Media Releases – Page 51

Director’s Message – Reaction to UNAIDS Report July 2017

I wish to congratulate the Partnership and to acknowledge the significant progress made towards achieving the 90-90-90 targets, as highlighted in the UNAIDS Report, July 2017.

I thank the Joint United Nations Programme on HIV/AIDS (UNAIDS) for responding to the National AIDS Programme Managers’ (NAPs) request to provide the Caribbean with disaggregated regional data. This information is very useful as it allows us to track progress towards the 90-90-90 targets, and to identify the gaps.

HIV testing has been significantly scaled up with the use of rapid diagnostic technology, greater community involvement and prioritizing key populations testing. These efforts have yielded results as more than two-thirds of people living with HIV in the region know their status.

Over the last six years, the number of persons accessing treatment in the region has more than doubled. More recently, guided by scientific evidence on the benefits of earlier initiation, eight countries in the region have adopted the World Health Organisation’s recommendation of initiating antiretroviral therapy irrespective of CD4 count. This shift has contributed to an increase of 81% of persons who know their HIV status accessing treatment. This increase has played a significant role in reducing AIDS related deaths from 21,000 in 2000 to 9,400 in 2016.

Although less robust, there has been progress in achieving viral suppression. In 2016 about half of the people receiving antiretroviral treatment had access to viral load testing and among these, 67% were virally suppressed.

While we celebrate the progress made, we acknowledge the significant gaps along the 90-90-90 continuum. To achieve these targets, the region has to scale up HIV testing to ensure that the additional 81,000 persons living with the disease receive their diagnosis. There must be greater community engagement and increased use of rapid diagnostic technologies and point of care testing. On the treatment front, it is crucial for the region to increase access to high quality, effective antiretroviral therapy in order to initiate and maintain an additional 92,000 persons living with the disease who are not on treatment.

In this regard, programmes must continue to be evidence driven and more countries must make the shift to Treat All and introduce newer ARV regimen with high potency, high genetic barriers to HIV drug resistance, low toxicity and low cost that will enhance retention and achieve viral suppression. We must continue to build our laboratory systems to support treatment programmes so that all persons receiving treatment will have access to viral load testing.

The Partnership remains committed to achieving 90-90-90 by 2020 and ending AIDS in the region by 2030.

Read the UNAIDS report here.

Prep: HIV ‘game-changer’ to reach NHS in England from September

The NHS in England has announced it will finally give people a drug to dramatically reduce the risk of being infected with HIV, from next month.
The health service had previously fought against paying for Prep and even took the issue to court, unsuccessfully, last year.
The drug will be given to 10,000 people in a £10m trial lasting three years. The Terrence Higgins Trust said it was “crucial” the NHS delivered plans to offer the protection routinely.

Prep (pre-exposure prophylaxis) is a daily pill that disables HIV before it gets a stranglehold in the body. Trials suggest it can cut the risk of being infected by up to 86%. People buying the drug privately has been linked to the first fall in new infections in gay men.
Scotland has already announced it will make Prep available on the NHS to people at risk of HIV. And in Wales, the government is also trialling the drug.

‘Supercharge’

Sexual health clinics in London, Brighton, Manchester, Liverpool and Sheffield are expected to be the first to offer Prep to high-risk people, starting September. The rest of the country will take part by April 2018. Simon Stevens, the chief executive of NHS England, said: “This major new intervention should complement and supercharge the wide-ranging and increasingly successful effort to prevent HIV.

“It’s another milestone in more than three decades’ worth of progress in tackling one of humanity’s major health challenges.” NHS England had fought not to offer the drug, arguing responsibility for paying for it should fall to local authorities, not the NHS. The trial will aim to answer questions about how Prep should be offered on a wide scale across England.

Harry Dodd, 25, is one of about 500 gay men in England who are taking Prep as part of a trial called Proud. He says: “I’ve seen the panic on the face of previous boyfriends when they are awaiting their [HIV test] results – it’s a huge fear, and it affects everything you do. “To be able to have sex without having that fear hanging over you all the time is huge.” Harry says taking Prep has still not become socially acceptable.

