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HIV diagnoses down from last year, state health officials say

2017 rate second-highest over past five years: report

Max Freund / The Gazette

(File photo) Devices used to take blood pressure, temperature, and examine eyes and ears rest on a wall inside of a doctor's office in New York March 22, 2010.  (REUTERS/Lucas Jackson)

The number of Iowans diagnosed with HIV in 2017 decreased from the previous year, but the figure still remains one of the highest on record, according to a report from the state health department.

In 2017, 125 people were diagnosed with HIV — or human immunodeficiency virus, which causes AIDS and interferes with the body’s ability to fight infections — according to the 2017 HIV Disease End-of-Year Surveillance Report from the Iowa Department of Public Health.

The 2017 diagnosis rate is the second-largest number of diagnoses in the past five years. However, this is less than 2016, which saw 137 Iowans diagnosed.

But the high figures might not necessarily be a bad sign.

“The high number of diagnoses may be an indication people at risk for HIV are responding to increased outreach and are getting tested. If that’s the case, it’s a positive sign,” said Nicole Kolm-Valdivia, Iowa Department of Public Health Bureau of HIV, STD and hepatitis data manager.

John McGlothlen / The Gazette

The decline in 2017 was due to a decrease in diagnosis among foreign-born individuals, which typically is influenced by migration to the state.

According to the report, diagnoses among foreign-born individuals accounted for 22 percent of all diagnoses in the past five years.

Among other findings in the report:

l The largest proportion of HIV cases are among non-Hispanic, white Iowans, but black and Latino Iowans continue to be disproportionately affected. Although African-Americans make up 3 percent and Latinos make up 6 percent of Iowa’s population, they account for 30 and 13 percent of the state’s HIV diagnoses, respectively.

l Thirty-eight black and 16 Hispanic and/or Latino Iowans were diagnosed with HIV in 2017.

l According to the Department of Public Health report, 274 individuals were living with HIV in Linn County at the end of 2017. One hundred eighty-four people were living in Johnson County during that same period.

l Fifty-six percent of people diagnosed with HIV in 2017 were men who have had sexual contact with other men, which is the leading exposure category for HIV, the report stated.

l Despite the high rate in the past two years, there is an estimate of more than 300 Iowans who have yet to be diagnosed, the report stated, so Iowa may “experience several more years of higher numbers of people diagnosed with HIV.”

l As of the end of 2017, there were 2,790 people living in Iowa who were with a diagnosed HIV disease. But state health officials estimate there may have been as many as 3,181 Iowans living with HIV or AIDS — meaning 391 people could be undiagnosed.

Since HIV infection became reportable by name in 1998, a total of 1,305 deaths have been recorded in Iowa among people diagnosed with HIV or AIDS.

Twenty-seven Iowans with HIV died in 2017. Of those, 13 deaths had HIV listed on the death certificate as a contributing factor.

In 2016, there were 39,782 total HIV diagnoses nationwide, 5,068 of which occurred in the Midwest, according to the Centers for Disease Control and Prevention.


Researchers uncover potential new drug targets in the fight against HIV

Johns Hopkins University
Credit: CC0 Public Domain

Johns Hopkins scientists report they have identified two potential new drug targets for the treatment of HIV. The finding is from results of a small, preliminary study of 19 people infected with both HIV—the virus that causes AIDS—and the hepatitis C virus. The study revealed that two genes—CMPK2 and BCLG, are selectively activated in the presence of type 1 interferon, a drug once used as the first line of treatment against hepatitis C.

Results of the study were published online Aug. 1 in Science Advances.

“We’ve known that HIV worsens our ability to treat hepatitis C with type 1 , but why that was has been unclear. In some way the viruses’ interactions with each other and with the treatment seemed at the root of the failure,” says Ashwin Balagopal, M.D., associate professor of medicine at the Johns Hopkins University School of Medicine.

To study the relationship, the researchers enrolled 19 participants—15 men and four women, all over the age of 20—from several Baltimore clinics, including the Johns Hopkins HIV Clinic and a Baltimore City Health Department sexually transmitted disease clinic. All participants were diagnosed with chronic HIV and hepatitis C infections.

The participants received injections of interferon to treat their hepatitis C. Before and after each treatment, the researchers took blood samples to measure the amount of both hepatitis C and HIV present in the blood.

After one week of treatment, the participants had on average 10 times less HIV in their blood.

“This told us that the interferon we were using to treat hepatitis C was working to control HIV as well, but we needed to investigate how it was accomplishing this,” says Balagopal.

To do this, Balagopal and his colleagues studied the patients’ CD4 T —the immune cells most suppressed and affected by HIV—in the lab.

In those cells, the researchers measured the levels of numerous gene products before and after interferon treatment.

They identified 99 genes with higher levels of expression after interferon treatment. Of these genes, the researchers found that two, CMPK2 and BCLG, had not been previously linked to HIV. Both genes are thought to be involved in the processes that guide how cells divide.

The researchers then infected lab-grown human cells (not from the 19 patients) with HIV to further study the interactions between the two genes and interferon.

First, they engineered human immune cells to render them unable to produce the protein made by the CMPK2 gene. They then added interferon and tested the cells’ HIV levels, finding that control cells with functioning CMPK2 had 10 times less HIV than cells in which CMPK2 was blocked.

On the other hand, BCLG normally has very low expression levels, according to the investigators, and is difficult to eliminate from human cells. So the researchers opted to increase its expression by adding more BCLG genes to HeLa cells infected with HIV in the lab.

