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Ending HIV transmission by 2030

Max Essex

Harvard’s Max Essex, one of the first scientists to hypothesize that a retrovirus was the cause of AIDS, discussed the Trump administration’s plan to end HIV transmission.

Stephanie Mitchell/Harvard Staff Photographer

Harvard professor emeritus Max Essex says it’s possible

After four decades of fighting AIDS and the human immunodeficiency virus that causes it, the U.S. government is pressing forward with a plan to end HIV transmission in the country by 2030.

The plan targets about 48 “hotspots” where transmission is concentrated with enhanced surveillance and tracking, as well as stepped up prevention and treatment efforts. It dovetails with a similar international goal supported by the Joint United Nations Programme on HIV/AIDS (UNAIDS), which also seeks to greatly reduce transmission by 2030.

Max Essex, the Mary Woodard Lasker Professor of Health Sciences Emeritus and chair of the Harvard T.H. Chan School of Public Health AIDS Initiative, has been on the epidemic’s front lines from its start in the early 1980s. He was one of the first scientists to hypothesize that a retrovirus was the cause of AIDS and conducted early work that led to one of the first blood tests for HIV. Through the Botswana-Harvard Partnership, he conducted research on the global pandemic in southern Africa, among the world’s hardest-hit spots.

Essex talked to the Gazette about the Trump administration’s plan to end HIV transmission — announced during last month’s State of the Union address — its chances of succeeding, and what the approach of such a milestone means to those who’ve worked in the field for decades.

Q&A

Max Essex

GAZETTE: What was your reaction when you heard about the plan?

ESSEX: I was a little bit surprised, but not hugely, because I think it was pushed hard by [Centers for Disease Control and Prevention (CDC) Director Robert] Redfield. Redfield has connections with Christian evangelical groups that he and others worked closely with in ’02 or ’03, during the second Bush administration, to set up the PEPFAR program [the President’s Emergency Plan for AIDS Relief].

I’m sure that constituency, with Tony Fauci [head of the National Institute of Allergy and Infectious Diseases], still exists, although it’s probably somewhat back-burnered by the others who are stronger voices in the Republican Party right now.

GAZETTE: How realistic is the idea that we can end transmission here in the U.S.?

ESSEX: It’s realistic.

Just as background, I’m on the UNAIDS advisory council. That was the group that initially proposed the 90-90-90 guidelines that recommend 90 percent of people who are HIV-positive in a given country should know they’re positive. Of those who are positive, 90 percent should be in treatment. And of those in treatment, 90 percent should be in complete viral suppression, meaning the treatment is working. And if the treatment is working, then they’re not infectious because virus levels in their body, including in reproductive tract fluids and blood, wouldn’t be infectious.

If, by 2020, the world is — or given countries are — in adherence with 90-90-90, then 10 years after that, by 2030, there should be a 90 percent reduction in new infections. That has been interpreted by some as meaning the end of the epidemic, but it’s not really the end.

That’s because the more cases that you successfully treat, the more HIV-positive people you’re keeping on drugs for a long time, maybe a lifetime. So, the total number of people who are infected goes up because they’re not dying.

That plan has worked best in countries that have had the highest rates of infection — in southern Africa: Botswana, Namibia, places like that — where the populations were ready to be tested and get treatment and everything else.

They’ve been doing extremely well and are already at 90-90-90. Probably in Botswana it’s 95-95-95.

GAZETTE: Really?

ESSEX: Yes. We published a paper two or three years ago saying Botswana was almost at 90-90-90. The bottom line is that in places like that, in Namibia for sure and to some degree in South Africa and Swaziland and Zimbabwe, new infections are decreasing very dramatically, much more so than in the U.S.

One of the reasons is probably because they’re generalized epidemics that affect a large fraction of adults. In the U.S., it’s an uneven epidemic that’s concentrated in certain populations and some of the poorest sections of big cities, like Washington, D.C., and Baltimore, where there’s high injection-drug use. It’s also in other communities, not necessarily the biggest cities, characterized by higher rates of hepatitis B and things that are associated with injection transmission, as well as cities that have high rates of gay-men transmission and poverty-related transmission.

It’s logical the CDC would focus in on [those hot spots] because the CDC first gets the information through surveillance. They know which populations are most infected geographically, behaviorally, and otherwise. So, they are the most logical ones to draw up a plan that says we’re going to concentrate our resources for testing and “treatment as prevention” in those places where incidence is highest.

It remains to be determined how universally accepted the interventions will be by those communities.

GAZETTE: Is that the biggest hurdle? Community acceptance?

ESSEX: I think the biggest hurdle is participation by many in the highest-risk groups. That’s especially true in those places and for those subpopulations who’ve been most marginalized and outside of public health programs, like injection drug users who haven’t been exposed to clean needle exchanges and programs like that.

That’s going to be very uneven, according to different state [programs] and local stigma and things like that. It will take a fairly involved analysis and a lot of education of the local political establishment, as well as of the population at risk.

GAZETTE: And do you have a sense that the folks at the CDC and Health and Human Services and whoever else might be involved can pull it off?

ESSEX: Redfield is certainly very knowledgeable, appreciates the magnitude of the problem, and knows what to do. But the extent to which he’ll get cooperation from local and regional politicians in places where there’s still a lot of stigma and discrimination, whether it’s based on sexual orientation or injection-drug use or whatever else, is not as clear to me.

I think that’s a much bigger hurdle for places like the U.S. and other somewhat developed countries of the world as opposed to places like southern Africa, where it was a generalized epidemic early on.

GAZETTE: That’s an interesting distinction you’re making. It sounds like the characteristic of the epidemic in southern Africa that made it such an existential threat — that most of the transmission was heterosexual and it was in the general population — has also made these prevention measures easier and more acceptable to the general population there. Here, antiretrovirals came in right away and the epidemic flirted with crossing into the general population, but we managed to beat it back, and the fear of AIDS has kind of receded. Is that success in some ways working against us in these last phases?

ESSEX: Yes, though I’m not sure a lot of injection-drug users who are at higher risk have quite the same issues.

But for example, younger gay men, some of whom may be fairly sophisticated and recognize that now, going on modern, three-drug regimens with drugs like Dolutegravir — which doesn’t generate drug resistance and is easily tolerated — is not hugely different from going on drugs for hypertension, in the context of taking drugs on a regular basis for the rest of your life, and not having huge side effects from them.

GAZETTE: You’ve been involved with this epidemic from the start. Did you think you’d get to a point where we’d be talking about the end of transmission — clearly a critical milestone — without a vaccine?

