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AIDS sufferers give up meds in bleak gay culture

Hopelessness leads to skyrocketing HIV rates in Indonesia

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Indonesian HIV infection rates, gay news, Washington Blade

Jakarta, Indonesia (Photo by Global Panorama via Flickr)

JAKARTA, Indonesia — Pernicious HIV-infection rates among gay men here that have skyrocketed in the last decade-plus amid police raids and vicious anti-gay rhetoric from officials and influential figures have created a stultifying culture for gay life so bad that some gay men with AIDS purposefully stop taking their medication because conditions are so bleak, the Associated Press reports. 

According to the United Nations, HIV affects more than a quarter of Indonesian men who have sex with men, up from just 5 percent in 2007, the AP reports. In Jakarta and the capital of Bali province Denpasar, the rate is one in three.

Many are not tested until they exhibit symptoms of illness and by then their immune systems have been compromised. Few are on antiretroviral medication.

Irregular condom use and lack of testing are lacking, officials told the AP.

Many of the outreach workers interviewed by the rights group reported “substantial and unprecedented negative impacts on their ability to contact and counsel” gay and bisexual men, the report said.

In Jakarta, raided venues such as saunas and clubs that were among the so-called “hotspots” for health workers to make contact with gay men closed.

“The remaining locations are getting harder and harder to work at,” said a health worker interviewed by Human Rights Watch. “Fewer and fewer guys agree to get tested or take condoms each time.”

Laura Nevendorff, a researcher at the HIV Research Center at Atma Jaya Catholic University, said the police practice of using condoms as evidence against gay men has had a pernicious ripple effect, turning the crucial rubber safeguard into possible grounds for criminal prosecution, the AP reports. 

Though deeply frowned upon, homosexuality is not illegal in Indonesia. Police have used an anti-pornography law to prosecute gay men.

Because of conservative morality in the world’s most populous Muslim nation and the intense LGBT backlash, Indonesia’s HIV prevention strategy does not openly target gay or bisexual men, who along with injecting drug users, female sex workers and transgender people are the high-risk groups in the Indonesian epidemic, the AP reports. 

Instead, overtaxed nongovernment organizations are trying to fill the gulf in a climate hostile to their work, the AP reports.

About nine percent of Thai gay and bisexual men have the HIV virus, compared with 26 percent in Indonesia, according to U.N. data. More than 90 percent of the people estimated to have HIV in Thailand have been tested and know their result, compared with only one in three in Indonesia, the AP article notes. 

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PEPFAR marks 20th anniversary

Achievements applauded throughout the advocacy community

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Then-President George W. Bush signing PEPFAR’s authorizing legislation on Jan. 28, 2003. (Photo courtesy of George W. Bush Presidential Center)

The President’s Emergency Plan for AIDS Relief marks its 20th anniversary Saturday, marking the largest commitment by any nation to address a single disease in the world.

The initiative which was personally led and launched by former President George W. Bush in 2003,  its funding has totaled more than $110 billion to date, including funding for the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund), to which the U.S. government is the largest donor.

PEPFAR is credited with saving millions of lives and helping to change the trajectory of the global HIV epidemic. The White House today released a statement by President Joe Biden marking the 20th anniversary:

“20 years ago today, President George W. Bush declared that preventing and treating HIV/AIDS was a foreign policy priority of the United States. At a time when nearly 30 million people were HIV positive, but very few were receiving life-saving medicines, the President’s Emergency Plan for AIDS Relief (PEPFAR) transformed the global AIDS response and laid a marker for America’s commitment to countries that were impacted the hardest by the AIDS epidemic. Helping lead the bipartisan effort in Congress to authorize PEPFAR is among my proudest achievements from my time in the Senate. To this day, PEPFAR remains a powerful example of America’s unmatched ability to drive progress and make life better for people around the world.
 