The researchers then again added interferon to the cells and 48 hours later, the cells engineered to have more BCLG expression had half the amount of HIV compared to cells with normal BCLG expression.

This seems to indicate that CMPK2 and BCLG play a role in interferon’s ability to suppress HIV, according to Balagopal, and potentially could serve as targets for new drug approaches to HIV treatment, particularly in people who are co-infected.

The researchers caution that the level of HIV suppression they saw in these interferon experiments is not large enough to warrant interferon’s use as a standalone treatment.

More than 1.1 million people in the U.S. are living with HIV and 25 percent of them are estimated to be co-infected with the hepatitis C virus. The researchers say nearly one-third of the HIV patients in their Baltimore clinics also have  C. Hepatitis C causes inflammation of the liver and, though it can take years for symptoms to arise, can cause nausea, weight loss, cirrhosis, liver cancer and liver failure. Complications from this virus are accelerated in people co-infected with HIV.

In the future, Balagopal hopes to better understand the genes and their roles in HIV suppression by investigating the cellular pathways with which they interact. He also hopes to examine the ‘ effects on HIV’s ability to hide for decades within cells—a factor that has stalled scientists’ efforts to cure HIV infections.



Gilead Said PrEP To Prevent HIV Was ‘Not A Commercial Opportunity.’ Now It’s Running Ads For It

A still from Gilead’s Truvada for PrEP commercial, which first aired in June. Truvada is the only FDA-approved drug that can be used to prevent the transmission of HIV.COURTESY OF ISPOT.TV

“I’m on the pill,” declares a transgender woman in an up-close shot featured in Gilead Science’s latest drug commercial. “But it’s not birth control,” says a young guy, with a smile, in another scene. The actors are touting Truvada, the only drug approved to prevent the transmission of HIV.

The commercial, aptly titled “I’m on the Pill,” is part of a marketing push that has helped turned the use of Truvada for preventing HIV into a $1.3 billion blockbuster, almost 5% of Gilead’s annual sales. It’s a big reversal for Gilead, just three years ago the company said using Truvada to prevent infection with the virus that causes AIDS did not represent a commercial opportunity. Now, Raymond James analyst Steve Seedhouse estimates this use could generate $2.9 billion in 2020 sales for Gilead, which is in investor disfavor as annual sales of its top-selling hepatitis C drugs have fallen 69% since 2015 to $4.4 billion.

“I’m on the Pill” has shown up on over 385 million screens (ad-jargon: “impressions”) since it first aired in June, according to ad-tracking firm iSpot.TV, which also estimates Gilead spent $13 million during that period placing the spot often in primetime TV slots during shows like The Late Show with Stephen ColbertFamily Guy, and Pose, a new FX show with a large transgender cast.

Truvada was first approved in 2004 as a treatment for HIV, not a preventative. It was the first once-a-day combination of HIV drugs, and its success made Gilead a biotech giant. Truvada’s total, global annual sales peaked at $3.57 billion in 2016. Another $2.6 billion was generated by Atripla, a combination of Truvada and Bristol-Myers Squibb BMY -1.06%’s Sustiva. Recently, Truvada’s sales have fallen (they dropped 12% last year) as HIV patients switched to newer medicines and Truvada’s patent in Europe expired.

In 2010, researchers funded by the Bill & Melinda Gates Foundation (Gilead donated the placebo and Truvada pills) presented data showing that giving Truvada to patients who did not have HIV, but who were at risk of contracting it, could reduce the risk of infection by 92%. The use, called PrEP–short for “pre-exposure prophylaxis”–caused a stir in public health circles. The Food & Drug Administration approved Truvada for PrEP in 2012.

Gilead was proud–Gilead’s chief scientific officer, Norbert Bischofberger, called it “the culmination of almost 20 years of research”–but the company saw using Truvada to prevent HIV infection as a commercial nonstarter. In 2013, Gilead’s vice president of medical affairs Jim Rooney told The New Yorker that the company did “not view PrEP as a commercial opportunity.” In 2015, Gilead spokesperson Cara Miller told Bloomberg the company “does not view PrEP as a commercial opportunity and is not conducting marketing activities around Truvada as PrEP.”

In 2014 there were just 22,000 PrEP users. But public health officials saw a population of more than one million Americans who might benefit from taking Truvada to prevent HIV infection.

New York City launched its first PrEP ad campaign in 2015, a year after the CDC put out its own clinical guidance recommending Truvada for PrEP. Other cities, like Washington, D.C., and San Francisco, also launched public information campaigns in recent years. (All three say they have not received funding from Gilead for their campaigns.)

Last year, Gilead started marketing Truvada on social media and dating apps like Snapchat, Tumblr and Grindr. Now the number of Truvada for PrEP users has since eclipsed the number of Truvada for HIV treatment patients. Gilead revealed in July that 180,000 people were taking Truvada for PrEP during their second quarter, which analyst Seedhouse estimates translates to some $500 million in sales.

“They really started experiencing pressure across many lines of their business, so it makes sense as to why they would be more aggressive in trying to build out into indications of other segments for Truvada,” says Piper Jaffray analyst Tyler Van Buren.

Truvada loses its U.S. patent in 2021, Gilead is developing another drug to replace it called Descovy and is running a Phase 3 clinical trial comparing the two drugs, which is expected to be complete in 2019. However, even Descovy’s patent would only last until 2022.

