[Viva] Fwd: Key affected populations at the centre of AIDS 2014

[Margarite Sanchez]

Some highlights from the IAC 2014 in Melbourne.
M

---------- Forwarded message ----------
From: aidsmap AIDS 2014 news <bulletins at bulletins.aidsmap.com>
Date: Wed, Jul 30, 2014 at 10:38 AM
Subject: Key affected populations at the centre of AIDS 2014
To: margaritesanchez at gmail.com


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<http://www.aidsmap.com/page/2896683?utm_source=NAM-Email-Promotion&utm_medium=conference-bulletin&utm_campaign=English>
           Wednesday 30th July 2014    Contents

   - Coverage of AIDS 2014 <#147885a84383e9ec_item2896692>
   - Key affected populations at the centre of AIDS 2014
   <#147885a84383e9ec_item2896684>
   - Harm reduction for people who inject drugs
   <#147885a84383e9ec_item2896686>
   - Men who have sex with men <#147885a84383e9ec_item2896687>
   - HIV prevention for sex workers <#147885a84383e9ec_item2896688>
   - Self-testing <#147885a84383e9ec_item2896689>
   - Option B+ for treatment of mothers and prevention of vertical
   transmission <#147885a84383e9ec_item2896690>
   - STEP – A community initiative to design the pathway to long-term
   remission of HIV <#147885a84383e9ec_item2896691>
   - Scientific analysis from Clinical Care Options
   <#147885a84383e9ec_item2896685>


<http://www.aidsmap.com/page/1036964/?utm_source=NAM-Email-Promotion&utm_medium=conference-bulletin&utm_campaign=English>
    Coverage of AIDS 2014

This is our final summary bulletin from the 20th International AIDS
Conference (AIDS 2014).

We hope you have found our news reports and bulletins informative and
useful. You can find all our news coverage
<http://www.aidsmap.com/page/2867290/?utm_source=NAM-Email-Promotion&utm_medium=conference-bulletin&utm_campaign=English>
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in English, French, Spanish, Portuguese, Italian and Russian – and selected
news and tweets from other sources on our conference webpages at
www.aidsmap.com/aids2014
<http://www.aidsmap.com/page/2866765/?utm_source=NAM-Email-Promotion&utm_medium=conference-bulletin&utm_campaign=English>

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.
 Key affected populations at the centre of AIDS 2014

Gottfried Hirnschall, Director of the HIV Department at the World Health
Organization (WHO), speaking at AIDS 2014. Photo: International AIDS
Society/Steve Forrest.

If there was a phrase that defined the 20th International AIDS Conference
(AIDS 2014), it was ‘key affected populations’
<http://www.aidsmap.com/Of-guidelines-targets-and-resources-the-documents-that-defined-the-2014-International-AIDS-Conference/page/2895350/?utm_source=NAM-Email-Promotion&utm_medium=conference-bulletin&utm_campaign=English>
.

The World Health Organization (WHO) released its new *Consolidated
guidelines on HIV prevention, diagnosis, treatment and care for key
populations* <http://www.who.int/hiv/pub/guidelines/keypopulations/en/> on
11 July.

These guidelines set out the priority services and interventions that
should be provided to meet the needs of people who inject drugs, sex
workers, men who have sex with men, transgender people and people in
prison. Members of these groups are at high risk of HIV infection in all
settings but their needs have been neglected in many parts of the world.

AIDS 2014 included numerous sessions looking at the issues faced by key
populations.
  Related links

   - Read this news story in full on aidsmap.com
   <http://www.aidsmap.com/page/2895350/?utm_source=NAM-Email-Promotion&utm_medium=conference-bulletin&utm_campaign=English>
   - Download the new WHO guidelines
   <http://www.who.int/hiv/pub/guidelines/keypopulations/en/>

 Harm reduction for people who inject drugs

Olga Varetska, of the International HIV/AIDS Alliance Ukraine. Photo:
©IAS/MarcusRose/Workers' Photos.

