Showing posts with label prevention. Show all posts
Showing posts with label prevention. Show all posts
Monday, August 20, 2012
Are we PrEPared for PrEP?
This article was written by Volunteer Blog Writer Tyler Faulds. Tyler is a student of Mount Royal University who is obtaining his Honours Degree in Psychology. This is Tyler's first article for The AWord. If you are interested in being a writer for The A Word, please visit: http://www.aidscalgary.org/getinvolved/volunteer/volunteeroverview.cfm
Since the introduction of treatment for HIV, the lines have been drawn between medical based approaches and those rooted in social change. The two schools of treatment differ in how they combat HIV and how they foresee an end to the spread of the virus. While medical oriented treatments put heavy emphasis on drug regimens and regular testing, treatments rooted in society and culture believe that change comes through people (Kippax & Stephenson). They often focus on behavioural change and dissect the socio-cultural context of HIV on our planet. Medical approaches can be conceptualized as treatment, and societal ones as prevention. Combined approaches have become more popular, and campaigns that focus on condom use along-side regular testing have been gaining momentum. Still, we see more than 2.6 million new HIV infections a year (Geneva, 2009), and the problem is evidently not under control – yet.
Enter PrEP, or Pre-Exposure Prophylaxis. Considered a medical based approach, this type of treatment involves prescribing HIV negative individuals with HAART as a way to prevent HIV acquisition. It stands as a possible breakthrough in the prevention of new HIV infections, but is also marred with controversy and critics. Approved by the United States’ FDA, Truvada is a combination pill of Tenofovir and Emtricitabine. With perfect adherence in clinical trials, it has shown to reduce the risk of transmission by approximately 40-70% (Okwendu, 2012). These trials evaluated the effectiveness of Truvada within six “high risk” categories including HIV negative men who have sex with men, males and females in relationships where one partner is HIV positive and one is negative, and people that use intravenous drugs. Due to its incredibly high costs (~12 000 USD a year) as well as numerous other factors, PrEP is a highly contentious issue.
The cost alone is a major barrier. While proponents of PrEP suggest that it is applicable to people in higher risk categories, it is evident that cost would be a huge hurdle to cross for some of these groups. In Sub-Saharan Africa, where incomes are low and HIV transmission is high, a $12 000 USD price tag is inconceivable when food is a daily concern. Reactions to this criticism, especially from the drug’s manufacturer Gilead, cite that cost is a concern for any new medical intervention, but through regulation and development the costs would come down.
Salim Karim of the Centre for the AIDS Programme of Research in South Africa, argues that PrEP empowers women. Many must rely on their sexual partners to get tested, get treatment, and wear condoms and that is often a difficult task to accomplish. PrEP would allow women to take their health into their own hands, protecting themselves from HIV with no help needed from others. Opponents argue that relying on PrEP will direct attention away from the heavily needed condom supply and prevention which so many communities still require.
PrEP has been branded a short cut in some arenas. Does it make sense to offer a solution where a person just takes a pill and forgets about it? – they could worry less about safer sex practices, condom use, and needle awareness. Is it that simple? Is it really that black and white? People living with HIV on HAART are all too aware of the possible side effects. Although they differ on a person by person basis, many of them are unpleasant, disruptive and a mountain to overcome. An HIV negative person taking PrEP would not be just taking a pill. They could endure the nausea, diarrhea, and fatigue that accompany the treatment, as well as the kidney damage and bone loss that are hallmarks of Truvada. This is another reason why proponents stress that PrEP is not for everyone. The second part of the shortcut argument is that a widespread use of PrEP (which has been shown to reduce HIV transmission by about 40+%) would change attitudes towards the risks of certain activities and cause people to lax on their diligence and safety. Note - condoms reduce HIV transmission ~90%). Countless studies have asked, “If Truvada or something similar was available to you, and you knew that it would cut your risk of transmission would you still use condoms?” The results have been inconclusive. A study by Golub et al. (2010) showed that 35% of the men they surveyed thought they would decline condom use if on PrEP. Other studies like the one performed by Holt et al. (2012) showed that only 8% of the men they surveyed thought they would reduce condom use. It’s worth knowing that those 8% were also correlated with older age and monogamous relationships.
These answers are likely swayed by the need to answer in a desirable fashion. That is, people will always answer in a way which they think they should rather than how they actually feel. There is no way to tell if people will really stop wearing condoms or using clean needles until actually given the chance. This illustrates why a combined social and medical model is the strongest, because all sides need to be addressed.
One of the largest arguments against PrEP is the issue of adherence. For Truvada to be effective it must be taken every day with no missed doses, and consistently this is not the case. Myers (2012) argues that just like a half-finished bottle of antibiotics following strep throat, an inconsistent adherence schedule would eventually develop resistance to the treatment. This in turn could create strains of HIV resistant to Truvada, a main component of treatment for people already living with HIV. In the pilot study of Truvada, participants were paid for their involvement and also received daily counselling on their medicine adherence. Even still, only 18% of participants adhered to treatment perfectly. If people who are paid and counseled to take a drug cannot do it consistently, how will HIV negative, unpaid and uncounseled individuals fare?
Finally, let’s revisit the side effects. The first antiviral for HIV is not 30 years old, and HAART hasn’t turned 20 yet. There is no denying the ground breaking leaps and bounds that these drugs have provided for those living with HIV. People are living longer and healthier, and the tides may be slowly turning. We know that if treated efficiently and if treatment adherence is high, a person today has a much better outlook than someone 20 years ago did. It might be what we don’t know however, that’s more important.
We still don’t know what will happen after 40 or 50 years on the drugs. What will happen to the virus, to the body or to resistance? There is no data on these risks. We know the drugs are toxic, and is there sense in giving these drugs to anyone other than the people that need them? Should we be putting more effort on social change, or is PrEP really the next step in the battle against HIV and AIDS?
There will always be those that rush ahead, and those that hang back and wait to see what happens. What should happen now? Would you take PrEP if it were an option?
References
Karim S. (2012). Antiretroviral prophylaxis for HIV prevention reaches a key milestone.
Kippax S. & Stephenson N. (2012). Between biomedical and social dimensions of HIV. American Journal of Public Health. 102 (5).
Myers , T. (2012, August 03). Hiv prevention pill will do more harm than good . Retrieved from http://www.usnews.com
Okwundu , Uthman , Okoromah (2012) Antiretroviral pre-exposure prophylaxis (PrEP) for preventing HIV in high-risk individuals". Cochrane Database Syst Rev 7 (7)
AIDS Epidemic Update (Geneva, Switzerland: Joint United Nations Programme on HIV/AIDS, 2009).
Golub, Sarit, Kowalczyk, Weinberger and Parsons (2010). Pre-exposure prophylaxis and predicted condom use among high-risk men who have sex with men. Journal of Acquired Immune Deficiency Syndromes. 54(5).
