HIV prevention failing MSM youth

Prevention Is Failing to Target MSM When They're Young Enough

by David Evans

If we are going to prevent HIV transmission in young men who have sex with men (MSM), we must find strategies to reach them when they are in their early teens. So say researchers who presented a study Monday, July 19, at the XVIII International AIDS Conference in Vienna. 

HIV infection among young MSM is often a conundrum. Studies show that they understand what sexual acts place them at highest risk for HIV infection, but many engage in unprotected anal intercourse with other men of unknown HIV status. What is paradoxical and frustrating is that when prevention researchers ask the young men why they engaged in high-risk behaviors, they typically respond that they didn’t think that what they were doing would lead to becoming infected.

To better understand the context behind this kind of reasoning, D. Dennis Flores III, from Emory Healthcare in Atlanta and his colleagues conducted interviews with 10 young MSM from that city who had recently been diagnosed with HIV. Nine of the men were African American, and one was Latino. Their ages ranged from 18 to 24. The interviews with the young men covered four topic areas: risk behavior, HIV education, the Internet and healthy role models.

As has been found in previous studies, the majority of the young men had viewed themselves as either unlikely or very unlikely to contract HIV in their lifetimes, and half reported experiencing coercion and sexual abuse at the time of sexual initiation.

One 18-year-old participant, Nathaniel, described his own sexual initiation: “I had to be around 13… He worked at my school, he was around 30, a janitor. He was always nice to me for no reason. I mean, I kind of guessed it after a while. He would talk to me. One day I just left school with him. The most we ever did was oral; we didn’t do anything else. But after that, like, he tried talking to me more about leaving school. I really didn’t like him after that.”

Flores and his colleagues found that while all the young men had undergone sex education while in middle school or high school, none reported that these classes included information about gay sex. Moreover, only one of the young men reported having any gay role models while growing up. This meant that relevant sex education occurred on the Internet, which from a sexual risk perspective, can be quite perilous. When these young men went online, most of them saw graphic high-risk sexual encounters, and this behavior quickly became what they perceived as normal and desirable.

“[The Internet] sure has taught me a lot of tricks,” explained 24-year-old Adrien. “Things that I never thought were humanly possible. It gave me a reference. I guess it was kind of revolutionary for me ’cause I’d never seen two men, like, actually get enjoyment out of it. So it was like getting exposed to that was, like, wow, you know…different.”

One of the most important findings, said Flores, was that by the time the young men encountered prevention messages and programs targeted to young gay men, higher-risk sexual activity had already become the norm. For some, they contracted HIV before having ever encountered targeted prevention information.

Flores concluded his presentation by stressing that targeted education, focused on young MSM, should be occurring as early as elementary or middle school and that parents should be taught to be supportive and to teach their sons how to avoid sexual coercion. Moreover, Flores’s team recommends engaging young MSM who are out about their sexual orientation to serve as peer educators and role models for other young men. Lastly, Flores stressed the critical need to use new technologies online to reach young MSM with prevention methods before it is too late.

[Posted by Paul Causey, MSM-Asia mailing list, 2010-07-30]

PrEP study gives hope - MSMGF

The Global Forum on MSM & HIV welcomes positive results of PrEP safety trial among MSM

Study gives hope about an expanded prevention tool kit

Vienna, Austria (July 24, 2010) - The Global Forum on MSM & HIV (MSMGF) welcomes the results from the CDC 4323 trial, released by the Centers for Disease Control and Prevention (CDC) during a late breaker session on the closing day of the 2010 International AIDS Conference in Vienna.  This trial, designed to assess the safety of the oral antiretroviral (ARV) drug tenofovir when used as pre-exposure prophylaxis (PrEP), was conducted among 400 HIV-negative gay men and other men who have sex with men (MSM) in the United States.  Preliminary findings from the trial suggest that the use of PrEP presents no significant safety concerns for MSM. 

It is important to note that CDC 4323 is a safety trial; no conclusions can be drawn about PrEP’s efficacy in preventing HIV among MSM by this study.  Other studies are currently underway around the world to determine if PrEP is effective at reducing HIV infection among individuals at high risk for HIV, including MSM.

In addition to clinical safety, CDC 4323 assessed whether those using PrEP might increase their risk behaviors. While analyses of risk behavior data are not yet complete, early results suggest there was no increase in risk behaviors among MSM taking PrEP during the first nine months of their participation in the study.

PrEP entails the administration of oral ARV agents before exposure to HIV in order to reduce risk of infection if exposure occurs. Although no conclusive evidence currently exists regarding PrEP’s ability to prevent HIV infections, CDC 4323 goes a long way towards lending additional assurance that the strategy may be well tolerated among MSM, should it prove effective. 

Key thought leaders have universally agreed upon the need for multiple, safe and effective HIV prevention approaches. Safety results released today offer hope for an expanded prevention portfolio, one that includes a broad range of peer-led behavioral and community-level approaches that are anchored with concerns for the broader health and human rights of MSM.

