Showing posts with label HIV/Undetectable. Show all posts
Showing posts with label HIV/Undetectable. Show all posts

December 10, 2018

The Black Gay HIV Community Are Reclaiming Their HIV by Celebrating Being Cer0

Larry Scott-Walker and Daniel Driffin can rattle off the date they tested positive for HIV as easily as their birthdays. So can Alfonso Mills.
In fact, so can most of the 1,000-odd members of the group they run in Atlanta to help gay men living with the virus. But they do not simply remember the date – they celebrate it.
In an act of empowerment that may initially make little sense to an outsider, many choose to mark the day that altered their lives with reflection and festivity. In the same way many in the LGBT+ community reclaimed the power of slurs such as “queer,” so too have these men taken control of the day that a generation ago would have meant something much darker. 

They mark their so-called “seroversaries” in different ways – a drink with friends, or a quiet dinner. A woman they know in New Orleans is this year marking her 25th seroversary with a blow-out bash for more than 100 guests.
The name seroversarsy takes its inspiration from several words that have their root in “sero”, which refers to blood serum. Serology is the scientific study of such serum, while the medical and HIV communities use the word serostatus in relation to whether someone is positive or negative.
“Once you’re a person living with HIV, no amount of shame is going to change it, so celebrate it,” says Scott-Walker, 39, one of the group’s three co-founders and the man credited with inventing the word. “Celebrate the way your life has changed since you were tested. I go to the doctor more than ever. A lot of amazing things have happened to me since I admitted I had HIV.”

Mills, 27, the group’s story telling project manager, added: “Mentally, it is so important. It’s a complete change in life. By calling it a seroversary, I focus on the point my life changed.”
The three men – gay, black and living with the HIV virus – are members of Transforming HIV Resentment into Victories Everlasting Support Services, or Thrive SS. It is one of the organisations supported by the Elton John AIDS Foundation, which The Independent and Evening Standard are raising money for this Christmas.
Sir Elton and Evgeny Lebedev, the owner of the newspapers, recently heard from groups such as Thrive after travelling to Atlanta, the Georgia city often touted as the shining example of the so-called new south, but which has HIV infection rates comparable to a number of cities in southern Africa. 

Elton John launches The Independent’s AIDSfree campaign

In the US today, a gay black man has a 50 per cent chance of being diagnosed as HIV positive. In Atlanta, the figure is closer to 60 per cent. Racism, homophobia, poverty and lack of education about HIV are all contributory factors.
Scott-Walker (whose seroversary is 5 June, 2007) says the group, which also has chapters in Washington DC, Oakland, California and Charleston in South Carolina, said Thrive SS was different to many other groups working in the field.
Firstly, the members placed their own experiences – of being gay, black men living in the south and living with HIV – at the heart of the organisation. By doing this, they “prioritise the experiences of our community”. Secondly, they offer 24/7 online support, unlike many government-supported groups that shut up shop at 5pm. 

Daniel Driffin, Larry Scott-Walker and Alfonso Mills’ group stresses authenticity and flexibility

Then, there is the twist that they allow alcohol at their meetings – the third co-founder, Dwain Bridges, describes the atmosphere as being “like a fraternity”. Core aims of the meetings are flexibility and authenticity.
Driffin (19 June, 2008) said the decision to take control of the day they tested positive was because for many, the experience was utterly traumatic. Staff can come across as unsympathetic – in that intense, vulnerable moment, many people feel they are being blamed for what happened.
Driffin, one of the co-founders, said when he was tested, a nurse pushed a piece of paper across the table to him, saying: “You know what that means.”
He said he refused to show any emotion in front of the nurse and walked out and telephoned a close university friend. It turned out she had just learned she was pregnant – something she was not expecting. “I said, ‘I’ve got one on you – I just found out I have HIV’.”
While he was able to share the news with his closest friends, Driffin felt unable to tell his mother for five years. She found out by accident when he posted a public Facebook message that he thought was in a private group. When he saw her three days later, his mother Jeanine offered her support and love. “She said: ‘Why did you not tell me before, so that I could have helped’?”

