Tagged: HIV

  • The issues we must address to #EndHIV4Her

    Adolescent girls and young women continue to be at unacceptably high risk for HIV infection. UNAIDS estimates that 7,500 girls and young women, 10 to 24 years of age, become infected with HIV every week, with the highest rates in southern and eastern Africa. Girls and young women account for 71 percent of new HIV infections among adolescents in sub-Saharan Africa, highlighting the gender disparity in this age group. Despite active prevention efforts, recent clinical trials in southern Africa have measured new HIV infection rates of 4 to 6 percent per year among young women. It is imperative that we implement aggressive measures to decrease new HIV infections among girls and young women.

    Our current HIV prevention package of HIV testing, behavioral risk reduction, management of sexually transmitted infections and condom use is inadequate because young women often lack the ability to control their risk. The evidence is clear that the source of HIV infection for most girls and young women in southern Africa is older men. For young women, a complex mix of economic dependency, limited educational opportunity, gender inequality, unequal power dynamics and social norms leads to a lack of choice of how and with whom to have sex.

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  • What do AIDS 2016 in Durban and integrated development have in common?

    A version of this post originally appeared on Huffington Post. Reposted with permission.

    As FHI 360 and the global health community prepare to travel the “Road to Durban” to the 21st International AIDS Conference (AIDS 2016), it is poignant to reflect on how far we have come since the AIDS 2000 meeting held in Durban, South Africa. I recommend taking the time to read a recent message from the conference organizers titled, The Return to Durban: A Critical Moment in History.

    After reading the piece, I was reminded of what a critical role the entire development community, including organizations like FHI 360, has played in the global response to HIV. I am inspired every day to witness how the broad global response has rallied around the concept of building on the available evidence and advancing integrated development solutions — which is why we continue to make real and sustainable progress in battling HIV.

    As part of FHI 360’s deliberate approach to advancing integrated development solutions, we will be hosting a summit June 13, 2016, in Washington, DC, titled, Greater than the Sum of its Parts: The Power of Integration. The event will be a space for innovative thinking, learning and dialogue that will focus on the “how” to achieve the Sustainable Development Goals. The discussions will include global development leaders and practitioners, policymakers, donor organizations and other change-makers.

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  • Want a Healthy World? Let the HIV Response Lead the Way

    Dr. Timothy Mastro

    Dr. Timothy Mastro

    World AIDS Day 2015 comes at a watershed moment in the fight for the health of people living with HIV and for the health of all the citizens of this planet. The two are intimately related: HIV has, for the last three decades, defined the landscape of ambitious, collaborative and innovative responses that marry science, rights, community-based responses and structural change. Ultimately, these responses can be leveraged to improve health everywhere, but only if we continue to make real progress in battling HIV.

    In recent years, collaborations between research teams and thousands of volunteers in clinical trials have yielded insights into how to use HIV prevention and treatment options to end the epidemic. These insights have led to the Joint United Nations Programme on HIV/AIDS (UNAIDS) “Fast-Track” approach to ending the epidemic, which sets ambitious targets for a range of interventions, including 27 million voluntary medical male circumcisions by year 2020, three million people on daily oral pre-exposure prophylaxis (PrEP) annually, major reductions in violence against women, improvements of human rights and, of course, the 90-90-90 targets for 2020: 90 percent of all people living with HIV will know their HIV status, 90 percent of all people with diagnosed HIV infection will receive sustained antiretroviral therapy (ART) and 90 percent of all people receiving ART will have viral suppression.

    Mitchell Warren

    Mitchell Warren

    The world has gotten this far because of massive investments in the HIV response. To actually end the epidemic, though, it is imperative that we resist complacency, cutbacks in funding and a sense that, on any level, our work is done.

    Over the last 15 years, the Millennium Development Goals guided the global response to development. Health, including controlling HIV, figured prominently in these goals. In September, the members of the United Nations adopted the Sustainable Development Goals (SDGs), which will guide policy and funding for ending poverty everywhere over the next 15 years. Health is one of 17 goals. To meet it, funders, implementers and country governments will need to be smarter with investments in HIV/AIDS. This means working side by side with people living with and most affected by HIV to develop rights-based approaches and efficient and community-supported service delivery models. And, it means thinking beyond any single health issue and toward integrated approaches that both fight HIV and contribute to ending poverty, hunger and inequality.