Gilead declined to be interviewed for this article. In a statement, the company noted that it has spent $100 million on grants to community-based organizations to support HIV prevention awareness since 2012 and noted that many people don’t realize they are at risk of HIV infection. “TV advertising is a natural evolution of efforts to educate people about risk factors and what they can do to protect themselves,” the company says.

Mitchell Warren, executive director of AVAC, a New York City-based nonprofit that promotes HIV prevention, agrees wholeheartedly. He has only one complaint about Gilead’s PrEP ads. “In my mind,” he says, “it’s six years too late.”



Undetectable means untransmittable: what you need to know about HIV

Stigma persists but studies show when treatment is working there is effectively no risk of HIV transmission

Thomas Strong: ‘It remains the case that there’s a certain kind of fearfulness and a certain kind of stigma associated with being HIV positive’

Thomas Strong: ‘It remains the case that there’s a certain kind of fearfulness and a certain kind of stigma associated with being HIV positive’

Recently, the Taoiseach Leo Varadkar attended the first HIV Ireland Red Ball and, in his speech, described HIV as “one of the most stigmatised medical conditions” in Ireland today.

“The stigma against gay people is largely lifted. The same must happen for people who are HIV positive,” he pronounced firmly.

But how do we lessen stigma that is based on fear of transmission rather than mere bigotry?

Dr Paddy Mallon, a consultant at the Mater Private Hospital in Dublin and a specialist in infectious diseases, believes the government and public health bodies need to do more. “HIV as a condition has completely changed since the last public health campaign in Ireland over a decade ago,” says Mallon, who is also director of the UCD HIV Molecular Research Group.

“It’s a chronic condition that people, by and large, manage to live normal lifespans with. And while they’re getting access to effective treatment, they’re not contributing to the ongoing epidemic, because they don’t transmit the virus. There’s a responsibility on government through public health agencies to ensure that these sorts of messages are getting out to the public, because they’re really important messages, not only to people with HIV but also to people without.”

Ninty-five per cent of people living with HIV in Ireland who take antiretroviral (ART) drugs are “virally suppressed”, a statistic the Taoiseach also referred to at the fundraiser. This means that their viral count is so low that, after several months’ treatment, HIV can no longer be detected in their bloodstream. This usually occurs within a relatively quick timeframe after starting treatment of three to six months.

The result is that there is effectively zero risk of them passing on the virus through sex, as demonstrated in a number of recent large-scale studies. But there has been scientific evidence for this as far back as 2008, when a paper was launched on the subject by the Swiss Federal Commission for HIV/AIDS.

No transmission

Dr Alison Rodger is a consultant in HIV and clinical director of public health at the Royal Free Hospital in London. She was one of the lead investigators in 2016’s landmark PARTNER study, which looked at the concept of “undetectable equals untransmittable”, or U=U for short, across 14 countries in Europe. “We’ve known about this for a while,” she says. “There was a big study published in 2000, 18 years ago, which showed that the level of virus in the HIV person’s blood directly relates to the chances of passing the virus on.”

The initial PARTNER study Rodger worked on included gay men and people who had heterosexual sex, all of whom had undetectable viral loads. The results were clear: zero transmissions from HIV positive to HIV negative partners after more than 58,000 condomless sex acts.

“Following on from that, there was another study called Opposites Attract last year, which showed the same results with a smaller sample of 17,000 condomless sex acts and again no transmission,” says Rodger. “The evidence is that there is no transmission. So effectively, undetectable equals untransmittable.”

Over the past two years, the U=U science has started to pick up pace and has now been endorsed by 682 organisations across 87 countries, including CATIE – a HIV and hepatitis C information organisation in Canada, the CDC (Centers for Disease Control and Prevention) in the US as well as the UK’s National Health Service.

Here in Ireland, the HSE has even quietly added this line to its website: “When treatment is working properly, there is effectively no risk that a person with HIV can pass on HIV to another person.”


Nevertheless, many HIV positive people who are undetectable still experience overwhelming stigma from potential partners – particularly within the gay community.

Thomas Strong, (47), a lecturer at Maynooth University, was first diagnosed as HIV positive back in 2006. “It remains the case that there’s a certain kind of fearfulness and a certain kind of stigma associated with being HIV positive, especially in the LGBT community,” he says. “If you’re a HIV positive person, and you’re looking to date or you’re just sexually active, you face a huge amount of rejection if you’re open about your status. It’s pretty remarkable. People are very open about it, they’ll just tell you, ‘oh, I’m sorry, I don’t sleep with people who have HIV’. They’ll be very upfront that that’s what they’ve based their decision on. It’s happened to me many, many times.”

The message that those with who are virally suppressed by ART effectively pose no HIV risk to others is one that activists are also keen to communicate, as well as the importance of regular testing.

“When you reduce people’s fear of HIV, it encourages them to get tested,” says Andrew Leavitt, an activist with ACT UP in Dublin.

Andrew Leavitt: ‘When you reduce people’s fear of HIV, it encourages them to get tested’
Andrew Leavitt: ‘If you’re HIV negative, seeing that there is treatment available; that getting diagnosed with HIV doesn’t mean the end of your life. . .all of that helps’

“If you’re HIV negative, seeing that there is treatment available; that getting diagnosed with HIV doesn’t mean the end of your life; it doesn’t mean you can’t have a fulfilling sex life and meaningful relationships – all of that helps in promoting testing and people availing of care if they do get diagnosed.

