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Have you heard the biggest news in ages? Science shows that there is a 96% reduction in risk to HIV transmission (LA Times article) if people have access to AIDS drugs.

We’ve been saying for years that  treatment – as a key component of comprehensive care — is among the best tools out there for ending the HIV/AIDS pandemic.

A few months ago, US-funded scientists proved we were right. Thanks to the HPTN 052 study, they found out that AIDS treatment reduces the risk of HIV transmission by 96%.

to urge the President to put the promise of this study into practice in the US & worldwide.
CLICK HERE
Unfortunately, the U.S. administration has actually been putting less funding directly into global AIDS treatment for the last few years, and is adding people to treatment only through “cost savings.” And domestic programs are on the chopping block of deficit reduction – even though treating HIV prevents future costs.
The science is clear  — but we are still waiting for White House leadership, and facing mounting challenges to domestic treatment expansion.

So the HIV Prevention Justice Alliance and our friends at SisterLove are supporting Health GAP, who put together a website that makes the choice clearer for the President: he can continue on the sidelines of the global AIDS fight, or he could step forward and commit to getting millions more people on treatment by 2013 – and stand firm on what we need in the United States.

Check out this new website, and share it with your friends. While there, you can add your name to the petition that will be personally delivered to White House officials next week.

Just a few weeks ago at the PEPFAR scientific advisory board meeting, advocates got see some of the newest modeling that shows that getting people on ARVs halts deaths and new infections – and saves money in the long run. Not a bad bang for the buck, by any means, and somthing that we should be proud to support.

We have the tools the end the AIDS pandemic. But what we lack is political leadership.

President Obama, despite his promises, has been missing on the global scene, and is under attack for the domestic strategies that could help here at home.

Please add your name to our petition and check out our website! The White House is making decisions right now, so sign today.

It’s time for the President to step up and do what’s right: treat the people to end the pandemic, and stand firm on expanding care and treatment in the United States.
CLICK HERE to sign the petition

Thank you for continuing to fight with us for life-saving treatment for everyone worldwide.

Julie, Jim, David and everyone at the HIV Prevention Justice Alliance (HIV PJA)

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Wednesday August 10, 2011 

The topic this Wednesday is Self-Esteem.   What is it?  How do you measure it?    Is lower self esteem responsible for the high HIV infection rate in the gay population?    Is it responsible for your HIV infection?   What is the connection between self-esteem and safer sex practices?   Is barebacking related to a lack of self-esteem?  

Come join the conversation

Steve

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New CDC HIV numbers

NEW CDC HIV NUMBERS REINFORCE NEED TO HEIGHTEN NATION’S COMMITMENT TO PREVENTION

 

Focus on Gay Men of All Races and Ethnicities Must be Strengthened

Washington, DC – “Today’s announcement from the Centers for Disease Control and Prevention (CDC) that new HIV infections in the U.S. remain stable but has increased among gay men and other men who have sex with men, particularly among black gay men, is further evidence that our Nation’s commitment to HIV prevention must be heightened,” commented Carl Schmid, Deputy Executive Director of The AIDS Institute. “At a time when Washington policy makers are debating ways to cut budgets, we cannot risk cutting HIV prevention programs, which account for only 4 percent of all federal HIV spending.  Instead we should be increasing our investment,” Schmid added. 

While the CDC reports the number of overall infections remain stable, there was an increase in the number of infections in one group, gay men.  Despite being about 2 percent of the population, they accounted for 61 percent of the new infections in 2009, compared to 56 percent in 2006.  This was driven by a dramatic number of new infections among young black gay men (48 percent increase among those ages 13-29).

 “It is obvious we must invest our resources, prevention programs and research on where the epidemic is and where it is increasing.  We hope federal, state, and local health departments together with community based organizations will appropriately adjust their programs to ensure the needs of the most affected communities are addressed.  The National HIV/AIDS Strategy developed by the Obama Administration reinforces this need, but change is often met with resistance,” added Schmid. 

