Category Archives: News

AIDS Vol. 26; No. 5: P. 609-615    (03.13.12):: Ron Gray; and others

Three randomized trials have demonstrated the efficacy of male circumcision for HIV prevention over two years, the authors wrote, “but the longer-term effectiveness of male circumcision is unknown.”

In Rakai, the researchers conducted a randomized trial of male circumcision in 4,996 HIV-negative men ages 15-49. After the trial, male circumcision was offered to control participants, and surveillance was maintained for up to 4.79 years. An as-treated analysis assessed HIV incidence per 100 person-years; Cox regression models, adjusted for sociodemographic and time-dependent sexual behaviors, were used to estimate the effectiveness of male circumcision. “For men uncircumcised at trial closure, sexual risk behaviors at the last trial and first posttrial visits were assessed by subsequent circumcision acceptance to detect behavioral risk compensation,” the authors wrote.

As of Dec. 15, 2010, 78.4 percent of the uncircumcised participants accepted male circumcision after the trial closed. During the posttrial surveillance period, overall HIV incidence was 0.50/100 person-years among the men who were circumcised and 1.93/100 person-years among the men who were not (adjusted effectiveness 73 percent [95 percent confidence interval 55 percent-84 percent]). Among participants of the control arm, posttrial HIV incidence was 0.54/100 person-years in circumcised men and 1.71/100 person-years in the uncircumcised men (adjusted effectiveness 67 percent [95 percent CI 38 percent-83 percent]). No significant differences were noted in sociodemographic characteristics and sexual behaviors between controls who accepted circumcision and those who did not.

“High effectiveness of male circumcision for HIV prevention was maintained for almost five years following trial closure,” the authors concluded. “There was no self-selection or evidence of behavioral risk compensation associated with posttrial male circumcision acceptance.”

To read this article online CLICK HERE.

The HIV/AIDS Translational Training Program (HATT) has been funded by NIMH to provide mentoring and grant related skills to post doctoral or emerging faculty who want to receive NIMH funding for research with under served and marginalized populations at risk for or living with HIV/AIDS.

On May 21 and 22, 2012, the Spring Training Institute will include presentations from scholars who have conducted seed grants and whose findings will form the basis for an R series grant application.

The HATT faculty invites up to 3 post graduate or emerging scholar faculty members to present findings from their CFAR/AIDS Institute grant, in order to receive mentorship and assistance with grant preparation.

The two day workshop from 9AM to 7PM with a working lunch and dinner included, will include presentations by faculty and will be interactive, using the format of NIH grant applications in a mock review approach.

This experience will help past CFAR/AI seed grant recipients to move their pilot research to the next level of federal or private foundation funding.

Interested applicants should contact Louise Datu (310.206.9860) or email a two page letter of intent with a summary of seed grant findings and specific aims to ldatu@mednet.ucla.edu.

HATT faculty includes:
~Gail Wyatt, Ph.D.
~Hector Myers, Ph.D.
~Norweeta Milburn, Ph.D.
~John Williams, M.D.
~Alison Hamilton, Ph.D.

Invited Reviewers:
~Anita Raj, Ph.D, UCSD
~Gilbert Gee, Ph.D, UCLA

AIDSmeds Drug Chart

Antiretroviral options abound for both those who are HIV treatment naive and those who are experienced. Our printable reference chart compares available medication options, including dosing and dietary restrictions.

Download the AIDSmeds Drug Chart here: [Download not found]

By JIM DWYER  Published: April 24, 2012

CLICK HERE to read the article at NYTimes.com

Last year, New York City health workers gave out 37.2 million condoms. That works out to an average of 70 condoms every minute of the year. The city got into mass-scale condom distribution to help prevent the spread of debilitating and deadly diseases.

On the other hand, the condoms are also used to mark people for arrest on prostitution charges.

