#pre exposure prophylaxis

[jcsmicasereports]

POFF SHOOTS OF PrEP ( Pre Exposure Prophylaxis for HIV) Clinics by Saraswathi Lakkasani MD in Journal of Clinical Case Reports Medical Images and Health Sciences

Introduction

HIV preexposure prophylaxis (PrEP), is use of antiretroviral medications to prevent acquisition of HIV infection, in a HIV negative person who has on going risk of acquiring HIV. This strategy has proven effective in several recently published reports. The regimen if used optimally has HIV reduction record of 99%. However, there are several positive unforeseen benefits in this strategy. In this observational study we are presenting some additional benefits we observed in our Prep Clinic.

We are reporting the findings of our on-going PrEP Clinic for your perusal. Saint Michaels Medical Center is a 150 to 200 bedded community hospital, at Newark, New Jersey. We follow more than 200 PrEP clients in our Prep Clinic. We follow the state mandated protocol for induction and follow up.

Observation Results

So far there is no seroconversion to HIV after starting PrEP. Two of our clients had successful full term, normal pregnancies with sero negative healthy babies. Statistically significant number of STI’s (sexually transmitted Infections) were diagnosed and successfully treated and Significant number of unimmunized clients for Hepatitis B and A were identified and immunized. One case of uncontrolled diabetes and one hypercalcemia were identified at the initial visit and referred to the respective specialist. One patient was found to have anal mass, six months into the program, being pursued by colorectal surgeon.

Conclusion

Among the risk groups benefited by PrEP, the use of PrEP has increased by 500%. The average age group of clients falls between 25 to 35 who are in good health and with very few comorbidities who may or may not come to Primary care clinics on regular basis.

PrEP clinics gives an excellent opportunity to detect, diagnose and treat some of the commonly missed but treatable medical issues. The demand will be increasing in future. Our findings may be the tip of an iceberg.

[molovesbooks]

thank you, tumblr dad!

ask a nurse/doctor or anyone else who works in hospitals/healthcare places if you need more info on this! (ideally even the janitors and cleaning staff should know some stuff, at least that's what we do in my hospital in Europe)

also, PrEP and PEP are definitely safe, but the side effects can be pretty severe, just be warned. definitely, definitely take them if you are or think you might be in any way at risk (some insurance companies in multiple European countries will cover the cost or at least a big part of it), but have your healthcare provider or a trusted internet source explain the entire thing to you in detail! our tumblr dad gave a great comprehensive overview, but please do some more research if any of it applied to you!

If you can, it's definitely worth looking at the product monograph of whatever you're being prescribed (or even the instruction leaflet), but if you're struggling with that for any reason, ask a trusted person in your life to look over it with you. I've had enough doctors not tell me everything I thought relevant.

(If you want, you can ask me too)

My dear lgbt+ kids,

Let's talk about PrEP and PEP.

PrEP is short for pre-exposure prophylaxis. It's a safe* and highly effective medicine (pills or shots) you can take to reduce your chances of getting HIV. When taken as prescribed, it reduces the risk of getting HIV from sex by about 99% and the risk of getting it from drug injection by at least 74% (Source)

PrEP may be the right choice for you if you have an ongoing risk of HIV exposure. For example, if you:

have frequently changing sexual partners, or

are a sex worker, or

do not consistently use condoms, or

have an HIV-positive partner, or

have been diagnosed with another sexually transmitted disease, or

have used multiple courses of PEP (see below), or

inject drugs and share needles, syringes, or other drug injection equipment (for example, cookers).

Even if none of these apply to you, PrEP could still be helpful for you - talk to a healthcare professional about your individual situation.

Some more important info:

Teenagers can take PrEP if they are at risk!

Before beginning PrEP, you must take a test to make sure you are currently HIV-negative.

PrEP takes some time to work (about 7 days for anal sex, about 21 days for vaginal sex or drug use).

It's not the right choice if you think you may already have been exposed to HIV - if you think you have been exposed within the last 72 hours, ask for PEP right away.

PrEP is much less effective when not taken as prescribed.

PEP is short for post-exposure prophylaxis. It's medicine for emergency situations. You can take it after possible exposure to HIV (e.g if a condom broke or after sexual assault). It's safe* and highly effective but only if taken within 72 hours of exposure - when it comes to PEP, every hour counts! Don't wait, talk right away to a health care provider, an emergency room doctor, or an urgent care provider.

PEP is not a substitute for condoms and doesn't provide ongoing protection.

*While they are safe, PrEP and PEP can have side effects (such as nausea). In almost all cases, these side effects aren’t life-threatening. They usually go away on their own or can be easily treated. Talk to a healthcare professional if you are concerned about side effects.

With all my love,

Your Tumblr Dad

[manispecialtycenter]

Exploring Alternative Methods of Std Prevention

In a world where awareness about sexually transmitted diseases (STDs) is crucial, it’s essential to stay informed about the various prevention methods available. Conventional methods like using condoms and practicing safe sex are well-known, but there’s a growing interest in alternative approaches to STD prevention.

[reasonsforhope]

"A large clinical trial in South Africa and Uganda has shown that a twice-yearly injection of a new pre-exposure prophylaxis drug gives young women total protection from HIV infection.

The trial tested whether the six-month injection of lenacapavir would provide better protection against HIV infection than two other drugs, both daily pills. All three medications are pre-exposure prophylaxis (or PrEP) drugs.

Physician-scientist Linda-Gail Bekker, principal investigator for the South African part of the study, tells Nadine Dreyer what makes this breakthough so significant and what to expect next.

Tell us about the trial and what it set out to achieve

The Purpose 1 trial with 5,000 participants took place at three sites in Uganda and 25 sites in South Africa to test the efficacy of lenacapavir and two other drugs.

Lenacapavir (Len LA) is a fusion capside inhibitor. It interferes with the HIV capsid, a protein shell that protects HIV’s genetic material and enzymes needed for replication. It is administered just under the skin, once every six months.

The randomised controlled trial, sponsored by the drug developers Gilead Sciences, tested several things.

The first was whether a six-monthly injection of lenacapavir was safe and would provide better protection against HIV infection as PrEP for women between the ages of 16 and 25 years than Truvada F/TDF, a daily PrEP pill in wide use that has been available for more than a decade.

