News and upcoming events
Small Media - what is in the bars and how to get more information about it:
Need Help?
Need Help? (5th edition, striped cover) is an update of our pocket-sized guide to
everything that's gay in London. It's a complete listing of virtually all the help lines,
websites, and support organisations across the capital. It includes contact details for
gay youth groups in several different boroughs. There is a large section on sexual health
clinics, divided up by location (so you can find the one nearest you), clinics that offer
gay-specific services and ones that offer 1-hour HIV testing. You will also find
contact details of support groups for HIV-positive men, victims of homophobic violence,
men who sell sex, and services for black and Asian men, as well as where to go for
counselling services and how to sign up for self-help workshops.
Camden Good Sexual Health Team small media resources
What do you do when you're Wasted? This is a new, mini version of Camden's
booklet about drugs, alcohol and how they affect the decisions gay
men make regarding their sexual health. A Little Bit Wasted looks at the
reasons why gay men use drugs and alcohol in the first place - and
gives practical advice on how to use them more safely or cut down. There is
information about which drugs don't mix together and why - and a section about
which HIV medications have negative interactions with recreational drugs. Wasted
includes advice for recreational drug and alcohol users on how to have safer sex
when high.
'Reasons To Be Tested' is a new mini booklet that explains why it's a good idea to
take a test and know your HIV status. It explains how, if you are HIV-positive,
your best chance of living a long and healthy life lies in knowing your status.
Once diagnosed, you will be able to get the medical, practical and emotional
help that you need.
Upcoming Courses & Workshops for gay men:
Workshops and courses in July and August are:
GMFA Courses
If you want to stop smoking then our seven session Stop Smoking course for gay men can help. Evidence shows that the support you get from a Stop Smoking course, combined with the relief from withdrawal symptoms that Nicotine Replacement Therapy gives you, makes your attempt to quit ten times more likely to succeed than if you use willpower alone.
- The following course begins 7pm Thursday 7th August for 7 weeks
- The next course begins 7pm Tuesday 26th August for 7 weeks
To book a place or for more information, click on the link above or call 020 7738 3712.
PACE Workshops
TwentySomething - is a relaxed and friendly monthly social and support group for gay and bi men in their 20s enabling them to meet others, talk about issues that matter to them and have fun. Monthly events will include discussions and workshops on all aspects of gay life including sex, relationships, coming-out, self esteem and assertiveness.
Mondays: 21 July, 18 August, 15 September. 6.15 till 9.15pm.
Sex Programme - is an opportunity to explore your own sexuality with other gay men in a safe and challenging environment over an eight-week period. Using individual and group exercises, homework assignments and discussion in the group, we will first explore how you relate to yourself sexually, and then move on to consider your sexual relations with other people.
Thursdays: 15 May to 10th July, 6pm. Plus Saturday 17 May and Sunday 6 July.
The Black Connection - is a monthly group for black men who have sex with men, to meet, talk & socialise as well as explore themes that will help celebrate the diverse community, relationships and lifestyles of Black men who love men.
Sundays: 20 July, 17 August, 21 September. 6 till 9pm
Positive Hub - is a monthly space for positive men to talk and engage in a new kind of positive community. This isn't a space for invited speakers and dead end conversations, but for connection, honesty, laughter and exploration.
Sundays: 27 July, 31 August, 28 September. 6 till 9pm
Out of Control? - is a weekend for gay men who are unhappy about the amount or kind of sex they are having.
Begins 6.30pm Friday 11 July. Continues Saturday 12 and Sunday 13 July.
Getting Intimate - is a weekend workshop exploring the art of intimacy and relationship skills. All gay⁄bi men welcome, whether or not in a relationship.
Begins 6.30pm Thursday 24 July. Continues Saturday 26 and Sunday 27 July.
Friend or Foe - is a weekend workshop on self-esteem, exploring how you can relate to yourself in more compassionate, supportive and constructive ways and move away from being critical, nasty or destructive to yourself.
Begins 6.30pm Friday 29 August. Continues Saturday 30 and Sunday 31 August.
Positive Sex - is a weekend workshop for gay men living with the virus to talk with other men and find their own way forward.
Begins 6.30pm Friday 26 September. Continues Saturday 27 and Sunday 28 September.
To book a place or for more information call 020 7700 1323.
THT Courses
Sex Addicts Course
If you see yourself as a sex addict or a sexual compulsive and feel that
your sexual behaviours are having an overwhelming and negative impact
on your life, then we may be able to help. In July, Terrence Higgins Trust
will commence a weekly group programme for gay men who feel that their
relationship with sex is somehow out of control.
Ten week programme begins Wednesday 16 July 2008 at 6.30pm.
For more information, venue details or to book an assessment, call 0207 812 1773.
Other courses
Recently Diagnosed Course - held four times a year, this is a structured course open to anyone newly diagnosed in London who would like to be better informed.
To access this course, call Simon Johnson on 020 7812 1777 during office hours from Monday to Friday.
Living with HIV in Tower Hamlets - this course is for you if you want to know more about sex, intimacy and status disclosure, dealing with medication, coping with frustration, fatigue and isolation, and moving forward with your life.
Whether you are recently diagnosed or have been living with HIV/AIDS for some time you will find this course helpful and fun!
For more information on the next available course, please call Simon on 020 8694 9988 ext 208 or email epp@thepositiveplace.org.uk
Support Groups
The Midweek Group
Thanks to sponsorship from The Eddie Surman Trust (020 7738 6893) and the hospitality of South Central pub in Vauxhall, 'The Midweek Group', formerly supported by the UKC, continues to meet, socialise and have speakers on a regular basis (Tuesdays 6 - 9pm). Anyone interested in joining the group can come along on a Tuesday to enquire about membership.