Since 2003, PEPFAR has saved more than 25 million lives and dramatically improved health outcomes in more than 55 partner countries. AIDS-related deaths have declined by 68 percent since their peak in 2004, and new HIV infections are down 42 percent. PEPFAR investments have ensured that 5.5 million babies have been born HIV-free. And two decades of investment in partner nations’ health systems played a critical role in countries’ ability to respond to other health crises such as COVID-19, Mpox, and Ebola.    
 
Today, PEPFAR continues to support 20.1 million people around the world with HIV/AIDS treatment, and my administration is committed to continuing to lead the global HIV/AIDS response. We will build on our decades of progress to reach the Sustainable Development Goal of ending AIDS by 2030, work to eliminate the stigma and inequities that keep people from accessing care, and keep the voices of people living with HIV/AIDS at the center of our response. I look forward to working with Congress on PEPFAR’s reauthorization this year.”

PEPFAR is overseen by the U.S. Global AIDS Coordinator, who is appointed by the president, confirmed by the Senate, and reports directly to the secretary of state, as established through PEPFAR’s authorizing legislation.

PEPFAR’s original authorization established new structures and authorities, consolidating all U.S. bilateral and multilateral activities and funding for global HIV/AIDS. Several U.S. agencies, host country governments and other organizations are involved in implementation.

Dr. John Nkengasong, the current coordinator was sworn in on June 13, 2022, and holds the rank of ambassador leading the Office of the Global AIDS Coordinator at the State Department.

Nobel Prize winning scientist Harold Varmus, who served as director of the National Institutes of Health from 1993-1999 and currently the Lewis Thomas University Professor of Medicine at Weill Cornell Medicine in New York, wrote in an article honoring World Aids Day 2013:

[…] “the PEPFAR story must begin with George W. Bush and his wife, Laura, and their interests in AIDS, Africa, and what Bush termed “compassionate conservatism.” According to his 2010 memoir, “Decision Points,” the two of them developed a serious interest in improving the fate of the people of Africa after reading Alex Haley’s “Roots” and visiting the Gambia in 1990. In 1998, while pondering a run for the U.S. presidency, he discussed Africa with Condoleezza Rice, his future secretary of state; she said that, if elected, working more closely with countries on that continent should be a significant part of his foreign policy. She also told him that HIV/AIDS was a central problem in Africa but that the United States was spending only $500 million per year on global AIDS, with the money spread across six federal agencies, without a clear strategy for curbing the epidemic.”

Key Facts (As provided by Kaiser Health and Family Foundation)

  • Although the U.S. has been involved in efforts to address the global AIDS crisis since the mid-1980s, the creation of PEPFAR in 2003 marked a significant increase in funding and attention to the epidemic.
  • PEPFAR is the largest commitment by any nation to address a single disease in the world; to date, its funding has totaled more than $110 billion, including funding for the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund), to which the U.S. government is the largest donor. PEPFAR is credited with saving millions of lives and helping to change the trajectory of the global HIV epidemic.
  • U.S. funding for PEPFAR grew from $2.2 billion in FY 2004 to $7.0 billion in FY 2022; FY 2022 funding includes $5.4 billion provided for bilateral HIV efforts and $1.6 billion for multilateral efforts ($50 million for UNAIDS and $1.56 billion for the Global Fund.)
  • As the COVID-19 pandemic continues to have profound effects across the world, PEPFAR has acted to respond to COVID-19 in countries that receive support in order to minimize HIV service disruptions and leverage the program’s capabilities to address COVID-19 more broadly.
  • Looking ahead, PEPFAR faces several issues and challenges, including how best to: address the short- and long-term impacts of COVID-19 on PEPFAR and the HIV response; accelerate progress toward epidemic control in the context of flat funding; support and strengthen community-led responses and the sustainability of HIV programs; define its role in global health security and broader health systems strengthening efforts; and continue to coordinate with other key players in the HIV ecosystem, including the Global Fund.

