Entitled Together we will end AIDS, the new UNAIDS report contains the latest data on numbers of new HIV infections, numbers of people receiving antiretroviral treatment, AIDS-related deaths and HIV among children. It highlights new scientific opportunities and social progress which are bringing the world closer to UNAIDS vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths.
The report also gives an overview of international and domestic HIV investments and the need for greater value for money and sustainability.
Calling for global solidarity and shared responsibility, the UNAIDS report contains commentaries from global and community leaders as well as people living with and affected by HIV.
As we prepare to enter our 25th year, we are reflecting on the global HIV events from the last three decades. HIV has swept across the globe touching communities on every continent. Here’s an introduction to some of the key moments in the early global history of HIV. Catch up on the story using the ‘Recent Posts’ link to the right.
UNAIDS and the World Health Organization (WHO) estimated in 1996 that more than 4.6 million people had died from AIDS since the beginning of the epidemic and that over 20.1 million were then living with the virus that leads to AIDS. The majority of those infected (over 15 million) lived in sub-Saharan Africa, followed by more than 31.8 million in Asia, 1 million in Latin America and the Caribbean and about 1.5 million in North America and Western and Central Europe.
On 1 January 1996, The UN aids agency, UNAids, is established. UNAids – the Joint United Nations Programme on HIV/AIDS opened for business. This was 15 years after the first published report of AIDS cases, 15 years during which most of the world’s leaders, in all sectors of society, had displayed a staggering indifference to the growing challenge of this new epidemic.
Tommy Morrison in February, 2007
In February, the heavyweight boxer Tommy Morrison was identified as HIV positive after being tested prior to a fight. A few days before a scheduled fight against Arthur Weathers, Morrison tested positive on a mandatory HIV test performed by the Nevada Athletic Commission. Morrison’s personal physician administered a confirmatory test, which was also positive. Nevada cancelled the fight and placed Morrison on indefinite suspension.
At a news conference, a “reflective” Morrison said that he had contracted HIV because of a “very permissive, fast, reckless lifestyle’ that involved unprotected sex with multiple partners.” Morrison also said that he once thought HIV was a danger only to drug addicts and homosexuals, but that his infection was evidence that HIV “does not discriminate.”Morrison stated that he would never fight again but later in 1996, he announced that he wished to make a comeback with one more bout, the proceeds of which would benefit his newly created KnockOut Aids Foundation.
To treat his HIV infection, Morrison told the New York Daily News in 2001, he took antiretroviral medication, which reduced his viral load to low levels and according to his promoter, saved his life.
Beginning in 2006, Morrison launched a comeback bid, alleging that his positive HIV tests had been false positives or that he was a victim of a plot by a rival boxer. The Nevada boxing commission’s medical advisory board reviewed Morrison’s status and concluded that the HIV positive results were “ironclad and unequivocal.” The commission’s Keith Kizer stated, “I hope he’s HIV negative, I really do, but it doesn’t seem likely…We’ll wait and see what happens. He said he’s been tested several times in recent years, but (we’ll ask) what happened from 1996 and 2002, the years he won’t talk about.” Morrison said he tried to get a copy of the original test results. “We’ve asked, but they can’t come up with it,” he said. “I don’t think it ever existed.” USA Today reported that “Goodman said that’s nonsense: ‘All Mr. Morrison has to do is contact the laboratory, and they would immediately release the results to him.’
It’s very interesting reading, for more on Tommy Morrison, follow these links:
Meanwhile in China it was estimated that the number of AIDS cases could be as high as 100,000. Two thirds of the reported AIDS cases had occurred in the southern province of Yunnan, where the use of heroin and the sharing of needles had helped the spread of HIV.
In the USA there had been a cumulative total of 81,500 AIDS cases in New York.
New outbreaks of HIV infection were erupting in Eastern Europe, the former Soviet Union, India, Vietnam, Cambodia, China and elsewhere.
The International Aids Vaccine Initiative set up to jumpstart the search for an effective vaccine.
The first major breakthrough in the treatment of HIV comes in 1996, with the introduction of protease inhibitors as part of antiretroviral combination therapies.
