Showing posts with label International HIV/AIDS. Show all posts
Showing posts with label International HIV/AIDS. Show all posts

December 8, 2016

Thanks to a Deadly Corrupt Duterte Gov. HIV Rates are Out of Control ‘No Condoms No Testing’

 A friend of mine in California with friends and trips to the Philippines told me unless you work and have good insurance there are no HIV meds in the Philippines for you. He said "the government sees these people as throw aways and they are deplorable that have no redemption. The sooner they die the better off the government is.”

Policies like restricting gay men from using condoms while having sex are causing an HIV epidemic in the Philippines, Human Rights Watch said in a report released on Thursday, 8 December.

According to official statistics, there has been a tenfold rise in the prevalence of the sexually transmitted virus in the country, the 46-page report, titled "Fuelling the Philippines' HIV Epidemic: Government Barriers to Condom Use by Men Who Have Sex With Men" notes.
The group said that among all Asia-Pacific nations, the Philippines is facing one of the fastest-growing HIV epidemics. It blamed the national and local governments for failing to address the growing HIV prevalence among gay men, which emerged as the biggest source of the spread of the deadly virus in the recent past.

The report states that although President Rodrigo Duterte's predecessors took adequate measures in the 1990s to prevent HIV spread in the country, they focused only on commercial sex workers and completely ignored same sex relations. The government even ignored data from the Department of Health that indicated that 81% of the 35,000 recorded HIV cases in the country between 1984 and June 2016 have been among men who have sex with men. The first HIV case was recorded in the country in 1984.

HIV Epidemic

Human Rights Watch has warned the Philippine government of an HIV epidemic in the country due to policies preventing gay men access to condoms and HIV testing facilities

"President Duterte has inherited a legacy of failed or counterproductive policies of previous administrations that are contributing to the alarming increase in HIV infections among men who have sex with men," Carlos H Conde, a Philippines researcher, said in a statement released by the human rights group.

"Reducing HIV transmission isn't rocket science. But it does require the Duterte government to implement an HIV prevention program and remove obstacles to condom and HIV testing access so that young Filipinos – particularly men who have sex with men – can protect themselves from an otherwise preventable illness," the researcher added.

According to health department data for 2015, at least 11 cities in the Philippines have recorded HIV prevalence rates of more than 5% among gay men, with the second largest city, Cebu City, recording a 15% prevalence rate.

The overall prevalence rate for the Asia-Pacific region is 0.2% and for Sub-Saharan Africa, it is 4.7%, which are way lower than the prevalence rates recorded in the Philippines, the report notes, adding that the dismal scenario was a result of “longstanding resistance of the Roman Catholic Church to sexual health education and condom use".

December 2, 2016

Sex Was Deadly-One Pill Changed That-Still Some Don’t see the Miracle Pill and Fall Overboard

 If where you live there is access to PrEp you have no excuse to put your self to becoming HIV positive, the health system thru the expense and your next partner that you might give it to.  If you forget to take a pill now if you are sexually active you will also forget to tell your partner about being  exposed and so the virus will live on.                                                                      

In late 2014 I received an email from one of New York City's largest sex parties for gay men. Usually, the email would have contained this: a time, an address, a dress code, the price. The party had long been condoms-only, but a new safe-sex provision had just been added: "If you do have condomless sex it is assumed that you are on PrEP/Truvada or undetectable."

I wouldn't have noticed this email if it hadn't been for a response from New York's one remaining condom-only party. This wasn't an invitation but a statement of policy, an email unlike any sent previously or since. Safe sex is an important project, it argued, and condoms are the only way to be safe. The second party remains condoms-only, and is still alone in this decision. It feels now like a holdover from a different time.

My generation of gay men came after the plague but before the pill. What I knew was that fifty thousand people died in the U.S. in 1995. I was thirteen. What I knew was that sex kills, that no pleasure is ever free of worry, of death. The first thing I learned about sex was Kaposi's sarcoma lesions, gaunt thirty-two-year-olds on TV. I became a gay man and a scientist with a background in microbiology and biochemistry. Viruses have always fascinated me for being so complex and yet so simple, for being so deadly with so few genes.

But HIV didn't just kill bodies. It killed a type of sex as well, a type of pleasure. It erased the possibility of my body and another meeting, one moment, without my mortality there too, watching. Sex is this: another body, my body, my mortality, all naked for me to see. I knew about HIV and death before I knew I was gay. I knew about death then, and that being gay might be deadly, and now I sleep with men.
HIV has never left me. I'm nostalgic for the pre-HIV era I never knew. Our image of those years is ambivalent: You could give head in abandoned buildings by the piers, but anything like a relationship seemed impossible to so many, the notion of gay marriage laughable. Gay people weren't often permitted relationships in a world so threatened by our bodies and how we use them. Now we can get married, but — thanks to HIV — we've lost the notion of pleasure without worry. I worry. I only have unprotected sex when in a monogamous relationship. Even then, who knows? Everyone cheats, even straight people.

Those who lived through or were born into the 1980s became a generation afraid of love and the sex it would bring. The writer Hilton Als, referencing the garbage bags that early AIDS victims were stuffed inside, wrote, "I did not say I loved him....If I did, wouldn't that end up in a garbage bag, too?" Even after HIV became less of a death sentence, I always viewed it fatalistically. Being positive would make it harder — I always felt — to find love and trust and sex. I had reservations about dating someone who was HIV-positive; I knew that if I were positive others would have the same reservations about me. If there were a pill for my worry, I would take it, a cure not for an infection of the body but for the traumatized mind. I would take this pill now, and I would never stop.

Some definitions: MSM: men who have sex with men, a term devoid of political or social overtones (unlike, say, "gay" or "queer"). MSM are the community most at risk for new HIV infection. PrEP: pre-exposure prophylaxis. PrEP is a pill taken by HIV-negative people to maintain their status. Truvada: The one pill approved for PrEP. It has been used as a component of HIV therapy since 2004, but was only approved for PrEP in the HIV-negative in 2012. In this article, "Truvada" refers to the drug used specifically by those who are HIV-negative, a shorthand that is almost universal in New York's gay community. Undetectable: An undetectable person is HIV-positive but controlling their infection with antiretrovirals. New research shows that their likelihood of communicating the virus is essentially zero.