Scott-Walker said his husband Derrick had been told by the doctor: “I thought we had talked about this”, the inference being – whether the doctor intended it to be or not – that he had somehow done something wrong.
Miller (15 September, 2012) got tested by himself. The nurse told him the results had come back positive. He managed to limit his emotions in the clinic to a single tear, before heading outside, feeling stunned. To try to pretend it was just like any other day, he bought a pet turtle. “I just did not want to think about it,” he said.
The group believes that by focusing on the experiences of the people they are trying to help, they can provide an essential network of support.
Two years ago, Driffin was invited to speak at a Democrat national convention in Philadelphia. 
“I’m living with HIV, and so many others are,” he told the audience. “Who is most at risk? Young, gay black men. Men like me. In fact, one in two black gay men will be diagnosed in their lifetime if the current rates continue. I’m sure black transgender women are more at risk, too.”
He said to beat the disease, it was essential to to ensure “the meaningful involvement of young gay black men at every level”.
“So what do we do to fight HIV/Aids today?” he challenged the crowd.
“As an organiser, as an advocate, as a black man, as a gay man, as a man living with HIV, I ask you: go get tested, and then go vote.”
Money raised from public donations through the AIDSfree appeal will be used to support the Elton John AIDS Foundation projects in six key cities around the world (London, Nairobi, Atlanta, Kiev, Delhi and Maputo). Through UK Aid Match the UK government will double public donations up to £2m to be spent across projects in Maputo and Nairobi.

July 25, 2018

AGAIN: U=U {If You Are Undetectable You are NOT Transmissible} This Is True Anywhere in The Planet

Slide from John Blandford's presentation on Vietnam's K=K campaign
Roger Pebody 

Being Undetectable does not kills you nor your sex partner but the stigma could

In Guatemala, the slogan is “Indetectable = Intransmisible” (I=I); in the Netherlands, it’s “Niet meetbaar = Niet overdraagbaar” (N=N); and in Turkey, “Belirlenemeyen = Bulaştırmayan” (B=B). One of the most striking aspects of yesterday’s pre-conference on “Undetectable = Untransmittable” (U=U), held in advance of the 22nd International AIDS Conference (AIDS 2018) in Amsterdam, was the extent to which the campaign has energized advocates around the world.

“U=U is a fact that every person with HIV around the world should know about,” said Jesús Aguais of AID for AIDS International, an organization working in six Latin American countries. “People have the right to be informed and it is our responsibility to disseminate this information.”

“I can’t believe this information has been known for ten years and I’ve only heard about in the past six months,” commented Lucy Wanjiku-Njenga of Positive Young Women’s Voices. She said that not many of her peer group in Kenya know what U=U means. Those who do know about it heard about it from a friend or on social media, rather than from a doctor or care provider.

The quotes she presented from other young women testified to the impact the U=U message can have:

“This is a message of hope to those living positively. It is the success that comes along with adherence. The victory after all those days you feel like the drugs were a burden. With this, young women can lead a life without worry of infecting their partners.”

“U=U gives young people who acquired HIV through vertical transmission like me a sense of ‘normalness’. For the first time, I see I am not afraid of infecting someone else because I am virally suppressed! I can finally have a fear-free relationship. I am the safest relationship any guy can have!”

Alex Schneider’s organisation Life4me+ works across Eastern Europe and Central Asia. For him, the Russian language slogan “НЕОПРЕДЕЛЯЕМЫЙ = НЕ ПЕРЕДАЮЩИЙ” (Н=Н) is a new tool for advocacy. It can help raise broader public awareness of HIV, reduce stigma towards people living with HIV, undermine self-stigma, increase HIV testing, motivate early initiation of treatment and improve treatment adherence. So far, 60 organisations, including eleven state organisations, have signed on to the statement in the 14 countries of the region.

Nonetheless, there are very real barriers to treatment in the region, including frequent stock-outs of medication. In terms of the 90-90-90 targets, currently 63% of people with HIV are diagnosed, 28% of those diagnosed are on treatment, and 22% of those on treatment are virally suppressed.

In many low- and middle-income countries, viral load monitoring is not routinely available, making it impossible for an individual to be confident that they really are undetectable. U=U provides an additional argument for increasing access to viral load monitoring.