Toward an AIDS-free generation

Researchers, ethicists wrestle with how to run a large study that could show effectiveness of ‘treatment as prevention’

ESSEX: It depends on the timeframe in which you’re asking the question. In the 1980s or early 1990s, I would have said our only hope is a vaccine. There’s no chance we’ll get ahead of this with drugs.

If it was in the early 2000s, before 2008 or 2010, I would say drugs are showing an awful lot of promise and the more people who are on them the fewer people who are going to get infected.

But if it was five to 10 years ago, I would say it’s really looking very promising that drugs will be the answer and a vaccine isn’t even needed. Further, I’d probably say that it wouldn’t be possible to do efficacy trials on a vaccine in a conventional way [which would require control subjects to forego known, effective treatment, like PrEP (pre-exposure prophylaxis)].

The change has been a combination of how well treatment-as-prevention is working to decrease transmission, and how well PrEP is working on high-risk groups who aren’t yet infected but are such high risk that drugs might prevent infection.

I think those things, to those of us in the business, were apparent years before they were apparent even to the general health establishment.

GAZETTE: You conducted trials on treatment-as-prevention — which aims to not only keep a person well, but also reduce their viral load to the point they’re not infectious, right?

ESSEX: Beginning by about 2010. We’re getting answers to these questions and they’re clearly affirmative.

It’s apparent to everyone now that you can do tremendous things with drugs. Even more than that, I would say the biggest change — that I wouldn’t have expected — is how well some of the drugs work. They don’t generate drug resistance because they’re well-tolerated, so people have no reason not to take them on a regular basis.

GAZETTE: So, we have good drugs. We have a strategy to slowly strangle the epidemic as opposed to killing it quickly with a vaccine, and here we are?

ESSEX: Yes. There was a timeframe where [many thought] such drug approaches wouldn’t work because the drugs were so expensive. Twenty years ago, some of us were saying, “Yeah, I don’t know how on earth they’ll ever be cheap enough or available enough for widespread use treating people at low-income sites.”

GAZETTE: I remember that narrative. What happened to it? Did the price come down? Or did more money, from PEPFAR, the Clinton Foundation, and other sources, just become available?

ESSEX: It was all of the above. The Clinton Foundation played a big role in that, for sure. And yet, making generics in India and a few other places played a big role in it too. And developing drugs that didn’t generate drug resistance, like Dolutegravir, played a big role. Now Dolutegravir is being used in Africa. For the future, newer slow-release formulations of such drugs will also be very important.

So it was all of the above. Some things more than others, but it’s been quite a ride.

Author:

Source: https://news.harvard.edu/gazette/story/2019/03/ending-hiv-transmission-by-2030-realistic-says-harvard-expert-max-essex/

Championing Choice & Safety: A Womxn’s World in Three Parts on IWD

International Women’s Day Event ‘Championing Choice & Safety: A Womxn’s World in Three Parts’. Options for Sexual Health and Battered Women Support Services are pleased to partner in the presentation and world premiere of the series ‘Her Story (In Three Parts), a short film anthology by local writer/director/actor Camille Hollett-French.

Our two organizations have chosen to work together on this project to advance the conversation of the value of choice and safety in the world of all women. These films explore issues of abortion, incarceration and sexual violence through the eyes of three young women in Vancouver, Toronto and Montreal.

Moderated by journalist Charmaine De Silva, the event aims to centre women’s resilience and the role that community supports and services can play in creating safety through choice. Dialogue panels after each film will allow for challenging conversations to be elevated by subject-matter experts and folks with lived experiences.

The evening will be held at the Djavad Mofwfaghian Theatre at the SFU Goldcorp Centre for the Arts in Vancouver. The event runs 7-9 PM, doors open at 6:15 PM. Tickets are a sliding scale of $5 – $15. We invite attendees to pay what they can.

There is also an after party meet-and-greet with cast from 9:30-11:00 PM. (additional purchase)   Please share this with all the feminists you know!

Get your tickets: for general admission, sliding scale ($5 – $15); for after party, a minimum  $25

For more information on the films, please visit herstoryinthreeparts.com

Source:

Championing Choice & Safety: A Womxn’s World in Three Parts on IWD

Black women and HIV: Oral history reveals their pain, disenfranchisement and endurance


Sophia Harrison has lived with epilepsy, breast cancer and HIV and is surviving all three, according to the Conversation. (Aamir Khuller)

Some 7,500 women were diagnosed with HIV in 2016 and the majority of them — 61 percent, according to the Centers for Disease Control and Prevention — were black. HIV is just one of the health challenges, including breast cancer, diabetes and heart disease, that affects black women more often than women of other races.

Thurka Sangaramoorthy, an HIV researcher and anthropologist, uses oral histories to learn more about the lives of black women living with HIV. In the past five years, the associate professor of anthropology at the University of Maryland has conducted ethnographic and oral history interviews with 45 women.

A recent article in the Conversation highlights that work and the stories of women such as Marcella Wright, who participated in one of the earliest treatment programs for HIV.

She’s not alone. The women Sangaramoorthy interviews tell stories of stigma and survival. “HIV for African-American women has never been a single issue, separate from histories of addiction, trauma and poverty,” she writes. Today, about 140,000 black women live with HIV.

Like other women living with HIV, the women Sangaramoorthy interviewed contracted the virus from intravenous drug use or sex with HIV-positive partners. Mortality rates among people with HIV have been declining for years, thanks to new medications and a better understanding of HIV/AIDS. But late diagnosis and social and health concerns unique to black women in the United States can make it harder for them to manage the disease.

The stories she collects are each unique — and worth hearing.

By Erin Blakemore

Source: https://www.washingtonpost.com/national/health-science/black-women-and-hiv-oral-history-reveals-their-pain-disenfranchisement-and-endurance/2019/02/28/c87b2f92-3a9d-11e9-a06c-3ec8ed509d15_story.html?noredirect=on&utm_term=.99c90d3d0f5f

Decline in HIV infections stalls as Trump administration aims to end epidemic

(CNN)As the Trump administration’s goal to end the HIV epidemic in the United States by 2030 rolls out, a new report reveals that a decline in HIV infections has plateaued.

Between 2010 and 2013, HIV incidence in the United States significantly decreased, but between 2013 and 2016, incidence remained steady — with about 38,700 new infections nationwide in 2016, according to the report released by the US Centers for Disease Control and Prevention on Wednesday.
The report comes as new efforts are underway to eliminate HIV transmissions nationwide. In President Donald Trump’s State of the Union address this month, he announced an initiative aimed at reducing new HIV infections in the United States by 75% in the next five years and by 90% in the next 10 years.
HIV, or human immunodeficiency virus, can lead to acquired immunodeficiency syndrome or AIDS if left untreated.
“In recent years, we have made remarkable progress in the fight against HIV and AIDS. Scientific breakthroughs have brought a once-distant dream within reach,” Trump said in the address.
“My budget will ask Democrats and Republicans to make the needed commitment to eliminate the HIV epidemic in the United States within 10 years. Together, we will defeat AIDS in America.”

