2017 World AIDS Day

Today is World AIDS Day. It is the 29th annual recognition of the impact on HIV and AIDS organized by the United Nations.  This year's theme is "Increasing Impact through Transparency, Accountability, and Partnerships."

New Study Shows Zero Transmission Between Serodiscordant Couples With One Undetectable Partner

Great news! A recently published very large research study of sexual activity (58,000 examples of condomless penetrative sex) between serodiscordant couples (both heterosexual and homosexual, where one couple is HIV-negative and the other is HIV-positive) has demonstrated that undetectable people have a near-zero probability of transmitting the virus to their sexual partners.

Over the course of two years, the study tracked 888 serodiscordant couples — that is, couples in which one partner is HIV-positive and one is HIV-negative. This included 548 different-sex couples and 340 same-sex male couples. The HIV-positive partners maintained undetectable viral levels with antiretroviral therapy (ART), but the HIV-negative partners did not use PrEP. 

There were 11 cases in the study in which partners contracted HIV, but they didn’t get it from their partners. Researchers tested the virus in each case and confirmed that what they had contracted was not phylogenetically linked to their partners’ virus. In other words, it was conclusively proven that they only contracted HIV because they had sex outside the relationship. 

Simon Collins, a member of the PARTNER study steering committee, described the results as “simple to understand.” In a statement, he explained, “This provides the strongest estimate of actual risk of HIV transmission when an HIV positive person has undetectable viral load — and that risk is effectively zero.”

The implications of this result for public policy around HIV stigmatization in the United States are profound. There are numerous HIV-positive Americans who are serving draconian criminal sentences for having sex with other people due to misguided laws (combined with overzealous prosecutions and bigoted juries). Oftentimes, it is people of color who are disproportionately impacted, as exemplified by one of the most (in)famous of these cases, the so-called "Tiger Mandingo" case where a 23-year-old African-American man named Michael Johnson was sentenced to 30 years in jail after being convicted of multiple felonies in Missouri.

Hopefully, this new scientific evidence from the PARTNER study can be used to help organizations like the SERO Project support the repeal of some of these pernicious laws around the country.

WORLD AIDS DAY 2015 Is Today

Today is World AIDS Day. Interestingly, the term "AIDS" is increasingly becoming disfavored among clinicians and doctors who work in this are, who are gravitating towards the term "HIV Stage 3."

Check out this helpful fact sheet:

1. Acute HIV Infection
   Acute HIV infection is the earliest stage of HIV. Acute HIV infection generally develops within 2 to 4 weeks 
2. after a person is infected with HIV. During acute HIV infection, many people have flu-like symptoms, such as fever, headache, and rash. In this acute stage of infection, HIV multiplies rapidly and spreads throughout the body. The virus attacks and destroys the infection-fighting CD4 cells of the immune system. HIV can be transmitted during any stage of infection, but the risk is greatest during acute HIV infection.


3. Chronic HIV Infection
   The second stage of HIV infection is chronic HIV infection (also called asymptomatic HIV infection or clinical latency). During this stage of the disease, HIV continues to multiply in the body but at very low levels. People with chronic HIV infection may not have any HIV-related symptoms, but they can still spread HIV to others. Without treatment with HIV medicines, chronic HIV infection usually advances to AIDS in 10 to 12 years.


4. AIDS 
   AIDS is the final stage of HIV infection. Because HIV has destroyed the immune system, the body can’t fight off opportunistic infections and cancer. (Examples of opportunistic infections include pneumonia and tuberculosis.) AIDS is diagnosed when a person with HIV has a CD4 count of less than 200 cells/mm3 and/or one or more opportunistic infections. Without treatment, people with AIDS typically survive about 3 years.

I wonder how Charlie Sheen is marking todays date (in light of recent revelations)?

QUEER QUOTE: Openly LGBT Los Angeles Supervisor Proposes PrEP Program

Sheila Kuehl is  widely known as one of the smartest politicians in California so it was great news when she was elected to be one of the five most powerful people in Los Angeles County last November. She is using her position to enact public policy that will positively impact her constiuents. Karen Ocamb of Frontiers Magazine reports that Supervisor Kuehl is going to propose that Los Angeles County find a way to implement Pre-Exposure Prophylaxis (commonly known as PrEP) to low-income and at-risk individuals.