“Too many people seem to think it will encourage a hedonistic lifestyle, but for me this is about saving lives,” he says. “People reacted with cynicism when the contraceptive pill for women was first introduced.

“For me, taking Prep has helped me to trust again, have relationships and build bridges, and that shouldn’t be taken away.”

Ian Green, Chief Executive of the Terrence Higgins Trust, said: “the priority must now be to make sure that the trial reaches everyone at risk of HIV, and that it is rolled out speedily across the whole country, by the end of this year at the very latest – spring 2018 is not soon enough.

“To make sure no-one at risk of HIV is left behind, it is crucial that at the end of this trial, a clear process for routinely commissioning Prep on the NHS is agreed.”

Deborah Gold, the Chief Executive at the National Aids Trust, said: “this is a pivotal moment in the fight against HIV. “Prep, if targeted properly at those in need and at high risk of HIV, offers the possibility of transforming the English HIV epidemic.

“We warmly welcome this announcement”.

HIV: End of Triple-Drug Therapy?

PARIS — With more powerful anti-HIV drugs, the triple therapy paradigm might be changing, researchers suggested.

Two studies, one conducted in the U.S. and one in Argentina, showed promising efficacy for different two-drug regimens, investigators told at an oral session here at the International AIDS Society meeting on HIV science.

The three-drug paradigm — highly active antiretroviral therapy or HAART — has been the norm since the later 1990s, commented James Hakim, MD of the University of Zimbabwe, who was not part of the research but who co-moderated the session at which the studies were presented.

“There has been a concern” that using fewer than three drugs would be less effective and more likely to allow the development of drug resistance,” Hakim told MedPage Today.

“But increasingly, with more powerful drugs, the observation has been that you could drop the third drug and still have the same level of efficacy with a reduced risk of mutations that would make the drugs ineffective,” he said.

The simpler regimens would have the advantage of lower cost and a smaller range of possible adverse events, Hakim said. As well, “psychologically and practically” many patients would prefer to take fewer drugs if they could get the same results, he said.

The two studies are preliminary, he said, but “so far — this is still early phase — it seems to be working,” he said.

The Argentine study, dubbed ANDES, is a phase IV study that is directly testing a two-drug regimen with ritonavir-boosted darunavir and lamivudine against a triple-drug regimen that adds tenofovir, according to Pedro Cahn, MD of Fundacion Huesped in Buenos Aires.

The primary endpoint is how well patients on each regimen do after 48 weeks of treatment, but Cahn presented an analysis of a secondary endpoint — efficacy outcomes after 24 weeks.

There’s evidence that a simplified regimen is effective at maintaining control of HIV after the virus has been suppressed on triple-drug therapy, Cahn said, but the ANDES trial enrolled 145 patients who had never been treated.

The study has two phases, Cahn said. In the first phase, ending after 24 weeks of therapy, he and colleagues were interested in what proportion of patients in each arm had plasma HIV RNA of fewer than 400 copies per milliliter.

If at least 75% of those in the experimental arm reached that level, he said, the trial would proceed to the next 24 weeks, in which the endpoint would be the proportion achieving undetectable HIV, defined as fewer than 50 copies of HIV RNA per milliliter.

The study was designed to demonstrate non-inferiority at both endpoints, Cahn said.

At 24 weeks, he reported, 95% of those on two drugs and 97% of those on three had reached or exceeded the 400-copy benchmark and the difference showed the two regimens were non-inferior to each other.

In the two-drug arm, 10 patients reported 11 adverse events that were thought to be possibly drug-related, while in the triple-drug arm 16 patients reported 21 events. There were eight serious adverse events, but none was related to the medications, he said.

The American study, ACTG A5353, had a different design: it was a single-arm study of dolutegravir (Tivicay) and lamivudine in 120 treatment-naïve patients, according to Babafemi Taiwo, MD, of Northwestern University Feinberg School of Medicine in Chicago.