In Vietnam, the Centers for Disease Control and Prevention (CDC) has promoted the slogan “Không phát hiện = Không lây truyền” (K=K). John Blandford of the CDC said that the campaign was conceived as an intervention that would both support changes in HIV care and reduce stigma. The information has been shared via social media, in community meetings and through press coverage.

The community advocacy has helped build support among people with HIV and healthcare practitioners for a switch from CD4 to viral load monitoring. The country’s treatment guidelines are now aligned with K=K, so that a key marker of success is two consecutive viral load test results of less than 200 copies/ml. The proportion of people having their viral load monitored increased from 21% to 73% in a year, with 93% of those on treatment now being virally suppressed.


The pre-conference opened with Anthony Fauci, probably the United States’ most senior HIV research scientist, reviewing the evidence that underpins U=U. Since the mid 1990s, data showing the inverse relationship between the level of virus and the rate of HIV transmission have been accumulating. The introduction of combination therapy “was the definitive moment of U=U and we didn’t even realise it then,” he said.

The research studies HPTN 052, PARTNER 1 and Opposites Attract have provided the strongest evidence. Tomorrow the final results of PARTNER 2, the study which more precisely quantifies the potential for HIV transmission during anal sex, will be presented at AIDS 2018. It is likely to be the most discussed study at this year’s conference.

Nonetheless, Fauci did not feel he needed to wait for these results to state: “The evidence that undetectable equals untransmittable is overwhelming.”

Pietro Vernazza was presented with a lifetime achievement award for the 2008 Swiss Statement he co-authored and other work which has laid the basis for U=U. Clearly moved by the advocates’ response to his work, he went back to the philosophy of science to explain why he felt that the accusation of the Swiss Statement not being founded on evidence was unfair.

If the hypothesis is that HIV can be transmitted when a person is taking effective antiretroviral therapy, then the null hypothesis is that HIV cannot be transmitted in these circumstances. In science, it is the null hypothesis which a researcher aims to disprove or falsify.

He said that the position of the ‘HIV establishment’ had always been the former, that there remains some transmission risk when a person has an undetectable viral load. He said it was up to those who hold that position to find a single documented case of transmission from a person with a durably suppressed viral load.

Vernazza quoted the logical philosopher Irving Copi: “In some circumstances it can be safely assumed that if a certain event had occurred, evidence of it could be discovered by qualified investigators. In such circumstances it is perfectly reasonable to take the absence of proof of its occurrence as positive proof of its non-occurrence.”


One remaining area of scientific uncertainty concerns breastfeeding. Eliane Becks Nininahazwe, a woman from Burundi living in the Netherlands, said that many women were waiting for the day when they could feel confident that U=U applies to breastfeeding. “Please people who are doing the science, hurry up!” she said.

Linda-Gail Bekker of the Desmond Tutu HIV Centre said that there are still gaps in the data, but there is clearly a strong relationship between viral load and the potential for transmission.

She pointed to two African cohorts (from Tanzania and Malawi) with a total of 477 infant-mother pairs in which no HIV transmissions have occurred from mothers with a plasma viral load below 100 copies/ml. However, some transmissions occurred in the latter study from women whose viral load would be described as ‘undetectable’ using a higher cut-off. This could be due to viral load being detectable between the (relatively few) occasions when it was measured, or due to reservoirs of virus in breastmilk that can’t be eliminated by antiretroviral therapy.

Even if she could not be definitive, Bekker said that her take-home message was that women taking HIV treatment who have an undetectable viral load have shown very little risk of HIV transmission. Weighing up the multiple benefits of breastfeeding for the infant with this low transmission risk, she said that it was appropriate that women in low- and middle-income countries continue to be recommended to exclusively breastfeed for six months after birth.

Pietro Vernazza said he had reviewed the same body of evidence to consider recommendations for the high-income setting of Switzerland. For an optimal scenario of a woman who was adherent to her medication and had a suppressed viral load of below 50 copies/ml throughout pregnancy and breastfeeding, his group had not been able to identify any confirmed cases of HIV transmission. While there are still gaps in the data, this risk needs to be considered alongside the proven benefits for all infants, such as fostering contact between mother and child, the anti-inflammatory and antimicrobial substances contained in breastmilk, and the development of the gut microbiota.

