IRMA - Rectal Microbicide Advocacy

Sexual transmission of HIV according to viral load and antiretroviral therapy: systematic review and meta-analysis

noreply@blogger.com (Marc-André LeBlanc) — Wed, 15 Jul 2009 14:28:00 +0000

Attia, Suzanna; Egger, Matthias; Müller, Monika; Zwahlen, Marcel; Low, Nicola

AIDS: 17 July 2009 - Volume 23 - Issue 11 - p 1397-1404

Objectives: To synthesize the evidence on the risk of HIV transmission through unprotected sexual intercourse according to viral load and treatment with combination antiretroviral therapy (ART).

Design: Systematic review and meta-analysis.

Methods: We searched Medline, Embase and conference abstracts from 1996-2009. We included longitudinal studies of serodiscordant couples reporting on HIV transmission according to plasma viral load or use of ART and used random-effects Poisson regression models to obtain summary transmission rates [with 95% confidence intervals, (CI)]. If there were no transmission events we estimated an upper 97.5% confidence limit.

Results: We identified 11 cohorts reporting on 5021 heterosexual couples and 461 HIV-transmission events. The rate of transmission overall from ART-treated patients was 0.46 (95% CI 0.19-1.09) per 100 person-years, based on five events. The transmission rate from a seropositive partner with viral load below 400 copies/ml on ART, based on two studies, was zero with an upper 97.5% confidence limit of 1.27 per 100 person-years, and 0.16 (95% CI 0.02-1.13) per 100 person-years if not on ART, based on five studies and one event. There were insufficient data to calculate rates according to the presence or absence of sexually transmitted infections, condom use, or vaginal or anal intercourse.

Conclusion: Studies of heterosexual discordant couples observed no transmission in patients treated with ART and with viral load below 400 copies/ml, but data were compatible with one transmission per 79 person-years. Further studies are needed to better define the risk of HIV transmission from patients on ART.

South Africa: Lesbians and HIV: Low risk but not no risk

noreply@blogger.com (Marc-André LeBlanc) — Tue, 14 Jul 2009 20:29:00 +0000

JOHANNESBURG, 14 July 2009 (PlusNews) - Women who sleep with women (WSW) are not at risk of HIV transmission – or are they? AIDS advocates warn that it is time for a wake-up call about who is and is not at risk.

HIV prevention among WSW and lesbian women remains off the prevention agenda, said Beverley Palesa Ditsie, a founding member of the Gay and Lesbian Organization of the Witwatersrand.

"When it comes to same-sex relationships other than male-to-male, [HIV] transmission is something we think we don't have to talk about," she commented at the launch of a new book on same-sex sexuality and HIV, published by the Human Sciences Research Council.

Zethu Matebeni, a fellow at the University of Witwatersrand's Institute for Social and Economic Research (WISER), who spent three years studying Johannesburg's black lesbian community, agreed that myths about the risk of female-to-female transmission were not being adequately addressed.

Rape as punishment

No data exists on HIV prevalence among lesbian women or WSW globally or in South Africa, but limited research by the gay and lesbian organization, OUT, indicated that the high rates of HIV in the WSW interviewed could be attributed mainly to rape, transactional sex and sexual violence.

Lesbian women in South Africa are being raped by men who believe it will "cure" them of their sexual orientation; women in townships in Johannesburg and Cape Town report a rising tide of brutal homophobic attacks, murders, and the widespread use of "corrective" rape as a form of punishment, notes a report published earlier this year by the international NGO, ActionAid.

According to OUT's research, only about 40 percent of WSW knew their HIV status, which often carried the same burden of stigma and silence it would in any relationship, Matebeni told IRIN/PlusNews. "Some women say it makes your partners think you have been sleeping around when it's not the case."

She said negotiating safe sex could be difficult for women even in loving, consensual relationships. It was also difficult to access barrier methods like finger condoms or dental dams - thin squares of latex rubber placed over the vagina or anus during oral sex to prevent sexually transmitted infections.

"Often, we don't know how to talk about safer sex because there aren't protection methods and, of the ones that are out there, many of them are extremely unpleasant – they make you feel ugly, and feeling beautiful is very important in sex."

Matebeni called for more attention to the HIV-prevention needs of women in same-sex relationships.

Gender differences in immune response to HIV

noreply@blogger.com (Marc-André LeBlanc) — Tue, 14 Jul 2009 17:49:00 +0000

From Kaiser News

New research showing that "a receptor molecule involved in the recognition of HIV-1 responds to the virus differently in women than in men," might "explain why HIV infection progresses faster to AIDS in women than in men with similar viral loads," the HealthDay/Greenville Daily Reflector reports. The study was conducted by researchers at the Ragon Institute of Massachusetts General Hospital, Massachusetts Institute of Technology and Harvard University and will be published in an upcoming issue of the journal Nature Medicine. Study authors also note that during the early stages of infection, women tend to have a stronger immune response to HIV than men, but then progress to AIDS more quickly. The different immune system response "then leads to differences in chronic T-cell activation, a known activator of disease progression, according to the researchers," the article states (7/13). Researcher Marcus Altfeld said the findings raise new questions about how sex hormones affect HIV in the body. "Focusing on immune activation separately from viral replication might give us new therapeutic approaches" to treating HIV, he added (AFP/Google News, 7/13).