Key Activities and Results (As provided by Kaiser Health and Family Foundation)

PEPFAR activities focus on expanding access to HIV prevention, treatment and care interventions. These include provision of antiretroviral treatment, pre-exposure prophylaxis (PrEP), voluntary male circumcision, condoms and other commodities related to HIV services. In addition, PEPFAR has launched specific initiatives in key strategic areas. For example, in 2015, PEPFAR launched DREAMS, a public-private partnership that aims to reduce HIV infections in adolescent girls and young women.

The latest results reported by PEPFAR indicate that it has:

  • Supported testing services for 63.4 million people in FY 2021;
  • Prevented 2.8 million babies from being born with HIV, who would have otherwise been infected;
  • Provided care for more than 7.1 million orphans and vulnerable children;
  • Supported training for nearly 300,000 new health care workers; and
  • Supported antiretroviral treatment for 18.96 million people.
  • In the 15 countries implementing the DREAMS initiative, new diagnoses among adolescent girls and young women have declined with most DREAMS areas (96 percent) experiencing declines greater than 25 percent and nearly two-thirds with declines greater than 40 percent.

The achievements of the PEPFAR program have been remarkable, well-documented by outside evaluators, and hugely applauded throughout the advocacy community and the developing world. In general, milestones have been met, the program has been enlarged (for instance, to include some research on implementation of medical assistance), the roster of PEPFAR countries has grown and spending plans have not been exceeded.

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FDA guidance eases blood donation restrictions for gay, bi men

Sen. Tammy Baldwin, Congressional LGBTQ+ Equality Caucus, LGBTQ groups celebrate new FDA proposal

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FDA headquarters (Public domain photo.)

The U.S. Food and Drug Administration (FDA) introduced a proposed change to its blood donation guidelines on Friday that would ease restrictions for gay and bisexual men.

The FDA notes the proposal, news of which was first reported in November, would bring U.S. policies in alignment with those in place in countries like the U.K. and Canada. The agency is expected to formally adopt the new guidelines after a public comment period.

The move follows criticism from LGBTQ groups and organizations like the American Medical Association (AMA) that have long argued the current policy is homophobic and based on an outdated understanding of the risks associated with blood donation by men who have sex with men.

As the AMA wrote of the current policy: “a man who has protected sex with another man in the three months prior to a blood donation cannot be a donor, but a man or woman who has unprotected sex with multiple partners of the opposite sex over the same time period remains eligible.”

The FDA’s proposal would lift the mandatory three-month deferral period for some men who have sex with men and instead use a “gender-inclusive, individual risk-based questions relevant to HIV risk.”

Potential donors would be asked for information about their sexual history over the past three months. Respondents who indicate they have had sex with one or more new sexual partners would then be asked whether they have had anal sex during this period. Those who answer “yes” would be deferred from blood donation.

Axios noted that as of this morning, about 20 percent of the country’s community blood centers have a one-day supply or less, while the FDA’s broadened eligibility criteria would increase the annual blood supply by two to four percent, citing data from America’s Blood Centers’ daily tracker and the Williams Institute.

U.S. Sen. Tammy Baldwin (D-Wis.) issued a statement celebrating the FDA’s proposal. “As I have long advocated for, this blood donation policy takes a step forward and is better rooted in the most up-to-date science with a focus on individual risk factors, not outdated stigmas that effectively ban gay and bisexual men,” she said.

Baldwin has repeatedly urged the agency to revisit its blood donation policy over the years, including by corralling support from other members of Congress to cosign letters to the FDA in 2014 and 2016, raising the issue again in 2020 as the COVID-19 pandemic exacerbated shortages in the blood supply.

The Congressional LGBTQ+ Equality Caucus also acknowledged the move in a statement by its chair, Rep. Mark Pocan (D-Wis.): “I am glad the FDA is finally moving toward an individual risk-based assessment model, but recognize, based on existing reporting, that many LGBTQI+ people may still be barred from donating,” he said. “I look forward to taking a closer look at the proposed guidelines once they are published and working with the FDA to ensure that any unnecessary barriers are removed.”