Given clinicians’ uncertainty about the balance of potential harms and benefits, he suggested that a shared decision-making approach was appropriate. Breastfeeding should not be actively promoted to women living with HIV in Switzerland, but women who choose to breastfeed should be supported by their clinical teams, in particular with adherence support and regular viral load monitoring.


How can organisations describe U=U in a way which is meaningful to people living with HIV, their sexual partners and the general public? Whereas the concepts of ‘treatment as prevention’ (TasP) and ‘universal test and treat’ (UTT) are rooted in public health and describe the impact of widespread treatment in a population, ‘undetectable = untransmittable’ focuses on the individual. The slogan has already reached far more people living with HIV than the idea of TasP ever did, but the language used is complex and may not reach the widest audience.

Michael Brady said that it was in 2016, after the second release of data from the PARTNER study, that the UK organisation the Terrence Higgins Trust decided it had a responsibility to share the information in a clear and definitive way. They would have to evolve the language, so that it would be clear, concise and easily understood, he said.

A number of slogans were tested, including “Yes we are sure”, “This changes everything”, “Won’t pass it on” and “Can’t be passed”. Two made it to the shortlist – “I’m not a risk” (which resonated most with people living with HIV) and “Can’t pass it on” (which had greater purchase with the wider public).

It was the latter slogan which has been taken forward. Without a larger than usual budget, it has been one of Terrence Higgins Trust’s most successful campaigns in terms of reach and exposure, especially on social media. Brady attributed this to the simplicity and definitiveness of the message, as well as the support of community advocates.

Nic Holas of the Australian online organisation the Institute of Many said that having people with HIV understand U=U was only half the battle. They needed their sexual partners and potential sexual partners to understand it as well. A particularly important audience are pre-exposure prophylaxis (PrEP) users and his organisation has developed a series of videos in collaboration with Dynamix International, one of the main companies importing generic PrEP medication to Australia, the UK and elsewhere.

While PrEP and U=U are often described as having synergies, he pointed to tensions between the two approaches. Some PrEP users remain fearful of and stigmatising towards people with HIV, he suggested. They prioritise their new found freedom but ignore the fact that PrEP could only be developed “after people with AIDS put their bodies on the line”.

“In the age of PrEP, people living with HIV must not shy away from taking up space and ensuring our voices are heard,” he said. “It is not enough to end the HIV epidemic with PrEP and leave us isolated, criminalised and stigmatised.”

