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Violence against women significantly more likely after high-risk sex

Violence against women significantly more likely after high-risk sex
Credit: Mary Ann Liebert, Inc., publishers

A study of the victimization of women who were living in areas of high poverty and HIV prevalence in multiple cities across the U.S. has shown that high-risk-sex, characterized by one or more HIV risk factors, was associated with a significantly greater likelihood of physical violence against the female participant within the subsequent 6 months. Detailed results of this study, its broader significance in light of the larger problem of violence against women, and implications of these findings for HIV prevention initiatives are discussed in an article published in Journal of Women’s Health.

“HIV-Risk Characteristics Associated with Violence Against Women: A Longitudinal Study Among Women in the United States,” was coauthored by Brooke Montgomery, Ph.D., MPH, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences (Little Rock) and a team of researchers from Emory University School of Medicine (Atlanta, GA), Rollins School of Public Health, Emory University (Atlanta, GA), University of Washington (Seattle), Fred Hutchinson Cancer Research Center (Seattle, WA), UNC School of Medicine and UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Milken Institute School of Public Health, George Washington University (Washington, DC), Johns Hopkins Bloomberg School of Public Health (Baltimore, MD), Columbia University School of Social Work (New York, NY), and West Virginia Clinical and Translational Science Institute (Morgantown).

In the accompanying editorial “Elevating Black Women in Contextually-Relevant Ways: A Top Priority in Violence and HIV Prevention Work,” Amy Bonomi, Ph.D., MPH, Michigan State University (East Lansing) lauds the researchers for focusing primarily on  (86% of the study population), noting that they “… have been historically under-represented in research and in larger societal conversations about violence against .”

“The findings by Montgomery, et al serve as an important call to action to prioritize black women in violence, sex risk, and HIV prevention programming across  care, , and broader societal settings, and to elevate their voices more broadly,” states Dr. Bonomi.

Author: Mary Ann Liebert


‘Game-changer’ HIV prevention drug could be leading to lower condom use: studies

stealthing condom removal

PrEP is so effective at preventing HIV that some men might be using condoms less often when they’re on it, studies suggest.

Pre-exposure prophylaxis, commonly known as PrEP, is a “game-changer” when it comes to preventing HIV infections, doctors say. But some new studies are suggesting that people who take it use condoms less often — increasing their risk of contracting other sexually-transmitted infections.

“If you take them before you get exposed to HIV, it can actually dramatically reduce your risk of actually acquiring HIV if you’re exposed to it,” said Dr. David Moore, an associate professor of medicine at the University of British Columbia and a research scientist at the B.C. Centre for Excellence in HIV/AIDS.


It has been shown to be between 90-100 per cent effective in a number of studies, he said. Some research suggests that the number of HIV diagnoses in certain communities has actually decreased since it was introduced there.

“We’re really kind of thinking of it as a game-changer, in that it has the potential to dramatically reduce the number of new infections, particularly in gay and bisexual men.”

Condom use

But as many men start using PrEP to reduce their risk of HIV transmission, they use condoms less, according to a recent analysis from Australia. 

The researchers reviewed existing research on the subject and found evidence of more people reporting condomless anal sex with more than 10 partners, condomless sex with an HIV-positive or unknown HIV status partner and never using condoms during anal sex.

This seems to have consequences. “Study findings suggest that STIs increase after participants commence PrEP,” the authors wrote.

However, in an email, study co-author Michael Traeger noted that condom use had already been declining and STI rates increasing among gay and bisexual men before PrEP was introduced. “PrEP is perhaps just one of many contributors to changing STI epidemiology among gay and bisexual men,” he wrote.


In another recent Australian study, researchers surveyed 16,827 men who reported having had casual sex with men in the last six months, between Jan. 1, 2013 and Mar. 31, 2017. They found that as PrEP use became more popular in the gay communities of Melbourne and Sydney, overall condom use declined. Consistent condom use dropped from 46 per cent of men in 2013 to 31 per cent in 2017.

This isn’t a surprise, said Dr. Paul MacPherson, an infectious disease physician at the Ottawa Hospital who holds the Ontario HIV Treatment Network research chair in gay men’s health.

“It should be no surprise to anyone that if you have a medication that reduces an unwanted outcome of sexual activity that people will use condoms less. That’s what heterosexuals do with the Pill, [so] it’s not surprising that’s what gay men will do with PrEP.”