Truvada came on the market four years ago, in 2012 , but prescriptions didn't start taking off until early 2014. Gilead Sciences, the company that makes and sells Truvada, reported earlier this year that eighty thousand to ninety thousand people were on PrEP. Twelve and a half thousand people in New York State have filled prescriptions, the overwhelming majority in the city. The number of individuals starting PrEP has increased exponentially, rising fivefold in two years, from the end of 2013 to the end of 2015. A survey by New York City's Department of Health estimates that 29 percent of MSM ages eighteen to forty in the city are already on PrEP.

For one week, those numbers included me. I wasn't having sex with a stranger. I was having sex with my ex. He'd been in and out of my life after he'd gone away for a month and I'd found evidence he was cheating. A part of me had always known.

We'd been having unprotected sex for a year. I've always had unprotected sex with my boyfriends, a sign that we cared for each other, that we had built something like trust. I insisted on couples trips to the free clinic after three months of monogamy. I loved this man in part because his sex seemed so free, so out of my control. I begged him not to put me at risk. I told him my body was in his hands. He looked me in the eye and said I could trust him. I did trust him. After I caught him cheating, we used condoms. I got tested. He said that he never had raw sex with anyone but me, that it was an intimacy I alone had earned. I believed he was telling the truth. I trusted that he only cheated safely.

My ex wanted another chance. He wanted to have raw sex again. So one of us — I don't remember who — suggested PrEP. This was in 2014, when hardly anyone knew about Truvada. PrEP and undetectable were not yet listed as safe-sex options in hookup apps. Gay activists still called it a poison, a party drug. This pill offered the promise of bringing us back together. Truvada was more certain than his word.

We both started swallowing that big, blue pill once a day.

A week later, without touching him much at all, I was on my way out of his life. PrEP made space for me to consider raw sex with him again, but I realized that it wasn't HIV that made him unsafe. Maybe for the first time in my life, I wasn't afraid of HIV. I was afraid of him. There was no cure for the damage we had done to each other. So I left, and I tried to stay gone.

Truvada is not one drug but two: emtricitabine and tenofovir disoproxil fumarate. HIV pills contain multiple (usually three) antiretroviral drugs. This is because HIV mutates rapidly to become resistant to any one therapy. The likelihood of a single virus simultaneously acquiring resistance to two or three drugs is the product of the individual probabilities, a number that approaches zero without ever reaching it.

People at high risk for HIV infection — sex workers, MSM, those with multiple partners — can take Truvada and have unprotected sex with little risk of contracting HIV. There is a 96 percent reduction in HIV transmission for those who take the drug four times a week. For daily use, the reduction is 99 percent. In one key study, none of the participants contracted HIV. Another option — post-exposure prophylaxis, or PEP — can be taken after a broken condom or risky sex. These drugs stop the virus from replicating before it manages to find and infect T cells. The virus never becomes a part of us.

In preventing the transmission of HIV, PrEP is at least as effective as condoms. Condoms reduce the risk of HIV transmission through anal sex by 70 percent with consistent and proper use. For men who don't use condoms consistently — and according to studies, most men don't — the difference in rates of HIV transmission between sex with and without condoms is not statistically significant.

Those who remain HIV-negative while on PrEP will have antiretroviral medicine consistently in their bloodstream and no virus in their blood. Undetectable people have antiretroviral medicine in their bloodstream and no virus in their blood. In terms of HIV transmission, there is no reasonable distinction between those who are HIV-negative and on PrEP and those who are HIV-positive and undetectable.

For many years there was a respectability politics of condoms. Truvada was vociferously opposed by traditional gay health organizations. Michael Weinstein, the head of the AIDS Healthcare Foundation, continues to campaign against it. The opposition to Truvada seems to have made Gilead cautious about marketing it. Though the drug has been available for four years, Gilead has started to underwrite advertising only in the past few weeks. Paranoia about PrEP remains, often driven by the idea that other infections (chlamydia, syphilis) will rise without condom use. Bacterial STIs did increase in 2015, though it's impossible to connect that increase to Truvada. In effect, much of the rhetoric about STIs continues a long history of pathologizing gay sex, particularly raw gay sex, now that we can no longer rely on HIV alone.

When single, I use condoms consistently. I believed this: Responsible, self-loving, caring, good gay men use them, always. I wanted to be that type of man. I was shocked, talking to my straight friends, to learn that they had unprotected casual sex. Gay men were considered unsanitary even before HIV. Our vice president–elect thinks us unfit to work because of our diseased bodies. We have to constantly prove to the world that we aren't, in fact, sexual monsters, deviants. Straight people don't carry the same burden of politics, the same history of HIV, into the bedroom.

In the era of HIV activism, gay sex was central to the conversation. HIV was a sexually transmitted disease; how we fucked was how we lived or died. In the fight for gay marriage, we willingly hid our sex. An ex-partner of mine worked at GLAAD, where he trained people to say "gay" and not "homosexual," because the latter puts the word sex in people's faces. The fight would be easier if people didn't imagine the icky things we do in the dark. We won the right to marriage by convincing straight nuclear families that our love is just like theirs. Our sex, too: three times a month, monogamous, missionary, seven minutes, safe.

But there's always been a tension. Queer people are a sexual and cultural vanguard. Anal sex is kind of our thing; now sitcoms joke about straight couples pegging. We had Grindr for years before Tinder popped up. We've been doing monogamish since basically forever.

Gay and HIV activists fought conservative institutions — public schools, the Catholic Church — to make condoms widely available and to train people how to use them. In a world where everyone was dying, condoms were the only way to stay alive. They worked. For decades, condom culture was a type of care among gay men. As we approach four years of a Trump administration, this fight against conservative institutions might be beginning anew. But condoms may have a cultural significance that now surpasses their usefulness in public health and public policy.

I bought into the politics that binds HIV and gay-marriage activism: that condoms matter, that sex must be contained, safe, respectable. I was raised Catholic and always had been a little afraid of my own sexuality. I thought myself better-than because I'd always used condoms. I looked down on my friends who didn't. Of course humans — of all sexualities — slip up. Of course people are going to find pleasure in doing the very thing they've always been told not to do. Sometimes we want things from love, from sex, precisely because they aren't safe. I wanted my ex; he wasn't safe. I always suspected he was cheating; we had unprotected sex anyway.