Secondly, the trial also tested whether Descovy F/TAF, a newer daily pill, was as effective as F/TDF...

The trial had three arms. Young women were randomly assigned to one of the arms in a 2:2:1 ratio (Len LA: F/TAF oral: F/TDF oral) in a double blinded fashion. This means neither the participants nor the researchers knew which treatment participants were receiving until the clinical trial was over.

In eastern and southern Africa, young women are the population who bear the brunt of new HIV infections. They also find a daily PrEP regimen challenging to maintain, for a number of social and structural reasons.

During the randomised phase of the trial none of the 2,134 women who received lenacapavir contracted HIV. There was 100 percent efficiency.

By comparison, 16 of the 1,068 women (or 1.5%) who took Truvada (F/TDF) and 39 of 2,136 (1.8%) who received Descovy (F/TAF) contracted the HIV virus...

What is the significance of these trials?

This breakthrough gives great hope that we have a proven, highly effective prevention tool to protect people from HIV.

There were 1.3 million new HIV infections globally in the past year. Although that’s fewer than the 2 million infections seen in 2010, it is clear that at this rate we are not going to meet the HIV new infection target that UNAIDS set for 2025 (fewer than 500,000 globally) or potentially even the goal to end Aids by 2030...

For young people, the daily decision to take a pill or use a condom or take a pill at the time of sexual intercourse can be very challenging.

HIV scientists and activists hope that young people may find that having to make this “prevention decision” only twice a year may reduce unpredictability and barriers.

For a young woman who struggles to get to an appointment at a clinic in a town or who can’t keep pills without facing stigma or violence, an injection just twice a year is the option that could keep her free of HIV.

What happens now?

The plan is that the Purpose 1 trial will go on but now in an “open label” phase. This means that study participants will be “unblinded”: they will be told whether they have been in the “injectable” or oral TDF or oral TAF groups.

They will be offered the choice of PrEP they would prefer as the trial continues.

A sister trial is also under way: Purpose 2 is being conducted in a number of regions including some sites in Africa among cisgender men, and transgender and nonbinary people who have sex with men.

It’s important to conduct trials among different groups because we have seen differences in effectiveness. Whether the sex is anal or vaginal is important and may have an impact on effectiveness.

How long until the drug is rolled out?

We have read in a Gilead Sciences press statement that within the next couple of months [from July 2024] the company will submit the dossier with all the results to a number of country regulators, particularly the Ugandan and South African regulators.

The World Health Organization will also review the data and may issue recommendations.

We hope then that this new drug will be adopted into WHO and country guidelines.

We also hope we may begin to see the drug being tested in more studies to understand better how to incorporate it into real world settings.

Price is a critical factor to ensure access and distribution in the public sector where it is badly needed.

Gilead Sciences has said it will offer licences to companies that make generic drugs, which is another critical way to get prices down.

In an ideal world, governments will be able to purchase this affordably and it will be offered to all who want it and need protection against HIV."

-via The Conversation, July 3, 2024

[k1nky-r0b0t-g1rl]

If you are sexually active, please discuss PrEP with your doctor. And everyone should discuss it with all of their friends. Programs like Ryan White are incredibly important to reducing the spread of HIV/AIDS https://ryanwhite.hrsa.gov/about/four-years-hiv-success. These programs provide both HIV antiretrovirals(ARV) and PrEP to low income people and are the reason HIV isn’t ravaging the LGBTQ community like in the 80s. With funding cut, it will be significantly harder for low income people to get access to these medications and will cause HIV to spread through those communities.

ARVs can get people living with HIV to undetectable levels. And undetectable HIV is untransmittable https://www.cdc.gov/global-hiv-tb/php/our-approach/undetectable-untransmittable.html. When people lose access to these medications, they can transmit HIV to their sexual partners. PrEP is 99% effective in reducing the spread of HIV https://www.hiv.gov/hiv-basics/hiv-prevention/using-hiv-medication-to-reduce-risk/pre-exposure-prophylaxis. Not everyone will be able to access PrEP if these programs are cut, but everyone who can should get on it to reduce the spread as much as possible.

We already see health disparities of racial minorities in HIV infection rates https://www.cdc.gov/hiv/data-research/facts-stats/race-ethnicity.html. Black and Latine people will be the first to be affected by these cuts, but like much of our culture it will spread from those communities. It most likely will not reach the level of the 80s, but it will devastate the most vulnerable people in our communities. The wealthiest among us will still be able to afford medication, but for the rest of us, we need to do everything we can to stop the spread. 

WE HAVE THE KNOWLEDGE

WE HAVE THE TOOLS

WE CANNOT ALLOW THESE MONSTERS TO KILL US AGAIN

[batmanisagatewaydrug]

wait, what's the difference between hpv and hiv and aids? i thought hiv was just aids and hpv was like. another term for hiv please 😭

okay. before I do this. I do want to remind everyone that this kind of info is incredibly easy to seek for yourself, with the help of simple search times like "what is hpv" or "hiv wikipedia," and I do really encourage doing that! learning how to seek out information is an important skill!

but god I am going to do this anyway, here we go.

HPV is human papillomavirus, an extremely common viral infection that virtually every sexually active person will contract at some point in their life. there are nearly 200 stains of HPV, nearly all of which are harmless, but there are 2 that can (but don't always) cause genital warts and 13 that can (but don't always) cause cancers of the cervix, anus, vagina, vulva, penis, and throat. roughly 90% of cases of HPV clear up and go away on their own within two years of contraction without ever causing any health problems; the majority of people who have it will be asymptomatic the entire time and may never know they have it.

HIV is human immunodeficiency virus, a virus that attacks and drastically weakens the immune system when untreated. it is considered an STI but is not spread exclusively through sexual contact, as it can also be transmitted via unclean syringes shared between people as well as from parents to children via childbirth or breastfeeding. while HIV can be fatal, usually when it develops into AIDS, as I posted about earlier tonight proper medicine and management can allow people with HIV can live full, healthy lives and even completely negate their risk of transmitting HIV.

it's also important to discuss PrEP (pre-exposure prophylaxis), which can be taken by people who do not have HIV to drastically reduce their risk of contracting it, and PEP (post-exposure prophylaxis) which can be taken for 28 days starting up to 72 hours after potential exposure to HIV to greatly reduce the risk of the virus taking hold.

