The head of the Centers for Disease Control and Prevention’s response to HIV/AIDS stressed on Wednesday that he is confident that an end to the epidemic is near.
“Ending the epidemic really means really reducing the numbers of new infections which are occurring as well as protecting the lives of those who are infected,” Dr. Kevin Fenton, director of the CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, told the Blade during the International AIDS Conference at the Walter E. Washington Convention Center. “The cure discussion is very exciting. I think we’re moving along and understanding what the elements of a cure are likely to be, but it will take some time to reach there. Ending the epidemic I think is within our grasp, and we must continue to push for a cure as well.”
Fenton spoke to the Blade a few hours before he took part in a panel that discussed older adults with the virus. The CDC estimates that nearly 11 percent of the roughly 50,000 new HIV infections that occur each year in the United States are among those older than 50. Statistics further indicate that 16.7 percent of new diagnoses in 2009 were among this demographic, with half of them also having AIDS.
The CDC further predicts that half of people with HIV in the country by 2015 will be 50 or older.
“We’re all getting older,” said Fenton. “The baby boomers are now coming out of the workforce, many of whom are HIV infected and are going to be living their lives.”
Stigma, a lack of health care, financial insecurity and a lack of information about the virus are among the challenges that public health officials and HIV/AIDS service providers continue to confront in their efforts to curb new infection rates among older people. In spite of these hurdles, increased access to anti-retroviral drugs and other medications have allowed people with HIV to live longer lives.
“That’s a huge difference to where we were 30 years ago,” noted Fenton. “We now need to prepare for the other health conditions that come with aging: high blood pressure, strokes, diabetes, etc., as people age. This is an appropriate time for us to be reflecting on that.”
Fenton stressed that both the health care reform law that President Obama signed in 2010 and the White House’s National HIV/AIDS Strategy provide what he described as a “framework” to effectively address older adults and other at-risk populations.
“We need to be honest that most infections are occurring among young people in the United States — those under 40 years, so we need to ensure that our resources are being used to address the epidemic in those who are at greatest risk,” he added. “Nevertheless, we still see a substantial proportion of new infections occurring in older adults and I think the conversations that we need to have collectively is how do we ensure that there are proportionate investments to meet the needs of older adults in the U.S. and that we’re mindful of their needs and actively planning for their needs as well.”
Fenton: Conference highlights American leadership on fight against HIV/AIDS
AIDS 2012 is the first time that the United States has hosted the International AIDS Conference since 1990.
“It’s wonderful that we’re able to bring the international community back to the United States to both celebrate the progress we’ve made in the global response against HIV and to reflect on certainly U.S. leadership in the fight against AIDS at home as well as abroad,” said Fenton. “It’s also been fantastic that new concepts and calls for a greater sense of urgency in moving towards an AIDS-free generation, the beginning of the end of AIDS — fantastic themes for everyone across the U.S. as well as around the world for everyone to begin to reflect on.”
More than 30,000 delegates, journalists and HIV/AIDS activists have traveled to D.C. for the five-day gathering that will end on Friday. Some, such as the AIDS Healthcare Foundation, have used the conference as an opportunity to criticize the Obama administration’s response to the epidemic.
“You have to think about where we’ve come from, especially in the last few years,” said Fenton who once again referred to the health care reform bill and the National HIV/AIDS Strategy. He also pointed to safer-sex campaigns that specifically target black men who have sex with men and further engagement with communities impacted by the epidemic. “There’s a lot that we have done over the last few years. We always can do more and we need to do more faster.”
One specific challenge to which Fenton pointed is the underlying socio-economic issues that prevent people with HIV from accessing treatment once they learn their status. He noted that only 28 percent of Americans with the virus are “maximally benefitting from treatment.”
“People may not want to go to an HIV clinic because they’re too embarrassed, they’re afraid of seeing their friends or colleagues or they may not be able to simply afford just to be there because a day in the clinic means a day not working and when you have a family to feed or rent to pay, sometimes you make decisions which are not necessarily to the benefit of your health,” he said. “So there are many issues and what we’re hearing at this conference is we need to be honest about that cascade and we need to think about improving on every aspect of the cascade to have an overall benefit.”