The conventional narrative of the past three decades is that we survived the plague. Then we got marriage, an assimilation into an institution that I always found too narrow for most relationships, even straight ones. What we lost was the freedom of queer sex, queer sluttiness, queer rage, raw sex, queer separatism, hedonism, and free queer love, which might not look like straight love at all. HIV gave gay men who believed in respectability, modesty, and monogamy the upper hand. Marriage used that respectability to gain legal rights. Truvada might be a step toward a new sexual liberation — sex parties, singles and swingers, threesomes even for committed couples — and away from the condoms that made our sex safer not just physically but culturally. No wonder it makes people, gay and straight alike, uncomfortable.

AIDS Taught Me Sex Was Deadly. A Pill Changed That 
Truvada is nothing special, nothing new. The antiretrovirals in it have been used for decades. The difference is the bodies the drugs are put inside, now HIV-negative, no virus in residence, now not ill but pre-ill, infected only by the type of sex we have.

The pill's out-of-pocket cost is roughly $18,000 a year. Truvada is made by only one company, Gilead. One common criticism of PrEP is that it requires HIV-negative people to take very expensive pills whose side effects are not insignificant. PrEP, the argument goes, turns gay sex into a profitable (and therefore palatable) enterprise in the age of late capitalism, where everything is moral if it's making someone rich. Gay sex parties aren't sinful debauchery; they're added value for Gilead shareholders.

The rebuttal is that PrEP works. It's most likely less expensive, and involves fewer years of dealing with side effects, than taking antiretrovirals for a lifetime, as those who are HIV-positive must. Yet $1,500 a month for the option of sex uncontaminated by fear of HIV is a high cost for an individual or society to pay.

Gilead has a program that provides free drugs to those without insurance, and there is a co-pay assistance program as well. Theoretically, anybody should be able to get Truvada at low cost. In practice, it's not that simple.

As I was writing this essay, I had dinner with a friend who had been on Truvada but who had recently had to stop taking the drug. He hit the yearly cap — $3,600 — for the Gilead co-pay assistance program and his co-pay, he said, was as high as $500 a month. With private insurance and a very high co-pay, he was — in terms of access to Truvada — in a worse position than those who have no insurance at all.

"I just want to be able to have sex again," my friend told me. He's single and mostly uses online apps for sex and dates, both. He was having a hard time finding men who would have sex with condoms. For my friend, in 2016, PrEP feels necessary to have sex. He wouldn't have unprotected sex without it, and hookup culture — according to him — has moved on. Condoms are no longer the norm. This does feel new.

I knew the city was building a program to help people with private insurance who max out the Gilead co-pay program. I had met with Dr. Demetre Daskalakis, the head of New York City's HIV prevention campaign, to talk about condoms and PrEP and the city's programs. We'd discussed people in my friend's situation. I spent the next two days on the phone with a full alphabet of agencies: first 311, then HASA (only for the HIV-positive) and ADAP (doesn't cover PrEP), then my city-associated HIV clinic. Nothing. Then state programs, PrEP-AP and the PrEP hotline; then PAN, then Xubex.

On hold listening to badly performed classical music I thought, This is how bureaucracy kills: to Bach. I'd spent months researching PrEP, and I couldn't help my friend. Once I'd exhausted all the options, I reached back to Dr. Daskalakis, hoping for a nudge in the right direction. Yes, the city knows about the PrEP donut hole for the underinsured. Yes, they are hoping to develop a solution. No, there is nothing yet. It's been months since my friend has taken Truvada and months, too, since he's had sex.

Truvada offers sex without worry for fifty dollars a pill. People live and die on the basis of a brief conversation at a clinic about whether and how to sign up. Fifty percent of black MSM are HIV-positive or are likely to be in their lifetimes. New York City is majority-nonwhite. In some places people are still — against medical and epidemiological evidence — going to jail for fucking while HIV-positive. Many still blame an HIV-positive person for their risk when both partners consent to unprotected sex. Even in New York, where the city government is committed to PrEP and stigma-free HIV policy, there are people who fall through the cracks. Outside of this city, those with the least access to PrEP will be people — queer people, poor people, people of color, people in prison, people in rural towns — who have always been excluded from healthcare.

And that is what HIV care looks like before Donald Trump starts running the federal government. Our vice president–elect has led the drive to defund Planned Parenthood — even as the closure of a Planned Parenthood testing center in his home state inflamed a major HIV outbreak.

The coming years could make geography matter even more than it already does — things like PrEP may be accessible in New York and entirely unavailable in rural Indiana. More than five hundred thousand people in America know they're HIV-positive but aren't on treatment. This is more than half of all people living with HIV. A friend of mine has a cousin in a deep-red state dying of AIDS, right now, today. He has KS lesions, he's unlikely to live much longer, he often can't get drugs, and when he does take medicine he tells his relatives only that he has "cancer." This isn't the story we're telling ourselves, and it's not one we often hear.

When PrEP was introduced, we all wanted to know: Would it change behavior? Would it lead to a world where condom use dwindled and raw sex became — again — the norm? Early research showed that PrEP users didn't decrease their condom usage. People on PrEP weren't more likely than they were before to have raw sex, they were just more protected in their actions.

More recent studies suggest otherwise. My experience and the experience of my friends also hints at a culture shift. Almost everyone I asked who still uses condoms has a story of someone backing out of a hookup if condoms were to be used. People are having more raw sex, and they're more open about it. They advertise it on apps. They talk about it with their friends. I see it now, and I didn't see it much before.

I've spoken to dozens of people, on and off the record, about PrEP. Sitting at my kitchen table with three gay writers, none of whom were taking PrEP, I realized that all the people I've talked to — whether they are taking the drug or not — are making a difficult and informed choice about their body, their pleasure, their risk, their sex. Some are using PrEP as a backup to condoms, others as a substitute. Many aren't using it at all; some use it on and off, when they are not in a monogamous relationship. Some want to start. At my kitchen table, one writer friend said that having lived through the 1990s, he'll never take the condom off. It'll never — for him — feel safe or sexy.