Here, for example, are affidavits filed in criminal court by two police officers in Brooklyn. They are part of the routine paperwork assembled in prostitution arrests. The first officer wrote that he “recovered from the defendant’s person currency in the following denominations: $1.25. Sexual paraphernalia, namely: One condom.”

The other wrote that he had found “condoms in the quantity of seventeen.”

One arm of the government is giving people condoms. Another arm is confiscating them from the very people who are most vulnerable to catching bugs and passing them along. How, precisely, does this make sense?

Beginning at least three years ago, the city’s Department of Health and Mental Hygiene tried to figure that out. Working with the Sex Workers Project of the Urban Justice Center, the city began collecting information on the confiscation of condoms from people in the commercial sex trade, and on whether the practice discouraged their use.

Audacia Ray, a former sex worker, said police officers often seized condoms, not for arrests, but to roust street prostitutes. “They need to make up their mind, whether the health department wants condoms to be used to protect people, or the Police Department wants to use it to arrest,” Ms. Ray said on Tuesday. “I know that prostitution is illegal and the district attorney does not want to make it any easier for people to do it, but it’s really problematic for public health. At times the condoms are being destroyed in front of people.”

Ms. Ray, who founded the Red Umbrella Project to support people in commercial sex work, said that she regularly stocked up on condoms at a clinic in the Chelsea section of Manhattan.

A year ago, the health department supported state legislation to ban the use of condoms as evidence of prostitution, and to “reduce all legislative barriers to condom use.” It planned to do mini-training sessions at police roll calls on the importance of condoms in preventing the spread of H.I.V.

Then things changed.

The city refused to release its study of sex workers and condom confiscation, written for Dr. Thomas A. Farley, the health commissioner, by Paul Kobrak, the director of risk reduction for the city’s AIDS and H.I.V. prevention bureau, said Sienna Baskin, the co-director of the Sex Workers Project. “They worked with us, and wouldn’t release it,” Ms. Baskin said.
“The report was an internal document,” Chanel Caraway, a spokeswoman for Commissioner Farley, said.Why wasn’t it made public?

Eventually, under the Freedom of Information Law, the city released a version of the report — labeled a draft more than a year after it was completed. Many pages were blacked out. Of the 63 people interviewed, 36 had condoms confiscated from them; 18 said they never carried them because of worries about the police.

“A sizable minority said that condom policing had at some point discouraged them from possessing safer sex materials,” the report stated. A follow-up study by the Sex Workers Project reached similar findings.

DESPITE the clear language of its own report, the city’s health department reversed its position on changing the law.

“After the commissioner reviewed the study, which found that the current law has not resulted in sex workers consistently failing to carry condoms because of fear of arrest, he decided not to support the legislation,” Ms. Caraway said. “We have seen no evidence that the current law undermines the public health aims of condom distribution.”

About 2,000 people a year are arrested on prostitution charges in New York, and the vast majority quickly plead guilty. On one of the rare occasions when a case went to trial, a judge scoffed at the presentation of a condom as evidence.

“I find no probative value at all in finding a condom,” said the judge, Richard M. Weinberg of Manhattan Criminal Court. “In the age of AIDS and H.I.V., if people are sexually active at a certain age, and they are not walking around with condoms, they are fools. I don’t need anything else on condoms.”

Consequences of homelessness – such as not having access to sleeping quarters, regular meals, clean clothing and hygiene essentials – had the greatest single effect on the physical and mental health of homeless HIV patients, according to a University of California-San Francisco (UCSF) survey.
The study’s 288 homeless male participants were given physical and mental health scores between zero and 100. The median physical and mental health scores were 43 and 46, respectively. Unmet basic needs most greatly affected scores, lowering the physical health score 3.8 percent, and the mental score by 3.5 percent. Although regular use of antiretrovirals raised mental health scores 1.7 percent, the drugs only negligibly affected physical health scores.