AIDS is acquired immunodeficiency syndrome. AIDS develops when HIV is left untreated and progresses over years, when the immune system has been severely depleted. at this point people are very prone to what are known as "opportunistic" infections and cancers, further health complications that their immune system is unable to fight off as it ordinarily would. people with AIDS often deal with a state of constant fatigue, fever, chills, weakness, inflammation, and weight loss.

so, you know. slightly different things!

[southeastasianists]

It was the mid-1980s when Paul Toh came of age as a gay man, decades before smartphones and dating apps made sex a lot more accessible right at your fingertips. Toh has been diagnosed with HIV since 1989. 

Now semi-retired with his own business distributing antiretroviral therapy medication and HIV pre-exposure prophylaxis (PrEP), the 59-year-old said that in those days, cruising in public parks, toilets, and back alleys of dirty shophouses along pre-cleanup Singapore River for sex was par for the course. 

Unsurprisingly, cruising in public made gay men easy targets for police officers. “They started going to these cruising grounds undercover, with the explicit intention of entrapping and arresting gay men,” Toh added.

Police raids in nightlife establishments with gay clientele also became common, with prominent gay discotheque Niche having its liquor license withdrawn by the police in 1989 and the Rascals incident of 30 May 1993, in which multiple patrons were arrested for not having their NRICs on them. This came to be remembered by veteran activists as Singapore’s Stonewall. 

Fear about the spread of AIDS was part of the reason why police intensified their clamp down on queer spaces. In April 1987, Singapore experienced its first AIDS-related death. And one year later, the Director of Public Affairs of the Singapore Police Department said in a Straits Times article that “homosexual activities have been strongly linked to the dreaded AIDS disease,” making it an “added reason in the public interest for police to disallow homosexuals to convert places licensed for entertainment into places where they can congregate.”

Iris’ Work of Fighting Stigma

76-year-old health advisor Iris Verghese was among the first health workers to rise to the occasion when Singapore reported its first HIV/AIDS cases. 

“I knew just as little about HIV/AIDS as everyone else,” said the retired nurse, who first joined Middle Road Hospital, a now-defunct treatment centre for sexually transmitted diseases, in 1974. As part of her job, Verghese was tasked with contact tracing people who had sexually transmitted infections. 

The job brought Verghese to brothels and nightclubs in Geylang’s red-light district, which meant she was no stranger to serving society’s Others with kindness. 

“A lot of it has to do with my faith.”

“I thought about my role models like Jesus and Mother Teresa—they didn’t care what illness you had. If they could hang out with people with leprosy, then who am I to refuse to care for those with HIV/AIDS?”

Verghese’s work is well-documented, and everyone has given her the accolades she deserves—from President Halimah Yacob to the Roman Catholic Archdiocese of Singapore to the Straits Times, which named her an everyday hero in 2019.

Plague, a 15-minute short film by Singaporean filmmaker Boo Junfeng, captures the emotional gravity of the care work performed by Verghese and health workers like herself. 

The emotionally-stirring film is inspired by Verghese’s work with HIV/AIDS patients in the ’80s and offers a look into the life of Jamie, a patient who stopped coming to the clinic for treatment and counselling.

In the film’s climax, set in the patient’s HDB flat, Verghese tries to dissuade Jamie from inflicting internalised stigma. Jamie insists on using disposable plastic cups and utensils and cleaning every surface he touches for fear of passing the virus to his loved ones.

Wanting to prove that HIV/AIDS is not transmissible through saliva, Verghese takes Jamie’s plastic cup and drinks from it. She then hands him a regular glass, beckoning for him to drink from it, only for him to swipe it away, breaking the glass and cutting himself in the process. 

Thus comes the true test of Verghese’s dedication to her profession as she steels herself to the drastically heightened risk. Now that her patient is bleeding, she is dealing no longer just with saliva, but with blood carrying the virus. 

In our interview, Verghese recalled many incidents like these. One that stuck with me was her counselling session with Singapore’s first HIV patient, a young gay professional, in 1985. “As I listened to him and gave him a hug, he broke down and cried,” she said. “He said he felt so good afterwards.”

Safe Sex Outreach in the 80s

“Things were very different in the ’80s and ’90s,” said Professor Roy Chan, Founding President of Action for AIDS Singapore (AfA). AfA is a non-government organisation founded in 1988 to fight HIV/AIDS infection in Singapore. 

“There was no internet then. When we set up AfA, we had to rely on word of mouth, phone calls, faxes, pagers, and so on. Mobilisation was not as easy then, but we overcame the obstacles we faced. It was very much more hands-on in those days,” Chan recalled. 

Chan set up AfA as a non-governmental organisation in 1988 to respond to the needs of people living with HIV/AIDS, regardless of their sexual orientation or gender identity, as well as to advocate for greater action and awareness around HIV/AIDS. 

AfA was also one of the first community groups in Singapore that served the needs of LGBTQ+ individuals—namely men who have sex with men—disproportionately affected by HIV/AIDS. 

“Back then, people didn’t have as much access to the internet as we do today, meaning that accurate information on HIV/AIDS was much harder to come by, making education efforts vital,” Chan recalled. “On the flip side, no internet meant the gay nightlife scene was more vibrant than what it is today.” 

Since the gay community in the 1980s and 1990s did not have the internet and mobile phone apps to meet other people online, they had to go to physical spaces to fulfil their need for connection, whether it was nightlife establishments or cruising grounds.

Gay clubs were hence crucial in AfA’s outreach programs on safe sex practices back in the ’80s—even if it meant risking the possibility of police raids.

Back then, there were very few places in Singapore where gay men felt safe enough to gather in abundance, making gay clubs a viable hub for outreach and education.

AfA’s outreach efforts endure today in the form of the Mobile Testing Van initiative on weekends. The van, parked outside popular gay nightlife spots in Singapore, aims to bring HIV testing closer to the public, bridging the fear and stigma of walking into a stand-alone clinic to get tested.

The Consequence of Outreach

The people brave enough to put themselves out there to serve a larger cause were but a small minority, especially given the cultural milieu of the time. 