Me? When my boyfriend read an early draft of this piece, he asked if I wanted to get on PrEP. "No," I said, "I don't. Do you?" Reading this made him feel like HIV is inevitable, especially given the numbers concerning men of color. But this moment we're in makes me feel hopeful. Even if HIV happens, so what? I used to think that HIV would make it harder to find love and sex. Now we know that HIV-positive and undetectable is safe. It's sexy. I have friends who prefer to sleep with undetectable men. They know that most HIV transmission is by people who don't know they're infected or aren't on treatment. For an acquaintance who prefers not to use condoms for his hookups, people who know they're positive and are on drugs are the safest bet.

"Our story is about to change," Dr. Daskalakis told me. He meant the public health programs the city is about to enact. For me, it's true of our cultural moment: a disorienting pivot from everything we told ourselves to be true. The line between HIV-negative and -positive, between bodies safe and not safe to sleep with, is becoming porous.

The political moment we're in only amplifies this feeling. We might go back to 2012 — before Truvada, before we knew that undetectable means safe. We might go back further. I can imagine a future where only people with money can treat or prevent HIV. For many, that's still today's reality anyway, and it probably won't change under the Trump administration. Remember that more than half of the people with HIV aren't on treatment right now.

So yes, we now have good HIV medicine for both treatment and prevention. Pills don't cure us, but they might keep us alive. In 1996, people were so near to death, and then they weren't. Pills do beautiful, beautiful things. Pills can't do it all. Pills can't make us better at negotiating consent or understanding risk. Pills are not healthcare infrastructure in communities that need it. Pills don't erase stigma. Pills exist where people can afford them. Pills exist for people who can get to doctors, clinics, and hospitals.

In New York City, Truvada has become something like mainstream. All living is risky. All sex, too. I've slept with people I didn't love enough when they loved me deeply. I've slept with people I loved who didn't love me enough, who lied, who cheated. I've had joy, too, even with that ex: when we made love as midnight brought in my thirtieth birthday. Joy: the Grindr hookup I had whose body fit mine. Joy: the first kiss with my current boyfriend, a bundle of nerves, leaning forward on my couch, our glasses clinking at the nose. For decades, and still too often, these small moments of pleasure could bring death.

In the past three years, I've been able to imagine a new type of pleasure. Remarkably, this pleasure is one willing to inhabit my own body. I don't know if it's PrEP — even though I don't take it — or the idea that being undetectable is safe, healthy. I don't know if it's because I have a partner I trust with my life, but I suspect it's something more than that.

Even with boyfriends or girlfriends I trusted before, I could never have sex without feeling my life and death were at stake. Now, with my boyfriend, we strip each other naked, no Truvada in either of our blood. In these moments, my mortality is growing smaller and smaller. Sometimes I don’t think about it at all.

December 1, 2016

In Russia Healthy Living and Family Values is giving them an Increase of Straight HIV Transmission

 Do You Know What Dec.1st is?(Even if You don’t use condoms, now there is no reason to get HIV in many countries, ask me!


- For a few weeks in 2012, Yury had a family: His wife, Katya, had given birth to a girl.

But when Yury took his ailing baby daughter to the hospital two months after she was born, he learned that she was HIV positive, and his world began to collapse. After he was tested and came up positive, he said, Katya told him that she had given him the virus -- and had known she had it while pregnant but kept it secret from him out of fear.

A month later, their daughter was dead. Katya, who refused to take antiretroviral therapy to prop up her ailing immune system, died last year.

"We didn't separate or run away from each other. We went to the end," said Yury, a 40-year-old auto mechanic from a gritty Moscow suburb who preferred not to be identified by his surname. "I've come to terms with it all. How can I blame the person who gave me a daughter?"

Russia's HIV epidemic passed a grim milestone in January as the country registered its millionth HIV-positive citizen -- double the number in 2010. About 200,000 of that million have died since HIV was first registered in Russia in 1987.

With less than one percent of the population of Russia's 142 million infected, the situation is less dire than epidemics that have ravaged Sub-Saharan Africa. And yet while the rate of new HIV infections across the world is ebbing, in Russia it is on the rise.

Russia accounts for the lion's share of infections in a Eurasian region, which UNAIDS -- the United Nations' program on HIV/AIDS -- says is the "only region in the world" where the HIV epidemic has "continued to rise rapidly." More than 93,000 new cases were registered in 2015 -- compared, for example, to 44,000 new diagnoses in 2014 in the United States, whose population is more than twice as large.

Yury does not know how Katya contracted HIV, but his own story fits into a trend that some leading experts say President Vladimir Putin's government must face up to fast: The number of Russians infected through straight sex is rising.

Vadim Pokrovsky, the longtime head of the Federal AIDS Center and an expert who has been tracking the disease's progress in Russia for almost three decades says the epidemic is advancing beyond traditional high-risk groups and spilling into general circulation.

Pokrovsky said that infections through heterosexual contact accounted for 45 percent of overall infections in 2015, compared with 10 percent 10 years ago.

He believes Russia stands at a critical juncture: The government should forsake what he casts as conservative policies that deviate from established global practice in the fight against HIV.

"I think it is now spreading into the heterosexual population," Pokrovsky told RFE/RL. "We can no longer keep on saying 'nyet-nyet' [Russian for "No-No"]. We have to urgently take measures."

'HIV Belt'

For years, the chief mode of transmission in Russia has been intravenous drug use, which boomed after the Soviet collapse as the social fabric frayed and factories shut down or slashed workers' jobs, particularly in industrial towns in the Urals and Siberia. Rampant drug abuse tore through cities on the heroin trail from Afghanistan westward in the 1990s and 2000s, forming something of an "HIV belt" across central Russia where the virus remains most prevalent today.

Pokrovsky believes the situation is moving from a "concentrated epidemic" among at-risk subgroups such as injecting drug users to a "generalized epidemic" -- defined by the World Health Organization as a situation with "HIV prevalence consistently exceeding 1 percent among pregnant women."

Pokrovsky said that in over 15 of Russia's 82 regions, more than one out of every 100 women who becomes pregnant has HIV.

"The trouble at the moment is that the number of people contracting HIV through heterosexual sex is rising," Pokrovsky said. "We cannot say that these transmissions are connected to the traditional vulnerable groups."

Other experts say there has been no major shift in the way HIV is spreading in Russia.

