HIV Australia
Volume 4: #1 | #2 | #3 (2004 / 2005)
Volume 3: # 1 | # 2 | #4 (2003 / 2004)
Volume 2: # 1 | # 2 | # 3 | #4 (2002 / 2003)
Last updated 23 May 2006
Voume 2, 2002/03
Vol. 2. No. 1
AIDS study: behaviour must change
Experts see dangerous trend in use of Viagra with 'party pills'
Sex education has little effect on teenage llifestyles
UK consumers reject direct advertising to patients by drug industry
Vol. 2 No. 2.
Philippines: HIV/AIDS campaigns must not forget gay people
Singapore teens offered sex education over their mobile phones
Indonesian TV stations yank condom ads
New city ad campaign shows HIV 'is no picnic'
Vol 2. No. 3
HIV/AIDS & Us Mob
Viacom and Kaiser Family Foundation launch comprehensive initiative to fight HIV/AIDS
Computer education may bridge affordability gap
Vol 2. No 4
US study identifies triggers for risky sex among gay men
Funds for San Francisco AIDS program in peril: CDC threatens to pull money for 'obscene' campaign
Gender and HIV prevention education
Volume 3 2003 / 04
Vol. 3 No. 1
The Internet's role as modern bathhouse is being scrubbed: on-line hookups increasingly popular among MSM
Unprotected anal intercourse between potentially HIV-serodiscordant men who have sex with men
Vol 3. No. 2
Brazil launches major HIV testing program
Barebacking profile emerges; panel examines evolving practice of condom-free gay anal sex
New Technologies, New Responses- The HIV/AIDS, Hepatitis C & Related Diseases (HHARD) Social Research Conference and The AFAO/NAPWA HIV Educators’ Conference
First-ever, Pan-European, multi-lingual, community-based website on AIDS treatments launched
The Internet's role as modern bathhouse is being scrubbed: on-line hookups increasingly popular among MSM
AIDS Alert, 1 October 2003
New epidemiological data, combined with anecdotal evidence and research, show that men who have sex with men (MSM) are increasingly using Internet chat rooms to schedule "real time" sexual encounters. According to researchers and prevention counsellors, the online venues for meeting sexual partners work nearly as fast as meeting at a bar or bathhouse.
HIV prevention organisations and researchers are already developing programs that target MSM looking for sex via the Internet, and some have found efficient ways to reach high-risk populations and provide interventions prior to MSM engaging in risky behaviour.
In California, the trend of MSM meeting through the Internet has contributed to alarming increases in syphilis cases. The number of MSM with primary or secondary syphilis increased from 162 reported cases in 2000 to 857 cases in 2002, said Terrence Lo, an epidemiologist with the California Department of Health Services in Berkeley. State data also show that 66 percent of the MSM whose syphilis was reported in 2002 were HIV-positive, and this percentage has also increased in recent years, according to Lo.
The Internet's role in this upturn is also apparent from the data. In the first half of 2001, 12 percent of the MSM with syphilis reported meeting their partners online; by the first half of 2003, this percentage increased to 40 percent, Lo pointed out.
In response, a number of community-based organisations and other groups have begun prevention projects that focus on Internet sex seekers by using the same technology in outreach. PowerOn in Seattle and SexEd4U in Ferndale, Mich., are two programs that reach MSM in chatrooms at the precise moments when they may be making a decision to have anonymous sex. Another new intervention is ISIS (Internet Sexuality Information Services Inc.,) which provides syphilis elimination services to MSM in San Francisco. ISIS also collaborates with the California Department of Health to coordinate an on-line Syphilis Action Coalition in the Bay Area.
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Unprotected anal intercourse between potentially HIV-serodiscordant men who have sex with men
San Francisco Journal of Acquired Immune Deficiency Syndromes, 1 July 2003, Vol.33; No. 2: P. 166-170, Sanny Y. Chen; Steven Gibson; Darlene Weide; Willi McFarland
There is an urgent need for prevention message promoting condom usage and disclosure of serostatus to sex partners, say US researchers. The study characterised potentially HIV-serodiscordant sex in a large community-recruited sample (n=10,579) of MSM from 1999-2001.
"Recent increases in UAI previously reported among MSM in San Francisco are not only the result of increases in UAI between MSM who are known to be of the same HIV status," the authors reported. "Our data suggest targeting particularly older, white, HIV-positive MSM. At the same time, our data also highlight the need for HIV counselling and testing among younger MSM and MSM of colour to increase awareness of their own HIV serostatus and to encourage them to avoid potential exposure to HIV," researchers concluded.
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Study identifies triggers for risky sex among gay men
AIDSWEEKLY Plus; June 16 2003, Michael Greer, Senior Medical Writer
Gay men who have poor communication skills and feel unable to protect themselves against HIV infection are more likely to engage in risky sexual behaviours, according to newly released data.
The research, published in the June 2003 issue of the American Journal of Public Health, concludes that these are among many different combinations of behavioural factors that may be linked to risky sex among gay men.
The two behaviours that proved the most likely predictors of risky sexual behaviour – non-injection drug use and enjoyment of unprotected receptive anal sex - accounted for risky sex in only one-third of the men, according to the study.
The wide variety in risk-related behaviours suggests that one-on-one counselling, tailored to the particular behaviours practiced by each man, might be useful in preventing new HIV infections, the researchers said.
The data come from a study, still in progress, called EXPLORE, the first randomised clinical trial examining whether behavioural counselling might help reduce the rates of HIV infection in the United States.
Men participating in the trial are randomly assigned to receive either 10 one-on-one counselling sessions along with HIV testing every six months or only standard testing and counselling every six months.