His own research in Ottawa suggested that the possibility of HIV transmission was the biggest source of anxiety around sex among gay men. With the introduction of PrEP, he didn’t find that men had more sexual partners or had sex more often, or even a significant increase in other STIs — just that they were using condoms less and reported much less anxiety around sexual activity.

Moore had similar thoughts.

“It seems that the STD that they’re most concerned about is HIV and so it’s not surprising that there may be less condom use over time while people are on PrEP,” he said.

Common STIs like chlamydia, gonorrhea and syphilis are fairly easy to treat and also don’t generally have big complications for gay men, he said, with the possible exception of some rare but serious complications of syphilis.


STI risk

There’s another issue with the studies on PrEP and condom use: who’s taking it. The Canadian guidelines recommend that gay men who report recently having condomless sex take it if they have been diagnosed with an STI in the last 12 months — meaning they were already engaging in riskier behaviour.

“You want actually the higher risk people to be taking it,” said Moore.

And once they’re on it, they’re regularly tested for STI infections, meaning that infections might be diagnosed faster and more often.

This could actually be a good thing for public health, he thinks. Through regular testing associated with PrEP, infections like gonorrhea and syphilis might be caught and cured quickly, before they’re spread to other partners.


He doesn’t think the evidence is there yet, but he thinks it’s possible this could actually mean that rates of these common STIs could go down, despite lower condom use. “We may end up better diagnosing and treating these other STIs than we were before.”

It’s a good idea for people on PrEP to keep using condoms to prevent diseases other than HIV, said MacPherson. “In a good motherhood kind of thing, it’s always good to promote condom use to maximize people’s risk reduction, but I’m not at all surprised when young women on the Pill get chlamydia or gay men on PrEP get chlamydia.”

“I would be very upset if gay men got stigmatized around this when they’re not doing anything different than the heterosexual population. Which is, taking a pill so they don’t have to use condoms.”

When people are aware of the risks, they can make an informed decision, he thinks. “As long as you know the risks when you get behind the wheel, I’m not going to tell you not to drive your car.”


Sanctum Survivor weekend illuminates challenges of homelessness- Saskatoon

My 36-hour glimpse of what it’s like to be homeless while coping with a physical limitation showed me how quickly pride can go out the window when barriers to necessities pile up.

It was around 8C outside and seven millimetres of rain was coming down. I was using a wheelchair to get around. My partner, Mike Gaff, and I had only the donated clothes on our backs.

Mike and I were two of 11 community members who agreed to step away from our regular lives, homes, cars, families and debit cards to participate in the 2018 Sanctum Survivor Challenge.

The project aimed to raise awareness of the realities of homelessness, poverty and the poor health that often accompany them, as well as to raise money for Sanctum Care Group’s 1.5, a home for pregnant women with HIV.

The house, which will be the first of its kind in Canada, is now being built near St. Paul’s Hospital. It will provide care to help prevent transmission of the virus to the infant and help keep babies in their mothers’ arms instead of in the child welfare system.

Sanctum Care Group has a fundraiser website on for those who want to donate.

At 7:30 a.m. Friday, I was wearing three short sleeved t-shirts, a light jacket and, under that, a small pair of thick sweatpants draped over my back and shoulders for extra insulation. I had a fleece blanket and a plastic poncho to cover my legs and arms.

Mike was told he had diabetes and needed to consult medical experts about diet and to monitor his blood sugar levels twice a day.

He wore a t-shirt and lightweight hoody.

We had a list of places to go, some as far away as AIDS Saskatoon on 33rd Street. We needed to obtain health services without identification, learn how to get ID without an address, be tested for HIV and learn how to get the opioid antidote naloxone. We were to wash our hands regularly, launder the only clothes we had and do an act of kindness.

Mike pushed my wheelchair 12 blocks to the Food Bank in a cold wind. We emerged from that brief, warm place with two heavy bags of canned food, meal replacement drinks, juice, bread and celery.

Next, we needed $2 to get some warmer clothes and toothbrushes from the Food Bank’s clothing depot.

It was starting to rain. Mike’s sweater would be soaked in a few minutes.

I did what I think anyone would do in the circumstances.