New Lab Test Offers Better Prediction of Microbicide Safety

noreply@blogger.com (Marc-André LeBlanc) — Mon, 13 Jul 2009 15:44:00 +0000

Newswise — Scientists at Albert Einstein College of Medicine of Yeshiva University have devised a laboratory test for predicting whether microbicides against HIV are safe for human use. The researchers have also discovered why several supposedly “safe” microbicides made women more susceptible to HIV infection. The study appears today in the online version of the Journal of Infectious Diseases.

For years, scientists have been trying to develop a topical vaginal microbicide for preventing transmission of HIV, the virus that causes AIDS. A safe and effective microbicide would help protect women in settings where male condoms are not used — a common situation in many cultures. The need for an HIV microbicide is especially urgent in Africa, where AIDS is the leading cause of death and where women account for six out of ten of those living with HIV.

Several microbicide gels have been assessed in clinical trials after passing laboratory and animal safety tests. But with just one exception, all the microbicides were found to be ineffective against HIV; and two of the gels — nonoxynol-9 and cellulose sulfate — actually increased the risk of HIV infection in women.

“Our goal was to develop assays that are predictive of safety before proceeding to clinical trials that typically cost millions of dollars, involve thousands of women, and take many years,” says study leader Betsy C. Herold, M.D., professor of pediatrics, of microbiology & immunology, and of obstetrics & gynecology and women’s health at Einstein.

In evaluating a microbicide’s safety, researchers look primarily for signs that the chemical inflames cells of the vaginal lining, or epithelium. That could cause more harm than good: When the epithelium becomes inflamed, T cells flock to the damaged area — which might actually encourage HIV infection, since T cells are the main targets of HIV.

Dr. Herold theorized that another mechanism may also compromise a microbicide’s safety. The cells of the vaginal epithelium normally are tightly packed together, forming an impermeable barrier to HIV. If a microbicide disrupts the barrier’s structural integrity, HIV would be able to slip through the gaps and infect circulating T cells.

To test this theory, Pedro Mesquita, a postdoctoral fellow in Dr. Herold’s lab, developed a model that mimicked the genital tract environment. It was composed of two chambers separated by a barrier of cultured human cells that form tight junctions. After treating the epithelial cells with different microbicides, the researchers tested the barrier’s permeability to HIV by placing HIV in the upper chamber, T cells in the lower chamber, and then monitoring the infection of the T cells over time.

When the epithelial barrier was treated with placebo, HIV was unable to pass through to the lower chamber, leaving the T cells uninfected. “But when we applied nonoxynol-9, the virus went right through the barrier and infected the T cells,” says Dr. Herold. This result was no surprise, since nonoxynol-9 is a detergent, a class of chemicals known to be disruptive to cells.

Read the rest

Tight junctions between genital tract epithelial cells provide an anatomic barrier and prevent HIV from reaching submucosal targets. Microbicides that disrupt the barrier increase the risk for HIV infection. This assay accurately predicts the safety of microbicides.

From Spain: Microbicides and Gender: An Open Debate

noreply@blogger.com (Marc-André LeBlanc) — Thu, 09 Jul 2009 21:41:00 +0000

Planeta Salud organized a roundtable discussion in Barcelona on May 26th, 2009, to analyze and discuss the issues surrounding microbicides and their potential effects on gender, power roles and sexual health within a Spanish context.

The event was attended by more than twenty participants representing a variety of fields such as women’s rights, gender issues, HIV/AIDS prevention, immigrant populations and the health administration. The multidisciplinary nature of the audience permitted a wide range of comments, observations and critiques to be expressed, offering a panoramic look into the HIV prevention context.

Participants discussed a wide range of issues, including: the realities of sexual prevention today, how microbicide introduction can build on lessons learned from participants’ experiences, risk reduction approaches, how men and women can work together on HIV prevention, the challenges of products with partial efficacy, and the need for sufficient funding, training and integration of microbicides into existing programs.

Many participants expressed interest in rectal microbicides, providing an opportunity for discussion and distribution of IRMA materials.

Planeta Salud will follow up with further sessions, awareness-raising and meetings with political stakeholders.

Does sex in the early period after circumcision increase HIV-seroconversion risk?

noreply@blogger.com (Marc-André LeBlanc) — Wed, 08 Jul 2009 15:12:00 +0000

Does sex in the early period after circumcision increase HIV-seroconversion risk? Pooled analysis of adult male circumcision clinical trials. AIDS, 29 June 2009, epub ahead of print.

Mehta SD, et al. (Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, Illinois, USA)

OBJECTIVE: To evaluate whether sexual intercourse soon after adult male circumcision affected HIV risk.

DESIGN: Combined analysis of data from African trials of men who were randomized to and underwent circumcision.

METHODS: We examined two associations: early sex (intercourse <42 days after circumcision) and HIV acquisition at 3 months for the Orange Farm and Kisumu trials and at 6 months for the Rakai and Kisumu trials and incomplete wound healing at 1 month and seroconversion at 3 and 6 months for the Kisumu trial and at 6 months for the Rakai trial.

RESULTS: Early sex was reported by 3.9% of participants in Kisumu, 5.4% in Rakai, and 22.5% in Orange Farm. HIV seroprevalence was 0.0% at 3 months and 1.9% at 6 months among 18-24-year-olds reporting early sex and 0.2% at 3 months and 0.6% at 6 months among those who did not report early sex. In pooled analyses, men reporting early sex did not have higher HIV infection risk at 3 or 6 months. In Kisumu, 16 (1.3%) men had incomplete wound healing at the 30-day visit. One (6.3%) of these seroconverted at 3 months compared with 2 (0.2%) of 1246 men with complete wound healing (P = 0.075). No association was observed between incomplete wound healing and seroconversion for Rakai participants.