The personalised counselling sessions begin by determining which of an individual's behaviours may be likely to lead to risky sexual behaviour, followed by more tailored sessions that address these specific behaviours. For instance, men who report having poor communication skills may receiving coaching on how to discuss their HIV status with their partners.
The men enrolled in the study are at "high risk" of HIV infection, according to Beryl Koblin, PhD, of the New York Blood Centre and colleagues. Koblin and colleagues reported that alcohol and drug use, multiple partners or one primary partner are all associated with unprotected sex among the men
The results of the trial will be available in 2004. This article was prepared by AIDS Weekly editors from staff and other reports.
Reference
Koblin BA, Chesney MA, Husnik MJ, et al., "High-Risk Behaviours Among Men Who Have Sex With Men in 6 US Cities: Baseline Data. From the EXPLORE Study", Am J Public Health. 2003 Jun;93(6):926-932
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Funds for San Francisco AIDS program in peril / CDC threatens to pull money for 'obscene' campaign
San Francisco Chronicle, June 14, 2003, Sabin Russell, Chronicle Medical Writer
The US federal Centers for Disease Control and Prevention threatened to pull funding from a controversial San Francisco AIDS prevention program that employs sexually explicit street language to promote safer sex workshops.
In letters to San Francisco's Stop AIDS Project and to the city Department of Public Health, the CDC said it appeared that the programs about gay sexuality violate a law barring use of federal money to "encourage or promote sexual activity."
At issue are three recent workshops sponsored by Stop AIDS that attracted only a few dozen men. At stake, say Stop AIDS supporters, is the question of whether AIDS prevention efforts should be designed by scientists or shaped by politicians.
The programs were cleared by the city's Program Review Panel, a board designed to assure that such programs meet "community standards." One program is a discussion of oral sex, another offers guidelines on "safe and friendly relations" with male prostitutes, and a third, called "Bootylicious," offers ways to improve anal sex.
Dr. Mitch Katz, director of the San Francisco Department of Public Health, said that the programs would continue, funded solely through city tax dollars. He compared the dispute to the federal government's long-standing refusal to pay for programs that provide clean needles for drug addicts. Those programs are proven in numerous studies to reduce the transmission of the AIDS virus and other diseases through sharing of dirty syringes.
Supporters of the explicit workshops say they are locally designed educational efforts meant to reach gay men who have sex without a condom, the group deemed most at risk for contracting the AIDS virus. But detractors have repeatedly attacked the programs as offensive and a violation of the law.
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Gender and HIV prevention education
Aegis, 14 April 2003
The Nordic Institute for Women's Studies and Gender Research (NIKK) announces publication of a hands-on manual for gender-focused HIV prevention work:
This manual lays out eight sessions, each with an array of diverse learning activities, for capacity building to help men and women participants grasp the implications of working with gender in HIV prevention. The session themes are: Perceptions of Gender, Ways of Understanding Gender, Key aspects of Gender for HIV prevention, Sex as a Gendered Activity, Gender and HIV, Embodying Change, A Sense of Working Together, and Reviewing Gender issues in Context.
Printed copies for use in trainings, schools, NGOs, other organisations or educational initiatives are available by contacting NIKK at: nikk@nikk.uio
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HIV/AIDS and Us Mob
Aboriginal & Torres Strait Islander HIV Treatments Resource
HIV/AIDS and Us Mob is a new development in Aboriginal and Torres Strait Islander HIV/AIDS and sexual health education. HIV/AIDS and Us Mob is the first resource designed to increase awareness of HIV/AIDS, testing and current treatment options for Aboriginal & Torres Strait Islander communities.
HIV/AIDS and Us Mob is a booklet style resource and is an initiative of the Indigenous Project at the Australian Federation of AIDS Organisations (AFAO), developed in collaboration between AFAO, the National Association Of People Living with HIV/AIDS (NAPWA) and the AIDS Treatments Projects of Australia (ATPA).
The resource is designed to offer baseline treatments information including:
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How the body uses the immune system to recognise and fight viruses;
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How HIV affects the body and the stages of HIV infection;
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Viral load, antiviral treatments, combination therapy, associated side-effects and structured treatment interruptions; and
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Care and support issues
The primary target group for this resource is Indigenous HIV positive people, with the secondary target audience including partners, family, carers and friends of Indigenous HIV positive people.
The resource has been written in a culturally sensitive manner that provides practical strategies of education and monitoring health. The resources layout and design includes Indigenous cartoon-like imagery that illustrates both the text and concepts.
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Viacom and Kaiser Family Foundation launch comprehensive initiative to fight HIV/AIDS
PRNewswire, 6 January 2003
http://ww2.aegis.org/news/pr/2003/PR030102.html
Viacom Inc., one of the largest media companies in the world, and the Henry J. Kaiser Family Foundation, a leader in health information and research, have launched KNOW HIV/AIDS, a global media campaign to combat HIV/AIDS through public service messages (PSAs), television and radio programming, and free print and online content. The multi-year effort combines the public health expertise of the Kaiser Family Foundation with the power of Viacom's media brands and unmatched audience relationships to foster awareness of the disease and its prevention.
The initiative targets the general population and groups hardest hit by the disease-young people under 25, people of colour, women, and men who have sex with men. A total of 49 television, radio and outdoor ads have been produced for the initiative, and will be placed strategically across Viacom's broadcast networks. In addition, a number of popular television shows have incorporated HIV/AIDS themes in upcoming episodes.