Although there is a strong international scientific consensus that harm
reduction is the most effective means of preventing HIV infection among
people who inject drugs, some countries choose not to implement provision
of sterile injecting equipment and opioid substitution therapy. Two strong
examples of the impact of harm reduction on national HIV epidemics were
presented at AIDS 2014
<http://www.aidsmap.com/page/2896534/?utm_source=NAM-Email-Promotion&utm_medium=conference-bulletin&utm_campaign=English>,
showing why harm reduction is a good investment.

Looking at the impact of Ukraine’s harm reduction programme between 2005
and 2013, Olga Varetska of International HIV/AIDS Alliance Ukraine,
reported that HIV diagnoses among people who inject drugs began to decline
in 2011 and have fallen by over 75% in young people who inject drugs since
2006, the best proxy for recent infections.

However, HIV infections among heterosexuals have risen sharply and now
predominate, emphasising the importance of HIV prevention to prevent sexual
transmission from male drug users to their partners.

In Greece, the expansion of harm reduction in response to an outbreak of
HIV among people who inject drugs resulted in a dramatic reduction in HIV
incidence between 2011 and 2013. Greek researchers used incidence data to
estimate the impact of the programme. They calculated that HIV incidence
was 88% lower than it would have been without scaled-up harm reduction.

The conference also heard a new recommendation on the prevention of
overdose in people who inject drugs
<http://www.aidsmap.com/Of-guidelines-targets-and-resources-the-documents-that-defined-the-2014-International-AIDS-Conference/page/2895350/?utm_source=NAM-Email-Promotion&utm_medium=conference-bulletin&utm_campaign=English>.


WHO’s Philip Read told the conference that more people who inject drugs now
died of heroin overdoses than AIDS and that 60% of overdoses occur in front
of another person.

WHO now recommends that people who inject drugs should be provided with
emergency packs of the heroin antidote naloxone for use by friends or by
the users themselves in case of accidental overdose.
  Related links

   - Read this news story in full on aidsmap.com
   <http://www.aidsmap.com/page/2896534/?utm_source=NAM-Email-Promotion&utm_medium=conference-bulletin&utm_campaign=English>
   - View the abstracts and webcasts from this session on the conference
   website <http://pag.aids2014.org/Session.aspx?s=1110>

 Men who have sex with men

Luiz Loures, of UNAIDS, speaking at AIDS 2014. Photo: ©UNAIDS.

A survey of young gay men and transgender women in Bangkok has found that
HIV incidence is running at 9% a year
<http://www.aidsmap.com/Nearly-half-of-young-gay-men-in-Bangkok-not-using-condoms-consistently-acquire-HIV-within-five-years-of-starting-sex/page/2895400/?utm_source=NAM-Email-Promotion&utm_medium=conference-bulletin&utm_campaign=English>
in those who don’t used condoms consistently – and 2% a year in those who
say they do.

What can we do to prevent HIV in such a fast-growing epidemic, which is by
no means unique to Thailand?

Luiz Loures of UNAIDS, who was chairing the session, commented: “It is a
huge problem that young gay men today are coming out into a population
where, already, a much higher proportion of their contemporaries has HIV
than was the case 20 years ago.”

The Thai Red Cross, which runs the largest HIV clinic in Bangkok, is
setting its sights on trying to get men who have sex with men (MSM) to test
as frequently as possible in the hope of catching early infections; this is
the inspiration behind the ‘Suck. F***. Test. Repeat
<http://www.testbkk.org/>.’ campaign which has garnered praise for its
videos but also criticism for not including condom use in its text.

Pre-exposure prophylaxis (PrEP) using antiretroviral drugs is another
potential option for HIV prevention among MSM, although largely unavailable
outside the United States.

In its key population guidelines, the World Health Organization recommends
PrEP as an additional prevention option for MSM. A survey conducted in
Australia and the Netherlands found low awareness of PrEP among
HIV-negative gay men
<http://www.aidsmap.com/Gay-men-interested-in-taking-PrEP-already-report-high-risk-behaviour/page/2895997/?utm_source=NAM-Email-Promotion&utm_medium=conference-bulletin&utm_campaign=English>,
but strong interest among a subset of men who reported recent unprotected
anal intercourse with a casual partner.