Researchers from the National Institutes of Health and the HIV Prevention Trials Network earlier this week released a study that found high rates of HIV, unemployment and incarceration among black gay men in six cities. The report notes that even though black gay men more likely to practice safer-sex than other groups, they remain at higher risk for the virus.
“It’s not just about individual risk behaviors; but poverty, homelessness, having a sexually transmitted infection, who you’re having sex with really matters, and the kind of sex you’re having really matters,” said Fenton in response to the study. “We now need to be thinking about ways of supporting black gay men — in fact all gay men in this country — to make the right choices for their individual health, but how do we create those social and structural support environments so that they can make the right choices for optimal health. And that’s really important moving forward.”
“We often think of it as being a very rare disease, but what we do know is that it isn’t really. Most people with HIV live in cities with more than 500,000 inhabitants and that four states in the United States account for more than 50 percent of the epidemic and the top 10 states account for about 73 percent of the epidemic,” he said. “The epidemic isn’t randomly distributed and you have these geographic pockets which are hard hit. The fact that we’re in D.C. allows us to both celebrate some of the successes we’re now having in D.C. with HIV response, but it challenges us again to do more.”
Should we vacation in homophobic countries?
Secret gay bar in St. Petersburg seemed unfathomable
ST. PETERSBURG, Russia — The tiny rainbow light projecting onto the corner baseboard of the bar and tipsy people constantly belting out Mariah Carey karaoke songs clued me in. There was something unique happening here. It wasn’t until a gentleman with glittered cheeks approached me to say how fabulous my dress was that I suddenly clocked it. I’d unknowingly ended up in a gay bar in the middle of Saint Petersburg, Russia.
A flood of overwhelming joy first took over. Before coming to Russia on vacation, I knew all too well the discrimination and fear LGBTQ Russians lived in. A gay bar in Russia, even a secret one like this, seemed unfathomable, so being where people could unapologetically be out and proud — even if it was only in the compounds of these four walls — was emotionally profound.
But within seconds, dread took over. Were we all safe? If you didn’t know what to look out for, you’d assume this was just like every other neighboring non-gay bar — it wasn’t hidden or anything. I wondered what was stopping a homophobe, if they found out, from vandalizing the bar or doing something much worse.
After all, Russia approved a legislation in 2013 prohibiting the distribution of information about LGBTQ matters and relationships to minors. The legislation, known as the “gay propaganda law,” specifies that any act or event that authorities believe promotes homosexuality to individuals under the age of 18 is a punishable felony. According to a 2018 report by the international rights organization Human Rights Watch, anti-LGBTQ violence in the country spiked after it passed. The bill perpetuates the state’s discriminatory ideology that LGBTQ individuals are a “danger” to traditional Russian family values.
A recent poll indicated that roughly one-fifth of Russians want to “eliminate” gay and lesbian individuals from society. In a poll conducted by the Russian LGBT Network — a Russian queer advocacy group — 56 percent of LGBTQ respondents said they had been subjected to psychological abuse, and disturbing reports of state-sanctioned detention and torture of gay and bisexual men in Chechnya, a semi-autonomous Russian region, have surfaced in recent years.
Considering this, it was no surprise that most of my gay friends refused to come on vacation with me to Russia. In our everyday, gay people don’t march around with a gay Pride flag so homophobic Russians would probably never be able to tell which tourists are gay. However, many LGBTQ people will never travel to Russia or any other homophobic country for one logical reason: Fear.
Unfortunately, many exotic locations abroad are dangerous territory for the LGBTQ community to be in. Physical safety isn’t guaranteed in countries like Nigeria, Iran, Brunei and Saudi Arabia where same-sex relationships are punishable by the death penalty. Not to mention the numerous transgender people who’ve been detained and refused entry to similar countries — even when it’s only been a layover! However, an alternative reason why someone may refuse to vacation in a homophobic country is having a conscience.