The goal was to estimate virologic success of the regimen after 24 weeks of therapy, defined as a plasma viral load of fewer than 50 copies of HIV RNA per milliliter, Taiwo reported.

The study protocol defined virologic failure as a confirmed viral load of more than 400 copies per milliliter at weeks 16 or 20 of therapy or more than 200 copies at or after week 24. Patients were followed for 52 weeks.

The bottom line, Taiwo said, was that 108 (or 90%) of the patients reached the efficacy endpoint, with only three meeting the criteria for virologic failure. The data showed those three patients were not correctly following the drug regimen, he said.

Demonstration projects explore the feasibility of PrEP for adolescents and young women in South Africa

One of the first studies to explore the acceptability, safety and use of pre-exposure prophylaxis (PrEP) in adolescents in an African context has found that PrEP was safe and tolerable, although PrEP usage and adherence did tail off during the twelve months of the programme.

Presenting the findings of the PlusPills project to the 9th International AIDS Society Conference on HIV Science (IAS 2017) in Paris yesterday, Katherine Gill of the Desmond Tutu HIV Foundation said that South African adolescents need access to PrEP with tailored adherence support and more frequent clinic visits. Less frequent dosing schedules, if validated, could be of interest to this population, she suggested.

PlusPills is just one of several demonstration projects on PrEP for adolescents and young women in South Africa that are underway or have recently been completed. Yogan Pillay, the country’s Deputy Director General for Health, told the conference that these findings would be considered together to inform the development of the country’s PrEP programming. South Africa is further ahead with PrEP provision for sex workers and men who have sex with men than it is for adolescents and young women.

Adolescent girls and young women aged 15 to 24 account for 23% of all new HIV infections in sub-Saharan Africa. Females are much more vulnerable to HIV than their male peers. Whereas 0.7% of adolescent boys aged 15 to 19 have HIV in South Africa, the equivalent figure for girls is 5.6%. In the 20 to 24 year age group, 5.1% of men and 17.4% of women have HIV. In some parts of the country, prevalence is even higher.

The primary objective of PlusPills was to evaluate the acceptability, safety and use of a daily regimen of daily Truvada PrEP as part of a comprehensive HIV prevention package. As there are not any data on PrEP in adolescents in an African context, such studies are needed before PrEP can be licensed for use by adolescents, Gill said.

PlusPills recruited a self-selected cohort in need of HIV prevention services. It enrolled 148 HIV-negative adolescents (ages 15 to 19 years) at two sites in Cape Town and Soweto. Of note, while 99 of the participants were female, 49 were male. The median age of study participants was 18, a quarter had completed formal schooling and 90% were living with their family.

Their median age at sexual debut was 14.5. One in five had had a partner who was at least five years older. While three-quarters had used a condom the last time they had sex, only a third always used a condom and 41% tested positive for a sexually transmitted infection (STI) at baseline.

This was a single arm study. In addition to PrEP, the HIV prevention package that all participants received included HIV testing, management of STIs, risk reduction counselling, male and female condoms, post-exposure prophylaxis (PEP), and circumcision counselling and referrals.

Recognising that many young people struggle to adhere to daily pill-taking, the programme also provided extra support using SMS, adherence clubs, and real-time feedback on drug levels.

The study participants were required to take PrEP daily for the first three months of the study but could opt out at the three-month mark. At each study visit after that, they could opt in or out of PrEP.

PrEP was reasonably well tolerated with minimal safety concerns. Sixteen participants (11%) experienced a grade 2 or 3 side-effect, including headaches, nausea and vomiting, abdominal pain, diarrhoea, skin rash and weight loss. Participants who stopped PrEP often complained of side-effects, although Gill said that many participants were starting contraception at the same time and it could be hard to be sure of the exact cause of problems.

The use of PrEP and adherence to daily dosing dropped off over time, something that has been seen in PrEP studies conducted with adolescents in the United States. There was a particular drop off when clinic visits switched from monthly to quarterly, suggesting that adolescents need more regular contact and support. Tenofovir (one of the drugs in Truvada) was detectable in blood in 57% of participants at week 12, 38% at week 24 and 38% at the end of the study. Young women had similar levels of adherence to young men.

