Health care for women has been a challenge for thousands of years. It's even been a point of celebration as depicted in images of a woman giving birth in a barn, iconic of the holiday season.
But at the last IAS International AIDS Conference (AIDS 2018) there were no stars shining over Bethlehem in the Amsterdam horizon for tens of millions of HIV-positive women. Instead, studies at last year's AIDS 2018 show that women living with HIV are experiencing significant barriers to comprehensive treatment, statistical representation, and the retention in care needed to prevent and treat co-morbidities.
In fact, co-morbidities are increasingly becoming the most complex, expensive, and serious manifestations of HIV in the antiretroviral era.
In a thought-provoking presentation at AIDS 2018, David Malebranche MD, MPH, from Morehouse School of Medicine, demonstrated how the HIV continuum of care is failing key population often overlooked. A key point of Dr. Malebranche’s presentation was to stop solely blaming patients for difficulties existing in their maintaining consistent treatment and care, and examine how the biases of the medical community are contributing to these inconsistencies.
This failure is also driving single HIV-positive mothers living below the poverty line, who are experiencing co-morbidities relating to their HIV, to fall through the cracks of the current treatment paradigm. These women experience extreme difficulty getting into and staying retained in clinical studies and maintaining medical appointments. In many cases, this is due to clearly defined barriers: transportation, lack of childcare, conflicting schedules, and a lack of support from an economy allotting just enough to survive but not the dignity needed to surpass mere existence.
Continued lack of support for key populations of people living with HIV (PLWHA) and the unique obstacles they face, only hinder efforts to meet challenges to delivering treatment, particularly of HIV associated co-morbidities.
Data presented at AIDS 2018, as well as in peer reviewed literature, indicates HIV-positive single mothers living below the poverty line have a high incidence of long-term economic and personal challenges that are counterproductive to treatment. As a demographic, women and many of the diseases that affect them remain unrepresented in recent studies by The AIDS Clinical Trial Groups (ACTGs), ANRS, and other publicly sponsored research networks.
A recent study showed that HIV-positive women with chronic depressive symptoms are twice as likely to die, even after adjusting for mortality predictors such as CD4 count and age. Also identified was the importance of mental health issues on factors of co-morbidities like cardiovascular disease and co-infections.
Without HIV exposure, women show greater predisposition for CVD, IBD, and parasitic infections such as toxoplasmosis. Toxoplasmosis has been shown to facilitate the progression of HIV along with other diseases including CVD, as well as facilitate the permissiveness of co-morbidities. Taken together, these clinical concerns are undermining the premise of HIV being a chronic manageable condition in neglected key populations.
There’s a library of literature substantiating that women generally present high risk factors for developing cardiovascular disease, and unsurprisingly, CVD is the leading cause of mortality in HIV- positive women. HIV exacerbates inflammation and compounds traditional cardiovascular disease risk factors. HIV is associated with a 50 percent increased risk of AMI beyond that explained by recognized risk factors.
Additionally, drugs like Maryzime’s MB103 for AMI may offer a significant advancement in the treatment of HIV associated AMI. The success seen in the REPREIVE study, where Patavastatin showed benefit in the prevention and treatment of HIV-related CVD, show the need for more research on interventions such as MB103 to address the various forms of CVD in women, and all PLWHAs, are experiencing CVD.
Studies on ARV adherence and poly-pharmacy at AIDS 2018 demonstrated the absence of focus on clinical challenges HIV-positive single mothers experience in navigating the complexity of treatment landscapes. And while studies addressing drug resistance are plentiful, correlations of resistance and co-morbidities in HIV-positive single mothers, remain unaddressed.
A study published in the June online edition of the Journal of Acquired Immune Deficiency Syndromes examining poly-pharmacy in HIV-positive people, reported that half of people over 50 were at risk of drug interactions between ARVs and other medications.
Studies at the conference focused on Immune dysfunction due to elevated inflammation- which drives co-morbidities and contributes to cancers that disproportionately affect HIV- positive women -was sparse. We know seven out of 10 women develop an autoimmune disease such as Crohn’s and IBS — comorbidities that occur more frequently in the context of HIV.
We also know that low CD4 lymphocytes affect severity in both HIV and IBD. The incidence of ulcerative colitis in HIV is about double that of what is expected in a normal population. Use of several drugs for autoimmune diseases that affect women most, such as IBD and Crohn’s, are known to increase risk of lymphoma. Two of the leading drugs approved for such conditions, Remicade and Humira, are immune suppressive and a third, Entyvio, increases risk for Progressive Multifocal Leukoencephalopathy (PML).
