevention from the three countries. Interviews were conducted concurrently with specially selected stakeholders in the three target countries.

Results: Among the three countries, 1,069 individuals answered the survey, and 572 completed all questions. Most respondents were from urban settings and identified as advocates, AIDS service organization personnel, doctors, and/or people living with HIV. Survey respondents were most in favour of expanded treatment and microbicides, but all had concerns about accessibility, economics, health systems impacts, and stakeholder resistance to these strategies. Forty semi-structured stakeholder interviews were conducted concurrently (India = 9, South Africa = 13, United States = 18) revealing some convergent opinions across geographies and disciplines about the strength of the science for treatment as prevention, but also strongly divergent opinions on issues such as readiness and feasibility. PrEP was the most polarizing strategy with concerns including prohibitive resource costs, behavioural disinhibition and drug resistance. There were also concerns about the individuals who needed treatment in all three countries who were unable to access ARV drugs.

Conclusions: Scientific results proving the efficacy of vaginal microbicides, PrEP, and TLC+ are not sufficient to successfully implement these strategies in India, South Africa, and the United States. Funders and policy makers must understand and address stakeholder support as well as stakeholder resistance when deciding whether or not to implement any ARV-based prevention strategy.

Click on "View on slideshare" to download the PDF

10 April 2012

AVAC Updates: Newest Issue of Px Wire and M2012 Road Map are Now Available!


This update provides a summary of and link to download the newest issue of Px Wire, as well as a roadmap for advocacy and communications-related sessions at the upcoming International Microbicides Conference (M2012).

Px Wire

Download the current issue of Px Wire (Volume 5, Issue 2), a quarterly update on biomedical HIV prevention research worldwide.

In this issue of Px Wire, we are excited to showcase a new ARV-based prevention timeline graphic, just in time for M2012. The timeline shows estimated efficacy trial end-dates, related confirmatory studies and dates of possible regulatory submission for a range of prevention options including oral PrEP with TDF, oral PrEP with TDF/FTC, vaginal and rectal formulations of tenofovir gel and the dapivirine-containing vaginal ring.

We also hope you enjoy reading the feature story in Px Wire where we describe the ongoing work of advocates who are working to influence PEPFAR Country Operating Plans.

Other highlights in this issue of Px Wire include:

• Information on how advocates can contribute their voices to the US FDA’s May 10 public meeting on Gilead Science’s submission for TDF/FTC (Truvada) as PrEP for HIV-negative adults

• Summaries of new AVAC resources: PrEP Using Daily Oral TDF/FTC or TDF in Women (and Men) — What the science tells us in March 2012, and new advocacy resources for voluntary medical male circumcision

• Upcoming events

2012 International Microbicides Conference (M2012)

Next week advocates, policy makers, researchers and funders will meet at the 2012 International Microbicides Conference taking place April 15-18 in Sydney, Australia. Building on past conferences, M2012 is a platform to discuss the latest in microbicides, PrEP and other ARV-based prevention research, as well as the basic science, structural, social and community issues that affect research and eventual rollout of these new tools. M2012 will feature several sessions that focus on advocacy and the role community advocacy and communication plays in the field. Our online conference “roadmap highlights a number of these sessions. If you will be attending the conference, we invite you to join us at these events. Please visit the AVAC M2012 page for updates on these activities.

If you are not able to participate in M2012 in Sydney, please watch out for information on special AVAC post-M2012 webinars covering critical issues that emerge at the conference. For key updates during the conference visit NAM/AIDSMAP.

As always, if you have any questions please contact us at

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

05 April 2012

AVAC Launches Research Literacy Database!

AVAC is pleased today to launch the Research Literacy Database at, an important new resource for the biomedical HIV prevention field.

The Research Literacy Database is the first central portal for educational resources on biomedical HIV prevention including:

• Global and country-specific materials;

• Resources specific to given prevention interventions including AIDS vaccines, ARV-based prevention and
voluntary medical male circumcision; and

• General information on clinical trials and the research process.

The tools featured in the database were developed by a range of stakeholders worldwide to meet specific needs. We will continue to expand the database and encourage our users to share their favorite materials on an ongoing basis. The database focuses on materials that won’t necessarily change substantially over time; for trial updates, timelines, recent results and their implications and current issues, please see other areas of the AVAC website.