 “The 34 percent increase in the number of new infections among young gay men is yet another reminder for the need to have age appropriate sexuality education that includes a positive discussion of both heterosexual and homosexual relationships,” said Michael Ruppal, Executive Director of The AIDS Institute.

The new CDC incidence numbers continue to demonstrate that HIV in the U.S. not only disproportionately affects gay men of all races and ethnicities, but African American and Latino men and women as well.   

 Investing in HIV prevention today will save money tomorrow.  Preventing one infection will save approximately $355,000 in future lifetime medical costs.  If we had prevented the 48,100 new cases in 2009 alone would translate into an astounding $17 billion less in lifetime medical costs.

 President Obama has proposed an increase to CDC’s HIV prevention programs by $57 million in FY12.  “When the U.S Congress returns to Washington in the fall and turns to completing action on its spending bills, we urge them to support at least this level of funding to ensure we can continue to prevent HIV infections in our country,” added Ruppal.

 “Today’s news from the CDC is not good news.  A stable number of new infections is not progress; we need to see a decline in the number of new infections.  President Obama stated in the National HIV/AIDS Strategy that he envisions a country where HIV infections are rare.  We look forward to that day, but it will only occur if we properly invest in HIV prevention today,” concluded Ruppal.

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The Washington Post reported that treating people with HIV drugs sharply cuts risk of transmission to other people. LINK to Article We’ve been discussing this in the Wednesday group for many years. Lower viral loads reduce risk of transmission. A prvious Swiss study stated that an undetetectable viral load was non-infectious and other studies have stated that viral loads less than 1,500 or even 3,500 are low risk.

HIV drugs sharply cut risk of transmission, study finds
By David Brown, Published: May 12
AIDS researchers announced Thursday that a study conducted in nine countries has proved the long-standing hunch that HIV-infected people on treatment are much less likely to transmit the virus than people who aren’t taking the drugs.

The study, which was stopped early because the results were so dramatic, found that men and women whose sexual partners were infected with the AIDS virus were almost completely protected if the partner took a combination of HIV-suppressing drugs.

The study provides evidence — useful in American cities and African villages — that getting HIV-infected people on treatment early, long before they have symptoms, may be the best strategy for slowing the 30-year-old epidemic. The District has the highest infection rate of any American city, on a par with that of Rwanda.

“This is far beyond expectation. It could completely change the way we are dealing with the epidemic,” said Michel Sidibe, head of UNAIDS, the United Nations’ AIDS program.

“This is data that you can’t ignore,” said Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases, which paid for the $78 million experiment.

Condoms, behavior change, clean hypodermic needles and a safe blood supply are the chief tools for preventing HIV infection. However, since the arrival of antiretroviral therapy (ART) in 1996, there has been a lot of indirect evidence that treatment is a tool for prevention.

The reason is simple. ART, three or more drugs taken every day, prevents the AIDS virus from replicating, and it rapidly disappears from blood and other bodily fluids that are the usual vehicles for infection.

The idea that treatment could be preventive was seen in studies of “discordant” couples — one partner infected, the other not — in Kenya. Researchers observed that when an infected person was in treatment, the partner was at much less risk of becoming infected. This observation held for whole populations.

Researchers in British Columbia last year reported that the rate of new infection for the entire province declined after a policy of widespread HIV testing and early treatment was adopted.

What was missing was evidence from a randomized, controlled trial — the gold standard of medical research — that treatment had a clearly preventive effect.

The new study enrolled 1,763 couples in five African countries, as well as Brazil, India, Thailand and the United States. Nearly all were heterosexual. The researchers wanted to include large numbers of gay men but were unsuccessful in recruiting them, possibly because they were already convinced that treatment reduces transmission.

All of the volunteers had a CD4 cell count of 350 to 550 cells per cubic millimeter of blood — evidence of mild damage to the immune system.

In half of the couples, the infected person immediately went on ART. In the other half, the medicines weren’t started until the infection became more severe, as evidenced by a fall of the CD4 count below 250. All were advised to use condoms.