Holt, Murphy, Callander, Ellard, Rosengarten Kippax and de Wit. (2012). Willingness to use HIV pre-exposure prophylaxis and the likelihood of decreased condom use are both associated with unprotected intercourse and the perceived likelihood of becoming HIV positive among Australian gay and bisexual men. Sexually Transmitted Infections. 88(4).
Thursday, April 14, 2011
"It's never just HIV": Thoughts on the controversial NYC Health Department's Public Service Announcement
People are talking! There have been controversial discussions about the new public service announcement (PSA) “It’s Never Just HIV”(click here to watch).
This PSA was released by the New York City Health Department to target gay men with the goal of increasing condom use. It features graphic images depicting what health conditions could be developed as a result of living with HIV.
The New York City Health Department has evoked a lot of emotionally charged opinions through this PSA, which are divided by those who agree with the graphic message and those who strongly oppose it. Those who are for the PSA’s messaging style feel that it is an effective educational tool as it strongly promotes prevention. Many believe an HIV PSA message should be in your face, as HIV is a serious disease. Some long term survivors and individuals who lost friends to the virus in the early days, believe that younger generations are not scared of contracting HIV anymore, that the fear of contraction has been lost. Advocates for this PSA also believe that indulging the perception that HIV is easily manageable needs to be examined, because living with HIV and taking medications is not really that easy at all.
Other arguments which defend this PSA believe that scare tactics and fear based messaging actually helped to change behaviors in the 80’s so why wouldn’t it work now? In their opinion, people should take HIV seriously, as seriously as presented in this PSA.
The opposing argument to the messaging strategy around “It’s Never Just HIV”, feel this ad is stigmatizing and demonizing. They believe the PSA singles out gay men and increases feelings of guilt and shame towards being gay and/or engaging in anal sex. There has been much discussion around the idea that effective prevention messaging should not engage in fear mongering, but instead go beyond condom use; there are much larger behavioral and societal issues that should be addressed when the dealing with why some individuals won’t use condoms. This group also believes the PSA creates a false sense of what it is actually like for people who are living with HIV and are able to live long, healthy lives. Those who oppose the harsh images and tone of the PSA also argue the ad will deter people from getting tested and could deter people living with HIV from taking their medications for fear of stigma and discrimination.
As an AIDS Service Organization who is engaged in prevention and support work, we at AIDS Calgary recognize there is a fine line of how to present certain messaging and engage our audience. It is important that people who are HIV negative understand the realities of living with HIV and how serious the effects of HIV are. On the other hand, it is important to promote that HIV has changed, it is no longer a death sentence and if you are living with HIV or newly diagnosed, there is every opportunity to live a full and healthy life.
This is a controversial subject and as a whole we’ve yet to figure out how to ensure both of these messages are being communicated and heard.
We’d love to hear from you! What do you think of the ad? Will the message work and promote condom use?
Sources:http://www.youtube.com/watch?v=d0ANiu3YdJg
This blog article was written by our Community Strategies Team Leader.
This PSA was released by the New York City Health Department to target gay men with the goal of increasing condom use. It features graphic images depicting what health conditions could be developed as a result of living with HIV.
The New York City Health Department has evoked a lot of emotionally charged opinions through this PSA, which are divided by those who agree with the graphic message and those who strongly oppose it. Those who are for the PSA’s messaging style feel that it is an effective educational tool as it strongly promotes prevention. Many believe an HIV PSA message should be in your face, as HIV is a serious disease. Some long term survivors and individuals who lost friends to the virus in the early days, believe that younger generations are not scared of contracting HIV anymore, that the fear of contraction has been lost. Advocates for this PSA also believe that indulging the perception that HIV is easily manageable needs to be examined, because living with HIV and taking medications is not really that easy at all.
Other arguments which defend this PSA believe that scare tactics and fear based messaging actually helped to change behaviors in the 80’s so why wouldn’t it work now? In their opinion, people should take HIV seriously, as seriously as presented in this PSA.
The opposing argument to the messaging strategy around “It’s Never Just HIV”, feel this ad is stigmatizing and demonizing. They believe the PSA singles out gay men and increases feelings of guilt and shame towards being gay and/or engaging in anal sex. There has been much discussion around the idea that effective prevention messaging should not engage in fear mongering, but instead go beyond condom use; there are much larger behavioral and societal issues that should be addressed when the dealing with why some individuals won’t use condoms. This group also believes the PSA creates a false sense of what it is actually like for people who are living with HIV and are able to live long, healthy lives. Those who oppose the harsh images and tone of the PSA also argue the ad will deter people from getting tested and could deter people living with HIV from taking their medications for fear of stigma and discrimination.
As an AIDS Service Organization who is engaged in prevention and support work, we at AIDS Calgary recognize there is a fine line of how to present certain messaging and engage our audience. It is important that people who are HIV negative understand the realities of living with HIV and how serious the effects of HIV are. On the other hand, it is important to promote that HIV has changed, it is no longer a death sentence and if you are living with HIV or newly diagnosed, there is every opportunity to live a full and healthy life.
This is a controversial subject and as a whole we’ve yet to figure out how to ensure both of these messages are being communicated and heard.
We’d love to hear from you! What do you think of the ad? Will the message work and promote condom use?
Sources:http://www.youtube.com/watch?v=d0ANiu3YdJg
This blog article was written by our Community Strategies Team Leader.
Friday, July 23, 2010
Risky Business
Risky Business - From High Risk to No Risk, Assessing Your Risk of HIV Transmission
Even in today's day and age, there is still some misunderstanding pertaining to HIV/AIDS; with some of the most common misconceptions being on the topic of HIV transmission. While composing this article, I had been given a list of actual questions received to the AIDS Calgary hotline. Two of the questions pertaining to HIV transmission struck me; "Can you contract HIV from a mosquito?", and "Can you contract HIV from kissing?". The answer to both these questions is no. But why?
In the world of HIV, we have something known as the Transmission Equation. Essentially, the transmission equation is as follows:
The transmission equation shows us that it is not possible to contract HIV from a mosquito bite (since a mosquito is neither injecting you with its own nor anyone else's blood), or kissing. You can, however, contract HIV from sexual intercourse, oral sex, or intravenous drug use. So how do we protect ourselves? Do we abstain from everything? This is where risk assessment comes into play.
Risk assessment is to understand the risk associated with the particular activities you are engaged in. Risk activities fall into four categories: No Risk, Negligible Risk, Low Risk, and High Risk. The High Risk category includes sharing needles and unprotected sex. The Low Risk category includes performing unprotected oral sex and having protected sex. Negligible Risk could be receiving oral sex, while No Risk would be kissing or abstinence.