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Computer education may bridge affordability gap
AIDS Alert, 1 November 2002
Researchers from CDC, the University of Washington-Seattle, California State University-Long Beach, and the Indiana University School of Medicine-Indianapolis, are collaborating with Resources Online, a Seattle computer consulting business, to create a computer-assisted, client-centred, educational CD-ROM product to encourage risk-reduction behaviours and testing for HIV and other STDs.
The product is designed to be an effective replacement for face-to-face counselling. The program will have a user-friendly interface that asks patients risk assessment questions, followed by individualised counselling messages and negotiation of a realistic prevention plan based on their responses. The CD-ROM is based on well-validated elements, programmed into the computer, incorporating common scenarios and probing techniques used by good counsellors.
Although the early versions of the program will be in English, eventually it may be available in a variety of languages. Researchers are building the program so it is appropriate for various at-risk populations and age groups. They are designing the program to be run on a wide variety of computers, reflecting the reality of the type of hardware found in clinics.
When the CD-ROM has been fully developed, the research team intends to distribute it widely, perhaps at no or low cost to health clinics and on a sliding income scale to venues such as emergency rooms and private practices. Users would be able to customize the program by adding phone numbers for local resources and language modules when those become available.
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AIDS study: behavior must change
Edith M. Lederer, Associated Press, 22 June 2002
A year after the 189 nation General Assembly adopted a plan to halt the AIDS epidemic, a UN report said "dramatic changes" in sexual awareness and behaviour are still needed in many poor countries to stop the advance of HIV. HIV/AIDS: Awareness and Behaviour examined data from 39 countries in Africa, Asia and Latin America and concluded that AIDS campaigns have not had a major impact on people's behaviour and their perception of risk.
The report was based on nationally representative surveys of about 5,000 households in each country. Even in countries where HIV rates are high, the report found a large majority of men and women considered themselves at little or no risk of contracting AIDS.
In all 39 countries, despite a great effort to promote the use of condoms, the report said, "Over the years, the condom has not become more popular among couples." In some countries in western and central Africa, "The difficulty in promoting the use of condoms is compounded by the fact that the large majority of women who are sexually active intend to become pregnant," it said.
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Experts see dangerous trend in use of Viagra with 'party pills'
Kim Curtis; Margie Mason, Associated Press, 20 June 2002
Dr. Jeffrey Klausner, chief of the San Francisco Department of Public Health, has found that nearly a third of gay men surveyed at STD clinics said they were using the anti impotence drug Viagra, often in combination with illegal drugs that tend to encourage risky behaviour.
Health experts say Viagra alone seems to pose no real danger to men who use it recreationally even if they do not need it to get erections. But Klausner said that people who use it to offset the impotence effect of "party drugs" like Ecstasy and crystal methamphetamine also acknowledged having unprotected sex with more partners. Viagra can be deadly if used with amyl nitrite.
Klausner's study in the journal AIDS, focuses on a particularly high-risk group of men in San Francisco – but health experts say other cities have similar subcultures where gay and straight men combine Viagra with other drugs.
Viagra needs to be studied more closely as another possible factor in sexually reckless behavior, said Dr. Ronald Valdiserri, the Centre for Disease Control's deputy chief of Sexually Transmitted Infections (STIs.)
Klausner's survey found that uninfected Viagra users were twice as likely to have unprotected sex with someone who is or might be HIV-infected, compared to those not taking Viagra. Viagra-users also reported more partners than non-users.
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Sex education has little effect on teenage lifestyles
James Meikle, Guardian (London), 14 June 2002
Sex education lessons are doing little to change teenagers' sexual behavior, suggest studies published in the British Medical Journal (2002;324;7351). One of the biggest studies ever conducted on the impact of sex education delivered by teachers suggested that a specially designed program aimed at Scottish secondary school pupils had no more impact on adolescents' sexual activity or risk-taking than conventional lessons, although it increased their knowledge of sexual health and marginally improved relationships.
Also, a review of research in the US and Canada indicated that pregnancy prevention programs for 11 to 18 year olds, including sex education classes, family planning clinics and other outside school initiatives, had not delayed sexual intercourse, improved birth control or reduced teenage pregnancies.
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UK consumers reject direct advertising to patients by drug industry
Mark Hunter, Leeds
The pharmaceutical industry has accused the UK Consumers' Association of "muddying the waters" over the European Commission's plans to relax controls on the information it can provide directly to patients.
The European parliament is considering a pilot project in which drug companies will be able to set up interactive websites and telephone helplines to provide information on treatments for AIDS and HIV, asthma, and diabetes.
But the Consumers' Association opposes the plan and has published a survey showing that the general public was deeply suspicious of industry advertising of prescription-only medicines directly to patients.
Of the 1,818 adults questioned in the survey, only one in four felt that drug companies could be trusted to provide unbiased and comprehensive information about treatments. Over 80 per cent felt that if direct to patient advertising was allowed, companies would spend ,more money advertising the most profitable drugs. Over half the respondents believed that drug companies would try to convince people they had non-existent illnesses.
The association claims that evidence from the US and New Zealand has shown that pharmaceutical advertising is likely to contain inadequate information about possible side effects and little educational content and could lead to a dramatic increase in drug costs.
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Philippines: HIV/AIDS campaigns must not forget gay people
Marites Sison, Inter Press Service, 21 October 2002
HIV/AIDS education campaigns and health care programs among lesbians are badly needed in the Philippines, activists say. Maria Cristina Cristobal, executive director of Lesbian Advocates Philippines (LEAP). says most lesbians are unaware that they can acquire HIV/AIDS and sexually transmitted infections from women partners who are bisexual or who may have had previous sexual contact with an HIV positive heterosexual male.
