buggery.org

From Aidsmap:

The western Canadian province of British Columbia will implement a new, aggressive strategy to expand antiretroviral coverage in order to curb new HIV infections, B.C.’s health minister, George Abbott, announced today. The new policy is based on a mathematical model from the B.C. Centre for Excellence in HIV/AIDS, published in the July 1st edition of the Journal of Infectious Diseases, and when implemented as early as this autumn, will be the first time that anti-HIV treatment has officially been used as an HIV prevention tool.

This will be a keenly-watched experiment. Coming on top of the Swiss Statement I’ve been writing and speaking about, the decision of the BC government to try to increase antiretroviral uptake represents a gradual but significant shift in our understanding of the relationship between HIV treatment, testing and prevention.

According to the Aidsmap story, BC is thought to have about 15,000 people living with HIV, of whom 27% are thought to be unaware of their infection, and just 4379 people are on treatment. That means the success of this strategy will depend somewhat on getting people tested, diagnosed and on treatment. This will be a significant challenge and will require some tough decisions, but it’s a worthwhile exercise and, if Julio Montagner’s mathematical model (which predicts that the HIV epidemic in BC would be ‘wiped out’ within 30-50 years if treatment uptake were maximised) is right, this could represent a major turning point in the response to HIV.

It’s worth stressing that the proposed approach is to offer antiretroviral treatment to all positive people with a CD4 count of 350 or below — the ‘standard’ approach to HIV treatment in western countries — and no-one will b obligated to start treatment if they don’t want to. There will need to be some serious work done on providing social, emotional and mental health support for many of the affected people, which I suppose would include a higher-than-normal proportion of drug users, indigenous people and other marginalised groups. Apparently there is talk of “paying [some] individuals to take their treatment as prescribed” — I suppose that’s a reasonable strategy but I hope they’ll also be offered the education, support and assistance they need, not just a bribe.

Please, Santa, I want an AIDS ring for Christmas…

Dontcha just love the way they highlighted the gp41 surface proteins in those darling little blue sapphires, and the single strand of RNA rubies is just gorgeous.

It certainly gives a whole new meaning to the expression “to die for”.

Link (via Boing Boing)

Here’s the presentation I gave last week to the AFAO HIV Educator’s Conference on the ‘Swiss Statement’ and our response to it.

The ‘Swiss Statement’ is the controversial position taken by a group of Swiss HIV clinicians who argue that HIV-positive people with completely suppressed viraemia (undetectable viral load) are essentially incapable of transmitting HIV sexually. It’s been the cause of some heated debate, as you’d imagine. I was asked to give this paper after presenting a similar argument to an ASHM event last month.

In a nutshell, my argument is that the Swiss Statement presents opportunities for HIV health promotion by emphasising the relevance of testing, treatments uptake, virological control and STI management as HIV prevention measures. I also argue that gay men are particularly adept at integrating complex scientific research into their sexual practice, and we should have faith in the capacity of that process to work in relation to this issue as it has in the past.

The paper was pretty well received at the conference, if a bit controversial. And of course my slides were a hit.

The Swiss Statement, gay men and safe sexual cultures: turning challenges into opportunities

Posting has been slow recently (I’m busy, dammit!) so here’s a bit of viral video for your amusement

A panel of Swiss HIV experts have declared that HIV-positive people with undetectable viral load are sexually non-infectious. This is the first time that medical experts anywhere have agreed that well-suppressed blood viral levels are a reliable measure of sexual infectivity. This will be controversial, but it’s a fascinating development.

The statement’s headline statement says that “after review of the medical literature and extensive discussion,” the Swiss Federal Commission for HIV / AIDS resolves that, “An HIV-infected person on antiretroviral therapy with completely suppressed viraemia (“effective ART”) is not sexually infectious, i.e. cannot transmit HIV through sexual contact.”

It goes on to say that this statement is valid as long as:

• the person adheres to antiretroviral therapy, the effects of which must be evaluated regularly by the treating physician, and
• the viral load has been suppressed (< 40 copies/ml) for at least six months, and
• there are no other sexually transmitted infections.

The experts noted the essential conundrum of proving the negative hypothesis (i.e. proving that something can never happen) but said “The situation is analogous to 1986, when the statement ‘HIV cannot be transmitted by kissing’ was publicised. This statement has not been proven, but after 20 years’ experience its accuracy appears highly plausible.”

A report on Aidsmap.com canvasses the implications of the announcement for medical practitioners, people with HIV, HIV prevention and the legal system.

As one colleague observed today, “I guess we know now what they’ll be fighting about at this year’s International AIDS Conference.”

Just a couple of days ago I was bragging to my friend Kirsty about my flawless medication adherence: “I don’t miss doses — it’s been years since I missed a dose,” I said.

Well, I woke up this morning and there on my bedside table are last night’s pills, unswallowed and ignored. It’s the ABC’s fault — I was so furious at the Swindle that I just forgot.

For the unschooled, missing doses of your HIV medications increases the risk of developing resistance to them — ideally you should take at least 95% of scheduled doses to ensure your treatments continue to work. Missing this one won’t take me below that threshold, so it’s very unlikely to have any significant negative effect, but it does spoil my perfect record.

There is a solution, of course: I can take the missed dose now, as my next dose isn’t scheduled until bedtime tonight. It’s the responsible thing to do, and it’ll restore my unblemished record (sort of), but if I do I’ll have to deal with the neurological side effects — essentially it feels like being stoned, but not in a good way.

If I start posting utter gibberish in the next hour or two I guess you’ll know why.