Qualitative research found that gay men in the two countries perceived PrEP
to be a highly effective prevention method that could reduce anxiety about
contracting HIV and allow greater intimacy with a partner, especially in a
serodiscordant relationship (in which one person is living with HIV and the
other is HIV negative). However, gay men expressed concerns about the cost
of PrEP and how to obtain access to it. They also expressed concerns about
their ability to take it consistently, and about possible side-effects.
  Related links

   - Read the news report about Thailand in full on aidsmap.com
   <http://www.aidsmap.com/page/2895400/?utm_source=NAM-Email-Promotion&utm_medium=conference-bulletin&utm_campaign=English>
   - Read the news report about Australia and the Netherlands in full on
   aidsmap.com
   <http://www.aidsmap.com/page/2895997/?utm_source=NAM-Email-Promotion&utm_medium=conference-bulletin&utm_campaign=English>

 HIV prevention for sex workers

The Official AIDS March to Federation Square. Photo: International AIDS
Society/Steve Forrest

While consistent condom use is generally high among female sex workers, the
same populations report lower rates of condom use with regular partners,
pointing to a potential gap in HIV prevention strategies and potential for
transmission to and from regular partners
<http://www.aidsmap.com/page/2896528/?utm_source=NAM-Email-Promotion&utm_medium=conference-bulletin&utm_campaign=English>
.

A study in six Central American countries found that 80% of female sex
workers reported consistent condom use with clients, but a lower proportion
reported consistent condom use with regular partners (30-60% by country)
and rates of HIV testing varied widely across the region. A combination of
behaviour change communication, free condom provision and HIV counselling
and testing was associated with a threefold increase in condom use with
regular partners.

The efficacy and acceptability of pre-exposure prophylaxis has not been
tested with female sex workers, but a study modelling its impact in India
found that 23% of HIV infections among female sex workers could be
prevented over a ten-year period if at least 40% of sex workers used PrEP.
  Related links

   - Read this news story in full on aidsmap.com
   <http://www.aidsmap.com/page/2896528/?utm_source=NAM-Email-Promotion&utm_medium=conference-bulletin&utm_campaign=English>
   - View the abstracts and webcasts from this session on the conference
   website <http://pag.aids2014.org/Session.aspx?s=1131>

 Self-testing

Rachel Baggaley, of the World Health Organization (WHO).
Photo©International AIDS Society/Marcus Rose/Workers' Photos.

Self-testing for HIV has great potential to broaden access to HIV testing,
conference delegates were told
<http://www.aidsmap.com/What-needs-to-be-done-to-make-HIV-self-testing-a-reality/page/2895542/?utm_source=NAM-Email-Promotion&utm_medium=conference-bulletin&utm_campaign=English>.


It’s not clear how self-testing will be made available, but the World
Health Organization set out some possibilities:

   - Open-access and unsupervised, with sales or distribution through
   retail pharmacies, websites or vending machines (the dominant model in the
   United States).
   - Some restrictions on access, with tests available from outreach
   workers, pharmacists or clinicians. Eligibility criteria might be more or
   less strict, depending on national policies and the epidemiological context.
   - Supervised self-testing, with additional support from a health worker
   or community volunteer, such as a demonstration of how to use the test or
   referrals to additional services.

However, research conducted in Kenya, Malawi and South Africa by PATH found
a high frequency of user errors when using existing self-testing kits. Half
of people filmed while using a kit made multiple errors as a result of
difficulties in understanding the instructions or design flaws in the test
kits. Similar problems arose in a separate study in South Africa. PATH is
now trying to develop a more user-friendly self-test kit in partnership
with industry.

However, manufacturers need to know more about how self-testing will be
used, not just by individuals but also within programmes, before committing
resources to developing new test kits.

More work is also needed to define how people who test positive should be
linked to confirmatory testing and care.
  Related links

   - Read this news story in full on aidsmap.com
   <http://www.aidsmap.com/page/2895542/?utm_source=NAM-Email-Promotion&utm_medium=conference-bulletin&utm_campaign=English>

 Option B+ for treatment of mothers and prevention of vertical transmission

The lifelong offer of antiretroviral therapy (ART) to women living with HIV
who are pregnant or breastfeeding, regardless of CD4 cell count – known as
Option B+ – was pioneered by Malawi’s Ministry of Health in order to
simplify the implementation of ART for prevention of vertical transmission
(from mother to child). Malawi began implementing the policy in 2011.