When you pay for accommodation, nights out and sightseeing tours, your money doesn’t just reach the hotel staff and waiters pockets — you’re also financially supporting that country’s government. Money talks so not giving homophobic countries tourism puts pressure on them. Ethically, why would anybody ever want to support a country through tourism that treats their LGBTQ community like dirt? Homophobia shouldn’t be shrugged off simply as a local “culture.”
Other LGBTQ people firmly embrace the right to go anywhere they choose, and that choosing to go gives them power. Homophobic countries still have closeted LGBTQ folks living there running underground gay spaces and groups. Is turning our back on the wonderful people and beautiful culture of a new place turning our back on their gay community too? There are countries where gay marriage is legal and trans rights are progressive, but abortion laws remain backwards. Do we boycott these countries too? And, how do we collectively define what a homophobic country is? Is legalizing gay marriage a requisite? Gay marriage is still illegal in Thailand when it is one of the most gay and trans-friendly countries in the world.
Increasingly the line of what is “right” and “wrong” erases all grey areas. Morality and activism — particularly when politics is involved — is never straightforward. The biggest surprise about Russia was how my own stereotypes I’d picked up from the media weren’t always true. Saint Petersburg in Russia is far more liberal and gay-friendly compared to rural Russia but the fact still stands that my bisexual friend and I actively chose to go to a homophobic country for pleasure. In an ideal world, anybody of any sexual orientation or gender identity would be able to vacation wherever they want but that’s sadly not reality. In the meantime, the wanderlust LGBTQ community will go on gay cruises that guarantee safe refuge or put civil rights and ideological differences aside to experience the world’s natural wonders and incredible cultures.
Ash Potter is a writer and radio host.
FDA approves injectable PrEP to reduce the risk of sexual HIV infection
Manufactured as Apretude, it will be available to at-risk adults & adolescents who weigh at least 77 pounds & have tested negative for HIV
SILVER SPRING, Md. – The U.S. Food and Drug Administration announced Monday that the agency had approved the first injectable treatment for pre-exposure prophylaxis (PrEP) to reduce the risk of sexually acquired HIV.
Manufactured under the name Apretude, it will be available to at-risk adults and adolescents who weigh at least 77 pounds and have tested negative for HIV immediately beforehand the agency said in a press release.
By granting its approval, the FDA opens up the option for patients to receive the injectable drug instead of a daily HIV prevention oral medication, such as Truvada.
“Today’s approval adds an important tool in the effort to end the HIV epidemic by providing the first option to prevent HIV that does not involve taking a daily pill,” said Debra Birnkrant, M.D., director of the Division of Antivirals in the FDA’s Center for Drug Evaluation and Research. “This injection, given every two months, will be critical to addressing the HIV epidemic in the U.S., including helping high-risk individuals and certain groups where adherence to daily medication has been a major challenge or not a realistic option.”
According to the U.S. Centers for Disease Control and Prevention, notable gains have been made in increasing PrEP use for HIV prevention in the U.S. and preliminary data show that in 2020, about 25% of the 1.2 million people for whom PrEP is recommended were prescribed it, compared to only about 3% in 2015.
However, there remains significant room for improvement. PrEP requires high levels of adherence to be effective and certain high-risk individuals and groups, such as young men who have sex with men, are less likely to adhere to daily medication.
Other interpersonal factors, such as substance use disorders, depression, poverty and efforts to conceal medication also can impact adherence. It is hoped that the availability of a long-acting injectable PrEP option will increase PrEP uptake and adherence in these groups.
The safety and efficacy of Apretude to reduce the risk of acquiring HIV were evaluated in two randomized, double-blind trials that compared Apretude to Truvada, a once daily oral medication for HIV PrEP.
Trial 1 included HIV-uninfected men and transgender women who have sex with men and have high-risk behavior for HIV infection. Trial 2 included uninfected cisgender women at risk of acquiring HIV.