Although there have been documented cases of lesbians living with AIDS in the West, Filipino lesbians tend to think their infection was more an outcome of lifestyle rather than a biological risk and susceptibility to the disease, explained Cristobal. Cristobal cited a LEAP study conducted among 50 lesbian activists that showed that all of them equated safe sex only with a limited range of factors - proper hygiene, monogamy, no use of sexual devices, experimentation and use of gloves. The fact that there has been no reported incidence of lesbians acquiring HIV/AIDS in the country has helped bolster the concept that "lesbian sex is safer sex," she said. Cristobal also cited a reluctance among lesbians to discuss their sexual health and practices because many suffer discrimination at the hands of doctors or other medical practitioners.
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Singapore teens offered sex education over their mobile phones
Gillian Wee, Associated Press, 8 October 2002
A 10-day sex education campaign offering free advice for teenagers via mobile phone text messaging was recently conducted in Singapore. During the Sex in the Air campaign, teens could send text questions through their mobile phones. Doctors from Singapore, Amsterdam and Melbourne responded to the questions within two days.
"It's difficult for children to ask parents about sex," said Dr. Peter Lim, a urologist and member of the Singapore Planned Parenthood Association, one of three private organisations supporting Sex in the Air. "The campaign provides answers by sex and fertility doctors while allowing teenagers to remain anonymous," he said.
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Indonesian TV stations yank condom adds
Deutsche Presse-Agentur, 25 October 2002
Indonesian TV stations dropped a condom ad aimed at preventing the spread of HIV after the commercial was criticised by several Muslim organisations. The ad was jointly developed by five Indonesian TV stations in cooperation with AIDS organisations. It shows young men who visit a brothel and opt to use condoms. The Jakarta Post reported that the decision to drop the ad was prompted by harsh criticism from several Muslim organisations, including the radical Indonesian Mujahiddin Council, which claimed the commercial was pornographic and encouraged promiscuity.
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New city ad campaign shows HIV 'is no picnic'
San Francisco Chronicle, 10 October 20002
At a time when gay and bisexual men are increasingly engaging in risky sexual behaviour, a provocative new ad campaign in San Francisco shows HIV- positive men suffering from the debilitating side effects of HIV/AIDS and the drugs used to treat it.
The city-funded ad campaign on bus shelters and public rest rooms around San Francisco, aims to get men talking about the consequences of HIV infection, said Stop AIDS Project spokeswoman Shana Krochmal. The city is spending US$37,500 on the campaign.
One ad, titled "Crix Belly," shows a man with a distended abdomen, next to the slogan "HIV is no Picnic." "Crix" is short for Crixivan, the protease inhibitor that has as one of its side effects the redistribution of fat from the face and arms to the belly and back.
Another depicts a man sitting on a toilet with diarrhea, another with facial wasting and a fourth with night sweats.
City Health Department studies indicate that gay men of all ages are less frequently using condoms and more are having unprotected sex with multiple, anonymous partners.
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Vol. 3. No. 2
Brazil launches major HIV testing program
United Press International, 30 October 2003
Brazil's government has launched a national campaign to encourage more people to be tested for HIV. Using the slogan "Get Informed," the effort is aimed at persons who are HIV positive but do not know it, according to BBC. Two-thirds of Brazil's estimated 600,000 HIV-infected people do not know they have the virus. The tests are free and confidential. Brazil already pays for antiretroviral treatment for those with HIV, and it has pressured drug companies to keep down the cost of medications. The government hopes the campaign will lead as many as 4.5 million Brazilians to test for HIV.
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Barebacking profile emerges; panel examines evolving practice of condom-free gay anal sex
Duncan Osborne, Gay City News, New York City, 16 October 2003
A recent panel at New York City's Lesbian, Gay, Bisexual and Transgender Community Center discussed barebacking – intentional anal sex without condoms - and how clinicians can aid clients who bareback. "We feel it is more than just condom-less sex," said Danny Carragher, a project director at the Center for HIV/AIDS Educational Studies and Training (CHEST).
Alex Carballo-Dieguez, a researcher with New York State Psychiatric Institute and Columbia University, presented studies showing that barebackers feel greater enjoyment, freedom, and masculinity when they have bareback sex. The risk of unprotected sex is also erotic for some men.
In a 2002 CHEST study of 518 gay and bisexual men in New York City, 204 reported having bareback sex in the previous three months. Of these men, 53 were HIV-positive and 151 were negative. The HIV-positive men had an average of 11 HIV-positive partners, less than three HIV-negative partners, and just over three partners whose serostatus was unknown. The HIV-negative men averaged less than one HIV-positive partner, nearly three negative partners, and just over two partners whose status was unknown.
Those surveyed said barebacking emerged in part because of new HIV medications (47.9 percent), AIDS fatigue (45.6 percent), "boring" safe sex campaigns (48.9 percent), and as a "sexual and cultural phenomenon" (40.3 percent). Data showed barebackers appeared to be happy and uninterested in changing their behavior.
Carragher said the research gives a more accurate picture of the sex lives of some gay and bisexual men. "It provides us with insight into the sexual practices of the community," he said. "As researchers we want to have clear answers. We don't want to speak about a community that we haven't studied empirically."
"I don't think that prevention has failed," said therapist Michael Shernoff. "I think that prevention has failed to evolve. We have to tailor the prevention messages to reach the diversity of men."
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New Technologies, New Responses
The HIV/AIDS, Hepatitis C & Related Diseases (HHARD) Social Research Conference and The AFAO/NAPWA HIV Educators’ Conference
The HIV/AIDS, Hepatitis C & Related Diseases (HHARD) Social Research Conference, and the HIV Educators’ Conference, will be for jointly for the third time in 2004. The conferences, from May 17- 21, will explore emerging issues in social research and health promotion practice in the areas of prevention, treatment, care and support for HIV, hepatitis C and other communicable diseases.