I put out my hand to a passing stranger and asked if they had any spare change.



Addiction help a phone call away through new Indigenous health program

Chippewas of the Thames First Nation secured three years of funding for the project through the province

Heather Nicholas (left) and Kimberly Fisher (right) are working on a new cultural outreach program based out of Chippewas of the Thames First Nation, slated to begin mid-July. (Paula Duhatschek/CBC)


Addiction help will soon be just a phone call away for people living in Chippewas of the Thames First Nation, Oneida Nation of the Thames and Munsee-Delaware Nation.

Beginning in mid-July, a cultural outreach team based in Chippewas of the Thames First Nation will circulate in all three communities, equipped with clean needles, safe drug use supplies—like sterile water and cooking pots—and information about addiction treatment.

The sacred medicines sage and tobacco will also be part of the toolkits, said community health nurse Heather Nicholas.


 want to talk to the Creator and do prayers, or put their tobacco down to ask for help, that’s available for them as well,” said Nicholas, who added that the team will also help clients access cultural services.

“If they need to see a traditional healer, [we] have that information for them; if they want a naming ceremony, how do they go about that; if they want to go to a sweat, how do they do that.”

The idea is that clients who begin using the outreach program for needle exchange will go on to use other healthcare and cultural services, and strengthen ties with their communities, said Nicholas.

The community has secured three years of funding for the program through the Ministry of Health and Long-Term Care.

How it works

Maintaining privacy is a major consideration for the project, given that the outreach staff will be working in small communities, said Nicholas.

“Everybody knows everybody’s business, like a fishbowl scenario,” she said.

With that in mind, clients can call a toll-free number and connect directly with an outreach worker. They won’t have to go through administration or wait for an appointment, which can in itself be a barrier for people living with addiction, Nicholas said.

The toll-free number is 1-833-289-0544.

Outreach staff will also use their own cars, rather than a designated vehicle.

“It’s the best way of servicing the community without saying ‘Oh yeah I see this van up at your place’ sort of thing,” said Nicholas. “So it’s individual cars, and they could be there for a number of reasons.”

Staff will be available between 10 a.m. and 6 p.m. every day. The hours were chosen in consultation with the the Regional HIV/Aids Connection, which operates a needle exchange program in London, and where peak times tend to be clustered between 11 a.m. and 3 p.m., Nicholas said.

A growing need for service

As in London, stray needles are an ongoing issue for the community, said Nicholas.

“I’ve had grandmothers come in with garbage bags full of needles [who] didn’t know what to do with them, and where to dispose of them,” she said, adding that the needles will pop up in all kinds of areas, including playgrounds, and fishing spots.

Meanwhile, the addiction rate in the community increased by 9 per cent between 2011 and 2016, according to health administrator Kimberly Fisher.

A statue outside the Chippewas of the Thames First Nation health building commemorates the students who attended the residential school and those who never returned home. (Paula Duhatschek/CBC)

The problem has links to the community’s historical experience with residential school, said Fisher. Some families at Chippewas of the Thames First Nation have had two or even three generations go through the school.

Compounding that intergenerational trauma are ‘everyday life’ traumas, such as car accidents, suicides and deaths, Fisher said.

“Not having the mechanism to identify that trauma and move on has had a great impact,” she said.

The cultural outreach program will help people deal with some of those traumas, and to draw on their strengths, Fisher said. For instance, a client with a talent for Indigenous languages could be tapped to help with youth language programs, she said.

“A lot of community members do isolate themselves, so this is building those relationships and drawing on their strengths and bringing them back into the community,” she said.

“It’s really to give them purpose, meaning, hope and belonging, because that’s what every community member wants.”


Human rights complaint alleges lack of harm-reduction programs puts Canadian inmates at risk of overdose

Former inmates on probation or recently released from prison are at a greater risk of a fatal-drug overdose, according to a recent review by the B.C. Coroners Service.
Former inmates on probation or recently released from prison are at a greater risk of a fatal-drug overdose, according to a recent review by the B.C. Coroners Service.BRIANAJACKSON / ISTOCK


Since the arrival of the synthetic opioid fentanyl, it’s become especially dangerous for B.C. residents who struggle with a drug addiction to enter a Canadian prison.