“If you’re a young woman living with HIV, and you wanted to become pregnant, knowing that if you’re on treatment your viral load is undetectable can assist you in making that decision,” says Mallon.

“Similarly, if you’re in what we call a HIV-discordant relationship, where someone’s positive and someone’s negative, it can have big implications for leading a more normal life.”

Testing and treatment

Both Leavitt and Mallon believe that existing HIV testing opportunities across Ireland are insufficient and that sexual health services require increased funding. They also would like to see PrEP, a drug which lowers risk of HIV transmission by an additional 82 to 85 per cent in high risk groups such as gay men, available directly through these services. PrEP is currently only available here via private prescription, with the cost prohibitive to many.

“It’s pretty straightforward from my point of view.” says Mallon. “All you have to do is look at what’s happening in places like London, New South Wales and San Francisco. They have a concept where they have increased testing and they give everyone who tests positive access to effective treatment. But then they also give people the opportunity to prevent HIV through safe sex education, use of condoms and also PrEP.

“In countries that have done that, you see a massive reduction in the HIV diagnoses. So there’s no great mystery about this – the formula is there. What they need to do in Ireland is get on and implement it and at the minute they’re just not doing that.”

Author: Aoife Moriarty


New method helps determine effectiveness of interventions in reducing spread of HIV

Using genetic sequencing to understand the evolutionary relationships among pathogens, an international team of researchers—including several from the Center for Drug Use and HIV/HCV Research (CDUHR) at New York University—has developed a new method to determine how effective interventions are against the spread of infectious diseases like HIV.

The study, published in the American Journal of Epidemiology, describes how the new method establishes the source of a disease and whether its  in the community can be traced back to individuals who were or were not part of an .

Over the last decade our understanding of how pathogens spread has improved, but preventing the transmission of infectious diseases still remains a challenge. The introduction and spread of pathogens now occur more easily than ever due to the ease of international travel and people living in densely populated areas.

“Given globalization and other social phenomena, controlling the spread of infectious diseases is an imperative public health priority,” said Gkikas Magiorkinis of the National and Kapodistrian University of Athens in Greece, the study’s lead author.

For scientists and public health practitioners, it can be difficult to determine whether an intervention—such as a needle exchange program or treatment with antiretroviral therapy—is actually effective in reducing  in the community. Evaluating the effectiveness of interventions that can mitigate the spread of pathogens is expensive, and in many circumstances unrealistic.

Importantly, most evaluations only measure those directly involved in an intervention but neglect the community effect, or the ability of the intervention to minimize the spread of disease from people directly involved to other community members.

“Our research seeks to understand if an intervention has a community effect and can reduce disease transmission not only by the recruited individuals, but also by the contacts in their risk networks,” said Samuel R. Friedman, director of the Institute for Infectious Disease Research at National Development Research Institutes (NDRI), associate core director and senior theoretician at CDUHR, and the study’s senior author.

To better measure the community effect of an intervention, the research team developed a new method to evaluate an intervention for reducing HIV transmission. In order to examine the transmission of the virus from already-infected people to those newly infected, the researchers use phylogenetics, or the evolutionary relationships among organisms, to understand the evolutionary dynamics of HIV.

The method involves collecting blood samples from three groups of people: individuals with HIV who participate in an intervention study, others with HIV who are not part of the intervention (the control group), and—at a later date—individuals who are newly infected with HIV.

Performing genetic sequencing of HIV, they can then compare characteristics of the virus to determine the source of transmission and whether new infections can be linked to individuals who did or did not participate in the intervention.

“Due to the inability of traditional methods to trace infections back to a source, there are major gaps in our understanding on how to best reduce the spread of HIV within a community. This new method enables us to quantify the flow of transmissions within a community, evaluate whether an intervention reduces new transmissions in comparison to a control condition, and thus estimate the relative decrease in new infections in the community due to the intervention,” said Magiorkinis.

The researchers provide proof of concept through simulating an intervention to prevent HIV transmission among people who inject drugs. Comparing transmission from those with HIV who did or did not participate in the intervention, they calculated fewer people contracting HIV from individuals in the intervention, suggesting that the simulated intervention reduces  transmission.

The researchers note that a key advantage of their method is that it can assess the wider community effect of an intervention without having to follow up with study participants. A one-time collection of blood samples is much easier than tracking participants long-term, especially in communities for which follow-up is a challenge, such as people who inject drugs. In addition, the method can be applied to evaluate interventions to reduce transmission of other  beyond HIV.


‘HIV-AIDS Remains a Critical Health Concern’

Mrs. Grigsby is concerned about the country’s youthful population.

The coordinator of decentralization at the National Aids Commission (NAC) in Monrovia,  says HIV- AIDS remains a very critical health problem in the country.

Although the virus may no longer pose a very serious death threat to people, Madam Jenebah Grigsby said there is a dire need to continue promoting public education among the country’s adolescent population.

She made the statement over the weekend in Kakata at the start of a week-long life skills training seminar for adolescents. The initiative is being held for 250 Peer Educators in Montserrado, Grand Bassa and Margibi counties.

Those counties, according to Madam Grigsby, are the most hardest hit among the 15 counties, with the HIV/AIDS virus of which 476 new cases were discovered, something she said was appalling and needed to have a serious public awareness, especially among the young ones.

