The Future of HIV and U=U

People all over the world are receiving effective HIV treatments and more treatment options are in the pipeline. Now, global health organisations want to end the AIDS epidemic

Via New Scientist

IN 2015, the Joint United Nations Programme on HIV/AIDS (UNAIDS) launched an ambitious target: to end the AIDS epidemic by 2030. The aim is that no child will be born with HIV and anybody already infected will be treated with medicines that give the best opportunity for healthy living.

This goal is in stark contrast to the early days of the epidemic, when the virus wreaked havoc. In the 1980s and 90s, an HIV infection was almost always fatal. But treatment has come a long way since then.

Today, nearly 21 million people around the world receive life-saving antiretroviral therapies, which can reduce the amount of the virus in the blood to undetectable levels. And scientists have even greater ambitions: some are developing vaccines, others are formulating long-acting treatments and still more are working on a cure. “HIV has changed from a deadly disease to a manageable disease,” says Jens Lundgren at the University of Copenhagen in Denmark, who has been working on HIV care and research for the past 30 years.

Until recently, HIV’s spread was rapid because it is easily transmitted via contact with infected blood and other body fluids. The most common routes of infection are through sex and shared needles.

But the risk of transmission can now be substantially reduced with antiretroviral medicines. Bruce Richman, who was diagnosed with HIV in 2003, says the treatments have changed his life. “For much of the time I had HIV, I isolated myself and had a sense of fear and shame,” he says. “Because I had a fear of transmitting HIV, I feared getting close to romantic partners.”

But that changed in 2012, when Richman’s doctor informed him that his antiretroviral treatment had reduced the amount of HIV in his blood to undetectable levels. The news was a revelation and Richman realised he no longer needed to hide.

Keen to spread the word, he started a campaign to publicise the life-changing effects of antiretrovirals and their impact on transmission rates. He called the campaign U=U (Undetectable = Untransmittable). His aim was to change the way people understand what an HIV diagnosis means, encourage those who are infected to keep up with their treatments and help lift the enduring stigma of HIV. “It improves the lives of people with HIV, and opens up social, sexual and reproductive lives that we didn’t think were possible,” says Richman.

“Eliminating AIDS as a public health threat by 2030 is potentially achievable”

Since 2016, the U=U campaign has teamed up with 570 other organisations in 71 countries to share the message. “In most of these countries people have been taught to fear HIV and people with HIV,” says Richman. “Now we’re turning a corner.”

The impact of this and other prevention strategies and campaigns has begun to reduce new infection rates. In 2016 in London, four sexual health clinics saw a 40 per cent fall in new HIV infections among gay men compared with 2015. And the number of new diagnoses in San Francisco has dropped by more than 50 per cent since 2006, in large part because of this “treatment as prevention” approach, also known as TasP.

But more work is needed, for example, on a vaccine. For some other viruses, vaccines work by mimicking the biochemistry of people who seem to be naturally protected from infection. “For HIV, we don’t have a good naturally protective correlate to work with,” says Lundgren.

Another difficulty is the lack of a good animal model for human HIV infections. Potential vaccines that show promise in monkeys infected with the similar simian immunodeficiency virus (SIV) have not been successful in human clinical trials.

There are also hopes for an HIV cure, but this has been harder to come by than expected. The main problem with trying to cure HIV is that there is a latent reservoir of the virus in the body.

That is why the leading strategy in the hunt for a cure is the “kick and kill” approach. This aims to kick HIV out of cells that act as a reservoir and then kill the virus.

While focusing on such scientific problems to make a cure a possibility in future, researchers at pharmaceutical company Gilead are also making progress when it comes to the potential for longer-acting treatments. At the moment, antiretroviral drugs must be taken on a daily basis and this can prove difficult for some.

Winston Tse, a senior scientist at Gilead, is working on a treatment that looks to be particularly potent and could take the form of a long-acting injection. He and his colleagues have set their sights on a protein that surrounds and protects the HIV RNA genome which is essential to viral life including its ability to infect new cells. The team is developing compounds that interfere with this protein and so inhibit the ability for the virus to replicate.