Participants continued to be diagnosed with STIs throughout the study. For example at the week 12 visit, there were 29 herpes diagnoses, 21 chlamydia and 8 cases of gonorrhoea.

One study participant acquired HIV during the study – a 19-year-old woman who had opted out of PrEP 24 weeks before diagnosis. While the study was not powered to demonstrate the efficacy of PrEP in adolescents, this population could be expected to have an HIV infection rate of around 7% a year and the STI data indicate that the participants continued to take sexual risks. It, therefore, appears that PrEP as part of a comprehensive prevention package did provide some protection in this population.

Opinion – HIV education in schools critical to ending the disease

While the home is a fundamental institution for educating young people, particularly teenagers, of the devastating effects of HIV and AIDS and other sexually transmitted infections (STIs), schools also play an equally important role since it is believed that in addition to the family, schools are the primary places responsible for the development of young people.

For this reason, health education should be seen as a significant step towards preventing the spread of HIV and other STIs, and therefore should be universally integrated into all educational systems.

To embark on this venture, an excellent first approach is to ask students what they already know about STIs. This would allow educators to identify any inaccurate information young people may have and provide an opportunity for introducing age appropriate education.

New strategic shift for CRN+

Mr Winfield Tannis-Abbott, Chair, Board of Directors, Caribbean Regional Network of People Living with HIV and AIDS (CRN+) spoke with the editor of PANCAP.org on new plans for the organisation.

‘Following our recently concluded Board Meeting – Strategic Planning, at which the new membership of an Interim Board was selected, it was evident that we need a strategic shift in how we manage our organisation. As well as how we operate on a day to day basis, how we communicate and associate with our affiliate networks; how we advocate for and on behalf of People Living with HIV (PLHIV) across the region and most importantly, how we mobilise necessary resources to continue our work and support ‘ending AIDS by 2030’. As the authentic voice for PLHIV in the Caribbean, we must ‘step up’ our leadership role, ensuring that all rights, health and dignity of PLHIV, as well as those of our partners and families, are respected during this social change of ending AIDS by 2030.

As we move forward, we recognise that ‘doing more of the same is not enough’. With the changes in the global, regional and national environments over the last 5 years, it has become necessary for CRN+ to revisit its strategic direction in order to maximise its potential, continue to grow and to achieve sustainability. This means that CRN+ will need to re-focus its energies and resources in the future as it continues to make a meaningful difference in the lives of PLHIV in the Caribbean and sustain a vibrant organisation.

As the Interim Board of Directors commences implementation over the next year, we will focus on four (4) strategic priorities:

Priority Area 1. Governance and Leadership: We need to be able to strengthen our governance and leadership in order to promote positive and sustainable growth, not only for the CRN+ Secretariat but also for our affiliates. Working closely with our Technical Advisory Group and our technical partners will be vital for our survival and success.

Priority Area 2. Empowerment of People Living with HIV: We have to do our best to empower not only our members but persons living with HIV in the Caribbean Region. Finding ways for them to live longer and with dignity and improve the quality of their lives.

Priority Area 3. Partnership and Resource Mobilisation: This speaks for itself. Partnership with national, regional and international organisations continues to be an integral role if we are to fulfil our mandate. CRN+ will continue to strengthen its partnerships at the national, regional and international levels. This will be essential in assisting the organisation to move forward. Working with the development and funding partners, CRN+ will refine its resource mobilisation strategy with a focus on cost-effectiveness and sustainability. Efforts will be made to look for new and non-traditional sources of funding.

Priority Area 4. Evidence and Lessons Learnt for Scaling Up Programmes: We must ensure that mechanisms exist to document the voices and experiences of PLHIV and that PLHIV advocacy messaging results in positive change at the international, regional and national levels. Implementation of relevant programmes will be scaled-up, based on evidence and lessons learnt. These will contribute to the sustainability of the HIV response in the Caribbean.