The policy has also been adopted in Uganda, Rwanda and Haiti, and will be
implemented from January 2015 in South Africa.

But how is Option B+ working in practice?

The number of women starting ART during pregnancy and breastfeeding
increased sevenfold during the first 15 months after Option B+ was
introduced, but research presented at AIDS 2014 shows almost one-in-four
women are lost to follow-up in the first year after starting treatment
<http://www.aidsmap.com/page/2896540/?utm_source=NAM-Email-Promotion&utm_medium=conference-bulletin&utm_campaign=English>.
Among women traced after loss to follow-up, distance to the clinic and
travel costs were the most frequently cited reasons for missing
appointments.

However, a survey of 141 health facilities in south-eastern Malawi found
that referring mothers living with HIV to a clinic where ART could be
managed resulted in better retention than initiating ART in an antenatal
clinic and then referring the mother later on.

A second survey, comparing national performance in both prevention of
mother-to-child transmission (PMTCT) and early infant diagnosis
<http://www.aidsmap.com/Strong-performance-on-HIV-drugs-for-mothers-doesnt-guarantee-optimal-care-for-infants-survey-shows/page/2894511/?utm_source=NAM-Email-Promotion&utm_medium=conference-bulletin&utm_campaign=English>
found that although Malawi did well at getting mothers onto ART, it did
less well at early infant diagnosis and provision of cotrimoxazole to
HIV-exposed infants.

The survey assessed the performance of six PMTCT interventions in Malawi,
Lesotho, Tanzania and Zambia between November 2011 and February 2012.

While 71% of pregnant women received antiretrovirals during pregnancy in
Malawi, only 5% did so in Tanzania. However, 58% of HIV-exposed infants had
been tested for HIV by eight weeks of age in Tanzania, compared to 17% in
Malawi and 83% in Lesotho.

Researchers concluded that early infant diagnosis could be improved by:

   - A family-centred approach so mothers and infants get services from the
   same place
   - Integration of paediatric HIV care into routine maternal and child
   health services
   - Point-of-care diagnostics to minimise loss to follow-up, long
   turnaround time and late initiation of care and treatment.

  Related links

   - Read this news story in full on aidsmap.com
   <http://www.aidsmap.com/page/2896540/?utm_source=NAM-Email-Promotion&utm_medium=conference-bulletin&utm_campaign=English>
   - View the abstracts and webcasts from this session on the conference
   website <http://pag.aids2014.org/Session.aspx?s=1132>

 STEP – A community initiative to design the pathway to long-term remission
of HIV

The European AIDS Treatment Group (EATG) is organising STEP, a community
training day.

The training will look at research into strategies for long-term remission
of HIV infection off antiretroviral therapy (often referred to as ‘cure’
research).

It will take place in Glasgow on Saturday, 1st November 2014 (in advance of
the HIV Drug Therapy Congress).

Participation in the training is open to all community members with an
interest in this area.

Depending on the funding available, EATG will offer up to 30 scholarships
for community members, to cover accommodation the night before the meeting.

If you wish to attend, please fill in the online registration form
<https://www.surveymonkey.com/s/STEPS_Application_Form>.

For more information on the training, please contact Giulio Maria Corbelli:
giuliomariacorbelli at gmail.com
  Related links

   - Online registration form for STEP training
   <https://www.surveymonkey.com/s/STEPS_Application_Form>

 Scientific analysis from Clinical Care Options

Clinical Care Options <http://www.clinicaloptions.com/HIV.aspx>' (CCO) is
the official online provider of scientific analysis for delegates and
journalists.

Over the next few weeks, their coverage will include expert audio
highlights, capsule summaries of important clinical data, downloadable
slidesets, and more.
  Related links

   - Visit the Clinical Care Options website
   <http://www.clinicaloptions.com/HIV.aspx>

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