“Such a treatment could help with compliance, as well as lessening the emotional burden of taking daily HIV treatment,” says Tse.

It is this focus on prevention and treatment that make the UNAIDS goal potentially achievable – eliminating AIDS as a public health risk by 2030. “I would love a cure, but I’m investing my time into the strategy of testing, treating and prevention, because I think that’s the way to end this epidemic,” says Richman.

Lundgren agrees. “We have the tools, we have the drugs, we have the tests,” he says. “If we push resources, we can control it.”

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Female Condoms: Difficult to find in the US, easy to get in UK.

Female condoms are an alternative to regular condoms. They provide pretty much the same great protection from pregnancy and sexually transmitted infections (STIs). What’s different about them? Instead of going on the penis, female condoms go inside your vagina for pregnancy prevention or into the vagina or anus for protection from STDs.

There are hundreds of different kinds of male condoms for sale in the US, but only one female condom and you need a prescription to get it. Female condoms are almost as effective as male condoms, so why are they so hard to find in the US?

At LASS, we’ve been providing female condoms for over 10 years, and when we mention them at our training events or offer them to individuals who test for HIV at LASS, they are often surprised at their existence.

The situation isn’t as bad in the UK compared to America as the above video from Vox describes but publication and awareness of female condoms isn’t as readily available as their male counterparts, (even in the UK) and we want to change that!

Female condoms have been around since the 1980’s, when a Danish doctor named Lasse Hessel came up with a prototype. However, the media ridiculed it, comparing it to a plastic bag.

Female condoms have never been marketed very well and stigma over a sexual health aid still hangs around to the point that in the US last year, the company that manufactures them stopped selling them in stores and changed to a prescription-only model, so indivuals in the states need to see a doctor, just to get a condom.

That’s backwards thinking and we say they are just as valid as male condoms to help prevent STIs (including HIV) Another excellent reason for using female condoms is they’re the only women -initiated method of planning and actively pursuing safer sex. Many say they’re preferable for anal sex too!

How do female condoms work?

Female condoms (also called internal condoms) are little nitrile (soft plastic) pouches that you put inside your vagina. They cover the inside of your vagina, creating a barrier that stops sperm from reaching an egg. If sperm can’t get to an egg, you can’t get pregnant. The female condom also helps prevent sexually transmitted infections.  Female condoms aren’t just birth control — they also reduce the risk of sexually transmitted infections.

Female condoms help prevent STIs by covering the inside of your anus, vagina, and some parts of your vulva. This decreases your chance of coming in contact with semen or skin that can spread STIs.

Unlike in the United States as the above video shows, female condoms are becoming easier to find online, in stores, and at family planning centers. And you don’t need a prescription or ID to buy them. They’re a small, discreet, and portable way to get big protection from pregnancy and STDs.

We provide them freely at LASS, since all the other condoms out there are worn on a penis, many female condom fans love that there’s a condom they can control. Female condoms let you take charge of your sexual health. Even if your partner doesn’t want to wear a condom, you can still protect yourself.

You can also buy them online, here’s a couple of links from Amazon (Pasante) (Velvet)

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Life Insurance & HIV. What’s happening now?

Research published last year revealed that young people receiving the latest HIV drugs now have a “near-normal” life expectancy. [Read that article here]

Yet despite such profound changes in the health of people with the conditions, one in four say they have been refused a financial product or quoted an unaffordable insurance premium in the past five years.

Life insurance customers who are HIV positive are now able to take out longer term policies, with premiums remaining stable, new research has shown.

Figures from Unusual Risks, the medical financial advisers, showed HIV positive men and women were taking out life insurance in the UK and insuring themselves for an average of £125,933.

The average term for policies taken between 2009 and 2013 was only 10 years but it is now possible to get a term of between 15 and 25 years.

