Category: Public health

Pre-exposure prophylaxis can be a cost effective addition to other preventative options for men who have sex with men

HIV pre-exposure prophylaxis (PrEP), the use of antiretroviral drugs by uninfected individuals to prevent HIV infection, has demonstrated effectiveness in preventing acquisition in a high-risk population of men who have sex with men (MSM).

Researchers from the Imperial College London have developed a mathematical model representing the HIV epidemic among MSM and transwomen (male-to-female transgender individuals) in Lima, Peru, to investigate how PrEP can be used cost-effectively to prevent HIV infection in such populations.

The study reported that strategic PrEP intervention could be a cost-effective addition to existing HIV prevention strategies for MSM populations.

However, PrEP will not arrest HIV transmission in isolation because of its incomplete effectiveness and dependence on adherence, and because the high cost of programmes limits the coverage levels that could potentially be attained.

15-year survival of patients on antiretroviral drugs similar to general population

In a recently published study by Hamish McManus and colleagues reported on long term survival and mortality in HIV-positive patients receiving anti-retroviral medication (cART )in the Australian HIV Observational Database (AHOD) and compared them to the general population.

They showed that observed mortality remained fairly constant by duration of cART and was modelled accurately by accepted prognostic factors.These rates did not vary much by duration of treatment.

Unlike previous studies which had shown an increase in mortality in HIV patients compared to matched non-infected populations changes in mortality with age were similar to those in the Australian general population. The increased mortality is more pronounced in females but is observed in both sexes and is unrelated to known risk factors such as smoking, hypertension, blood fat abnormalities, or obesity and is thought to relate to long term effects of anti-reroviral therapies currently in use.

Rising gonorrhoea antimicrobial resistance in Europe

A recent report by the European Centre for Disease Prevention and Control has highlighted the danger that rising antibiotic resistance may mean that soon gonorrhoea may become an untreatable disease in some parts of Europe.

According to the report the most worrying result is the increase in the percentage of isolates with decreased susceptibility to cefixime and the increase in the number of countries where this phenotype was identified between 2009 and 2010. [Fig 1]

 

Fig 1. European Centre for Disease Prevention and Control

Patient characteristics of isolates with decreased susceptibility did not differ greatly when compared to the overall population, except for age: patients with decreased susceptibility to cefixime were more likely to be older.

There is some evidence that the rates of ciprofloxacin and azithromycin resistance have both decreased since 2009. However they remain worringly high across Europe (53% and 7%, respectively).

Similar results for cefixime – which is the first line drug therapy in many centres – have been reported by the European gonococcal antimicrobial surveillance programme (Euro-GASP) – Fig 2

 

Cephalosporine resistance in gonococcal isolates 2009 – Euro-GASP

No increase in sexual behaviour in HPV vaccinated teenage girls in US

Since US public health officials began recommending in 2006 that young women be routinely vaccinated against HPV, many parents have hesitated over fears that doing so might give their children license to have sex. Research published on Monday in the journal Pediatrics and reported in the New York Times of October 15 may help ease those fears.

Using a sample of nearly 1,400 girls, the researchers found no evidence that those who were vaccinated beginning around age 11 went on to engage in more sexual activity than girls who were not vaccinated.

“We’re hopeful that once physicians see this, it will give them evidence that they can give to parents,” said Robert A. Bednarczyk, the lead author of the report and a clinical investigator with the Kaiser Permanente Center for Health Research Southeast, in Atlanta. “Hopefully when parents see this, it’ll be reassuring to them and we can start to overcome this barrier.”

HPV, the most common sexually transmitted virus in the United States, can cause cancers of the cervix, anus and parts of the throat. Federal health officials began recommending in 2006 that girls be vaccinated as early as age 11 and last year made a similar recommendation for preadolescent boys. The idea is to immunize boys and girls before they become sexually active to maximize the vaccine’s protective effects.

Data from the CDC showed that in 2011 nearly a third of children 14 to 19 years old are already infected with HPV. But despite the federal recommendations, vaccination rates around the country remain low, in part because of concerns about side effects as well as fears the vaccine could make adolescents less wary of casual sex. A study by Basu et al from Yale on parental attitudes toward the vaccine found that concern about promiscuity was the single biggest factor in the decision not to vaccinate.

HIV Infection Among Ethnic Minority and Migrant Men Who Have Sex With Men in Britain

A study by Jonathan Elford and colleagues published in in the journal Sexually Transmitted Infection has examined human immunodeficiency virus (HIV) infection among men who have sex with men (MSM) from different ethnic and migrant groups living in Britain.

A diverse national sample of MSM living in Britain was recruited in 2007-8 through Web sites, in sexual health clinics, bars, clubs, and other venues. Men completed an online survey that included questions on HIV testing, HIV status, and sexual behaviour. A sample of just under 12,000 white British men were used as comparison

Results: Nine hundred and ninety-one ethnic minority MSM, 207 men born in Central or Eastern Europe (CEE), 136 men born in South or Central America, and 11,944 white British men were included in the analysis.

