9 October 2015 VOLUME 16 ISSUE 41

Projects such as the Colorado Family Planning Initiative and Contraceptive Choice Project have been gaining steam, spreading the good word about long-acting reversible contraceptives (LARCs)....But knowledge and finances still remain monolithic barriers when it comes to accessibility of other types of sexual health resources. As one example, there's PrEP.....still not a resource many people know about....The LARC initiatives and the continuing advocacy for PrEP are just two examples of what continues to be a complex issue around accessibility to sexual health resources.

THE National Emergency Response Council on HIV/AIDS (NERCHA) has clarified on the ‘AIDS-free’ statement, saying it does not mean complete elimination of people with HIV but elimination of new infections. Making a presentation to the Swazi Observer staff yesterday morning, NERCHA’s Nokwazi Mathabela said ‘AIDS-free’ relates to controlling new infections through certain interventions that the organisation facilitates.

Khanyisile Mavimbela was five months pregnant in 2008 when she took a test and learned she had HIV....Her partner...wouldn’t talk to her about it. But someone who did offer her a compassionate ear and was able to provide her information on treatment was a Mentor Mother with mothers2mothers, a nonprofit organization that pays local women in African communities [who have HIV themselves] to be educators and counselors.

Approximately 40% of [US] women and 20% of men showed serological evidence of exposure to at least one of the nine types of HPV, according to recent data. Moreover, race/ethnicity disparities were observed in the seroprevalence of all type categories....For all type categories, men had lower seropositivity than women.

[N]o one, other than perhaps the trade reps who made the deal, appears to be happy...; not the pharma giants that want to protect major investments and not the countries with national health plans or NGOs that want access to cheaper biosimilars or generics...."The big losers in the TPP are patients and treatment providers in developing countries," said Judit Rius Sanjuan, US manager and legal policy adviser for Doctors Without Borders' Access Campaign.

"The findings of this study suggest that most infectious diseases providers who are HIV specialists in the United States generally recommend early ART and that many also perceive a role for themselves in providing PrEP to partners of their HIV-infected patients. However, only 1 in 3 clinicians had prescribed PrEP to partners, [and] many do not feel prepared to deliver protective interventions to PWID,” conclude the authors. “Investing in interventions to optimize practices among frontline infectious diseases specialists could have an appreciable impact on the HIV epidemic.

It wasn’t his first broken condom, so Rafael didn’t worry. But three weeks later, the man he’d met in a bar called to say that he had “probably been exposed” to H.I.V....Despite bad luck in sex-with-strangers roulette, Rafael did have some good fortune: He lives in San Francisco, which is turning the tide against H.I.V. and serving as a model for other cities. The city once the epidemic’s ground zero now has only a few hundred new cases a year, the result of a raft of creative programs that have sent infection rates plummeting.

Medical leaders have the knowledge and the tools to greatly curtail the global AIDS epidemic within the next 15 years. The question is whether the nations of the world will invest the resources to do it....The United States is by far the largest donor, but needs to put up hundreds of millions of dollars more in the next two years to meet its own targets.

Obatunde Oladapo, national coordinator, Treatment Access Movement, and member of UNAIDS Programme Coordinating Board NGO, raised an alarm when individuals accessing their HIV/AIDS treatment at the PEPFAR site of University College Hospital, Ibadan, suddenly woke up to series of levies to access treatment hitherto not there before....This...contradicts the Federal Government’s policy and instruction that People Living With HIV/AIDS be treated free at all government hospitals covering HIV and other associated illnesses.

“Despite these significant challenges, the time to act is now. If we are serious about ending the epidemic in South Africa, we need to move towards implementing all evidence based tools at our disposal,” said McIntyre. He encouraged the South African government to consider revising its HIV treatment strategy to align with the WHO guidelines as soon as possible, insisting that doing so will save lives.

Dr. Gottfried Hirnschall of WHO said if the guidelines are adopted around the world, the number of HIV-positive people on ART would jump from 28 million to 37 million....But Hirnschall was more circumspect when he predicted the immediate impact of Wednesday's new guidelines. "Does this mean that Monday morning all these people are at the doorstep of the clinic in low- and middle-income settings?" he asked. "No, because many do not know they are HIV-positive."