We look forward to your support as we commence a new chapter of CRN+’.

Beauty Queen Uses Her HIV Positive Status As A Platform For Change

If you are in need of a little inspiration, look no further than Horcelie Sinda Wa Mbongo, a 22-year-old activist, Fine Arts student, and recently crowned Miss Congo UK 2017.

She is more than just a pretty face. According to BBC Africa, she has found a way to use her platform to end the stigma around living life with HIV and AIDS.

“I was born in the Congo and I only discovered that I was HIV positive here in the UK,” Mbongo told BBC Africa of receiving her diagnosis at age 11-years-old. “I was one of many children born with HIV who did not have the medication, but somehow the virus is not fighting the body as fast as other people. What that means, is that I lived ten years without any medication at all”.

According to UNAIDS, there are approximately 370,000 people living with HIV in the Democratic Republic of Congo; with 11 percent being children under that age of 14-years-old. In contrast, there are an estimated 1.2 million people in the United States living with HIV, including 156,300 individuals who do not know they are infected, the Centers for Disease Control and Prevention reports.

Prudence Mabele: The life of the South African HIV campaigner

Prudence Mabele’s decision to become one of the first black South African women to declare her HIV-positive status was the start of a lifetime’s campaigning.

It was 1992, and the stigma which came with such an announcement cannot be underestimated. But Mabele was determined to be brave, and to encourage others to live without shame. That bravery and determination would become the hallmark of Mabele’s next 25 years, and would, when she died earlier this month, see her hailed as “a global icon” and “a true South African hero”.

Stigma

Mabele was born in Benoni, just east of Johannesburg, in 1971, just one woman in a long line of activists, according to friends.
She was just 18 when she contracted HIV in 1990 but a search for a friend to share her fears and hopes with over this new diagnosis reportedly only led her to hospital wards filled with dying babies.

In 1992, South Africa’s HIV epidemic was in its infancy. The proportion of 15 to 49-year-olds infected was just 2.5%, according to the World Bank, and it was still largely seen as a disease which affected gay men.

And yet, here was a bright, young university student, revealing she too had been infected. It was just the start of a fight which would see her not only battle prejudice but her own government.

“When you think about how she had to confront this pandemic in 1992, how she had to go through the time when often times in South Africa, they didn’t acknowledge that HIV was the cause of the pandemic — yet she was that voice,” Deborah Birx, the US global Aids coordinator, told American news site PRI.

“And we should all be asking the question: ‘Would we be willing to make that same personal sacrifice?'”
Over the next few years, she threw herself into trying to break the silence around HIV status, founding organisations like the Positive Women’s Network in 1996.

At the same time, the numbers infected with HIV/Aids in South Africa continued to soar: by 1998, 2,900,000 were thought to be infected, equating to 15.1% of the adult population.

But there were also developments when it came to treatment: the first anti-retrovirals went on to the market in the latter half of the 1990s, and ensuring people had access to them became one of Mabele’s key causes. At the time, they cost 7,000 rand (£415/$541) a month, Mabele said later in interviews. It was too expensive, out of reach of many of those infected. As a result, the Treatment Action Campaign (TAC) was founded – and once again, Mabele was at its heart.

Aids denialism

But then, in 2000 when some 1,500 people were being infected every day, things took an unexpected turn: President Thabo Mbeki declared that while he could accept that HIV contributed to the collapse of the immune system, it was not the only cause. Other factors like poverty and poor nutrition were also involved, he said.

“A virus cannot cause a syndrome,” Mr Mbeki told parliament. “A virus can cause a disease, and Aids is not a disease, it is a syndrome.”
Suddenly, the fight was not just for funding. It was against the government, and its new “Aids denialism”. It was up to the TAC, and women like Mabele, to fight when the government delayed the roll out of ARVs to pregnant mothers, which would stop the transfer of the virus from mothers to babies, potentially saving thousands of lives. The TAC took the government to court, and won. But Aids denialism ran deeper than just those at the top of government.