“There was so much that was unknown about HIV/AIDS even among the medical community, much less the general public,” said Verghese.

“Even at Middle Road Hospital, two doctors resigned, and twenty-five nurses asked to be transferred out.”

AfA’s awareness campaigns and fundraiser drives drew a lot of publicity—and no doubt some backlash.

Still, beneath all the headlines and the star power lent by high-profile celebrity allies was the silence surrounding individual HIV/AIDS cases. 

“It was all very hush-hush. People didn’t want to talk about it. No one wanted to know who died of AIDS,” Verghese shared when I asked if the atmosphere in the 90s was similar to that depicted in films and drama series such as The Normal Heart and Pose. 

The shows portrayed the HIV/AIDS crisis in the disease’s epicentre in New York as being a time of deaths and countless funerals attended by surviving gay men. 

One exception to this veil of silence was Paddy Chew, the first Singaporean person to come out publicly as being a person living with HIV/AIDS. 

Chew—well-known for his one-man autobiographical play Completely With/Out Character—told Verghese and her husband that he wanted no crying at his funeral. 

“He asked me to arrange his funeral such that his ashes will be thrown into the sea from a Singapore Armed Forces boat,” said Verghese. She and Chew’s close friends were instructed to be dressed in their party best, with helium balloons that were to be released out at sea. 

“There was one helium balloon that drifted away from the other balloons. To me, that felt like it was Paddy’s soul saying goodbye to us one last time.”

A Tale of Two HIV Diagnoses

Perhaps by coincidence—or not, since Verghese was one of the very few nurses dedicated to caring for HIV/AIDS patients at the time—Toh’s then-partner was also one of Verghese’s patients. 

“My then-partner Freddie and I handled our HIV diagnoses very differently, but of course, we also came from very different backgrounds and life experiences,” said Toh. 

“I found out about my status because an ex-lover of mine had come down with pneumocystis pneumonia (PCP). I flew to Sydney for a diagnosis so that I wouldn’t be registered in the local system here if I was found to be positive.” 

On the other hand, Freddie found out about his HIV-positive status because he was a regular blood donor. Not only was his diagnosis inevitably recorded in the national registry, but Freddie also ran into legal trouble. He was charged in court for false disclosure of his sexual activity. 

“Because of how the entire trial turned out, Freddie was sentenced to imprisonment for twice the expected duration. It affected his entire outlook in life, feeling like he was being framed by a bigger power with an agenda, with the whole world against him,” said Toh, who cared for Freddie until he passed in 2008. 

Toh, on the other hand, took his diagnosis as an opportunity to re-evaluate his life and make the most of the eight years that the doctor told him back in 1989 he had left to live. 

“When I received my diagnosis, the only thing in my mind was this: it is the quality of life that matters, not the quantity.” And so, the two spent the next few years of their lives travelling the world, making their remaining years as meaningful as they could be. 

Anything for a Chance at Life

Maximising his remaining years did not stop at travel for Toh. Having managed to get his hands on antiretroviral therapy in Sydney in the form of azidothymidine (AZT), he went on to look for more effective forms of medication while the technology was being developed in real-time. Toh wanted to help other HIV patients like himself. 

In 1994, Toh joined the Asia Pacific Network of People with HIV/AIDS (APN+), a regional network advocating for the improvement of the lives of people with HIV/AIDS in the Asia-Pacific region, later becoming a Board member and secretariat.

“North America and Europe were progressing swiftly in their battle against HIV/AIDS thanks to the work of activists there putting pressure on their governments and the medical community to channel funding towards the research and development of suitable treatment for HIV/AIDS,” said Toh.

“In Asia, however, it’s a different story. We had to be street smart in our advocacy while also looking elsewhere for allies.”

This meant looking to donors in the West who could be persuaded to recognise the importance of HIV/AIDS advocacy in Asia.

“I was very lucky to have the opportunity to be one of the first few Asians who had access to HAART, said Toh. 

HAART (Highly active antiretroviral therapy) is a triple-combination of antiretroviral drugs discovered in 1996 by Professor David Ho. Toh had been invited to attend the 11th International Conference on AIDS in Vancouver, Canada, where the discovery of this triple cocktail was announced. 

Within three months of beginning HAART treatment in 1996, Toh saw his health improving tremendously, with his CD4 count—a measure for the immune system of PLHIV—increasing exponentially and his viral load becoming undetectable within the fourth month. 

Although Toh already had a supply of free antiretroviral medication from his healthcare provider in Sydney, he continued to look elsewhere for alternative sources for patients who were unable to afford the patented medication. 

“Unlike Taiwan, Hong Kong, and South Korea, where medication for HIV/AIDS was provided to patients for free, Singapore was the only Asian Tiger which did not do so,” said Toh. 

“Meanwhile, pharmaceutical companies in developing countries like Brazil, India, and Thailand were manufacturing their own generic antiretroviral medication in spite of patent laws, making it more affordable.”

While still not free, MOH announced in 2020 that HIV medication would become subsidised.

Singapore’s Very Own ‘Buyers Club’

With patented HIV/AIDS medication in the ’80s continuing to be inaccessible to many who needed it, buyers clubs—similar to the one featured in the 2013 film Dallas Buyers Club—would soon emerge worldwide, including Singapore. 

“The funny thing was that Australia had easy access to HIV/AIDS medication, so there was a lot of stock available in Sydney,” said Verghese. A family vacation down under in 1987 turned into an informal research trip for her to network and gather the information that she needed to perform her job optimally. 

During her trip, she met HIV researcher Dr David Cooper, who brought her to Albion Street Centre (now known as The Albion Centre), which specialises in HIV/AIDS management. 

Through her newfound contacts, Verghese managed to get her hands on some of the unused stocks of medication in Sydney back to Singapore for her support group. 

“We even got the help of the Singapore Airlines flight attendants to pool together their unused baggage allowance to bring this medication back,” she recounted with a laugh. 

Antiretroviral medication was not the only asset that Verghese brought back. She learned a lot about the virus from the professionals she met in Sydney, allowing her to move faster than the national response and gather the information needed to tend to her patients. 

A Ground Up Initiative

“George Yeo was actually very impressed with what we were doing,” recounted Verghese. “He wanted to meet with the community to learn more about our efforts and arranged a closed-door meeting with us.”

