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Study weighs use of HIV drug ‘before-after’ sex

Study weighs use of HIV drug ‘before-after’ sex

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Michael Weinstein, gay news, Washington Blade, PrEP, Truvada
Michael Weinstein, gay news, Washington Blade, PrEP, Truvada

Michael Weinstein, president of the AIDS Healthcare Foundation, said condom use is the best way for gay men to protect their sexual health. (Washington Blade file photo by Michael Key)

A study evaluating the effectiveness of limiting the dose of the pre-exposure HIV prophylaxis drug Truvada to between two and 24 hours before sex and for two days after sex showed that gay and bisexual men who followed this regimen reduced their risk of HIV infection by an average of 86 percent.

The findings of this and a separate study also yielding an 86 percent risk reduction rate for HIV by taking Truvada as a pre-exposure prophylaxis or PrEP on a daily basis were presented on Tuesday before the Conference on Retroviruses and Opportunistic Infections in Seattle.

“These findings together provide additional evidence of the power of PrEP to reduce the risk of HIV infection,” the U.S. Centers for Disease Control and Prevention said in a statement.

CDC officials expressed caution, however, that the first-of-its-kind study by researchers in France of a ‘before-and-after-sex” regimen of Truvada might be most effective for men who have frequent sexual encounters with multiple partners. Participants in the study, which was conducted in France and Canada, had a median of 10 sex acts per month and eight partners every two months, according to the CDC analysis.

With that many instances of sexual encounters, those participating in the study were taking PrEP on an average of three to four times per week, suggesting that a buildup of Truvada in their bodies gave them a level of protection closer to those taking PrEP on a daily basis.

“CDC cautions that researchers do not yet know if this regimen will work among MSM who have sex less frequently and would therefore be taking PrEP less often,” the CDC analysis says. “CDC continues to recommend daily dosing of PrEP and urges people at substantial risk for HIV infection and their health care providers to continue to follow current CDC guidelines.”

Those guidelines along with recommendations by other health experts call for MSM and others to continue to use condoms when engaging in sex, in part, because PrEP does not protect against other sexually transmitted diseases, including hepatitis.

The second study analyzed by the CDC consisted of gay and “other men who have sex with men” who were clients at sexual health clinics in England.

“Participants incorporated PrEP into existing risk reduction strategies, which included condom use,” says a write-up by organizers of the study, who have named the study PROUD. “There was no difference in the number of men diagnosed with other sexually transmitted infections between those on PrEP and those not on PrEP,” the write-up says.

That finding is considered significant because critics of PrEP have expressed concern that men taking PrEP would no longer be motivated to use condoms, placing them at risk of other sexually transmitted diseases.

A third study presented at the Seattle conference, which was conducted by CDC researchers and published in the Journal of the American Medical Association, used statistical modeling to show how the rate of new HIV infections would change if more people with HIV became virally suppressed through treatment.

“More than 90 percent of new HIV infections in the United States could be averted by diagnosing people living with HIV and ensuring they receive prompt, ongoing treatment,” a CDC statement says the study shows.

The statement says the study for the first time developed estimates of the number of HIV transmissions caused by people in different stages of care, including those who are unaware they are infected, those who are retained in care, and those who have their virus under control through treatment.

“By quantifying where HIV transmissions occur at each state of care, we can identify when and for whom prevention and treatment efforts will have the most impact,” said Jonathan Mermin, director of the CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention.

“We could prevent the vast majority of new infections tomorrow by improving the health of people living with HIV today,” he said.

“People who were successfully keeping the virus under control through treatment were 94 percent less likely than those who do not know they are infected to transmit their virus,” a CDC statement says the study shows. “However, previous national estimates have indicated that just 30 percent of people with HIV have reached this critical step in care.”

Michael Weinstein, president of the AIDS Healthcare Foundation, which has opposed the widespread use of PrEP, said his organization was reviewing the latest data from the new studies. He said the data he has seen so far show that the French study was limited to the most sexually active gay men.

“This is a small subset of the total gay male population and a far cry from the 500,000 men that the CDC recommended take the drug,” Weinstein said. He cited a recent study in San Francisco that found a 45 percent decrease in condom use among PrEP patients.

“Based on the currently available data consistent condom use is the best way for gay men to protect their sexual health,” he said.

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Commentary

Asian American and LGBTQ: A Heritage of Pride

May is Asian American, Native Hawaiian and Pacific Islander Heritage Month

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Glenn D. Magpantay (Photo courtesy of Glenn D. Magpantay)

Asian Americans and Pacific Islanders (APIs) are the nation’s fastest growing racial minority group by 2040, one in 10 Americans will be of Asian ancestry. And, while many Americans think that anti-Asian hate and racism towards Asian Americans has disappeared, the community disagrees.

The Asian American Foundation which found that Asian Americans are continually subjected to hate, violence, and discrimination, baldly reveals that disparity. 