Support groups for gay men from THT
Newly Diagnosed Gay Men's Group which meets twice a month at a Soho location, a support group for gay men diagnosed within the last year in London.
Gay Men's HIV Support Group which meets each Monday evening at a Soho location, for longer term diagnosed gay men in London.
Negative Partners Group which meets the last Thursday of the month at THT on Gray's Inn Road, open to the negative partner in a serodiscordant relationship.
In the autumn THT will be starting a Sex Addiction Support Group facilitated by their new addictions counsellor.
To access any of the above support groups, please call Simon Johnson on 020 7812 1777 during office hours from Monday to Friday.
Helplines
London Lesbian & Gay Switchboard - 020 7837 7324
LLGS normal opening helpline hours are 10am to 11pm daily.
THT Gay Men's Sexual Health Helpline - 020 7998 4161
This is a new helpline to give, information, advice and support about sexual health to gay men in London, whether they have HIV or not.
Broken Rainbow
The Broken Rainbow LGBT Domestic Violence Helpline is now open during the hours outlined below. The Helpline has recently partnered with London Lesbian & Gay Switchboard to provide an improved service to the Lesbian Gay Bisexual and Transgender community specifically. The helpline is staffed by LGBT people and offers a confidential service, across the UK, and supports LGBT individuals, family, and friends experiencing domestic violence. They also take calls from agencies seeking information and advice.
The Broken Rainbow LGBT Domestic Violence Helpline is open on: Mondays and Thursdays from 2pm to 8pm; Wednesdays 10am till 1pm. The Helpline number is 08452 60 44 60.
Further information is also available via their website: www.broken-rainbow.org.uk.
FS magazine
The summer 2008 issue of FS is now available online and in bars and clubs across
London. You can download the pdf of the current issue by clicking on the image on the
right. Download pdf's of previous issues of FS from the
website.
Issue magazine
The latest edition of 'Issue', the magazine of HIV and sexual health sector development,
has been published. Copies can be obtained by emailing Andie Dyer at
andie.dyer@tht.org.uk.
U+ magazine
Terrence Higgins Trust have launched a new magazine for gay men with HIV. U+ presents
health information in an easy to read magazine format, with a mix of articles, interviews
and quizzes, as well as a problem page.
Each issue focuses on a particular theme. Issue three (out now) is about sex for gay men with HIV dealing with HIV treatment, who's who at your clinic, other ways to look after your body and mind. Click on the image to download a copy from this website.
If you distribute health promotion resources to gay venues in your area, we would particularly encourage you to help us make U+ available on the commercial gay scene.
To order free copies for your organisation, please contact healthpromotion@tht.org.ukMass Media - what is in the press and how to get more information about it:
GMFA's Arse Facts Campaign:
It's tricky getting to know your arse; it's not something you look at everyday.
But whether you're a top, bottom or flip both ways, there are a few essential
facts that you should know to help keep you and your partners safe and healthy.
After reading the facts, why not
enter The Arse Factor for a chance to
win £100 of underwear or swimwear.
For more information contact rob.dawson@gmfa.org.uk
THT's Biology of Transmission Pt 2:
On the 17th December THT launches the new CHAPS national campaign
'Biology of Transmission Pt 2' which aims to alert gay men to the added risk of
using nitrite inhalents (commonly known as 'poppers') when being the receptive
partner during UAI.
The programme of work will be lead by a mass media campaign in gay publications from 19/12 until mid-February and will be supported by a website www.chapsonline.org.uk/biology; a new booklet 'Ready for action' which details how HIV is passed and how to reduce the risk; Exposed! 11, and a CHAPS Poppers Sector Summary Report.
For more information on the campaign and materials contact campbell.parker@tht.org.uk
Counselling waiting times & information:
New Counselling Service from GMIP
The new GMI partnership counselling Service offers talking therapies which are designed to assist men who have sex with men:
- identify their risk factors for unsafe sex
- reflect on the issues and challenges in practising safer sex
- set goals and plan and implement strategies for reducing or eliminating risk.
This service is open to all men who have sex with men regardless of HIV status who have concerns with adopting or maintaining safer sex and HIV risk reduction behaviour. All men entering the Service will be offered a confidential assessment, and through a process of discussion will be able to identify the most appropriate talking therapy for them. These include:
- cognitive behaviour therapy
- peer mentoring
- sexual health counselling
For further information or to book an appointment please call 020 8305 5002 or email info@gmipartnership.org.uk.
Healthy Gay Living Counselling @ THT
THT now have a dedicated substance misuse and addictions counsellor within the well-being team offering a One-2-One service to gay and bisexual men. It may well be that you do not want to talk to friends or family about your concerns so if you are worried or anxious about the drugs you take, then this counselling resource may be able to help. So if your relationship with drugs is having a negative impact on other areas of your life, feels out of control or you are using drugs in combination and don't know what the consequences might be, feel free to call us with your concerns. You can arrange an assessment by calling the Wellbeing Service on 020 7812 1777 and speak with either Simon or Jason.
Also appointed is a specialist young person's counsellor working with young men living, working or studying in the borough of Southwark. To access this service you need to be male, aged between 16 and 24 and either gay, bisexual or questioning your sexuality. There is currently no waiting time for this service.
Languages we can provided counselling in are: English, French, German, Portuguese, Spanish, Italian, Yoruba, Luganda, Shona. Counselling is available for couples and individuals at sites across London, with appointments available in the evenings or on Saturdays, as well as during the day.