Risk assessment takes your theoretical risk (based on the activity), and poses it against actual evidence of transmission. Theoretically, there is risk involved in all but the No Risk category; however there is strong evidence of transmission only in the High Risk category. In the Low Risk category there is some evidence, and in the Negligible and No Risk categories there is no evidence.
So what is the answer? Should we or shouldn't we partake in "risky business"?
At AIDS Calgary we understand that it is not a realistic expectation that people are going to abstain from sexual activity or from drug use. Instead, we provide awareness, education and support on the topic of HIV/AIDS. Educate yourself on the transmission equation, and assess your risk. If you choose to engage in the any of the risk activities, take the necessary precautions to make sure you and your partner are both protected. We all have the right to have fun so let's just keep ourselves safer while doing so.
This guest post was submitted by Ana M. Saskowski. Ana is a full-time mom and part-time student living in Sylvan Lake. Her recent attendance at AIDS Calgary Core Training had a profound impact on her life and prompted her submissions to The A Word.
Even in today's day and age, there is still some misunderstanding pertaining to HIV/AIDS; with some of the most common misconceptions being on the topic of HIV transmission. While composing this article, I had been given a list of actual questions received to the AIDS Calgary hotline. Two of the questions pertaining to HIV transmission struck me; "Can you contract HIV from a mosquito?", and "Can you contract HIV from kissing?". The answer to both these questions is no. But why?
In the world of HIV, we have something known as the Transmission Equation. Essentially, the transmission equation is as follows:
Bodily Fluids
(i.e. Blood, Semen, Vaginal Fluid, Breast Milk, Anal Secretions)
+
Risk Activity
(i.e. Unprotected Sex, Mother to Child, Sharing Needles)
+
Direct Access
(i.e. Open Wounds or Cuts, Direct Access to the Bloodstream, Mucous Membranes)
=
The Possibility of an HIV Infection
(i.e. Blood, Semen, Vaginal Fluid, Breast Milk, Anal Secretions)
+
Risk Activity
(i.e. Unprotected Sex, Mother to Child, Sharing Needles)
+
Direct Access
(i.e. Open Wounds or Cuts, Direct Access to the Bloodstream, Mucous Membranes)
=
The Possibility of an HIV Infection
The transmission equation shows us that it is not possible to contract HIV from a mosquito bite (since a mosquito is neither injecting you with its own nor anyone else's blood), or kissing. You can, however, contract HIV from sexual intercourse, oral sex, or intravenous drug use. So how do we protect ourselves? Do we abstain from everything? This is where risk assessment comes into play.
Risk assessment is to understand the risk associated with the particular activities you are engaged in. Risk activities fall into four categories: No Risk, Negligible Risk, Low Risk, and High Risk. The High Risk category includes sharing needles and unprotected sex. The Low Risk category includes performing unprotected oral sex and having protected sex. Negligible Risk could be receiving oral sex, while No Risk would be kissing or abstinence.
Risk assessment takes your theoretical risk (based on the activity), and poses it against actual evidence of transmission. Theoretically, there is risk involved in all but the No Risk category; however there is strong evidence of transmission only in the High Risk category. In the Low Risk category there is some evidence, and in the Negligible and No Risk categories there is no evidence.
So what is the answer? Should we or shouldn't we partake in "risky business"?
At AIDS Calgary we understand that it is not a realistic expectation that people are going to abstain from sexual activity or from drug use. Instead, we provide awareness, education and support on the topic of HIV/AIDS. Educate yourself on the transmission equation, and assess your risk. If you choose to engage in the any of the risk activities, take the necessary precautions to make sure you and your partner are both protected. We all have the right to have fun so let's just keep ourselves safer while doing so.
This guest post was submitted by Ana M. Saskowski. Ana is a full-time mom and part-time student living in Sylvan Lake. Her recent attendance at AIDS Calgary Core Training had a profound impact on her life and prompted her submissions to The A Word.
Thursday, September 10, 2009
Recent medical breakthroughs in the fight against HIV/AIDS
Are microbicides the condom of the future?
Micro…what?
Microbicides are a protective material inserted into the vagina or rectum prior to intercourse. Microbicides can come in the form of gels, creams, suppositories, films, or as a sponge or ring and release an active ingredient that is designed to destroy microbes (bacteria and viruses) or to reduce their ability to establish an infection.
To date, efforts to develop a microbicide that effectively prevents the transmission of HIV in real world situations have failed. Factors from application to storage have stymied researchers. Despite these stumbling blocks, scientists and researchers are just beginning to see the potential of microbicide technology and already medical breakthroughs have taken place. The latest one occurred earlier this month at the University of Utah.
What is it?
A new kind of microbicidal "molecular condom". Before sex, women insert a vaginal gel that turns semisolid in the presence of semen, trapping HIV particles in a microscopic mesh so they can't infect vaginal cells. The gel will potentially block sperm and other STI viruses. In addition to preventing STI/HIV transmission, this gel could act as a contraceptive.
When was it discovered?
August 2009
Who is doing the research?
Dr Kiser, Dr Jay and other University of Utah scientists. The study was funded by National Institutes of Health. The University of Utah research team is continuing the effort to develop microbicides to prevent the spread of HIV/AIDS thanks to a $100,000 grant from the Bill and Melinda Gates Foundation.
Why is this groundbreaking?
The discovery of the new “molecular condom” is groundbreaking because of how it prevents transmission, how it is applied, the social implications, and the low cost to produce.
How does it work?
It is the first vaginal gel designed to prevent the movement of the HIV virus rather then trying to kill the virus. The barrier would last until the end of the virus’s lifecycle. Researcher’s are hopeful that this will be a better strategy to approach HIV, a very fragile virus which cannot live long without a host.
Unlike other microbicides which have to be taken right before sex, this new microbicide technology would be applied once a day or even once a month.
What is the cost to produce?
The cost to produce a male condom is approximately three cents, a female condom is 60 cents. Dr. Kiser has sated that the “molecular condom” should cost no more than five cents for each dose, with a shelf price comparable to male condoms. How long until this treatment is available? It is still around 5 years away from being tested in humans. Researchers estimate 10 years before it might be in widespread use.
Other issues:
Because this microbicide doesn’t need to be applied right before sex, women are able to take control of their own prevention strategies. This is especially helpful for women living in third-world countries where HIV/AIDS is widespread and they are not able to access condoms or successfully negotiate condom use with sexual partners.
Unfortunately, this product is designed only for protection during vaginal intercourse. The product would not effectively prevent transmission of HIV/STI’s that occur during anal or oral sex.
For more on this study:
BBC
Utah Engineering
The Globe and Mail
Micro…what?
Microbicides are a protective material inserted into the vagina or rectum prior to intercourse. Microbicides can come in the form of gels, creams, suppositories, films, or as a sponge or ring and release an active ingredient that is designed to destroy microbes (bacteria and viruses) or to reduce their ability to establish an infection.