November 26, 2017

U=U Undetectable HIV Means Untransmittable

Mark S. King, right, who is HIV positive and is considered noninfectious with proper antiretroviral treatment, is seen at home with his husband, Michael Mitchell, on Nov. 22, 2017, in Baltimore. (Bill O’Leary/The Washington Post)
Last year, Chris Kimmenez and his wife asked their doctors a simple question. Could Chris, who has been HIV positive since 1989 but keeps the virus in check through medication, transmit it sexually to Paula?
They were pretty sure they knew the answer. Married for more than 30 years, they had not always practiced safe sex, but Paula showed no signs of having the virus.
Their physicians were less certain. “They had a conversation, and they did some research on it,” Kimmenez said. “They came back to us and said there may still be a risk, but we’re comfortable enough” that unprotected sex is safe.
“We knew that all along,” said Kimmenez, 56, who works with ex-offenders in Philadelphia.
Simple acknowledgments like that one, spoken quietly in the privacy of doctors’ offices, mark the arrival of a historic moment in the history of HIV: Medical authorities are publicly agreeing that people with undetectable viral loads cannot transmit the virus that causes AIDS.
The policy change has profound implications for the way people view HIV. The change promises not just unprotected sex for couples like Kimmenez and his wife but also reduced stigma for the 1.2 million Americans living with HIV. The policy change also offers the hope that more people will be tested and begin treatment if they are found to have the virus rather than live in denial. 
“There was something in me that said I’m damaged and I made a mistake, and people see it and I’m a danger,” said Mark S. King, 56, a writer and activist who tested positive for HIV in 1985. But now, treatment has fully suppressed the virus. “When I finally internalized this message . . . something suddenly lifted off of me that is hard to describe. It was almost as if someone wiped me clean. I no longer feel like this diseased pariah.” 
Once considered a death sentence, HIV infection can now be managed via medication, much like chronic diseases such as diabetes, and people with the virus live full lives. The rate of new infections in the United States dropped by 10 percent from 2010 to 37,600 in 2014, according to the U.S. Centers for Disease Control and Prevention. Fewer than 7,000 people died of HIV/AIDS that year.
In July, Anthony S. Fauci, head of the National Institute of Allergy and Infectious Diseases and one of the world’s leading authorities on HIV, publicly agreed at an international conference that people with undetectable viral loads in their blood cannot transmit the virus.  
On Sept. 27, the CDC followed, releasing a letter that said people who take medication daily “and achieve and maintain an undetectable viral load have effectively no risk of sexually transmitting the virus to an HIV-negative partner.”
The influential British medical journal the Lancet HIV endorsed the idea in an editorial this month. All told, more than 500 organizations in 67 countries now agree, according to Bruce Richman, who is leading the “Undetectable = Untransmittable” (U=U) campaign credited with beginning to change public perception of HIV transmissibility. 
 Like many developments in the four-decade history of HIV, this one has been slow to gain acceptance among mainstream health-care providers. Many are not aware of it or must unlearn the habit of drilling safe-sex lessons into patients, as they have been doing almost since the AIDS epidemic began. HIV-positive people also must alter deeply ingrained beliefs that nothing good can come from revealing their status.
The change in philosophy also has sparked concerns, for which there is some evidence, that more condomless sex will lead to an increase in other sexually transmitted infections. And experts acknowledge that a few people whose viral load is not truly suppressed will eventually transmit HIV to others. 
Laws in many states also are out of date. Many still criminalize the failure to reveal HIV status to a sex partner, even when there is no danger of transmissibility.
But on balance, authorities said, the agreement that people with HIV can prevent sexual transmission by taking a single pill each day is nothing less than revolutionary.
“Nothing is completely risk-free,” Fauci said in an interview. “What the community feels is that all of the good that will come from the lack of social stigmatization” is worth the risk. “This means a lot to them. This has a lot to do with their self-worth, their identity.”
An undetectable viral load is defined as fewer than 200 copies of the virus in a milliliter of blood. Generally, people with HIV should maintain that level or a lower level for six months before beginning to consider themselves incapable of transmitting the virus sexually.
Many who faithfully take antiretroviral medication and lead healthy lifestyles can bring their viral loads considerably lower, to 50 or even 25 copies.  But progress raises other questions, said Jonathan Mermin, director of the CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. What if a person forgets to take medication for one day? What about two, or more? How long after resuming therapy should someone wait before once again considering himself or herself incapable of transmitting the virus? And what about people who go above and below the 200-copy threshold over time? Studies show that to be the case for about 10 percent of the people with HIV, Mermin said.
As yet, there are no evidence-based answers to these questions, he said. “The public-health challenge now is moving from theory to implementation,” he said. “Many questions arise following the information that when a person with HIV has an undetectable viral load, he has effectively no risk of transmitting the virus.”
In 2008, Swiss experts announced that those with undetectable levels of HIV could not transmit HIV through sex. But the world was not ready to hear the message then.
Starting in 2011, three large studies confirmed the idea, tracking more than 75,000 vaginal and anal condomless sex acts without finding a single HIV transmission to an HIV-negative partner from someone whose viral load was undetectable. The initial 2011 study was named “breakthrough of the year” by Science magazine.
Now the challenge is to get the message out to HIV-positive people, caregivers, and the public. And that process has been slow.
“I would tell everyone about this, friends and family and people I wanted to date, and I was coming across so much resistance because major institutions were saying this is wrong,” Richman said.
He launched U=U last year, initially a lonely and sometimes controversial campaign to let the world know something that many people with HIV had concluded for themselves. His breakthrough moment came in August 2016 when New York City’s health department signed on. Soon, other cities and organizations were joining.
Still, the message is moving mainly from people with HIV to health authorities and policymakers, rather than in the other direction, Richman said.
“This is a radical challenge to the status quo and to 35 years of HIV and fear of people living with HIV,” Richman said.
Brigitte Charbonneau, 71, of Ottawa, found out this year that she could not transmit the virus after 23 years of being HIV positive. “I thought, ‘My God, I’ve been living with my man for 20 years, and we’ve been using condoms,’ ” the retired hairdresser recalled. “And I phoned him right that afternoon.” Jennifer Vaughan of Watsonville, Calif., vividly remembers the moment she learned she could not transmit the virus to her boyfriend. The mother of three tested positive in February 2016 after she became critically ill with what was finally determined to be AIDS. HIV was not among the possibilities she or her doctors considered until a blood test revealed the virus. She thinks she was infected by a previous boyfriend with a history of intravenous drug use.
Vaughan attended a speech Richman gave and was talking with him in a parking lot outside a Starbucks.
“I’ll never forget him saying those words, ‘You can’t transmit the virus if you’re undetectable,’ ” the 47-year-old substitute teacher recalled. “And I said, ‘Wait, what?’
“It was like the sky opened. Are you kidding? There’s, like, zero risks? I don’t feel like I’m a threat anymore. I don’t feel like I’m dirty. I don’t feel like I’m a dangerous person.”