“The average sum assured has remained fairly stable for HIV Life Assurance over the last few years, at between £125,000 and £130,000,” said Chris Morgan, lead financial adviser of Unusual Risks, Mortgage & Insurance Services.

“The products have become established and premiums have remained stable. That is due to there being several product providers that now offer life insurance to people living with HIV.

“Due to the complex nature of the underwriting of HIV Life Assurance and the range of different policies, premiums and terms available it is advisable to seek specialist professional advice before taking out HIV Life Assurance. It is not a product that can be bought instantly and directly via online money and insurance websites.”

Alan Lakey from CI Expert, said the number of insurers who will accept customers with HIV had increased hugely in recent years.

“Interestingly, some of the insurers offer cover but don’t shout about it,” he said. “Some big names now offer HIV cover but don’t publicise it until you ask.”

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Greg Louganis,two-time Olympic Gold Champion. On life and HIV.

I sold my life insurance. My insurance policy actually showed up on the show “American Greed”! Which was fascinating. They reached out to me: “Well, this 92-year-old woman in Florida bought your life insurance policy.” Oh my god, I felt so bad. And when I did the interview, they produced a document that was notarized and signed by my previous doctor saying that I only had a maximum of six months to live. It was so devastating. That was a good reason why he’s not my doctor anymore [laughs].

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Getting on Track in Agenda 2030

A new report released today by the Global Forum on MSM and HIV (MSMGF) in collaboration with the Global Platform to Fast Track the Human Rights and HIV Responses with Gay and Bisexual Men and the Free Space Process argues for consistent and robust reporting on HIV in the Voluntary National Reviews on Sustainable Development.

Titled “Getting on Track in Agenda 2030,” the report is released ahead of regional meetings commencing this month in preparation of the annual High Level Political Forum on Sustainable Development. The report calls upon UN agencies, Member States, and members of civil society to collaboratively ensure HIV-related data is included in the framework of Agenda 2030.

The 17 Sustainable Development Goals (SDGs) and accompanying 169 Targets in Agenda 2030 for Sustainable Development include a commitment to end the epidemic of AIDS by 2030. This is monitored by an agreed upon indicator for the number of new HIV infections per 1,000 uninfected population by sex, age, and key population, which includes gay men and other men who have sex with men, people who inject drugs, sex workers, and transgender people. This commitment is aligned with the UNAIDS Fast-Track strategy to end the epidemic by 2030.

The international mechanism for review of progress on the SDGs is the annual High Level Political Forum (HLPF), which includes a thematic review of selected SDGs, side events, the adoption of a Ministerial Declaration, and the Voluntary National Review (VNR) of SDG implementation by Member States. 48 countries will participate in the VNR process this year at the HLPF at UN headquarters in New York from July 9 – 18.

Among the 43 VNR reports submitted by Member States in 2017, only 32 VNR reports included any mention of HIV. Coverage of HIV is inconsistent and uneven across VNR reports, with most reports referring to aggregate HIV prevalence or incidence in the general population. Only nine VNR reports mentioned key populations, and even fewer refer to HIV-related stigma and discrimination. MSMGF believes this is not enough to meet Fast-Track and SDG targets, and more coordinated action and commitment is necessary.

MSMGF Senior Policy Advisor, Stephen Leonelli, commented:

“There remains unfinished business in the global HIV response, including persistent health disparities, stigma, and discrimination. HIV continues to severely impede the ability of countries to achieve development priorities beyond health, and continued visibility and integration of HIV within mainstream development goals has never been more important.”

The report finds that civil society and community representatives were essential in shaping the content around HIV issues in many VNR reports in 2017. Thus, we encourage civil society members to continue advocating during 2018 VNR national consultations.

The report also highlights:

  • HIV-related data and topics included in 32 VNR reports from 2017.
  • Efforts and effective strategies of eight activists across six countries who participated in 2017 VNR national consultation processes.
  • Potential sources of HIV-related data that could and should be utilized by Member States to feed into VNR reports.
  • Main entry points for civil society to participate in national VNR processes, including guidelines for preparing civil society spotlight or status reports, and how to leverage Major Groups and international non-profit organizations to influence the content of VNR reports and the Ministerial Declaration.