Elise Riley, the study’s lead author and an associate professor in the UCSF HIV/AIDS division at San Francisco General Hospital (SFGH), said keeping patients healthy and halting the spread of the virus requires a simultaneous focus on subsistence needs and HIV treatments. Spending on medication is “not going to be doing as much good if we don’t have more opportunities for housing or other needs,” said Riley.

SFGH HIV Clinic Medical Director Dr. Brad Hare agrees. He said the recession exacerbates the struggle to regulate treatment for patients who must prioritize basic necessities. “This study validates what we’ve seen,” said Hare. “It recognizes just how important the structural barriers are to HIV care.”

Dr. Edward Machtinger, UCSF’s Women’s HIV program director, found comparable associations between trauma and poor health outcomes for HIV-positive women in other studies. Machtinger said health providers must “ask the real questions” about patients’ needs and prioritize linking them to existing services.

“Our focus in medicine needs to be broader than simply seeing patients in clinic and prescribing medications,” Machtinger said.

The study, “Social, Structural and Behavioral Determinants of Overall Health Status in a Cohort of Homeless and Unstably Housed HIV-Infected Men,” was published in PLoS One.

CLICK HERE to read the study.

CLICK HERE to read the full article on the UCLA CARE website.

A new year of cutting edge research and community relationships.

2012 is a year of paving new ground in HIV prevention research, developing novel treatment approaches for HIV/AIDS, and collaborating with community groups throughout Los Angeles and worldwide.

March 6, 2012

Dr. Raphael Landovitz Awarded $10,000 for Innovative Use of Technology

On March 6, 2012, at the AAHIVM Membership reception at the CROI conference in Seattle, WA, the CARE Center’s Dr. Raphael Landovitz was presented with an AAHIVM/Institute for Technology in Health Care (ITHC) HIV Practice award for his creative use of social media to reach young men-who-have-sex-with-men (YMSM), which included a $10,000 grant.

Dr. Landovitz and his study staff used the GPS-based social networking application, GRINDR, to recruit YMSM to a sexual risk behavior survey.

“Everyone bemoans the fact that it’s difficult to engage YMSMs for interventions, and most larger studies that have been done have focused on the older population,” Dr. Landovitz said. “But statistics show that the individuals most at risk and most impacted by HIV are MSM ages 13 to 29. This is the population where HIV infections are going up most dramatically and consistently – particularly young Latin American and African American men.”

Landovitz and his HIV prevention research team at UCLA decided to launch a study to determine if GRINDR, a location-based networking app popular for MSM, could be used effectively to connect with these individuals. The app works on iPhone, Blackberry, and Android platforms.

Two-person teams went to venues in Los Angeles where YMSM congregate late at night and contacted prospective participants through the GRINDR app to ask if they would complete the survey in return for a $25 iTunes gift card. It took 4,500 individual contacts over five months to eventually obtain the 375 YMSM ages 18-29 who successfully completed the 37-question iPAD-administered survey that focused on beliefs about HIV risks and their own behavior. Even with the late nights, the study team members appreciated the research experience as a great opportunity to test innovative mechanisms for HIV prevention education, a cause close to their hearts.

“I was super excited to work on the GRINDR Study because it was the first of its kind,” says study coordinator Matthew Weissman. “Technology has advanced to the point where everything is digital, so it seems natural to me to tap into these innovative tools and utilize them for research, especially when the target population is young and technologically savvy.  I believe this research is extremely important since young gay men are not only very difficult to recruit into research studies, but also because they are disproportionately burdened by new HIV infections.  The GRINDR study is the first of hopefully many studies that will utilize new avenues in order to reach such an important population in the fight against HIV.”

Study team member Michael Haymer echoes Weissman’s sentiments; “I decided to work on the GRINDR study because understanding how technology functions in the social lives of young gay men has important implications for the health of the community. I have seen the use of technology for partnering evolve over my lifetime – from AOL chat rooms to Craigslist to Adam4Adam – but GRINDR is unique because it allows people to mesh their virtual lives with the tangible possibility (i.e. GPS position) of meeting someone. This interesting dynamic prompted me to join the team because using technology to reach at-risk populations is the future of public health and this innovative study is setting a framework for such work.”