According to an April 2018 B.C. Coroners Service report, of people who died of an illicit-drug overdose in B.C. between January 2016 and July 2017, 66 percent were under B.C. Corrections supervision or had spent time in a provincial prison during their lifetime.

“The increase in mortality among released prisoners who formerly used opiate drugs is attributed to loss of tolerance and erroneous judgment of dose on return to opiate use,” the reportreads.

It means that it is especially important for Canadian prisons to offer inmates addiction-treatment options. But it is often inside Canadian prisons where such services are not available. While options for treatment generally are available in B.C. Corrections facilities, the same cannot be said for institutions operated by Correction Service Canada (CSC).

Now a B.C. group of prisoners’ advocates has filed a complaint with the Canadian Human Rights

Commission with the goal of expanding access to addiction-treatment options inside federal facilities.

“WCPJS [West Coast Prison Justice Society] is concerned that prisoners are at great risk of fatal overdose, and HIV and hepatitis C infection because of barriers to treatment with Suboxone or methadone, as well as a lack of adequate harm reduction initiatives and psychosocial therapy,” reads a June 4 media release.

“Other prisoners reported having been cut off Suboxone or methadone, some cold-turkey, and suffering painful and dangerous withdrawal symptoms, on the basis of unproven speculation that they were trying to share medication with other prisoners,” it continues.

“The complaint asserts that these practices discriminate against prisoners who suffer from addiction, which is considered a disability under human rights law, as well as against Indigenous and Black prisoners who are disproportionately affected.”

Jennifer Metcalfe, executive director of WCPJS’s Prisoners’ Legal Services, is quoted in the release noting the benefits of addictions treatment for inmates extends beyond those individuals.

“Providing treatment for opioid use disorder helps prisoners to heal, rehabilitate and become productive, law abiding members of the community,” she says quoted there.

There were 1,448 illicit-drug overdose deaths in B.C. in 2017. That compares to an average of 204 deaths per year recorded across the province from 2001 to 2010. In 2017, fentanyl was associated with more than 80 percent of fatal overdoses in B.C.


Drug to treat alcohol addiction also helps with suppression of HIV    

A half-completed jigsaw puzzle depicting a beer bottle on its side.

A medication commonly prescribed to treat alcohol use disorder also appears to help maintain or improve suppression of HIV among individuals at risk for relapse receiving HIV antiretroviral treatment, Yale researchers said.

In a new study, a research team led by Dr. Sandra Springer conducted a placebo-controlled, randomized trial involving individuals incarcerated in Connecticut who had both HIV and alcohol use disorders. Upon release, the 100 study participants were given either extended-release naltrexone — an FDA-approved drug that treats alcohol addiction — or a placebo. The researchers followed the individuals for six months from the time of release.

At the end of the study period, the research team found that the study participants taking extended-release naltrexone were more likely to have either maintained or improved suppression of HIV.

The study findings confirm the added benefit of extended-release naltrexone for people who have alcohol use disorders and HIV disease, and demonstrate its effectiveness in helping patients to meet the goals of HIV treatment. The paper is published in the Journal of Acquired Immune Deficiency Syndrome.

Author: Ziba Kashef


These Gay Men Have Spent 30 Years Learning How To Be Long-Term HIV Survivors

“It was hell to watch people die in the ’80s, but my personal hell was when long-term survivors were forgotten.”
Long-term HIV survivor Sean McKenna today.

Long-term HIV survivor Sean McKenna today.

Sean McKenna, 55, was diagnosed with HIV in 1992. He takes 22 pills a day and deals with diarrhea, joint pain and HPV. He’s been on disability, unable to work, for over 20 years.

Luigi Ferrer, 59, has been HIV-positive since 1985, but he works full time and takes only one pill a day.

McKenna has survived bouts of pneumocystis pneumonia and other HIV-related complications that have killed many of his peers. Ferrer has never had a life-threatening complication.

Scott Kramer, 50, was diagnosed in 1988. He survived a bout of PCP in 1992 but was able to return to work full time.

“There’s no one way to be a long-term HIV survivor,” said Kramer, a therapist who specializes in people with HIV and runs support groups in New York City for gay men with the virus. “We’ve all been through trauma, but with a mix of support and luck, we’ve survived longer than we ever imagined.”