In order to end the epidemic, Member States must show the political will to proactively and meaningfully engage civil society and communities, especially key population-led organizations. HIV must be addressed as a cross-cutting a development challenge, and all stakeholders must realize that fulfilling the SDGs and ensuring the principle of “leaving no one behind” will require more effort to include HIV-related data and national HIV priorities.

About MSMGF
The Global Forum on MSM & HIV (MSMGF) was founded in 2006 at the Toronto International AIDS Conference by an international group of activists concerned about the disproportionate HIV disease burden being shouldered by men who have sex with men worldwide. Today, they are an expanding network of advocates and experts in sexual health, human rights, research, and policy, working to ensure an effective response to HIV among gay men and other men who have sex with men. MSMGF watchdogs public health policies and funding trends; strengthens local advocacy capacity through our programs initiatives; and supports more than 120 community-based organizations across 62 countries who are at the frontlines of the HIV response.

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We really can beat HIV!

In October 2017, Public Health England reported an 18% drop in the numbers of people diagnosed with HIV in 2016 – this includes 18% fewer diagnoses among people of black African ethnicity compared to 2015.

This was the first time that we’ve had such a significant drop and it is was all down to a combination of things we can all do to make a difference.

New ways to stop the spread of HIV

The HIV epidemic started more than 30 years ago but recently there have been some big changes which we want to share with you and make sure everyone knows about. The number of HIV infections is starting to come down in some areas and this is down to a combined approach to stopping HIV. It’s no longer JUST about condoms, HIV treatment is now a part of our armoury against HIV – and part of protected sex.

Here’s how:

1) Treatment as Prevention (TasP)

If someone is on effective HIV treatment and has an ‘undetectable viral load’ they cannot pass on HIV. (The viral load is the amount of HIV measured in a blood test – most clinics in the UK classify undetectable as being below 20 copies/ml.)

We are saying this based on findings from the PARTNER study which looked at 888 gay and straight couples (and 58,000 sex acts) where one partner was HIV positive and on effective treatment and one was HIV negative. Results found that where the HIV positive partner had an undetectable viral load, there were no cases of HIV transmission whether they had anal or vaginal sex without a condom. It can take up to six months from starting treatment to become undetectable.

What this means: This is exciting news as it means treatment is a new way to stop the spread of HIV. Don’t forget though that sex without a condom still means you can get or pass on another sexually transmitted infection (STI) and can result in a pregnancy.

2) Pre-exposure prophylaxis (PrEP)

PrEP is a course of HIV drugs taken by an HIV negative person who is at risk of getting HIV to lower their chance of becoming infected. When taken correctly, PrEP significantly reduces the chances of becoming HIV positive.

In England PrEP is not currently available on the NHS routinely, although 10,000 people will be taking it as part of the IMPACT trial, which started this autumn. In Scotland and Wales PrEP is available on the NHS.

What this means: If you are likely to be exposed to HIV, PrEP is another way to protect yourself.

3) Post-exposure prophylaxis (PEP)

PEP is a month-long course of HIV medication taken by an HIV negative person after possible exposure to reduce the chance of getting HIV. When started in time (within 72 hours, but within 24 hours is best) PEP can stop HIV infection after sex without a condom (or other exposure) with someone who is infectious – but it does not work every time.

What this means: PEP is the third way HIV treatment can be used to protect yourself, a doctor will assess whether you will be eligible or not depending on the risk taken.

Testing and treatment saves lives

In terms of stopping HIV this new information is monumental and the facts show that people power can dramatically reduce HIV transmissions. Regular testing means more people with HIV will be diagnosed and taking treatment – so they will be less likely to become ill and less likely to pass on HIV.