CONCLUSION: Most men delayed intercourse after circumcision. Early sex after circumcision was not associated with HIV risk, although the study power was limited. Nevertheless, men should delay intercourse to limit the potential for increased HIV risk until complete wound healing.

PMID: 19571722 [PubMed - as supplied by publisher]

[IRMA reminds readers that circumcised men in these trials were 50 to 60 percent less likely to get HIV from having (what is presumed to be mostly) vaginal sex. This does not mean that circumcised men cannot get or transmit HIV. It only means that they are about half as likely as uncircumcised men to get HIV from having vaginal sex with a woman who has HIV.

Trial data have not shown that circumcision makes a man less likely to transmit HIV to his partner through vaginal sex. In fact, one trial showed the opposite. This trial enrolled Ugandan married couples in which the husbands were HIV-positive and wives were HIV-negative. The wives of the men who got circumcised in this trial appeared to be at greater risk of getting HIV than the women married to uncircumcised men. The increased risk may have occurred when couples started having sex again before the skin on the man’s penis had fully healed (become keratinised) – a process that takes about six weeks.

Trial data also do not show whether circumcision lowers the risk of transmission for either men or women during unprotected anal sex.]

For more on male circumcision.

For more on what male circumcision means for women.

HIV serosorting and the risk of STIs in MSM

noreply@blogger.com (Marc-André LeBlanc) — Wed, 08 Jul 2009 14:51:00 +0000

[Presented at SÖDAK 2009: The German-Austrian-Swiss AIDS Congress, June 24-27 2009]

Marcus ULRICH and Axel J. SCHMIDT (Robert Koch Institut)

Objectives: We aimed to quantify the frequency and effectiveness of HIV risk management strategies and tactics other than condom use among men who have sex with men (MSM) in Germany and their impact on the frequency of sexually transmitted infections (STI).

Methods: For a cross-sectional survey a self-administered questionnaire was distributed via German MSM websites and medical practices in 2006. The majority (87%) of 6,833 analyzed participants were recruited online. We analyzed risk management of participants who reported HIVserosorting as a strategy (premeditated, planned) or as a tactic (depending on the situation) and explored the impact of HIV serosorting on the incidence of self-reported bacterial STIs by comparing serosorters with participants who reported other forms of risk management.

Results: HIV status has a large impact on the way how HIV serosorting is implemented. While HIV serosorting used strategically and tactically seems to be very similar in HIV positive MSM, there are distinct differences between HIV negative strategic and tactic serosorting. Except for HIV negative strategic serosorters, serosorting is associated with reduced condom use, higher partner numbers and a two to four fold increased risk of being diagnosed with bacterial STIs.

Discussion: HIV serosorting within primary relationships as well as with casual partners has emerged as a common risk management strategy and tactic in MSM. Apart from the problems of unambiguous communication about HIV status and the reliability of an HIV negative serostatus information, HIV serosorting as practiced currently by MSM in Germany is often used as an alternative to condoms, contributes to high incidences of STIs and hence elevated per-contact-risks for HIV transmission. Exclusive emphasis on HIV testing may encourage HIV serosorting, and thus may not solve the problems of HIV prevention, mainly because it lacks a comprehensive sexual risk reduction strategy for ART-naïve MSM diagnosed with HIV.

Slides from the presentation (in German)

Rectal Microbicide Development - An African Perspective - IAS 2009

noreply@blogger.com (IRMA) — Wed, 08 Jul 2009 14:00:00 +0000

Please plan to join IRMA and colleagues for this exciting satellite session on Sunday, July 19 in Cape Town, South Africa

Click to enlarge

Heterosexual Anal Intercourse among Community and Clinical Settings in Cape Town, South Africa

noreply@blogger.com (Marc-André LeBlanc) — Tue, 07 Jul 2009 16:31:00 +0000

Seth Kalichman (1), Leickness Simbayi (2), Demetria Cain (1) and Sean Jooste (2)

1 University of Connecticut, United States
2 HSRC Cape Town, South Africa

Sex Transm Infect. Published Online First: 7 May 2009. doi:10.1136/sti.2008.035287
Copyright © 2009 by the BMJ Publishing Group Ltd. Accepted 28 April 2009.

Abstract

Background: Anal intercourse is an efficient mode of HIV transmission and may play a role in heterosexual HIV epidemics of southern Africa. However, little information is available on the anal sex practices of heterosexuals in South Africa.

Purpose: To examine the occurrence of anal intercourse in samples drawn from community and clinic settings.

Methods: Anonymous surveys collected from convenience samples of 2593 men and 1818 women in two townships and one large city STI clinic in Cape Town. Measures included demographics, HIV risk history, substance use, and three month retrospective sexual behavior.

Results: A total of 14% (n = 360) men and 10% (n = 172) women reported engaging in anal intercourse in the past three months. Men used condoms during 67% and women 50% of anal intercourse occasions. Anal intercourse was associated with younger age, being unmarried,having a history of STIs, exchanging sex, using substances, having been tested for HIV, and testing HIV positive.