In e-mailed comments to RFE/RL, UNAIDS said that "the majority of the new HIV cases in Russia remain concentrated among key populations -- particularly injecting drug users and their sexual partners."

But almost all agree on the need for urgent action in Russia, where several factors -- including the persistent stigma attached to homosexuality, a strained health-care system, a lack of education about risks, government pressure on NGOs, and logistical problems that critics say have been created or aggravated by the state -- are making the HIV/AIDS problem worse.

Rising Concern?

There are some signs of new attention from the government, and the media that serve it, to an issue that was long considered peripheral.

Recently, newspapers such as Komsomolskaya Pravda, a popular pro-Kremlin tabloid, have carried stories with headlines like: "HIV can happen to anyone: go out and get tested!"

Prime Minister Dmitry Medvedev declared the situation a matter of "national security" in March, and on October 20 signed off on a five-year strategy to combat the crisis through 2020. 

But despite the indications of increased concern, activists, doctors, and NGO workers fear that the new government plan remains hamstrung by the same conservative, go-it-alone approach that has stymied efforts to rein in the epidemic so far.

Among other things, the strategy prioritizes raising awareness, with the help of NGOs, among "key groups of the population." But in a common point of criticism, Pokrovsky said the strategy fails to clarify how the government plans to work with key HIV risk groups such as injecting drug users, sex workers, and gay or bisexual men.

"No one has answered the question of how we are going to warn people about the circulation of HIV among drug users -- although about 20 percent of intravenous injecting drug users already are infected," said Pokrovsky. "Nothing is said about how to prevent the infection of the remaining 80 percent."

"The same goes for sex workers," he told RFE/RL. "There is not a word about prevention among them. Everyone knows there are many of them. But there are no special programs planned for this group. The same goes for men who have sex with men."

The state "just does not pay enough attention to prevention -- prevention is very weak in Russia," Pokrovsky said, adding that this is reflected in government funding to fight HIV. "If 18 billion rubles ($278 million) are spent on treatment, only 400 million rubles ($6 million) go to prevention."

Zero Tolerance

There are no well-known state outreach organizations or programs working with high-risk groups. This is the exclusive preserve of largely foreign-funded NGOs such as the Andrey Rylkov Foundation For Health and Social Justice -- the only group in Moscow that distributes clean needles, contraceptives, and medication to drug users, the main group incubating and spreading the virus.

The Rylkov foundation receives no financing from the Kremlin and relies on grants from abroad. In July, the group was labeled a "foreign agent" under legislation signed by Putin early in his third term in 2012 that pressures and marginalizes many NGOs with foreign funding.

Foundation activists also encounter street harassment. In October 2013, police threatened to arrest activists who had traveled to a pharmacy in a rundown district in southeast Moscow where they handed out clean needles, bandages, condoms, and ointments. The police ordered them to disperse, prompting them to move to a new location where they continued their work. 

Although 1 million Russians have been registered with HIV in the last 30 years, Pokrovsky estimates there could be another 500,000 living with the virus who have not been identified -- many of them injecting drug users.

"Over half of our cases are contracted through drug use," said Elena Orlova-Morozova, a doctor at the Moscow Region AIDS Center. "It is very hard to identify HIV in this group and make progress with this group. Drug use is criminalized here and there is no talk of decriminalizing it."

“Drug users therefore are scared, of course, and cannot go to state buildings [such as hospitals] to be monitored,” she added. 

Activists also criticize Russia's refusal to legalize heroin substitution therapy which has been used widely across the world -- including in authoritarian countries such as Iran -- to wean drug users off heroin by giving them orally imbibed methadone.

Anya Sarang, head of the Andrei Rylkov Foundation, dismissed Medvedev's strategy as more of the same policy that has brought the epidemic this far. She suggested that one big obstacle to improvement is the growing prominence during Putin's third term of conservative ideas, anti-Western sentiment, and views espoused by the Russian Orthodox Church leadership.

"I guess the Health Ministry is still trying to figure out the 'Russian' and more godly way to deal with the problem since they are not in favor of internationally accepted, evidence-based prevention programs such as needle and syringe distribution and opioid substitution therapy," Sarang said.

'My Son Died Today'

LaSky, an HIV NGO that works with homosexual and bisexual men in Moscow, has not been labeled a foreign agent despite receiving money from abroad. But it has had to adapt to other restrictive legislation passed during Putin's third term.

On a November afternoon, Aleksandr, 29, a shop director who moonlights at LaSky, pasted "18+" stickers onto fliers and pamphlets about HIV and homosexuals so as to avoid being accused of violating a 2013 law that criminalizes the spread of gay "propaganda" to minors.

Rights groups and Western governments say the law marked a major setback for gay rights in Russia, encouraging prejudice and adding to the stigma attached to the lesbian, gay, bisexual, and transgender (LGBT) community in Russia, where homosexual relations were a crime in the Soviet era.

Ilya, a 20-year-old gay man who has attended counseling sessions at LaSky, has felt the stigma firsthand since he contracted HIV in December 2015 and was disowned by his family, which is prominent in his Siberian hometown. 

When he called his mother with the news of the test result, she said "my son died today" and hung up the phone.

Ilya, who did not want his last name published, said he became depressed and fell behind on his studies at a Moscow university. When exam time came in May he asked for an extension, citing his HIV status and a doctor's note, but was swiftly expelled, he said.

"In Russia, HIV-infected people are not seen as people who need help and are sick, but as people deliberately spreading the plague," said Ilya.

Activists at LaSky say the lack of information about HIV is a major problem. Aleksandr, a gay man from a Volga River town who preferred not to be identified by his surname, said he had no idea when he contracted HIV in 2013 that sexually active gay and bisexual men are at a high risk of infection.

"This information is nowhere, no one talks about it, no one knows anything about it," he said.

Activists say sex education in schools is grossly insufficient. At his high school, Aleksandr said, there was just one lecture that talked about condoms -- and it focused on using them to prevent unwanted pregnancy.

"There was nothing specifically about HIV," he said. "No one in the regions gets that. As a rule, they say superficially that there are sexually transmitted infections and you need to use a condom."

LaSky offers support in getting around a major logistical hurdle for many HIV sufferers in Moscow: The state guarantees free medical treatment for citizens, but only in the locale whether they officially reside -- and many Russians who live in the capital formally remain residents of their hometowns.

