Daily HIV medicine taken by men who have sex with men (MSM) reduces risk of HIV infection by 86% as was reported by Molina J-M, and colleagues in the ANRS Ipergay trial at the Conference on Retroviruses and Opportunistic Infections held in Seattle, USA in 2015 (23LB.).
Molina et al reported the final results of a three year study which randomised MSM who were negative for HIV to either take daily HIV prophylaxis with two anti-retroviral drugs in a single tablet immediately or deferred for 1 year.
The study showed that those taking the drugs on a daily basis have a 86% reduction in the risk of being infected by HIV than MSM not taking the drug (p=0.0001). The trial was stopped in October of 2014 and all participants in the deferred group were offered pre-exposure prophylaxis (PrEP)
As a Lancet editorial commented:
The science is now clear: oral pre-exposure prophylaxis (PrEP) with a coformulation of tenofovir disoproxil fumarate and emtricitabine (Truvada) significantly reduces the risk of HIV infection among individuals at high risk of HIV infection.
The news that PrEP has shown consistent efficacy among those who take it as prescribed should be a cause for celebration, and galvanise action to ensure access to PrEP for those who could benefit the most. But almost 3 years since the US Food and Drug Administration approved tenofovir–emtricitabine for PrEP little is being done on implementation.
With more than 2 million new HIV infections every year worldwide, it is time for that to change.
A workshop on philosophical aspects of sexual health is being held at
Seminar Room 3.28, New Business School, Manchester Metropolitan University Manchester, United Kingdom
The workshop is run by Dr Phil Hutchinson and was part funded by a research grant from Sexually Transmitted Infections Research Foundation (STIRF). Project STIRF-026
Workshop 1: The Problem of Selection Bias in Biomedical & Public Health Research. Wednesday September 16
Workshop 2: Shame, Stigma and HIV. Thursday September 17
Venue: Seminar Room 3.28, New Business School, Manchester Metropolitan University, Manchester, UK
Mandatory registration: contact: email@example.com
Further information can be obtained from Phil Hutchinson firstname.lastname@example.org
The incidence of high grade cervical lesions in young women in the United States has fallen, a new analysis has found. Susan Hariri and her colleagues reported in the journal Cancer that this may be caused by the introduction of the human papillomavirus (HPV) vaccine but may also be due to changes in screening guidelines.
From 2008 to 2012, 9119 cases of high grade cervical lesions (CIN2+) were reported among 18 to 39 year olds as part of a sentinel system for the US Centers for Disease Control and Prevention.
In all four catchment areas the researchers found a dramatic and consistent decrease in the incidence of high grade lesions among women aged 18 to 20 over the study period.
In California the incidence fell from 94 in 100 000 to 5 in 100 000
In Connecticut it fell from 450 to 57 in 100 000
In New York it fell from 299 to 43 in 100 000
In Oregon it fell from 202 to 37 in 100 000.
No change was seen among 30 to 39 year olds.
Vaccination against HPV has been available in the US since 2006. It is offered to girls aged 9 to 12 and as part of short term catch-up scheme targeting 13 to 26 year olds. The picture is unclear, however, as the recommended age for initiating cervical cancer screening was raised to 21 years during the same period, and screening intervals have been extended.
The study concluded that the declines in CIN2+ detection in young women were likely due to reduced screening but could also reflect the impact of vaccination.
A new project funded by STIRF (STIRF-027) has just been completed.
Background: In the United Kingdom there is an established and growing refugee population from Somalia. Despite this Somalis have remained absent from much of the official statistics largely because ‘Somali’ is rarely recognised as a distinct ethnic category. Little is known about the sexual health needs of this particular community but in terms of their broader health issues, Somalis are known to have a high level of need but low uptake of health care services (Carswell et al.2011).
Aims: Through the use of focus groups and individual interviews this study sought to explore the sexual health needs of the local Somali community by ascertaining from their perspective, what they know about sexual health services, the challenges that may prevent them taking up these services and how services could be adapted to best meet their needs.
Results: The study showed little knowledge of services, especially about sexual health, how to accessing services, issues relating to shame, stigma and taboo, the influence of gender, religious and cultural norms, the perceptions of young people, the language barrier lack of cultural awareness and sensitivity demonstrated by healthcare professionals.
- Urgent attention be given to raising awareness, amongst the Somali community, about local sexual health services and how they can be accessed.
- Information about sexual health services be made available in a format that is accessible to the Somali refugee community, for example, via a CD, DVD or USB stick.
- That public health professionals and health care practitioners make clear the concept of preventative screening, making explicit the value of screening and early diagnosis for infectious diseases including TB and HIV/AIDS.
- Health practitioners and public health professionals exercise extreme sensitivity when discussing issues related to sexual health and well-being. Every effort must be made to gain the trust of the individual so that they are able to discuss their fears or concerns.
- Public health professionals and health care practitioners receive appropriate training and education so that they are equipped with the necessary cultural understanding and skills when working with the Somali community.
- That a proactive approach be taken to helping Somali refugees to attend a programme of induction that includes language classes.