The meeting was the culmination of months of sending letters to Yeo, the Minister of Health at the time. The dialogue session was held to discuss the government’s rule that mandated the bodies of AIDS sufferers to be buried or cremated within twenty-four hours of dying. 

This rule was finally lifted in December 2000, after four years of advocacy by AfA.

They argued that the policy was outdated, having been implemented in the mid-1980s when hardly anything was known about HIV/AIDS. 

“I think we’ve certainly had to prove ourselves as an organisation over the years,” Chan said. “There might have been concerns among some who thought of us as a gay rights organisation, or misconceptions that AfA worked solely on issues that concern gay people.”

“But we’ve proven ourselves over the years to be a serious and effective organisation tackling HIV/AIDS and sexual health with clear metrics of success, and the results and continued support from the government speak for themselves,” added Prof Chan. 

Toh, who served as AfA’s Executive Director from 2007-2009, concurs. 

“Actually, not many people know this, but MOH has been quite supportive of AfA over the years. Even during my term, they would hold closed-door discussions with us, intently wanting to work with us on eliminating HIV/AIDS,” said Toh. He reckoned that MOH did not want to be publicly seen as supporting something considered by society as ‘morally corrupt’ no matter how beneficial it is to wider society. 

The Fruits of Our Predecessors’ Labour Are Not Handed on a Silver Plate

The history of HIV/AIDS and its role in fomenting community-building among the LGBTQ+ community has always been a topic of fascination for me.

I can only imagine what it must have been like to see everyone in your social circles and communities succumbing, one by one, to an unknown disease. 

Covid-19 provided the closest representation of the tumultuous and uncertain time in the ’80s.

In the midst of writing this, however, the comparison became a much closer one. Monkeypox is now affecting men who have sex with men more than the rest of the general population. 

“It’s not the same thing,” Chan said, cautioning against making blanket comparisons between monkeypox and HIV/AIDS.

“For starters,” he intoned, “monkeypox is not an unknown disease. We’ve known about monkeypox for decades, so it is nothing close to HIV back in the ’80s.”

Admittedly, life is easier for a gay man like me, who came of age at a time when HIV/AIDS is no longer considered a significant threat. 

With common knowledge of medication as well as preventative measures like safer sex and pre and post-exposure prophylaxis (PrEP and PEP), it is easy for me and my peers to take for granted the freedoms that we now enjoy, thanks to decades of advocacy and destigmatisation. 

But as Prof Chan said, “It is important not to be complacent. The freedoms and advancements we have today were not handed on a silver platter. Earlier generations had to fight very hard for all of these things.”

[covid-safer-hotties]

Reference saved in our archive

62% of responding EU's nations accept organs for transplants from covid-positive donors with ongoing acute symptoms. A new route for blood-borne illness going unchecked?

Abstract

SARS-CoV-2 infection represents a new challenge for solid organ transplantation (SOT) with evolving recommendations. A cross-sectional survey was performed (February–June 2024) to describe practices among Member States of the Council of Europe (COE) on the use of organs from deceased donors with resolved or active SARS-CoV-2 infection. Overall, 32 out of 47 Member States with a transplant program participated in the study. Four (12.5%) countries did not use organs from deceased donors either with resolved or with active SARS-CoV-2 infection and 8 (25%) countries accepted organs only from deceased donors with resolved SARS-CoV-2 infection. Donor evaluation for SARS-CoV-2 included universal screening with standard PCR testing on respiratory specimens generally (61.4%) performed within 24 h prior to organ recovery. Further microbiological, immunological and radiological investigations varied. Most waitlisted patients receiving organs from a deceased donor with active (94.5%) or resolved (61.5%) SARS-CoV-2 infection were preferred to have natural, vaccine-induced or hybrid SARS-CoV-2 immunity. Most countries did not require recipients to undergo specific anti-SARS-CoV-2 treatment as pre-exposure (0%), post-exposure prophylaxis (15.4%) or modification of immunosuppression regimen (24%). This study highlights similarities and heterogeneities in the management of SARS-CoV-2 positive donors between COE countries, and a potential to safely expand donors’ pool.

[mariacallous]

After a lifetime on the frontiers of the fight against HIV, Linda-Gail Bekker could finally see the end of the epidemic in sight. For decades, HIV experts had dreamed of an elusive vaccine to block the ongoing chain of infections, which still sees more than 1 million people worldwide contract the virus annually. Bekker, a 62-year-old medical professor from the University of Cape Town, had helped identify a drug that could do just that.

But now, thanks to the Trump administration’s executive orders, it’s unclear when—or possibly even ever—this breakthrough medicine will see the light of day.

At the AIDS 2024 conference held in Munich last July, Bekker had triumphantly unveiled the results of a momentous clinical trial she had led, called PURPOSE 1. It showed that lenacapavir, an antiretroviral developed by the pharmaceutical company Gilead Sciences, could prevent sexual transmission of HIV with 100 percent efficacy by disrupting the function of the virus’s capsid protein, which allows it to replicate.

Even more remarkably, compared with existing daily pre-exposure prophylaxis (PrEP) pills, which do a similar job, injections are only required every six months. While not strictly a vaccine, lenacapavir promises to be the next best thing. It was named as 2024’s “Breakthrough of the Year” by the prestigious journal Science, and Gilead promptly committed to manufacturing 10 million doses by 2026, enough to treat 2.5 million people, ahead of anticipated regulatory approval later this year.

A collaborative effort between the medicines-financing initiative The Global Fund and PEPFAR, the US government’s global HIV/AIDS program, had pledged to procure 2 million of those doses over the course of three years, which would be directed toward countries with the highest incidence of HIV, most notably in sub-Saharan Africa. But with President Donald Trump’s decision to freeze all foreign aid funding, this plan has been left in tatters.

“There’s despondency and a sense of tragedy,” says Bekker. “Because just as we’ve had the breakthrough, we also see the taps turning off of resources. We had a laid-out map where the product would be supplied via PEPFAR and The Global Fund while we wait for generics [cheaper off-label versions of lenacapavir] to come online, which will take 18 months to two years. And at this moment, that plan is falling through in front of our eyes.”