The HHARD conference will cover the latest findings from the field of social research into HIV and HCV, while the HIV Educators’ conference will focus on current issues in HIV education and health promotion. International issues will also be addressed and international abstracts and delegates are welcome.
An overlapping day provides an opportunity for social researchers, educators, health care professionals, and policy analysts and community representatives to meet and talk about key challenges facing the HIV and hepatitis sectors.
ew responses to a shifting epidemic; Internet technologies for research and education; the treatments/prevention nexus; technologies of the body; new prevention technologies; pre-exposure prophylaxis (PREP); cyber-sex and sexual risk; clinical markers; testing technologies; iinnovation in prevention; negotiating HCV; language and rhetoric in drug policy and media.
Abstracts for oral presentations, posters, workshops, panel discussions and performances/demonstrations must be submitted by 19 March 2004. For more information, visit the conference website at www.afao.org.au/conference2004
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First-ever, Pan-European, multi-lingual, community-based website on AIDS treatments launched: www.eatg.org
1 December 2003
The European AIDS Treatment Group (EATG) has launched a new design of its website www.eatg.org. The virtual meeting point for European AIDS activists, open to worldwide colleagues, has been prepared to hold and reflect the diversity of the AIDS work on treatment issues, including access to therapies and access to knowledge.
www.eatg.org includes real-time, constantly updated information in English, French, Greek, Portuguese, Spanish, Italian, German and Russian.
It also features a description of the successful Continuous Patient Education Project (COPE) that has contributed to produce and disseminate basic AIDS treatment information material throughout Eastern Europe in local languages, including Russian, Bulgarian, Latvian, Polish and others.
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Vol. 3. No. 4 June - August 2004
Changes Urged to Sex Education
Cheryl Wetzstein, Washington Times, June 21 2004
A group of doctors, scientists and researchers unveiled a new science-based sex-education program that encompasses more than disease prevention or risk-reduction techniques. Joe Webb, president and CEO of the Austin-based nonprofit Medical Institute for Sexual Health, said "integrated sexuality education" is about getting people, communities and societies to live free of STDs, unwanted sex and the costly health problems associated with risky behavior. He envisages a norm of intimacy fulfilled through life-long, mutually monogamous relationships.
"Condoms are discussed factually as to the amount of risk reduction they provide against various STDs," Webb told the conference. However, "Because sexual restraint is an aspect of emotional health and maturity, it must be the foundation of sexual public-health policy," said Webb.
"In many cases, the same teens who are struggling with sexuality and sexual decisions are also struggling with issues" like obesity, tobacco or alcohol use, noted CDC Director Julie Gerberding. CDC supports youth programs that understand the connectivity between these issues and work with youth "in a holistic manner," she said.
According to Gerberding, it is time to "get over the dichotomization" of sex education - "that you're either for abstinence of you're against it, either you're for condoms or you're against it." "We need a comprehensive, integrated approach, and it starts with abstinence in our kids. And it may have to move forward into other forms of prevention, depending on the target population," Gerberding said, noting Uganda's "ABC" message of "abstain, be faithful and use condoms consistently and correctly". "My own personal bias is to add 'D' for diagnosis," as two-thirds of new US HIV/AIDS cases occur among people who had sex with people that did not know they were infected, she added.
New York: Groups Get Anti-Crystal Funds
Duncan Osborne, Gay City News, June 17 2004
The New York City Department of Health and Mental Hygiene (DHMH) has awarded US$100,000 each to three community groups to fund efforts aimed at curbing crystal methamphetamine use among gay men. The three groups - Gay Men's Health Crisis (GMHC), Lesbian, Gay, Bisexual and Transgender Community Center, and the Crystal Meth Working Group - are coordinating their efforts to ensure a sustained anti-crystal campaign through the end of 2004.
Group representatives said they would place ads in subways, on phone kiosks, and in gay community publications. The groups will flood the market with ads during June, Gay Pride month, including a billboard truck in the parade on Fifth Avenue. Volunteers will march with the truck and hand out informational pamphlets about the drug.
"As long as they keep funding the Crystal Meth Working Group we are going to keep producing stuff that is in your face," said group member Peter Staley. "We think there needs to be a component of confronting the gay community about what we are doing to ourselves with this drug."
The $300,000 came from federal HIV prevention funds that went unspent in fiscal 2003, according to Dr. Marjorie J. Hill, an assistant commissioner in DHMH who heads the Bureau of HIV-AIDS. The money is a one-time expenditure; the department is seeking federal funds for an ongoing effort.
The groups' outreach will include African-American and Latino gay and bisexual men. Although meth is typically seen as a white gay man's drug, data from 2000 and statements from former users show that African-American and Latino men also use crystal.
Activists stressed the need for a continuing anti-meth campaign. "The goal here is to keep plugging away and to keep the messages fresh and in your face," said Staley.
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Vol. 4. No. 1 September - November 2004
Negative NZ Role Models
Sydney Star Observer, September 30 2004
New Zealand health promoters have taken a unique approach to HIV prevention with a new campaign praising "negative gay role models".
"Nathan is a negative gay role model: HIV-negative" is the message accompanying the first ad of the campaign, which appeared last week in Auckland's gay newspaper Express.
The ad features 25-year-old Nathan, a Dunedin gay man whose parents support him in his efforts to remain HIV-negative.
The ad reads: "Thinking about your family and the impact your having HIV would have on them, and the efforts Mum and Dad make to help keep me safe, helps reinforce my efforts to stay free of HIV."