The latest trends in America’s HIV epidemic

The new CDC report includes data from the 50 states and the District of Columbia between 2010 and 2016, the year with the most recently available data.
The data suggests that the annual number of HIV infections in 2016, compared with 2010, was higher among adults age 25 to 34 but decreased among people 13 to 24 and those 45 to 54. The annual number of infections in 2016, compared with 2010, was stable among adults 35 to 44 and 55 or older, according to the report.
The data also suggests that the annual number of HIV infections in 2016 decreased from 2010among women but remained stable among men. In 2016, the rate of HIV infection for men was 4.7 times the rate for women, according to the report.
In 2016, the highest percentages of HIV infections — 68.2% overall — were attributed to male-to-male sexual contact, the report said. Between 2010 and 2016, among men who have sex with men, HIV infections decreased in white men, remained stable amongblackmen, and increased in Latino men, according to the report.
How many people are living with HIV

Regionally, the annual number of HIV infections in 2016 dropped from 2010 levels in the Northeast but remained stable in the Midwest, South and West.
In 2016, rates of HIV infection were 19.3 per 100,000 people in the South; 12.8 per 100,000 in the Northeast; 12.8 per 100,000 in the West; and 8.2 per 100,00 in the Midwest, according to the report.
Overall in 2016, an estimated 1,140,400 people age 13 and older were living with HIV infection in the United States, including 162,500, or 14.2%, whose infection had not been diagnosed, according to the report.

What’s needed to end the epidemic

“The new data confirms that progress in reducing HIV infections in the United States has stalled,” said Heather Bradley, an assistant professor of epidemiology and biostatistics at Georgia State University’s School of Public Health, who was not involved in the report but who has conducted research on HIV surveillance.
To reduce infections, more people living with HIV need to be diagnosed, and those diagnosed need to be in care and treated with viral suppression medications, according to a paper published last week in the journal AIDS and Behavior.
The paper involved using CDC data from 2010 to 2015 to project trends in the HIV epidemic that could occur between 2019 and 2030 under three scenarios: No changes happen; or 95% of those targets for diagnosis, care and viral suppression are met by 2025; or 95% of those targets are met by 2030.
“What we found is that, if we could achieve those targets by 2025 — so that’s just six years from now — plus avert an additional 20% of infections by targeted interventions for people at risk for HIV — for example, increasing pre-exposure prophylaxis coverage — we may be able to achieve up to a 67% decrease in new HIV infections in the next 10 years,” said Bradley, who was first author of that paper.
Although that could be achieved, she added that it would require a lot of government resources.
“The administration’s goal for 2030 is a 90% reduction in incidence; our paper suggests, at most, a 67% reduction can be achieved with currently available HIV prevention tools scaled up to levels never before seen in the US HIV epidemic,” Bradley said.
“We are greatly in need of a national strategy with achievable goals for reducing new infections, but a strategy doesn’t work without substantial resources and political commitment behind it,” she said. “To achieve meaningful reductions in HIV diagnoses, we’ve got to see an injection of resources that are commensurate with the goals we have.”
Trump’s plan to end America’s HIV epidemic will fund programs in geographic hot spots of HIV infections, data to identify and track the spread of HIV, and the creation of local efforts in targeted areas to expand HIV prevention and treatment. However, the exact costs of the program have not been confirmed.
“Now is the time for our Nation to take bold action,” CDC Director Dr. Robert Redfield said in a statement Wednesday.
“We strongly support President Trump’s plan to end the HIV epidemic in America,” he said. “We must move beyond the status quo to end the HIV epidemic in America.”
Source: https://www.cnn.com/2019/02/28/health/hiv-infections-cdc-study/index.html

Decline in HIV infections stalls as admin aims to end epidemic

38,700 new infections nationwide in 2016

Getty Images
An HIV-positive patient has her blood tested and measured during one of her frequent appointments to the Georgetown University Hospital Infusion Center in 2013 in Washington, D.C., an area identified as a hot spot for the HIV-AIDS epidemic.

 

As the Trump administration’s goal to end the HIV epidemic in the United States by 2030 rolls out, a new report reveals that a decline in HIV infections has plateaued.

Between 2010 and 2013, HIV incidence in the United States significantly decreased, but between 2013 and 2016, incidence remained steady — with about 38,700 new infections nationwide in 2016, according to the report released by the US Centers for Disease Control and Prevention on Wednesday.

The report comes as new efforts are underway to eliminate HIV transmissions nationwide. In President Donald Trump’s State of the Union address this month, he announced an initiative aimed at reducing new HIV infections in the United States by 75% in the next five years and by 90% in the next 10 years.

HIV, or human immunodeficiency virus, can lead to acquired immunodeficiency syndrome or AIDS if left untreated.

“In recent years, we have made remarkable progress in the fight against HIV and AIDS. Scientific breakthroughs have brought a once-distant dream within reach,” Trump said in the address.

“My budget will ask Democrats and Republicans to make the needed commitment to eliminate the HIV epidemic in the United States within 10 years. Together, we will defeat AIDS in America.”

The latest trends in America’s HIV epidemic

The new CDC report includes data from the 50 states and the District of Columbia between 2010 and 2016, the year with the most recently available data.

The data suggests that the annual number of HIV infections in 2016, compared with 2010, was higher among adults age 25 to 34 but decreased among people 13 to 24 and those 45 to 54. The annual number of infections in 2016, compared with 2010, was stable among adults 35 to 44 and 55 or older, according to the report.

The data also suggests that the annual number of HIV infections in 2016 decreased from 2010 among women but remained stable among men. In 2016, the rate of HIV infection for men was 4.7 times the rate for women, according to the report.

In 2016, the highest percentages of HIV infections — 68.2% overall — were attributed to male-to-male sexual contact, the report said. Between 2010 and 2016, among men who have sex with men, HIV infections decreased in white men, remained stable among black men, and increased in Latino men, according to the report.

Regionally, the annual number of HIV infections in 2016 dropped from 2010 levels in the Northeast but remained stable in the Midwest, South and West.

In 2016, rates of HIV infection were 19.3 per 100,000 people in the South; 12.8 per 100,000 in the Northeast; 12.8 per 100,000 in the West; and 8.2 per 100,00 in the Midwest, according to the report.