Long-term HIV survivors ― generally defined as those diagnosed before lifesaving drugs were released in 1996 ― face their own set of physical and emotional challenges as they age. Some were lucky to have relatively mild bodily symptoms. Others became isolated by illness, stigma and the inability to work. But all dealt with a terrifying diagnosis at a time when doctors had little to offer.

In recent years, a few survivors have emerged to speak up for their peers, whose lives and stories they say are unappreciated or forgotten by today’s gay community.

Sean McKenna shortly after learning he was HIV-positive in 1992.

Sean McKenna shortly after learning he was HIV-positive in 1992.

On June 5, 1981, the Centers for Disease Control and Prevention reported cases of young gay men dying from a rare pneumonia, later identified as PCP. It was the first official recognition of the HIV/AIDS epidemic.

For five years now, June 5 has been designated HIV Long-Term Survivors Day by the advocacy group Let’s Kick ASS (AIDS Survivor Syndrome), which estimates there are some 34,000 long-term survivors in the U.S.

Long-term survivors face challenges generally not shared by those diagnosed after 1996. Many continue to experience a cascade of physical symptoms in part because they spent years taking early drugs that were either ineffective or harmful. Emotionally, they suffer from the trauma of years of watching their friends die painfully while expecting they would be next.

At the beginning, no one knew long-term survival was possible, much less what it would look like.

In 1996, McKenna survived his second PCP hospitalization and went on antiretroviral drugs, known as ARTs. His condition was no longer life-threatening, but persistent symptoms, some debilitating, meant he couldn’t hold a full-time job.

Many of his friends had either passed away or were too sick to socialize, and without a job, he’d often spend weeks or months without any meaningful social interactions.

During the worst days of the plague, when he’d attend about eight funerals a month, McKenna said there was more support for people living with HIV. But once better treatments became available, he said the gay community moved on to new issues, like marriage equality.

“In the beginning, people would check on me, but around the late ’90s, people stopped dying from HIV like they used to. And then the calls and visits stopped,” he recalled. “It was hell to watch people die in the ’80s, but my personal hell was when long-term survivors were forgotten.”

When Ferrer was diagnosed, he went through an initial phase of denial. He didn’t seek treatment or take medication and continued pursuing his Ph.D. in oceanography. He didn’t have any symptoms for some eight years.

But that changed in 1993 when he developed minor infections. “It started with bronchitis, but I was always running to the doctor for something,” Ferrer said. “I saw the writing on the wall.” He assumed the worst was coming.

Luigi Ferrer in 2018.

Luigi Ferrer in 2018.

He gave up oceanography to become the executive director of an AIDS service organization, and he has worked in HIV/AIDS advocacy and support since then. He’s now the community relations manager at Miami’s Pridelines, where he spends his days administering free HIV testing and passing out information.

“There’s days where I miss being out on the ocean diving,” he said. “But I didn’t feel like I had a choice: I was drafted into this work. At the time, I never thought I’d still be here doing this.” His health has been mostly stable since 1996.

His career shift had one welcome result: the new connections he made with the queer community.

In his first AIDS service job, Ferrer shared an office with a local bisexual support and advocacy group. Through them, he embraced his own bisexuality and became an advocate. He’s currently on the board of BiNet USA, a national bisexual network. He also got involved with the Radical Faeries, a community he describes as gay hippies who reject society’s norms. Since 1998, he’s attended their 10-day festival in a forest outside Nashville every year.

“Nudity is not frowned upon,” he said, laughing. “People come and share art and stories of their communities. For me, it’s a family of older queers.” He said that some of the festival-goers are fellow long-term survivors as well, but he doesn’t know how many. “There’s no stigma there, so we don’t talk about it much or count the numbers.”

Activism and the need for community eventually called McKenna as well.

He said he received a wakeup call in 2012 when prominent HIV activist Spencer Cox died after he stopped taking his medication. Cox had what advocates call “pill fatigue,” when long-term survivors lose the motivation to stay on their meds, generally because of depression.

In the beginning, people would check on me, but around the late ’90s, people stopped dying from HIV like they used to. And then the calls and visits stopped.Sean McKenna

McKenna felt obligated to speak up for long-term survivors, but he said it wasn’t easy.

“People didn’t want to pay attention to me at first. They wanted to think ARTs had solved everything,” he said. “It was like, you’re alive, isn’t that enough?” He said there were barely any services for long-term survivors even in New York City.