Despite the good news of a drop in HIV rates, 54% of newly diagnosed black African people were diagnosed late in 2016, which means they will have an increased risk of developing an AIDS-defining illness. The British HIV Association (BHIVA) recommends everyone with HIV starts treatment when they are diagnosed. This is because a study called START found that starting straight away significantly reduced people’s chances of developing AIDS-related illnesses.

So the problem we have is that although lots of us are being diagnosed and getting onto treatment in time, an even bigger proportion are finding out they have HIV at a point where their immune systems have been damaged. Regular testing is the linchpin of reducing late diagnoses and keeping people well.

Additionally, people are extremely infectious when they are first infected with HIV which is why early diagnosis is so important – if you are on effective treatment and have an undetectable viral load you cannot pass on HIV.

The Simple Science

HIV stands for Human Immunodeficiency Virus. It was identified in the early 1980s and belongs to a group of viruses called retroviruses.

HIV uses your CD4 cells to reproduce, destroying them in the process. These are important cells which co-ordinate your immune system to fight off illnesses and infections. As the number declines, you may not have enough to keep your immune system working properly. At the same time the amount of HIV in your body (the ‘viral load’) will usually increase.

Without treatment your immune system will not be able to work properly and protect you from ‘opportunistic infections’.

Effective treatment will mean your CD4 count increases and your viral load decreases – hopefully to ‘undetectable’ levels.

The viral load test shows how much HIV is in your body by measuring how many particles of HIV are in a blood sample. The results are given as the number of ‘copies’ of HIV per millilitre of blood – for example 200 copies/ml.

An ‘undetectable’ viral load does not mean there is no HIV present – HIV is still there but in levels too low for the laboratory test to pick up. Different laboratories may have different cut off points when classifying an undetectable viral load, however most clinics in the UK classify undetectable as being below 20 copies/ml.

Modern HIV treatment means that many people with HIV are living long, healthy lives and if you’re taking HIV medication and have an undetectable viral load you cannot pass on HIV.

Getting tested

Our Rapid HIV testing service is available Monday-Friday between 9am – 4pm.  You do not need an appointment.

The test is performed at our office on Regent Road, Leicester by qualified and experienced HIV testers.  The process usually takes around 20 minutes.

The test is free to ‘at risk groups’ and always confidential.  If you’re not at risk, we can refer you to an alternative service who will be able to provide you with a free HIV test.  You can still test with us for £20 or you may prefer a free Home Sampling kit or buy a Home Testing kit from BioSure for £29.95.  You can also find details of other testing services by clicking here.

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It’s 2018 and we still have HIV/AIDS denialism from “professionals”.

Kelly Brogan (Photo: Bryan Bedder)

This weekend, Lululemon-clad wellness aficionados descended on New York for the In Goop Health summit, where they learned about trendy workouts, nibbled on Instagram-worthy organic food, and heard from a doctor who doesn’t think HIV causes AIDS, despite conclusive science saying it does.

Article via Fast Company

As Jezebel reports, one of the featured speakers at the one-day conference was Dr. Kelly Brogan, a “holistic health psychiatrist,”who said back in 2014 that the idea that “HIV causes AIDS is a ‘meme’ brought upon us by the ‘medical-scientific-industrial marriage,’ and that ‘drug toxicity associated with AIDS treatment may very well be what accounts for the majority of deaths.’”

When Newsweek asked Brogan about it recently, she called the link between HIV and AIDS an “assumption.” Brogan also brought the world the article headlined, “Why you should stop taking your antidepressants” and pretty much argues against taking any and all medicine.

In short, she’s basically the medical world equivalent of a climate change denier, ignoring overwhelming research that HIV does cause AIDS.

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A gay man’s experience of using PEP (Emergency HIV medication)

In recent months I experienced something I never thought I’d have to deal with when I faced the possibility that I might have contracted HIV.