After Aleksandr tested positive for HIV, he had to travel back home -- 400 kilometers east of the capital -- for time-consuming treatment. He tried to hold onto his job by asking in advance for time off, but eventually was forced to resign. He has now managed to get registered for treatment by registering at the Moscow Region AIDS Center with LaSky's help.

Champagne, Not Condoms

Activists criticize some of the awareness campaigns that do exist, such as state-sponsored signs at Moscow train stations that make no mention of the use of condoms as a preventive measure.

One public-service poster sponsored by the Moscow government says simply, "Ignorance puts you in the risk group," without further explanation. Another suggests that adhering to traditional family values is key, warning: "Infidelity puts you in the risk group."
Pavel Lobkov -- a TV presenter who broke a taboo last year when he disclosed his HIV-positive status on the air on World AIDS Day, December 1 -- said condoms should be far more accessible.

"They should be handing them out free of charge in clubs where there is a heightened sexual atmosphere, or at rave parties, and so on," Lobkov told RFE/RL in an interview.

"When in a normal shop a pack of 12 condoms costs as much as a bottle of Soviet champagne, a couple of 18-year-olds will buy the champagne and not those boring condoms."

Lobkov said that "there were outreach programs for many years" -- but that times have changed.

"In the 1990s, I remember in all gay clubs or rave clubs there were free condoms at the bar," he said. They've disappeared now. They should be in your face" he said.

But social conservatives who have gained influence during Putin's public push for adherence to what he and the Russian Orthodox Church cast as traditional values tend to oppose such measures.

Lyudmila Stebenkova, a long-time Moscow legislator who heads the city Duma's public health committee, called on November 15 for a ban on the distribution of free condoms.

Stebenkova, who has won awards from the church, said condoms only offer 80 percent protection from infection and that their free distribution inculcates "irresponsible sexual behavior."

In a follow-up Facebook post, Stebenkova attacked foreign NGOs whose methods she called "strange and even irresponsible: giving out one-use needles to drug addicts and propagandizing condoms, which they give out even to schoolchildren." 

“In Moscow we decided to go down a different route: the propaganda of healthy living and family values," she wrote

November 28, 2016

Why China Needs a Conversation About Gays,Sex and HIV

Lin Hui, a student in China, thought condoms only served to prevent pregnancy. So when he had sex with another man, in high school, he didn’t think he was exposing himself to any risk.
Lin, who asked that his real name not be revealed, was diagnosed with HIV in 2014, a few months before turning 18. He is now a university student in Nanjing, keeping the virus in check with daily medication. He feels resentment, however, about contracting a disease society taught him little about.
“I never imagined it could happen to me,” Lin says. “There is very little sex or HIV-prevention education in schools or in society in general. People only talk about it around World Aids Day, and then we forget about it.”
Lin is one of a growing number of young people in China to have been diagnosed with HIV in recent years. While the country has managed to dramatically reduce HIV transmission through drug use and blood transfusions, the rate of new, sexually transmitted infections among young people has accelerated in the past five years, particularly among men who have had sex with other men.

Almost 17,000 people aged between 15 and 24 were diagnosed with HIV in 2015, according to China’s National Centre for Aids/STD Control and Prevention (NCAIDS). That was 10 per cent more than the number of new cases identified in 2014 in the same age group, and more than double the number of new cases reported in 2008.
Over the past decade, the number of HIV transmissions among young Chinese has increased by as much as 20 per cent annually. China’s health authorities have recognised the problem but have been slow to respond.

“The real challenge today is especially among young populations, especially among young gay men,” says Bernhard Schwartl√§nder, the WHO representative in China. “There’s a real spread of HIV in these populations, and we don’t seem to reach them well. I think it’s a real challenge to Chinese society to deal with populations that are outside of social norms, that are different in some way.”
Almost 70 per cent of the people aged between 15 and 24 years who were diagnosed with HIV last year were infected through homosexual sex. Of the students in that age group, gay sex was the cause of infection in 82 per cent of cases, according to NCAIDS. About 3,200 students received HIV diagnoses last year, but four times as many newly infected young people were outside the school system.
This suggests that starting HIV prevention education in university might already be too late, because most young people at risk are outside of college campuses, says Catherine Sozi, UNAids country director for China.
“So if they don’t get the information while they’re in school ... then it’s a bit of a missed opportunity to help young people” gain the knowledge that will help protect them, she says.
The Ministry of Education and the National Health and Planning Commission have mandated six hours of sexual education for all middle school pupils and four hours for high school students.
But few schools offer any type of sex education, sexual health activists say. And when they do, classes are usually focused on biological changes during puberty, not on relationships or gender identity diversity.
Liu Shi, project manager at the non-profit Beijing Gender Health Education Institute, sees two barriers preventing young people from receiving sex education in schools. One is parents.
“So many parents want their children to stay away from any sexual education before college because, especially if the sex education is in high school, they are worried that their kids may be encouraged to have sex earlier,” says Liu, who is HIV positive.
Many Chinese parents want their children to concentrate on studying for the national college entrance exams, wait until college to have personal relationships, and wait until they’re married to have sex, after graduating from university.
The reality, of course, is different. Technologically savvy, and increasingly free from the constraints of living with their families in small, rural communities, young people are exploring their sexuality earlier and more boldly than previous generations. At the same time, sex remains a taboo subject in schools, official discourses and pop culture.
“There’s not enough government and social publicity,” says Wang Long, founder of the non-profit Zhejiang Love Working Group. “Movies, TV series, talk shows, newspapers and radio all avoid talking about sex.”

The Ministry of Health has a condom distribution programme, but condoms adverts are banned from television.
Even though many universities have programmes, clubs or lectures that address HIV prevention, the message often goes astray, according to Martin Yang, China Aids Walk project manager at Beijing Gender Health Education Institute. The content fails to resonate with young people, or they merely ignore it, Yang says.
“I think the perception of a lot of people in this country is that [HIV] is far away,” says Sozi. “It’s a sex worker somewhere, and some gay man somewhere. It’s not here.”
Health workers are realising there needs to be a paradigm shift in the way they tackle HIV/Aids prevention, she says. “We’re still doing what we did 20 years ago,” Sozi adds. “There’s been no shift in keeping up with the emerging populations and how they do things, how business is done. It’s done on the phone; it’s no longer posters and reading newspapers.”