He focused his efforts on the Gay Men’s Health Crisis, a pioneering nonprofit founded in 1982 to respond to the AIDS epidemic. McKenna urged them to pay more attention to the needs of long-term survivors, and in 2015, after three years of lobbying, they implemented a buddy program.

Susan Rowley, who runs the program, said in an email that the phrase “long-term survivors” wasn’t in use until recently, and it took some time to adjust programming to meet the specific needs of that community.

“They’re still dealing with the stigma of HIV, societal ageism, and the increasingly challenging physical and medical conditions that come with age,” she said. “We know that face-to-face meetings in a social setting or even a weekly phone call can be a significant help.”

The program currently has 28 survivors, with two on the waiting list.

Kramer, the therapist, said community support is absolutely essential for people with HIV. “That’s why I do what I do, to create a sense of community,” he said.

Like Ferrer, Kramer spent some years in denial after his diagnosis. But in 2005, he decided to leave his career as a graphic designer and become a social worker, specifically to help others diagnosed with HIV.

Scott Kramer, seen on a Gay Men's Health Crisis ID card.

Scott Kramer, seen on a Gay Men’s Health Crisis ID card.

All three survivors spend time talking to younger gay men about HIV and safe sex. Ferrer said there’s not nearly enough awareness about the virus, noting that Miami has the highest infection rate in the country.

Kramer said the younger men he encounters are reasonably well-informed, although they could know more. “When I was their age, I wasn’t so concerned with what happened 30 years ago either,” he said.

McKenna said he tries to explain to younger men that PrEP, the HIV prevention drug that’s become widely used in the last few years and encouraged many gay men to stop using condoms, doesn’t protect against other sexually transmitted diseases. He cautions that unprotected sex still carries risk ― a message that often falls on deaf ears.

“They tell me, ‘You’re slut-shaming us,’” McKenna said.

He’s heard that before.

In 1981, in the early days of the epidemic, writer Larry Kramer, who co-founded the Gay Men’s Health Crisis, began to sound the alarm about unprotected sex, but many gay men saw that as a fear tactic that would diminish their newly found sexual liberation. McKenna listened to the warning and volunteered to pass out condoms at a Pride parade. It was a tough sell.

“The first person I gave one to threw it back at me, spit in my face and accused me of slut-shaming,” he recalled.

“I just want young people today to be safe. They don’t realize ― my generation, we were the guinea pigs, we put faith in bad drugs that failed us,” he said.

Whether people want to listen or not, McKenna will keep speaking up. After his success with the buddy program, he knows he has more to give.

“No one ever asks about my future,” he said. “I don’t know how much longer I’ll live, but my future is not sealed.”


T cells alone are sufficient to establish and maintain HIV infection in the brain

T cell
Scanning electron micrograph of a human T lymphocyte (also called a T cell) from the immune system of a healthy donor. Credit: NIAID

A new study by University of North Carolina School of Medicine researchers has found that T cells, a type of white blood cell and an essential part of the immune system, are sufficient by themselves to establish and maintain an HIV infection in the brain.

“These results are paradigm changing,” said co-corresponding author J. Victor Garcia, Ph.D., Oliver Smithies Investigator, professor of Medicine and a member of the UNC Institute for Global Health and Infectious Diseases, the UNC Center for AIDS Research and the UNC Lineberger Comprehensive Cancer Center. “We have demonstrated for the first time that infection of the  can be established and maintained by both human macrophages and T .”

The study, published today in the Journal of Clinical Investigation, builds upon previous work by the same group of researchers, which found that the virus persists in HIV-infected macrophages and demonstrated the ability of tissue macrophages to support HIV replication in vivo in the total absence of human T cells. Macrophages are large  found in tissues throughout the body including the liver, lung, bone marrow and brain.

HIV/AIDs researchers long believed that  are critical for HIV infection of the central nervous system. But more recent research indicates that HIV infection in cerebral spinal fluid can originate from both T cells and/or macrophages.

To directly address whether or not T cells contribute to the seeding and persistence of HIV infection in the brain, researchers in the laboratories of Angela Wahl, Ph.D. and Garcia used a humanized T-cell only mouse model to determine whether or not myeloid cells are essential for HIV infection of the brain.

