7 JANUARY 2022 VOLUME 24 ISSUE 1

Over the last decade, criminal cases brought against women for alleged HIV exposure or transmission through breast milk have been on the increase. This is particularly concerning in sub-Saharan Africa, where nine such cases have been reported since 2013.

With the new year comes a new law. California has become the first state to require health insurance plans to cover at-home testing for sexually transmitted infections (STIs), such as HIV, syphilis, gonorrhea and chlamydia. It’s the latest effort to address an ongoing nationwide spike in STIs that has only worsened amid the COVID-19 pandemic.

A mixed methods study looked how health literacy and communication with healthcare providers impacted the health outcomes of women living with HIV, with a focus on Black and Latina women in the United States. Communications issues with providers, amplified by low health literacy, resulted in diminished trust, lower quality of patient and provider interactions, and poor health outcomes.

PrEP services can be successfully integrated into public HIV care clinics across Africa, a trial in 25 high-volume public clinics in Kenya found. There were 4,898 PrEP initiations, with reasonable continuation and high adherence observed. This was achieved with existing personnel and infrastructure in the health facilities.

The one-stop shop model for pre-exposure prophylaxis (PrEP) delivery may be useful for making the process more client-focused and also may gain buy-in from providers, according to a paper published in Journal of the International AIDS Society.

Financial support for the research and development (R&D) of HIV prevention declined in 2020, marking a drop for the second year in a row and continuing an eight-year trend of either decreased or flat funding, according to the latest annual report on the topic from AVAC, a global organization focused on HIV prevention.

As 2021 comes to a close, it is a good time to take a moment to reflect on the year and think about the challenges ahead. This year, we commemorated the 40th anniversary of the first cases of what would become known as AIDS, welcomed a budget proposal from President Biden that more than doubled the funding for the Ending the HIV Epidemic in the US initiative and was fully supported by both the House and Senate. President Biden gave his full commitment to ending HIV during a White House World AIDS Day event and released an updated National HIV/AIDS Strategy for the US 2022–2025.

I first came across Mr. B. while reviewing charts for new patients in my primary care HIV clinic. Even in a public hospital where many patients were down-and-out, his case struck me. He lived in a single-room–occupancy hotel and had a history of homelessness. He’d received an HIV diagnosis years before and had managed occasional contact with the health care system but had never started HIV treatment.

The penis is the primary site of HIV acquisition in heterosexual men. Elevated penile inflammatory cytokines increase sexual acquisition risk, and topically applied cytokines enhance foreskin HIV susceptibility in an explant model. However, the impact of penile-vaginal sex on these immune parameters is undefined.

Broadly neutralizing antibodies (bNAbs) represent an alternative to drug therapy for the treatment of HIV-1 infection. Immunotherapy with single bNAbs often leads to emergence of escape variants, suggesting a potential benefit of combination bNAb therapy. Here, a trispecific bNAb reduces viremia 100- to 1000-fold in viremic SHIV-infected macaques. After treatment discontinuation, viremia rebounds transiently and returns to low levels, through CD8-mediated immune control. These viruses remain sensitive to the trispecific antibody, despite loss of sensitivity to one of the parental bNAbs.

Pre-exposure prophylaxis (PrEP) is a daily regimen that reduces the risk of acquiring HIV by up to 97 percent. There is limited information on the use of telehealth to provide PrEP in a program aimed toward the primary prevention of HIV. This was a 6-month telePrEP feasibility study that assessed process measures, clinical outcomes and patient satisfaction. Descriptive statistics and Chi-square analysis were used to evaluate measures and outcomes from the start to the end of the study.

First identified as a viral defense mechanism, clustered regularly interspaced short palindromic repeats (CRISPR) and CRISPR-associated proteins (Cas) has been transformed into a gene-editing tool. It now affords promise in the treatment and potential eradication of a range of divergent genetic, cancer, infectious, and degenerative diseases.

Orphanhood increased markedly in the 1980s and 1990s in sub-Saharan Africa because of HIV-related mortality. Little is known about the contribution of HIV interventions, such as antiretroviral therapy (ART) and male medical circumcision, to more recent trends in orphanhood. In this study, we examined trends over time in maternal-only, paternal-only, and double orphanhood among adolescents before and after ART and male medical circumcision became widely available in the Rakai region of south-central Uganda.

Interventions to improve HIV service uptake are increasingly addressing inequitable and restrictive gender norms. Yet comparatively little is known about which gender norms are most salient for HIV testing and treatment and how changing these specific norms translates into HIV service uptake. To explore these questions, we implemented a qualitative study during a community mobilization trial targeting social barriers to HIV service uptake in South Africa.

Infant positivity and infant mortality at 24 months were low for a breastfeeding population. Starting ART pre-conception had the greatest impact on HIV-free survival in HEIs. Further population-level reduction in MTCT may require additional intervention during breastfeeding for women new to PMTCT programmes. Pre-partum diagnosis and linkage to ART, followed by continuous engagement in care during breastfeeding can further reduce MTCT but are challenging to implement.

Pre-exposure prophylaxis is a powerful HIV prevention tool that can reduce the risk of acquiring HIV from unprotected sex by over 90 percent and more than 70 percent from injection drug use. The peripartum period is a time of heightened HIV risk which underscores the need for HIV prevention counselling and the provision of biomedical interventions in all stages of a woman’s reproductive life. It is important that women receive non-judgmental care, have access to discussions of HIV risk, and are provided with pre-exposure prophylaxis counseling from their women’s health practitioners.

HIV remission clinical researchers are increasingly seeking study participants who are diagnosed and treated during acute HIV infection—the brief period between infection and the point when the body creates detectable HIV antibodies. This earliest stage of infection is often marked by flu-like illness and may be an especially tumultuous period of confusion, guilt, anger, and uncertainty. Such experiences may present added ethical challenges for HIV research recruitment, participation, and retention.

HIV self-testing (HIVST) and pre-exposure prophylaxis (PrEP) are complementary tools that could empower sex workers to control their HIV protection, but few studies have jointly evaluated PrEP and HIVST in any setting.

Adolescent girls and young women (AGYW), as well as pre- and post-menopausal women globally would benefit from expanded choice to address their sexual and reproductive health (SRH) needs related to Human Immunodeficiency Virus (HIV), sexually transmitted infections (STIs) and pregnancy prevention. Lack of adequate preventative vaccines for HIV/STIs reinforces public health prioritization for options women may use independently to mitigate risk for infectious disease and unplanned pregnancy.

HIV pre-exposure prophylaxis (PrEP) in the form of a daily oral medication is highly effective at preventing HIV. In the United States, awareness about PrEP has steadily increased over time among individuals vulnerable to HIV, however awareness has not translated into widescale uptake. Estimates are that fewer than 20 percent of 1.2 million Americans for whom PrEP is indicated are utilizing it. We sought to understand how individuals moved from PrEP awareness to PrEP utilization.