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Some interesting information on risk of HIV transmission

Author: May 30, 2014 0 Comments

From: HIV Update <bulletins@bulletins.aidsmap.com>
Date: Thu, May 29, 2014 at 9:04 AM
Subject: Long-term HIV transmission risks – HIV update, 29 May 2014

Long-term HIV transmission risks

A group of American researchers have published an analysis which attempts to estimate the long-term risks of HIV being passed on within a couple.

This was a mathematical modelling study – in other words, it does not report new findings from a study of couples in the real world. Instead, modelling studies use previous research findings, assumptions and mathematical techniques to simulate a sequence of likely future events.

Their findings show that even if the risk of HIV being passed on during one sexual act is relatively small, the risk can accumulate over time for a couple who have sex regularly for a number of years.

The researchers wanted to get a rough idea of the long-term benefits and risks of using different methods to reduce the likelihood of HIV transmission. They were interested in couples where one person is HIV-positive and the other person HIV-negative, who were assumed to have penetrative sex six times a month.

For example, for an HIV-positive woman and HIV-negative man, who only have vaginal sex:

  • If no protective measures are taken, 6% risk of transmission after one year, which adds up to 44% after ten years.
  • If the negative partner takes pre-exposure prophylaxis (PrEP), 2% risk after one year, 15% after ten years.
  • If condoms are used, 1% risk after one year, 11% after ten years.
  • If the positive partner takes HIV treatment, 0.2% after one year, 2% after ten years.
  • If condoms and PrEP are used, 0.3% after one year, 3% after ten years.
  • If condoms and HIV treatment are used, 0.05% after one year, 0.5% after ten years.
  • If condoms and PrEP and HIV treatment are used, 0.01% after one year, 0.1% after ten years.

The risks are much greater for couples who practise anal sex, whether they are heterosexual or gay. (The risk of HIV transmission during receptive anal sex is 18 times greaterthan that during vaginal sex).

For a gay male couple:

  • If no protective measures are taken, 52% risk after one year, which adds up to 99.9% after ten years.
  • If the negative man takes PrEP, 34% risk after one year, 98% after ten years.
  • If condoms are used, 13% risk after one year, 76% after ten years.
  • If the positive man takes HIV treatment, 3% after one year, 25% after ten years.
  • If condoms and PrEP are used, 8% after one year, 59% after ten years.
  • If condoms and HIV treatment are used, 1% after one year, 6% after ten years.
  • If condoms and PrEP and HIV treatment are used, 0.3% after one year, 3% after ten years.

Some mathematical models that we have reported on in the past could be criticised for being based on unrealistically optimistic assumptions. This one can be criticised for including some rather pessimistic assumptions.

In particular, the estimates for pre-exposure prophylaxis (PrEP) and condoms assume that people who plan to use them don’t always manage to. Both PrEP and condoms are likely to be much more effective when they genuinely are used consistently.

The figures produced are rough estimates and there is much that scientists can debate. Nonetheless, the study brings to light four key points:

  • A small risk of transmission in a single act of sex translates into a much larger risk during a sexual relationship that lasts several years.
  • The risks of transmission through anal sex, especially in the long term, are much greater than through vaginal sex.
  • Current research shows that effective HIV treatment provides more protection than other strategies, including condoms.
  • The safest strategy is to use several prevention methods in combination, such as HIV treatment, PrEP and condoms.

HIV STI info

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Why would you want to know if you are immune to HIV?

Author: March 15, 2014 0 Comments

Why would you want to know if you are immune or partially immune to HIV?

Most gay men will know someone who has lots of unsafe sex but they are still negative it is likely because they are immune to HIV.   There are also lots of people who have been HIV positive for along time but are relatively healthy, these people are likely partially immune.

IF both your parents have the gene (CCR5) to make one immune to HIV then you will be immune.  IF one of your parents has the gene (CCR5) then you  will be partially immune to HIV.

 

IF YOU ARE HIV NEGATIVE – you may want to know you are immune because:

You can find out if you are immune to HIV or partially immune to HIV but getting a simple swab of your mouth.  The results will tell you if you are unlikely to become HIV + (partially immune), or if you will almost certainly will not become HIV+.  This knowledge may help you to have less anxiety about sex or some people may decide to have risker sex.

If one is partially immune then you will be a slow progresser, then the HIV virus will not have the same effect on you as someone who is not partially immune.

 

The immunity comes from not having receptors that allow the virus to enter the body.  One who is partially immune has fewer receptors so becoming infected is lessened and if one does get infected the disease will progress more slowly.

 

IF YOU ARE HIV POSITIVE – you may want to know you are immune because:

You will know if you are a slow progresser.   You may want to take less HIV medication to keep your viral load suppressed.  You may have peace of mind that you are not so likely to get sick from HIV.

