One-in-five US gay men don’t test for HIV while in a relationship
The study recruited 275 HIV-negative male couples via Facebook. It found that 21% said they tested for HIV every three to six months, 29% had an annual test, 30% tested only when they thought one of them might have taken a risk, and the other 20% had not tested for HIV while in their current relationship.
Men who had not tested for HIV were – not unexpectedly – more likely to be in a new relationship but were also more likely to be young and of lower educational attainment. They were less likely to have negotiated an agreement about sex outside the relationship and more likely to say they were faithful and trusted their partner to be. Conversely, men who tested frequently were older, less trusting, more likely to have an open relationship or to have had recent ‘extramarital’ sex and more likely to have an agreement with their partner about their relationship’s sexual boundaries.
Clearly, men who don’t test may be right to trust their partners but, as the researchers say, “additional research is warranted to further explore how concepts of trust affected...gay couples’ HIV testing behaviours”.
Comment: Given that HIV testing rates are still lower in the UK and in most other European countries than they are in the US, especially for frequent testing, the percentage of gay men in a primary relationship who don’t test is likely to be a higher figure here. The authors say that the Centers for Disease Control, as a result of this study, should recommend more strongly than ever that that all sexually active gay men should test for HIV regularly, regardless of whether they think they are at risk of it in their current relationship.
Intravenous AZT still useful to stop HIV if women giving birth have high viral load
A large French study of over 11,000 women with HIV has concluded that intravenous AZT, which until recently has been recommended for all HIV-positive women giving birth to prevent mother-to-child transmission (MTCT), has helped to bring down the overall MTCT rate. But it made no difference for the majority of mothers who had a well-controlled viral load (400 copies/ml or less). It also made no difference if the baby was given two- or three-drug ART regimens as post-exposure prophylaxis (PEP) after birth.
The overall MTCT rate for the entire time period of the 13-year study (1997-2010) was 7.5% without intravenous AZT, and 2.9% with it.
However, there were no transmissions from any woman with a viral load below 400 copies/ml who did not receive intravenous AZT. In fact, there were 42 transmissions (0.6%) from women who did receive intravenous AZT. This is because the guidelines did not stop recommending intravenous AZT until July 2010, so the vast majority of women in the study received it.
In contrast, women with virological failure who had caesarean sections were five times more likely to pass on HIV (9.5%) if they did not have intravenous AZT than if they did (1.8%). The survey therefore generally supports dropping intravenous AZT from guidelines for the prevention of MTCT but shows that there may still be a role for it where women have virological failure or present very late. In addition, because there were still too few women not given intravenous AZT to make a reliable recommendation, the researchers support its use in cases of complicated delivery such as emergency caesareans.
Comment: This large study provides useful evidence for case management of women who are diagnosed late in pregnancy but should not obscure the fact that the biggest contributor to reducing MTCT is to offer antiretroviral therapy to all pregnant women and to ensure virological suppression.
Few HIV-negative gay men stick to one role, but they do attempt to ‘seroposition’
The study found that 63% of gay men were versatile, 17% exclusively ‘top’ (insertive) and 10% exclusively ‘bottom’ (receptive). The other 10% did not have anal sex. These figures are similar to UK figures from the Gay Men’s Sex Survey of 2008, which found that 56% of respondents were versatile, 18% top, 15% bottom and 11% did not have anal sex.
The researchers comment that versatile men were more likely to pass on HIV than single-role men – because they are more likely to acquire it through receptive sex and then transmit it through insertive sex. This may be one reason why HIV incidence is so much higher in gay men than in heterosexual people, even more than one would expect from the relatively greater efficiency of anal sex in transmitting HIV.
The study also found, as some others have done, that younger men are more likely to take the receptive role than older men; this is also a pattern that facilitates HIV transmission, as seen in studies of cross-generational sex.
The study did find that many gay men attempt to reduce the risk of HIV transmission by ‘seropositioning’. When the HIV-negative men in the survey had sex with a man they knew to have HIV, they were 2.3 times more likely to be exclusively insertive and 1.5 times more likely when they did not know their partner’s HIV status.