The study’s lead author is Jenna B. Honeycutt, Ph.D., a postdoctoral research associate in the division of infectious diseases at UNC and the UNC Center for AIDS Research.

“In our studies we show that T cells are a major target of HIV infection in the brain, both in the presence and in the absence of ,” said Honeycutt. “In addition we describe a previously unknown phenomenon that occurs in the central nervous system rapidly after infection—specifically, a significant depletion of CD4 T cells within 1-2 weeks of infection in the brain.

“This has previously been reported for mucosal tissues, but has not been reported previously in the brain. We also report that the depletion of CD4+ T cells in the brain can be efficiently reversed by antiretroviral therapy,” said Honeycutt, whose work on this research recently led to her being awarded the Lineberger Comprehensive Cancer Center’s Pagano Award.

Another significant aspect of this work is that it establishes that the brain is not an immune-privileged site as previously thought, and that the possibility of a persistent reservoir for HIV in the brain has been severely underestimated.

“Despite effective suppression of HIV virus in the blood by antiretroviral therapy, we were still able to detect virus in the brain in more than 65 percent of the brains analyzed,” said Wahl, who is co-corresponding author of the study. “These results indicate that the brain may be an important reservoir for HIV in patients that should be targeted by HIV cure approaches. Future studies will be needed to determine if the virus that persists in the brain during ART is able to re-ignite the  if ART is removed.”


Gilead takes HIV prevention message to TV, pushing PreP awareness with hipster ad

Gilead pushes HIV prevention in a new awareness commercial in which young adults get honest about sex and health. (Gilead)

‘Emotional closeness’ key to successful HIV treatment support

The type of relationship someone living with HIV has with both their social network and a nominated ‘treatment partner’ is likely to influence whether they are virally suppressed, research from Botswana suggests.

large family sitting on the ground in Botswana

As more countries recommend the use of treatment partners to help people living with HIV adhere to their antiretroviral treatment, there is a need to understand better what makes these partnerships succeed. A recent study conducted in Botswana, suggests that individuals whose partners provided more holistic, non-medical support, were more likely to be virally suppressed.

The researchers interviewed 131 adults living with HIV and their treatment partners attending an HIV clinic in Gaborone, Botswana. Participants had been on antiretroviral treatment for at least six months and half (51%) of those selected were virally suppressed.

Participants and their treatment partners were interviewed separately. Wherein they provided details of the nature of their relationship and the characteristics of the HIV-positive person’s social network overall.

The findings suggest people who selected spouses or other intimate partners as treatment partners, and who trusted and felt close to members of thei social network as a whole, were more likely to be virally suppressed.

This is because a treatment partner who was in a close and trusted relationship with someone living with HIV has more frequent opportunities to observe that person and provide on-hand support to meet a range of needs.

The researchers also found that the treatment partners of people with suppressed HIV tended to provide more in-depth adherence support, such as dropping off medications, as well as broader, non-medical support that encouraged someone to stay healthy in ways not directly tied to medication.

For example, treatment partners of people with suppressed HIV were more likely to prepare food or baths, and proactively attend to other emotional and physical needs. They were also more likely to remind the person to eat healthily, to exercise, to avoid alcohol and drugs, and provide general support and acceptance. Overall, 69% of patients who reported receiving these kinds of nonmedical support from their treatment partner were virally suppressed.

Treatment partners of people with unsuppressed HIV tended to focus more narrowly on reminding people to take medication or attend appointments. Even when providing nonmedical support, treatment partners in this category tended to focus on medication, for example, by reminding someone to eat before taking antiretrovirals.

Citing similar findings from Uganda, researchers suggest the reason why treatment partners who took a more holistic approach were more successful was because they may have been perceived to be more caring, whereas treatment partners with a more narrow or ‘badgering’ focus on adherence were more likely to be viewed as failing to understand the wider context and challenges experienced by someone living with HIV.

At the moment, people living with HIV are rarely given guidance on who they should select, and likewise treatment partners are often not advised on how to provide effective support.

These findings suggest treatment partners not only need basic, biomedical training about HIV medication, adherence and side effects, but they could also benefit from training about what kinds of support are most effective, how to provide this support through the use of non-confrontational counselling skills, and which approaches to avoid.