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  • Srey Sros: Addressing the needs of transgender populations in Cambodia

    Srey Sros model

    A transgender model promotes the Srey Sros program. Photo: Graphic Roots Studio, Cambodia

    I have three long-haired boys, and wherever we go in Cambodia, people are confused, certain they are girls. We are constantly asked, “Why?” The answer is simple: They like having long hair. My boys’ push against traditional gender expressions is perhaps acceptable only because Cambodians have come to expect odd behavior from foreigners.

    Yet, it is a different matter for a Cambodian transgender individual with long hair. Transgender individuals in this setting face many acute challenges, and their unconventional appearance is only one of them.

    Transgender individuals in Cambodia carry a high burden of HIV. According to a study conducted by FHI 360 in select urban centers of the country, transgender individuals have an HIV prevalence of 4.15 percent (compared to 0.6 percent for the general population). Despite this striking percentage, they have historically been left out of HIV prevention and care programs. When they were included, they were incorrectly targeted as men who have sex with men. This means that there were no distinct behavior change communications or services for this group.

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  • Final results from two research studies presented at IAS 2015 yesterday demonstrated clear scientific evidence on the benefits of early initiation of antiretroviral therapy (ART). Building on early results of HPTN 052 released in May 2011 that then showed a 96 percent reduction in HIV transmission, the study results presented yesterday provide conclusive evidence that ART should be provided to all HIV-positive people as soon as they are diagnosed for the benefit of both themselves and their sexual partners.

    Jens Lundgren of the University of Copenhagen presented the initial results of the Strategic Timing of AntiRetroviral Treatment (START) study, a randomized trial looking at whether starting ART in people with CD4+ cell counts above 500 cells/mm3, rather than waiting for CD4+ cell counts to drop below 350 cells/mm3, reduces the occurrence of serious morbidity and mortality. START was recently unblinded by the international Data & Safety Monitoring Board (DSMB) 18 months early due to data that showed very clear benefits of immediate treatment versus delayed treatment. Previous studies and guidance from the World Health Organization (WHO) suggested that ART should not be given to patients unless they had symptomatic HIV and/or CD4+ counts that were below 350 cells/mm3. The interim results from START show that ART is safe and effective for all HIV-infected persons regardless of CD4+ count.

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  • Exploring the potential link between hormonal contraceptive use and HIV acquisition

    morrison_charles_2012_220x200Are women who take hormonal contraceptives at an increased risk of acquiring HIV? If so, do some contraceptives put women at higher risk than others?

    This week, the influential health journal, PLOS Medicine, published the results of a large individual-participant data meta-analysis, authored by FHI 360 and collaborators, that seeks to answer these questions.

    While this issue matters to the field of reproductive health, it is especially critical to women in East and Southern Africa. In these regions, women potentially have a double risk factor: high rates of HIV and high use of hormonal contraception, particularly depot-medroxyprogesterone acetate (DMPA), a type of contraceptive that is injected every three months. So far, the evidence on DMPA shows that it is the hormonal contraceptive that has the most potential to increase HIV acquisition; however, the evidence is inconclusive.

    FHI 360’s meta-analysis combines the results of 18 prospective studies, including more than 37,000 women, of whom more than 1,800 became infected with HIV. We found that women who used DMPA had a 50 percent increased risk of HIV acquisition compared with women who did not use hormonal contraceptives. We found no significant increase in HIV risk among women using combined oral contraceptives (COCs) or norethisterone enanthate (Net-En), a contraceptive injected every two months. Women using DMPA also had an increased HIV risk when compared directly with COC or Net-En users.

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  • Can women living with HIV and taking antiretroviral therapy use hormonal contraceptive methods?