Protease Inhibitors stop HIV replication by preventing the enzyme protease from cutting the virus into the shorter pieces that it needs to make copies of itself. Incomplete, defective copies are formed which can’t infect cells.
This new class of medicine means that viral loads drop, t-cells rise, and death rates plummet, even as it becomes clear that the new medications cannot “eradicate” HIV from the body and thus fall short of being a cure. Alongside these tremendous advances, new HIV infections remain undiminished, and the drugs also prove difficult to take, cause serious side effects, and don’t work for everyone.
Robert Gallo, an American biomedical researcher, best known for his role in the discovery of HIV published his discovery that chemokines, a class of naturally occurring compounds, can block HIV and halt the progression of AIDS. This was heralded by Sciencemagazine as one of the top scientific breakthroughs within the same year of his publication. The role chemokines play in controlling the progression of HIV infection has influenced thinking on how AIDS works against the human immune system and led to a class of drugs used to treat HIV, the chemokine antagonists or entry inhibitors.
Gallo’s team at the Institute of Human Virology maintain an ongoing program of scientific research and clinical care and treatment for people living with HIV/AIDS, treating more than 4,000 patients in Baltimore and 200,000 patients at institute-supported clinics in Africa and the Caribbean. In July 2007, Gallo and his team were awarded a $15 million grant from the Bill and Melinda Gates Foundation for research into a preventive vaccine for HIV/AIDS.
Just 12 months earlier, AIDS was considered a death sentence, and those seeking to treat it seldom uttered the words “AIDS” and “hope” in the same sentence. However, in 1996 those terms have become inextricably linked in the minds and hearts of researchers and patients alike and while the new optimism must be tempered with numerous caveats, 1996 had ushered in a series of stunning breakthroughs, both in AIDS treatment and in basic research on HIV.
Protease inhibitors can now dramatically reduce HIV levels in the blood when taken with other antiviral compounds. At the same time, natural weapons in the immune system’s defences, polypeptide molecules called chemokine’s, have been unveiled as potent foes of HIV. This work offered new insight into the pathogenesis of HIV and may one day blossom into new treatments or even vaccines.
These major breakthroughs resulted in a steep decline in the number of AIDS cases and deaths reported each year which gave hope to the many millions of people with HIV. Less and less people with HIV were dying however, the number of infections continues to rise, and peaks at a new high from 2000, due in part to living healthy with HIV but also due to decreased education and awareness.
At the 11th International Aids Conference in Vancouver, excitement over the development of combination drug therapies is tempered by their extreme cost – estimated at $20,000 a year per patient.
Brazil introduces free combination therapy for HIV-positive citizens
At the end of the year UNAIDS estimated that during 1996 some three million people, mostly under the age of 25, had become newly infected with HIV, bringing to nearly 23 million the total number of infected people. In addition an estimated 6.4 million people – 5 million adults and 1.4 million children – had already died.
As we prepare to enter our 25th year, we are reflecting on the global HIVevents from the last three decades. HIV has swept across the globe touching communities on every continent. Here’s an introduction to some of the key moments in the early global history of HIV. Catch up on the story using the ‘Recent Posts’ link to the right.
By 1st January 1995, a cumulative total of a million cases of AIDS had been reported to the World Health Organisation Global Programme on AIDS. Eighteen million adults and 1.5 million children were estimated to have been infected with HIV since the beginning of the epidemic.
AIDS had become the leading cause of death amongst all Americans aged 25 to 44.
Two research reports provided important new information about how HIV replicates in the body and how it affects the immune system.
The South African Ministry of Health announced that some 850,000 people – 2.1 percent of the 40 million population – were believed to be HIV positive. Among pregnant women the figure had reached 8 percent and was rising.
By the autumn of 1995, 7-8 million women of childbearing age were believed to have been infected with HIV.
By December 15th, the World Health Organisation had received reports of 1,291,810 cumulative cases of AIDS in adults and children from 193 countries or areas. The WHO estimated that the actual number of cases that had occurred was around 6 million. Eight countries in Africa had reported more than 20,000 cases.
Other organisations estimated that by the end of 1995, 9.2 million people worldwide had died from AIDS.