Overall in 2016, an estimated 1,140,400 people age 13 and older were living with HIV infection in the United States, including 162,500, or 14.2%, whose infection had not been diagnosed, according to the report.

What’s needed to end the epidemic

“The new data confirms that progress in reducing HIV infections in the United States has stalled,” said Heather Bradley, an assistant professor of epidemiology and biostatistics at Georgia State University’s School of Public Health, who was not involved in the report but who has conducted research on HIV surveillance.

To reduce infections, more people living with HIV need to be diagnosed, and those diagnosed need to be in care and treated with viral suppression medications, according to a paper published last week in the journal AIDS and Behavior.

The paper involved using CDC data from 2010 to 2015 to project trends in the HIV epidemic that could occur between 2019 and 2030 under three scenarios: No changes happen; or 95% of those targets for diagnosis, care and viral suppression are met by 2025; or 95% of those targets are met by 2030.

“What we found is that, if we could achieve those targets by 2025 — so that’s just six years from now — plus avert an additional 20% of infections by targeted interventions for people at risk for HIV — for example, increasing pre-exposure prophylaxis coverage — we may be able to achieve up to a 67% decrease in new HIV infections in the next 10 years,” said Bradley, who was first author of that paper.

Although that could be achieved, she added that it would require a lot of government resources.

“The administration’s goal for 2030 is a 90% reduction in incidence; our paper suggests, at most, a 67% reduction can be achieved with currently available HIV prevention tools scaled up to levels never before seen in the US HIV epidemic,” Bradley said.

“We are greatly in need of a national strategy with achievable goals for reducing new infections, but a strategy doesn’t work without substantial resources and political commitment behind it,” she said. “To achieve meaningful reductions in HIV diagnoses, we’ve got to see an injection of resources that are commensurate with the goals we have.”

Trump’s plan to end America’s HIV epidemic will fund programs in geographic hot spots of HIV infections, data to identify and track the spread of HIV, and the creation of local efforts in targeted areas to expand HIV prevention and treatment. However, the exact costs of the program have not been confirmed.

“Now is the time for our Nation to take bold action,” CDC Director Dr. Robert Redfield said in a statement Wednesday.

“We strongly support President Trump’s plan to end the HIV epidemic in America,” he said. “We must move beyond the status quo to end the HIV epidemic in America.”

 

Source: https://www.wsls.com/health/decline-in-hiv-infections-stalls-as-admin-aims-to-end-epidemic

Are HIV Initiatives Putting Single Mothers Last?

Women

But at the last IAS International AIDS Conference (AIDS 2018) there were no stars shining over Bethlehem in the Amsterdam horizon for tens of millions of HIV-positive women. Instead, studies at last year’s AIDS 2018 show that women living with HIV are experiencing significant barriers to comprehensive treatment, statistical representation, and the retention in care needed to prevent and treat co-morbidities.

In fact, co-morbidities are increasingly becoming the most complex, expensive, and serious manifestations of HIV in the antiretroviral era.

In a thought-provoking presentation at AIDS 2018, David Malebranche MD, MPH, from Morehouse School of Medicine, demonstrated how the HIV continuum of care is failing key population often overlooked. A key point of Dr. Malebranche’s presentation was to stop solely blaming patients for difficulties existing in their maintaining consistent treatment and care, and examine how the biases of the medical community are contributing to these inconsistencies.

This failure is also driving single HIV-positive mothers living below the poverty line, who are experiencing co-morbidities relating to their HIV, to fall through the cracks of the current treatment paradigm. These women experience extreme difficulty getting into and staying retained in clinical studies and maintaining medical appointments. In many cases, this is due to clearly defined barriers: transportation, lack of childcare, conflicting schedules, and a lack of support from an economy allotting just enough to survive but not the dignity needed to surpass mere existence.

Continued lack of support for key populations of people living with HIV (PLWHA) and the unique obstacles they face, only hinder efforts to meet challenges to delivering treatment, particularly of HIV associated co-morbidities.

Data presented at AIDS 2018, as well as in peer reviewed literature, indicates HIV-positive single mothers living below the poverty line have a high incidence of long-term economic and personal challenges that are counterproductive to treatment. As a demographic, women and many of the diseases that affect them remain unrepresented in recent studies by The AIDS Clinical Trial Groups (ACTGs), ANRS, and other publicly sponsored research networks.

A recent study showed that HIV-positive women with chronic depressive symptoms are twice as likely to die, even after adjusting for mortality predictors such as CD4 count and age. Also identified was the importance of mental health issues on factors of co-morbidities like cardiovascular disease and co-infections.

Without HIV exposure, women show greater predisposition for CVD, IBD, and parasitic infections such as toxoplasmosis. Toxoplasmosis has been shown to facilitate the progression of HIV along with other diseases including CVD, as well as facilitate the permissiveness of co-morbidities. Taken together, these clinical concerns are undermining the premise of HIV being a chronic manageable condition in neglected key populations.

There’s a library of literature substantiating that women generally present high risk factors for developing cardiovascular disease, and unsurprisingly, CVD is the leading cause of mortality in HIV- positive women. HIV exacerbates inflammation and compounds traditional cardiovascular disease risk factors. HIV is associated with a 50 percent increased risk of AMI beyond that explained by recognized risk factors.

Additionally, drugs like Maryzime’s MB103 for AMI may offer a significant advancement in the treatment of HIV associated AMI. The success seen in the REPREIVE study, where Patavastatin showed benefit in the prevention and treatment of HIV-related CVD, show the need for more research on interventions such as MB103 to address the various forms of CVD in women, and all PLWHAs, are experiencing CVD.

Studies on ARV adherence and poly-pharmacy at AIDS 2018 demonstrated the absence of focus on clinical challenges HIV-positive single mothers experience in navigating the complexity of treatment landscapes. And while studies addressing drug resistance are plentiful, correlations of resistance and co-morbidities in HIV-positive single mothers, remain unaddressed.

A study published in the June online edition of the Journal of Acquired Immune Deficiency Syndromes examining poly-pharmacy in HIV-positive people, reported that half of people over 50 were at risk of drug interactions between ARVs and other medications.

Studies at the conference focused on Immune dysfunction due to elevated inflammation- which drives co-morbidities and contributes to cancers that disproportionately affect HIV- positive women -was sparse. We know seven out of 10 women develop an autoimmune disease such as Crohn’s and IBS — comorbidities that occur more frequently in the context of HIV.

We also know that low CD4 lymphocytes affect severity in both HIV and IBD. The incidence of ulcerative colitis in HIV is about double that of what is expected in a normal population. Use of several drugs for autoimmune diseases that affect women most, such as IBD and Crohn’s, are known to increase risk of lymphoma. Two of the leading drugs approved for such conditions, Remicade and Humira, are immune suppressive and a third, Entyvio, increases risk for Progressive Multifocal Leukoencephalopathy (PML).