While a temporary 90-day waiver has been issued for PEPFAR funding, this has only reinstated funding for life-saving antiretroviral treatments for HIV-positive individuals. Existing forms of PrEP are covered, but only for pregnant or breastfeeding women. There have been no indications that the planned purchase of lenacapavir will be fulfilled.

According to Kenneth Ngure, an HIV-prevention expert in Kenya and president-elect of the International AIDS Society, the loss of PEPFAR funding for prevention represents a major setback in the world’s ability to control HIV. “Even if The Global Fund partners with others, they will probably not be able to reach the number of doses they had promised,” he says. “We have this potential game-changer, which could accelerate the end of HIV as a public health threat, and yet it looks like access will be highly compromised.”

For Ngure and others, there is a sense of history repeating itself. The major limitation of PrEP is that adherence is notoriously poor, with studies showing that target groups often struggle to access or forget to take daily pills and feel stigmatized doing so. “We know that particularly for young people, taking a daily oral PrEP pill is challenging,” says Bekker. “We’ve tried all sorts of things, like sending text messages. São Paulo is even giving PrEP in a dispensing machine. But it’s sometimes very difficult to take something daily when you’re not sick and you’re doing it for prevention.”

Longer-acting injectables have long been viewed as a better way forward, and in 2021, the HIV field was galvanized by promising trial results for cabotegravir, a form of injectable PrEP that only needed to be administered every two months, with a trial demonstrating that people receiving this drug had 90 percent less risk of contracting HIV compared with oral pills. Yet access has been the major hurdle.

Last month a new study revealed that while regulators in 53 countries have approved cabotegravir, rollout has been painfully slow. Generic versions of the jab are not expected to become available until 2027. In Africa and Asia, where cabotegravir is most needed, the only access so far has been through so-called Phase 4 or implementation science studies, which attempt to understand more about the real-world challenges of offering a new drug by dispensing it to a few thousand people.

And also as a consequence of orders coming out of the White House, a number of these Phase 4 studies have abruptly ceased. “They’re very concentrated in East and Southern Central Africa,” says Bekker. “Some of them were PEPFAR supported, and with the stop-work order, these studies have ground to a halt.”

The frustration for researchers like Bekker is that while long-acting injectables are extremely effective at blocking HIV transmission, to end the epidemic, their rollout needs to be as rapid and as wide-reaching as possible. She points out that to prevent over a million new infections each year, these jabs need to be targeted at HIV hotspots and administered on a scale of millions—exactly as the plan with lenacapavir was proposing.

“We’ve seen with both cabotegravir and oral PrEP that if you get a new tool, but roll it out gently, that will not impact the epidemic,” says Ngure. “The number of new infections still outpaces the impact of the tool. You need something which is potent and to roll it out fast.”

With lenacapavir, things were supposed to be different. Gilead has partnered with six generic drugmakers, which have been licensed to produce enough of an off-label supply of lenacapavir to cover 120 countries. Estimates have suggested that if the global demand exceeded more than 20 million doses, the manufacturing costs could fall to just $35-40 per person per year. However, Bekker says that PEPFAR was expected to be a significant buyer, and without its financial clout the commercial viability of manufacturing generic lenacapavir at vast scales is in doubt.

“It requires a nice healthy demand to ensure that for each of the generic companies, it’s going to be worth their while,” says Bekker. “We are all hoping that governments [across sub-Saharan Africa] are writing the generic product into their budgets for the future, but the reality is that in the interim, we were relying on donor funding. Even my country, South Africa, which has a good GDP and funds 80 percent of its HIV response, is already purchasing antiretrovirals for 6 million individuals annually. I would imagine it will take them some years to be able to mobilize the money for lenacapavir as well.”

With PEPFAR seemingly now focused primarily on the treatment of existing patients, at the expense of prevention, clinicians like Nomathemba Chandiwana, a physician-scientist at the Desmond Tutu Health Foundation in South Africa, are concerned that the infection rate will begin to rise rather than fall, something which will have a marked public health impact across the African continent and beyond.

Speaking at last week’s NCD Alliance Forum in Kigali, Chandiwana explained that the consequences of new infections are not solely related to HIV itself. Research is increasingly showing that people living with long-term HIV infections, even those controlled by antiretroviral treatment, are at a greater risk of developing metabolic conditions such as hypertension, obesity and type 2 diabetes, a disease burden which is already on the rise in sub-Saharan Africa. “HIV itself disrupts your metabolism, as do many of the antiretrovirals,” says Chandiwana. “We see the same chronic diseases in people living with HIV as we do in the general population, but at an earlier age and in an accelerated fashion.”

Because of this, there is also a need for a new generation of HIV treatments, and one concept being explored was to use lenacapavir as a foundation of future combination therapies for those already with the virus. As well as potentially alleviating some of the metabolic side effects, it was hoped that this could lead to treatment protocols that did not require HIV-infected individuals to take daily medication.

“Various ideas have been mooted,” says Bekker. “Could you combine bimonthly cabotegravir with a six-monthly lenacapavir injection [as a form of viral suppression], so you’d only come in six times a year for treatment, and it would all be injectable? There’s a weekly antiretroviral pill in the works, and could you combine that with a six-monthly injectable? This could be very liberating for people, as they tell us all the time how stigmatizing it is to need to take daily medication.”

Yet many of these studies are now in doubt, as Bekker says they were expected to be funded by US resources. “It’s not just PEPFAR; we’re also worried about restrictions being placed on other sorts of research funding, such as the National Institutes of Health,” she says. “It’s just going to get harder to innovate and move progress forward.”

According to Ngure, there is still hope that other donors may emerge who can support The Global Fund in procuring lenacapavir, while Bekker says she is exploring new options for funding HIV prevention and research through European agencies, and possibly donor funding from sources in Scandinavia, Japan, and Australia. At the same time, she believes that the events of the past month have illustrated that African countries need to become capable of funding more preventative efforts themselves.

“Somehow Africa needs to step up and contribute to the fight,” she says. “I think that’s the big question. How much we can also contribute on this continent through countries which haven’t necessarily been able to cover a big amount of research and development but in the future need to.”

At the same time, she is afraid that without the same resources coming from the US, the unique opportunity provided by lenacapavir could be lost.