  • 33 percent of Americans think hate towards Asian Americans has increased in the past year, compared to 61 percent of Asian Americans themselves.
  • In the past year, 32 percent of Asian Americans across the country reported being called a racial slur; 29 percent said they were verbally harassed or verbally abused.
  • Southeast Asian Americans report even higher incidences of being subject to racial slurs (40 percent), verbal harassment or abuse (38 percent), and threats of physical assault (22 percent).
  • Many Asian Americans live in a state of fear and anxiety with 41 percent of Asian American/ Native Hawaiian/Pacific Islander (AANHPI) believing they will likely be the victims of a physical attack due to their race, ethnicity, or religion. These numbers are disturbing.  

I serve as the only Asian American Pacific Islander member on the U.S. Commission on Civil Rights. And, I am the first and only queer AAPI on the U.S. commission. I am deeply honored to both serve my country and represent my Asian Americans and Pacific Islander community.    

Last year, the commission investigated the Federal Response to Anti-Asian Racism in the United States. With congressional authorization, the report documented the experiences of AANHPIs in the U.S. since the dubbing of COVID-19 as the “China Virus” infecting people with the “Kung Flu” by government leadership. Words matter, as this report shows.

This report has a deep personal connection for me. I am the survivor of a hate crime of 25 years ago for being gay, and the victim of a hate crime for being Asian 25 months ago 

The Stop AAPI Hate Coalition reported that bias incidents against individuals who are Asian and lesbian, gay, bisexual, transgender or queer (LGBTQ) were most prominent between 2019 and 2022, highlighting the intersectional nature of these incidents. For example, two transgender Asian women stated: 

“I was with my new boyfriend at a restaurant. When we walked in the server started calling me names … a b—h, ch—k, tra—i.e. … He said I have a big fat p—s, and told me to go back to China. Then my boyfriend proceeded to walk in the restaurant and when I took a step forward, the server hit me, so I left.” 

“Left a restaurant with friends in the Asian district of town. A man began to follow me calling out ‘Hey you f—got c—k!’ and ‘Come here you virus!’ I began to walk fast towards a crowd until he stopped following me.”

To address these and other equally appalling experiences, I helped shepherd the bipartisan Commission on Civil Rights recommendations to the president, Congress, and the nation that: 

  • Prosecutors and law enforcement should vigorously investigate and prosecute hate crimes and harassment against Asian Americans, as well as Asian Americans who are LGBTQ.
  • First responders should be trained to understand what exactly constitutes a hate crime in their jurisdiction, including the protections of LGBTQ people.
  • Federal, state, and local law enforcement and victim services should identify deficiencies in their programs for individuals with limited English proficiency

Greater language access will make an enormous impact for the Asian American community as one in five Asian individuals speak a language other than English at home. A third (34 percent) is limited English proficient. The most frequently spoken languages are Chinese, Korean, Vietnamese, Tagalog, Thai, Khmer, Bengali, Gujarati, Hindi, and Punjabi.   

For me, this report comes full circle. Since 1988, I’ve lobbied for passage of LGBTQ-inclusive federal and state laws to prevent hate crimes. Since 2001, I’ve supported South Asian and Muslim victims of post 9/11 violence. In response to the shootings at the Pulse nightclub in Orlando, Fla, in 2016; Atlanta Spa in Georgia in 2021; and Club Q in Colorado Springs, Colo., in 2022, I‘ve trained over 3,000 lawyers, law students, and community leaders on hate crimes law.  

And yet, our work is not yet done. 

May is Asian Pacific American Heritage Month. June is LGBTQ Pride Month. Despite these challenges, we are resilient. Let us join together in celebrating our Heritage of Pride 

Glenn D. Magpantay, Esq., is a long-time civil rights attorney, professor of law and Asian American Studies, and LGBTQ rights activist. Glenn is a founder and former Executive Director of the National Queer Asian Pacific Islander Alliance (NQAPIA). He is principal at Magpantay & Associates: A nonprofit consulting and legal services firm. In 2023, the U.S. Senate (majority) appointed Glenn to the U.S. Commission on Civil Rights to advise Congress and the White House on the enforcement of civil rights laws and development of national civil rights policy. 

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Health

CDC issues warning on new ‘deadlier strain’ of mpox

WHO says epidemic is escalating in Congo

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JYNNEOS mpox vaccine (Photo courtesy of the CDC)

The Centers for Disease Control and Prevention has issued a health advisory regarding a deadlier strain of the Mpox virus outbreak which is currently impacting the Democratic Republic of Congo.

According to the CDC, since January 2023, DRC has reported more than 19,000 suspect mpox cases and more than 900 deaths. The CDC stated that the overall risk to the U.S. posed by the clade I mpox outbreak is low.

The risk to gay, bisexual, and other men who have sex with men who have more than one sexual partner and people who have sex with men, regardless of gender, is assessed as low to moderate the agency stated.

While no cases of that subtype have been identified outside sub-Saharan Africa so far, the World Health Organization said earlier this week that the escalating epidemic in Congo nevertheless poses a global threat, just as infections in Nigeria set off the 2022 outbreak according to a WHO spokesperson.