A company called delta-32 will sell you the test to find out if you are immune to HIV.   Their website gives a lot of interesting information on HIV immunity.

Their website is:     http://www.delta-32.com/

HIV STI info

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PEP Coming to BC Finally

Author: April 12, 2012 0 Comments

 

 

Accessing HIV post-exposure drugs
GAY MEN’S HEALTH / BC launches nPEP pilot project
Nathaniel Christopher / Vancouver / Wednesday, April 11, 2012
Gay men in Vancouver will soon have expanded access to a drug therapy that can prevent them from becoming HIV-positive after exposure to the virus.

Next month the Ministry of Health and the BC Centre for Excellence in HIV/AIDS (BC-CfE) will implement an 18-month pilot project called non-occupational post-exposure prophylaxis (nPEP).

Right now PEP treatments, which are initiated within 72 hours of exposure to HIV and cost between $1,000 and $1,500, are publicly funded only for victims of sexual assault or people exposed to the virus in the workplace. Under nPEP the government will cover the costs for treatments following other high-risk exposures to HIV, such as unprotected sex and intravenous drug use.

“Non-occupational post-exposure prophylaxis will be rolled out in the next few weeks,” confirms Dr Val Montessori, co-chair of the therapeutic guidelines committee at BC-CfE. “If the individual is assessed as having been in a high risk situation, nPEP, which includes three medications active against HIV, will be prescribed. A physician is the only one who can prescribe these HIV medications. The cost of the medications will be covered for this pilot by PharmaCare.”

Bill Coleman welcomes the nPEP pilot project, but he wonders why it took so long to launch and says it will leave gay men outside Vancouver at risk.
(Nathaniel Christopher photo)

NPEP will soon be available at St Paul’s Hospital’s emergency department, the John Ruedy Immunodeficiency Clinic at the BC Centre for Disease Control, the Bute St Clinic, Spectrum Health Clinic and the Vancouver Coastal Health Downtown Community Health Centre.

“We are in the process of carefully reviewing the necessary information for the pharmacy, the pilot sites and the individuals who may access nPEP,” Montessori says. “We anticipate that the pilot will be ready to roll out in May.”

NPEP is not the “morning-after pill” for unsafe sex, but it can be an effective tool to prevent infection, says Jody Jollimore, project manager for the Health Initiative for Men (HIM).

“PEP is not a silver bullet,” he notes. “It’s not going to prevent HIV infections in our community completely, but certainly in certain instances it can be an effective tool. Our key will be to promote it not as the end of condom use but something that can be used in addition to a condom.”

PEP can have mild to severe side effects for many people, he adds.

“This is not a walk in the park,” he says. “In fact, the research says that over 80 percent of guys who access PEP once never return for a second course. So guys aren’t using this as a morning-after pill. And they won’t.”

HIM has been pushing for PEP to be more accessible to gay men for years. In 2010, the organization released a position paper titled “Post-Exposure Prophylaxis for Consensual Sexual Activity in British Columbia” which argues that gay men are becoming HIV-positive because they can’t access PEP.

The paper describes three Vancouver-area men who attempted to access PEP after having unprotected receptive anal sex with other men. One of them was “able and eager” to pay for the PEP himself; the other two were not given the option of paying. All three were denied the treatment and subsequently seroconverted.

Bill Coleman, a Vancouver therapist who has worked with the HIV community for more than 25 years, says inaction from provincial HIV policymakers led to many needless HIV infections.

“They are slow and backward in their policy,” Coleman says “That is just really unforgivable. I still see people who, if they would have known about PEP, might not be infected and may not have infected other people. I just think it’s quite unforgivable that they didn’t take any action for years.”

Jollimore notes that some gay men are able to access PEP with the right health insurance, a doctor who will prescribe it and knowledge of the treatment itself. “Without that it’s a bit of a patchwork as to who can get it and who can not,” he says. “Certain third party health insurance companies already cover these medications. For instance, we had a flight attendant contact us about a year ago and we directed him to the appropriate health care providers, he got a prescription, submitted the prescription to his insurance company and they covered the medications for him.”

Coleman says some gay men in the community, unable to access PEP, have taken matters into their own hands by taking their HIV-positive friends’ medication. “But most people wouldn’t know enough about PEP to do it.”

Jollimore believes the nPEP pilot project was implemented in response to growing pressure from the gay community, as well as studies that show PEP is an integral component of HIV prevention, especially among people at higher risk of HIV infection such as gay men and intravenous drugs users.