Lodonal, a formulation of low-dose Naltrexone in phase IIB/III development by Immune Therapeutics, demonstrated significant improvements in symptom relief in Crohn’s, reduction of inflammation, and could be an option for these women and many conditions that disproportionately affect them.
HIV-related diarrhea was reported at AIDS 2018 to still be occurring at the same rate as it was 17 years ago. According to a poster presentation, a review of 38 ARV focused clinical trials found that the rate of non- infectious diarrhea has remained at 17-18 percent despite the widespread use of ARVs. Mytesi, the only FDA approved treatment for HIV-related diarrhea, continues to be under-prescribed. This troubling condition is linked to ARV non-adherence, malnutrition, depression and isolation conditions many HIV-positive women struggle with.
The AIDS 2018 and HIV Glasgow 2018 conferences demonstrated how far we’ve come over the course of the epidemic in advancements of ART and the HIV prevention toolbox.
Atreca published data on their BNAB immune capture platform showing exceptional activity directed against HIV from individuals with serum activity capable of potently neutralizing genetically diverse strains of HIV. So, while we’re waiting in the purgatory of balancing the marginal, incremental advances of small molecule antiretroviral drug development for therapeutic vaccines like the phase 2B Vacc-C5 from Bionor Pharma, early stage BNABS by Atreca, and with long acting ARV’s just on the horizon, that could transform the course of epidemic, poz patients continue to die from preventable co-morbidities driven by elevated inflammation.
The HIV pandemic is changing and the community needs to support prioritizing agendas at the ACTG’s, MHRP, and the CTN to address the emerging risks of GI co-morbidities like Crohn’s and IBS, HIV-related CVD manifestations of AMI and A-Fib. Not to mention, accelerated aging with HIV along with the concerns that co-infection with toxoplasmosis, HPV, and other pathogens represent to morbidity — not just for women and single HIV-positive mothers, but on a global scale.
AIDS 2018 should have been a turning point for a new scientific agenda that created room at the table for overlooked HIV key populations. The upcoming 2019 HIV Science Conference in Mexico City in July is our next best chance to make that priority a reality.
Written by: Jennifer LeAnne & David Miller. 01 March 2019. plus.com
“The stigma associated with HIV is one of the main reasons HIV/AIDS is still spreading at an alarming rate in some parts of the world.
The images that were burned into our memory from the 1980s and 1990s were effective at shocking people back then but we haven’t moved past that and for many, when they think of or hear the letters HIV, that is all they know.
It shocks me and saddens me that within the younger gay community there is so much stigma and discrimination towards those of us live with HIV.
To be asked if I am ‘clean’ when it comes to inquiring about my sexual health and overall health is not only offensive but it’s incredibly ignorant.
It’s time we have a new and very real conversation about what it means to be HIV-positive in this day and age and hopefully by me telling my story I’m helping to facilitate that a little.”
— ABC News reporter Karl Schmid in an interview with the Star Observer.
Scientists are speaking out against a directive by the Trump administration that has shut down research into a cure for HIV.
A scientist who was supposed to supply mice that have been modified with human fetal tissue for an HIV study emailed researchers that the Department of Health and Human Services (HHS) “has directed me to discontinue procuring fetal tissue.”
“This effectively stops all of our research to discover a cure for HIV,” he wrote.
A “pause” on research that uses aborted fetal tissue, something Christian conservatives strongly oppose, was announced by the Trump administration this past September. The move will affect numerous biomedical research programs.
Congressional Republicans have tried to ban all fetal tissue research for years to appease the religious right. 85 Republican House members wrote a letter to the head of the FDA asking for a ban on fetal tissue research shortly before the “pause” was announced.
The ban has long been a goal of the anti-abortion industry and has been part of the most recent attacks on Planned Parenthood. The group was falsely accused of selling aborted fetuses earlier this year.
In a statement, the NIH said that there is only a “pause in place” on the research, which is “an action NIH thought was prudent given the examination of these procurements.”
“We were all poised to go and then the bombshell was dropped,” said Warner Greene, director of the Gladstone Center for HIV Cure Research. Greene was about to collaborate with the Montana lab on HIV research when the project came to a halt.
“The decision completely knocked our collaboration off the rails. We were devastated.”
The study would have relied on fetal tissue donated by women who have had legal abortions in order to produce “humanized mice,” mice that have human-like immune systems, according to Science. The mice have been used for years for research in infectious diseases, including HIV.
Mice are one of the few non-human animals that can be infected with HIV, which makes them key to testing HIV medication.
Researchers at the lab were going to test a promising antibody they developed to prevent HIV from developing reservoirs, which are cells infected with HIV but are not producing the virus. These cells aren’t affected by currently available HIV medication.
“You spend your life trying to do good experiments and organize your science carefully, and suddenly, at the whim of some politicians in Washington, D.C., they remove a critical piece of your scientific armamentarium,” Greene said.