“If we don’t muster the courage now to provide the needed training and public awareness, especially among our youthful population, I am afraid that within ten years, a substantial damage could have been done to them,” Madam Grigsby said.

She said studies conducted back in 2014, shows that HIV/AIDS remains prevalent in the three counties, “this is why we are targeting the young people to train peer educators that will in return train their peers on the danger of the virus.

Participants doing a pre–test prior to the start of the training.

Grigsby then urged the youths to at all times check their HIV/AIDS status as having new cases of the virus could be a serious threat to their survival.

NAC Margibi Coordinator Eric Bombo, said the 250 Peer Educators that will train their colleagues in the three counties are expected to also train about 6,250 other Peer Educators with each of them training at least 25 persons, who may be able to convince at least 10 persons out of the 25.

Bombo said at the end of the training circle, they would have reached a total target of 12, 500 peer educators in the three counties, which they are expected to achieve.

He said those trained Peer Educators will liaise with Bombo’s office, and the County Health Teams of the three counties to organize their own forums in their respective communities, while members of the County Health Teams will be providing free testing and counseling for HIV/Aids patients.


Naltrexone helps HIV positive individuals reduce heavy alcohol use


New Haven, Conn. – Extended-release naltrexone — an injection that decreases heavy drinking in the general population when taken in conjunction with counseling — appears to help HIV-positive individuals reduce their number of heavy drinking days too, say Yale researchers.

This study was published online on Aug. 2 in AIDS and Behavior.

“While we know that patients with heavy alcohol use are less likely to take their medications for HIV, there is a paucity of interventions that target alcohol use to improve how patients take their medications,” said Jennifer Edelman, M.D., first author and associate professor at the Yale School of Medicine. “Extended-release naltrexone is a medication that is safe and effective for patients living with HIV that can be delivered in HIV treatment settings that could potentially help this problem.”

Conducted between April 2011 and February 2015, the trial involved 51 HIV positive individuals who exhibited heavy drinking and suboptimal (less than 95%) antiretroviral adherence. All the participants in the study received counseling. Researchers found that the extended-release naltrexone led to clinically and statistically significant decreases in the number of heavy drinking days for the participants.

However, the researchers saw no appreciable effect of the extended-release naltrexone, versus a placebo, on the adherence of HIV-positive individuals to their antiretroviral therapy regimens.

“We hope that these results will stimulate further research focused on enhancing the coupling of alcohol interventions with antiretroviral medication adherence interventions to improve both alcohol use and HIV related outcomes,” said Lynn Fiellin, M.D., senior author, director of the Yale Center for Health and Learning Games, and associate professor at the Yale School of Medicine.


Other authors on this study include Brent A. Moore, Stephen R. Holt, Nathan Hansen, Tassos C. Kyriakides, Michael Virata, Sheldon Brown, Amy C. Justice, Kendall J. Bryant, and David A. Fiellin.

This study was funded by the U.S. National Institutes of Health, National Institute on Alcohol Abuse and Alcoholism.


Mutated HIV Strain May be Causing Earlier AIDS Symptoms

New research warns that mutated strains of HIV detected in Saskatchewan, Canada, appear to be leading to faster-developing AIDS-related illnesses.

The research, published this month in the science journal “AIDS“, came about after health workers reported rapidly-growing HIV rates in 2016 in the west Canadian province of Saskatchewan, with the vast majority of cases among the province’s First Nation peoples. What was perhaps even more alarming was that these cases appeared to progress to AIDS-related illnesses very quickly after first detection.

HIV is a sinister virus in that its most common strains today can lurk in our bodies for several months without manifesting symptoms. Some people may go years without showing obvious signs of HIV, and the virus may not be picked up unless they undergo regular screening or the infection is caught during another round of tests for an unrelated illnesses.

Cases in Saskatchewan appeared to be different, however, with rapid-onset toward AIDS-illness. Researchers wanted to find out why this might be.

Researchers at a laboratory at the BC Centre for Excellence in HIV/Aids used a multi-year analysis of 2,300 samples of HIV strains from Saskatchewan province and compared those to other strains obtained from across Canada and the United States. This enabled them to see if there was anything unique or different about the strains — and there was.

Around 98 percent of the strains from Saskatchewan displayed a certain level of immune resistance. The more worrying thing, however, was that 80 percent of the sample carried a mutation that is known to accelerate HIV’s progression into AIDS.

It isn’t the first time that HIV mutations have been a source for concern.

As HIV is a virus we would expect that its various strains would, over time, begin to change as they circulate in their host communities. However, we know that HIV strains in certain regions, for example in the Philippines, are proving harder to treat and are circulating among different populations than in the West. We need new treatment protocols to fully answer this problem.

In Saskatchewan’s case, the illness isn’t necessarily harder to treat, but because it progresses more rapidly than the norm it is a challenge. There is nothing medical making First Nation peoples more susceptible, something the researchers are keen to point out. Rather, it poses a wider population risk.

“It was almost as if there might have been something particularly nastier about the virus,” Zabrina Brumme, the lead author of the study, is quoted by the Guardian as saying, “…What has happened is that HIV has adapted quite quickly as it has been transmitted throughout the communities of people.

“We want to make it clear that HIV strains in Saskatchewan have the potential to cause more rapid disease, period,” Brumme said. “It doesn’t matter who you are.”

The strains are highly treatable, so once the virus is caught a person living with the virus can be helped to get their viral load back under control and, hopefully, down to undetectable levels.

