HIV and sex
In 2007, 1217 gay men with HIV completed a survey about their experiences of living with the virus.
Almost three-quarters (70%) reported some kind of sexual problem in the previous year.
The most common problems were lack of confidence, poor self-image and loss of libido.
Fear of rejection and concerns about transmitting HIV were also common.
Disclosure to sexual partners was a cause of worry, especially for men who had been diagnosed with HIV less than five years ago.
Approximately a third of men said their problems had become worse in the previous twelve months. An equal proportion told researchers they’d welcome the opportunity to participate in some kind of group therapy to improve their self-image and self-esteem.
For more information, you may find our HIV & sex booklet helpful.
Infectiousness
In the past few years, there has been a lot of excitement about the use of HIV treatment as prevention.
Results of a large study published in 2011 showed that antiretroviral treatment can reduce the risk of HIV transmission by 96%.
The debate about the impact on HIV treatment and infectiousness was kick-started in 2008 when a group of senior HIV doctors in Switzerland issued what came to be known as the 'Swiss statement'.
The doctors argued that, in certain circumstances, people taking HIV therapy should not be considered infectious to their sexual partners.
The criteria set by the doctors were:
- Adherent to treatment and receiving regular medical care.
- A viral load below 40 copies/ml (‘undetectable’) for at least six months.
- No sexually transmitted infections.
However, researchers in the US found that only 49% of the people who took part in their study who were taking antiretroviral therapy met these requirements.
A third of participants had a detectable viral load at least once during the study period; approximately a third of people took fewer than 85% of their doses of HIV treatment; and approximately a fifth were diagnosed with a sexually transmitted infection during the study.
The researchers commented: “The Swiss Statement unambiguously specifies the circumstances under which a person with HIV should be considered non-infectious. Unfortunately, these conditions do not reflect the realities of many people living with HIV.”
Take a look at our Transmission and viral load resource, designed to support conversations around sexual transmission and HIV treatment. For more detailed information, visit our HIV treatment as prevention factsheet or our online Preventing HIV resource.
Lubricants
The advice always to use condoms and water- or silicone-based lubricants is a cornerstone of HIV prevention. (Oil-based lubricants can damage latex, the material many condoms are made of.)
Laboratory research was therefore performed to look more closely at this question. It involved 13 commonly used sexual lubricants. All were water- or silicone-based.
The findings show that even though some lubricants could potentially cause cell damage, this didn’t increase the risk of infection with HIV.
“Despite the lack of increased HIV infection in...tissue,” the researchers write, “these results convey the importance of using condoms in conjunction with compatible lubricants.”
For more information on research into condoms and lubricants, visit our online Preventing HIV resource.
HIV and hepatitis C
Liver disease caused by hepatitis C is a major cause of serious illness and death in people who are co-infected with HIV and hepatitis C.
Standard treatment for hepatitis C consists of pegylated interferon and ribavirin. Therapy normally lasts for 48 weeks. People who have an undetectable hepatitis C viral load 24 weeks after completing this treatment are said to have a sustained virological response (SVR) – in other words they’ve been cured of hepatitis C.
However, current treatment for hepatitis C doesn’t always work and can cause unpleasant side-effects.
Telaprevir is a new drug recently approved for the treatment of hepatitis C in people with mono-infection (people who have hepatitis C but not HIV). It needs to be taken in combination with pegylated interferon and ribavirin.
Now a study has shown that the drug also improves treatment outcomes in people with co-infection.
The study involved 60 people, who were randomised to take telaprevir or a placebo, plus standard hepatitis C therapy.
Overall, 74% of people taking telaprevir achieved an SVR compared to 45% of those in the placebo group.
Telaprevir can interact with anti-HIV drugs, so participants could only take specified antiretrovirals.
Outcomes in the telaprevir arm varied slightly according to which anti-HIV drugs participants were taking. Just over two-thirds (69%) of people taking efavirenz (Sustiva, also in Atripla) had an SVR, compared to 80% of those treated with ritonavir-boosted atazanavir (Reyataz).
Side-effects were more common among people taking telaprevir. The most frequent were headache (34%), feeling sick (34%), rash (29%) and dizziness (21%).
Telaprevir didn’t cause any complications with HIV infection.
Other hepatitis news
An important conference on liver disease has been taking place in the US.
Several studies have looked at the safety and effectiveness of experimental hepatitis C treatments. Most of the people involved in these studies have hepatitis C mono-infection.
Overall, the results have been extremely promising, showing that effective treatment consisting of drugs that work directly against hepatitis C is now a real prospect. In one study, good results were seen in people with characteristics normally associated with a poor response to hepatitis C therapy.
Most of the drugs are in the early stage of development but, encouragingly, results suggest that they will be effective for people taking treatment for the first time and those whose earlier course of therapy didn’t work.
Other research has looked at how best to manage side-effects caused by existing treatments, for example, the anaemia associated with ribavirin and the protease inhibitor boceprevir.
For more news from the conference, visit www.aidsmap.com/conferences.
Editors' picks from other sources
Uganda: Anti-gay bill could be passed before Christmas
from IRIN Plus News
Uganda's parliament will, before Christmas, pass a highly controversial bill which seeks more stringent punishments for people engaging in homosexual acts and those perceived to be "promoting" homosexuality, says the speaker of the house.
USA: 20 percent of youth with HIV didn’t know they were infected at first sexual experience
from NIH News
In the United States, roughly 20 percent of youth who have had HIV since birth did not know their HIV status when they first became sexually active. Researchers recommend that families and caregivers inform children about their HIV status before they reach adolescence and become sexually active.
"I'm on antivirals and undetectable: what about safe sex?"
from Positive Lite
In a wide-ranging interview that poses difficult questions, Bob Leahy asks clinician/scientist Dr Rupert Kaul about how can we interpret risk of HIV transmission in the age of undetectable viral load, especially in the context of a recent decision by the Supreme Court of Canada.
UK lags behind Germany, France and Slovenia in international index on hepatitis care performance
from Hepatitis C Trust
The Euro Hepatitis Care Index, the first ever EU-wide comparison of national efforts to address hepatitis, will be published on 6 November in Brussels. It shows that hepatitis care in UK lags behind Germany, France and Slovenia, with clear deficits in routine screening and testing.