On September 28, researcher Kim Hasenkrug, who was supposed to provide humanized mice for Greene’s study on the HIV antibody, sent an email to Greene explaining that HHS told them to stop using fetal tissue.
[HHS] has directed me to discontinue procuring fetal tissue from ABR, the only source for us. I think that they are the only provider of fetal tissue for scientists in the nation who don’t have direct access to aborted fetal tissue. This effectively stops all of our research to discover a cure for HIV.
“The mice were ready,” Greene said. “Just as we’d shipped antibody [to Montana], we were ready to go, and boom, the rug was pulled out from underneath us.”
It is unclear whether non-NIH labs that receive NIH funding will also be banned from using fetal tissue. If so, even more research will be affected.
“Everything I am doing involves humanized mice. It would shut my lab down if we were not able to use fetal tissues,” said Jerome Zack, who has used humanized mice for 25 years to study HIV at UCLA.
But Greene said that the NIH’s actions have already slowed down progress on a cure.
“If we were given the green light right now, it would probably take us a year to get back in the position we were in when the ban was put in place,” he said.
Earlier this year, the Department of Health and Human Services announced a new Conscience and Religious Freedom Division that would handle complaints from health care providers who did not want to take part in an abortion or treat transgender people.
Written by: Alex Bollinger. 10 December, 2018. LGBTQNation.com
The film Philadelphia marked a turning point in Hollywood history–the moment when mainstream movies could finally tackle the proverbial elephant in the room: AIDS. Said beast had long cast a shadow over Tinseltown when the movie finally hit cinemas in 1993. Celebrities like Rock Hudson had already died of the disease, and the Reagan & Bush White Houses had done their best to ignore the epidemic. It was the crime of the century, writing HIV/AIDS off as a “behavior-based” condition, which allowed it to become an international pandemic which actually hit many more straight people than gay men.
With Philadelphia, Hollywood joined the cry of the LGBTQ community for empathy, with major stars like Denzel Washington and Tom Hanks (who won his first Oscar) appearing in the movie, which became a major hit with audiences and changed the way many people thought about the disease.
Now Coca-Cola has partnered with the noted anti-AIDS charity (Red) to produce a new video recalling that pre-Philadelphia world, the impact of the film, and how American progress since Reagan (yes, even President George W. Bush became a champion in the fight) has helped stem the spread of HIV, especially in sub-Saharan Africa.
Featuring interviews with Hanks, Washington and co-star Mary Steenburgen, the emotional short film reminds viewers of one powerful truth: even in the most desperate of times, we can still find hope.
Written by: David Reddish
Health care experts have been informed of a US man contracting HIV despite being on PrEP. He’s thought to be the first man in California – and only the third in the US – to contract HIV while adhering to a daily PrEP regime.
PrEP is a medication that minimizes the chances of someone acquiring HIV, even if they do not use condoms.
News of the case was presented at the annual IDWeek conference in San Francisco, which concluded over the weekend. The conference is run by the Infectious Diseases Society of America.
The man was HIV negative when he began taking PrEP in San Francisco in late 2016. He continued to diagnose HIV negative when testing at three, six and ten months. Blood tests also demonstrated he continued to take his medication consistently.
HIV positive after being on PrEP for a year
After just over a year on PrEP, he received an HIV positive diagnosis in early 2018. He was immediately placed on HIV drugs and has maintained a suppressed viral load since that time.
Doctors were able to accurately diagnose the exact strain of HIV he picked up. It’s one identified with people who have taken HIV medication in the past but no longer take it. It was then revealed that the patient’s main male partner was HIV positive but no longer taking medication.
The partner was tested and found to have a high viral load of the resistant strain. He has resumed taking medication.
Researchers say it was the fact the patient came into contact with a resistant strain that led to him acquiring the virus. They believe he stuck to his PrEP regime well. They could tell this from analyzing his hair, which he happened to grow long.
Dr. Robert Grant, of the University of California San Francisco, said, ‘[The patient’s] long hair allowed us to test by centimeters, which allowed us to go back and read drug levels from six months ago.’
Previous cases of men becoming HIV positive while on PrEP
There have been five previous reports on men acquiring HIV while on Pre-Exposure Prophylaxis (PrEP). The first two occurred in Toronto and New York in 2016. In 2017, there were three more cases. One involved a man in North Carolina, one in Australia, and a fifth a man in Amsterdam.
The first four cases are believed to be due to the person on PrEP having sex with someone with a high viral load of a rare, resistant strain of HIV.