Worldwide during 1995, it was estimated that 4.7 million new HIV infections occurred. Of these, 2.5 million occurred in Southeast Asia and 1.9 million in sub-Saharan Africa. Approximately 500,000 children were born with HIV.
The WHO estimated that by the end of the century, 30 to 40 million people would have been affected by HIV.
British DJ and entertainer Kenny Everett dies from AIDS on 4 April 1995.
Sex education: too much emphasis on the mechanics, says Doortje Braeken, who argues for more teaching about sexuality. Photograph: David Levene (The Guardian)
Sex education polarises opinion, sets legislators against parents and parents against schools and regularly inflames media opinion. Somewhere in the middle sit young people: ill-served, receiving confused messages and gaining their information from famously unreliable sources, such as peers or the internet.
Sex education, as all too many experience it, is like teaching people how to drive by telling them in detail what’s under the bonnet, how the bits work, how to maintain them safely to avoid accidents, what the controls do and when to go on the road. It’s all about the mechanics. And that’s it.
There’s a growing consensus that young people don’t need sex education, they need comprehensive sexuality education or CSE.. CSE is sex education plus: the mechanics, plus a lots more about sexuality.
That means not just teaching young people about the biology of sex, but also teaching them about the personal, emotional, societal and cultural forces which shape the way in which they choose to conduct their lives. Armed with this understanding, young people can make far more considered decisions.
This approach has the potential to unite the warring factions that bicker over the fundamental rights and wrongs of sex education: CSE equips young people with basic biological knowledge, but at the same time it equips them to question why they act in certain ways, and whether or not it is right, valuable or desirable to do so. CSE imparts information, and promotes responsibility.
CSE contains components which allow learners to explore and discuss gender, and the diverse spectrum of gender identities that exist within and between and beyond simple heterosexuality. It also contains components that examine the dynamics of power in relationships, and individual rights.
These are not taught as theoretical concepts. They have serious practical effects on the way in which young people interact with each other, both in the sexual and the wider social and educational spheres. Studies have shown that addressing such issues can have a marked impact both in school and the expansion of young people’s social networks.
CSE also engages with what some doubtless regard as difficult territory. Sexuality – however, individually, we choose to regard it – is a critical aspect of personal identity. The pleasure that we derive from sexuality, even if that pleasure is the pleasure of feeling that a reproductive duty is being fulfilled, is a vital part of our lives: it’s what makes us human. CSE views sexuality as a positive force.
CSE exploits a variety of teaching and learning techniques that are respectful of age, experience and cultural backgrounds, and which engage young people by enabling them to personalise the information they receive.
What is most telling is that a large number of studies have reached the clear conclusion that CSE does not lead to earlier sexual initiation or an increase in sexual activity. To paraphrase, traditional sex education seems to say: “If you’re going to do it, this is how everything works and you need to protect yourself in these ways to prevent this.” CSE says all that, but it also asks young people to ponder what exactly “it” is, and to deepen their perception of its implications.
In a political environment which is quantitatively driven, we measure the success of sex education in straightforward health behaviour indicators. These are easy to manage: numbers which build on existing health surveillance and measurement systems, and which are simple to understand from an objective point of view.
However, CSE is a far more nuanced discipline, and it will be necessary to include other measures of programme success: qualitative, subjective indicators which relate to gender equity, empowerment and critical thinking skills.
While governments have recognised young people’s right to CSE via various intergovernmental resolutions and conventions, the journey from recognition to delivery will be a long one. Even in the UK, there are notable differences, with England having a bare-bones biological approach “puberty, menstruation, contraception, abortion, safer sex, HIV/Aids and STIs should be covered”, while Wales and Scotland have curriculums which incline far more towards the CSE agenda.
The International Planned Parenthood Federation, the organisation I work for, and its 153 member associations around the world, has been instrumental in pressing for the adoption of international policy commitments to CSE. For many, it may seem like we are pushing 10 steps ahead of the agenda when the basic principle of young people’s right to even the most basic introduction to the biology of sex is still not universally accepted.