At the Blued offices in Beijing’s Chaoyang district, employees are making last-minute preparations for World Aids Day events. Blued is China’s largest gay dating app, with 27 million users. Since 2008, its parent company, Danlan, has worked with government agencies on online and offline HIV prevention efforts.
The app has a section with information about HIV, and a feature that allows users to find the nearest testing centre and make an appointment. There are regular live-streaming events and photo contests. Its HIV-related information has logged 70 million views in 12 months, says Hank Chen, director of Danlan Public Welfare.
“Compared with the entertainment feature and the socialising feature, the HIV-prevention feature is not that popular,” Chen says, adding they are looking at new ways to get the message across.
Discussion on HIV prevention should not just involve medical terms, says Fabio Scano, a disease control coordinator at the WHO Beijing office. It should be tied to people’s lifestyles, and to combating stigma and discrimination by involving more NGOs and community groups. In particular, gay men should be involved in “the planning and implementation of services: from being merely service providers, to full partners in planning”.
The government has established a fund for NGOs to tap into for HIV testing. However, funds are not available for most advocacy or awareness-raising work.
Yang of China AIDS Walk wants students to become more involved in the search for efficient ways to get the HIV-prevention message across to other young people. The organisation is making available micro-grants for student groups at 100 universities around the country to conduct their own outreach experiments. The funds come from individual donations but should be enough to plant the seeds of community work among students.
“It can be anything from a board game to a radio show,” Yang says. “It will give them the opportunity to disseminate information and be creative.”

imina MistreanuWang YanSouth China Morning Post
Additional reporting by Qu Chaonan

November 10, 2016

Scientists Have Developed New HIV (USB) Home Computer Test

Researchers have developed a screening test for HIV that uses a USB stick to process data in a move they say vastly improves upon conventional methods.

Typically, HIV screenings can take as long as three days to produce results. Scientists at Imperial College London and DNA Electronics say their novel solution is not only more accurate, but can provide a diagnostic in roughly 30 minutes with the help of a computer or handheld device.

The USB device works by using a drop of blood to create an electrical signal that can be read by a computer. The technology then measures the amount of the virus in the blood. Patients can also use it to monitor their own treatment. Researchers tested their new method in a study published in the journal Scientific Reports.

"Monitoring viral load is crucial to the success of HIV treatment," senior author Graham Cooke said in a press release. "At the moment, testing often requires costly and complex equipment that can take a couple of days to produce a result. We have taken the job done by this equipment, which is the size of a large photocopier, and shrunk it down to a USB chip."

During the study, the technology was used to test 991 blood samples with 95 percent accuracy. Results were produced in an average time of 20.8 minutes. Researchers say the ease of the test may have positive implications for Sub-Saharan Africa and other HIV hotspots where many conventional tests are often unavailable.

"This is a great example of how this new analysis technology has the potential to transform how patients with HIV are treated by providing a fast, accurate and portable solution," DNA Electronics founder Chris Toumazou said. "At DNAe we are already applying this highly adaptable technology to address significant global threats to health, where treatment is time-critical and needs to be right first time."

Scientists say the next step will be investigating how the USB device can be used to screen for other viral infections such as hepatitis.

August 10, 2016

He Told His Chinese Wife He’s HIV But Never Would He Tell He’s Gay

 Gay sex is easily found in China

When HIV first emerged in China, it was largely transmitted through blood transfusions. China managed to contain tanat epidemic that broke out in the 1990s, but now HIV rates are on the rise again.

This time, it’s among gay men. Last year, men who have sex with men accounted for about 28 percent of all new HIV infections in China.

That includes gay men who are married to women.                                     

Maitian lives in Chengdu with his wife. They have been married for 20 years and have an 18-year-old son. Maitian is not his real name. He asked us to use a pseudonym because he is gay and HIV positive.

Maitian says shortly before he got married, he started exploring his sexuality. At the time, homosexuality was punishable under the crime of “hooliganism.” In 1997, China eliminated the crime of hooliganism, and homosexuality was in effect decriminalized. Four years later, it was removed from a list of mental illnesses in China.

Even though He’s gay, Maitian says he always expected that he would marry a woman and have a child. Living with a man was never an option.  Even though he's gay, Maitian says he always expected that he would marry a woman and have a child. Living with a man was never an option.  

Zhang Beichuan, a professor at Qingdao University's Medical School who researches gay issues, estimates that China is home to more than 21 million gay men, and more than half of them are married to women.   

Maitian says he always expected that he would get married and raise a child. Living with a man was out of the question for him. Although there are young gay Chinese who live openly in big cities like Beijing and Shanghai, they are still a small minority.

“I think that is only for the privileged,” Maitian says. “We are just common people and we have a lot of everyday business to take care of. Our parents and our siblings are concerned about how we lead our family lives.”

Maitian says he stayed in his traditional marriage, but he continued to meet up with men.

The first time he went to a gay bathhouse in Chengdu, he says someone gave him an address and he found the place on his own. He says he was amazed that it was filled with men like him. He soon became a regular.

“I got what I wanted,” Maitian says. “And it didn’t cost much. I was satisfied.”

He says he didn’t use condoms at the bathhouse.

According to the Chinese Center for Disease Control and Prevention, the rate of HIV among gay men in China was about 8 percent in 2015. That’s up from 1.3 percent in 2004. Among the concerns about the rising rates are that gay married men with HIV would transmit the virus to their wives.

In 2009, Maitian went in for some minor surgery at a local hospital, and they gave him an HIV test. Maitian tested positive, though he says he didn’t even know what HIV was. He went back home and searched online and found photos of people with HIV who had lesions all over their bodies. Maitian says he felt scared and helpless. Later, he joined an online support group for people living with HIV, which helped him deal with his fears.

Local health officials pressed Maitian to bring in his wife for testing. But it took him a year to tell his wife that she should get an HIV test. He says she nearly broke down when she learned she had HIV. She couldn’t believe it.

Confronted with the dilemma of whether to tell his wife about his secret life, Maitian chose to shift the blame.

“Our son was born in 1997 via C-section and she had to have a blood transfusion. So I said it must be from that. And she believed it,” Maitian says.