The spokesperson also noted that as Pride Month and events happen globally, there is more need for greater caution and people to take steps at prevention including being vaccinated.

The CDC advises that while there are no changes to the overall risk assessment, people in the U.S. who have already had mpox or are fully vaccinated should be protected against the type of mpox spreading in DRC. Casual contact, such as might occur during travel, is not likely to cause the disease to spread. The best protection against mpox is two doses of the JYNNEOS vaccine.

The CDC also noted the risk might change as more information becomes available, or if cases appear outside DRC or other African countries where clade I exists naturally.

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Commentary

Journalists are not the enemy

Wednesday marks five years since Blade reporter detained in Cuba

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The Hungarian Parliament in Budapest, Hungary, on April 4, 2024. Prime Minister Viktor Orbán and his government over the last decade has cracked down on the country's independent media. (Washington Blade photo by Michael K. Lavers)

Wednesday marked five years since the Cuban government detained me at Havana’s José Marti International Airport.

I had tried to enter the country in order to continue the Washington Blade’s coverage of LGBTQ and intersex Cubans. I found myself instead unable to leave the customs hall until an airport employee escorted me onto an American Airlines flight back to Miami.

This unfortunate encounter with the Cuban regime made national news. The State Department also noted it in its 2020 human rights report.

Press freedom and a journalist’s ability to do their job without persecution have always been important to me. They became even more personal to me on May 8, 2019, when the Cuban government for whatever reason decided not to allow me into the country.  

Washington Blade International News Editor Michael K. Lavers after the Cuban government detained him at Havana’s José Marti International Airport on May 8, 2019. (Washington Blade photo by Michael K. Lavers)

‘A free press matters now more than ever’

Journalists in the U.S. and around the world on May 3 marked World Press Freedom Day.

Reporters without Borders in its 2024 World Press Freedom Index notes that in Cuba “arrests, arbitrary detentions, threats of imprisonment, persecution and harassment, illegal raids on homes, confiscation, and destruction of equipment — all this awaits journalists who do not toe the Cuban Communist Party line.” 

“The authorities also control foreign journalists’ coverage by granting accreditation selectively, and by expelling those considered ‘too negative’ about the government,” adds Reporters without Borders.

Cuba is certainly not the only country in which journalists face persecution or even death while doing their jobs.

• Reporters without Borders notes “more than 100 Palestinian reporters have been killed by the Israel Defense Forces, including at least 22 in the course of their work” in the Gaza Strip since Hamas launched its surprise attack against Israel on Oct. 7, 2023. Media groups have also criticized the Israeli government’s decision earlier this month to close Al Jazeera’s offices in the country.

• Wall Street Journal reporter Evan Gershkovich, Washington Post contributor and Russian opposition figure Vladimir Kara-Murza and Radio Free Europe/Radio Liberty’s Alsu Kurmasheva remain in Russian custody. Austin Tice, a freelance journalist who contributes to the Post, was kidnapped in Syria in August 2012.

• Reporters without Borders indicates nearly 150 journalists have been murdered in Mexico since 2000, and 28 others have disappeared.

The Nahal Oz border crossing between Israel and the Gaza Strip on Nov. 21, 2016. Reporters without Borders notes the Israel Defense Forces have killed more than 100 Palestinian reporters in the enclave since Hamas launched its surprise attack against Israel on Oct. 7, 2023. (Washington Blade photo by Michael K. Lavers)

Secretary of State Antony Blinken in his World Press Freedom Day notes more journalists were killed in 2023 “than in any year in recent memory.”

“Authoritarian governments and non-state actors continue to use disinformation and propaganda to undermine social discourse and impede journalists’ efforts to inform the public, hold governments accountable, and bring the truth to light,” he said. “Governments that fear truthful reporting have proved willing to target individual journalists, including through the misuse of commercial spyware and other surveillance technologies.”

U.S. Agency for International Development Administrator Samantha Power, who is a former journalist, in her World Press Freedom Day statement noted journalists “are more essential than ever to safeguarding democratic values.” 

“From those employed by international media organizations to those working for local newspapers, courageous journalists all over the world help shine a light on corruption, encourage civic engagement, and hold governments accountable,” she said.

President Joe Biden echoed these points when he spoke at the White House Correspondents’ Association Dinner here in D.C. on April. 27.

“There are some who call you the ‘enemy of the people,'” he said. “That’s wrong, and it’s dangerous. You literally risk your lives doing your job.”

I wrote in last year’s World Press Freedom Day op-ed that the “rhetoric — ‘fake news’ and journalists are the ‘enemy of the people’ — that the previous president and his followers continue to use in order to advance an agenda based on transphobia, homophobia, misogyny, islamophobia, and white supremacy has placed American journalists at increased risk.” I also wrote the “current reality in which we media professionals are working should not be the case in a country that has enshrined a free press in its constitution.”

“A free press matters now more than ever,” I concluded.

That sentiment is even more important today.

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