Self-reported HIV seropositivity was low for men of South Asian, Chinese, and “other Asian” ethnicity (range, 0.0%–5.8%) and for men born in Central or Eastern Europe (CEE 4.5%) but elevated for men born in South or Central America (18.7%), compared with white British men (13.1%) (P < 0.001).

Interestingly there were no significant differences between these groups in high-risk sexual behavior (P = 0.8). After adjusting for confounding factors in a multivariable model, substantial differences in the odds of HIV infection remained for South Asian and Chinese MSM as well as for migrants from CEE, but not for other groups, compared with white British men; for example, South Asian men, adjusted odds ratio 0.43, 95% confidence interval 0.23, 0.79, P = 0.007.

The authors concluded that despite marked differences in HIV between ethnic minority, key migrant, and white British MSM  there was no significant difference in high-risk sexual behaviour between the groups studied.

Their study highlights the importance of health promotion targeting MSM from all ethnic and migrant groups in Britain.

Sex workers collective show long-term health gains of self-empowerment

A parallel AIDS conference in Kolkota, India gave the rights an update on the success of the VAMP sex-workers colective – now in its 15th year reports, reports Andera Cornwall the Guardian.

They have shown an impressive ability to minimise risk of HIV and other sexually transmitted infections in sex workers.

Founded in 1997, Vamp now has more than 5,000 members. Weekly meetings bring the collective together to tackle a wide range of issues faced by members. Health work and advocacy for sex rights’ human rights are interwoven with Vamp’s everyday work in the densely populated alleyways in the red-light districts of Sangli and other towns in the region.

Vamp’s mission is to change society. Rather than treating sex workers as victims to be rescued or rehabilitated, it demonstrates the power of collective action as a force for women’s empowerment, mobilising sex workers to improve their working conditions, and claim rights and recognition. And they’re yielding results.

The report showed how self-empowerment and education can achieve high rates of safe sex in women at high risk of sexually transmitted infections and HIV. It is yet another reminder to that the most effective way to protect this vulnerable population is to help then self-organise and self-protect rather than to criminalise prostitution.

The latter, as many studies have shown, merely drives women into the hands of criminal gangs, or leads to risk-taking sexual practices and high rates of self-harm.

Dramatic drop in health spending according to OECD

Growth in health spending slowed or fell in real terms in 2010 in almost all OECD countries, reversing a long-term trend of rapid increases, according to OECD Health Data 2012.

In real terms average health spending has declined by over 6% compared to the start of the millenium.

Overall health spending grew by nearly 5% per year in real terms in OECD countries over the period 2000-2009, but this was followed by zero growth in 2010. Preliminary figures for a limited number of countries suggest little or no growth in 2011. The halt in total health spending in 2010 was driven by a fall of 0.5% in public spending for health, following an increase of over 5% per year in 2008 and 2009.

While government health spending tended to be maintained at the start of the economic crisis, cuts in spending really began to take effect in 2010. This was particularly the case in the European countries hardest hit by the recession.

UK gonorrhoea rates increase by 25%

Although overall rates of sexually transmitted infections rose by 2%, there has been an increase of 25% in new infections by gonorrhoea reported to the UK Health Protection Agency (HPA) – the second increase in two years running. Gonorrhoea rates increased from 16,835 to 20,965.

Other significant increases in sexually transmitted infections were in infectious syphilis (10%; 2,650 to 2,915) and genital herpes (5%; 29,794 to 31,154).

In contrast there was only a 1% rise in genital warts, perhaps reflecting the effectiveness of the vaccination programme. Diagnoses of genital warts cases in women aged 15-19 actually fell by 14% (11,251 to 9,700).

The greatest increase in sexually transmitted infections was in men who have sex with men and in heterosexual men and women aged 15-24. The high rates of infection reported in girls aged 15-19 is particularly worrying.

According to Professor Cathy Ison, director of sexually transmitted bacterial reference laboratory, the appearance of resistant strains for which no single antibiotic is effective is particularly worrying. This opens the prospect of having to use combination therapy in the future.

Research on effective behavioural change therefore remains a top priority.

Invitation to apply for research funds

We have entered a new round of invitation to apply for research funds. We are particularly interested in providing initial funding in projects that may allow young researchers to obtain preliminary results as a prelude to acquire further funds from larger funding bodies.

We invite applications from researchers in the East and West Midland, the North East and North West Regions on projects relating to sexually transmitted diseases and HIV. All projects will be initially screened by the Scientific Committee of STIRF and those considered suitable will be sent for peer review by experts in the field. We encourage applications for

The following fields of research will be considerd in relation to STIs and HIV

  • Epidemiology of HIV and other sexually transmitted diseases
  • Health care delivery including views of clients
  • Issues relating to deprived or marginalised communities.
  • Pathophysiology of diseases and syndromes
  • Inter-relationship between diseases
  • Treatment modalities
  • Complications of treatment and co-morbidities

Applications should not exceed £50,000 in the first year. Depending on satisfactory reports a further £25,000 may be available for the second year. Joint funding with other grant giving bodies will be considered.

Further information and guidance on how to apply can be found on

How to Apply for Research funds