Conclusions: Anal intercourse is reported relatively less frequently than unprotected vaginal intercourse among heterosexuals. The low prevalence of anal intercourse among heterosexuals may be offset by its greater efficiency for transmitting HIV. Anal sex should be discussed in heterosexual HIV prevention programming.

The HPV Vaccine for Men: Yes or No?

noreply@blogger.com (Marc-André LeBlanc) — Tue, 07 Jul 2009 15:14:00 +0000

IRMA would love to hear your thoughts and comments...

1. Last month, IRMA member Robert Reinhard shared the news story from Bloomberg that "Merck's Guardasil May Not Be Cost Effective in Boys", wondering whther the Harvard study mentioned in the article sufficiently addressed cost effectiveness and use of the HPV vaccine for MSM, even allowing for the ambiguity of what that group looks like in populations <26>

"Vaccinating all boys with Merck & Co.’s Gardasil, used to prevent cervical cancer, may be less cost effective than for girls, a study said.

The improvement in quality and length of life may not be worth the cost of vaccinating boys with Gardasil to protect against the spread of the sexually transmitted virus that causes cancers of the cervix, anus and penis, according to an analysis by Harvard researchers. The study was presented today to advisers to the U.S. Centers for Disease Control and Prevention. Health officials should focus on vaccinating girls, said the study authors.

The research differs from Merck’s analysis of boys and young men up to age 26 that found vaccinating them with Gardasil was cost effective. Vaccinating males may help prevent them from spreading the cancer-causing human papillomavirus, or HPV, to women as well as protect them against genital warts and pre- cancerous lesions, Merck said. CDC’s Advisory Committee on Immunization Practices plans to vote in October about whether Gardasil should routinely be given to boys."

2. IRMA member Mark Hubbard then shared the presentation from Dr. Anna Giuliano on HPV in Males: The Future of Vaccination to Prevent Cancer, making a case for male vaccination.

3. Finally, a recent article from Xtra, the Canadian gay and lebian newspaper, reports that a University of California, San Francisco study funded by Merck found that vaccination for males is cost effective. The article reports:

"Palefsky [the lead researcher from the UCSF study] says the vaccine would still make an effective preventative health tool for everyone because the same strains of HPV that cause most cervical cancers in women also cause a majority of anal cancers in men.

“They’re entirely the same,” he says. “That’s why we’re optimistic that if boys do get vaccinated with the same vaccine that girls are using, it should prevent a substantial number of anal cancers.”

HPV is sexually transmitted. The US Centers for Disease Control suggests that gay men are as many as 17 times more likely to develop anal cancer than are heterosexual men.

“On a per-individual basis the risk is clearly much higher in MSM than the general population,” says Palefsky. “That’s presumably due to anal sex, though we also know that you don’t have to have anal sex to get anal HPV infection.”

What are YOUR thoughts? HPV vaccine for all men? Gay men and other MSM only? Provided to boys or adults? Still for girls only?

Follow the IAS 2009 Live - Via Blog

noreply@blogger.com (Marc-André LeBlanc) — Mon, 06 Jul 2009 16:49:00 +0000

IAS 2009 Live tracks the latest developments from the 5th IAS Conference on HIV Pathogenesis, Treatment and Prevention. We'll highlight new research and information on http://www.ias2009.org/ along with news reports from Cape Town. Scientists and community and policy leaders will also blog about their observations.

Adult Male Circumcision Does Not Reduce the Risk of 3 Non Ulcerative STIs

noreply@blogger.com (Marc-André LeBlanc) — Mon, 06 Jul 2009 14:30:00 +0000

Adult Male Circumcision Does Not Reduce the Risk of Incident Neisseria gonorrhoeae, Chlamydia trachomatis, or Trichomonas vaginalis Infection: Results from a Randomized, Controlled Trial in Kenya.

J Infect Dis. 2009 Aug 1;200(3):370-378.

Mehta SD, Moses S, Agot K, Parker C, Ndinya-Achola JO, Maclean I, Bailey RC.
Department of Epidemiology and Biostatistics, University of Illinois at Chicago School of Public Health, Chicago, Illinois; 2RTI International, Research Triangle Park, North Carolina; Departments of 3Medical Microbiology, 4Community Health Sciences, and 5Internal Medicine University of Manitoba, Winnipeg, Canada; and 6University of Nairobi, Illinois, and Manitoba Project, Kisumu, and 7Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya.

Background. We examined the effect of male circumcision on the acquisition of 3 nonulcerative sexually transmitted infections (STIs).

Methods. We evaluated the incidence of STI among men aged 18-24 years enrolled in a randomized trial of circumcision to prevent human immunodeficiency virus (HIV) infection in Kisumu, Kenya. The outcome was first incident nonulcerative STI during 2 years of follow-up. STIs examined were laboratory-detected Neisseria gonorrhoeae, Chlamydia trachomatis, and Trichomonas vaginalis infection.

Results. There were 342 incident infections among 2655 men followed up. The incidences of infection due to N. gonorrhoeae, C. trachomatis, and T. vaginalis were 3.48, 4.55, and 1.32 cases per 100 person-years, respectively. The combined incidence of N. gonorrhoeae and C. trachomatis infection was 7.26 cases per 100 person-years (95% confidence interval, 6.49-8.13 cases per 100 person-years). The incidences of these STIs, individually or combined, did not differ by circumcision status as a time-dependent variable or a fixed variable based on assignment. Risks for incident STIs in multivariate analysis included an STI at enrollment, multiple sex partners within <30 days, and sexual intercourse during menses in the previous 6 months; condom use was protective.