July 26, 2017

CNN Reports on Something We Have Known: Undetectable Means 99.99 for Transmission

Adamfoxie has been reporting this news for 18 months or more. If you have become undetectable, after you wait a few months you won't be transmitting the disease. Undetectable means in layman's terms if they are not able to detect your virus means you won't be transmitting the virus. There has been a reluctance for the government and pharma to let the good news out and the answer is money from Pharma. Think about it. It's the same reason a "Cure" is not preached and the pharmaceuticals have not been interested in talking about that in a serious way.  Why cure diabetes when it makes so much money for so many? HIV is no diabetes and it killed people a lot faster and it was a pandemic brought under control by money and meds. Under control! If you read yesterday's article about the girl cured after being undetectable together with this article it will enhance your knowledge on this.
Blog Publisher 

The evidence is in and the message is clear: When someone is HIV positive, taking regular treatment can pretty much zero their chance of spreading the infection to others during sex.
Sexual transmission of HIV is negligible when someone is on treatment, whether they're in a heterosexual or homosexual relationship, according to results from previous studies and now a large-scale study of homosexual men, presented at the Ninth International AIDS Conference on HIV Science in Paris on Tuesday.
HIV experts emphasized this aspect of prevention, highlighting the "Undetectable equals Untransmissible" campaign, during a press conference at the international meeting. The campaign works to encourage people worldwide to stay on treatment by ensuring they understand that doing so could mean they cannot infect others.
    This message is not aligned with the status quo in terms of the care people infected with HIV receive today, believes Bruce Richman, founder and executive director of Prevention Access Campaign and the "Undetectable = Untransmittable" initiative. "This is transmission-stopping information," he said.
    New vaccine results have shown promise at the meeting this week and in recent studies, but are still far from becoming a reality to end the epidemic.

    Overwhelming evidence

    In the largest-ever trial on HIV transmission risk among homosexual men, Australian researchers explored the sex lives and HIV rates of more than 350 homosexual couples where one person is HIV positive. The couples were from Brazil, Thailand, and Australia.
    Each couple reported their sexual activity when visiting clinics involved in the trial and HIV-negative partners were regularly tested to diagnose any new infections.
    The couples participating reported having sex almost 17,000 times without condoms between them over four yearsand none of those times resulted in new infections.
    "There was not a single linked HIV infection in these couples," said Andrew Grulich, professor of epidemiology at the University of New South Wales in Australia, who led the study. "Nobody became infected from their partner."
    Three new infections were discovered during the trial, but analysis of the virus showed they had come from sex outside of the relationships, not from the person on treatment within the couple.
    Sex without a condom is not necessarily advised, however, to prevent risk of other sexually transmitted infections (STIs). "This (group) had very high STIs," Grulich told CNN, adding that 20% of the men in the trial developed STIs each year, yet there were zero HIV infections. 
    Approximately 10% of men had STIs associated with anal sex, which experts had previously thought aided HIV transmission, Gulich said.
    The new evidence builds on previous studies on couples where one partner is HIV positive and on treatment, including a landmark study in 2011 that found that treatment can prevent new infections among couples by 96% and a second study in Europe in 2016 showing no transmission at all.
    Treatment as prevention is now recommended by the World Health Organization as a key component to include in HIV prevention programs,
    The latest trial is the first to explore the benefits of treatment as prevention across multiple continents, showing this approach could be universally applicable. "We wanted to see if this could be applied in different settings where there are also HIV epidemics among homosexual men," said Grulich.
    An estimated 68% of new HIV infections in Australia in 2015 were among homosexual men, according to the Australian Federation of AIDS Organizations.
    The preventative effects are particularly strong due to the increased risk of transmission that comes with anal sex.