In 2004, Mabele decided to become a sangoma – or traditional healer. By now, she was on ARVs – but many within her new community did not agree with her choices. They accused her of promoting Western medicine over traditional remedies.

“They all looked at me as a traitor,” she told South Africa’s Bhekisisa health news site in 2013. “I remember them coming [down the street], toyi-toying and singing ‘phansi ngo Prudence’ [down with Prudence]!” The two, she maintained, could work alongside each other but Mabele, for one, was not prepared to abandon the ARV to “put my life at stake for an experiment that is not even checked”.

After Mr Mbeki lost power in 2008, the government’s stance on Aids changed. But Mabele did not stop her fight, either on the streets during protests or just being there for people, visiting them in hospital or sitting with grieving relatives. Writer and activist Sisonke Msimang described her friend as “the Pied Piper of the broken hearted” in South Africa’s Mail & Guardian. Her attention also turned to other causes. Violence against women in South Africa and the kidnapped Nigerian school girls among other things.

All the while, the numbers living with HIV continued to rise: by 2015, the figure was estimated to be seven million, according to the UN Aids programme. The World Bank’s figure said that equated to 19.2% of the adult population. Mabele died in hospital on 10 July, at the age of 46, following a battle with pneumonia. Her funeral, held just over a week later, was attended by Cyril Ramaphosa, South Africa’s deputy president, and a host of other dignitaries.

In amongst kind words from across the globe, it was a friend’s tribute which stood out. “Everything that we got from Prudence was how to love,” Phindile Mkhabela told SABC. “Prudence was a force of nature; Prudence was joy and compassion; Prudence was acceptance; Prudence was release; Prudence was forgiveness; Prudence was respect; Prudence was generous, and that generosity cost her life. She didn’t know when to stop. “May we honour her; may we celebrate her, and may we remember how to live, because that’s what she did.”

World on track to reach the 90-90-90 targets for HIV treatment by 2020

The world is on track to reach global targets for reducing AIDS deaths and HIV treatment access by 2020, but some regions of the world risk falling further behind due to lack of political commitment, UNAIDS announced in the run-up to the 9th International AIDS Society Conference on HIV Science (IAS 2017), which opened today in Paris.

More than half of all people living with HIV (53%) now have access to HIV treatment and AIDS-related deaths have almost halved since 2005, UNAIDS reports in Ending AIDS: progress towards the 90-90-90 targets.

The 90-90-90 targets endorsed by governments in 2014 call for 90% of people to know their HIV status, 90% of people with diagnosed HIV infection on treatment, and 90% of people on treatment to be virally suppressed. If all these targets can be met, AIDS deaths can be cut dramatically and new infections will begin to fall.

Past the tipping point

The world has passed a tipping point in progress towards the 90-90-90 targets, UNAIDS Executive Director Michel Sidibé said.

The report shows that in 2016, 70% of people living with HIV knew their HIV status. Of the people who know their status, 77% were accessing treatment, and of the people on treatment, 82% were virally suppressed. In lower- and middle-income countries, progress towards achieving the targets has been especially strong in Cambodia and Botswana, which have already reached the 90-90-90 goals.

“There is no level of funding that compensates for the lack of political commitment. In the two regions that have made the least progress, lack of political commitment and poor policy decisions are more important than the lack of funding.” Marijke Wijnrocks, Global Fund
Eastern and southern Africa has also made good progress and the region is on course to reach the 90-90-90 targets. Seventy-six per cent of people living with HIV know their HIV status, 79% of people who know their HIV-positive status have access to antiretroviral therapy and 83% of people who are on treatment have undetectable levels of HIV – this equates to 50% of all people living with HIV in Eastern and Southern Africa with viral suppression.

Denmark, Iceland, Singapore, Sweden and the United Kingdom have also reached the 90-90-90 target. Australia, Belgium, France, Germany, Italy, Kuwait, Luxembourg, Netherlands, Spain, Swaziland and Switzerland are close to reaching the target, and four ‘fast-track’ cities – Amsterdam, Melbourne, New York City and Paris – have either reached the target or are very close.