Conclusions. Circumcision of men in this population did not reduce their risk of acquiring these nonulcerative STIs. Improved STI control will require more-effective STI management, including partner treatment and behavioral risk reduction counseling.

PMID: 19545209 [PubMed - as supplied by publisher]

Follow the IAS 2009 Live - via Blog

noreply@blogger.com (IRMA) — Mon, 06 Jul 2009 14:00:00 +0000

IAS 2009 Live tracks the latest developments from the 5th IAS Conference on HIV Pathogenesis, Treatment and Prevention. We'll highlight new research and information on www.ias2009.org along with news reports from Cape Town. Scientists and community and policy leaders will also blog about their observations.

KENYA: Struggling to Meet Demand for Male Circumcision

noreply@blogger.com (Marc-André LeBlanc) — Fri, 03 Jul 2009 15:24:00 +0000

KISUMU, 1 July 2009 (PlusNews) - Demand for medical male circumcision has been rising in Kenya's south-western Nyanza Province since it became available as part of a package of HIV prevention services in November 2008.

Although local communities do not traditionally practice male circumcision, intensive sensitization programmes by governmental and non-governmental organizations are boosting acceptability.

"We are ensuring that this public health measure is implemented in a culturally sensitive environment, and that men and their families have the information they need to make informed choices," said Dr Jackson Kioko, Nyanza's director of public health.

So far 20,701 men have been medically circumcised at 124 private and public health facilities across Nyanza, the only province where the programme has been rolled out.

Nyanza has the highest HIV prevalence in Kenya - 15.3 percent, more than double the national average - and a low level of male circumcision.

A national task force will coordinate wider implementation of the procedure, and the National AIDS Control Council has set aside 16.1 million Kenya shillings (US$212,500) to encourage greater acceptance of it.

Dominic Oyier, 30, a member of the Luo community, which does not traditionally circumcise men, feared he would be ridiculed by his friends and relatives if he decided to get circumcised. "Later, when I received the information from community sensitizers, I thought it was a good thing, especially when I was told that it can even benefit my wife by reducing her chances of getting cervical cancer," he told IRIN/PlusNews.

"I decided to go for it ... It is a scary experience but it is worth it and even some of my friends consult me because they also want to try it out."

Read the rest

Study confirms international outbreak of sexually transmitted hepatitis C

noreply@blogger.com (Marc-André LeBlanc) — Fri, 03 Jul 2009 14:00:00 +0000

From CATIE News
Canadian Treatment Information Exchange (CATIE)

Hepatitis C virus (HCV) can be spread in ways similar to HIV, particularly through sharing or receiving the following:

* equipment for substance use
* tattooing needles
* contaminated blood or blood products

HCV infects the liver and can cause inflammation and liver damage. Over a period of many years, liver damage builds up and this organ becomes increasingly dysfunctional. Complications ensue, and in some cases liver cancer occurs. HIV infection appears to accelerate the course of HCV-related disease.

For the past two decades, HCV infection has mostly affected people who share needles to inject street drugs or who have received contaminated blood products, such as clotting factors, before routine testing for HCV was available. Now an international team of researchers has uncovered evidence that HCV has been transmitted sexually, in many cases among HIV positive people. The emergence of a previously unrecognized sexually transmitted germ is troubling and has implications for sexual health and disease prevention programs.

Read the rest

Gay sex decriminalised in India - India's "Stonewall"

noreply@blogger.com (IRMA) — Thu, 02 Jul 2009 15:12:00 +0000

via BBC

A court in the Indian capital, Delhi, has ruled that homosexual intercourse between consenting adults is not a criminal act.

The ruling overturns a 148-year-old colonial law which describes a same-sex relationship as an "unnatural offence".

Homosexual acts were punishable by a 10-year prison sentence.

Many people in India regard same-sex relationships as illegitimate. Rights groups have long argued that the law contravened human rights.

Delhi's High Court ruled that the law outlawing homosexual acts was discriminatory and a "violation of fundamental rights".

The court said that a statute in Section 377 of the Indian Penal Code, which defines homosexual acts as "carnal intercourse against the order of nature" and made them illegal, was an "antithesis of the right to equality".

Read the rest.

A Summary of Preclinical Topical Microbicide Rectal Safety and Efficacy Evaluations in a Pigtailed Macaque Model

noreply@blogger.com (IRMA) — Thu, 02 Jul 2009 14:00:00 +0000

Sex Transm Dis. 2009 Jun;36(6):350-356
Authors: Patton DL, Sweeney YT, Paul KJ

BACKGROUND:: There is widespread recognition of the potential promise of vaginal microbicides as a tool to combat global human immunodeficiency virus/acquired immunodeficiency syndrome and sexually transmitted infections epidemics, and candidate product development has maintained a rapid pace in recent years; however, rectal microbicide development has received less attention. As it is likely that commercial products developed for vaginal use will also be used rectally, there is a clear need to assess the safety and efficacy of candidate microbicide products specifically in the rectal compartment.

METHODS:: We have developed a standardized protocol for preclinical rectal safety and (chlamydial) efficacy assessment of topical microbicide candidates in a nonhuman primate model. We evaluated a total of 12 test compounds for rectal safety (via rectal pH, microflora, and rectal lavage) and 1 compound for efficacy against rectal chlamydial infection.