While it is critical to acknowledge that this HIV strain is not capable of targeting specific groups of people, it is just as critical to notice that there is a major HIV problem in Saskatchewan and its First Nation population.

Doctors have called for the government to declare a public health emergency in the province, but more funding hasn’t yet been directed to this problem. The current rate of new infections in Saskatchewan is almost triple the national average, and First Nation people in Canada as a whole have HIV infection rates closer to those of African nations rather than North American averages.

All this has led experts to say that systemic racism, poverty and, by extension, poorer health outcomes among this section of the community is leading to First Nation peoples being more at risk of HIV acquisition. Put simply, if you otherize people for long enough, you plunge them into a vicious cycle of poorer health and life opportunities.

As is the case globally, we can only ever meet the challenge of eradicating HIV if we work aggressively to end discrimination and cultural prejudices, because these are the social barriers that keep people locked in high risk behaviors and an inability to access timely and comprehensive medical care. The provincial and national governments must act to get Saskatchewan’s HIV problem under control and prevent this cycle from affecting more and more lives.

Author: Steve Williams


Sask. housing for pregnant women with HIV, seniors, families, gets $6.7M funding boost

Funding will be distributed in communities such as Saskatoon, Battlefords, and Pinehouse Lake

From left: Saskatoon Mayor Charlie Clark, legislative secretary to the Minister of Social Services and Moose Jaw Wakamow MLA Greg Lawrence, Minister of Status of Women Maryam Monsef, Minister of Public Safety and Emergency Preparedness Ralph Goodale, and president of Stewart Properties Tyler Stewart, all at Sanctum 1.5(Bridget Yard/CBC)

A new Saskatoon building aimed at housing pregnant women with HIV is still tarped with exposed wiring inside but Katelyn Roberts already knows the 10-unit, co-housing project will be full when it opens.

“And we’ll continue to be full,” said Roberts, the executive director of Sanctum, a non-profit that provides care to people living with HIV/AIDS.

On Monday, the Saskatchewan and federal governments announced a joint investment of $765,500 to Stewart properties, the housing corporation constructing Sanctum 1.5. An additional $100,000 is being provided by the City of Saskatoon.

The home on Avenue O South has a common kitchen, four bathrooms, and recreational space that will be used by women living with HIV and AIDS, or are at risk of contracting the disease.

The non-profit Sanctum is building a pre-natal home for women with HIV. Pictured: Executive director Katelyn Roberts (left) and program director Kathy Malbeuf. (Submitted by Sanctum)

“In Saskatchewan, we have the highest rates of HIV in the country and we also have the highest numbers of women who are HIV-positive of child-bearing age and we also live in a community where many women struggle with addiction and chronic homelessness,” said Roberts.

The most meaningful intervention and support that can be provided, she said, is when women are pregnant. The goal of Sanctum in this project is to prevent children being apprehended by social services at birth.

The Ministry of Social Services generally does not work with mothers until after they’ve given birth.

“Because of the lack of support while [the mothers] were pregnant, the baby gets apprehended and placed in childcare and that critical bond between mom and baby doesn’t take place,” said Roberts.

Providing support and parenting support to the future mothers who will live at Sanctum 1.5 might also aid in reducing the risk of vertical transmission of HIV.

The chances of such transmission is less than 2 per cent when women have access to appropriate medication.

Over 50 affordable units to be built

The Sanctum 1.5 funding announcement is part of a larger injection of funds into Saskatchewan’s affordable housing infrastructure. Maryam Monsef, Minister of Status of Women, was on hand Monday for the announcement, and described how social housing supported her and her family when she and her family came to Canada as refugees.

“It was a welcoming community that let us in with open arms. It was safety networks like social housing that allowed me to continue my education and finish, to see the value in community organizations like the ones we’re supporting today,” she said.

Those organizations include Sanctum in Saskatoon.

The other projects funded by the $6.7 million announced on Monday include:

  • $2.5 million for 10 affordable rental units for seniors in La Ronge.
  • $1.1 million for nine family rental units in Pinehouse Lake, Sask.
  • $640,000 for Methy Housing Corporation to build six rental units in La Loche for single-parent families.
  • $312,500 for Prince Albert CMHA to build six units for people with mental illness and complex needs.
  • $570,000 for Gabriel Housing Corporation in Regina to build six units for families with complex needs.
  • $500,000 for Battleford Indian and Métis Friendship Centre to develop an eight-unit co-housing project for the city’s homeless population.

When Saskatoon Mayor Charlie Clark stepped to the podium at Sanctum 1.5, he encouraged those present to remember what the area near Avenue O South and 21st Street was like 15 years ago.

​He called it “the stroll.”

“It was a dark time, a dark place to have in the community, and you think, what can we do to come together to create the conditions to prevent this?”

To break cycles of poverty, homelessness, and racism that keep people marginalized, Clark says partnerships need to come from the community.

Monsef agreed when speaking to reporters on behalf of the federal government.

“We can play the role of a convener and bring different partners together, but ultimately, communities know their neighbours best,” she said.

Author: Bridget Yard


AIDS 2018 told the story of a global health crisis

A community march in Amsterdam, where the 22nd International AIDS Conference was held. Photo by: Matthijs Immink / IAS

AMSTERDAM — The fight to end HIV/AIDS was given a boost by a star-studded week of presentations, panel sessions and the occasional protest at this year’s International AIDS Conference in Amsterdam. However, tensions within the community remain, and with few new funding pledges announced, there are questions about how to translate strong rhetoric into action.