MSM continue to shoulder a disproportionate disease burden when it comes to the HIV epidemic in all regions of the world.  Prevalence among MSM is higher than that of the general population in nearly every country that reliably collects and truthfully reports HIV and AIDS surveillance data. On average, MSM are 19 times more likely to be infected with HIV than the general population in low- and middle-income countries. And in resource rich countries, MSM are up to 40 percent more likely to be infected with HIV than the general population, as is the case in the United States. Stigma, violence and discrimination facing MSM worldwide work to aggravate the situation;  homosexuality is criminalized in nearly 80 countries in stigmatized in countless others.

News about the CDC 4323 safety trial follows the positive results of CAPRISA 004, a proof-of-concept study that found a 39 percent lower HIV infection rate in HIV-negative women living in South Africa who used a 1% tenofovir vaginal gel when compared to women who did not. While more exciting progress on ARV-based prevention interventions is anticipated in the near future, we must continue to stress the importance of a comprehensive and balanced approach to the fight against HIV, one that addresses both the unacceptably high HIV sero-prevalence among MSM and the ongoing human rights abuses they endure.

[Posted by Jack Beck of MSMGF, MSM-Asia mailing list, 2010-07-25]

Exploring PrEP to prevent MSM HIV infections

Gay Men Don't Engage in Riskier Sex When Taking AIDS Pills, CDC Study Says

By Simeon Bennett

Gay and bisexual men didn’t have riskier sex or suffer serious side effects while using Gilead Sciences Inc.’s Viread in a study of whether taking pills to prevent HIV infection would loosen inhibitions or harm health.

Gay and bisexual men who took a daily pill -- either Viread or a placebo -- were no more likely to take greater sexual risks on the assumption they were protected than those who didn’t take one, researchers from the U.S. Centers for Disease Control and Prevention said at the International AIDS Conference in Vienna today. The study also compared the rate of side effects between those who received Viread and those who got a placebo, and found no significant difference.

The study supports efforts to test whether drugs approved to treat AIDS patients can also be used to prevent infections in the first place. That theory, called pre-exposure prophylaxis, or PrEP, was partially validated this week when a vaginal gel containing Viread was shown to reduce infections by 39 percent among women in South Africa.

“It is encouraging to hear there were no serious safety concerns and that the men in the study did not appear to increase risk-taking behaviors while taking a pill,” said Mitchell Warren, executive director of the New York-based AIDS Vaccine Advocacy Coalition, in an e-mailed statement. “Much more safety, adherence and risk data will be needed before PrEP can be implemented if it is proven effective.”

400 Men

The study involved 400 HIV-negative gay and bisexual men in San Francisco, Atlanta and Boston. About half received either Viread or placebo immediately, and the other half started nine months later.

There were seven HIV infections overall, and none in the group that took Viread. The trial wasn’t designed to test whether the drug prevented infections and no conclusions about its effectiveness can be drawn from the study, the researchers said. The distribution of infections could be due to chance, said Lisa Grohskopf, a CDC researcher who presented the results.

“PrEP is one of the most-promising new prevention approaches being explored, and if effective, could help address an urgent need for additional solutions to help slow the HIV epidemic in the U.S. and around the world,” the CDC said in a statement.

[Posted by Paul Causey, MSM-Asia mailing list, 2010-07-24]

Circumcision unlikely for MSM HIV prevention

Circumcision Unlikely to Have Major HIV Prevention Benefit Among Gay Men

by Tim Horn

Circumcising men who have sex with men (MSM) is likely to have a negligible effect on the rate of new HIV cases in the United States, according to a survey conducted in San Francisco in 2008 and reported Thursday, July 22, at the International AIDS Conference in Vienna.

Clinical trials in South Africa, Uganda and Kenya have indicated that heterosexual men who undergo circumcision are 60 percent less likely to become infected compared with uncircumcised men. Ever since these findings, public health leaders have sought to promote circumcision as a proven, cost-effective method. In Vienna, ambassador Eric Goosby, the U.S. global AIDS coordinator, and David Okello of the World Health Organization, along with Bill Clinton and Bill Gates, lent their voices to support male circumcision in Africa.

Circumcision is thought to reduce the risk of HIV transmission by removing cells in the foreskin that are most susceptible to infection by the virus.

Whether or not circumcision of adult males in the United States, notably men who have sex with men, will influence the incidence of HIV in this country remains a matter of debate. As recently as March, an analysis of data collected in the United States and other Western countries indicated that circumcision will not necessarily prevent transmission among MSM.

To explore this further, Jonathan Fuchs, MD, MPH, of the San Francisco Department of Health and his colleagues conducted a survey of MSM in San Francisco measuring HIV prevalence, circumcision status, condom use with insertive and receptive anal intercourse, and willingness to be circumcised.

Of the 521 MSM surveyed, 115 (21.1 percent) were HIV positive and 327 (62.7 percent) were already circumcised, leaving 69 (13.2 percent) for whom circumcision may have an additional preventive benefit.