To date, efforts to develop a microbicide that effectively prevents the transmission of HIV in real world situations have failed. Factors from application to storage have stymied researchers. Despite these stumbling blocks, scientists and researchers are just beginning to see the potential of microbicide technology and already medical breakthroughs have taken place. The latest one occurred earlier this month at the University of Utah.
What is it?
A new kind of microbicidal "molecular condom". Before sex, women insert a vaginal gel that turns semisolid in the presence of semen, trapping HIV particles in a microscopic mesh so they can't infect vaginal cells. The gel will potentially block sperm and other STI viruses. In addition to preventing STI/HIV transmission, this gel could act as a contraceptive.
When was it discovered?
August 2009
Who is doing the research?
Dr Kiser, Dr Jay and other University of Utah scientists. The study was funded by National Institutes of Health. The University of Utah research team is continuing the effort to develop microbicides to prevent the spread of HIV/AIDS thanks to a $100,000 grant from the Bill and Melinda Gates Foundation.
Why is this groundbreaking?
The discovery of the new “molecular condom” is groundbreaking because of how it prevents transmission, how it is applied, the social implications, and the low cost to produce.
How does it work?
It is the first vaginal gel designed to prevent the movement of the HIV virus rather then trying to kill the virus. The barrier would last until the end of the virus’s lifecycle. Researcher’s are hopeful that this will be a better strategy to approach HIV, a very fragile virus which cannot live long without a host.
Unlike other microbicides which have to be taken right before sex, this new microbicide technology would be applied once a day or even once a month.
What is the cost to produce?
The cost to produce a male condom is approximately three cents, a female condom is 60 cents. Dr. Kiser has sated that the “molecular condom” should cost no more than five cents for each dose, with a shelf price comparable to male condoms. How long until this treatment is available? It is still around 5 years away from being tested in humans. Researchers estimate 10 years before it might be in widespread use.
Other issues:
Because this microbicide doesn’t need to be applied right before sex, women are able to take control of their own prevention strategies. This is especially helpful for women living in third-world countries where HIV/AIDS is widespread and they are not able to access condoms or successfully negotiate condom use with sexual partners.
Unfortunately, this product is designed only for protection during vaginal intercourse. The product would not effectively prevent transmission of HIV/STI’s that occur during anal or oral sex.
For more on this study:
BBC
Utah Engineering
The Globe and Mail
Thursday, August 20, 2009
Did you ever wonder?
Did you ever wonder how condoms were tested? How condom manufacturers made sure that their product could hold up under pressure? Well it turns out that they used returned product, questionnaires and a machine. Below is a picture of a coital model. This particular model is used by SSL International, the manufacturer of Durex condoms.
We all know that condoms are an excellent way to prevent the transmission of Sexually Transmitted Infections (STI's). The effectiveness of perfect condom use is extremely high but human error does enter into the equation. Tears, unpinched tips, and slippage can all result in condom failure.
SSL International is using it's coital model to investigate further causes into condom breakage. An article in Contraception Journal states that:
SSL International is using it's coital model to investigate further causes into condom breakage. An article in Contraception Journal states that:
"Evidence combined from examining returns, questionnaire responses and the coital model strongly suggests a single predominant mechanism of failure we named "blunt puncture," where the tip of the thrusting male penis progressively stretches one part of the intact condom wall until it ultimately breaks. Blunt puncture appears to be the mechanism of breakage responsible for more than 90% of condom breakage not attributable to misuse. Knowledge of the main mechanism of breakage should help develop better user instructions, better test methods and, ultimately, better condoms."
It's nice to know that science is on our side and working towards building a better condom.
Sources:
White, Nicholas D. (2008) Male condoms that break in use do so mostly by a “blunt puncture” mechanism. Contraception An International Journal, Volume 77 Issue 5. http://www.contraceptionjournal.org/article/S0010-7824(08)00064-4/abstract Retrieved August 2009.
Pescovitz, David. (2009) Coital "model" machine used in condom study. http://www.boingboing.net/2009/08/19/coital-model-machine.html Retrieved August 2009
Monday, March 30, 2009
Condoms: An essential tool in the fight against HIV
Recently there has been a media buzz surrounding Catholic Church leaders and the use of condoms to prevent the spread of HIV in Africa.
In an article published in the Calgary Herald on March 18, Pope Benedict was quoted saying that AIDS “is a tragedy that cannot be overcome by money alone, that cannot be overcome through the distribution of condoms, which even aggravates the problems.”
On March 27, the Calgary Herald published an article when Bishop Fred Henry sent a letter to the Calgary Catholic Teacher’s Association encouraging members to focus their AIDS charity fundraising efforts on organizations which share Catholic values. Previously the teachers had raised money for the Stephen Lewis Foundation, a prominent organization that promotes the use of condoms as an effective means to prevent the spread of HIV.
AIDS Calgary was very disappointed to hear the Bishop’s position on teachers raising funds for the Stephen Lewis Foundation. We took the opportunity to respond when approached by local media.
To quote UNAIDS Condoms and HIV Prevention Position Statement, “The male latex condom is the single, most efficient, available technology to reduce the sexual transmission of HIV and other sexually transmitted infections.”
We at AIDS Calgary firmly believe that access to condoms is essential in the fight against HIV. While abstinence is also a tool in the arsenal, it is not always an option. Evidence shows that condom use prevents the spread of HIV. Further, “condom use is more likely when people can access them at no cost or at greatly subsidized prices” according to UNAIDS.
But what are your thoughts? Do you agree with the Pope that condoms should not be used to fight the spread of HIV? Do you think that the Catholic Teachers Association should not be allowed to raise money for an organization that does not strictly adhere to Catholic values?
We would love you hear your opinions!
Pope Denounces Condom Use In AIDS-plagued Africa - Calgary Herald, March 18, 2009
Calgary Catholic Teachers Drop AIDS Charity - Calgary Herald, March 27, 2009
Condoms and HIV Prevention: Position Statement by UNAIDS, UNFPA, and WHO
In an article published in the Calgary Herald on March 18, Pope Benedict was quoted saying that AIDS “is a tragedy that cannot be overcome by money alone, that cannot be overcome through the distribution of condoms, which even aggravates the problems.”
On March 27, the Calgary Herald published an article when Bishop Fred Henry sent a letter to the Calgary Catholic Teacher’s Association encouraging members to focus their AIDS charity fundraising efforts on organizations which share Catholic values. Previously the teachers had raised money for the Stephen Lewis Foundation, a prominent organization that promotes the use of condoms as an effective means to prevent the spread of HIV.
AIDS Calgary was very disappointed to hear the Bishop’s position on teachers raising funds for the Stephen Lewis Foundation. We took the opportunity to respond when approached by local media.