Over the next four years, 28 people acquired HIV from their partner. (Gene fingerprinting of the virus revealed that in 11 other cases, people became infected by someone other than their regular partner.) Of those 28 new infections, 27 occurred among couples in which the HIV-infected partner had not started taking antiretroviral drugs at the start of the study. That amounted to a 96 percent reduction in the risk of acquiring HIV in the couples in which the infected partner was on ART.

Significantly, 17 of the 27 infections occurred in couples in which the infected partner’s CD4 count was greater than 350. The World Health Organization’s guidelines call for starting ART when the count dips below 350. This study shows that having a partner whose CD4 count is above that cutoff is no assurance the person won’t transmit the virus.

The leader of the study, Myron Cohen of the University of North Carolina at Chapel Hill, said the results are “probably generalizable” to all heterosexuals. But that’s not absolutely certain.

The study marks a further swing of the pendulum back toward the once-popular and later discredited HIV treatment strategy known as “hit hard, hit early.”

Prescribing ART long before an infected person has symptoms or evidence of severe immune system damage was popular until it became clear the drugs could have serious side effects. (They can damage nerves, raise blood cholesterol and change the distribution of body fat). More recent evidence shows that putting off treatment for too long increases the risk of early death.

Although it is now clear that ART protects a person’s partner, what isn’t certain is whether ART benefits the patient when it’s started soon after infection and before the immune system is measurably damaged. A study designed to answer that question recently started but won’t be finished for several years.

Some AIDS experts fear the new study may be used to browbeat newly infected people into starting ART earlier than they might otherwise.

“I can imagine people deciding to get treatment because they are in a relationship and they want to protect the partner. But if a person has a CD4 count of 800, it is wrong to mislead people that they will benefit when we really don’t know,” said Joseph A. Sonnabend, 78, a retired physician and researcher previously affiliated with St. Luke’s-Roosevelt Hospital Center in New York City.

Like many cities with a high AIDS prevalence, the District has an aggressive policy of testing for HIV infection and urging infected people to enter care.

As of Dec. 31, 2008, the most recent year for which data are available, 16,513 city residents were living with HIV. About 3.2 percent of people older than 12 in the city are thought to be infected.

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Truvada slashes HIV Infection Risk in ‘Breakthrough’ Study

This past week a study was released that showed giving HIV-negative men Truvada significantly reduced the percentage of them becoming positive.

About 2,500 trial participants were divided into two groups. One group was given Truvada, the other a look-a-like placebo. Both groups were also given condoms, counseling on safe sex, and tested for HIV and other STD’s once a month. They also returned their pill bottles to see how diligent they were taking the drug. The trial lasted a little longer than a year.

A total of 100 men contracted HIV during the trial, 36 of them were on Truvada and 64 were on the placebo. That translates into a 44% reduction in risk.

Truvada costs between $5,000 and $7,000 a year in the U.S. when purchased through the health care system and more if bought privately.

My Comments: Forgive me for being cynical, BUT we talked about this concept at least two years ago in group with a slightly different slant. The street has been using Truvada to prevent HIV infection for years as part of the Party-n-Play-Cocktail. The PnP-Cocktail consists of 3 drugs; Crystal Meth to get high and remove inhibitions, Vigra to keep an erection (Erectile Dysfunction is a common side effect of Crystal Meth) , and Truvada to prevent HIV infection allowing people to practice unsafe sex totally uninhiiBBited (BB= BareBack). By taking all three drugs, the idea is that you can stay up all weekend having unprotected sex and then go back to work on Monday HIV-negative.

Although the Gilead study is more scientific than the street experiment, I’m not sure a reduction of 44% over just a year is the “end of the AIDS” in the Gay community. Combining that with the cost of Truvada at $5-7,000/year and I also don’t put much faith in the idea that we have the tools “to break the back of the epidemic”.

We don’t know the long-term side-effects of taking Truvada or any anti-HIV medication over a lifetime. HIV is only 30 years old and these HIV medications are still within their patent period.

Even if Truvada became readily available at affordable rates, would Gay men who were using condoms, abandom them for Truvada? These are questions that need to be answered before we jump on the bandwagon that the AIDS epidemic is over.

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