Using an innovative design, the database allows users to search for what they need based on key criteria. For example, a journalist in South Africa who wants to learn more about the basics of microbicide research can use the database to find relevant fact sheets, e-learning courses and other helpful tools. Research organization staff members who need tools for training and outreach to wider audiences can use the database to get a tailored toolkit according to location, audience and specific content.

We all know that the science behind HIV prevention research is challenging. AVAC believes that building
basic research literacy among key stakeholders is fundamental to effective advocacy, to moving research forward as quickly and ethically as possible, and ultimately to getting new prevention options to people who need them. Whether you are a researcher, advocate, journalist, policy maker or someone interested in learning more about clinical trials and new ways to prevent HIV, we hope this database will make learning and outreach efforts easier and more effective.

The database is an iterative tool, and will be constantly updated with new materials and other user input. We need your help in ensuring that useful materials are available and used! Please contact us at with any and all feedback you have as you use the database—and we are especially keen to receive additional relevant resources to be shared with the field.

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

04 April 2012

Researchers Report Chinese MSM's Acceptability of PrEP

via PLoS ONE, by Feng Zhou


In pre-exposure prophylaxis (PrEP), antiretroviral (ARV) drugs are given to HIV-negative people to decrease their chance of becoming infected. Several studies conducted among men who have sex with men (MSM) have shown that PrEP awareness was very low, and few participants reported having the experience of PrEP use, even in some countries where it is available. Although strategies including abstinence, being faithful, and condom use (ABC) have been proved to be effective for prevention of HIV transmission, the virus still prevails among MSM. It was estimated that 2.6 million individuals were newly infected in 2009 worldwide, which 19% fewer than the 3.1 million in 1999. China had about 740,000 people living with HIV and 105,000 with AIDS by the end of 2009. Homosexual intercourse has become a major mode of HIV transmission since 2009, and the prevalence of HIV in MSM has increased significantly from 2.5% in 2006 to 8.6% in 2009. A sociological study has estimated that there are 1.8–2.4 million homosexual or bisexual men in mainland China. In China, high-risk behavior, such as multiple partners and unprotected sex, have been reported to be common in this group. Also, recent studies have reported rapid transmission of HIV in this specific population from various geographic areas in China, despite the efforts made by the national and local governments and non-governmental organizations in the past few years. New effective approaches are urgently needed for this population.

In recent decades, researchers have made great efforts to explore alternative biomedical interventions, such as male circumcision (MC), HIV PrEP and post-exposure prophylaxis (PEP), HIV vaccines, and microbicides. Among these potential strategies, PrEP is considered to be one of the most promising strategies in MSM. Several animal and human studies have suggested that ARV drugs might reduce the risk of HIV infection either by PrEP or by non-occupational PEP. A 12-month PrEP clinical trial of daily oral tenofovir disoproxil fumarate (TDF) for HIV prevention was performed among 400 HIV-negative Ghanaian women, and achieved good acceptability and >82% adherence. In November 2010, the US National Institutes of Health (NIH) announced the results of the iPrEx trial of PrEP conducted among 2499 HIV-seronegative MSM in six countries, which showed that daily oral Truvada, a combination of emtricitabine (FTC) and TDF, reduced risk of HIV incidence by 44%, with a median 1.2 years follow-up, compared with the placebo group, and >75% adherence was reached. These findings represent a major advance in HIV prevention research, providing the first evidence that PrEP, when combined with other prevention strategies, can reduce HIV risk among MSM. A further study is ongoing in HIV Prevention Trials Network (HPTN) 067 to evaluate the feasibility of intermittent dosing of PrEP. Recent results from Partners PrEP and CDC TDF2 have shown that PrEP with daily oral TDF/FTC or TDF was effective at reducing HIV risk in heterosexual men and women. However, the Fem-Prep program on Truvada, a closed clinical trial implemented by Family Health International (FHI) in partnership with research centers in Africa, does not support the theory of PrEP having an effect on HIV prevention. Therefore, some factors that might influence the efficacy of PrEP, including adherence, sexual behavior, or other factors still need to be determined.