To quote UNAIDS Condoms and HIV Prevention Position Statement, “The male latex condom is the single, most efficient, available technology to reduce the sexual transmission of HIV and other sexually transmitted infections.”
We at AIDS Calgary firmly believe that access to condoms is essential in the fight against HIV. While abstinence is also a tool in the arsenal, it is not always an option. Evidence shows that condom use prevents the spread of HIV. Further, “condom use is more likely when people can access them at no cost or at greatly subsidized prices” according to UNAIDS.
But what are your thoughts? Do you agree with the Pope that condoms should not be used to fight the spread of HIV? Do you think that the Catholic Teachers Association should not be allowed to raise money for an organization that does not strictly adhere to Catholic values?
We would love you hear your opinions!
Pope Denounces Condom Use In AIDS-plagued Africa - Calgary Herald, March 18, 2009
Calgary Catholic Teachers Drop AIDS Charity - Calgary Herald, March 27, 2009
Condoms and HIV Prevention: Position Statement by UNAIDS, UNFPA, and WHO
Thursday, March 5, 2009
Condom, Latex Condom.
I know I don’t look very strong. But look at me. I’m waterproof, flexible and oh so thin.
Who wouldn’t want me?
They call me Condom. Latex Condom.
I have the coolest friends too. Coloured, Flavoured and Ribbed. Sure, I’m not as flashy as them, but trust me, we’re all up for any situation. I’m sure you know what I mean.
We’re smart too eh. Nothin’ gets past us. We’re like the bouncers to the exclusive club where only sexy sensations have access. No bribes will convince us to let in sperm, STI’s like the syph and gonorrhea, even HIV – no, we’re awesome like that.
Actually, hold up. There is a slight possibility that some things you don’t want in your club will slip through, but look it’s normally not our fault. We go through so much to be the best for you – we have a maturing stage, take electric shock tests, get locked in a square foil with lube, take leakage and quality control tests and sit on store shelves, waiting patiently to be bought.
It’s taken 400 years to get us this way. Our ancestors were made of oiled silk paper, tortoise shells, linen sheaths, leather and the various insides of animals. Even today we’re not the only option because you can find our friends lambskin and polyurethane.
I think we’re the best though.
I’m not placing blame, but you people - sometimes you get so caught up in the heat you poke holes, let us slip off, damage us with oil-based lubricant or forget to use us at all!
Let’s just agree that neither of us is perfect. Pay attention now, here’s how to do it the right way:
- make sure the expiry date has not passed
- tear package and be careful not to rip with teeth or fingernails
- place, still rolled, over the tip of an erect penis
- pinch the tip to get all the air out, and unroll with your other hand
Consider using some water-based lube on the outside, we really like that and think you will too. Or, get your partner to help – it might be fun!
I admit we’re low maintenance. I’ll liven up your day or night in playful, seductive ways. Trash me after one use and go on to one of my friends for the next time…
So, come on. Pick us up. Put us on. Protect yourself.
Who wouldn’t want me?
They call me Condom. Latex Condom.
Who wouldn’t want me?
They call me Condom. Latex Condom.
I have the coolest friends too. Coloured, Flavoured and Ribbed. Sure, I’m not as flashy as them, but trust me, we’re all up for any situation. I’m sure you know what I mean.
We’re smart too eh. Nothin’ gets past us. We’re like the bouncers to the exclusive club where only sexy sensations have access. No bribes will convince us to let in sperm, STI’s like the syph and gonorrhea, even HIV – no, we’re awesome like that.
Actually, hold up. There is a slight possibility that some things you don’t want in your club will slip through, but look it’s normally not our fault. We go through so much to be the best for you – we have a maturing stage, take electric shock tests, get locked in a square foil with lube, take leakage and quality control tests and sit on store shelves, waiting patiently to be bought.
It’s taken 400 years to get us this way. Our ancestors were made of oiled silk paper, tortoise shells, linen sheaths, leather and the various insides of animals. Even today we’re not the only option because you can find our friends lambskin and polyurethane.
I think we’re the best though.
I’m not placing blame, but you people - sometimes you get so caught up in the heat you poke holes, let us slip off, damage us with oil-based lubricant or forget to use us at all!
Let’s just agree that neither of us is perfect. Pay attention now, here’s how to do it the right way:
- make sure the expiry date has not passed
- tear package and be careful not to rip with teeth or fingernails
- place, still rolled, over the tip of an erect penis
- pinch the tip to get all the air out, and unroll with your other hand
Consider using some water-based lube on the outside, we really like that and think you will too. Or, get your partner to help – it might be fun!
I admit we’re low maintenance. I’ll liven up your day or night in playful, seductive ways. Trash me after one use and go on to one of my friends for the next time…
So, come on. Pick us up. Put us on. Protect yourself.
Who wouldn’t want me?
They call me Condom. Latex Condom.
Thursday, February 26, 2009
Do You Have What it Takes?
For the past year AIDS Calgary has been working as a member of the Steering Committee for the “Do you have what it takes?” national sexual health campaign, for gay men, bisexual men and men who have sex with men (MSM). Sero Zero, an AIDS Service Organization in Montreal, has been the lead agency in this campaign and has brought together the 8 members of the Steering Committee. The 2009 campaign builds on the successes of the past 2 national campaigns; Assumptions and Gay Men Play Safe.“To reinforce these previous messages of prevention, the present campaign continues to disseminate information that will enable men who have sex with other men to identify their own areas (factors) of vulnerability that may lead them to sexual risk taking. A resolutely playful, sexy, and provocative tone gives a particular color to Do you have what it takes?—a new campaign based on data and observations gathered by community groups as well as on data from social research.” Source: http://www.what-it-takes.org/en/campaign.html
The campaign works to assist gay men/MSM in understanding different areas of vulnerabilities and options to reduce HIV/STI transmission, while still maintaining a healthy and satisfying sex life. The campaign materials utilize the slogan “Sex, Passion, Romance, Adventure... Do you have what it takes?” with fun and provocative visuals that encourage people to visit the website for an interactive experience. The materials include posters, condom pack inserts, table top displays with post cards, Youtube video, computer wall paper, website and interactive self assessment quiz. The website based quiz allows individuals to identify potential areas of vulnerability and provides specific strategies to reduce risk. In some regions, the campaign will be complimented by offering a sensual risk reduc
tion workshop series, for gay men/MSM, based on the Pheonix Project.AIDS Calgary has benefited tremendously from being a part of this campaign process as it has allowed us to contribute a local perspective to this national campaign. We would not have the resources to do such a large scale and interactive campaign alone. We will integrate the campaign concepts and materials into our ongoing outreach via the HEAT Program. The HEAT Program has been a longstanding service of AIDS Calgary. HEAT (HIV Education and Awareness Today) - is a program designed to address HIV/STI education, awareness and prevention for gay men/MSM. The program provides HIV/STI education, support and health promotion, and free safer sex supplies, through outreach at GLBT events, venues, and online.