To book an appointment call Simon Johnson on 020 7812 1777 - Office hours are 9.30am to 5.30pm
Volunteers needed
The Gay Men's Interactions Partnership has exciting new opportunities for
volunteer peer mentors, counsellors and health trainers. For more information
click on the image to view the full advert, call 020 8583 2404 or email
info@gmipartnership.org.uk
Sector Information
Resources from THT
Healthy Respect
The Healthy Respect web pages give advice and information for people who have experienced problems with their healthcare because of their HIV status. Problems with GPs, dentists and other healthcare professionals are highlighted and solutions are offered. For more information, visit www.tht.org.uk/healthyrespect
GPs and Gay Men (CHAPS)
This programme of work has launched with the aim of providing gay and bisexual men with information which will enable them to have a better understanding of how the healthcare system works and why being gay or bisexual is important to their health care.
The programme includes a website for gay men including issues such as how the health
system works, what it can do and how being gay might effect your health and healthcare.
This can be found at
http://gpsandgaymen.chapsonline.org.uk
The website also contain a health professionals’ section containing extra
resources to ensure their services are meeting the needs of their gay and bisexual
patients.
A booklet accompanying this site, ‘GP treatment for gay and bisexual men’ is also available by contacting James Glavin at james.glavin@tht.org.uk or can be ordered individually by calling THT Direct 0845 12 21 200.
Your next steps
This booklet is for you if you’ve just found out you have HIV. You might also find it helpful if you’ve known for a while, but have not wanted to think about it much until now.
The booklet covers things that we often want to know about at this time.
There’s straightforward information about what HIV is and how we can
look after our health. The booklet talks about having sex when you have HIV,
and whether or not it’s a good idea to share your news with other people.
‘Your next steps’ is available by contacting James Glavin at james.glavin@tht.org.uk or can be ordered individually by calling THT Direct 0845 12 21 200.
Advice services for Homeless LGBT people across London are saved and will expand
Stonewall Housing is delighted to announce that its vital advice service for
LGBT Londoners has been secured, due to new funding from London Councils. This
means that lesbian, gay, bisexual and transgender people who are homeless or
experiencing housing crisis will be able to access specialist, expert advice
from Stonewall Housing until 2012.
Anyone who is homeless or has a housing problem and needs advice can call the advice line: 020 7359 5767. www.stonewallhousing.org.
Other Services or events of interest to gay men in London.
Living Well
Living Well is an NHS funded programme and is one of the core healthcare initiatives being offered to people living with HIV across London. Living Well provides a wide range of options that are intended to promote long-term life skills, encourage the development of a supportive social community and empower participants with the ability to self manage their condition and work in partnership with their health care professionals.
Options provided are:
Non-residential Weekend
Participants who have completed the PSMP are invited to attend an optional residential weekend. This is an opportunity to engage in workshops that will encourage a deeper experience and exploration of some of the issues and topics raised throughout the seven week programme
Facilitator Training
Training is offered to participants who have completed the PSMP and wish to become tutors, delivering the PSMP to their peers. Training is delivered under assessed conditions under license of Stanford University.
Life-Coaching
Twelve one-to-one sessions are offered with a qualified coaching psychologist. Coaching is suitable for clients who are keen to work strategically towards achieving future goals.
Counselling
Hour long sessions with a Living Well counsellor. These sessions are suitable for clients who are dealing with emotional issues which are usually related to their HIV status.
Positive East
The Gay Men's Team at Positive East offers a comprehensive range of services for gay men and men who have sex with men who are positive, negative or untested, who live or work in East London. For details visit www.gaymenswellbeing.com, email us at gaymen@positiveeast.org.uk or telephone Positive East on 020 7791 2855.
Himat, a group for South Asian gay, bisexual and men who have sex with men exploring issues of sexuality, culture, religion and race. For many South Asian gay men in London, facing up to being different can be full of unique problems. Being a minority within a minority can create a strong sense of isolation from other gay men. For details on Himat visit www.gaymenswellbeing.com or call on 020 7791 2855.
Positive Life is an activities group for HIV positive gay and bisexual men. The groups main aims are to offer a non-scene space for gay and bisexual men to meet and discuss topics of interest; to make friends with other positive gay men; be able to share experiences and where they can give and/or receive support, as well as an opportunity to learn new skills. For details on Positive Life go to www.gaymenswellbeing.com email positivelife@positiveeast.co.uk or call on 020 7791 2855
Signpost, a confidential telephone helpline for men who have sex with men provides basic information and guidance on sexual health, HIV/STI's as well as accessing services and groups across east London. Signpost operates every Tuesday and Thursday from 6.30 to 8.30pm on 020 7790 5795. For details on Signpost visit www.gaymenswellbeing.com
Interesting articles and news from around the world:
Sex partners link trust with low STD risk
VANCOUVER, British Columbia, June 30 (UPI) - People often determine a sexual partner's risk for sexually transmitted disease by how long they have known each other, Canadian researchers said.
Cindy Masaro of the University of British Columbia and colleagues had 317 people at Canadian STD clinics complete questionnaires. The study subjects were questioned on their first visit to the clinic and had not yet been diagnosed with a STD.
A Partner Safety Beliefs Scale was developed to determine the factors that most influenced perceived partner safety.
The study, published in the journal Sexually Transmitted Diseases, said study participants endorsed statements indicating that knowing or trusting a sexual partner influences their beliefs about their partner's safety.
Linear regression analysis indicated that those well-educated and with higher incomes were more often considered "safe" from STDs/HIV, the study said.
The results indicate that many individuals rely on partner attributes and relationship characteristics when assessing the STD/HIV status of a sexual partner, and that this reliance is associated with a decreased perception of personal STD/HIV risk.
AIDS groups urge African leaders to devote more to effort
NEW YORK: Farai Mahaso was studying accounting in London when he received the dreaded call from Harare, Zimbabwe: His mother had died.
At that point, Mahaso's future work became clear.
His mother, Auxillia Chimusoro, was a hero to many in Zimbabwe for becoming the first person to publicly declare her HIV-positive status in 1989. She worked to demystify HIV/AIDS and formed dozens of support groups throughout the southern Africa country.