At next Tuesday's Board of Supervisors' meeting Kuehl is going to introduce this motion which is today's Queer Quote:

Recommendation as submitted by Supervisor Kuehl: Authorize the Interim Director of Public Health, in partnership with the Director of Health Services, to develop and implement a plan for a robust, comprehensive program to deliver Pre‑Exposure Prophylaxis (PrEP) throughout the County, considering a broad range of medical providers, including the Departments of Public Health and Health Services’ operated clinics as well as community‑based organizations and clinics, that can effectively provide PrEP to those at high risk for contracting HIV; instruct the Interim Director of Public Health to report back to the Board in writing within 30 days on the PrEP program implementation plan, including details on program target population, program elements such as robust public education and awareness campaign, the provision of technical assistance to local providers and service delivery elements, specific timeline and milestones for program implementation, program monitoring and evaluation of the plan, and the Departments of Public Health and Health Services’ financed investment strategy; and instruct the Interim Director of Public Health to develop and release a solicitation within 45 days to fully support private‑sector delivery of PrEP services to benefit uninsured and underinsured residents of the County at high risk for HIV infection.  (15‑2677)

The motion itself goes into far more detail about the necessity of the move and discusses the potential positive impacts it could have on the transmission of HIV in Los Angeles County. For example:

Since the FDA approved PrEP in 2012, Los Angeles County has become home to more PrEP demonstration projects than any other area of the U.S. These projects, including projects at multiple DHS sites, are designed to assess the feasibility, acceptability, and cost-effectiveness of PrEP as an HIV prevention intervention. These demonstration projects show that the delivery of this intervention is, in fact, feasible and that demand is high and growing, particularly among those groups of Los Angeles County residents most at risk for HIV. Outside of these demonstration projects, numerous Los Angeles County residents have been able to access PrEP through their private health insurance plans and Medi-Cal. Despite increasing local access to this intervention, however, many Los Angeles County residents at high risk for contracting HIV, who could benefit from PrEP, are still unable to access this service.  

Among the factors contributing to limiting access to PrEP are a lack of knowledge and awareness by consumers and providers, cost, and limited PrEP service delivery sites. The delivery of PrEP as part of a comprehensive public health HIV prevention strategy must include access for high risk uninsured and underinsured individuals in Los Angeles County, especially young African-American and Latino gay men, transgender persons and African-American and Latina women. For these reasons, the Los Angeles County Commission on HIV recommended, in an October 2014 resolution, that this Board authorize and expedite expanded access and comprehensive implementation of PrEP. 

I'm happy to see this moving forward. I wonder how this will spur other large urban jurisdictions with large HIV-impacted populations like New York City, Atlanta and Chicago to act similarly sooner rather than later?

CDC Announces $185M To Combat HIV In Gay Men and MSM

The CDC announced a substantial investment of $185 million in HIV prevention among gay and bisexual men and men who have sex with men. This is a huge endorsement in the efficacy of PrEP (Pre-Exposure Prophylaxis) in combating the HIV/AIDS epidemic.

Up to $125 million of the funding will be provided over three years to state and local health departments to scale up two new, powerful HIV prevention strategies:

• Increasing PrEP uptake: Numerous studies have shown that people who take PrEP daily can reduce their risk of contracting HIV by more than 90 percent.

• Health departments will be funded to provide PrEP information and referrals and to conduct outreach and training to increase the number of health care providers who are knowledgeable about PrEP and offer it to their patients.

• The primary objective is to increase the knowledge about and uptake of PrEP among MSM and transgender people at greatest risk of infection.

• Twenty-four health departments in areas where MSM are severely impacted are eligible to apply for these funds.

• Using routinely collected data to increase engagement in HIV care: A recent CDC study showed that more than 90 percent of new HIV infections in the U.S. could be averted by diagnosing people living with HIV and ensuring they receive prompt, ongoing care and treatment. Only about half of MSM diagnosed with HIV in the U.S. are engaged in regular care.

• Health departments will be funded to expand the use of HIV surveillance data to help connect and reengage people diagnosed with HIV but not in care with needed services, prioritizing MSM and transgender people.

• Twelve health departments in areas where MSM are severely impacted and that have sufficient clinical data are eligible to apply for these funds.

“Science tells us that increasing PrEP access and engaging more HIV-positive people in care and treatment could prevent tens of thousands of new HIV infections, but these strategies remain underused,” said Eugene McCray, M.D., director of CDC’s Division of HIV/AIDS Prevention. “This new funding will drive wider adoption where it’s urgently needed and provide lessons on how to improve uptake nationwide.”

Finally some good news about the HIV/AIDS epidemic in the United States.

Science Magazine Has Special Issue On HIV/AIDS This Week

The most prestigious scientific journal in the world has a special issue on HIV/AIDS this week, with a cover devoted to an article about transgender sex workers in Jakarta (pictured above). Next week, the 20th International AIDS Conference is being held in Melbourne, Australia.

Hopefully the news on progress in the fights against AIDS/HIV will be good in the next few weeks!

CDC Endorses Truvada For HIV Prevention Purposes

There was important news in the fight against HIV/AIDS this week. The federal government announced they were issuing guidelines that recommend that sexually active HIV-negative gay men take doses of Truvada for "pre-exposure prophylaxis" (PrEP) purposes.

The guidelines say PrEP should be considered for HIV-uninfected patients with any of the following indications:

• Anyone who is in an ongoing sexual relationship with an HIV-infected partner.

• A gay or bisexual man who has had sex without a condom or has been diagnosed with a sexually transmitted infection within the past six months, and is not in a mutually monogamous relationship with a partner who recently tested HIV-negative.