Comment: This study interestingly confirms what other studies have found, but it is difficult to derive a public health message from it, as HIV-negative gay men are unlikely to switch roles immediately following diagnosis any more than they already do. HIV-negative gay men already seem to be aware that it is safer to be ‘top’ with an HIV-positive or unknown-status partner. The study did find that such ‘seropositioning’ became less common in longer-term relationships, so the advice that partners should make no decisions about dropping condoms before both getting tested needs to be reinforced. See ‘One in five US gay men don’t test while in a relationship’ above.
Young gay men catch HPV early in sexual history, but vaccine could still help
However, it found that fewer than one in five who did not already have the strains of HPV associated with a higher risk of cancer (HPV 16 and 18) caught them during the year and that none of the men studied had all four types of HPV that Gardasil, the vaccine currently used in the UK, protects against.
The researchers say their study reinforces the importance of vaccinating young gay men before they become sexually active. “But”, they add, “the fact that most young men who have sex with men (YMSM) appeared to remain susceptible to at least some HPV types included in the vaccine show that catch-up immunisation programmes do offer YMSM some benefit.”
During the study, of 94 gay men aged between 16 and 30 (median age 21), 70% had anal HPV infection detected at some point, with 28% having HPV 16, the most common and virulent cancer-causing type. Among men who did not already have HPV at baseline, annual incidence was 47% – in other words there was a roughly 50/50 chance of them getting at least one strain of HPV within a year. However, annual incidence of HPV 16 or 18 was only 18% (this compares with an annual incidence of 7% for type 16 alone in young women in the first vaccine efficacy trials).
A recent study in older gay men, which we reported on in July’s HIV prevention news: Europe bulletin, found that while 30% had HPV 16, only 5% were acquiring new infections per year, so older gay men might benefit too.
Comment: This study not only adds to the strong evidence that boys as well as girls should receive Gardasil before they start having sex, it also suggests that, because HPV subtypes can be eliminated by the immune system but then re-acquired, the vaccine might be useful for gay men at any age, especially those with HIV who are much more likely to develop the lengthy HPV infections that can end up as anal cancer.
PrEP acceptable to Kenyan gay men and sex workers, but stigma and gossip may be barriers
Participants who were randomised to an intermittent PrEP regimen, however (taking doses every Monday and Friday and also two hours after sex), only had 55% adherence, with the main difficulty being the post-sex dose, which only 23% of participants managed to take. Participants pointed out that sex often happened in the context of drink and drugs and they too often fell asleep afterwards to take the post-sex dose.
The study also found that the biggest barrier to PrEP acceptability was the fear that others would assume they had HIV if they saw them taking PrEP – a fear that was borne out on some occasions, with one participant blaming PrEP for the break-up of his marriage and another taking his wife to have an HIV test with him to prove he did not have HIV. Participants suggested that Truvada for PrEP could be formulated to look clearly different from the Truvada used for treatment.
Comment: This study confirms that, as has been found in other studies, the barriers to taking PrEP are largely social. On the other hand, it also shows that this extremely high-risk study population – mainly MSM who often did sex work with men and also had sex with women and were married – were happy to consider the idea of PrEP and in some cases even believed that, by removing the fear of HIV, it also enhanced the experience of sex.
Other recent news headlines
US PrEP prescriptions more likely to go to Southern women
An initial study of prescriptions of Truvada for pre-exposure prophylaxis (PrEP) given out by doctors in the US has found that PrEP recipients were more likely to live in the southern states, and were more likely to be young and female, than people taking Truvada as treatment for HIV. About 2000 individuals, excluding ones taking part in clinical trials, have so far been prescribed PrEP in the US since 2011.
Partner violence may undermine use of female-controlled forms of HIV prevention
Women who experience violence from their male partner are less likely to use condoms or diaphragms, an international team of investigators report in the online edition of the Journal of Acquired Immune Deficiency Syndromes. Intimate partner violence increased the risk of condom non-use by up to 47% and non-use of diaphragms by a quarter.
Text messages do not reduce early resumption of sexual activity in recently circumcised men
Text messaging did not help reduce early resumption of sex after male circumcision (MC) in a large randomised, controlled trial conducted at twelve sites in Nyanza province, Kenya. However, the study did confirm a number of key risk factors for resumption of sexual activity prior to wound healing, and also identified that men who resumed sex before the end of the recommended period of abstinence were more likely to have unprotected sex when they did so.