The awareness and acceptability of new strategies are very important when they are recommended for use. Therefore, the objective of our study was to investigate the awareness and acceptability of PrEP among MSM and potential impact factors, which will provide suggestions and guidelines for future clinical trials in China.

Read the Rest.

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

03 April 2012

Statements from New US AIDS Policy Director, Dr. Grant Colfax, Causes Mixed Reactions

via The Colorado Dependent, by Todd A. Heywood

With a president who has declared the end of AIDS is in reach, Dr. Grant Colfax has a massive job in front of him. But his first interview with The American Independent has some activists challenging his take on controversial elements of the epidemic impacting an estimated 1.2 million Americans.
The former director of the San Francisco Department of Public Health HIV programs was appointed by President Barack Obama to run the Office of National AIDS Policy (ONAP), March 14.

In a brief phone interview with The American Independent, Colfax praised the National HIV/AIDS Strategy (NHAS) and said he was looking forward to implementing the plan. NHAS was released by the Obama administration in July of 2010 and is the first time in the 30 year history of the epidemic that the federal government has developed a comprehensive plan to address HIV in the United States.

HIV-specific criminalization

A key segment of the plan calls for addressing HIV-related stigma and discrimination, including addressing the bevy of HIV-specific criminal state laws that activists have identified as stigmatizing.

“Certainly, criminalization is one of the issues we’ll be looking at as we engage stakeholders in a broader conversation about how stigma and discrimination are contributing to HIV risk and core health outcomes,” Colfax said.

Asked what his personal take on criminalization and its impact on the HIV epidemic was, Colfax demurred.

“I think it’s really premature for me to speak specifically about that beyond what I just said,” Colfax said.

That response did not sit will with activists.

“Dr. Colfax’s boiler-plate reaction to the criminalization issue is disappointing,” said Catherine Hanssens, executive director of the Center for HIV Law and Policy, which houses the anti-HIV criminalization group Positive Justice Project. “Prosecuting and incarcerating people with HIV for years and decades for consensual and no-risk conduct is a profoundly serious form of discrimination that has been stigmatizing people with HIV for decades.”

Sean Strub, a board member for the Global Network of People with HIV– North America, was also disappointed.

“To have any discussion about stigma that doesn’t start with removing HIV-specific criminal statutes is hollow,” Strub said. “Those statutes, which create a viral underclass, are the most extreme manifestation of stigma.”

Read the Rest.

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

The Impact 'The Affordable Care Act' Will Have on HIV Treatment and Care

via HuffPost Chicago, by Gregory Trotter

For the 1.2 million Americans living with HIV, the Affordable Care Act will be utterly life-changing. For some, it will be life-saving.

Just ask Will Wilson, 58, who was diagnosed with "full-blown AIDS" in 2002.
"It will basically mean freedom," said Wilson, a Chicago resident and an advocate for the Illinois Alliance for Sound AIDS Policy.

For the first time, Wilson will be able to purchase private insurance without fear of being rejected for his preexisting condition. The former graphic designer will be able to aggressively re-enter the job market without risking his continuous access to lifesaving HIV drugs that cost him $3,000 a month.

He'll have options he's never had.

This week, the Supreme Court has heard oral arguments on the constitutionality of the Affordable Care Act, specifically the legality of the individual mandate provision and the expansion of Medicaid. It is slated to rule in June on what is widely considered to be the most important Supreme Court case in decades. Many people living with HIV/AIDS and other preexisting conditions will be hoping and praying that the court rules in favor of health care reform.

In January, the AIDS Foundation of Chicago (AFC) signed on to a legal brief -- along with 130 other HIV/AIDS organizations throughout the country -- asserting that the Affordable Care Act is, in fact, constitutional. It's also necessary to stopping the AIDS epidemic in the United States.

"The list of supporters for our brief urging the court to uphold the ACA continues to grow because of the law's enormous potential to impact the domestic AIDS epidemic," said Scott Schoettes, HIV Project Director for Lambda Legal, the legal firm that submitted the brief.

About 24 percent of people living with HIV are uninsured, according to data from the U.S. Department of Health and Human Services. The majority of people living with HIV depend on Medicaid and Medicare for medical treatment.

Read the Rest.

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