    Protective, despite greater risk

    "We know transmission risk by anal sex is approximately 10 times higher than risk by vaginal sex," said Grulich, who feared this could lead to some infections during the trial. "This provides reassuring evidence that treatment is as effective in homosexual men," he said.
    "This (study) is confirmation of something we have known for some time," said Dr. Anthony Fauci, director of the National Institute for Allergy and Infectious Disease, within the US National Institutes of Health. 
    The fact that transmission risk is clearly greater by anal intercourse shows this is a powerful tool for prevention, he said. "Now is the time to push for it."
    International AIDS Society President Linda-Gail Bekker believes working to ensure more people get tested for HIV and therefore treated is a crucial component of the current fight against the virus, but not necessarily the immediate one.
    "Let's have a reductionist approach, but I think there is also lag in terms of treatment as prevention. You've got to get things up to scale," she told CNN. In the meantime, she said, the services we already have for people who are uninfected to protect themselves should be pushed.
    These currently available services include high-risk groups taking drugs to prevent infection, known as pre-exposure prophylaxis (PrEP), medical male circumcision, which can reduce transmission from women to men by 60%, and condom use. "That will curb the transmission rate more quickly" while we begin treatment as prevention and wait for it to become more widely available globally, she said.
    Bekker used the example of Swaziland, where rates of HIV were reported on Monday to have dramatically declined since 2011, according to the US President's Emergency Plan for AIDS Relief. Swaziland has the highest prevalence of HIV in the world, but new infections have almost halved since 2011, after providing treatment and male circumcision for more than 12 million people.
    By the time these prevention options are extensively promoted and provided to those who need them, Bekker hopes a vaccine may then finally ready. This would truly eliminate the disease, rather than control it, she believes.

    New vaccine promise

    Results from a recent vaccine trial, known as the APPROACH trial, were presented at the conference Monday and revealed this type of vaccine could instigate an immune response against HIV when tested on almost 400 volunteers across five countries.
    The type used were mosaic vaccines, where components of different HIV viruses are combined together to create an immune response in the body.
    Being a 'superhero': The South African volunteers trialing a HIV vaccine
    Being a 'superhero': The South African volunteers trialing an HIV vaccine
    Seven different regimens of the vaccine were tested and all elicited an immune response and were well tolerated in the body. One that previously showed promise in animals shined through, giving the strongest response in humans.
    The researchers stress, however, that simply because an immune response was created does not mean it will prevent someone becoming infected with HIV.
    "The promising, early-stage results from the APPROACH study support further evaluation of these candidate vaccines to assess their ability to protect those at risk of acquiring HIV," said Dr. Dan Barouch, a principal investigator for APPROACH, in a statement.
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    "A safe and effective HIV vaccine would be a powerful tool to reduce new HIV infections worldwide and help bring about a durable end to the HIV/AIDS pandemic," said Fauci, whose Institute supported the trial. "By exploring multiple promising avenues of vaccine development research, we expand our opportunities to achieve these goals." 
    Bekker added that this is one of three avenues currently being explored to create an effective vaccine against HIV, including one being trialed in her home country, South Africa. Whichever one wins the race, it can't come fast enough.
    "Finally, a vaccine will clean (HIV infections) up" after these prevention services are in place, she said. "And hopefully eliminate HIV."

    By Meera Senthilingam, CNN

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