Lodonal, a formulation of low-dose Naltrexone in phase IIB/III development by Immune Therapeutics, demonstrated significant improvements in symptom relief in Crohn’s, reduction of inflammation, and could be an option for these women and many conditions that disproportionately affect them.

HIV-related diarrhea was reported at AIDS 2018 to still be occurring at the same rate as it was 17 years ago. According to a poster presentation, a review of 38 ARV focused clinical trials found that the rate of non- infectious diarrhea has remained at 17-18 percent despite the widespread use of ARVs. Mytesi, the only FDA approved treatment for HIV-related diarrhea, continues to be under-prescribed. This troubling condition is linked to ARV non-adherence, malnutrition, depression and isolation conditions many HIV-positive women struggle with.

The AIDS 2018 and HIV Glasgow 2018 conferences demonstrated how far we’ve come over the course of the epidemic in advancements of ART and the HIV prevention toolbox.

Atreca published data on their BNAB immune capture platform showing exceptional activity directed against HIV from individuals with serum activity capable of potently neutralizing genetically diverse strains of HIV. So, while we’re waiting in the purgatory of balancing the marginal, incremental advances of small molecule antiretroviral drug development for therapeutic vaccines like the phase 2B Vacc-C5 from Bionor Pharma, early stage BNABS by Atreca, and with long acting ARV’s just on the horizon, that could transform the course of epidemic, poz patients continue to die from preventable co-morbidities driven by elevated inflammation.

The HIV pandemic is changing and the community needs to support prioritizing agendas at the ACTG’s, MHRP, and the CTN to address the emerging risks of GI co-morbidities like Crohn’s and IBS, HIV-related CVD manifestations of AMI and A-Fib. Not to mention, accelerated aging with HIV along with the concerns that co-infection with toxoplasmosis, HPV, and other pathogens represent to morbidity — not just for women and single HIV-positive mothers, but on a global scale.

AIDS 2018 should have been a turning point for a new scientific agenda that created room at the table for overlooked HIV key populations. The upcoming 2019 HIV Science Conference in Mexico City in July is our next best chance to make that priority a reality.

Authors: Jennifer LeAnne Reyes and David Miller

Source: https://www.hivplusmag.com/long-term-survivors/2019/3/01/are-hiv-initiatives-putting-single-mothers-last

Transgender teen can proceed with hormone treatment despite father’s objections, B.C. court rules

The judge said he was satisfied A.B. understood the benefits and risks of treatment and that postponing it further could result in A.B. trying to harm himself again

The B.C. Supreme Court building in Vancouver. ARLEN REDEKOP/POSTMEDIA/FILE

A 14-year-old transgender boy has the capacity to consent to his own medical treatments and should be allowed to proceed with hormone injections to help transition from a female to a male body without delay, a B.C. Supreme Court judge has ruled.

The teenager, who can be identified only as “A.B.,” has been at the centre of a complicated legal fight that raised questions about parental rights and child autonomy. His parents are separated and have joint custody.

While the boy and his mother were prepared to begin testosterone injections last summer, his father objected, citing the need for more time to examine the implications of such a move.

But in a written decision released Wednesday, B.C. Supreme Court Justice Gregory Bowden said he was satisfied A.B. understood the benefits and risks of treatment and that postponing treatment further could result in A.B. — who had previously attempted suicide — trying to harm himself again.

“The totality of the evidence regarding A.B.’s medical needs … leads me to conclude that his hormone treatment should not be delayed further,” the judge wrote.

 

“While A.B.’s father does not consent to the treatment, I am satisfied that A.B.’s consent is sufficient for the treatment to proceed.”

The father believes his child does not understand the risks and consequences of the gender transition treatment

The boy’s father is planning an appeal, his lawyer, Herb Dunton, wrote in an email.

“The father is disappointed. He intends to appeal. He believes his child does not understand the risks and consequences of the gender transition treatment, and the harm that can come to the child,” he wrote. “The father does not believe his case for the protection of the child was heard by the B.C. Supreme Court.”

The boy’s lawyer, barbara findlay, and the mother’s lawyer, Jessica Lithwick, did not have any immediate comments on the decision.

In an affidavit to the court, the mother previously wrote: “If his treatment is put on hold, I am terrified that A.B. will conclude there is no hope and will take his life.”

According to the ruling, A.B., who is in Grade 9, has identified as male since he was 11 and is referred to by his teachers and classmates as a boy using male pronouns.

A.B. had multiple visits with Wallace Wong, a registered psychologist experienced in treating children with gender dysphoria, a condition in which a person experiences significant distress with the gender they were assigned at birth. Wong determined A.B. to be a “good candidate” for hormone treatment and referred him to B.C. Children’s Hospital last year.

Dr. Brenden Hursh, a specialist in the hospital’s gender clinic, concluded hormone therapy was in A.B.’s best interests and told the court that youth who are provided with hormone therapy can see an improvement of their gender dysphoria and relief from mental issues.

Earlier this month, the hospital did another evaluation of A.B. to make sure he had the ability for informed consent and concluded that he did, the court was told.

The father had sought to block any medical treatments until a fuller hearing could be heard on the implications of gender transition treatment. The father provided the court with supporting affidavits from Dr. Quentin Van Meter, a pediatric endocrinologist in Atlanta, Ga., and Miriam Grossman, a psychiatrist in Airmont, N.Y., that discussed the potential harmful psychological and physical effects of gender transitioning on children.

But the judge said he gave their evidence little weight since neither of them commented on the facts of A.B.’s case.

This serves notice that the court recognizes the harms that can occur when family members disregard and disrespect a person’s gender identity

The judge also said the father may have been “disingenuous” when he said he wanted more scientific evidence, noting “some evidence suggests that he has been delaying proceedings as a way of preventing his son from obtaining the gender transition treatment that he seeks.”

The judge went on to make the following declarations: that A.B. be referred to as male and identified by his chosen name in all legal proceedings, that he be allowed to change his legal name without the need for consent from his parents, that he is “exclusively entitled” to consent to medical treatment for his dysphoria, and that any attempt to persuade A.B. to abandon treatment or references to A.B. as a girl or using female pronouns “shall be considered to be family violence” under the Family Law Act.

“This serves notice that the court recognizes the harms that can occur when parents and other family members disregard and disrespect a person’s gender identity,” said Elizabeth Saewyc, a professor at the UBC school of nursing and principal investigator of the first nationwide trans youth survey.