"More than 1.3 million people are living with HIV, and more than 23,000 people are dying every week," Mahaso said. " thought of that, and I said it was better for me to go to Zimbabwe and do something about HIV."
Mahaso is now an officer with Batanai, one of the groups started by his mother, who died in 1998.
Southern Africa remains the global center of the epidemic, with almost one in three of all people infected with the disease living in this subregion, according to a recent United Nations report.
In the wider sub-Saharan Africa, there have been some victories in the battle against the disease. Many point to Uganda and Senegal among a handful of countries that have made progress.
But activists and international AIDS organizations continue to criticize many governments for failing to devote the needed time and energy to preventing their populations from contracting HIV and treating those infected with the disease.
The U.N. report said that about 25 million people live with HIV in sub-Saharan Africa, 64 percent of all people living with the disease in the world.
Some African leaders are beginning to get the message. At the recent UNAIDS High-Level Meeting in New York, several presidents pledged to move more aggressively to fight the disease in their countries.
President Faure Gnassingbe of Togo said he was concerned about the stigma that many with AIDS face in his tiny West African country.
"We should not add moral suffering to the physical suffering that those with the virus are already suffering," Gnassingbe told The Miami Herald, adding that his country needs international help to scale up its anti-AIDS efforts.
"We need access to international funds," said Gnassingbe, who succeeded his father in 2005. "Togo has already missed two rounds of funding. My presence here is to make sure we don't miss any more."
Mahaso said he would welcome more energy from the continent's leaders. In many countries, civil society groups have waged a lonely fight. In Zimbabwe, for example, a long-running political feud between President Robert Mugabe and the opposition has been a barrier to better care for those suffering with HIV and AIDS.
The U.N. report said that Zimbabwe showed a decline in the number of people living with AIDS because many were dying without access to medication.
Also, many doctors and nurses, fearing political violence and intimidation, have fled the country, Mahaso said.
"A lot of good personnel leave to go to rich countries. We train people, then they leave," said Mahaso, 40. " feel the government could do a lot more to help."
But he is not waiting on the government. Batanai has formed international partnerships and is operating centers around the country. The centers provide counseling and medical supplies through funding from the United States and other countries.
It was vital to expand services beyond Harare, the capital, Mahaso said.
"When people get sick here, they go home to the rural areas to die," he said. "We have to be there."
In the future, Mahaso said his organization plans to open even more counseling centers to keep up with the need. He says about 360,000 people need medication but that less than 30,000 get the drugs.
That's why Mahaso said he plans to remain in Zimbabwe, carrying on his mother's legacy.
"I was inspired by my mother and what she was doing," he said. "I've taken the negative of the situation in Zimbabwe and made it a positive energy. Now, that positive energy is helping people with HIV and AIDS."
Reference: Miami Herald - June 29, 2008 - John Yearwood
UN Organs Train Beijing Olympic Volunteers in AIDS Awareness
BEIJING: About 5,500 volunteers for the Beijing Olympic Games have received training about HIV/AIDS awareness, prevention and how to avoid disease-related discrimination, UNAIDS recently announced. People with HIV/AIDS were among the trainers. In addition, about 100,000 volunteers for the Olympic and Paralympic games received a basic information package about the same issues.
"Many young people do not have the right information on AIDS -- fueling false fears, stigma, and discrimination. This is bad in itself and also hampers HIV prevention work," said Bernhard Schwartlander, the UNAIDS country coordinator in China. "Engaging some of China's most capable young people and making them the messengers of positive and correct knowledge on HIV can help dispel inaccurate myths and break down the stigma and discrimination against people affected with HIV/AIDS."
The volunteers will now be prepared to welcome everyone to the Olympic Games, especially those with HIV/AIDS, said Subinay Nandy, the country director of the UN Development Program, which co-funded the June 14-15 training session with UNAIDS and UN Volunteers (UNV). In addition to their roles as Olympic ambassadors, Nandy hopes the youths will continue to share their knowledge about HIV with others as well.
The training was jointly convened by UNAIDS and UNV, in cooperation with the Beijing Communist Youth League, Marie Stopes International China, and the Red Cross Society of China.
The more people take anti-HIV treatment, and the sooner they start, the more new infections are averted
CANADA: Expanded use of antiretroviral therapy - accompanied by good adherence - has the potential to significantly reduce the spread of HIV, according to the results of a mathematical model developed by Canadian researchers and published in the July 1st edition of the Journal of Infectious Diseases.
They calculated that over two-thirds of all projected new HIV infections by 2030 in British Columbia would be averted if all individuals eligible for antiretroviral therapy started such treatment when their CD4 cell count was in the region of 350 cells/mm3 - the current recommended threshold for initiating anti-HIV treatment.
There is unlikely to be an effective vaccine for HIV for some time and current prevention work is only partially effective. Treatment with anti-HIV drugs can mean a longer, healthier life for HIV-positive individuals, and access to antiretroviral therapy is expanding across the globe.
As well as having benefits for the individual patients, antiretroviral therapy may also have public health benefit. Treatment with anti-HIV drugs lowers the amount of HIV in the body, significantly reducing the infectiousness of HIV-infected individuals. In a recent controversial statement, leading HIV physicians in Switzerland suggested that patients taking anti-HIV treatment who have had an undetectable viral load in their blood for at least six months, who take their treatment properly, and who do not have a sexually transmitted infection, should not be considered infectious to their sex partners.
Even in countries with universal access to antiretroviral therapy, large numbers of patients do not start treatment, even when their CD4 cell count suggests that they are at risk of developing an AIDS-defining illness. Very high levels of adherence to anti-HIV treatment are needed to obtain the best results and to avoid the development of drug resistance, but many patients find this difficult to achieve and maintain.
