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Tag Archives: Prevention

Treatment for HIV Prevention – a Continuum of Care

Key stages of the Universal Test and Treat approach and linkage to care for HIV prevention.

HIV-negative individuals remain in the system and receive further counselling whilst HIV-positive are linked to care where they receive continuous attention and support to achieve viral suppression. Top: weaknesses and threats faced by the approach. Bottom: strengths and opportunities to address the challenges of delivering ART in a variety of contexts building on existing resources and “know-how” and developing new approaches to solve systemic problems.

Download as a PDF: TasP Continuum of Care 1

 

Treatment for Prevention stands at the epicentre of a number of services. It can only succeed by being part of a whole.

Download as a PDF: TasP Continuum of Care 2

 

 

African Migrant MSM

MSM Migrants Rich PictureThis picture was drawn as part of a project to explore the provision of HIV prevention services to African Men who have Sex with Men (MSM) migrants to the UK. The Health Protection Agency (HPA) estimates that 86,500 people are living with HIV in the UK in 2010. The disease disproportionately affects MSM who represents nearly half of those newly infected with a consistently higher proportion of black MSM. African migrants and MSM are an underserved group in terms of HIV prevention services.

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HIV Prevention: towards the medicalisation of sex?

2010 will be a year to remember for the field of HIV prevention. After decades of interventions with limited results (with the exception of circumcision and the prevention of mother to child HIV transmission), two clinical studies are raising the hope that the HIV epidemic can be tamed.

In July, the CAPRISA team (based in South Africa) reported that a vaginal gel containing the anti HIV drug tenofovir could reduce the risk of HIV infection by 39%. This was the first proof of concept that a microbicide could potentially reduce the risk of HIV infection whilst offering women an HIV prevention tool that they could control.

In November of the same year, the iPrEx study conducted on a population at high-risk of infection showed that taking the anti HIV Drug Truvada reduced the risk of contracting the virus by an average of 44 percent.

Both studies are hailed as a milestone and landmark in the history of HIV prevention and expectations are high that HIV prevention will finally mean more than the ABC of ‘Abstinence, condom and faithfulness’. But despite the hope, neither approach will immediately translate into marketable products as there are a number of questions that needs answering before microbicide and PrEP are available to the public. Read more »

Postexposure prophylaxis, preexposure prophylaxis or universal test and treat: the strategic use of antiretroviral drugs to prevent HIV acquisition and transmission

Weber, Jonathan; Tatoud, Roger; Fidler, Sarah

AIDS 24 (S4): S27–S39, 2010.

This review considers the use of antiretroviral drugs specifically to prevent HIV transmission. Antiretroviral therapy (ART) can be implemented for the protection of uninfected individuals both before (preexposure prophylaxis) and after (postexposure prophylaxis) exposure to HIV infection. Preexposure prophylaxis may be used coitally dependently when individuals are intermittently exposed or by continuous daily dosing for those constantly exposed; postexposure prophylaxis is used in 28-day courses. Alternatively, ART can be used strategically to reduce the viral load and consequent infectiousness of an HIV-infected individual, thereby limiting the risk of onward viral transmission. A policy of universal HIV testing to enhance the identification of all HIV-positive individuals followed by immediate treatment of all HIV-positive individuals, irrespective of their CD4 cell counts (universal test and treat), has been postulated as a potential tool capable of reducing HIV incidence at a population level. This concept represents a paradigm shift in the use of ART, targeting infectious individuals for prevention rather than protecting uninfected exposed populations. This strategy could have the advantage of preventing transmission and reducing HIV incidence at a population level, as well as delivering universal access to therapy for all people living with HIV and AIDS, potentially eliminating mother-to-child HIV transmission and limiting concomitant diseases such as tuberculosis. This review critically examines the scientific basis of ART for HIV prevention, summarizing the risks and opportunities of the potential expansion of ART for prevention. Specifically, we consider the evidences for and against targeting HIV-uninfected individuals compared with enhanced HIV testing and treatment of HIV-infected individuals in terms of impact on viral transmission.?

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A funding struggle for an HIV prevention in women’s hands

Attendees at the 18th International AIDS conference held in Vienna in July 2010 felt a tremor of hope when Prof. Salim Abdool Karim received a standing ovation following the announcement that a vaginal gel containing the anti-HIV drug tenofovir could reduce the risk of HIV infection by 39%. The groundbreaking results came out of the CAPRISA clinical trial conducted amongst 900 women in rural Vulindela district (KwaZulu-Natal) and urban Durban, South Africa. Euphoria followed in the audience, online and later in the printed media. After 30 years of limited success, the field of HIV prevention could potentially add a new powerful tool to circumcision, condoms, and the prevention of mother to child transmission. Most remarkably, that tool is in women’s hands and the story could unfold with even more good news if it weren’t for a small setback: funding the next clinical studies. Read more »

The road to HIV infection

Being infected with HIV is not just a question of having unsafe sex with someone who is HIV+. Such reductionist approach ignores the complex set of factors, circumstances and events that lead to unsafe sex to take place. This concept map tries to survey these factors starting from the remote to the more intimate. As always, this is a work in progress and comments and suggestions are welcome.

ARV for HIV prevention, an overview

Despite the interesting results of an HIV vaccine trial in Thailand (RV144), HIV prevention is still limited to a small number of options many of which are not bullet-proof. Biomedical interventions based on vaccines and microbicides are still a long shot away. Conversely, treatment is working well in bringing HIV-infected people back to a normal life and potentially reducing the risk of HIV transmission by reducing their viral load. The use of antiretroviral drugs as a means to prevent HIV infection is controversial and a lot of background work will be required before embarking on massive “Test and Treat” campaigns.

Microbicides: Efficacy and Effectiveness

What is good enough? Who decides?

This presentation was prepared for an IRMA global teleconference on December 4, 2009.


Small Media Volunteer @ GMFA

GMFA was founded in 1992, by a group of gay men who felt that there was not enough HIV prevention work being specifically targeted at gay men. GMFA‘s mission is to improve gay men’s health by increasing the control they have over their own lives.

As a regular volunteer between 2008 and 2011, I contributed to the design of information booklets and to the content of GMFA magazine “Fit and Sexy”. Due to an increased workload in 2012 and evolving interests, I now have a very limited involvment with GMFA which remains a key resources to where I point people to when they seek sexual health information.