RESULTS:: In this article, we describe our methods in detail and summarize our results, particularly noting the ability of our model to distinguish products with deleterious effects on the rectal environment. We also outline the specific criteria used to recommend products move into preclinical rectal efficacy trials or be recommended for reformulation to the product developer. In summary, we observed significant adverse effects in 2 products. The single product that underwent efficacy evaluation was not observed to be protective against rectal chlamydial infection.

CONCLUSIONS:: A preclinical safety and efficacy model is critical to promoting rectal microbicide development, which will ultimately offer a significant opportunity for intervention in the global HIV/AIDS epidemic.

PMID: 19556929 [PubMed - as supplied by publisher] [PubMed-HIV]

Uganda: Campaigns tackle "the complexity of sexuality"

noreply@blogger.com (Marc-André LeBlanc) — Thu, 02 Jul 2009 02:00:00 +0000

[Seems to IRMA that microbicides could be useful tool in relationships, where condoms are seldomly used. What are your thoughts on "zero-grazing", "Go Red for Fidelity", "True Manhood" and other campaigns?]

From UN Integrated Regional Information Networks - June 22, 2009

KAMPALA, 22 June 2009 (PlusNews) - New HIV prevention campaigns in Uganda are beginning to reflect the complexity of sexual relations, but experts warn they constitute only a small first step.

"Go Red for Fidelity" is one approach; it seeks to encourage faithfulness within marriage or long-term relationships, where over 40 percent of new infections reportedly occur.

"The Go Red campaign highlights the complexity of adult sexuality, which is something we haven't really approached before," said Cathy Watson, executive director of the Straight Talk Foundation, a local NGO that produces mass media messages on HIV for young people.

Uganda's much-lauded prevention campaign in the 1990s cut HIV prevalence in the adult population from about 18 percent to roughly six percent in 2000. But over the past few years prevalence has begun to creep up again, to around 6.4 percent.

A UNAIDS Modes of Transmission survey completed in 2008 found that 43 percent of new HIV infections in Uganda occurred in monogamous relationships, highlighting the need for prevention messages to shift from the traditional target of unmarried youth.

That is the point of "Go Red", according to Monica Ariyo Rukundo, the spokesperson for Program for Accessible Health, Communication and Education (PACE), which runs the campaign in conjunction with the Uganda AIDS Commission (UAC).

"After a strong emphasis on 'zero-grazing' [a campaign promoting faithfulness to one sexual partner] in the 1990s, the focus changed; it stopped being the marrieds," Rukundo said. "This campaign is trying to encourage marriage and promote mutual faithfulness among 25-to-45 year-olds."

Since February 2009, billboards, television and radio spots, wristbands and viral text messages have encouraged Ugandans to be 'Reliable, Exceptional and Dependable'. The campaign seeks to "create a movement of passionate fidelity ambassadors" who identify themselves by wearing a splash of red "as a spark to ignite a conversation", the web site says.

Other recent public awareness programmes have also tried to deal with the more complex aspects of HIV transmission: an earlier PACE campaign focused on curbing cross-generational sex, while True Manhood, launched in June by local NGO, Young People Empowered and Healthy (YEAH), targets young men and the factors like alcohol abuse and transactional sex that puts them at high risk.

Read the rest

Rectal Microbicide Development - An African Perspective - IAS 2009

noreply@blogger.com (IRMA) — Wed, 01 Jul 2009 15:16:00 +0000

Please plan to join IRMA and colleagues for this exciting satellite session on Sunday, July 19 in Cape Town, South Africa

Click to enlarge

HIV disease progression by hormonal contraceptive method: Secondary analysis of a randomized trial

noreply@blogger.com (Marc-André LeBlanc) — Wed, 01 Jul 2009 14:49:00 +0000

[IRMA wonders what the implications are for some potentially contraceptive microbicides, which would be non-hormonal.]

Stringer, Elizabeth M; Levy, Jens; Sinkala, Moses; Chi, Benjamin H; Matongo, Inutu; Chintu, Namwinga; Stringer, Jeffrey SA

AIDS: 17 July 2009 - Volume 23 - Issue 11 - p 1377-1382

Background: HIV-infected women need access to safe contraception. We hypothesized that women using depomedroxyprogesterone acetate (DMPA) contraception would have faster HIV disease progression than women using oral contraceptive pills (OCPs) and nonhormonal methods.

Methods: In a previously reported trial, we randomized 599 HIV-infected women to the intrauterine device (IUD) or hormonal contraception. Women randomized to hormonal contraception chose between OCPs and DMPA. This analysis investigates the relationship between exposure to hormonal contraception and HIV disease progression [defined as death, becoming eligible for antiretroviral therapy (ART), or both].

Results: Of the 595 women not on ART at the time of randomization, 302 were allocated to hormonal contraception, of whom 190 (63%) initiated DMPA and 112 (37%) initiated OCPs. Women starting IUD, OCPs, or DMPA were similar at baseline. Compared with women using the IUD, the adjusted hazard of death was not significantly increased among women using OCPs [1.24; 95% confidence interval (CI) 0.42-3.63] or DMPA (1.83; 95% CI 0.82-4.08). However, women using OCPs (adjusted hazard ratio (AHR) 1.69; 95% CI 1.09-2.64) or DMPA (AHR 1.56; 95% CI 1.08-2.26) trended toward an increased likelihood of becoming eligible for ART. Women exposed to OCPs (AHR 1.67; 95% CI 1.10-2.51) and DMPA (AHR 1.62; 95% CI 1.16-2.28) also had an increased hazard of meeting our composite disease progression outcome (death or becoming ART eligible) than women using the IUD.