Gay men recall seeing mass media campaign, but impact on behaviour remains unclear
A media campaign promoting condom use and sexual health check-ups to gay and other men who have sex with men in Scotland was recalled by 60% of the target group, but there is no evidence that it had an impact on risky sexual behaviour. While researchers did find that men with medium and high levels of exposure to the campaign were more likely to test for HIV, it is difficult to show whether the campaign caused this or men who tested more often were more likely to notice the campaign.
South American survey finds rectal microbicide formulated as a douche acceptable
A qualitative study in three cities in Peru and Ecuador has found that most gay men and transgender women asked thought that a rectal microbicide formulated as a douche, rather than as a gel or lubricant, might offer additional safety or efficacy. However, participants doubted the practicality of such a formulation for use in sex away from home. The researchers also discovered that some participants were already using a variety of homemade douching preparations before anal sex, some of them potentially hazardous.
Editors' picks from other sources
AIDS vaccine candidate appears to completely clear virus from the body
from Eurekalert Medicine & Health
An HIV vaccine candidate developed by researchers at Oregon Health & Science University appears to have the ability to completely clear an AIDS-causing virus from the body. The promising vaccine candidate is being developed at OHSU's Vaccine and Gene Therapy Institute. The research results were published online today by the journal Nature.
HIV vaccine produces no adverse effects in trials
from Western University press release
A phase I clinical trial (SAV CT 01) of the first and only preventive HIV vaccine based on a genetically modified killed whole virus (SAV001-H) has been successfully completed with no adverse effects in all participants. Whole-virus vaccines were seen as potentially dangerous but this phase 1 trial may clear the way to further research into this approach, which could generate a broader immune response than other HIV vaccine candidates.
‘Ruins’ – the 2012 HIV sweeps and what came next
from Ekathimerini
“Ruins: Chronicle of an HIV Witch Hunt” is a 53-minute film that documents a 'witch hunt' that targeted HIV-positive women in Athens. During the run-up to a tense parliamentary election, and at a time of national austerity and concern about rising HIV rates, the Greek health ministry took the decision to round up, force test and publicly name, shame and prosecute a group of HIV-positive women. The film examines the psychological impact of the stigma forced on the prosecuted women and their families. At the same time, the documentary sets out to deconstruct the social causes and political motives that led to the operation.
Overly broad HIV criminalisation is doing more harm than good
from HIV Justice Network
The HIV Justice Network has released a new documentary, More Harm than Good: How overly broad HIV criminalisation is hurting public health, which had its world premiere at the US Conference on AIDS in New Orleans on September 10th. Despite strong recommendations against overly broad use of the criminal law by UNAIDS and the Global Commission on HIV and the Law, the latest report from the Global Network of People Living with HIV and the HIV Justice Network highlights that new laws continue to be proposed and enacted, and more prosecutions are taking place than ever before
Facebook peer groups may be useful for HIV education
from Reuters
Researchers found that specially created Facebook social media groups helped encourage men who have sex with men to reach out for information about testing themselves at home for HIV. They randomly assigned the participants to two different types of groups. One type was led by people who sent information on HIV prevention and testing through Facebook to their members. The other type was led by people who sent their members information on maintaining a healthy lifestyle. Of the 57 men in the HIV prevention groups, 25 requested at-home HIV tests and nine of those tests were returned. In the healthy-living group, only 11 of the 55 men requested HIV tests, with only two being returned.
See also this piece for a critique of this study.
Free webinar: HIV prevention in people who inject drugs
As part of its European HIV prevention work, NAM is collaborating with AVAC to provide a series of webinars (conference calls with accompanying slides) to train and inform prevention advocates and anyone interested in the newest developments in HIV prevention technology.
The next webinar is on HIV prevention in people who inject drugs (PWID), with a focus on eastern Europe.
This 90-minute webinar will, it is planned, examine the epidemiology of HIV and TB in PWID in eastern Europe; harm reduction policy, including needle exchange, opiate substitution therapy and PrEP; HIV treatment access for PWID in eastern Europe; and national programmes for PWID and how stigma works within them.
The presentations will be followed by a question and answer session with our expert speakers. The webinar will be conducted in English and chaired by Rebekah Webb of AVAC.
Because October is a busy month for conferences, the webinar will be conducted later in the month than usual, at 2pm UK time (GMT), 3pm European time (CET) on either Tuesday 22 or Thursday 24 October. Watch for more details on aidsmap or the AVAC website.