“It’s incredible that this has happened just as we’ve had the breakthrough,” she says. “I think this is going to set us back many years and ultimately cost a lot more in public health spending. Because ultimately, if we can bring this epidemic under control more quickly, it’s going to save the planet more money in the long run, and save lives too.”

[self-chiller]

"but but but we EVOLVED to be scared of and repulsed by and avoid people who act weird--" to whatever extent we did, that was about rabies (contagious! deadly! marked by acting weird! The other things that cause people to act weird are sometimes deadly - to the affected person - but they aren't contagious). The rest is all conditioning, socially reinforced prejudice, etc. do we have to worry about rabies anymore? not so much. We have pre- and post-exposure prophylaxis for that now and most of us don't come into contact with wild animals on a regular basis. This is one of those things you will have to use your logical brain about. Yes, every time.

[apesoformythoughts]

"Consequences of this type of sex are not limited to HIV. The risk for anal cancer is twenty times higher for men who have sex with men who are HIV-negative and up to forty times higher for MSM who are HIV-positive. And going against the design of the body can lead to more than just disease, such as diminution or destruction of function. Male or female, gay or straight-identified, there is a heightened risk of fecal incontinence from engaging in this behavior. Of course these risks failed to make the pages of Teen Vogue, which advised the young that “anal sex can be perfectly safe if you take the correct precautions.” Less dangerous? Perhaps. “Perfectly safe?” Dangerous deception.

To say that such risks are biological rather than behavioral is a reckless lie. Sexually transmitted diseases (STDs) are at epidemic levels, and men who have sex with men have the highest case numbers of all. The CDC reported 2019 as the sixth year in a row for all-time high STD rates, and in 2020 they continued to rise. Men using pre-exposure prophylaxis for HIV have exhibited higher rates of other STDs; PrEP guards against one type of infection, but not others—the unhealthy behaviors continue as do the consequences.

Recent data show that 17 to 32 percent of men diagnosed with monkeypox are diagnosed with another STD at the same time; 41 percent are already living with HIV. And now antibiotic resistant STDs are emerging—once again, “something else” is coming along. Socially, would we change our behaviors if gonorrhea, chlamydia, or syphilis become untreatable again? Would anything make our culture advocate restraint? The cheap sex market’s demand for silver bullets is already exceeding supply."

— Jean C. Lloyd: "Monkeypox, Sexual Health, and the Limits of Medical Technology"

[osokasstuff]

in relation to the last reblog, some things about HIV. (it's not really a proper educational post (tm) just some facts and misconceptions that i wanna bring so please do your own research if you're able).

HIV is transmitted through blood and sex.

HIV is NOT transmitted through air, saliva, common dishes, household items, etc.

PrEP = pre-exposure prophylaxis. treatment that you get if you regularly participate in risky activities to prevent getting HIV. if you regularly participate in risky activities (share syringes with someone, have unprotected sex), you may consider using PrEP. YOU NEED TO BE HIV- TO USE PrEP!! usage of PrEP if you've already got HIV is dangerous! HIV may develop resistance to the anti-retroviral drug you intake for PrEP, and it can make treatment more difficult!

PEP = post-exposure prophylaxis. treatment that you get as an emergency if you get at risk suddenly (had unprotected sex with someone whose status you don't know, were sexually assaulted, don't remember whether you used condoms or not, condom slipped/teared, shared syringe with someone, etc). it is an EMERGENCY MEASURE that couldn't be used on a regular basis. if you're exposed at risk on a regular basis, consider using PrEP.

PEP needs to be started NO LATER THAN IN 72 HOURS after exposure. the earlier you start, the higher the effectiveness is.

what does it mean: after exposure, you'll have HOURS to contact with medical provider/center/place where you can get PEP and start treatment. so it's better to research opportunities beforehand. maybe get a supply, if it's legal. but at least you need to find a place where to go in emergency case.

the most risky activities are: usage of same syringe for injections, unprotected sex with contact of genitalia and anal, sexual assault (PEP is recommended). consencual oral sex has very very very low risks (PEP is not recommended). anyways, if you think you have been exposed at risk, you should contact your medical provider or centers that specialize in HIV prophylaxis and treatment. it's better to contact in any doubts.

idk how it works in other countries, but where i live we have (some) HIV/AIDS centers where people can get tested, get PrEP, PEP, and help with access to antiretroviral treatment. places that you can research: HIV/AIDS centers, planned parenthood, reproductive clinics, queer-specialized places, etc.

HIV IS NOT ADDICTS-ONLY DISEASE. HIV IS NOT QUEER-ONLY DISEASE. HIV IS NOT MARGINALIZED PEOPLE-ONLY DISEASE. marginalized groups have their risks because of stigma, ostracization, medical neglect, etc. BUT no one is immune to HIV. A LOT OF, and i mean it, generally privileged people get and transmit HIV because they're sure they will never get it.

there are MORE THAN ONE HIV STRAIN. and you can get more than one HIV strain. so if you're living with HIV and going to have risky activity with someone living with HIV and you've not gotten it one from another, YOU STILL NEED PROTECTION. (if you both don't have undetectable viral load).

UNDETECTABLE = UNTRANSMITTABLE. if someone lives with HIV and has undetectable viral load, they can't transmit HIV to someone else. which means you can have unprotected sex with them (if you all don't have other STDs), they can give birth and don't transmit HIV to the children, etc.

HIV IS NOT THE ONLY STD. there are others, and their transmission differs from HIV transmission. for example, oral sex is risky for gonorrhea. so DON'T NEGLECT CONDOMS!

HIV and STDs are not the worst things in the world. most STDs are either curable or controllable, and you can live fine with them. and anyways, no disease should be stigmatized.

HIV and STDs aren't dirty. thinking that "only dirty shameless people can get HIV/STD" is a) discriminatory; b) factually incorrect - everyone can get STDs; c) prevents people from getting tests and treatment; d) promotes the spread and evolution of STDs.

anti-retroviral therapy may be expensive/inaccessible in lots of places. research the situation where you live and your opportunities in case you'll need HIV-associated treatment (PrEP, PEP, anti-retroviral treatment).

people who know that they have HIV are not the "dangerous" ones. the "dangerous" ones are people who have never gotten tested, who are sure that HIV is not something that they can get, and who ask you to have a sex without a condom.

i'm sorry if i say obvious things here, but i'm not sure about public awareness around HIV and thought that if someone can be surprised that person living with HIV can have children without HIV, then these things should be articulated.