Participants who took Apretude started the trial with cabotegravir (oral, 30 mg tablet) and a placebo daily for up to five weeks, followed by Apretude 600mg injection at months one and two, then every two months thereafter and a daily placebo tablet.
Participants who took Truvada started the trial taking oral Truvada and placebo daily for up to five weeks, followed by oral Truvada daily and placebo intramuscular injection at months one and two and every two months thereafter.
In Trial 2, 3,224 cisgender women received either Apretude or Truvada. The trial measured the rate of HIV infections in participants who took oral cabotegravir and injections of Apretude compared to those who took Truvada orally.
The trial showed participants who took Apretude had 90% less risk of getting infected with HIV when compared to participants who took Truvada.
Apretude includes a boxed warning to not use the drug unless a negative HIV test is confirmed. It must only be prescribed to individuals confirmed to be HIV-negative immediately prior to starting the drug and before each injection to reduce the risk of developing drug resistance.
Drug-resistant HIV variants have been identified in people with undiagnosed HIV when they use Apretude for HIV PrEeP. Individuals who become infected with HIV while receiving Apretude for PrEP must transition to a complete HIV treatment regimen.
The drug labeling also includes warnings and precautions regarding hypersensitivity reactions, hepatotoxicity (liver damage) and depressive disorders.
FDA slow in responding to calls for end to ban on MSM tissue donors
‘Scientific evidence does not support these restrictions’
As of early this week, the U.S. Food and Drug Administration had yet to respond to a Nov. 29 joint letter by 52 members of the U.S. House and U.S. Senate calling on the FDA to end its policy of restricting the donation of human tissues such as corneas, heart valves, skin, and other tissue by men who have sex with men, or MSM.
The letter is addressed to Acting FDA Commissioner Janet Woodcock and Department of Health and Human Services Secretary Xavier Becerra. The FDA is an agency within the HHS.
The letter says the FDA’s restrictions on MSM tissue donation date back to a 1994 U.S. Public Health Service “guidance” related to the possible transmission of HIV, which stated that any man “who has had sex with another man in the preceding five years” should be disqualified from tissue donation.
“We also call your attention to the broad consensus within the medical community indicating that the current scientific evidence does not support these restrictions,” the letter states. “We have welcomed the FDA’s recent steps in the right direction to address its discriminatory MSM blood donation policies and urge you to take similar actions to revise the agency’s tissue donation criteria to align with current science so as not to unfairly stigmatize gay and bisexual men.”
The letter adds, “In fact, a recent study in the medical journal JAMA Ophthalmology estimated that between 1,558 and 3,217 corneal donations are turned away annually from otherwise eligible donors who are disqualified because of their sexual orientation, an unacceptable figure given widespread shortages of transplantable corneas.”
The letter continues, saying, “FDA policy should be derived from the best available science, not historic bias and prejudice. As with blood donation, we believe that any deferral policies should be based on individualized risk assessment rather than a categorical, time-based deferral that perpetuates stigma.”
U.S. Sen. Tammy Baldwin (D-Wisc.), the nation’s only out lesbian U.S. senator, and U.S. Rep. Joe Neguse (D-Colo.) are the two lead signers of the letter. All 52 signers of the letter are Democrats.
Among the others who signed their names to the FDA letter are four of the nine openly gay or lesbian members of the U.S. House. They include Reps. David Cicilline (D-R.I.), Richie Torres (D-N.Y.), Mondaire Jones (D-N.Y.), and Mark Takano (D-Calif.).
Also signing the letter are D.C. Congressional Del. Eleanor Holmes Norton (D-D.C.), and Rep. Jamie Raskin (D-Md.).
In response to a Dec. 21 email inquiry from the Washington Blade, FDA Press Officer Abigail Capobianco sent the Blade a one-sentence statement saying, “The FDA will respond to the letter directly.”
The statement didn’t say to whom the FDA would respond or when it would issue its response.
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