Steve Atwood, communications coordinator with the New Zealand AIDS Foundation, told Sydney Star Observer the campaign was the result of intensive research and feedback from nationwide community forums. "There are a lot of good role models out there for HIV-positive men," Atwood said. "Some of those role models are helpful when it comes to HIV prevention and some are not: particularly some of the role models that promote HIV as no big deal now, because you can just take a pill …
"[But] we're not actually role modelling staying negative. We're not actually saying 'this is a really good lifestyle choice'."
The images have appeared in a variety of both queer and mainstream media as part of the Foundation's "End the Silence" campaign, formulated in response to a rise in HIV infections in New Zealand.
"AIDS organisations including the NZAF have for a long time been assuming that gay men wanted to avoid HIV and only needed to be told how, that is, use condoms," Atwood said. "But with the new age of improved care, the stark evidence of why you would want to avoid HIV has become less visible. And so we needed to start telling men why you would want to avoid HIV and not just how."
U.K. To Redesign HIV/AIDS Initiative in India
AIDS.org, October 7 2004
The United Kingdom plans to redesign its US$219 million HIV/AIDS initiative in India to reflect the "willingness" of the country's newly elected Congress Party government to address the epidemic, according to Gareth Thomas, British junior minister for international development, the Financial Times reported. According to the most recent United Nations data, India has 5.1 million HIV cases - second only to South Africa with 5.6 million (Kaiser Daily HIV/AIDS Report, 16/9). "The sheer numbers of vulnerable people mean [HIV/AIDS] is a huge challenge for the country," Thomas said. However, the U.K. HIV/AIDS initiative has "hit bureaucratic barriers" in India's National AIDS Control Organization in the past, and only $49.9 million of the US$219 million has been distributed over the past few years, according to the Times. The U.K. initiative has experienced additional "hiccups". Last year, the government banned an advertisement funded by the initiative that showed a woman packing condoms in her husband's suitcase, the Times reported.
China Adopts Peer Education Programs
Xinhua News Agency, October 12 2004
In China, where sex is rarely discussed in public, peer education programs are teaching people how to prevent HIV/AIDS, use contraception, respond to sexual harassment, and reject unwanted sexual advances. Experts say the peer education concept, which was brought to China from Australia in 1996, is playing an increasing role in the sexual education of Chinese youth.
International non-governmental groups like Maria Stopes China, a branch of a British non-commercial public service agency, have led programs in China. MSC has been offering peer education services on sexual and reproductive health issues for students at eight Beijing universities since September 2003. So far, the group has trained 200 students as peer educators.
With its interactive nature, peer education helps teenagers develop proper attitudes toward sex, sexual discrimination and drugs, said Cui Qi, MSC program officer. "Young people should be given a chance to learn how to make rational and proper decisions on sexual relationships and reproductive health," said Cui, who described the experience as "a game" instead of a lecture or seminar.
"Teenagers have become sexually mature and active much earlier, but lack of sexual education will put them in a position that's very vulnerable to HIV/AIDS," said Liu Liqing, chief representative of Marie Snopes to its China office.
Experts have called for governments to train more sex-education teachers for primary and middle schools while cultivating more professionals by offering sexology majors at some universities.
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Education Briefs - Vol. 4 No. 2
December 2004 - February 2005
US: Transmission of multi-drug resistant HIV in New York
Michael Carter, aidsmap.com, February 14, 2005 with Chris Gadd and Theo Smart, February 25, 2005
A gay man in his 40s has been newly infected with a strain of HIV resistant to drugs from the three main classes of antiretrovirals and has experienced rapid disease progression, the New York City Health Department announced.
The man was diagnosed with HIV in December 2004, having previously received a negative test result in May 2003. However, the man subsequently had unprotected anal sex with multiple male partners, often after taking the recreational drug methamphetamine.
After his diagnosis, the man experienced rapid HIV disease progression and has received an AIDS-diagnosis.
Further details of the case were discussed at the recent Conference on Retroviruses and Opportunistic Infections in Boston. On HIV diagnosis, the man’s CD4 cell count was 80 cells/mm3 and viral load was 280,000 copies/ml. By mid-January 2005, his CD4 cell count had fallen to 28 cells/mm3, and he had lost 4kg by the start of February. The AIDS diagnosis was made on the basis of his low CD4 cell count.
At the conference, Dr David Ho reported that genotypic analysis of the virus showed that it had multiple resistance mutations which are predictive of resistance to most antiretroviral drugs, however phenotypic analysis of the virus revealed that it is fully susceptible to two antiretrovirals: efavirenz (Sustiva) and to the fusion inhibitor T-20 (enfuvirtide, Fuzeon). Consequently, the man has started to take a combination of these two drugs, but no data are available on his response yet.
It is well known that the precise rate of HIV disease progression varies considerably from individual to individual. Although it may take 10 years or more in some patients, others develop an AIDS-defining condition much more quickly, even when multi drug resistant HIV is not present.
Cases of rapid disease progression after the acquisition of multi-drug resistant virus have been reported rarely, and evidence presented at recent conferences suggests that the transmissibility of multi-drug resistant HIV is much lower than that of wild-type virus.
While the New York patient did not have the identified genetic predisposition to faster disease progression, host factors in disease progression are as yet poorly understood.
The virus was found to be ‘dual tropic’, so rather than preferentially infecting either the CCR5 or the CXCR4 co-receptor, it was able to infect both.
Taken together, this case of rapid progression is a perplexing medical phenomenon that is probably representative of the tip of a wider spectrum of disease progression rates. Whether this is due to an exceptional HIV strain or an exceptional patient cannot be determined from the information available.