Over the years, Maitian says his wife has more or less accepted the transfusion explanation. There were moments when she asked him why their son tested negative for HIV, and he pointed out that their son was not breastfed. He says she never really asked him again how they both became infected. Now Maitian and his wife are on medication and are relatively healthy. But it hasn’t been easy.

“HIV is not like other diseases. It’s a lifetime disease. It takes a great toll on our bodies,” Maitian says.

“I feel very guilty for my family and for my wife. As much as I can, I think I should do more for my family and for her.”

But there is one thing Maitian doesn’t plan to do: Tell his wife that he is gay.

Originally Posted at pri.ORG

February 10, 2016

The Philippines Gets hit by the HIV Bullet it had otherwise Dodged

Cebu City has been listed as one of the areas of the Philippines with the highest increase in HIV cases.
 (Veejay Villafranca / Pulitzer Center on Crisis Reporting)

Increasing HIV infection rates are raising fears that the Philippines will be faced with a public health crisis that it has long escaped.

Since the Philippines reported its first case of HIV in 1984, the island nation has had one of the lowest rates of infection in the world; less than 1% of its 100 million population has been infected with the virus that causes AIDS.

But that may be changing.

Globally, new HIV infections have fallen dramatically in recent years, according to UNAIDS, the United Nations’ program to combat the disease. But in the Philippines, more than 20,000 new HIV infections were reported from 2010 to 2015 — more than four times as many as had been recorded in the 26 years before that. 

Along with India and Pakistan, the Philippines is seeing new infections and AIDS-related deaths sharply rise among men who have sex with men and among transgender women, sex workers and people who inject drugs.

A nationwide study conducted by the Department of Health showed that in some areas, infection rates among these groups were higher than 5%.

“That 5% threshold is like a tipping point,” said Dr. Genesis Samonte, head of the department’s HIV/AIDS monitoring and tracking unit. “There is already a large base of people who have the virus, so the rate of infection will be exponentially faster.” 

“No one is saying ‘national emergency’ yet, but a lot of people are thinking it,” said HIV activist Tony Benfield.

Benfield, 53, vividly remembers the early days of AIDS, in the 1980s, when HIV had yet to be discovered as its cause and men were dying from what was called “gay cancer.”

“I lost many friends then. It offends and angers me that I continue to lose friends today,” Benfield said. “Back then, we called it for what it was. ‘He died of AIDS,’ we would say.”

 Rina and Gabby Cardinas, who have both been HIV positive for more than 10 years, live in a small town outside Cebu City, Philippines.
 (Veejay Villafranca / Pulitzer Center on Crisis Reporting)

But 30 years and many medical advancements later, HIV-related deaths are shrouded by attributing them to more socially acceptable diseases such as “hard-core pneumonia” or “brain tumor.”

In 2009, Benfield was working for a nongovernmental organization when he began offering free HIV screening and counseling to friends through home test kits. Covering the cost of the $2 test kit himself, he would go out in his spare time to parking lots of malls or coffee shops to meet people — anywhere but the homes, offices or schools where they could be recognized.

It was basic but utilitarian. And it was better than the other options available at the time: government-run testing centers where clients could wait most of a day to receive their test, or private hospitals that charged as much as $100.

Benfield’s testing service spread, initially through word of mouth, later through social media. But as it grew, so did the problem.

“Before, one out of five tested positive,” Benfield said. “Now, it’s more like four out of five. It’s depressing.” 

In 2012, Benfield and some friends opened Sustained Health Initiatives in the Philippines, a small private HIV testing clinic. Benfield considered it a memorial of sorts to a friend he had lost to HIV-related complications. He did not know the friend was HIV-positive until after he had died.

“It’s a train wreck coming. Can’t anybody else see that?” Benfield said.

The government did see it — as far back as 2009, when new HIV infections showed their first jump. Health officials noted that the virus, formerly transmitted primarily by female sex workers, now was being spread largely by men having sex with men. 

The increase hit some areas especially hard. Cebu City in the central Philippines saw one of the biggest explosions in infection rates.

More than 70% of the total HIV infections are now attributed to men having unprotected sex with other men. Most of them are in the 25-34 age group. 

The Health Department puts AIDS-related deaths since 1984 at 1,501. But health experts and activists alike say the number is grossly understated, with many deaths quietly passed off as pneumonia or meningitis.

From January to November 2015, there were 415 HIV-related deaths.

“That’s more than one death every day — of mostly young gay men. Ignoring this is like saying that the deaths of gay men don’t matter,” said Jonas Bagas, former executive director of the Library Foundation, one of the first HIV awareness and advocacy groups in the Philippines.

The Health Department forecasts total HIV infections will reach 133,000 by 2022 if the current trend continues.

“To reverse the increase in infections, we need to increase condom use and bring it up to the level of 80%. We need to get people tested and get them on treatment,” said Samonte. 

Increasing condom use among men who have sex with men from its current level of 44% will mean overcoming social, religious and legal obstacles. Condoms are only sold in convenience stores and drug stores — mostly behind the counter.

In the heavily Roman Catholic country, condom ads and public service campaigns on HIV/AIDS are muted by protests from religious groups, which see them as promoting promiscuity.

And existing laws bar minors from getting an HIV test or being offered condoms from public health clinics without parental consent.

“It no longer responds to the current HIV situation,” said Rom Dongeto, executive director of the Philippine Legislators’ Committee on Population and Development. “Isn’t it baffling that the government has no massive and sustained information campaign about HIV and AIDS, given this dramatic increase in new infections? This is a public health issue that is exploding as we speak.” 

A commercial sex worker puts on her makeup while  waiting for customers in Cebu City, Philippines. (Veejay Villafranca / Pulitzer Center on Crisis Reporting)
The government is considering incorporating HIV education into public school curricula to catch risky behavior before it starts.

Bic Bic Chua, executive director of Catholics for Reproductive Health, decried a recent decision by Congress to eliminate the Health Department’s contraceptive budget.

“We are running a race against time — against increasing maternal deaths, increasing teen pregnancies and increasing HIV rates. Nobody wins. We will all lose,” said Chua.

Santos is a special correspondent. Reporting for this story was supported by a grant from the Pulitzer Center on Crisis Reporting.

Ana Santos, Manila

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