Not only did the ruling affirm that young people have the capacity to consent to health care when professionals have assessed that a young person is able to understand their decision, it also reinforced that delaying or refusing care for young people with gender dysphoria “is not neutral, it can have health consequences,” Saewyc said.

“While health-care providers usually try to engage families in health-care decisions, and hope they are supportive of their adolescents’ health-care needs, they still have a professional, ethical responsibility to support adolescent patients in getting the treatment that is in their best interest for their health.”

Author: DOUGLAS QUAN

Source: https://vancouversun.com/news/canada/transgender-teen-can-proceed-with-hormone-treatment-despite-fathers-objections-b-c-court-rules/wcm/c871d61f-707d-4e33-b6f0-a97ee94c5685?fbclid=IwAR3Rg_QayliiKbc-97yQSlGliVzhCkcO7dpRDdW_5n-mN3XXT-445EgC5Ps

The Elizabeth Taylor AIDS Foundation Provides $1million For HIV/AIDS Programs

These funds will be used for programs all across the United States, supporting three 2019 ETAF priorities: families and children, women, and young people.


Below is a table of US based facilities but it is nice to see all that is available.


LOS ANGELESFeb. 27, 2019 /PRNewswire/ — The Elizabeth Taylor AIDS Foundation (ETAF) releases $1,000,000 in grant funding to the following community based organizations to fight HIV/AIDS.  These funds are a result of ETAF’s partnership with Macy’s, via their 2018 Thanks For Sharing program.

“Through Macy’s Thanks for Sharing program, we raise funds for charitable organizations like ETAF that have an incredibly positive impact in our communities. We are honored to partner with them to support, through this grant, the lives of youth, women, children and families affected by HIV and AIDS across the nation,” said Sam Harrison, vice president of giving and volunteerism at Macy’s.

The following organizations will receive funding to implement our priorities in each area.

Youth HIV Education and Prevention

Annex Teen Clinic

Robbinsdale, MN

Boulder County AIDS Project

Boulder, CO

Cascade AIDS Project

Portland, OR

Chicago House and Social Service Agency

Chicago, IL

Children’s Hospital of Philadelphia Foundation

Philadelphia, PA

Conejo Free Clinic

Thousand Oaks, CA

Desert AIDS Project

Palm Springs, CA

Equality California

Los Angeles, CA

Hollywood Heart

Pasadena, CA

Huckleberry Youth Programs

San Francisco, CA

Los Angeles LGBT Center

Los Angeles, CA

Lost-N-Found Youth

Atlanta, GA

Maui AIDS Foundation

Wailuku, HI

Memorial Medical Center Foundation

Long Beach, CA

Minority AIDS Project

Los Angeles, CA

Pacific Pride Foundation

Santa Barbara, CA

Peer Health Exchange, Inc.

Los Angeles, CA

REACH LA

Los Angeles, CA

San Diego LGBT Community Center

San Diego, CA

San Francisco LGBT Community Center

San Francisco, CA

Southern Arizona AIDS Foundation

Tucson, AZ

UCLA Art and Global Health Center

Los Angeles, CA

Utah AIDS Foundation

Salt Lake City, UT

Quality of Life Care for Children and Families Affected by HIV and AIDS

Camp Laurel Foundation, Inc.

Pasadena, CA

Family Health Centers of San Diego

San Diego, CA

Food For Thought

Forestville, CA

Phoenix Shanti Group

Phoenix, AZ

San Diego Volunteer Lawyer Program, Inc.

San Diego, CA

Health Navigation and Mental Health Wellness for Women Affected by HIV and AIDS

ACRIA/Gay Men’s Health Crisis

New York, NY

AIDS Delaware

Wilmington, DE

Alliance for Housing and Healing

Los Angeles, CA

Equality California Institute

Los Angeles, CA

Foothill AIDS Project

Claremont, CA

Hawaii Health and Harm Reduction Center

Hauula, HI

Hawaii Island HIV/AIDS Foundation

Kailua-Kona, HI

Hudson Valley Community Services

Hawthorne, NY

The Knights and Orchids Society

Selma, AL

Our House of Portland

Portland, OR

Pierce County AIDS Foundation

Tacoma, WA

Project Open Hand

San Francisco, CA

Shanti Orange County

Laguna Hills, CA

Sierra Hope

Angels Camp, CA

Us Helping Us, People Into Living, Inc.

Washington, DC

Venice Family Clinic

Venice, CA

Visual AIDS

New York, NY

HISTORY OF MACY’S AND ELIZABETH TAYLOR

Elizabeth Taylor and Macy’s have a long history of partnership in the fight against HIV and AIDS. Elizabeth Taylor was Founding Chair of Macy’s Passport, an awareness-raising fashion show and gala event which began in the 1980’s and continued for thirty years. In addition, Ms. Taylor was involved in related cause-driven promotions with Macy’s, including Glamorama and Fashion Pass. In 2017, ETAF supporters, actress Judith Light and renowned HIV specialist Dr. Michael Gottlieb MD, presented Macy’s with the inaugural Elizabeth Taylor AIDS Foundation Dr. Michael Gottlieb Partnership Award. Since the onset of the AIDS pandemic, Macy’s has supported top designers and community organizations in raising millions of dollars as well as invaluable HIV and AIDS awareness.

ABOUT ETAF

The Elizabeth Taylor AIDS Foundation (ETAF) provides direct care and support to people affected by HIV and AIDS. Inspired by Elizabeth’s personal passion for the cause, ETAF also engages with advocacy and education initiatives to advance its goal of an AIDS-free world. www.etaf.org

For more information:

Kelly Vogt Campbell
Small Girls Public Relations
310-927-4537
kelly.campbell@smallgirlspr.com

Catherine Brown
Executive Director
The Elizabeth Taylor AIDS Foundation
310-339-3643
cbrown@etaf.org

SOURCE The Elizabeth Taylor AIDS Foundation

Related Links

http://www.etaf.org

 

Source: https://www.prnewswire.com/news-releases/the-elizabeth-taylor-aids-foundation-provides-1million-for-hivaids-programs-300803216.html

Cannabis and HIV: So much more than palliative aid

Review showed combining the use of cannabis with HAART made patients withstand antiretroviral medications for significantly longer periods of time

HIV also multiplies by entering healthy CD4 T cells
HIV also multiplies by entering healthy CD4 T cells Artem_Egorov / iStock / Getty Images Plus

 

Even though cannabis and cannabinoid-derived pharmaceuticals are frequently used by HIV/AIDS patients, several studies show that something interesting happens when cannabis is consumed.

 

What is HIV and how is it manifested?

Human immunodeficiency virus (HIV), as the name implies, harms the immune system. HIV produces this effect by killing specific white blood cells (CD4 T cells),otherwise known as T-helper cells), which are in charge of destroying pathogens.