Investigators in the Canadian province of British Columbia, which has universal free access to antiretroviral therapy, developed a series of mathematical models to assess how increasing access to antiretroviral therapy, the early initiation of anti-HIV treatment, and improved levels of adherence would affect the spread of HIV in the province by 2030.
At the moment only 50% of HIV-positive individuals in British Columbia start antiretroviral therapy before their CD4 cell count falls to below 200 cells/mm3, and patients on treatment take approximately 78% of their doses well below the 95% target and at the level which involves the greatest risk for the development of drug resistant virus. The investigators calculated that this level of treatment coverage and adherence would lead to a modest increase in the annual number of new HIV infections every year from 421 in 2006 to 462 in 2030.
They then calculated the potential impact of more patients starting anti-HIV treatment before their CD4 cell count fell to the 200 cells/mm3 threshold. Their calculations showed that if 75% of eligible patients had started treatment by this stage it would yield a 37% reduction in the total number of new HIV infections, and if 100% of patients had started treatment by the time before they reached a CD4 cell count of 200 cells/mm3, then 62% of onward transmissions would be averted.
HIV treatment guidelines around the world now recommend that patients should start antiretroviral therapy when their CD4 cell count is in the region of 350 cells/mm3 and the investigators included this earlier initiation of therapy into their models.
Once again, they found that the current coverage rate of 50%, accompanied by 78% adherence would mean a modest increase in the number of annual HIV infections.
But they found that greater coverage of anti-HIV treatment would result in substantial reductions in the number of new HIV infections. Their calculations showed that if 75% of patients started treatment when their CD4 cell count was 350 cells/mm3, then 40% of the projected new infections by 2030 would be averted, and this increased to 67% of anticipated infections if all patients started treatment when their CD4 cell count was around 350 cells/mm3. Increasing patient adherence would further modestly increase the number of averted infections.
Faster expansion of anti-HIV treatment would result in faster decreases in the numbers of new infections, according to the investigators' model. Furthermore, immediate expansion of access to anti-HIV treatment would save a total of Canadian $95 million, or Canadian $368,000 per patient.
"Our results indicate that higher HAART coverage consistently leads to a decrease in the number of individuals testing newly positive for HIV", write the investigators. They conclude, "expansion of HAART coverage should lead to a substantial reduction of the growth of the HIV epidemic and related direct treatment costs. Our model supports a powerful and as-of-yet little appreciated additive preventative value for expanding HAART coverage."
Reference: Lima VD et al. Expanded access to highly active antiretroviral therapy: a potentially powerful strategy to curb the growth of the HIV epidemic. J Infect Dis 198 (online edition), 2008.
Scoring tool predicts risk of KS progression
SWITZERLAND: Swiss researchers have developed a scoring tool to help identify HIV-positive patients with Kaposi's sarcoma (KS) who are most likely to experience KS disease progression. The tool, they write in a report in the May 31st edition of AIDS, can help target treatment to patients who would benefit the most, while sparing lower-risk cases.
Effective HIV therapy has reduced incidence of Kaposi's sarcoma among people with HIV, with dramatic decreases in the number of new cases seen following the introduction of effective antiretroviral therapy in the mid 1990s. Nonetheless, response of established KS to treatment is unpredictable; some cases regress, many progress, and 30% of patients with progression will die.
There is little information on predictors of KS disease progression, and clinicians have difficulty in directing treatment for KS to the patients who are mostly likely to have progression. A scoring method would help identify high-risk patients while sparing lower-risk patients the toxicity associated with anti-KS chemotherapy.
To better understand predictors of KS progression, investigators with the Swiss HIV Cohort Study performed a retrospective analysis of cases of KS pulled from the study's extensive database. The records of patients with laboratory confirmed or clinically diagnosed KS were evaluated for a series of potential prognostic factors, including sociodemographic characteristics, KS disease stage, characteristics of HIV disease and treatment and virologic markers of infection by human herpesvirus 8 (HHV-8), the virus associated with KS.
KS tumours were staged as either T0: KS lesions confined to the skin, lymph nodes or with limited oral involvement; or T1: advanced KS of the skin and mouth, KS-associated oedema, or KS involving any visceral organ. Virologic markers of HHV8 were quantitative PCR of HHV-8 DNA and titres for antibodies against the virus.
Investigators recorded prognostic factors at baseline and then looked to see which cases resulted in chemotherapy or in death. Chemotherapy was started in 27% of cases, and the mortality rate, due to any cause, was 21%. These numbers, the investigators note, are in line with other published reports of KS survival.
In multivariate analysis the investigators identified three baseline factors associated with increased risk of poor outcome:
- Disease stage of T1 with a hazard ratio (HR) of 5.22 (p < 0.001), that is, patients with T1 stage disease were just over five times more likely to go on to need chemotherapy or to die
- CD4 cell count below 200 cells/mm3, with a HR of 2.33 (p = 0.01)
- PCR assay positive for HHV8 DNA, with a HR of 2.14 (p = 0.01)
Factors not associated with a worse outcome included age, sex, sexual orientation, geographic origin or the use of antiretroviral therapy.
Based on the three factors and their associated risks, the investigators proposed a simple scoring system in which T1 disease stage counts for two points and CD4 cell count below 200 cells/mm3 and positive HHV8 DNA PCR both count for one point.
"Our score is simple to use at the patient's bedside," the investigators write. "Each point increase in the scale is associated with a two-fold increase in the risk of death or need for chemotherapy. We suggest that patients with an index of two or more have a poor risk and should be followed more closely and chemotherapy should be considered, whereas patients with a lower score could be treated with HAART alone." A recent report by Italian researchers has suggested that antiretroviral therapy may be key to treating KS.