Among those for whom circumcision may confer a protective effect—those who predominantly engaged in insertive anal intercourse (21.7 percent reported “topping” at least 80 percent of the time, without condoms, with their five most recent partners)—only three (0.5 percent) were willing to participate in an MSM circumcision trial. What’s more, only four (0.7 percent) were willing to get circumcised, even if it proved to be a safe method that did reduce the risk of HIV transmission.

Extrapolating these findings to the entire MSM population of San Francisco—an estimated 65,700 people, Fuchs indicated—only 500 men would potentially benefit from circumcision.

Fuchs and his team concluded that circumcision as an HIV prevention strategy would apply to few MSM in San Francisco and thus, even if effective, would have limited influence on HIV incidence in this population. However, if shown to be an effective prevention strategy for MSM, the researchers argue, circumcision could potentially benefit MSM populations with low rates of circumcision and condom use among those who engage in predominately insertive anal intercourse.

[Posted by Paul Causey, MSM-Asia mailing list, 2010-07-24]

MSM ignored at IAC 2010?

Xtra West Article: Are Men That Have Sex With Men Being Ignored By The International AIDS Conference In Vienna Austria? [blog]

Vienna AIDS pre-conference on men who have sex with men a great idea INTERNATIONAL AIDS CONFERENCE / But also a missed opportunity

Phillip Banks / Vancouver / Monday, July 19, 2010

Last night marked the opening of the 18th International AIDS Conference in Vienna, Austria. From July 18-22 more than 20,000 people from all over the planet will converge to discuss the good, the bad, and the ugly of the global HIV crisis.

In the next few days, research findings will be shared, interesting programs and services will be presented, and more models, frameworks, and strategies than you can shake a stick at will be unveiled to the world.

And if Bill Clinton was telling the truth, we can expect some good news to come out of all of this too. Unfortunately, I’m not so sure the good news is going to apply to gay men.

Too many International AIDS Conferences have come and gone in the last decade without enough attention being given to the situation facing gay men and other men who have sex with men.

This isn’t unique to gay men. Over the years many different groups have had to fight to get the world’s attention.

It seems scientists, world leaders, international organizations, donors, and the conference host itself — the International AIDS Society — are all unable or unwilling to practice what they preach: to respond to the HIV epidemic based on the best available evidence.

If they did, they would be hard pressed to continue to ignore the new, growing, and resurgent HIV epidemics among gay men and other men who have sex with men around the globe.

In an effort to give some serious attention to HIV among gay men, the Global Forum on Men who Have Sex with Men (MSMGF) organized BE HEARD, a pre-conference event on July 17 here in Vienna.

At this one-day event 650 men and women from all corners of the globe came together to address the worsening global AIDS crisis among gay men.

The day featured presentations, workshops, and discussions among activists from every continent and more than 100 countries. Topics covered government denial and neglect; inadequate funding; limited access to prevention, treatment, and care; heartbreaking human rights abuses; and the resulting HIV-related deaths among gay men.

This situation was reiterated throughout the day by a number of high-level experts in the HIV field. Plenary speakers included Michael Sidibé, executive director of UNAIDS; Michel Kazatchkine, executive director of The Global Fund; and Stephen Lewis, the previous United Nations Special Envoy on HIV in Africa.

One after another they stepped up to the podium and told the crowd how bad the situation is for us, how it is made worse by a serious lack of human rights in jurisdictions around the globe, and how, finally, we could count on their support as we fight on.

BE HEARD gave men a chance to get together and hear about challenges of HIV in our communities. It was an incredible opportunity to connect with men on the frontlines from around the world.

But it was also a missed opportunity.

This gathering of global gay activists did not need to spend the limited time they had together presenting statistics and program models to each other. If we really want to be heard, we should have spent that time strategizing about how we are going to use this international platform to demand action to end HIV in our communities.

Gay men need to dust off their whistles and take a page from the playbook of sex work activists, treatment activists, or the emerging activists from Eastern Europe. They aren’t afraid to make some noise because there’s too much at stake for them.

As the 18th International AIDS Conference starts, there’s too much at stake for gay men too.

Only one in five gay men on the planet has access to HIV prevention, care, and support. Top level officials pay lip service to epidemics among gay men but they offer us no good news.

George Ayala, executive officer of the Global Forum, said only 2 percent of scheduled events at this year’s AIDS conference will address the needs of men who have sex with men.

Gay men have been silenced at this conference and if we don’t make some noise, we’ll remain invisible.

There was a time when gay men refused to sit quietly while people in positions of power and authority apologized for our situation but provided no solutions or commitments.

In those days, gay guys demanded action. We demanded money. We demanded laws to protect our dignity and our human rights.

In those days we refused to be silent.

There is an opportunity for leadership here from the MSM Global Forum. It needs to decide if it wants to play nice with the big boys and girls, or throw down the gloves.

The conference is just getting started. Before it’s over I hope gay men do what needs to be done to Be Heard.

[Posted by Paul Causey, MSM-Asia mailing list, 2010-07-21]