“There are a number of factors I think that are influencing why it’s happening now,” Jollimore says. “One of them is the Stop HIV/AIDS pilot project which of course is touting a treatment-as-prevention model, which is saying that having people on medication can prevent transmission of HIV. So PEP fits within that model, of course, but also there’s been a growing pressure that comes from the community onto the various health authorities to make this prevention available.”

Montessori agrees that nPEP “dovetails nicely with the efforts currently underway in BC to expand HIV treatment as prevention, which is aimed to curb AIDS-related morbidity and mortality, as well as new HIV infections. BC is currently leading the country regarding the rate of decline of AIDS-related morbidity and mortality, as well as new infections, and this trend has remained apparent over the last decade.”

Coleman wonders why the project is limited to just Vancouver. He believes the action being taken is halfhearted and still leaves much of the population at risk.

“Why would it be a pilot project and why isn’t it available everywhere in the province?” he asks. “What if you live in Victoria or Prince George and need PEP? Many provinces  provide it so why is this place so backwards?”

Access to nPEP varies by province and territory. It is covered only in Quebec, Prince Edward Island, Newfoundland and Labrador and on a case-by-case basis in Alberta, according to Jim Pollock, communications director at the Canadian AIDS Treatment Information Exchange.

NPEP has been available to Quebec residents since 1999 and is funded there by the provincial drug plan regardless of how the patient was exposed to HIV.

It’s also available at every hospital and health centre in Newfoundland and Labrador.

“It’s all covered here,” says Gerard Yetman, executive director of the AIDS Committee of Newfoundland and Labrador. “We’re also in discussion to have PEP available with our needle exchange van that actually operates in two centres in the province. PEP is available basically for anybody who requires it.”

Montessori says the BC-CfE will share the results of the pilot project with the BC government, which will ultimately decide how readily available nPEP will be in the future.

HIV STI info, Xtra newspaper columns

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The failure of medical community in delivering HIV messages

Author: March 7, 2012 0 Comments

 

 

It has been more than 25 years that gay guys have been told to use condoms for sex.  Yet many of us still sometime do not do what we are told.  Almost no sexually active gay guys will say “I did not know I should use condoms”.  So why do we still get the same message, for 25 years, that clearly is not working?

Sex is complex and there are a lot of emotions that are part of our sex lives.  But the emotional part of who we are and the importance that sex plays in our lives, is not addressed.  Our originations around the world still shout at us to “USE CONDOMS”.  This message gets old and tiresome, yes we know that.   Where are the messages that help us to understand why we are not using condoms?

HIV has for over 25 years been dominated by the medical profession.  Medicine has done wonders at helping those of us who may be infected to have a healthier and better life.   But medicine tends to take a scientific and logical approach to problems.  Hence the simple message of “use condoms”.  Medicine is not as good at dealing with complex emotional aspects of human behaviour.

I think it is time for medicine to step aside in addressing HIV prevention and give way to the social scientists to explore more effective messaging.  It is also time for our organizations to focus more on messages other than “use condoms”.

If you ask gay guys why they sometimes do not use condoms they often have no more understanding than “I do not like condoms.”  There was an effort to tell us that condoms were fun and sexy but that message did not go very far.  So we may know that sex is better, more fun, easier, and more intimate without condoms.  But we are not assisted much in understanding how we sometimes allow ourselves to not use condoms.

It seems that there has been an underling message of: “be afraid of HIV”, and then by extension that leads to  fear  HIV poz guys.  Many gay guys have become so scared of HIV that they reject HIV poz guys.  Messages of fear are not effective.   Messages of fear have had the effect of marginalizing members of our community, not building a stronger community.  We know too much about stigma in our community; we do not need any messages that promote stigma amongst members of our own community.  We need messages of understanding, acceptance and support.  Where are the messages that a poz guys with undetectable viral load is not going to transmit HIV?  Where are the messages of support and understanding?

I have spent almost 20 years talking to guys about their sex lives and HIV.  I have noticed a few trends in HIV infections.   For over 10 years I would say “Guys are most vulnerable to get infected when a relationship ends.”  In the last few years I have seen that perhaps this message is too narrow.  It seems to me that guys are most vulnerable to get HIV when they are feeling their life is falling apart.  That can be death of a parent or a loved one, job loss, depression,  loss of home and loss of relationship, etc.

I do not pretend to have “the answer” to why we do not always use condoms but I feel I have some understanding of how bare sex happens.  But let’s focus more on why we take risks, when we will take risks and how to support all of us to take better care of ourselves.

Stuff that did not make it in the newspaper

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Risks and HIV Transmission for Gay Men

Author: March 7, 2012 0 Comments

 

 

This one tends to continuation on from my last article in Xtra on 15 Dec 2011, but from a new angle.