Some 16,000 stakeholders from more than 160 countries gathered in the Dutch capital last week for AIDS 2018, the conference’s 22nd edition and one of the biggest events in the global health calendar, featuring sessions on the latest HIV science, policy, and practice.

The week-long event was awash with celebrities including Elton JohnCharlize Theron, and the United Kingdom’s Prince Harry, as well as former United States President Bill Clinton, who gave the keynote speech at the closing plenary. The heads of the world’s major health donors, notably U.S. President’s Emergency Plan for AIDS Relief, the Global Fund to Fight, AIDS, Tuberculosis and MalariaWorld Health Organization and Joint United Nations Programme on HIV/AIDS were also in attendance.


Held under the theme of “Breaking Barriers, Building Bridges,” the real story of this year’s conference was the growing realization that the HIV/AIDS epidemic is in crisis, with 1.8 million new infections in 2017. There are also alarming spikes in new HIV cases among key groups including adolescent girls in sub-Saharan Africa and drug users in eastern Europe and parts of Asia, according to recent figures from UNAIDS. At the same time, development assistance for HIV dropped $3 billion between 2012 and 2017, according to a study by the Institute for Health Metrics and Evaluation.

“The feel is definitely less congratulatory than past conferences and more sobering,” Rachel Baggaley, coordinator for HIV prevention and testing at WHO, told Devex, but added that it was good to see the community responding with force. The activist spirit which has defined the fight against AIDS in the past was never far away, she noted, with many sessions interrupted by campaigners.

“It is very positive to see the AIDS movement hasn’t gone away … I went feeling rather down and have come away challenged and inspired; there’s a lot of things we must do and a lot of people who continue to take this [AIDS agenda] forward,” she said.

One protest challenged the leadership of the U.N.’s dedicated AIDS agency, UNAIDS, with more than 20 female campaigners interrupting Executive Director Michel Sidibé — who has been criticized for his response to a sexual harassment scandal — during his address on stage at the opening plenary. Sidibé insists he has made changes and has resisted calls to step down, but his presence was a source of controversy.

In terms of funding, the conference saw the launch of the new $1.2 billion MenStar coalition to expand HIV services for men and boys, and £6 million ($7.87 million) in new funding from the U.K. government for grassroots HIV groups, provided through the Robert Carr Fund. The real test, however, will be next year’s Global Fund replenishment in France.

The key now will be turning the strong rhetoric and passion seen throughout AIDS 2018 into action on the ground, according to youth HIV activist Mercy Ngulube.

“We are all going to build bridges this week … but where is your bridge going to lead us? Don’t let your bridge be a bridge to nowhere,” she said during the opening plenary.

A Devex team was on the ground throughout the week and rounds up the key takeaways.

1. Target key populations

Attendees agreed that, without drastic change, the world will see global HIV targets missed and a possible resurgence of the epidemic. But Peter Piot, founding executive director of UNAIDS and now director of the London School of Hygiene and Tropical Medicine, warned the targets themselves could leave key populations even further behind.

Speaking on Thursday, Piot reminded the audience that the 90-90-90 targets set by UNAIDS in 2014 will miss 27 percent of HIV patients. The framework calls for countries to get 90 percent of people living with HIV diagnosed; 90 percent of those diagnosed to be accessing treatment; and 90 percent of people on treatment to have suppressed viral loads by 2020.

“The 90-90-90 targets are actually 90-81-73,” he said, adding that “what the future of the epidemic is going to be determined by is the 10-10-10” — those not hit by the targets.

The 10-10-10 is likely to be made up of key populations including sex workers, men who have sex with men, LGBTI groups, people who inject drugs, and young people — all of whom are less likely to access HIV services due to social stigma, discrimination, criminalization, and other barriers, Piot said. These groups currently account for 47 percent of people with new infections, according to UNAIDS data.

Reaching these key populations was high on the agenda last week. Dudu Dlamini, a campaigner for sex workers’ health and rights who was awarded the Prudence Mabele prize for HIV activism during the conference, spoke to Devex about the need to decriminalize sex work in order to remove barriers to HIV services for sex workers.

Leading HIV scientists also put out a statement in the Journal of the International AIDS Society about laws that criminalize people with HIV for not disclosing their status and for exposing or transmitting the disease. Such laws, which exist in 68 countries, “have not always been guided by the best available scientific and medical evidence,” it said, and when used inappropriately can reinforce stigma and undermine efforts to fight the disease.

2. Prevention pay off

With new infections standing at 1.8 million last year, the recent UNAIDS report describes a “prevention crisis.” Traditionally, prevention has received only a tiny proportion of HIV funding, with the bulk going toward treatment. But there was a new buzz around the prevention agenda at this year’s event, in part driven by excitement around oral pre-exposure prophylaxis, or PrEP, which can prevent HIV infection among those at high risk. The antiretroviral medication has been successfully rolled out in North America, western Europe, and Australia, and has been shown to help reduce new infections among men who have sex with men.

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International AIDS Conference@AIDS_conference

WHO’s Baggaley said PrEP had “energized the prevention agenda.” However, questions remain about the feasibility of rolling it out in low-income countries, and about its efficacy for women.

“There is a prevention crisis and we need to find better ways of addressing it,” said Christine Stegling, executive director of the International HIV/AIDS Alliance. But while PrEP is a promising tool, a full approach to prevention needs to include a range of methods, combined with interventions that tackle human rights issues and gender inequality, she said.