Our view is different: it is that CSE is what will secure widespread acceptance of sex education, because it is about more than the mechanics of sex. It is about helping young people, the world over, to become more healthy, more informed, more respectful and more active participants in the life of their community and their nation.
Doortje Braeken is the IPPF’s senior adviser on adolescents and young people, responsible for co-ordinating programmes in 26 countries implementing a rights-based approach to youth friendly services and comprehensive sexuality education. She will be among the panellists for a live discussion on sex and sexuality education, taking place on the SocietyGuardian site from noon to 2pm on Thursday 31 May
Since the original recommendations on fertility were published in 2004 there have been many advances in both treatments and in the understanding of different techniques.
Childless women aged between 40 and 42 will be able to receive IVF on theNHS for the first time under proposals by the treatment regulator to help more people become parents.
Since 2004 women aged 23 to 39 in England and Wales with an identified cause of infertility, or who have been infertile for at least three years, should have been offered up to three cycles of IVF.
But a squeeze on NHS spending and controversial restrictions mean many have been denied treatment.
The regulator conceded, however, its stipulation that such women must not have previously undergone IVF was likely to mean that “quite small” numbers would actually benefit.
“Only a small minority of women aged 40-42 may benefit from the chance to have one cycle of IVF at that age,” said Susan Seenan, deputy director of patient group Infertility Network UK .
“It is good to see that the upper age limit for women has been raised as the evidence shows that we can have success with older women, though that should not take away from the clear message that age is still a major factor in fertility and that the longer one waits the greater the likelihood of problems”, said Professor Chris Barratt of Dundee University‘s school of medicine.
NICE also wants to cut the time women aged up to 39 should have been trying to conceive from three to two years. Seenan said that would reduce the frustration felt by childless couples and enable them to access IVF more quickly and thus increase their chances of starting a family.
The new proposals will also rule that only a single embryo should be transferred where possible.
It will also recommend for the first time that doctors can advise HIV-positive male patients that they can have unprotected sex with their female partner in order to conceive as long as the man meets certain criteria, such as being up to date with his antiretroviral medication, and agrees that they only do so when she is ovulating.
Catherine Murphy, head of policy at the Terrence Higgins Trust, welcomed the proposed change. “HIV medications have improved enormously in the last decade, making mother to baby transmission of HIV preventable and ensuring people can live long and healthy lives. It also means that natural conception is now a possibility for HIV positive men and HIV negative women in the right circumstances.
“An HIV diagnosis should no longer be a barrier to parenthood and we are very encouraged that NICE have recognised this in their consultation”, she added.
As we prepare to enter our 25th year, we are reflecting on the global HIV events from the last three decades. HIV has swept across the globe and support touching communities on every continent. Here’s an introduction to some of the key moments in the early global history of HIV. Catch up on the story using the ‘Recent Posts’ link to the right.
One of the primary routes of HIV transmission is through direct contact between your blood and HIV infected blood. Although the majority of HIV infections via blood occur through injecting drug use, medical settings still account for a significant number of new HIV infections. Across the world numerous cases of HIV transmission through blood transfusions, medical injections, medical waste and occupational exposure, are both reported and unreported.
There are an estimated 250,000 new infections per year as a result of the reuse of needles and syringes,1 and in Africa 250 to 500 people are newly infected with HIV each day as a result of unsafe blood transfusions.2 3 Testing of blood is essential but remains absent in many low and middle-income countries.
In 1990, at the beginning of the year, it was reported that a large number of children in Romanian hospitals and orphanages had become infected with HIV as a result of multiple blood transfusions and the reuse of needles.
In China, 146 people in Yunnan Province near the Burmese border were found to be infected with HIV due to sharing needles.
In June, a TV programme called ‘The AIDS Catch’ was screened in the UK, questioning whether HIV caused AIDS and whether AIDS was infectious. It was felt the programme caused significant distress among people with HIV and undermined the efforts carried out in the field of HIV/AIDS prevention.
Prime Minister John Major announced that the Government would pay £42 million compensation to haemophiliacs infected with HIV and their dependants.