Conclusion: In this secondary analysis, exposure to OCPs or DMPA was associated with HIV disease progression among women not yet on ART. This finding, if confirmed elsewhere, would have global implications and requires urgent further investigation

India Poised to Decriminalize Gay Sex

noreply@blogger.com (IRMA) — Tue, 30 Jun 2009 15:00:00 +0000

via Edge Boston, by Kilian Melloy

Among the relics left behind in India by British colonialism is a law punishing consensual sex between adults of the same gender. But that may be about to change.

The Indian Penal Code embraced the law against sexual relations between individuals of the same gender, a holdover from the days when Britain wrote the laws for India. Earlier attempts to repeal the law, which prescribes prison sentences of up to a decade for gay sex, have been unsuccessful, reported a June 29 article in the Pakistan newspaper the Daily Times.

But government officials have indicated that they are willing to reconsider the ban on gay sex. One driving motive is a need to curb the spread of HIV and AIDS, which afflict an estimated two and a half million people in India.

The decriminalization of gay intimacy could bring more people in for testing and encourage gays to learn about safer sexual practices.

Meantime, at least one member of the Indian royalty, a gay prince, has spoken approvingly of the possibility that the law might change.

A June 30 article in The Hindustan Times reported that Manvendrasinh Gohil spoke out, saying, "It’s a very positive and encouraging initiative taken by the Central Government.

"I really appreciate the fact that the Home Ministry convened a meeting in this regard," Gohil added, going on to state, "I am hopeful about a positive outcome and justice to us," the article reported.

Read the rest.

L.A. County sheriff considers expanding condom distribution in jail

noreply@blogger.com (IRMA) — Tue, 30 Jun 2009 13:00:00 +0000

via Los Angeles Times, by Ari B. Bloomekatz

Inmates call Ron Osorio "West Hollywood" because the words are printed on the cream-colored cloth bag he carries inside Men's Central Jail each Friday.

The bag is filled with 300 Lifestyle condoms. Osorio, who works for the nonprofit Center for Health Justice, has been visiting the jail almost weekly since 2001, when Los Angeles County Sheriff Lee Baca approved a small but groundbreaking program that allowed the health group to pass out prophylactics to inmates in a segregated unit for gay men.

"We go to the dorms and a guy hands out the bagged lunches. There's another guy that hands out the juice. . . . and I stand between those two as they go through the line. They get their lunch, they get a condom, and they get their juice," Osorio said.

Not all inmates take condoms, but Osorio talks to those who do about the risks of HIV/AIDS.

Read the rest.

There are no gay pride parades in Jamaica

noreply@blogger.com (IRMA) — Tue, 30 Jun 2009 10:52:00 +0000

via Worldfocus

Lisa Biagiotti is working on signature stories for Worldfocus on HIV/AIDS and homophobia in Jamaica. She reported with Producer Micah Fink and Director of Photography Gabrielle Weiss, both from the Pulitzer Center on Crisis Reporting. Their reports will air on Worldfocus later this summer. Lisa gave the below interview to Thirteen.org.

Q: Gay pride is celebrated across the U.S. every June. Could there be similar celebrations of gay pride in Jamaica?

Lisa Biagiotti: No, there could not be an openly gay pride parade on the streets of Kingston, Jamaica, as in New York or San Francisco. In Jamaica, anti-sodomy laws criminalize sex between men, fundamentalist interpretations of the bible and pride in reproduction contribute to the general disdain and non-acceptance of the gay lifestyle.

Read the rest.

Uganda to Reintroduce Female Condoms

noreply@blogger.com (IRMA) — Mon, 29 Jun 2009 20:49:00 +0000

via RH Reality Check,
by Serra Sippel

When a man comes up with excuses for not using a male condom, women have a right to introduce their own tool for protection.

- Deusdeait Kiwanuka, Project Coordinator, Safe Homes and Respect for Everyone (SHARE)

Deusdeait's words poignantly capture a major challenge in fighting HIV/AIDS: to ensure women have access to prevention tools designed to put them in charge and give them an opportunity to initiate protection. Enter the female condom - the only safe and effective prevention tool that is designed for women to initiate and is available for use NOW. But "available for use" doesn't necessarily translate into "accessible to women" - whether in the U.S. or abroad.

Consider Uganda, where the Ministry of Health reports that 76% of the country's new infections are sexually transmitted and women make up 60% of those infected. Moreover, 42% of new infections occur in marital sex. These sobering statistics cry out for expanding prevention options that put women in the driver's seat. Despite this, women and their partners currently have no access to female condoms in the country.

Read the rest.

A condom specifically for anal intercourse?

noreply@blogger.com (IRMA) — Mon, 29 Jun 2009 13:00:00 +0000

IRMA chats up Dan Resnic of Strata Various Product Design about the ORIGAMI Condom - a new product in development designed specifically for anal intercourse.

IRMA - Tell us about this ORIGAMI condom you are working on. What is it? How is it different from other condoms?