AIDS deaths and new infections continue to fall

The sharpest reduction in deaths has been seen in Eastern and Southern Africa – a 62% fall since 2004. Deaths have fallen by 52% in the Caribbean and 39% in the Asia-Pacific region but risen by 48% in the Middle East and North Africa and by 38% in Eastern Europe and Central Asia.

Deaths were 27% lower among women and girls than among men and boys due to better rates of diagnosis and earlier treatment.

AIDS deaths have almost halved among children from 210,000 to 120,000 a year since 2010.

Since 2010, the annual number of new HIV infections has declined by 16% to 1.8 million, but progress is still far short of the 2020 target of fewer than 500,000 infections per year.

UNAIDS says that the new estimates for 2016 should be more accurate because more countries are producing better-quality data, especially in Eastern and Southern Africa. Independent door-to-door surveys in several countries in the region, Population Health Impact Assessments, have fed into these estimates, giving confidence that the changes seen in the region are real.

National progress towards 90-90-90 shows level of political commitment

The countries that have made the best progress all show strong political commitment to achieving the 90-90-90 targets, speakers at the 90-90-90 Targets Workshop agreed. The workshop, sponsored by UNAIDS and the International Association of Providers in AIDS Care (IAPAC), took place immediately prior to the opening of IAS 2017.

“There is no level of funding that compensates for lack of political commitment. In the two regions that have made the least progress, lack of political commitment and poor policy decisions are more important than lack of funding, I’m convinced,” said Marijke Wijnrocks, Interim Executive Director of the Global Fund to Fight AIDS, Tuberculosis and Malaria.

Least progress towards the targets has been made in Eastern Europe and Central Asia where 63% of people living with HIV know their HIV status but only 43% of those diagnosed are on treatment. Seventy-seven per cent of people on treatment are virally suppressed in this region. Furthermore, new infections have continued to rise in the region even as new infections continue to decline by 29% in Eastern and Southern Africa between 2010 and 2016.

Even fewer people living with HIV know their status in Western and Central Africa: just 42% of people have been diagnosed in this region according to UNAIDS, and of these 83% are on treatment and 73% are virally suppressed.

Dr Debbie Birx, US Global AIDS Coordinator, said that Western and Central Africa had received the highest rate of investment but showed the least success in diagnosing and bringing people onto treatment. She blamed the persistence of formal and informal fees – effectively, tips or gratuities to salaried individuals to obtain medical attention – for the low rates of diagnosis and treatment.

“I think that policy is key. Our money can’t work if we don’t have the policies to make it work. We need to eliminate all clinical and informal fees. I’ve seen fees charged for what we provide for free,” she said.

Community health workers

Another factor determining regional success is the way that services are delivered, argued Dr Badara Samb of UNAIDS. “What is characteristic of health service delivery in eastern and southern Africa? It relies heavily on good community health systems and community health workers,” he told the 90-90-90 Targets Workshop.

UNAIDS won the endorsement of African heads of government at a recent African Union summit for an ambitious plan to recruit, train and put to work 2 million extra community health care workers at a cost of $4-$6 billion a year. UNAIDS calculates that this expenditure will result in a return on investment of $21.75 billion a year from health care savings, disease reduction and expanded employment.

Read the entire UNAIDS Report here.

International study of gay couples reports no transmissions from an HIV-positive partner on treatment

A study of 343 gay couples, where one partner had HIV and the other did not, has not found a single case of HIV transmission in 16,889 acts of condomless anal sex, the 9th International AIDS Society Conference on HIV Science (IAS 2017) in Paris, France, was told today.

The Opposites Attract study looked at whether HIV is transmitted between gay male couples of different HIV status when the HIV-positive partner is on treatment that fully suppresses HIV. The HIV-positive partners in Opposites Attract had a so-called ‘undetectable viral load’ 98% of the time.

The study recruited and followed-up gay couples at clinics in Australia, in Bangkok and in Rio de Janeiro.

