HIV and tuberculosis
Researchers analysed the results of eleven published studies looking at the impact of HIV treatment on TB risk for HIV-positive people in poorer countries.
HIV treatment reduced the risk of TB for all study groups, including reducing the risk for people with a high CD4 cell count.
Worldwide, TB is the biggest single cause of serious illness and death in people living with HIV. Even in countries like the UK, rates of TB are much higher in HIV-positive people than in the general population.
Rates of all AIDS-defining illnesses and cancers have fallen dramatically, thanks to HIV treatment.
World Health Organization HIV guidelines recommend that antiretroviral treatment should be started when CD4 cell count falls to around 350. This is also the threshold for starting treatment in UK guidelines, though earlier treatment is recommended in some cases.
Researchers wanted to see what impact starting HIV treatment had on the risk of TB for people with HIV.
They found that regardless of CD4 cell count, HIV treatment reduced the risk of TB.
Overall, treatment reduced the risk of TB by 65%. The benefits were biggest for those with a CD4 cell count below 200.
However, antiretroviral therapy also meant that people with a CD4 cell count above 350 were 57% less likely to develop TB.
The findings could have implications for ongoing debates about the best time to start HIV treatment.
For information resources, news and features on TB, visit our Tuberculosis and HIV topics page.
Partner violence and gay men
The research involved over 1000 gay men in the US city of Atlanta.
The researchers worked with the men to develop a definition of partner violence that would be meaningful to them. Violence was defined in a number of ways: physical violence; monitoring behaviour (for example, checking emails); and controlling behaviour. Overall 46% of men reported experiencing some sort of violence. This included 13% of men who had experienced physical or sexual abuse.
Controversially, the group defined non-disclosure of HIV status before sex as a form of violence. The appropriateness of this was questioned from the floor when the study was presented. The presenter agreed she was uncomfortable with that definition, but stressed the definition had come from the men who participated in the study.
Men who had been victims of partner violence were more likely to report recent unprotected anal sex.
In the UK, the organisation Broken Rainbow offers confidential support to lesbian, gay, bisexual and transgender people experiencing or concerned about partner violence.
HIV epidemic in gay men
There is little evidence that rates of new infections are falling, and there is particular concern about the epidemic in some minority populations, especially black gay men.
One possible way of reducing the rate of new infections is the rollout of pre-exposure prophylaxis (PrEP). This involves HIV-negative gay men taking HIV treatment to reduce their risk of becoming infected with the virus.
Researchers emphasised that in ideal situations PrEP could be highly effective. However, mathematical models showed that its potential impact on transmissions in ‘real-world’ settings would be affected by factors such as uptake and adherence.
However, the models showed that combination prevention, including condom promotion, PrEP and use of HIV treatment as prevention had the potential to prevent large numbers of infections.
Other researchers showed the importance of addressing wider health issues faced by gay men. They highlighted research showing an association between experiencing stigma and discrimination and higher rates of depression, substance misuse and risky sexual behaviour.
“Having supportive conversations with adults and role models may lead to successful maturation,” said one researcher.
This underlined the importance of gay-friendly healthcare services. However, some research showed that this wasn’t always provided and that sexual health advice didn’t take account of the real lives of gay men.
For more news coverage of the International AIDS Conference in Washington DC, visit www.aidsmap.com/aids2012.
Editors' picks from other sources
Safe sex? Indonesia's conservatives would rather 'sinners' and sex-workers got Aids
from The Independent
Katherine Butler reports from Jakarta, where religious intolerance is undermining the fight against Asia's fastest-growing HIV epidemic.
HIV awareness 'drops off radar'
from BBC Health
Sexual health experts and leading HIV charities say not enough is being done to raise awareness of the dangers of the virus for young people in the UK.
Zimbabwe woman fights conviction of deliberately transmitting HIV
from Voice of America
A 34-year-old Zimbabwean woman – who last month was found guilty of deliberately infecting her husband with the HIV virus – is fighting her conviction. Her lawyers have approached the country's highest court, demanding repeal of the law she she was charged under, saying it stigmatizes HIV/AIDS.
Greg Louganis on living with HIV: 'I didn't think that I'd see 30'
from Huffington Post
"Back in 1988 when I was diagnosed with HIV, we thought of HIV as a death sentence." US Olympic diver Greg Louganis reveals how he won a medal shortly after being diagnosed with HIV, and the discrimination he faced.