Several LGBTQ groups also issued statements celebrating the FDA’s new guidance.

“These changes are 40-plus years in the making, and are a tremendous leap forward toward elevating science over stigma,” said GLAAD President Sarah Kate Ellis. “GLAAD and leading medical experts have long been advocating for guidelines that see and treat LGBTQ people the same as any other person, including as potential donors who want to help others.”

“This new policy removes a decades-long barrier for many in our community – and there is more to do to ensure gay, bisexual and transgender people are no longer unfairly stigmatized when they try to donate blood,” Human Rights Campaign President Kelley Robinson said. “The assessment criteria have flaws, focusing excessively, for instance, on the number of partners a potential donor has instead of just on new partners,” she added.

Carl Schmid, executive director of the HIV+ Hepatitis Policy Institute, said: “While this long-overdue change is being made based on the science and the facts, which have been clear for years, it is the result of the leadership of the Biden administration that continues to tear down discriminatory government policies.”

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Global HIV vaccine trial ends in disappointment

Experimental vaccine called safe but ineffective

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A worldwide trial of an experimental HIV vaccine involving 3,900 volunteers resulted in disappointment. (Image of HIV courtesy of the NIH)

A worldwide clinical trial of an experimental HIV vaccine involving 3,900 volunteer men who have sex with men and transgender people that some researchers were hopeful would finally result in an effective HIV vaccine was found to be safe but ineffective in preventing HIV infection.

According to a Jan. 18 statement released by the U.S. National Institute of Allergy and Infectious Diseases, which partially funded and helped organize the trial, the vaccine trial is being discontinued and participants were being notified of the findings, with further analysis of the study data planned.

The NIAID statement says the Janssen pharmaceutical company developed the experimental vaccine based on what researchers call “mosaic” immunogens or vaccine components featuring elements of multiple HIV subtypes. It says the goal was to induce immune responses against a wide variety of global HIV strains.

The statement says the investigational vaccine regimen consisted of four injections over a period of one year for the volunteers, who were based in the U.S., Latin America, and Europe. It says an independent data and safety monitoring board, referred to as DSMB, analyzed the data obtained from the vaccine trial, which began in 2019.

“In its scheduled data review, the DSMB determined there were no safety issues with the experimental vaccine regimen,” the statement says. “However, the number of HIV infections were equivalent between the vaccine and placebo arms of the study,” the statement continues. “During the clinical trial, all participants were offered comprehensive HIV prevention tools, including pre-exposure prophylaxis or PrEP,” it says.

“Study staff ensured that participants who acquired HIV during the trial were promptly referred for medical care and treatment,” according to the NIAID statement.

The NIAID study findings prompted the United Nations Program on HIV/AIDS, known as UNAIDS, to issue its own statement this week calling for the aggressive deployment of existing HIV prevention and treatment options as efforts to develop a vaccine continue.

“The disappointment of the vaccine trial further underlies the importance of rolling out available HIV treatment and prevention innovations, including oral PrEP, long acting injectables and the vaginal ring,” UNAIDS Executive Director Winnie Byanyima said in the UNAIDS statement.

“The research for a vaccine must continue, but it’s important to remember that despite this setback the world can still end AIDS by 2030 by delivering all the proven prevention and treatment options to all people who need them,” she said.

“Global research efforts into vaccines and a cure must carry on,” the UNAIDS statement says. “At the same time, the world cannot wait for, or depend on, a vaccine or cure. The end of AIDS by 2030, as promised, is still possible, but leaders have no time to wait.”

An organization called the Global Advocacy for HIV Prevention, which keeps track of HIV vaccine studies, shows on its website that at least a dozen other HIV experimental vaccine trials are currently taking place in the U.S., Latin American, Europe, and Africa. Two of them in the U.S. are being sponsored by the Bill and Melinda Gates Foundation, the website shows.

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