We have been waiting quite a long time to get an HIV prevention method that you can use in privacy, without anxiety and PrEP is really the answer to that,” said Dr Nittaya Phanuphak, Chief, Prevention Department, Thai Red Cross AIDS Research Centre.

The WHO released updated guidelines today calling for antiretroviral therapy for everyone diagnosed with HIV, regardless of CD4 cell count, and pre-exposure prophylaxis for people at substantial risk of HIV infection...."The new recommendation will enable a wider range of populations to benefit from this additional prevention option...., allows the offer of PrEP to be based on individual assessment rather than risk group, and is intended to foster implementation informed by local epidemiological evidence regarding risk factors for acquiring HIV."

103 drug-using women in Kuala Lumpur were recruited to assess their medical, psychiatric and social comorbidity [and] engagement in...HIV testing and monitoring activities. Sex work and infrequent condom use were common, as was underlying psychiatric illness and physical and sexual violence during childhood and adulthood. Most women had unstable living situations and suffered from an unmet need for social support and health services. Suboptimal HIV testing and/or monitoring was positively associated with interpersonal violence.

Hormonal implants and injectables significantly predicted lower mortality; implants were protective for ART initiation. OCPs and pregnancy were not associated with death or ART initiation, while breastfeeding was protective for both. Findings from this 18-year cohort study suggest 1) HIV-positive women desiring pregnancy can be counseled to do so and breastfeed, and 2) all effective contraceptive methods including injectables and implants should be promoted to prevent unintended pregnancy.

This work advances our understanding of the complex barrier properties of mucus and highlights the differential protective ability of different species of Lactobacillus...against HIV and other sexually transmitted infections. These findings could lead to the development of novel strategies to protect women against HIV.

Among persons with HIV, calendar trends in cumulative incidence and hazard rate decreased for Kaposi sarcoma and non-Hodgkin lymphoma. Despite decreasing hazard rate trends for lung cancer, Hodgkin lymphoma, and melanoma, cumulative incidence trends were not seen because of the compensating effect of the declining mortality rate. The high cumulative incidences by age 75 years for Kaposi sarcoma, non-Hodgkin lymphoma, and lung cancer support early and sustained antiretroviral therapy and smoking cessation.

Adolescent females (N=387) were recruited from primary care clinics for a longitudinal cohort study of STIs and sexual behaviour. Less than 30% of bleeding-associated vaginal sex events were condom protected. Low condom rates during bleeding-associated vaginal sex can increase STI and bloodborne virus risk. Providers should consider integrating partner-specific and behavioural factors when they deliver sexual health messages to young women.

Over a 15-year simulation, the HIV epidemic among YMSM [in Chicago] continued to rise, with Latino/white YMSM facing a steeper increase in the HIV burden compared with black YMSM. YMSM in partnerships with older MSM, in particular black YMSM with older black MSM, were at highest risk for HIV....[O]f all HIV infections among YMSM, 14.6% were attributable to NG and CT infections.

In a widely anticipated move, WHO today endorsed antiretroviral treatment for all 37 million HIV-infected people around the world....WHO dubbed the new recommendations an “early release guideline” and plans to release more complete revisions in 2016. WHO began releasing HIV treatment guidelines in 2002, at which point ARVs were recommended only for people who had fewer than 200 CD4s.

The majority of patients consented to acute HIV (AHI) testing. AHI prevalence was substantially higher in sexually transmitted infection (STI) clinics than HIV testing and counseling (HTC). Remarkably high viral loads and concomitant genital sores demonstrates the potential for transmission. Universal AHI screening at STI clinics, and targeted screening at HTC centers, should be considered.

Our results suggest that inclusion of a Tat inhibitor in current ART regimens may contribute to a functional HIV-1 cure by reducing low-level viremia and preventing viral reactivation from latent reservoirs....The latent pool of cells in an infected individual would be stabilized, and death of the long-lived infected memory T cells would result in a continuous decay of this pool over time, possibly culminating in the long-awaited sterilizing cure.