[dilfsisko]

could i pls have a disease?

You get an infection with Australian Bat Lyssavirus! ABLV infection is caused by the aforementioned Australian bat lyssavirus. It is closely related to the virus that causes rabies, so much so that you can use rabies PEP and PREP(post and pre exposure prophylaxis, ie the rabies vaccine and rabies immunoglobulin) for ABLV. As of now, it is the ONLY lyssavirus in Australia (meaning no rabies!) and so far there have only been three reported cases, each ending in fatality.

[reasonsforhope]

"Since it was first identified in 1983, HIV has infected more than 85 million people and caused some 40 million deaths worldwide.

While medication known as pre-exposure prophylaxis, or PrEP, can significantly reduce the risk of getting HIV, it has to be taken every day to be effective. A vaccine to provide lasting protection has eluded researchers for decades. Now, there may finally be a viable strategy for making one.

An experimental vaccine developed at Duke University triggered an elusive type of broadly neutralizing antibody in a small group of people enrolled in a 2019 clinical trial. The findings were published today [May 17, 2024] in the scientific journal Cell.

“This is one of the most pivotal studies in the HIV vaccine field to date,” says Glenda Gray, an HIV expert and the president and CEO of the South African Medical Research Council, who was not involved in the study.

A few years ago, a team from Scripps Research and the International AIDS Vaccine Initiative (IAVI) showed that it was possible to stimulate the precursor cells needed to make these rare antibodies in people. The Duke study goes a step further to generate these antibodies, albeit at low levels.

“This is a scientific feat and gives the field great hope that one can construct an HIV vaccine regimen that directs the immune response along a path that is required for protection,” Gray says.

-via WIRED, May 17, 2024. Article continues below.

Vaccines work by training the immune system to recognize a virus or other pathogen. They introduce something that looks like the virus—a piece of it, for example, or a weakened version of it—and by doing so, spur the body’s B cells into producing protective antibodies against it. Those antibodies stick around so that when a person later encounters the real virus, the immune system remembers and is poised to attack.

While researchers were able to produce Covid-19 vaccines in a matter of months, creating a vaccine against HIV has proven much more challenging. The problem is the unique nature of the virus. HIV mutates rapidly, meaning it can quickly outmaneuver immune defenses. It also integrates into the human genome within a few days of exposure, hiding out from the immune system.

“Parts of the virus look like our own cells, and we don’t like to make antibodies against our own selves,” says Barton Haynes, director of the Duke Human Vaccine Institute and one of the authors on the paper.

The particular antibodies that researchers are interested in are known as broadly neutralizing antibodies, which can recognize and block different versions of the virus. Because of HIV’s shape-shifting nature, there are two main types of HIV and each has several strains. An effective vaccine will need to target many of them.

Some HIV-infected individuals generate broadly neutralizing antibodies, although it often takes years of living with HIV to do so, Haynes says. Even then, people don’t make enough of them to fight off the virus. These special antibodies are made by unusual B cells that are loaded with mutations they’ve acquired over time in reaction to the virus changing inside the body. “These are weird antibodies,” Haynes says. “The body doesn’t make them easily.”

Haynes and his colleagues aimed to speed up that process in healthy, HIV-negative people. Their vaccine uses synthetic molecules that mimic a part of HIV’s outer coat, or envelope, called the membrane proximal external region. This area remains stable even as the virus mutates. Antibodies against this region can block many circulating strains of HIV.

The trial enrolled 20 healthy participants who were HIV-negative. Of those, 15 people received two of four planned doses of the investigational vaccine, and five received three doses. The trial was halted when one participant experienced an allergic reaction that was not life-threatening. The team found that the reaction was likely due to an additive in the vaccine, which they plan to remove in future testing.

Still, they found that two doses of the vaccine were enough to induce low levels of broadly neutralizing antibodies within a few weeks. Notably, B cells seemed to remain in a state of development to allow them to continue acquiring mutations, so they could evolve along with the virus. Researchers tested the antibodies on HIV samples in the lab and found that they were able to neutralize between 15 and 35 percent of them.

Jeffrey Laurence, a scientific consultant at the Foundation for AIDS Research (amfAR) and a professor of medicine at Weill Cornell Medical College, says the findings represent a step forward, but that challenges remain. “It outlines a path for vaccine development, but there’s a lot of work that needs to be done,” he says.

For one, he says, a vaccine would need to generate antibody levels that are significantly higher and able to neutralize with greater efficacy. He also says a one-dose vaccine would be ideal. “If you’re ever going to have a vaccine that’s helpful to the world, you’re going to need one dose,” he says.

Targeting more regions of the virus envelope could produce a more robust response. Haynes says the next step is designing a vaccine with at least three components, all aimed at distinct regions of the virus. The goal is to guide the B cells to become much stronger neutralizers, Haynes says. “We’re going to move forward and build on what we have learned.”

-via WIRED, May 17, 2024

[snarp]

Toward a Radically Simple Multi-Modal Nasal Spray for Preventing Respiratory Infections

https://onlinelibrary.wiley.com/doi/10.1002/adma.202406348

Joseph, John et al. “Toward a Radically Simple Multi-Modal Nasal Spray for Preventing Respiratory Infections.” Advanced materials (Deerfield Beach, Fla.), e2406348. 24 Sep. 2024, doi:10.1002/adma.202406348

Abstract: Nasal sprays for pre-exposure prophylaxis against respiratory infections show limited protection (20-70%), largely due to their single mechanism of action-either neutralizing pathogens or blocking their entry at the nasal lining, and a failure to maximize the capture of respiratory droplets, allowing them to potentially rebound and reach deeper airways. This report introduces the Pathogen Capture and Neutralizing Spray (PCANS), which utilizes a multi-modal approach to enhance efficacy. PCANS coats the nasal cavity, capturing large respiratory droplets from the air, and serving as a physical barrier against a broad spectrum of viruses and bacteria, while rapidly neutralizing them with over 99.99% effectiveness. [...]

Someone send me the full text of this please