The investigators note that both KS disease stage and CD4 cell count have been previously associated with disease progression, but theirs is the first study to identify HHV-8 DNA quantification as a predictor. Results from the few, small studies completed have suggested that the absence of HHV8 in blood cells predicts a better clinical response.
The investigators also highlight that, in contrast with some reports that protease inhibitor-based antiretroviral regimens may be more effective at controlling KS than non-nucleoside reverse transcriptase inhibitor-based regimens, their results revealed no difference in outcomes between antiretroviral regimen types.
Reference: Boffi El Amari E et al. Predicting the evolution of Kaposi sarcoma, in the highly active antiretroviral therapy era. AIDS 22:1010 1028, 2008.
Researchers blame HPV for rise in throat cancer
CHICAGO: For five grueling months in 2006 and 2007, Carol Kanga suffered through treatment for a life-threatening case of throat cancer linked to an unlikely source: a sexually transmitted viral infection.
Unable to swallow food or water during chemotherapy and radiation treatment, Kanga was fed through a stomach tube. Her one respite came on Thanksgiving, when she savored a single spoonful of weak broth.
"The radiation basically burns the skin off the outside and inside of your throat," said Kanga, 52, a Rockville, Md., artist. "It's like there's a fire inside your neck."
Kanga's treatment was successful, but the virus that struck her is causing increasing concern among some researchers who think it is causing a small-scale epidemic of throat cancer.
That virus, scientists have proved only in the last two years, is human papillomavirus, or HPVthe same virus that's behind most cases of cervical cancer.
With 6,000 cases per year and an annual increase of up to 10 percent in men younger than 60, some researchers say the HPV-linked throat cancers could overtake cervical cancer in the next decade.
"It's almost a new disease, in a sense," said Dr. Ezra Cohen, an oncologist at the University of Chicago Medical Center. "It's now becoming a dominant sub-type of the disease that we see in our clinic."
The HPV infections likely took root decades ago as the Baby Boomers were reaching adulthood, and only now are spurring a rise in throat cancer cases, mostly among men and women in their 50s.
No one understands the precise reason for the increase, though experts suspect it's linked to changes in sexual practices that emerged in the 1960s and '70s. For example, oral sex is a known risk factor for HPV-related throat cancers, and studies have shown that people who have come of age since the 1950s are more likely to have engaged in oral sex than those who were born earlier.
"Those people were in their teens during the sexual revolution, so they may be leading the wave," said Dr. Maura Gillison, a professor of oncology and epidemiology at the Johns Hopkins Kimmel Cancer Center who has published numerous studies indicating that HPV-related throat cancer is a distinct type of disease.
The virus targets a specific portion of the upper throat called the oropharynx, which includes the tonsils and base of the tongue. Just a decade ago, doctors believed nearly all such cancers were linked with smoking or extremely heavy drinking.
Last year, however, Gillison's team published a major study that found stark differences between the risky behaviors of throat cancer patients with HPV and those without. The HPV-positive cancer patients tended to have had higher numbers of sex partners than the others and were far more likely to have had multiple oral-sex partners.
Although Gillison had been methodically testing the HPV link to throat cancer since the late 1990s, she did not expect to see such clear signs that the cancer was hitting a distinct set of patients. The HPV-positive cancers even looked subtly different under a microscope.
"I realized it's an absolutely different disease," Gillison said.
Scientists think the virus causes cancer by commandeering part of a cell's molecular machinery. It seems to interfere with the function of a key gene that normally would cause cells with potentially cancerous mutations to self-destruct.
The virus-linked cancer appears somewhat less deadly than throat cancers that arise from smoking or drinking. A paper published this year found that 96 percent of HPV-positive patients survived at least two years after diagnosis, compared with 62 percent survival for HPV-negative cancers.
"They have a better prognosis, but these are still very aggressive cancers," said Dr. Marshall Posner, medical director of head and neck oncology at the Dana-Farber/Harvard Cancer Center in Boston.
While doctors had hoped for an overall drop in throat cancer as the percentage of Americans who smoke declined, the rise of HPV-related throat cancers seems to be offsetting any such benefit.
Gillison's group tested hundreds of head and neck tumors that doctors began saving in the early 1970s, long before anyone knew such cancers might be linked to HPV. The work showed that the number of HPV-positive tumors increased by about 1 percent a year on average, though the trend has quickened in the last decade, especially in men younger than 60.
More from this article here: Chicago Tribune
HIV men 'having unsafe sex'
LONDON: 21 June 2008, the BBC reports on a study that suggests a third of gay men who know they are HIV positive are still having unsafe sex.
To watch the report visit: www.bbc.co.uk
Kerry/Smith - America's unfair HIV/AIDS policy
WASHINGTON: There are approximately 32 million people outside of the United States living with HIV/AIDS. Since 2003, America has extended a helping hand to these individuals by spending more than $15 billion on the largest international health commitment ever to fight a single disease. Unfortunately, as we open our wallets to fund lifesaving treatments to those living with HIV/AIDS overseas, we will not open our doors.
Today, HIV is the only medical condition that renders people inadmissible to the United States. In fact, we are just one of 12 countries that prohibit, almost without exception, HIV-positive non-citizens from entering the country (China has recently overturned its ban). This policy places the United States in the same company as Sudan, Russia, Libya and Saudi Arabia.
Such a discriminatory policy has no basis in public health, let alone common sense.
We are proud to have introduced the HIV Nondiscrimination in Travel and Immigration Act to overturn this unfair policy.
There is no excuse for a law that goes out of its way to stigmatize a particular disease and separate parents from children, sisters from brothers, and people of all stripes from their work, travel and dreams of a better life.