We encourage you to visit the website http://www.what-it-takes.org/en/campaign.html take the quiz, watch the fun video, review the information and find out What it takes, for you!
Resources:
HEAT Program
HEAT Facebook Profile: “Heat Worker”
Do you have what it takes? Website
Do you have what it takes? Quiz
Youtube Video
Pheonix Project
Thursday, February 5, 2009
Treatment as Prevention – A Three Part Series
Part Three – Early Treatment for the Good of All?
What if you went to the doctor, and the doctor said, “We know that even though you have HIV, you are healthy and feel great. But, we want to put you on some medication anyway. Our research has shown that this will help prevent you from passing on the HIV, but it may also make you feel terrible and make you even sicker in the long run.”
This is the crossroads health authorities have arrived at, one where individual health priorities could become dwarfed by a public health imperative to start using HIV treatment as HIV prevention. Recent studies have demonstrated that individuals on HIV treatment are less likely to pass on HIV, primarily due to decreased levels of the virus in their bodies (see Treatment as Prevention Parts 1 and 2).
Based on a recent mathematical modeling study, the impact of this could be dramatic in a country like South Africa with a generalized HIV epidemic. The study measured the impact on HIV transmission if all people received universal voluntary HIV testing followed by immediate treatment with anti-retroviral therapy.1 The results are striking, predicting that new HIV infections would drop by 95% within 10 years.2
This seems like wonderful news, a way to end new HIV infections and to stem the tide of a devastating global pandemic. But, this study ignores one very important factor- whether the people actually need treatment! In a North American context, people newly infected with HIV can often live for 10 years without experiencing symptoms. Treatment is typically not started until a person’s immune system starts to falter or the person starts to develop opportunistic infections.
The reason for delaying treatment is to postpone serious medication side effects such as fatigue, nausea, diarrhea, facial wasting, lipoatrophy and neuropathy.3 This delay may also enable people to postpone onset of significant liver, kidney and other health problems.4 Finally, people may develop drug resistances over time so it may be better to delay treatment in order to help prolong treatment efficacy given the limited number of treatment options available.
There are new studies which challenge the exact CD4 count at which people should start treatment.5 However, there is still a general consensus that treatment should be started when an individual’s health status warrants it. Ultimately, individuals have a fundamental right to individual treatment determination, and any public health policy must respect the importance of this.
Before implementing broad based treatment programs for the sake of prevention, it is also important to recognize that regular risk reduction strategies and safer sex practices are still effective ways of preventing HIV transmission. For those who do not engage in high risk activities, placing them on early treatment may simply force them to compromise their good health in order to prevent transmission of a virus they weren’t going to transmit anyway.
Clearly, HIV treatment has an important role to play in improving the health of individuals and contributing to a reduced risk of HIV transmission. Likewise, wider HIV testing in our community would help diagnose people living with HIV earlier and reduce their risk of unknowingly passing on the virus. However, any major shifts in treatment or testing policy must carefully weigh the rights of individuals and the possible long term health impacts on them against the possible benefits of a new and controversial approach to treatment as prevention in our communities.
1 Universal voluntary HIV testing with immediate antiretroviral therapy as a strategy for elimination of HIV transmission: a mathematical model. 2008. Granich, Reuben M, Gilks, Charles F Gilks, Dye, Christopher, DeCock, Kevin M, Williamns, Brian G. The Lancet. Retrieved January 2009 http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(08)61697-9/fulltext
2 Math model: HIV can be eliminated in a decade, 2008. Associated Press. Retrieved January 2009 http://www.msnbc.msn.com/id/27911541/
3 HIV Medications: When to Start and What to Take, 2006.The Body. Retrieved January 2009 http://www.thebody.com/content/art12718.html and Side Effects, Opportunistic Infections and Coinfections Prevention and Treatment, The Body. Retrieved January 2009 http://www.thebody.com/index/treat/oipage.html
4 A Practical Guide to HIV Drug Side Effects, 2006. Canadian AIDS Treatment Information Exchange. Retrieved January 2009 http://www.thebody.com/content/art46570.html
5 Growing Evidence Supports Early Treatment, 2008. Dalton, Paul. Project Inform. Retrieved January 2009 http://www.thebody.com/content/treat/art47351.html
What if you went to the doctor, and the doctor said, “We know that even though you have HIV, you are healthy and feel great. But, we want to put you on some medication anyway. Our research has shown that this will help prevent you from passing on the HIV, but it may also make you feel terrible and make you even sicker in the long run.”
This is the crossroads health authorities have arrived at, one where individual health priorities could become dwarfed by a public health imperative to start using HIV treatment as HIV prevention. Recent studies have demonstrated that individuals on HIV treatment are less likely to pass on HIV, primarily due to decreased levels of the virus in their bodies (see Treatment as Prevention Parts 1 and 2).
Based on a recent mathematical modeling study, the impact of this could be dramatic in a country like South Africa with a generalized HIV epidemic. The study measured the impact on HIV transmission if all people received universal voluntary HIV testing followed by immediate treatment with anti-retroviral therapy.1 The results are striking, predicting that new HIV infections would drop by 95% within 10 years.2
This seems like wonderful news, a way to end new HIV infections and to stem the tide of a devastating global pandemic. But, this study ignores one very important factor- whether the people actually need treatment! In a North American context, people newly infected with HIV can often live for 10 years without experiencing symptoms. Treatment is typically not started until a person’s immune system starts to falter or the person starts to develop opportunistic infections.
The reason for delaying treatment is to postpone serious medication side effects such as fatigue, nausea, diarrhea, facial wasting, lipoatrophy and neuropathy.3 This delay may also enable people to postpone onset of significant liver, kidney and other health problems.4 Finally, people may develop drug resistances over time so it may be better to delay treatment in order to help prolong treatment efficacy given the limited number of treatment options available.
There are new studies which challenge the exact CD4 count at which people should start treatment.5 However, there is still a general consensus that treatment should be started when an individual’s health status warrants it. Ultimately, individuals have a fundamental right to individual treatment determination, and any public health policy must respect the importance of this.
Before implementing broad based treatment programs for the sake of prevention, it is also important to recognize that regular risk reduction strategies and safer sex practices are still effective ways of preventing HIV transmission. For those who do not engage in high risk activities, placing them on early treatment may simply force them to compromise their good health in order to prevent transmission of a virus they weren’t going to transmit anyway.