The fifth case is not believed to be linked to a drug-resistant strain of HIV. The Amsterdam man had an ‘unusually high number’ of sexual partners – averaging 50-70 a month – and several other sexual infections. Researchers have speculated he may have repeatedly exposed himself to HIV, which took a hold in his body after a slight dip in Truvada levels.
‘Greater than 99% effective’
Health experts say despite these rare cases, PrEP remains highly effective. The medication is taken by more than 350,000 people worldwide.
Dr. Grant said, ‘We know PrEP is greater than 99% effective. There are some cases where HIV will break through. We only have a handful of cases now, and next year, we’ll probably have a handful more. Fortunately, these cases are caught early, treated, and suppressed quickly. The person goes from taking one pill a day to one pill a day. The biggest difference is the stigma.’
Matthew Hodson, Chief Executive of HIV information organization NAM, agrees. 'We estimate that PrEP is more than 99% effective at preventing HIV. By comparison, a recent meta-analysis of the efficacy of condoms found that they prevented nine out of ten cases, this was a better result than previous analyses.
‘PrEP is still better than condoms at preventing HIV. PrEP failure makes the news. Condom failure doesn’t.
He said that in the UK, 93% of people diagnosed with HIV have suppressed the virus to a point where it cannot be passed on ‘in any circumstance.’ This is regardless of whether it’s a drug-resistant strain or not.
‘It’s vital to acknowledge that PrEP, just like other safer sex strategies isn’t 100% effective. It is also vital not to let isolated cases obscure how effective it is. PrEP has played a significant role in bringing down new HIV infections in London, Sydney, New York, San Francisco and other cities around the world.’
H/T: The Body Pro
Source: Hudson, David. California man on PrEP medication acquires HIV.9 October 2018. Gay Star News.
Grindr is trying to handle the negative publicity over sharing users' HIV data. The popular hookup app has announced plans to remind users to get tested for HIV and has offered free advertising to clinics and LGBT centers that provide free testing.
HIV is still considered a global epidemic, there has been a rise in sexually transmitted infections that can be tracked to the uses of PreP (pre-exposure prophylaxis), a drug taken once a day and when property used is almost 100% effective in preventing HIV transmission. Doctor's still caution patients to use condoms while on PreP, however, many gay men treat it as license to throw caution to the wind and just have bareback sex.
A stark report completed by the University of California of Los Angeles (UCLA) found a direct link between the use of PreP and a drastic increase in STI's. To make matters worse most gay men believe that STI's and HIV can be easily cured. For example, herpes cannot be treated with antibiotics, and some infections are now developing resistance to antibiotics, such as "super gonorrhea," or multidrug-resistant gonorrhea.
So if Grindr is interested in the health of the LGBT community then shouldn't they focus on STI's as a whole and not just HIV? The plain fact remains that while people will get tested for HIV and community centers many gay and bi men still define 'disease" in terms of HIV, while the STI's issue just remains in the background.
But issues with Grindr don't just stop there (along with other hook-up apps), as most of these apps pride themselves on shirtless (sometimes nude) photos men, might contribute to high rates of depression, body sysmorphia, and eating disorders to 3.6 million users (Grindr).There are a few professional studies that have been conducted to offer analysis and the effects of gay social media sites on mental health. But since most funding goes to HIV research very little finds it's way to other LGBT public issues. Grindr could in effect pressure medial professionals to study LGBT health on a broader scope.
With millions of users worldwide, Grinder has positioned itself to broaden the framework of LGBT health and address issues that might never receive attention.
SO, will Grindr step up to the plate and open honest dialog about STI's within the LGBT community or will the app just ignore it?
Three porn actors two men, and one female have claimed in a Federal law suit that they contracted HIV in 2014 while filming scenes for Kink. U.S. District Judge Dames Donato granted the insurance company a summary judgment saying a physical-sexual abuse exclusion "exempts the insurer from covering claims arising from sexual activity," according to a report in the Courthouse News. The three actors are being represented by Atain Specialty Insurance.
According to one of the actors now retired stated he was infected while filming "Bound in Public" in 2013. Another performer claims that while filming at the Armony in San Francisco, he was blindfolded and required to perform oral sex with dozens of men of the general public - "they were untested, unidentified members of the general public." He tested positive two week later. However does admit he had a cut in his mouth at the time of filming.
“The language of this exclusion is not ambiguous in the context of this policy and the circumstances of this case,” Donato wrote in his 6-page ruling. “Because the contractual language is clear and explicit, it governs.”
In a statement to Courthouse News Karen Tynan attorney for Kink.com in 2015 “None of these claims were made at the time of the shoots, and are easily refuted both by detailed shoot records, our testing protocols, and the video footage itself."
I am sure there are many points of view regarding "bareback", "risky" porn. What are your thoughts?
h/t: Courthouse News