US: Routine HIV screening cost-effective
Michael Carter, aidsmap.com, February 10, 2005
Expanding routine HIV screening would increase the life-expectancy of individuals with previously undiagnosed HIV infection, cut HIV transmission rates by 20%, and be as cost effective as screening programmes for other disease areas, according to a study published in the New England Journal of Medicine. A second study published in the same edition argued that in all but the lowest risk populations, routine HIV testing every three to five years could be justified on both clinical and cost grounds, and that there are also health and economic grounds for one-off HIV testing of individuals with the very lowest risk of HIV.
The studies should be viewed within the context of changes in attitudes towards routine HIV testing in the US in recent years. In May 2002 the Centers for Disease and Control (CDC) recommended that all sexually active gay and bisexual men have an annual HIV test, and in 2003 the CDC issued its Advancing HIV Prevention strategy which encouraged healthcare providers to make testing for HIV as routine as screening for other chronic conditions such as hepatitis B virus or diabetes in areas with a high HIV prevalence (above 1% of the population), or in clinics serving populations with a high risk of HIV infection (such as sexual health services).
It is currently estimated that there are as many as 280,000 undiagnosed cases of HIV in the US.
Earlier identification of HIV would increase the life expectancy of an individual by 18 months, the investigators calculated. In addition, the investigators calculated that screening would reduce annual HIV transmission by 21%.
Reference
Sanders GD et al. Cost-effectiveness of screening for HIV in the era of highly active antiretroviral therapy. N Eng J Med: 352: 570 – 85, 2005.
Paltiel AD et al. Expanded screening for HIV in the US – an analysis of cost-effectiveness. N Eng J Med: 352: 586 – 95, 2005.
Australia: Undetectable viral load associated with unprotected sex amongst HIV discordant gay couples in Sydney, Michael Carter, aidsmap.com, February 1, 2005
An undetectable viral load is associated with unprotected anal sex amongst HIV serodiscordant gay couples in Sydney, according to a study published in AIDS. However, the investigators also established that the majority of gay men involved in serodiscordant relationships do not have unprotected sex, and an editorial accompanying the study notes that a large meta-analysis of studies examining sexual risk taking in the HAART era failed to find any association between an undetectable viral load and an increased risk of unprotected sex.
A total of 45 HIV-negative men and 74 HIV-positive men were included in the investigators’ analysis, providing data for 119 HIV serodiscordant couples.
In 21% of relationships, there was no anal sex, and 48% reported only having anal sex with condoms. However, in the remaining 31% of relationships, the men had unprotected anal sex.
Unprotected anal sex was significantly more likely when viral load was undetectable (39% versus 21%, p = 0.04). In multivariate analysis, the investigators found that younger age (p = 0.05), and greater HIV optimism (p = 0.02) were also significantly associated with unprotected anal sex in serodiscordant relationships.
The investigators conclude, “given that gay men in HIV serodiscordant relationships are incorporating clinical information in their sexual practice, it is important that they are made aware of how transmission risks, viral load variability and drug-resistant strains of HIV may relate to their specific situation.”
References: Van de Ven P et al. Undetectable viral load is associated with sexual risk taking in HIV serodiscordant gay couples in Sydney. AIDS 19: 179 – 184, 2005.
UK: London men report increasing UAI-C
Michael Cater, aidsmap.com, January 27, 2005
The percentage of gay and bisexual men in London reporting unprotected anal sex with a casual partner (UAI-C) increased significantly between 1998 and 2003, according to a study published in the December 2004 edition of Sexually Transmitted Infections. Although the investigators note that this increase in high risk sexual behaviour has coincided with the introduction of HAART, they do not believe that the availability of effective antiretroviral treatment can explain changes in behaviour at a population level and call, as a priority, for further research to understand the sexual behaviour of gay and bisexual men in London.
Since 1998, gay and bisexual men attending gyms in central London have been asked to complete a questionnaire about their HIV status, their sexual risk behaviour, and the HIV status of their partners. The confidential questionnaire also included items on demographics, steroid use, and use of the Internet to seek sex.
Men were asked if they had had unprotected anal sex in the previous three months, and if so, if it was with a main or casual partner, and what their partner’s HIV status was. Unprotected anal sex was then classified by the investigators as being concordant (between men of the same HIV status), or non-concordant (with a man of a different or unknown status).
A total of 4264 men were included in the investigator analysis. A total of 654 men (15%) said they were HIV-positive, 2652 (62%) said they were HIV-negative and 958 men (23%) reported never having had an HIV test.
Between 1998 and 2003, there was a significant increase in the percentage of men reporting both non-concordant unprotected anal sex (15% to 22%, p <0.001), and concordant unprotected sex (10% to 15%, p <0.001). The majority of men reporting non-concordant anal sex did not know the HIV status of their partner, but assumed it was the same as their own.
Only a very small minority of men reported having unprotected anal sex with a man whose HIV status they knew to be different from their own. The investigators highlight 2002 as an example. Of the 181 men who reported non-concordant unprotected sex, 167 said that it was with men whose HIV status they did not know, and only 14 men (1.7%) said it was with a man whose HIV status was known to be different from their own.
The increase of non-concordant anal sex was only seen with casual partners (7% to 16%, p <0.001). There was no significant trend over time for non-concordant unprotected anal sex with a main partner (p < 0.7).
HIV-positive men were more likely in all years to report non-concordant unprotected anal sex with a casual partner than with a primary partner (p < 0.001), whereas men who had never had an HIV test were more likely to report non-concordant unprotected sex with their main partner than their casual partners (p < 0.001). For HIV-negative men, the pattern varied by year.