Preliminary study results showed that the sample was 42.4% white, 6.4% African-American, and 33.6% Latino. 359 (95.7%) self-reported an HIV-uninfected status, with a mean of 3.8 (SD 7.2) anal sex partners in the past month. Approximately 41% reporting inconsistent condom use; 20% of partners were HIV-infected or of unknown serostatus. 274 (76.3%) believed that they were unlikely or very unlikely to become HIV-infected in their lifetime. 42 (11.2%) had previous participated in a clinical research study, and only 54 (14.4%) expressed no interest in participation in a future HIV prevention trial; 194 (51.7%) stated they definitely would participate. 13 (3.6%) reported previous use of PEP, and 6 (1.7%) reported previous use of PrEP. The surveys demonstrated that YMSM could be effectively reached through GRINDR, opening up possibilities for future use social networking apps to communicate effectively with vulnerable and difficult-to-reach populations for counseling and care.

In the end, the team’s hard work paid off. Preliminary results are promising, and the study staff gained invaluable experience in conducting research in a high-risk population, with whom they felt a personal connection.

Says study team member Brett Mendenhall; “I felt lucky to be working on a study that used innovative survey methods to target a population that not only is at high risk for HIV exposure, but that I also take a personal interest in.  While it was not an easy process to hit our target of 375 participants, I learned a good deal about adapting study protocols to best suit a population.  Furthermore, I developed a sense of empowerment by using a popular communication tool to educate young MSM about health issues directly impacting them, in environments where these behaviors were most exposed.”

Dr. Landovitz presented these preliminary study results during a slide presentation at the 51^st ICAAC on September 19, 2011.  A manuscript is underway as well.

Article Written By Kieryn Graham.

CLICK HERE to read the article at AIDSBeacon.com

Published: Apr 18, 2012 10:23 am

The CAHR project

Injecting drug use is a hugely significant driver of the HIV epidemic worldwide. CAHR is working with community-based organisations; involving people who use drugs in the design and delivery of services; sharing knowledge and increasing capacity, with the aim of bringing harm reduction services to more than 180,000 injecting drug users.
The website brings together resources, case studies and news from the project to support people working at the frontline of services. The website is an open and accessible resource for anyone with an interest in HIV, drug use and community involvement in harm reduction.The CAHR project is supported by the International HIV/AIDS Alliance and draws on the expertise of a network of international partner organisations. The focus of the project is in five key countries – India, Indonesia, Kenya, China and Malaysia.

The new website has now been launched – you can find it here: www.cahrproject.org

An interesting and informative article by AIDSmeds.com writer Tim Horn.

While studies exploring the effectiveness of antiretroviral (ARV) therapy for HIV prevention purposes have generally yielded encouraging results, a group of researchers at the University of North Carolina at Chapel Hill suggest that the way forward is not entirely clear and that additional research is needed, particularly in understanding the combined benefits of biomedical and behavioral interventions in specific at-risk communities.
“Recent research developments in [pre-exposure prophylaxis, or PrEP] and [treatment of people living with HIV to curtail HIV transmission] provide a unique opportunity to highlight areas of advancement that have galvanized changes in HIV treatment and prevention, and to highlight topic areas that remain undecided and controversial,” write Myron Cohen, MD, and his colleagues in an editorial published ahead of print by the journal AIDS.

The paper reviews much of the scientific research that has contributed to our current understanding of ARV treatment as prevention, including pharmacologic and observational studies, ecological evaluations and various modeling and empirical data. And despite the completion of several sound clinical trials—also summarized by Cohen and his colleagues and reviewed here—gaps in knowledge remain.

CLICK HERE to read the full article.