Charleson was a noted actor on the British stage as well, with critically acclaimed leads in Guys and Dolls, Cat on a Hot Tin Roof, Fool for Love, and Hamlet, among many others. Over the course of his life Charleson performed numerous major Shakespearean roles, dies on January 6, 1990 from AIDS at the age of 40. His death marked the first showbusiness death in the United Kingdom openly attributed to complications from AIDS.
Later, in 1991, the annual Ian Charleson Awards are established in his honour in to reward the best classical stage performances in Britain by actors aged under 30.
Teenager Ryan White, who in 1987 had surgery to remove two inches off his left lung and believed this was the moment of his infection, dies on April 8, 1990 at the age of 18 from pneumonia caused by AIDS complications.
Congress enacted The Ryan White Comprehensive AIDS Resources Emergency (CARE) Act or Ryan White Care Act, the United States’ largest federally funded health related program (excluding Medicaid and Medicare).
As we prepare to enter our 25th year, we are reflecting on the global HIV events from the last three decades. HIV has swept across the globe and support touching communities on every continent. Here’s an introduction to some of the key moments in the early global history of HIV. Catch up on the story using the ‘Recent Posts’ link to the right.
1989: On February 7th, the FDA announced that it was going to approve an aerosol form of the drug Pentamidine for the treatment of PCP (Pneumocystis Pneumonia) AIDS Patents. It’s still in use today for some people with PCP.
By March 1st, 145 countries had reported 142,000 cases of AIDS to the World Health Organisation (WHO). The WHO regarded this as under-reporting, and estimated the actual number of people with AIDS around the world to be over 400,000. It was predicted that this figure would rise to 1.1 million by 1991. It was also estimated that 5-10 million people were already infected with HIV.
Click to read Hans Paul’s letter to the US Government
A Dutch man, Hans Paul Verhoef, was imprisoned in Minnesota, USA because did not declare that he had HIV when he entered the country. Mr. Verhoef landed at Minneapolis St. Paul International Airport en route to a gay and lesbian health conference in San Francisco in April 1989.
Supporters intervened in his behalf, and Mr. Verhoef was released after five days and allowed to attend the conference.
In August, results from a major drug trial known as ACTG019 were announced. The trial showed that AZT could slow progression to AIDS in HIV positive individuals with no symptoms. These findings were thought to be extremely positive; on August 17th a press conference was held, at which the Health Secretary, Louis Sullivan said:
“Today we are witnessing a turning point in the battle to change AIDS from a fatal disease to a treatable one.”
The initial optimism was short-lived when the price of the drug was revealed. A year’s supply for one person would cost around $7,000, and many Americans did not have adequate health insurance to cover the cost. Burroughs Wellcome, the makers of AZT, were accused of ‘price gouging and profiteering’. In September, the cost of the drug was cut by 20 percent.
By this time, 100,000 people diagnosed with AIDS had been reported to the CDC. The proportion of AIDS diagnoses among women had increased, and smaller cities and rural areas were increasingly affected.
The television movie “The Ryan White Story” aired. It starred Judith Light as Jeanne, Lukas Haas as Ryan and Nikki Cox as Sister Andrea. Ryan White had a small cameo appearance as Chad, a young patient with AIDS.
Another AIDS-themed film, The Littlest Victims, also debuted in 1989, biopic-ing James Oleske, the first U.S. physician to discover AIDS in new born children during the early years of AIDS when many thought it was only spread by homosexual sex and drug use.
The first drug licensed to treat HIV was Zidovudine, (AZT). Dr. Robert E. Windom, assistant secretary for health at the Health and Human Services Department, emphasized that AZT, to be sold under the trade name Retrovir, is not a cure for AIDS (sic) but he said the action “means that significant medical relief will be available to thousands of those afflicted with this dreaded disease.”
Windom said that licensing of the drug, “Marks an important step but by no means a final victory in our ongoing war against AIDS.” AZT was expected to be expensive, costing each patient as much as $10,000 a year.
Final approval of AZT, first administered to AIDS patients in human studies begun in July, 1985, came in record time, the result of a decision by the Food and Drug Administration to consider AIDS drugs as a top regulatory priority. Typically, the process takes an average of 8½ years from the earliest studies to licensing, AZT smashed this timeframe and was licenced after just 2 years.