“The increase in high risk sexual behaviour among London homosexual men between 1998 and 2003 was seen only with casual partners and not with main partners”, write the investigators, “STI/HIV prevention interventions among these men should therefore target high risk practices with casual partners since these appear to account entirely for the recent increase in high risk sexual behaviour”, they add.
Similar increases in non-concordant unprotected anal sex have also been noted, the investigators comment, amongst London gay men surveyed in bars and clubs, and amongst gay men attending sexual health services.
Reference: Elford J et al. Trends in sexual behaviour among London homosexual men 1998 – 2003: implications for HIV prevention and sexual health promotion. Sex Transm Infect 80: 451 - 454, 2004.
Prevention failing
Chris Gadd, February 11, 2005
Preventive measures are failing to curb the rise in HIV infections, according to an editorial by two leading British HIV doctors in a February edition of The British Medical Journal.
According to current estimates, 38 million people are now living with HIV worldwide, including 2 million children. In 2003, a record 4.8 million people became infected with the virus.
Angela Robinson from University College London Hospital and Brian Gazzard from London’s Chelsea and Westminster Hospital, argue that the underlying reason for the continued increase is socioeconomic. “HIV infection is rooted in poverty, ignorance and a lack of autonomy of women,” they state.
However, they also state that current prevention measures are failing to stop the rise in new infections.
Although several alternative prevention technologies are in the pipeline, including microbicides, vaccines and use of antiretroviral drugs as pre-exposure prophylaxis, lengthy trials are required to test their effectiveness.
The authors conclude, “For the present, most efforts at prevention are therefore linked to trying to change behaviour.”
Although the epidemic in the United Kingdom is small in comparison to the global catastrophe, there was a 20% increase in the prevalence of HIV in this country in 2003 and 2004 compared to 2002. This, they warn, included a doubling of the risk of heterosexual transmission over the last five years.
Reference: Robinson AJ et al. Rising rates of HIV infection. Br Med J 330: 320-321, 2005
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Concerns over early HIV treatment
BBC news, May 25, 2005
Sexual health experts from London's Mortimer Market Centre warn knowledge that post exposure prophylaxis (PEP) treatment is available could increase risky behaviour and HIV transmission. Writing in the journal Sexually Transmitted Infections, they call for more research into the effects of PEP, which is known in the UK as PEPSE.
Guidelines in the UK and US say the antiretroviral treatment should be given promptly to people who think they may have become infected with the virus within 72 hours after potentially risky sex. But the effectiveness, impact on changing 'risky' sexual behaviour, and the financial implications of this policy have never been properly evaluated, say the experts.
A total of 167 patients who attended the London clinic where the researchers work were given PEPSE in 2003 and 2004. They say the projected cost of PEPSE drugs this year is set to be around 180,000 pounds (approximately AUD$432,000).
The researchers warn this is being done despite a lack of evidence about the effects of the treatment, and at a time when sexual health clinics are struggling to cope with demand for services and to contain the associated rising costs.
Dr Martin Fisher, an HIV/Aids consultant at Brighton and Sussex University Hospitals NHS Trust, said concerns that PEPSE would lead to complacency and risky sexual behaviour had not been borne out by the data which was available.
He said: "In the two studies that have examined behaviour after individuals have taken PEPSE, the opposite appears to occur. PEPSE may well act as a 'wake-up call' and have a beneficial effect on behaviour rather than a deleterious one."
Study On Gay Men's Brains Response To Sexual Stimulus
Associated Press - May 9, 2005
Gay men's brains respond differently from those of heterosexual males when exposed to a sexual stimulus, researchers have found. The homosexual men's brains responded more like those of women when the men sniffed a chemical from the male hormone testosterone.
The study, published in Proceedings of the National Academy of Sciences, was done by researchers at the Karolinska Institute in Stockholm, Sweden.
They exposed heterosexual men and women and homosexual men to chemicals derived from male and female sex hormones. These chemicals are thought to be pheromones -molecules known to trigger responses such as defense and sex in many animals.
Whether humans respond to pheromones has been debated, although in 2000 American researchers reported finding a gene that they believe directs a human pheromone receptor in the nose.
The Swedish researchers divided 36 subjects into three groups -heterosexual men, heterosexual women and homosexual men. They studied the brain response to sniffing the chemicals, using PET scans. When they sniffed smells like cedar or lavender, all of the subjects' brains reacted only in the olfactory region that handles smells.
But when confronted by a chemical from testosterone, the male hormone, portions of the brains active in sexual activity were activated in straight women and in gay men, but not in straight men, the researchers found.
And when estrogen, the female hormone was used, there was only a response in the olfactory portion of the brains of straight women. Homosexual men had their primary response also in the olfactory area, with a very small reaction in the hypothalamus, while heterosexual men responded strongly in the reproductive region of the brain.
Savic said the group is also doing a study involving homosexual women but those results aren't yet complete.
United Nations blasts ad campaign by maverick German doctor
Agence France-Presse, May 11, 2005
The United Nations' paramount health agencies launched a joint attack on Wednesday on a German doctor who has been running a media campaign that attacks anti-HIV drugs as toxic and claims vitamins destroy the AIDS virus.
The World Health Organisation (WHO), UN Children's Fund (Unicef) and UNAIDS attacked Matthias Rath's advertisements as misleading and potentially dangerous.
The ads, along with flyers distributed by Rath and material posted on his website, claim that antiretroviral drugs damage all the cells in the body and that a combination of micronutrients can roll back HIV.
"These advertisements, placed in the international press, are wrong and misleading," the joint statement by the UN agencies said.
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