Infections are caused by either bacteria or viruses, and CD4 T cells react to those threats in two distinct ways:

  • by releasing chemicals that inform other cells of the immune system to the site of the infection; and
  • by releasing chemicals that cause other white blood cells to multiply.

These newly created white blood cells create markers called antibodies, which can identify the same foreign invader throughout the body. Antibodies attach to bacteria and viruses, but also to infected cells, marking them for destruction by the immune system.

HIV also multiplies by entering healthy CD4 T cells, and the quantity of HIV in the body directly determines how rapidly it can enter and kill other CD4 T cells. The amount of HIV in one’s blood is called the viral load.

 

 

If left untreated, HIV spreads to such an extent that the immune function is so diminished that the body cannot protect itself anymore, leading to various dangerous infections. When these infections occur as a result of a weakened immune system, they are called “ opportunistic infections.” Examples include pneumonia, cancers, tuberculosis, chronic diarrhea and inflammation-based conditions such as meningitis and encephalitis.

When HIV weakens the immune system so much that opportunistic infections start to occur, it is then considered that a patient now has acquired immunodeficiency syndrome (AIDS).

 

How classical pharmaceuticals fight HIV

GettyImages 875359052 534x306 Cannabis and HIV: So much more than palliative aid
Even though these pharmaceuticals slow down the progression, many sufferers experience severe pain from antiretroviral therapynito100 / iStock / Getty Images Plus

 

Drugs used for the treatment of HIV and AIDS are called antiretroviral medications, and there are several different classes of these drugs:

  • fusion/entry inhibitors—they prevent, or more precisely, slow down HIV from entering healthy cells;
  • reverse transcriptase inhibitors—they prevent the RNA—which functions as an information carrier or messenger—of the virus to be reverse transcribed into DNA;
  • protease inhibitors—they prevent the protease enzyme from producing mature virions of the virus;
  • integrase inhibitors—they prevent the retroviral integrase (IN) enzyme from integrating the RNA of HIV to the DNA of the infected immune cell.

These medications are combined in what’s known as HAART, or highly active antiretroviral therapy.

Even though these pharmaceuticals slow down the progression and lessen the quantity of the virus in a patient’s body, many sufferers experience severe pain from antiretroviral therapy. Other side effects include nausea and vomiting, loss of appetite and weight, chronic exhaustion, physical weakness and cachexia (wasting syndrome). HIV patients frequently combat anxiety and depression, and the intensity of these side effects often cause patients to stop their therapy in a bid to experience relief.

 

Cannabis as a palliative aid for HIV patients

As most people are probably already aware, medical cannabis is used to fight many of the aformentioned symptoms, including pain, nausea and vomiting, lack of appetite, disorders of the gastrointestinal tract, and also anxiety and depression. The results of a 252-patient review showed that combining the use of cannabis with HAART made patients withstand antiretroviral medications for significantly longer periods of time compared to patients who weren’t using cannabis.

 

 

Another survey published in the Journal of Acquired Immune Deficiency Syndrome showed that HIV patients who used cannabis in combination with their regular treatment experienced significant relief from anxiety, depression and pain, as well as had improved appetite. They also reported an overall increase in pleasure.

What’s also very important to understand is that palliative care isn’t the only way cannabis influences the way a body reacts to HIV.

 

Before getting into all of that, however, first it’s necessary to take a step back and analyze how cannabis impacts an organism.

All vertebrate species on the planet have an endocannabinoid system (ECS) embedded in their biochemical structure. This system consists of endocannabinoid receptors stationed on the membranes of many different cell types, which are present in all important parts of the body, including the brain and spinal cord, vital and reproductive organs, gastrointestinal tract, muscles, connective tissues and so forth.

The second part of the ECS are endocannabinoids, the internal chemical compounds that entice these cellular receptors, causing many different reactions within each individual cell.

 

The function of the ECS

This ancient mammalian physiological system is in charge of maintaining homeostasis on a cellular level. Homeostasis is a posh term used to describe state of balance between the separate, but interconnected, systems that make up an organism. Cannabinoids from the cannabis plant trigger the endocannabinoid receptors of the cells in the same way as endocannabinoids, and this additional enticing of the receptors is beneficial in many ways.

There are many different cell types in the human body. Depending on what type of cell it is, but also the type of condition a person is struggling with, these factors determine how a specific cell will react to cannabinoids.

The ECS is extremely complex and very adaptive, and because of these characteristics, cannabis is regarded as beneficial for many different conditions and disorders.

 

Cannabis as medicine against HIV

GettyImages 479942410 534x306 Cannabis and HIV: So much more than palliative aidBesides offering palliative aid for numerous side effects that accompany HAART therapy, cannabis also directly influences how a human body reacts to HIV. Even though scientific data is still somewhat scarce on this topic, several studies, including the following, confirm that cannabis directly acts on the cells of the immune system affected by HIV.

 

  • 2016: 55 HIV-positive patients, who reported their personal use of cannabis, were divided into three categories: non-users, light users and moderate to heavy users. Both light and moderate/heavy use patients had a lower viral load, and a higher number of CD4 T immune cells, compared to patients who didn’t consume cannabis.
  • 2003: This study from the University of California San Francisco included 62 HIV patients who were randomly separated into three groups. Twenty patients received an oral placebo, 20 patients got cannabis in the form of a joint and 22 received dronabinol (U.S. Food and Drug Administration-approved medication containing synthetically created and isolated THC, branded and sold as Marinol or Syndros). The study lasted for 25 days, and after comparing results, researchers found there was a 20 percent increase of CD4 T cells in both real-cannabis and dronabinol groups. The team behind this study also found that the number of CD8 T-cells rose 20 percent in the real-cannabis group, and 10 percent in patients who were given dronabinol. CD8 T cells of the immune system could be considered as the secondary target for the HIV virus, right after CD4 T cells.
  • 2011: This study focused on the SIV virus (simian deficiency virus), which is a disease that affects primates, and is very similar to HIV. Researchers frequently analyze SIV to draw conclusions about HIV. Scientists observed numerous positive effects on the subjects upon administering THC, including slowing down the progression of the disease, lower viral loads and lessened inflammation via immunosuppression. Combined, these factors significantly reduced the mortality rate.
  • 2007: This research was performed on microglia cell cultures (microglia are a type of different immune cells found in the brain and spinal cord), with a synthetic compound very similar to THC. This study showed that by introducing this compound, which affected these microglia cells via both CB1 and CB2 cannabinoid receptors, the replication of the HIV virus was suppressed. What’s also very interesting is that microglia cells “create” these cannabinoid receptors when they need to be affected by cannabinoids/endocannabinoids (on demand), in a process known as reverse transcription-polymerase chain reaction.