 

I recently talked to an MD who works for the government in the field of HIV and s/he said that we need a nuanced message to deal with the new information out there about undetectable viral load reduces the risk of transmitting HIV.  S/he feels we need new messaging because s/he see people every day coping with viral load questions.  My response was that the CDC does not know the meaning of nuance they only know short messages with an all or nothing message, Later I talked with one of those bureaucrats that is part of developing those all or nothing messages. (S/he does not see patients in real life, and I wonder if s/he only knows about sex from journals and books.)  S/he confirmed s/he likes the all or nothing short simple messages.  Short and simple seems to be more important than how accurate the message is.

 

 

 

What if you wanted to go skiing and wanted to make sure you would not get injured in an accident on the dangerous highway 99.  You could decide to drive only between 2AM and 3AM, when there are fewer cars, you can get the best snow/ice tired there are, you can get the safest car with the most air bags, you could decide to only drive on days when there is no snow or rain.  But likely this would not be practical or fun – but safer.  Likely you will just drive to the ski hill when you want to ski and tell yourself to be careful.  After all you did it for two years and had no problems so just tell yourself to be careful.  Well it is a lot like fucking.  There are things you can do to make it safer but they may not all be fun or practical.

 

The Journal Science has declared that the scientific breakthrough of 2011 was a study (HPTN 052), this study found that a person with an undetectable viral load reduces transmission of HIV by 96%.  One article said “Having an undetectable viral was as effective as condoms.

 

That is like going to buy a pair of jeans for $100.00 but finding out they are reduced by 96% so they now cost $4.00.  That is a huge difference.

 

So lets look and what this means for fucking without condoms.  If you are getting fucked raw by a HIV poz guy with and undetectable viral load the chance of getting infected goes from 1 in 200 (no HIV treatment) to 1 in 5,000.  If you are fucking a poz guy raw with undetectable viral load the chances of getting HIV goes from 1 in 1,538 (no treatment) to 1 in 38,461.

 

So if you have sex with a poz guy with an undetectable viral load and if you use a condom that reduces it a further 96%.  So it is like those $100 pair of jeans go to $4.00, and then are deduced again by 96% and now they cost 16 cents.

 

We are told that BC government is spending $50,000,000 to get as many positive persons as possible to have an undetectable viral load.  They call it “Treatment as Prevention”, but that is just the marketing to the government.  It is not preventing HIV transmission but it is reducing the risk of getting HIV by 96%.

 

The risk of fucking without condoms changes dramatically – yea it is reduced by 96%!.  What do us as gay guys do?  Do we take more risks?  Do we decide that maybe we play more in the sandbox with the poz guys with undetectable viral load because they are not so scary now?

 

Do negative guys become scarier to play with because 2.5% of them may be poz and not know it and therefore may be 20 -25 time more likely to pass on HIV. For the guys who think they are negative but are newly positive then getting fucked by them changes the risk from 1 in 200 for a (poz guy with detectable viral load) to 1 in 10 for newly poz guy.

 

You may ask a negative partner if he get tested on a regular basis.  If he does it likely is because he is concerned he is maybe positive.  So why would you think he is negative if he thinks he may be poz and gets tested regularly to find out.

 

So if you decide to have sex only with guys who believe they are negative what is the chance of getting HIV?  We know 2.5% of those guys who think they are negative are really positive.  If we assume that those 2.5% are newly infected and that is why they do not know they are poz then the chance of becoming poz is about 1 in 200 if you choose only guys who think they are negative.   An interesting number – it is the same number as getting fucked by a poz guy with detectable viral load.

 

Where do all these numbers leave us.   Well poz guys with undetectable viral load are a lot less likely to infect someone then if they did not have an undetectable viral load.   Negative guys who will take risks with you will take risks with others also, – did you think you were special – so he may be poz.

 

A number of negative guys have told me that often poz guys are just more fun to have sex with than negative guys.

 

So where does the leave us?  Are poz guys (with undetectable viral load) sought after now, and are the “negative” guys shunned as having the potential for infecting others?  The science may say there is a good case for this.  But after all it is fear and prejudges that made many negative guys shun poz guys in the first place, – it was not science!  Our prejudges against poz guys as sex partners will not change easily.

 

What we do not need is the institutional marginalization of poz guys.  Many organizations will tell us we are at higher risk if we have sex with a poz guy.  Surveys ask “do you have sex with poz guys?”, they then tell you are at more risk if you do have sex with poz guys, this is not true if the viral load is undetectable. The institutional response should be: “ know your partners viral load” not his HIV status!

 

Well this is my last regular column in Xtra,   I plan on doing a retrospective piece next month outlining what I have learned while writing these pieces and bring up a few points to consider.  I may be back with the occasional writing on gay men’s health.

HIV STI info, Interesting stuff for gay guys, Stuff that did not make it in the newspaper

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