Soon after its introduction, activists establish the AIDS Coalition to Unleash Power (ACT UP) to challenge high drug prices and rally on Wall Street where “17 homosexual-rights protestors” were arrested, charged then released.
The US government closes its country’s borders to HIV-positive immigrants and visitors which eventually lead to many non-profit organisations to boycott the international AIDS conference in San Francisco in 1990. By 1992, the conference moves from Boston to Amsterdam because of America’s border controls.
An advert featuring The Grim Reaper was launched in Australia to warn people about the dangers of HIV was launched by the National Advisory Committee on AIDS (NACAIDS). The advertisement depicted the Grim Reaper in a bowling alley, bowling over various people from men and women to babies and toddlers, knocking over human ‘pins’ which represented people with HIV. The commercial first screened on 5 April 1987 and was highly controversial; one reason is the unfortunate blow to the gay community, which had already taken the lead in AIDS awareness and safe sex practices.
The Grim Reaper became identified with gay men rather than as the Reaper which was unintentional, however viewers believed that the Reaper was people with HIV infection, rather than the Reaper harvesting the dead.
The commercial was widely criticised at the time, but it succeeded in creating widespread discussion about AIDS.
1987 also marked a UK Government Cabinet Committee devoted to combatting the epidemic. £20 million was earmarked for a publicity campaign, £5 million of which was to be spent on television commercials which could be adapted for cinema. The dilemma facing the government and advertising agency was whether to use shock tactics, as recommended by health groups or take heed of moral campaigners like Mary Whitehouse, who called for the promotion of “monogamy, not sexual precautions”. Another contentious issue was whether to overturn the Independent Broadcasting Authority’s restriction on commercials recommending condom use.
The result was a hard-hitting campaign containing apocalyptic images of icebergs, crumbling mountains and falling monoliths crashing on our screens. The aim was to shock people into practising safer sex.
The most remembered of the five advertisements were Tombstone and Iceberg, with their iconic, nightmarish imagery, compounded by John Hurt’s chilling commentary.
The television advertisement campaign was accompanied by educational television and radio programmes on AIDS and related leaflets, bearing the ‘Don’t Die of Ignorance’, slogan were sent to every home in the country. (Click the image above for a copy). Despite widespread apprehension, the campaign was later acknowledged that it had been successful in precipitating more open discussion about AIDS in the media.
Although cases of AIDS in the UK had remained low, due in part to high profile campaigns, it had become a global epidemic, by this time, the World Health Organisation had been notified of nearly 44,000 cases of AIDS in 91 countries including the cases first recorded in the Soviet Union.
At a time with high ignorance and constant struggle in the face of stigma and discrimination, most of the population thought you could get AIDS from touching someone or sharing equipment or facilities. This was the experience of Mike Sisco, a gay man with HIV.
Mike simply took a dip in a local swimming pool. Word spread quickly, and by the next day fear, panic and rumours – including one that claimed Mike had spit on food at a grocery store—had forced the pool to be closed and prompted a front-page banner headline in the local newspaper which also made the national news.
Mike says that when he went swimming at the pool, the lifeguard was the first person to recognise him, but soon the other bathers did as well. “They kind of ran like in those science fiction movies where Godzilla walks into the street.”
This wasn’t the first time the community had reacted negatively to seeing Mike in public. He says he returned home after contracting AIDS (sic) while living in Dallas. He says his illness quickly became known in the community through the whispers of small-town gossip. The Opera Winfrey show examed the case in an hour long special filmed at the town hall.
Watch Mike tell Oprah his story in his own words here and read more about it here.
At a time when panic, fear, prejudice, stigma and discrimination were wide spread, people with HIV were often rejected by friends and family, and ostracised by society, there seemed to be little hope of educating socialy. What was needed was a public figure to openly demonstrate that HIV could not be caught by sharing cups, towels or even air and that support came in the form of Princess Diana.
Diane was drawn to people she felt were not treated fairly and did not receive the support they deserved. She understood that people living with HIV were desperately in need of understanding and support and that is why HIV was a cause she supported so passionately.