• A heterosexual man or woman who does not always use condoms when having sex with partners known to be at risk for HIV (for example, injecting drug users or bisexual male partners of unknown HIV status), and is not in a mutually-monogamous relationship with a partner who recently tested HIV-negative.

• Anyone who has, within the past six months, injected illicit drugs and shared equipment or been in a treatment program for injection drug use.

“While a vaccine or cure may one day end the HIV epidemic, PrEP is a powerful tool that has the potential to alter the course of the U.S. HIV epidemic today,” said Jonathan Mermin, M.D., M.P.H., director of CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. “These guidelines represent an important step toward fully realizing the promise of PrEP. We should add to this momentum, working to ensure that PrEP is used by the right people, in the right way, in the right circumstances.”

This is a very important step. California's largest AIDS service providers had endorsed this position a few weeks ago, so it is good that this policy position will adopted nationwide.

CA AIDS Service Organizations Applaud Easier Access To Truvada For HIV Prevention With HIV-Negative Gay Men

For Immediate Release
Friday, April 18, 2014

Phil Curtis
213.201.1623
pcurtis@apla.org

Gil Diaz
323-993-7604
gdiaz@lagaycenter.org

Anne Donnelly
415.558.8669x208
adonnelly@projectinform.org

California Improves Access to HIV Prevention Pill
Important new tool in fighting AIDS, Pre-exposure prophylaxis (PrEP)
may be up to 99% effective in preventing new infections

Three leading California AIDS organizations -- AIDS Project Los Angeles, the L.A. Gay & Lesbian Center and Project Inform in San Francisco -- today applauded California’s Medi-Cal program for easing access to a well-established AIDS medication that has been proven to prevent HIV infection in at risk individuals.

The action lifts a requirement that doctors complete an authorization request when prescribing PrEP for HIV negative individuals.  PrEP is the brand drug Truvada, an AIDS drug manufactured by Gilead Sciences in Foster City, CA.  The action is effective immediately and will be published in Medi-Cal’s June Provider Bulletin.

Many in the HIV/AIDS community consider PrEP a groundbreaking HIV prevention tool.  The authorization request is considered an obstacle for both doctors and patients. With Medi-Cal’s action, doctors will now be able to prescribe the drug for men and women who test HIV negative and indicate that they are “at risk” of infection through HIV exposure.

“The Medi-Cal ruling is a game changer in HIV prevention,” said AIDS Project Los Angeles Executive Director Craig E. Thompson. “Appropriate access to PrEP through Medi-Cal provides us with another intervention – along with safer sex and condom use – to reduce the number of new HIV infections.”

“Medi-Cal’s action also brings an element of health equity to the program’s low-income beneficiaries,” Thompson said. “Private insurance plans have been covering PrEP for some time, often without prior authorization.”

"Project Inform and other organizations working directly with people at risk of acquiring HIV have conjectured that the slow uptake of PrEP may be more attributable to clinicians' reluctance to provide sexual health services of this type than to patients' lack of knowledge of PrEP or willingness to take it,” said Project Inform’s Executive Director Dana Van Gorder. “Lifting the TAR removes a potential obstacle that may have contributed to providers’ reluctance to prescribe PrEP."

Research modeling shows Truvada may be up to 99 percent effective in preventing new infections, depending on adherence and whether the drug is used in conjunction with safer sex counseling, provision of condoms and other prevention services.

“By making it easier for people at-risk of HIV infection to get access to medicine that has been proven to prevent HIV infection, California has set an important precedent for the rest of the nation,” said L.A. Gay & Lesbian Center Chief of Staff Darrel Cummings. “This collaboration between Medi-Cal and community advocates will move California closer to the comprehensive response that is needed to help end the HIV epidemic.”

The policy change resulted from discussions with Medi-Cal’s Pharmacy Policy Branch Chief, Mike Wofford, his staff and representatives from APLA, the L.A. Gay & Lesbian Center and Project Inform. The discussions focused on provider knowledge of PrEP, possible side effects associated with long-term use of Truvada, and community acceptance of the intervention.

Previously, Medi-Cal patients asking for Truvada could have been asked to meet several conditions outlined in the TAR for “high risk” individuals. Some of these conditions could have required the provision of condoms and monthly HIV testing – not necessarily real world conditions.

“There is a reason the AIDS community is talking about ending the epidemic,” Thompson said.  “We have three successful medical interventions to reduce new infections, including PrEP. What we need now is broad community and provider education on these interventions to increase acceptance and utilization.”

The three interventions include: PrEP for at risk HIV negative individuals, post-exposure prophylaxis or PEP for people who know or suspect they have been exposed to HIV, and HIV anti-retroviral treatment as prevention (TasP) for those living with HIV (HIV/AIDS drugs can bring viral load -- the amount of virus in the body -- down to undetectable levels in people who are HIV positive, reducing the likelihood that they will be able to transmit the virus to sexual partners).

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