We are glad that President Bush wants to weaken the ban - but we should simply strike it from the books so that HIV is considered like any other infectious disease. Our bill has been included in the Senate version of the President's Emergency Plan for AIDS Relief (PEPFAR) reauthorization bill and we hope that this legislation passes and is signed into law so we can finally get rid of this outdated policy.
The law we seek to overturn first came into being back in 1987, when a deadly, explosive epidemic spawned a climate of fear and ignorance that got the better of many well-intentioned people. A sense that HIV/AIDS was a dangerous disease that belonged exclusively to others - to people from another continent or those who practice a different lifestyle - hardened into a bunker mentality.
But in 2008, we know better. HIV is transmitted through sex or needle-sharing - not the casual contact that might lead a government to aggressively restrict movement. We have known better for years - which is why then-Presidents George H.W. Bush and Bill Clinton also supported overturning the ban.
There is no just cause for treating those with HIV-AIDS as modern-day lepers, and many of us personally know at least one of the 1 million HIV-positive Americans who rise above the stigma of their disease to lead long and productive lives.
Laws denying freedom of movement to the HIV-positive aren't just immoral - they also hurt our ability to fight and understand the disease. The International AIDS Society, one of the most important groups dedicated to combating HIV/AIDS has held its last two biannual conferences in Canada and Mexico because it desperately wants American scientists to attend, but too many of its researchers and panelists cannot enter the country. Being able to host conferences like these is a crucial factor in - and an important symbol of - leading the world's fight against HIV/AIDS.
We have come a long way and we are proud of that. It wasn't that long ago when the name of this disease was rarely uttered in public. Today, the current president doesn't just talk about fighting HIV/AIDS, but works with Congress to put another $30 billion behind America's words.
Actions matter. Leading by example in the fight against HIV/AIDS has left millions in the developing world grateful to America for our life-saving help.
It's time we sent the same message by finally ending our needlessly discriminatory laws penalizing those with HIV/AIDS.
Reference: Washington Times, Wednesday, June 25, 2008
Rapid rises in diagnoses in US gay men concentrated in black and younger men
The number of HIV diagnoses continues to rise in American gay men and other men who have sex with men (MSM), with especially rapid increases seen in young black men, according to figures released by the Centers for Disease Control and Prevention (CDC) in the June 27th edition of the Morbidity and Mortality Weekly Report.
The CDC tracked new diagnoses of HIV from 2001-2006, and calculated the estimated annual percentage change in diagnoses. For gay men and other MSM, the annual rise was 1.5%.
The analysis covers the 33 states that had a system of confidential, name-based HIV case reporting throughout the five year period. This includes a number of states with large gay populations, including New York, Florida and Texas, but not others such as California and Illinois.
During this time, a total of 214,379 people were newly diagnosed with HIV, and 46% of the diagnoses were in gay men and other MSM. There were statistically significant decreases in diagnoses for all transmission categories apart from gay men and other MSM. For example, there was a 4.4% annual decrease for heterosexuals, and a 9.5% annual decrease for injecting drug users.
However, diagnoses in gay men and other MSM increased by 1.5% each year (95% CI: 0.8 2.1), or 8.6% over the five year period. Moreover, there were marked variations in the increase in diagnoses in gay men and other MSM, according to race and to age.
Annual increases in black men and in Hispanic men were both 1.9%, in contrast to 0.7% seen in white men. A total of 36% of all diagnoses were in black men, although only 12% of the US population is black.
Moreover, the estimated annual increase in Asian and Pacific Island men was 12.1%. However as the total number of infections remains low in this group, the confidence intervals for this figure are relatively wide (95% CI: 5.0 19.6).
In terms of age, there were particularly large increases in diagnoses amongst the youngest men in all ethnic groups. For men aged 13-24, looking at all ethnicities together, the increase each year was 12.4%. A particularly large annual increase was seen in young black men 14.9%, amounting to 93.1% over the five years.
Although the greatest increases were in the youngest men, this group only contributed 14% of the total number of diagnoses. As has long been the case, the majority of diagnoses occurred in the 25-44 age group. However the trends here are more encouraging, with an annual decrease of 1.1%, and decreases concentrated in both white and black men.
Diagnoses increased amongst those aged over 45, however, rising by 2.7% each year. There was a particularly marked increase of 3.8% in white men of this age group (compared to the increase of 0.7% for white men of all ages).
Finally, there were large variations according to region, with greater increases in the South and the Midwest.
During this period, and in contrast to the UK, the US reporting system was not set up to provide accurate measures of HIV incidence (i.e. the rate of new infections in the population). However this data does strongly suggest that incidence is rising in many groups of American men who have sex with men, and may be higher than previously estimated.
At the Conference on Retroviruses and Opportunistic Infections earlier this year, Ron Stall of the University of Pittsburgh had said that his systematic review of incidence studies concluded that incidence in community samples of American gay men was around 2.4% a year. Moreover, Stall went on to demonstrate the long term implications of such an incidence rate.
Taking this figure as a starting point, Stall ran a mathematic model to see how this incidence in a group of 18 year-olds would translate into HIV prevalence as the group got older. The key assumptions of the model were that each year 2.4% of the group acquired HIV, and that mortality rates were the same as for equivalent age groups in the general population.
By age 20, around 5% of the group would be HIV-positive; by age 25, around 15% would have HIV; by age 30, around 25% would be living with HIV, and when they were 40, 41% of the group would be HIV-positive.
Moreover, Stall re-ran the model for black men, based on a "low" estimate of 4% incidence in this group. The results were even more alarming: by age 40, around 60% of the group would have HIV.
Stall commented that he was "horrified" by these estimates. However he concluded that "at the HIV incidence rates we're already seeing in the published literature, we can expect an ongoing HIV epidemic among gay men that will yield high prevalence rates over time."