Clearly, HIV treatment has an important role to play in improving the health of individuals and contributing to a reduced risk of HIV transmission. Likewise, wider HIV testing in our community would help diagnose people living with HIV earlier and reduce their risk of unknowingly passing on the virus. However, any major shifts in treatment or testing policy must carefully weigh the rights of individuals and the possible long term health impacts on them against the possible benefits of a new and controversial approach to treatment as prevention in our communities.
1 Universal voluntary HIV testing with immediate antiretroviral therapy as a strategy for elimination of HIV transmission: a mathematical model. 2008. Granich, Reuben M, Gilks, Charles F Gilks, Dye, Christopher, DeCock, Kevin M, Williamns, Brian G. The Lancet. Retrieved January 2009 http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(08)61697-9/fulltext
2 Math model: HIV can be eliminated in a decade, 2008. Associated Press. Retrieved January 2009 http://www.msnbc.msn.com/id/27911541/
3 HIV Medications: When to Start and What to Take, 2006.The Body. Retrieved January 2009 http://www.thebody.com/content/art12718.html and Side Effects, Opportunistic Infections and Coinfections Prevention and Treatment, The Body. Retrieved January 2009 http://www.thebody.com/index/treat/oipage.html
4 A Practical Guide to HIV Drug Side Effects, 2006. Canadian AIDS Treatment Information Exchange. Retrieved January 2009 http://www.thebody.com/content/art46570.html
5 Growing Evidence Supports Early Treatment, 2008. Dalton, Paul. Project Inform. Retrieved January 2009 http://www.thebody.com/content/treat/art47351.html
Thursday, January 22, 2009
Female Condoms and Anal Sex
What is the female condom?
In Canada, the female condom is called the Reality Female Condom and is from The Female Health Company and is designed for vaginal sex. Female condoms have an inner and outer polyurethane ring and a thin, loose-fitting polyurethane sheath. The inner ring is inside of the sheath which is inserted into the vagina while the outer ring is left outside of the vagina.
Female Condoms and Anal Sex
“FC female condoms are not specifically approved or recommended for anal sex. There are reports from all over the world, however, that the original FC has been used for anal sex. Several studies have been done and published and others are on-going.” (The Female Health Company, n.d.)
Some of the concerns with using female condoms for anal sex include slippage of the female condom, the penis being accidentally inserted beside the female condom, anal discomfort, tearing and bleeding.
The 2003 study, “Safety and acceptability of the Reality condom for anal sex among men who have sex with men” reported the following conclusions “Men reported more frequent problems with Reality condoms than male latex condoms used for anal intercourse, particularly slippage, discomfort, and rectal bleeding. Design modifications, training, and research on the clinical significance of safety outcomes are needed for use of Reality condoms with anal sex.” (University of Washington, 2003)
Based on the current recommendations and approval for use of the female condom, as well as some of the potential problems associated with use for anal sex, we recommend the use of a latex male condom, with water based lube, as currently the best option for safer anal sex.
What if I still want to use female condoms for anal sex?
As a harm reduction approach for individuals who have decided to use female condoms for anal sex, NAM – AIDS Map a UK base HIV/AIDS information provider, has the following “Provisional guidelines for anal sex with female condoms” which can be found at: http://www.aidsmap.com/en/docs/A85BA23D-6F72-4CD2-90A4-D914A60BEF79.asp
References
The Female Condom Company. (n.d.). (n.t.). Retrieved November 24, 2008 http://www.femalehealth.com/QAs_PL.htm#q8
NAM. (2004). Female condoms for anal sex. Retrieved November 24, 2008 http://www.aidsmap.com/en/docs/A85BA23D6F72-4CD2-90A4-D914A60BEF79.asp
University of Washington/Seattle HPTU. (2003). Safety and acceptability of the Reality condom for anal sex among men who have sex with men. Retrieved November 24, 2008 http://depts.washington.edu/hptu/realityabstract1.html
In Canada, the female condom is called the Reality Female Condom and is from The Female Health Company and is designed for vaginal sex. Female condoms have an inner and outer polyurethane ring and a thin, loose-fitting polyurethane sheath. The inner ring is inside of the sheath which is inserted into the vagina while the outer ring is left outside of the vagina.
Female Condoms and Anal Sex
“FC female condoms are not specifically approved or recommended for anal sex. There are reports from all over the world, however, that the original FC has been used for anal sex. Several studies have been done and published and others are on-going.” (The Female Health Company, n.d.)
Some of the concerns with using female condoms for anal sex include slippage of the female condom, the penis being accidentally inserted beside the female condom, anal discomfort, tearing and bleeding.
The 2003 study, “Safety and acceptability of the Reality condom for anal sex among men who have sex with men” reported the following conclusions “Men reported more frequent problems with Reality condoms than male latex condoms used for anal intercourse, particularly slippage, discomfort, and rectal bleeding. Design modifications, training, and research on the clinical significance of safety outcomes are needed for use of Reality condoms with anal sex.” (University of Washington, 2003)
Based on the current recommendations and approval for use of the female condom, as well as some of the potential problems associated with use for anal sex, we recommend the use of a latex male condom, with water based lube, as currently the best option for safer anal sex.
What if I still want to use female condoms for anal sex?
As a harm reduction approach for individuals who have decided to use female condoms for anal sex, NAM – AIDS Map a UK base HIV/AIDS information provider, has the following “Provisional guidelines for anal sex with female condoms” which can be found at: http://www.aidsmap.com/en/docs/A85BA23D-6F72-4CD2-90A4-D914A60BEF79.asp
References
The Female Condom Company. (n.d.). (n.t.). Retrieved November 24, 2008 http://www.femalehealth.com/QAs_PL.htm#q8
NAM. (2004). Female condoms for anal sex. Retrieved November 24, 2008 http://www.aidsmap.com/en/docs/A85BA23D6F72-4CD2-90A4-D914A60BEF79.asp
University of Washington/Seattle HPTU. (2003). Safety and acceptability of the Reality condom for anal sex among men who have sex with men. Retrieved November 24, 2008 http://depts.washington.edu/hptu/realityabstract1.html
Friday, December 19, 2008
Treatment as Prevention – A Three Part Series
Part Two – Controversy Rocks Foundations of Prevention Messaging
Community Response to the Controversial Swiss Study
Community Response to the Controversial Swiss Study
The mantra of AIDS Service Organizations for the last twenty years has been that the best way to prevent the transmission of HIV is to use a condom, properly, every time you engage in sexual activity. But the recent statement made by the Swiss Federal Commission for HIV/AIDS in their Bulletin of Swiss Medicine is posing a challenge to this fundamental message (see Part 1 – HIV Treatment Debate Rages).
The statement suggests that people living with HIV who are on antiretroviral treatment and have undetectable viral loads do not pose a risk of sexual transmission to their partners. The community has responded with a resounding cry for proof, assailing the Commission’s statement and admonishing them for publishing a document based on “opinion” and “belief” rather than fact. Interestingly, even the Commission is reluctant to make any firm guarantees in relation to their statement.