DAN RESNIC - This is a radical new design concept, made of non-latex material and the first AI (anal intercourse) condom data ever presented to the FDA for review. The data will be used to help establish the first safety standards for a condom used exclusively for AI. ORIGAMI Condoms are designed foremost for the pleasure of both partners and simultaneously to improve safety. Its improved capacity for better sensation during AI is intended to increase consumer acceptability and to promote its consistent use among men and women currently at risk.

The non-latex material we developed is unique. It's been lab tested as a male condom against a leading brand of a male latex condoms. The ORIGAMI material had zero viral permability compared with the latex condom, which had 5% viral permeability. Viral permeability is tested by introducing virus smaller than HIV into sterile water inside the condom, suspended in sterile water for 72 hrs. The water outside the condom is then tested to detect virus that may permeate through the condom. The test is repeated in reverse, starting with virus outside the condom then testing for viral premeability in the opposite direction. The tests are repeated again with pinholes punctured into the condoms. Again, the ORIGAMI tested at zero viral permeability even with puncture holes while the latex condom failed. In addition, the new material will not degrade in sunlight as does a latex condom and, after accelerated aging tests, it is expected to offer an extended shelf life of 10-12 yrs.

Future condom studies currently under funding review include a new, reusable ORIGAMI elastomer material we developed that can be washed and dried in a washer/dryer at high temperatures and can even be sterilized in a microwave or boiling in water and air dried in sunlight without compromising its structural integrity. The latter could be especially significant in regions like Africa and India where cost and distribution can be issues that prevent consistent condom use.

Photos and further details will be made available following FDA pre-market approval.

I – Where is the research at the moment?

DR - Phase 1 research will begin next month, in July 2009, with the Behavioral Epidemiology Research Group at the UCLA Dept of Epidemiology, with co-Investigator Dr. Pamina Gorbach. R&D will be supported with the assistance of male and female consultants from design, medical and commercial sectors. The optimal design will undergo pre-clinical testing, with modified structural testing crietria appropriate for the higher stress in AI use. Clinical research will follow with study groups and data will be analized for final reports.

I – How are you collaborating with the NIH and UCLA? What is the timeline?

DR - As the PI for the project, I've awarded a sub-contract to UCLA, which will conduct the clinical research with volunteer couples who will test the condom in a unique study design developed by Dr. Gorbach, who heads the Behavioral Epidemiology Research Group at UCLA. The project has been funded by a substantial grant from the NIH. The study will run for 18-24 mos. starting July 1st. Subsequent Phase II research will take the project through to the end
of 2014, when the data can be reviewed by the FDA. Since there is no existing precedent the data cannot be reviewed under FDA's 510K application. Consequently, the process is much longer and much more expensive. The same is true of the ORIGAMI Female Condom we've developed. The FDA requires 3-4 similar products approved on the market before a similar device can be reviewed under a 510K application, which is typically a 90 day review process.

I – Why is it so important to have a condom specifically designed for anal intercourse?

DR- This is an excellent question. It would appear to many to be a frivolous and unnecessary product, however, the typical rolled condom design we are all familiar with, has not been tested for anal intercourse (AI), yet its the only means of protection available to men and women who engage in AI. The FDA states that condoms are the ". . . best available protection for anal sex..." although, to date, no data has been submitted to the FDA for review to support its use for AI.

I – Since unprotected anal intercourse is the most efficient means of sexual transmission of HIV, and since many people don’t use traditional condoms during anal intercourse each and every time, it seems odd that a condom like ORIGAMI hasn’t been thought of before. Why do you think that is?

DR- Inventive ideas for new condoms that address specific needs such as AI have been consistently inhibited by the high cost of R&D as well as the socio/political barriers that existed until 2008. It wasn't until the concept of a female condom emerged that it was even possible to consider an inseted anal condom. For many years people had tried using the female condom for AI but it's not strong enough and it's lacking the unique design features compatible with AI.

Essentially, condoms are tested and FDA approved for vaginal use only. The FDA is typically provided with testing documentation from condom manufacturers based exclusively on vaginal use, and consequently there are no established guidance documents available from the FDA for condoms used for AI. For many years, in the US and elsewhere, it was considered taboo to discuss AI. In recent years, the subject was discussed at a special summit conference conducted by the FDA, specifically intended to encourage manufacturers to produce condoms for AI, however, none of the manufacturers who attended the meeting followed through. No existing condom manufacturer would risk producing such testing data as the failure rate for breakage, leakage and viral permeability would be significantly higher than testing results for vaginal use.

The FDA relies on manufacturers to present data for their review. Unless a manufacturer submits data (of any medical device) for review, the FDA does not conduct independent testing. As a regulatory agency, they are authorized only to review data from manufacturers but the agency cannot conduct its own independent research to set guidelines. It would be cost prohibitive to cover all medical devices. FDA Guidance Documents are established over time based on existing products and related testing data provided by manufacturers. Regarding latex condoms, the most current guidance document for manufacturers was last updated with minor changes on November 14, 2005.

I – Next steps?

DR - We anticipate successful Phase I study data by June 2011, which we intend to follow with a larger, Phase II study. We will work closely with the FDA to help determine further testing criteria appropriate for condoms used for AI. For example, the breakage standards, not yet established for AI, will be significantly different from existing condoms designed and sold for vaginal intercourse. AI condoms must meet a higher safety standards than typical existing condoms that were originally designed in 1918 for vaginal sex.

Thank you Dan! We look forward to learning more about this important work.