I have been sexually responsible for my entire adult life and have always been heavily influenced by warnings of the past regarding HIV and AIDS, however all it takes is one moment of passion to let your guard down and you can find yourself in a situation similar to mine which resulted in me taking the HIV emergency medication known as PEP. The days leading up to my 28-day treatment were possibly some of the scariest of my life. Experiencing this drug first hand and the people I encountered along the way brought on a variety of conflicting emotions and an understanding of sexual health I never thought I’d have to comprehend.

Story via Metro

What is PEP?

Post-exposure prophylaxis (PEP) is a month-long course of medication which aims to prevent HIV infection after the virus has potentially entered a person’s body. The drug is used as an emergency measure on a person who may have been exposed to the virus, either through infection or sexual transmission. Although PEP is not 100% guaranteed to always work, the success rate is very high. It’s very important to make clear that PEP should not be considered an alternative to using condoms as prevention for contracting HIV. Using condoms is the most effective method of preventing HIV transmission as well as other sexually transmitted diseases.

The drug should also not be viewed as some form of a morning after pill either – PEP is a powerful drug and users like me risk side effects, not to mention the fact PEP isn’t taken on just one occasion like with morning after pills. I myself am lucky enough to have not experienced any side-effects of PEP, but the potential side-effects include prolonged headaches, diarrhoea, nausea and vomiting. If you experience any of these side effects you should not stop taking the medication as once stopped, PEP will not be effective. Contact your doctor to discuss any issues you may be encountering on the drug to get an informed decision on what to do next. Timing is also crucial when it comes to PEP. If the course of drugs has not started within 72 hours of potential infection, the drug will no longer be effective.

Why I took PEP

My reasoning for using this often misunderstood drug was down to one thing: paranoia. The partner I had engaged in potentially risky sexual activity with was someone I know to be practising safe sex, and although we weren’t in a relationship we were very open with one another about our fears of HIV risks in the gay community and HIV tests we had previously taken. Nonetheless, I couldn’t shake the feeling of ‘what if?’ after this particular sexual encounter.

After two days of endless overthinking, excessive Googling and sheer panic I decided to bite the bullet and visit my nearest sexual health clinic. On this particular evening the clinic stated upon my entrance that the session was for appointment-only patients – my heart sank as this was my final chance to obtain PEP before the 72 hour window had closed. However, after quietly asking if I could speak to a nurse in private I was humbled to learn how genuinely concerned and helpful the staff at the clinic were. I was ushered into a private room where I explained my situation and within five minutes the nurse had made space for me and I was on the waiting list.

After a short wait I was seen by the doctor who carefully took note of my situation, perfectly explained what PEP was and reassured me that coming to the clinic after potentially being exposed to HIV was the right thing to do. Hearing that my decision to take PEP was the right one was all I wanted to hear from a medical professional at that time. The doctor agreed with my sentiment that if you’re asking yourself ‘what if?’ then you should absolutely take no risks when it comes to HIV, because, ultimately, the only sexual health status you can be 100% sure of is your own. After taking a few blood samples and a quick HIV test, which is something I had done many times over the past few years, I was given my PEP medication.

The instructions were to take one tablet in the morning and two at night, taken exactly 12 hours apart at the same time every day. I was however only given a three day supply of the drug. The doctor informed me that this is normal practice and it’s up to the patient to pick up the remainder of their 28 day supply from their pharmacy. It is absolutely imperative that users of PEP plan ahead to make sure their supply of pills does not run out before retrieving the full medication.

The future

My experience with PEP, which I am currently still using until my 28 days are up, has been both fearful and insightful. In the short amount of time between considering starting a course of the drug and actually taking it I learned more about HIV and the treatments available than ever before. I also came to appreciate the services we have available in this country – if I wasn’t lucky enough to live in such a privileged part of the world who knows how I would be forced to handle a situation like this. Life after PEP will most likely enhance my sexual health paranoia, however I believe that being overly careful is always better than being slack when it comes to an issue such as this. Although I’m confident my treatment will be successful, I am currently still in my PEP bubble which involves a daily routine of taking pills with an alarm reminder at either end of my days. In the end, whether I actually needed the drug or not in the first place, it was most definitely worth it.

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