Obstacles to ‘test and treat’

A study conducted in Zambia has given an idea of some of the obstacles facing test-and-treat strategies.

It involved 2443 patients recruited at HIV clinics and community organisations.

Reasons people gave for not testing included a fear of ostracism and stigma, as well as concerns about antiretroviral therapy. These included worries about side-effects and the difficulties of adherence.

There were a number of other reasons why people didn’t want to take antiretroviral therapy.

These included:

• The fact that they were feeling well.

• Trust in religious beliefs.

• Use of traditional therapies.

• Distrust of the efficacy of HIV therapy.

• Lack of support.

• Financial concerns.

• Limited access to HIV care.

HIV epidemic in black men who have sex with men

Researchers believe that the high levels of HIV infection among black men who have sex with men (MSM) in the US aren’t simply due to factors such as risky sex, number of sexual partners and drug use.

Studies consistently show very high rates of HIV infection among black MSM in the US. Investigators wanted to get a clearer understanding of the reasons. They therefore reviewed the results of 174 studies addressing this issue.

This meta-analysis showed that black men actually reported fewer HIV risk behaviours, including sex without a condom, than other ethnic groups. Black men also had fewer sex partners and were less likely to report the use of drugs.

However, the investigators found that black men had lower levels of education attainment and were also more likely to be living in relative poverty.

They believe that these social and economic factors mean that black men are more likely to be isolated within their communities, where there is a very high prevalence of HIV.

The meta-analysis also showed that black people with HIV had much lower levels of engagement with HIV care than individuals in other ethnic groups.

Life expectancy in South Africa

Life expectancy has increased dramatically with the introduction of effective HIV treatment, but the impact has varied in different parts of the world.

Life expectancy in rural Kwazulu-Natal, South Africa, has increased dramatically with the roll out of antiretroviral (HIV) therapy.

The province has a high HIV prevalence (28%).

Investigators measured life expectancy at a population level between 2000 and 2011. Between 2000 and 2003, life expectancy fell from 59 to 52 years.

A programme rolling out antiretroviral therapy started in 2003. By 2011, average life expectancy had increased to 60 years.

Treatment as prevention – ‘population viral load’

A ‘test-and-treat’ strategy in rural Uganda is having a big impact on ‘population viral load’. This is a monitoring tool that looks at different measures of viral load and related factors across a whole population.

Increased emphasis is being placed on the role of diagnosis of HIV, through HIV testing, in efforts to control the epidemic. This is central to the implementation of HIV treatment as prevention.

Testing campaigns were conducted in part of rural Uganda in May 2011 and again in May 2012.

Approximately three-quarters of adults in the area were screened in both campaigns. Approximately 8% of participants were diagnosed with HIV in 2011 and 9% in 2012.

The testing campaigns were accompanied by a big increase in the proportion of HIV-positive people with an undetectable viral load (from 37 to 55%).

There was also a substantial fall in the proportion of people who had a very high viral load, above 100,000 (from 13 to 3%).

The results of the study show that increasing testing and the use of treatment can quickly reduce the proportion of people with infectious levels of HIV.

Transforming PMTCT programmes into ARV programmes

Chewe Luo of UNICEF speaking the Wednesday plenary session. 

© IAS/Ryan Rayburn - Commercialimage.net

UNICEF has expressed its support for the provision of lifelong, potent HIV therapy to all pregnant women, regardless of their CD4 cell count.

UNICEF is emphasising the benefits of an emerging model for prevention of mother-to-child transmission of HIV. The World Health Organization’s ‘Option B+’ approach removes the use of a CD4 count threshold for eligibility for lifelong treatment, rather than just treatment during pregnancy and immediately after the birth.UNICEF's Executive Director Anthony Lake has endorsed this approach: “Of course every woman wants her baby to live, but every woman wants to live, and who should deny that right?”

In keeping with the conference theme of affordability and financing of initiatives, it was pointed out that – although Option B+ is more expensive than WHO’s other models – savings will be made with reduced transmission to male partners, and to babies in current and any future pregnancies.

Home testing for HIV

Earlier this month (July 2012), the US Food and Drug Administration approved the first HIV test for home testing.
The OraQuick In-Home HIV Test will be sold over the counter and used without medical supervision. Other countries may follow suit. While the approval has been welcomed by many people, there are lots of questions about how it will be used and what it might mean in practice.
One of these questions was whether people would use the test to screen sexual partners. The findings of research into this were presented at AIDS 2012 on Tuesday, to great interest.
The study involved 27 HIV-negative MSM who had more than one partner. Of the people who were asked to take a test, 101 out of 124 agreed. Nine people were reported as testing positive, of whom five did not know their status already.
Few problems were reported with using the test, and the study concludes its use is highly acceptable amongst high-risk MSM.

Participants in the session raised other questions about the test’s use, such as the implications of the window period, and the test’s impact on levels of other safer sex practices – as well as how it might work in negotiations between men and women.

Telling people about HIV

Research conducted in South Africa shows that the vast majority of people with HIV tell their family about their status, but that disclosure to sexual partners was much less common.

The study involved approximately 700 participants, most of whom (73%) were women. Sixty per cent were on HIV treatment.

The likelihood of disclosure to family members differed by sex and by the use of HIV treatment.

Some 70% of women not on HIV therapy had disclosed to a family member, as had 93% of women taking HIV treatment. Rates of disclosure were lower for men (54% of those not on therapy; 77% of men taking treatment).

Disclosure to sexual partners was much less common. In comparison, about a quarter of women disclosed, as did 45% of men. Being on treatment or not didn’t make the same difference to disclosure rates.

People more recently diagnosed seem to find it easier to disclose their HIV status.