Health
Study weighs use of HIV drug ‘before-after’ sex
Study weighs use of HIV drug ‘before-after’ sex
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.
Health
MISTR announces it’s now prescribing DoxyPE
MISTR, the telemedicine provider that offers free online PrEP and long-term HIV care in all 50 states, D.C., and Puerto Rico, announced it is now prescribing Doxycycline Post-Exposure Prophylaxis (DoxyPEP), an antibiotic that reduces bacterial STIs, including gonorrhea, chlamydia, and syphilis. Patients can now use MISTR’s telehealth platform to receive DoxyPEP online for free, according to a release from the company.
With this launch, MISTR plans to offer patients access to post-exposure care, in addition to its existing preventive and long-term HIV treatment options, which include PrEP and antiretroviral therapy (ART). This comes at a time when the rate of STIs continue to rise. In 2022, more than 2.5 million cases of syphilis, gonorrhea, and chlamydia were reported in the U.S; of that population, gay and bisexual men are disproportionately affected, the company reported.
“Despite an ongoing STI epidemic affecting the LGBTQ+ community, there are few resources available for this underserved, vulnerable community to get the preventative medication they need,” said Tristan Schukraft, CEO and founder of MISTR. “I’m proud that MISTR is democratizing access to PrEP, HIV care, and now DoxyPEP.”
An NIH-funded study published by the New England Journal of Medicine in April 2023 found that doxycycline as post-exposure prophylaxis, now known as DoxyPEP, reduced syphilis by 87%, chlamydia by 88%, and gonorrhea by 55% in individuals taking HIV PrEP, and reduced syphilis by 77%, chlamydia by 74% and gonorrhea by 57% in people living with HIV.
MISTR is a telemedicine platform offering free online access to pre-exposure prophylaxis (PrEP) and long-term HIV care Visit mistr.com for more information.
Health
UNAIDS to commemorate Zero Discrimination Day’s 10th anniversary
UN agency urges global action to protect human rights
As the world marks the 10th anniversary of Zero Discrimination Day; UNAIDS is sounding the alarm on the increasing threats to human rights, calling for renewed efforts to protect the rights of all individuals as a fundamental step towards ensuring health for everyone.
Established by UNAIDS a decade ago, Zero Discrimination Day aims to promote equality and fairness regardless of gender, age, sexuality, ethnicity or HIV status. The progress achieved over the past years is now in jeopardy, however, due to rising attacks on the rights of women, LGBTQ people and other marginalized communities.
UNAIDS Executive Director Winnie Byanyima emphasized the critical link between protecting human rights and safeguarding public health.
“The attacks on rights are a threat to freedom and democracy and are harmful to health,” she said in a press release. “Stigma and discrimination obstruct HIV prevention, testing, treatment and care and hold back progress towards ending AIDS by 2030. It is only by protecting everyone’s rights that we can protect everyone’s health.”
Despite challenges, there has been notable progress.
At the onset of the AIDS pandemic more than 40 years ago, two-thirds of countries criminalized consensual same-sex sexual relations. They are now decriminalized in two-thirds of countries. An additional 38 countries around the world have pledged to end HIV-related stigma and discrimination, contributing to positive changes that include 50 million more girls attending school compared to 2015.
To sustain and enhance these advancements; UNAIDS urges global support for women’s rights movements, LGBTQ rights, racial justice, economic justice, climate justice and peace initiatives. By standing with communities advocating for their rights, the U.N. aims to reinforce the collective effort towards a more inclusive and equitable world.
Zero Discrimination Day is observed on March 1.
Events and activities that will take place around the world throughout the month will serve as reminders of the essential lesson and call to action: Protecting everyone’s health is synonymous with protecting everyone’s rights.
“Through upholding rights for all, we will be able to achieve the Sustainable Development Goals and secure a safer, fairer, kinder and happier world — for everyone,” said Byanyima.
Health
New CDC report finds transgender women at higher risk for HIV
More than 1,600 people in seven cities surveyed
The Centers for Disease Control and Prevention issued a new study report this week that revealed that restricted by employment and housing discrimination and lack of access to needed gender-affirming healthcare for transgender women increasing the risk of contracting HIV.
Researchers reviewed data from a 2019-2020 survey, the National HIV Behavioral Surveillance Among Transgender Women, which found that the demographics of HIV/AIDS have been disproportionally high, especially among Black and Latina trans women, who had experienced employment and housing discrimination coupled with lack of access to gender-affirming healthcare.
The Jan. 25 Morbidity and Mortality Weekly Report was based on data studies of more than 1,600 trans women in seven major urban locales. Participants from Atlanta, Los Angeles, New Orleans, New York, Philadelphia, San Francisco and Seattle were chosen by referrals from people and community-based organizations who knew or were part of the local population of trans women.
The study’s researchers noted: “Employment discrimination occurs at the overlapping nexus of poverty, homelessness, incarceration, health insurance, disability, food insecurity and survival sex work. These issues are interconnected.”
The study stated that trans women’s inability to access quality healthcare, including gender-affirming treatment or access to PrEP, and can expose them to potential incarceration as many turn to “survival sex work” and violence, which increases the risk of contracting HIV.
The study’s author’s pointed out: “When economically marginalized transgender women are refused employment, this refusal cyclically contributes to economic hardships. This analysis …demonstrates the importance of transgender women working and living with dignity and without fear of unfair treatment.”
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