    Extraordinary gains have been made in the last decade toward increasing access to antiretroviral therapy (ART) for HIV. With an eye toward ending the AIDS epidemic by 2030, UNAIDS recently released bold targets related to HIV diagnosis and treatment. By the year 2020, their aim is to have 90 percent of all people living with HIV aware of their status, 90 percent of people diagnosed with HIV receiving sustained ART and 90 percent of people on ART achieving viral suppression. As we move closer to these laudable public health goals, we must also consider how expansion of ART may affect and be affected by other health issues, such as prevention of unintended pregnancy among women living with HIV.

    An increasingly important issue is whether certain ART regimens are expected to have drug interactions when used with certain hormonal contraceptive methods. In theory, an interaction could affect the efficacy of either medication or cause side effects or toxicity. If contraceptive efficacy decreases, the chances of contraceptive failure, unintended pregnancy and the accompanying consequences increase. A decrease in ART efficacy could lead to treatment failure, viral resistance and greater likelihood of subsequent HIV transmission. Increases in side effects or toxicity can affect quality of life and medication adherence. Yet, despite the importance of this issue, relatively few studies (particularly those with clinical outcomes such as ovulation, pregnancy or treatment failure) have been conducted.

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  • Inextricable links: HIV and human rights

    The AIDS epidemic has been characterized by the stigma and discrimination of people who are all too often already on the margins of society.

    This marginalization has made it more difficult for millions of people on every continent to access much-needed HIV prevention, treatment, care and support services. As we recognize International Human Rights Day on Dec. 10, we cannot lose sight of the inextricable link between HIV and human rights, which should be the cornerstone of our response to and understanding of this epidemic.

    And there is, perhaps, reason for cautious optimism. Despite some policy gains and increased global attention, HIV continues to disproportionately affect “key populations” — men who have sex with men, sex workers, people who inject drugs and transgender people. UNAIDS estimates that 40 to 50 percent of new adult HIV infections worldwide occur among key populations and their partners.

    Read the remainder of the blog here.

  • Bringing heart and mind to the fight against HIV

    The rapid spread of the Ebola virus through human-to-human contact — compelled by the urge to embrace a family member with symptoms of infection, to transport a neighbor to the nearest clinic, to nurse the infected or bury the dead despite the lack of basic protective gear — reminds us of the complex relationship between health and human behavior.

    Like Ebola, HIV was once an emergent infectious disease. Although HIV may take years rather than days to kill its victims, similarities exist between HIV and Ebola in the conditions that facilitate their spread and the challenges to containing both diseases. Highly stigmatized, those who fear infection may avoid being tested or disclosing to loved ones; those diagnosed may face limited treatment options provided by harried health care workers within overburdened health care systems.

    Now in its fourth decade, the fight against HIV has seen tremendous breakthroughs in medical technology. A spectrum of antiretroviral (ARV) treatment options now exists and is available around the globe. Clinical studies have proven that taking a daily oral ARV-based pill can reduce a healthy person’s chance of getting the infection — and, other types of ARV prevention products (i.e., gels, rings and injections) are on the horizon. Increased testing through provider-initiated strategies has increased access to both treatment and prevention technologies. There is even some thought that we will have a cure for HIV one day.

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  • Research on key populations leads Botswana to smarter HIV prevention

    At approximately 18 percent, the prevalence of HIV in Botswana’s general population is one of the highest in the world. As a result, national HIV prevention efforts have focused more intensively on the general population than on other populations. Little is known about key populations, such as female sex workers and men who have sex with men, whose behaviors are both stigmatized and illegal in Botswana.

    In 2012, the Botswana Ministry of Health used an integrated behavioral and biological surveillance survey to estimate population sizes and prevalence of HIV and sexually transmitted infections (STIs) among female sex workers and men who have sex with men. The study was historic. For the first time, it showed the HIV and STI burden among these two key populations and raised awareness about how they might have contributed to the generalized HIV epidemic.

    The survey, carried out with technical assistance from FHI 360 through the Preventive Technologies Agreement (funded by the U.S. Agency for International Development), uncovered a population of more than 4,000 female sex workers in the three districts where the survey was conducted. Among these female sex workers, HIV prevalence was 61.9 percent, and the prevalence of gonorrhea and chlamydia were both higher than 10 percent. The female sex workers had a mean of more than seven partners per week, and condom failure, which includes condom breakage and being paid or forced not to use condoms, was common.

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