She knew that her public profile meant any cause she supported would receive enormous public attention and recognition. For this reason, she chose to support causes which were not considered popular and glamorous – as she knew it was these causes she could make a major difference to.
Princess Diana worked tirelessly both in front of the cameras and behind the scenes to support people living with HIV and to change society’s attitude to HIV – whether visiting HIV positive people in hospital, opening wards, attending conferences and events or supporting fundraising initiatives.
Princess Diana’s commitment and dedication to raising the profile of HIV helped challenge the stigma of the virus. She often publically wore a red ribbon and was the first prominent public figure in the UK to be pictured holding the hand of a person with AIDS in his hospital bed. This iconic image was seen by millions all over the world and had an amazing effect in challenging attitudes towards people living with HIV and breaking down stigma and misconceptions.
In Leicester, an initial meeting brings together around 40 people with an interest in practical action to address the issues related around AIDS and HIV. A general meeting adopts a constitution and elects a management committee which carries on the work of an initial steering group forming links with other agencies pursuing funding and seeking premises. The organisation is called: Leicestershire AIDS Support Services.
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.
These data confirm and reinforce findings from a study reported in November 2011, which found that half the gay men surveyed would consider taking PrEP. Once again, daily dosing was preferred to taking a dose before sex. In the qualitative data, men commented that sex is often spontaneous and that they felt daily dosing would facilitate adherence.
However these data are all based on giving men a few key facts about PrEP and presenting it as a hypothetical option. In real-life circumstances, where men think more seriously about PrEP as an option and hear friends’ experience of taking it, actual uptake and sustainability may be very different.
While the Manchester respondents largely assured the researchers that they would take all their doses of PrEP and wouldn’t have more risky sex, real-life experience needs to be tested in research.
To this end, the Medical Research Council are seeking funding for a 5000-participant, two-year study which would randomise HIV-negative gay men who report unprotected anal intercourse to either take PrEP (Truvada) and attend motivational interviewing (intervention group) or to be put on a one-year waiting list for PrEP and to have motivational interviewing in the meantime (control group).
For the researchers, it is crucial that this is an open label but randomised study, in which participants know whether they are receiving the actual drug. This unusual research design would, they argue, tell us more about the real-world effectiveness of PrEP than a blinded study as it would take into account the possible impact of participants taking more sexual risks because they felt that PrEP afforded some protection. (Researchers call this ‘risk compensation’ or ‘behavioural disinhibition’).
Rather than test efficacy in artificial conditions, the study would therefore test effectiveness in more realistic UK conditions.
So far, however, the potential funders of this costly study have not been persuaded by this argument and it is unclear whether the study will be able to go ahead.
What will, however, start recruiting later this year is a pilot version of the same study, aiming to include 500 men who attend one of around twelve sexual health clinics.
As well as allowing the researchers to have a dry run of the main trial and identify teething problems with its strategy, it should also provide valuable information on the number of men who actually follow through on a clinician’s offer of PrEP. Data on the characteristics of men who seek PrEP, drop-out rates and risk compensation will also be collected.
The researchers intend to take some of these data back to the main study’s potential funders, in order to support a revised application.
Acceptability of taking HIV treatment for prevention purposes
As well as asking people hypothetical questions about PrEP, researchers have also been asking people waiting for an HIV test result hypothetical questions about treatment as prevention.
Individuals from high-risk groups attending the Jefferiss Wing at St Mary’s Hospital for HIV testing were given an explanatory paragraph about treatment, infectiousness and safer sex. They were then asked: “If you were diagnosed with HIV would you consider taking treatment to reduce the risk of passing on infection (even if you did not need to take treatment for your own health)?”.
Four out of five respondents said ‘yes’. Encouragingly, gay men who reported unprotected anal intercourse in the past three months were more likely than others to be interested in the idea. Less encouragingly, people who had had a sexually transmitted infection or who had previously taken PEP were slightly less likely to say that they would take treatment for prevention.
The researchers suggested that the latter factor may be associated with PEP users’ experience of side-effects. It contrasts with the findings of the London PrEP attitudes study described above which found people who had previously taken PEP more likely to be interested in PrEP.
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