As they explain, “medical and biologic data available today do not permit proof that HIV-infection during effective antiretroviral therapy is impossible, because the non-occurrence of an improbable event cannot be proven. If no transmission events were observed among 100 couples followed for two years, for instance, there might still be some such events if 10,000 couples are followed for ten years. The situation is analogous to 1986, when the statement ‘HIV cannot be transmitted by kissing’ was publicised. This statement has not been proven, but after 20 years’ experience its accuracy appears highly plausible.” 1
In many ways, this parallel pinpoints the grey areas within which public health officials and AIDS Service Organizations have operated for the past 30 years. In truth, when it comes to HIV transmission, it is almost impossible to prove anything beyond a level of uncertainty. Ethically speaking, scientists cannot run controlled studies on human subjects while knowingly placing them at risk of HIV transmission. In the absence of hard scientific evidence, the community is forced to operate within a realm of estimations, based on the best scientific data available, but often without totally definitive scientific proof. In other words, recommendations get made, and everyone crosses their fingers and hopes that they are right.
In the case of the Commission’s statement, there seems to be a general consensus that the risks are too high to just cross our fingers and hope for the best, and the evidence is not strong enough to inspire confidence.
Significantly, a recent study by UNSW's National Centre in HIV Epidemiology and Clinical Research (NCHECR) found that if the Swiss Commission’s statement were adopted at the community level, over a ten year period HIV transmission among serodiscordant couples would be four times higher in couples who abandon condom use than if condoms had been used. The study used mathematical modeling to extrapolate HIV transmission in a population of 10,000 serodiscordant couples and showed that there would be 215 female-to-male transmissions, 425 male-to-female transmissions and 3,524 male-to-male transmissions. As Dr. Wilson, one of the study authors states, "While it is true that the individual risk of HIV transmission per act is fairly small for people on antiretrovirals, the risk of transmission over large numbers of acts could be substantial.” 2
It is within this context that we must view the statements put forward by the Swiss Commission. The best way to reduce HIV transmission remains to use a condom properly every time you engage in sexual activity. For people living with HIV/AIDS, being adherent to your HIV treatment, maintaining an undetectable viral load, testing for and treatment of all STIs are all additional ways to reduce the risk of passing HIV to your partner. Practicing these steps, in conjunction with regular and consistent condom use, provides a new strategy for reducing risks even further. In many ways, this is great news for serodiscordant couples as it provides new tools and peace of mind for preventing the onward transmission of the virus, and poses a great incentive to stay adherent to one’s treatment and improve one’s overall health.
Part Three of Treatment as Prevention
1 Bernard, Edwin J. (2008). Swiss experts say individuals with undetectable viral load and no STI cannot transmit HIV during sex. http://www.aidsmap.com/en/news/4E9D555B-18FB-4D56-B912-2C28AFCCD36B.asp Retrieved November 2008
2 Study Says Swiss Commission Advice may See HIV Infection Quadrupling http://www.medindia.net/news/Study-Says-Swiss-Commission-Advice-may-See-HIV-Infection-Quadrupling-40023-1.htm Retrieved November 2008.
Thursday, December 11, 2008
Treatment as Prevention – A Three Part Series
Part One – HIV Treatment Debate Rages
An Introduction to the Controversial Swiss Study
Following a review of recent medical research, the Swiss Federal Commission for HIV/AIDS issued a highly controversial statement in their Bulletin of Swiss Medicine. The Swiss study stated that “an HIV-infected person on antiretroviral therapy with completely suppressed viraemia (“effective ART”) is not sexually infectious, i.e. cannot transmit HIV through sexual contact.”1
According to the Commission, this is true so long as the following requirements are met:2
- the person adheres to antiretroviral therapy (and the effects of this are monitored regularly by the treating physician)
- the viral load has been suppressed to an “undetectable level” (less than 40 copies/ml) for at least six months
- the person does not have any sexually transmitted infections
- the person is in a “stable relationship”
Since the Commission issued this statement, their conclusions have come under considerable scrutiny by UNAIDS, WHO, Public Health Agency of Canada and AIDS Service Organizations such as AIDS Calgary. Criticisms have centred both on the scientific accuracy of their argument and the real world applicability of their statement. Some key areas of concern are:3
- People are not always adherent to their medication regime, particularly in the face of severe side effects or other life challenges, and this can cause their viral loads to increase suddenly and significantly. Even those who do adhere to treatment can develop resistance to their drug regime or simply have “blips” in their viral load. In addition, the frequency with which people actually visit the doctor for viral load testing combined with the waiting period to receive test results makes it extremely difficult for someone to accurately know their viral load levels.
- Although the Commission argues that antiretroviral therapy eliminates HIV from genital secretions, this statement has been challenged. Critics point out that with only 2% of the body’s immune cells carried in the blood, blood may not accurately reflect viral load levels in other parts of the body (98% of immune cells are found in the lymph nodes and lymph tissues that line the gastrointestinal tract).
- It is common for people to have sexually transmitted infections without experiencing any symptoms; therefore it is difficult for people to know whether they have an STI at any given time.
- While some people maintain long term monogamous relationships, others do not, and people may be unaware of whether their relationships are monogamous due to the undisclosed affairs of their partners. The Commission’s statement is also based solely on data from studies of heterosexual couples, so the applicability of their statement to relationships between men is unclear.
While it may be true that adherence to treatment reduces viral load and that undetectable viral load correlates with a reduced likelihood of HIV transmission, when placed in real world conditions, the feasibility of the Commission’s statement comes under significant fire.
Next Week: Part 2 of Treatment as Prevention explores the community response to the Swiss study.
1 Bernard, Edwin J. (2008). Swiss experts say individuals with undetectable viral load and no STI cannot transmit HIV during sex. http://www.aidsmap.com/en/news/4E9D555B-18FB-4D56-B912-2C28AFCCD36B.asp%20%20Retrieved%20November%202008
2 Bernard, Edwin J. (2008). Swiss experts say individuals with undetectable viral load and no STI cannot transmit HIV during sex. http://www.aidsmap.com/en/news/4E9D555B-18FB-4D56-B912-2C28AFCCD36B.asp Retrieved November 2008; Canadian AIDS Treatment Information Exchange (2008). Swiss guidelines take a troubling turn. http://www.catie.ca/catienews.nsf/news/A2EFD4077BD44FB285257405005EE5EF?OpenDocument%20%20Retrieved%20November%202008.
3 Canadian AIDS Treatment Information Exchange (2008). Swiss guidelines take a troubling turn. http://www.catie.ca/catienews.nsf/news/A2EFD4077BD44FB285257405005EE5EF?OpenDocument%20%20Retrieved%20November%202008