Commenting on the CDC figures to the New York Times, Jennifer Hecht of the Stop AIDS Project in San Francisco said: "The high rates we see among black men and other minorities indicate that it's very much connected to larger issues like poverty and racism."
References: Centers for Disease Control and Prevention. Trends in HIV/AIDS diagnoses among men who have sex with men 33 states, 2001-2006. MMWR 57: 681-686, 2008. Stall R et al. What's driving the US epidemic in men who have sex with men. 15th Conference on Retroviruses and Opportunistic Infections, Boston, abstract 53, 2008.
Risk of death for people with HIV now similar to that seen in the general population
Thanks to improving anti-HIV treatment, people with HIV, in the first five years after diagnosis with HIV, now have mortality rates similar to those seen in the general population, according to a large European study published in the July 2nd edition of the Journal of the American Medical Associations.
However, although the investigators also found a dramatic overall reduction in the risk of death for people with HIV since effective anti-HIV treatment became available in 1996, they still found that longer-term infection with HIV was still associated with an increased risk of death.
Many studies have recorded significant and sustained falls in rates of serious illness and death in HIV-positive patients in countries like the UK since effective anti-HIV treatment became available. But soon after such treatment was first introduced, a Swiss study suggested that even patients doing well on antiretroviral therapy still had an increased risk of death compared to HIV-negative individuals of a similar age.
However, earlier studies examining the impact of treatment on mortality were limited because they lacked information on the duration of HIV infection in their populations. Furthermore, anti-HIV treatment and care has improved significantly in recent years, and anti-HIV drugs are now considerably more potent, less toxic and easier to take than the first generation of effective anti-HIV medicines.
Investigators from the European CASCADE cohort collaboration, therefore, looked at rates of death amongst HIV-positive patients enrolled in 23 cohort studies and compared these to those seen in the general age-matched population. All the patients enrolled in the CASCADE cohorts had a date of infection with HIV that was accurate to within 18 months. Data were also available on the use of antiretroviral therapy.
A total of 16,534 HIV-positive individuals were included in the investigators' analysis. These patients were infected with HIV between 1980 and 2006, the median year of infection being 1994. The majority of patients were infected with HIV via sex with another man (57%), with 24% of infections attributed to heterosexual sex and 18% to injecting drug use. The median duration of follow-up was a little over six years.
In all, 2571 individuals died by the end of 2006. This compared to an estimated mortality of 235 for age-matched HIV-negative individuals.
But the rate of excess mortality amongst patients with HIV declined significantly during the period under observation. Before effective anti-HIV treatment became available in 1996, patients with HIV had an excess mortality rate of 41 per 1000 patient years. This decreased in every subsequent year and was just 6 per 1000 patient years by the period, 2004 06. Indeed, in this most recent period, patients with HIV had an increased hazard of death compared to HIV-negative individuals of just 0.09 (95% CI, 0.07 0.11).
Factors associated with an increased risk of death were older age (p < 0.001) and infection with HIV via injecting drug use (p < 0.001). Women appeared to have a lower risk of death than men (p = 0.001). But in subsequent multivariate analysis, only injecting drug use remained associated with a significantly increased risk of death (p < 0.001).
When the investigators took a closer look at mortality amongst patients infected with HIV through sex, they found that mortality rates for these individuals decreased towards background levels seen amongst their HIV-negative peers between 1996 and 2006. Indeed, by 2004 06, there was no evidence of any excess mortality amongst patients with HIV in any age group during the first five years following infection with HIV.
But in the longer-term, some excess mortality was still evident, being 4.8% amongst 15 24 year olds in the first ten years after infection with HIV and 4.3% in those aged 45 and above.
Rates of excess mortality were, however, higher amongst injecting drug users, being 5% greater than rate seen in the general population in the first five years after diagnosis with HIV, increasing to 6.2% by year ten.
The investigators then looked at uptake of antiretroviral therapy. They found that the amount of time patients spent on anti-HIV treatment increased from 17% in 1996-97 to 73% by 2004 06. Approximately equal numbers of patients were taking antiretroviral regimens based on NNRTIs (40%) and protease inhibitors (42%) by 2006. Of the patients taking a protease inhibitor, 79% were taking a ritonavir-boosted protease inhibitor by 2006.
"We found that the gap in mortality rates between HIV-infected individuals in our study and the general population narrowed in every calendar period from 1996 onwards", write the investigators. By 2004 06, excess mortality amongst people with HIV was "94% lower than pre-1996 levels." Accompanying this decreased risk of death was increased uptake of antiretroviral therapy and increased use of more potent and effective regimens those based on an NNRTI or boosted protease inhibitor.
The investigators note that many of the patients in their study had been infected with HIV for a considerable time. They therefore believe that the excess mortality rate seen ten years after diagnosis "may be pessimistic in terms of the long-term outlook for more recently infected individuals."
Despite this optimism the investigators caution: "it is likely that even with current standards of HIV management, some long-term excess mortality would remain because problems of toxicity, resistance, and therapy adherence are likely to increase with time receiving highly active antiretroviral therapy."
Reference: Bhaskaran K et al. Changes in the risk of death after HIV seroconversion compared with mortality in the general population. Journal of the American Medical Association, 300: 51 59, 2008.
Disclaimer: Please don’t assume that GMFA or the London Gay Men’s HIV Prevention Partnership endorse or oppose the points of view of the authors. Please read these articles critically. Sometimes articles may contain mis-statements, we believe they are important to include because of the information they contain or the arguments they put forward. If you have a story or article on STI or HIV prevention which you would like to be distributed please forward it to lgmhpp.update@gmfa.org.uk.
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If you'd like to be consulted on future LGMHPP campaigns and interventions in development, please let us know at lgmhpp.update@gmfa.org.uk and we will add you to the consultation list.
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