The evidence from Opposites Attract adds to the evidence from the PARTNER study that HIV-positive people on effective HIV treatment that fully suppresses their virus cannot transmit their infection through sex. Taken together, the two studies have not found a single case of HIV transmission in nearly 40,000 acts of condomless anal sex between gay men.

This adds further strength to the “U=U” (Undetectable equals Untransmittable) tagline of the Prevention Access Campaign, whose consensus statement has been signed by NAM and also by the International AIDS Society (IAS), organisers of this week’s Conference on HIV Science in Paris.

The studies also found that if the positive partner is on successful treatment, even having another sexually transmitted infection (STI) does not increase the risk of HIV being transmitted. In Opposites Attract, participants had an STI during 6% of anal sex acts and in PARTNER, 17.5% of participants had an STI at some point in the study.

Sexual position also made no difference even though when viral load is not suppressed, transmission is 10-20 times more likely if the HIV-positive partner is the insertive one; in Opposites Attract, the HIV-positive partner was ‘top’ over a third of the time.

During the Opposites Attract study, three men became infected with HIV, but genetic analysis showed that these infections came from a partner outside the main relationship who was not virally suppressed.

Only 0.9% of the total proportion of condomless anal sex acts happened where the HIV-positive partner had a detectable viral load and only 1.7% during their first six months on antiretroviral therapy. There were no transmissions from men in these groups either. Presenter Andrew Grulich commented: “In our Thai site, 40% of the men who entered the study were not on antiretroviral therapy when they entered the study, but immediately started it and were rapidly virally suppressed. They were really good at using condoms and other strategies to avoid transmission while they were still detectable, so the number of condomless anal sex acts with a detectable partner was very small.”

In PARTNER, despite not many more episodes of condomless sex, there were ten such ‘unlinked’ infections in gay men. The difference may be due to 24% of the HIV-negative partners in Opposites Attract taking pre-exposure prophylaxis (PrEP). Researcher Benjamin Bavinton told aidsmap.com there was evidence that PrEP-takers in Opposites Attract were indeed mostly taking it to protect themselves from HIV infection from partners outside the main relationship.

At a press conference the previous day on viral load and infectiousness, Dr Anthony Fauci, director of the US National Institute for Allergies and Infectious Diseases, said: “Scientists never like to use the word “Never” of a possible risk.

“But I think in this case we can say that the risk of transmission from an HIV-positive person who takes treatment and has an undetectable viral load may be so low as to be unmeasurable, and that’s equivalent to saying they are uninfectious. It’s an unusual situation when the overwhelming evidence base in science allows us to be confident that what we are saying is fact.”

Dr Luiz Loures, Deputy Executive Director of UNAIDS, said that in terms of the public impact of treatment as prevention, the agency was seeing more and more cities where HIV incidence was falling as they reached a tipping point in terms of the number of people who are on therapy and non-infectious: he quoted San Francisco, Sāo Paulo and Nairobi as examples.

Bruce Richman, a Harvard-trained lawyer, is the prime mover behind the “U=U” campaign.

He said: “In 2006 when I was diagnosed, I was terrified of infecting someone I loved and was terrified of taking a pill that reminded me every day I was infectious. But in 2012 when I finally started therapy, my doctor told me that if I suppressed my viral load, I would become non-infectious.

“Terror turned to outrage because every website I found was saying I was still a risk. The breakthrough science was not breaking through to communities that needed to know it. Doctors would tell people on a one-to-one basis while withholding the info from those they deemed irresponsible.

“So we collaborated with doctors to endorse the U=U consensus statement. This is demolishing HIV stigma and encouraging people to start treatment and bring an end to the epidemic. We need people like UNAIDS, as they did today, to confirm it’s true.”

Reference:

Bavinton B et al. (presenter Grulich A) HIV treatment prevents HIV transmission in male serodiscordant couples in Australia, Thailand and Brazil. 9th International AIDS Society Conference on HIV Science, Paris, abstract no TUAC0506LB, July 2017.