- That a register of trained interpreters, who understand medical terminology and who are trained to work with those who may have experienced rape and torture should be available for public health professionals and health practitioners. Telephone interpretation should also be made available during consultations.
The results of the study have been presented in international meetings and published in reputable international journals.
The US based Centre for disease control (CDC) has recently updated its factsheet on lesbian and bisexual health. The CDC emphasises the potential risks of acquiring sexually transmitted infections and HIV from certain sexual practices. The article provides advise on how lesbian and bisexual women can protect themselves.
A large international study (INSIGHT START) published in the New England Journal of Medicine has found that starting antiretroviral therapy immediately after human immunodeficiency virus (HIV) diagnosis rather than waiting until a patient’s CD4+ count has declined is of considerable benefit.
The results of the study were also released at the International AIDS Society conference in Vancouver, Canada, on 20 July.
Currently most authorities strongly recommend starting anti-HIV once CD4+ count drops to below 350 cells per cubic millimetre. Until the INSIGHT START study there was no randomized trials showing the benefits and risks of initiating antiretroviral therapy in patients with asymptomatic HIV infection who have a CD4+ count of more than 350 .
START study conducted in 35 countries randomly assigned 4,685 HIV positive patients to either receive immediate antiretroviral therapy (median CD4+ of 650) or wait until their counts fell to below 350.
After a mean follow up of 3 years the study found that 42 patients in the immediate-initiation group died, as compared with 96 patients in the deferred-initiation group (95% confidence interval, 0.30 to 0.62; P<0.001). Reduction in deaths were largely from tuberculosis, Kaposi’s sarcoma, and malignant lymphomas – conditions that can occur in HIV-infected individuals with only moderately damaged immune systems.
Currently the WHO requires all patients with HIV to be treated CD4+ of 500 or less. WHO may need to extend that to treating anyone at diagnosis. This would not only benefit the individual but by reducing viral shedding in body secretions reduce transmission and hence have a public health benefit. Moreover some of the costs of starting early would be offset by not needing to perform repeated CD4+ counts.
Men and women, aged 17–24 years, were interviewed from 2010–2012 for third National Survey of Sexual Attitudes and Lifestyles in the UK. The authors examined how the source of information about sexual matters was associations with sexual behaviours and outcomes.
The study looked at the main source of information (school, a parent or other); age and circumstances of first heterosexual intercourse; unsafe sex and distress about sex in past year; experience of sexually transmitted infection (STI) diagnoses. Women were also asked if they ever had non-volitional sex or an abortion.
The results, published in the BMJ, concluded that gaining information mainly from school was associated with reduction of a range of negative sexual health outcomes, particularly among women. These included, older age at first sex, less likelihood of unsafe sex and previous STI diagnosis. In all cases the effect was more significant for women.
Women were also more likely to be sexually competent at first sex and less likely to have non-volitional sex, abortion and distress about sex.
Gaining information mainly from a parent was associated with some of these, but fewer participants cited parents as a primary source.
The findings emphasise the benefit of school and parents providing information about sexual matters and argue for a stronger focus on the needs of men.
In a recent editorial in the British Medical Journal (available only on subscription), Margaret Stanley and coauthors urged the UK government to introduce a gender neutral vaccination programme against HPV in schools for boys and girls aged 12-13 to reduce not only ano-genital warts but HPV-related cancers. These include cervical cancer in women, anal cancers in men who have sex with men and oropharyngeal cancers.
The authors point out that oropharyngeal cancers have the fastest rising incidence (15% per year) and anal cancer rates in the UK have risen by nearly 300% in the last 40 years..
On May 8 2014 the UK Court of Appeal dismissed the appeal of David Golding against a 14 month prison sentence for transmitting herpes to his partner.
An Editorial in the BMJ by Emily Clarke an colleagues highlights the numerous and complicated issues that arise from this verdict including:
what constitutes grievous bodily harm,
how you determine that sexual transmission has occurred,
how serious is herpes infection, and
what this judgement means both for health care workers who advise and inform patients on the risks of transmission and on the infected individual and their duty of informing all partners of potential risk of transmitting an infection even during asymptomatic shedding.
The Editorial correctly highlights the dangers of criminalizing sexually transmitted infections and the various problems that arise from this judgement which was based on a law passed 170 years ago addressing totally unrelated issues and at a time when STI’s were not understood as they are today.
This is part of a series of articles on HIV and sex workers published by The Lancet and freely available.
In this article Michelle Decker et al reviewed evidence from more than 800 studies and reported on the burden and HIV implications of human rights violations against sex workers.
Abuses of human rights are perpetrated by both state and non-state actors. Such violations directly and indirectly increase HIV susceptibility, and undermine effective HIV-prevention and intervention efforts.
Violations include homicide; physical and sexual violence, from law enforcement, clients, and intimate partners; unlawful arrest and detention; discrimination in accessing health services; and forced HIV testing.
Abuses occur across all policy regimes, although most profoundly where sex work is criminalised through punitive law.
The authors conclude that protection of sex workers is essential to respect, protect, and meet their human rights, and to improve their health and wellbeing.
Research findings affirm the value of rights-based HIV responses for sex workers, and underscore the obligation of states to uphold the rights of this marginalised population.