3. A youth bulge

It was impossible to miss the strong youth presence at this year’s AIDS conference, which organizers said had a larger number of young people attending than ever before, and featured dozens of youth-focused events. This is linked to a growing recognition that adolescents face a disproportionately high risk of becoming infected with HIV, especially in Africa where the population is set to rapidly increase, and where new infection rates are on the rise among young people.

Ugandan youth advocate Brian Ahimbisibwe, a volunteer ambassador for the Elizabeth Glaser Pediatric AIDS Foundation, said: “Without the youth, the future of all these conferences, and more importantly [of] services and programs, [is] compromised.”

However, 28-year-old Tikhala Itaye, co-founder of women’s rights group Her Liberty in Malawi, said the youth voice had not been fully integrated and that young people were still being “talked at” during many of the sessions, as opposed to being listened to.

“There’s now acceptance that young people need to be at the center … they do have the demographic weight and power to influence issues around HIV,” she said, but “you still find the different youth events happening in different rooms … Why aren’t we all coming together as one to build the bridges and have a global voice?”

Signs at the 22nd International AIDS Conference in Amsterdam, The Netherlands. Photo by: Marcus Rose / IAS

4. The need for integration

A number of sessions talked about the need to integrate HIV programming, which has traditionally been siloed due to having its own funding streams, into broader health care. This was a key message of The Lancet Commission report on strengthening the HIV response published ahead of the conference, and was also the message delivered by WHO director-general Tedros Adhanom Ghebreyesus during the opening plenary.

“We have not truly helped a child if we treat her for HIV, but do not vaccinate her against measles. We have not truly helped a gay man if we give him PrEP but leave his depression untreated … Universal health coverage means ensuring all people have access to all the services they need, for all diseases and conditions,” he said.

Baggaley said integrating HIV into the broader health agenda posed both “an opportunity and also a challenge and risk for those populations most marginalized,” explaining that key populations currently served by externally funded nonstate health services could see their assistance diminished under UHC if the country in question did not believe UHC includes key populations or had punitive laws against gay men or sex workers, for example.

There was much discussion around the need to combine HIV and tuberculosis efforts, especially in the run up to the first U.N. high-level TB event in September. TB is the number one killer of people with HIV, who are up to 50 times more likely to develop it, according to WHO.

Speaking in between interruptions from the crowd, former U.S. President Clinton highlighted the need to address HIV and TB in tandem during the closing plenary and called on world leaders, notably India which has the highest TB burden, to attend the upcoming U.N. TB meeting.

“If you think … anyone ..that we can possibly bring the developing world to where we want it to be by abandoning the fight against HIV/AIDS and the collateral struggle against TB, you need to think again,” he said.

New findings from the Sustainable East Africa Research in Community Health program, presented during the conference, showed positive results from a community-based program which combined HIV testing and treatment with other diseases including TB, diabetes, and hypertension. The findings of a three-year randomized controlled trial in Kenya and Uganda showed that communities receiving testing and care for HIV alongside related conditions saw nearly 60 percent fewer new TB cases among HIV-infected people and that hypertension control improved by 26 percent.

5. Medical developments

Concerns about GlaxoSmithKline’s so-called “wonder drug” dolutegravir, which a study recently suggested might be linked to serious birth defects among children in Botswana, sparked debate amongst conference goers about whether potential mothers should be prescribed the drug.

WHO already advises that women of childbearing age wishing to take the antiretroviral have access to effective contraception, and will be re-evaluating its guidance as new evidence emerges, Baggaley told Devex. But there are concerns the agency could introduce blanket restrictions for women of childbearing age, which would force them to take other antiretroviral drugs that have worse side effects. The controversy could also lead to delays in the rollout of other forms of the drug, such as a pediatric version.

The conference also featured new data from the APPROACH study, which is evaluating the safety of several different HIV vaccines currently undergoing clinical trials in the U.S., East Africa, South Africa, and Thailand — but researchers admitted a vaccine will take years to develop.

6. The Trump effect

The shadow of U.S. President Donald Trump’s beefed-up “global gag rule,” otherwise known as the Mexico City Policy, loomed large over the conference, and a number of sessions discussed how it is negatively affecting HIV programs. Unlike previous iterations of the policy — which restricts U.S. funding to non-U.S. organizations that offer services related to abortion — Trump’s version is applied to almost all U.S. global health assistance, including PEPFAR.

Santos Simione from AMODEFA, an NGO that offers sexual health and HIV services in Mozambique, said his organization had lost U.S. funding due to the gag rule and was forced to close half of its youth clinics, which offered sexual and reproductive health services alongside HIV testing, counseling, and antiretroviral therapy.

“We could not provide condoms … testing … we just stopped everything,” Simione said.

Participants also spoke of a chilling effect, whereby organizations have stopped offering services that may not actually be prohibited under the rule, and raised concerns about PEPFAR’s staying power within a hostile Trump administration.

Meanwhile, there was heated debate about arrangements for the next conference, which the International AIDS Society has said will take place in San Francisco, California, in 2020. The decision has been met with fierce opposition and threats to boycott the event from AIDS campaigners who say many key population groups affected by HIV will have difficulties attending due to strict immigration policies. In 2009, former U.S. President Barack Obama lifted a restriction banning people with HIV from entering the country, but sex workers and people who use drugs still face legal challenges entering.