 

Biggest cannabis/HIV study is yet to come

University of Florida received a US$3.2 million grant from the National Institute on Drug Abuse in 2017 to conduct a five-year study on the effects of cannabis on HIV. It will be the biggest and most comprehensive research on this topic to date, and will involve 400 HIV patients from Florida.

The head researcher, Dr. Robert Cook, shared his views on the goals of the study: “I’ve seen some very interesting data that looked at just how much of the virus is in people’s blood before they were treated with antiretrovirals. The research showed that those who used marijuana had a lower amount of the virus in their blood compared to those who didn’t use marijuana. That’s a good thing if there is a lower amount of the virus. But I haven’t seen any clinical trials looking at the direct effects of THC on the virus. We also don’t have a lot research comparing THC alone versus THC and CBD on people with HIV.” This study is expected to provide the much-needed insight for HIV-infected patients.

So to sum things up, cannabis greatly diminishes the side effects of HAART therapy, and it also influences the cells of the endocannabinoid system to directly fight the virus.

 

Want to keep up to date on what’s happening in the world of cannabis?  Subscribe to the Cannabis Post newsletter for weekly insights into the industry, what insiders will be talking about and content from across the Postmedia Network.

Source: https://www.thegrowthop.com/cannabis-health/cannabis-medical/cannabis-and-hiv-so-much-more-than-palliative-aid

Gay Men Cannot Get HIV From Partners Who Are Virally Suppressed, New Study Proves

Alison Rodger discusses PARTNER2 study findings during a press conference at AIDS 2018
Alison Rodger discusses PARTNER2 study findings during a press conference at AIDS 2018 in Amsterdam. (Credit: Kenyon Farrow)

When British researcher Alison Rodger finished her presentation at the 22nd International AIDS Conference (AIDS 2018) in Amsterdam, the Netherlands, on July 25, she was met with an eruption of cheers and sustained applause — an unusual reaction during a scientific data-sharing session. But this was no typical presentation: The findings she presented, that HIV-positive men who have sex with men (MSM) who were virally suppressed had zero risk of transmitting HIV to their partners, provided the most definitive conclusion yet that antiretroviral treatment is an extremely powerful tool in preventing HIV transmission — and that the concept of U=U (undetectable equals untransmittable) can be applied just as reliably to gay men as to heterosexuals.

Rodger et al’s research was a follow-up to the 2011 breakthrough PARTNER study, which primarily focused on heterosexual couples and was not as sufficiently powered for anal sex, a more efficient route of HIV transmission than penile-vaginal sex. This new study, called PARTNER2, followed a new cohort of 779 gay, male, serodiscordant couples from 14 European countries.

In the four-year (2014 to April 2018) observational study results presented at AIDS 2018, the researchers assessed 783 couples who contributed 1,596 couple-years of follow up (CYFU) including 76,991 individual acts of condom-free sex. The couples had sex an average of three to four times per month, with a median average of 43 sex acts per year. Every six to 12 months, both partners completed questionnaires about their sexual behavior; the HIV-negative partner received an HIV test; and the HIV-positive partner received a viral load test. CYFU data consisted of the time between HIV tests in which the couples had condomless sex with each other; the HIV-negative partner reported no use of pre- or post-exposure prophylaxis; and the HIV-positive partner had maintained a viral load below 200 copies/mL throughout the prior 12 months.

During the course of PARTNER2, 15 men acquired HIV. Using phylogenetic sequencing, researchers compared the newly acquired viruses of those men to the virus of their primary partner. They found zero linked infections, which means that each newly diagnosed person contracted HIV from a non-primary sexual partner who did not participate in the study. Thirty-seven percent of the enrolled couples reported having sex with an outside partner.

Researchers extrapolated the data to determine that it would take at least 419 years for there to be even the possibility of a transmission between serodiscordant MSM couples when the partner living with HIV is virally suppressed.

The PARTNER2 results yielded an equivalent level of confidence for gay men as it had for heterosexual couples in the original PARTNER study, also referred to as PARTNER1. Taken together, the findings affirm that there is no risk of HIV transmission when a person’s HIV viral load is suppressed on treatment.

“It is clear through the PARTNER clinical trials that the chance that people who are virally suppressed can transmit HIV is zero. Undetectable does equal untransmittable,” Rodger declared.

Carl Dieffenbach, Ph.D., director of the Division of AIDS at the National Institutes of Health, reinforced this message. “This update helps wrap up the [U=U] issue and adds to the data set, which will help reduce self-stigma for people living with HIV while also improving adherence,” he told TheBodyPRO.

Dieffenbach added that the PARTNER2 results should help ensure no further pushback from health care providers who had been hesitant to affirm U=U with their gay patients. “The data clearly states an HIV virally suppressed gay man could have been having anal sex every day since the year 1600 and still would not have transmitted the virus,” he said.

As the PARTNER2 results became public, the immediate response from the gay community was overwhelmingly positive.

“It’s magical,” said Daniel Driffin, M.P.H., the cofounder of THRIVE SS in Atlanta, Georgia, who attended AIDS 2018. “To know that people living with HIV can take treatment to prevent HIV is great. We still have to continue the efforts to get key populations — especially black people in the U.S., gay and bisexual men, and trans women.”

After Rodger completed her presentation of the PARTNER2 data, Bruce Richman, founder and executive director of the Prevention Access Campaign (and the creative mind behind the “U=U” campaign), stepped up to one of the microphones set up to facilitate audience questions in the large conference auditorium. “There are many providers that are still not accepting this message,” Richman said. “They try to focus on [how] the risk is not zero scientifically; or they focus on [how] their patients aren’t going to be adherent, and they won’t know that they’re detectable; or they say there’s a rise of STIs [sexually transmitted infections] already, so they don’t want to share this with their patients. We get every single kind of excuse. What would you say to clinicians — or any other information provider — who is withholding this information from people with HIV?”

Rodger didn’t hesitate. “I think the time for excuses are over,” she replied. “I think it’s very, very clear that the risk is zero.”

The packed room of attendees — an international gathering of health care providers, researchers, non-clinical health workers, advocates, and community leaders — began applauding again even before she had finished her answer.

By Ace Robinson and Kenyon Farrow

Source: http://www.thebodypro.com/content/81184/gay-men-cannot-get-hiv-partners-virally-suppressed.html?ap=2009&fbclid=IwAR0P6fnQw4OnaJOQWKW4fzZJXzfNvZrqiypOSvc4k9f59MR_cy4x1Z_6tpw