scholarly journals HIV incidence among gay men and other men who have sex with men in 2020: where is the epidemic heading?

Sexual Health ◽  
2017 ◽  
Vol 14 (1) ◽  
pp. 5 ◽  
Author(s):  
Shauna Stahlman ◽  
Carrie Lyons ◽  
Patrick S. Sullivan ◽  
Kenneth H. Mayer ◽  
Sean Hosein ◽  
...  
Keyword(s):  
Hiv Transmission ◽  
Hiv Infections ◽  
Retention In Care ◽  
Hiv Treatment ◽  
Treatment As Prevention ◽  
Structural Level ◽  
Hiv Incidence ◽  
Hiv Risks ◽  
Sex With Men ◽  
Hiv Acquisition

The goal to effectively prevent new HIV infections among gay, bisexual, and other men who have sex with men (MSM) is more challenging now than ever before. Despite declines in the late 1990s and early 2000s, HIV incidence among MSM is now increasing in many low- and high-income settings including the US, with young, adolescent, and racial/ethnic minority MSM being among those at highest risk. Potentiating HIV risks across all settings are individual-, network-, and structural-level factors such as stigma and lack of access to pre-exposure prophylaxis (PrEP) and antiretroviral treatment as prevention. To make a sustained impact on the epidemic, a concerted effort must integrate all evidence-based interventions that will most proximally decrease HIV acquisition and transmission risks, together with structural interventions that will support improved coverage and retention in care. Universal HIV treatment, increased access to HIV testing, and daily oral PrEP have emerged as integral to the prevention of HIV transmission, and such efforts should be immediately expanded for MSM and other populations disproportionately affected by HIV. Respect for human rights and efforts to combat stigma and improve access to prevention services are needed to change the trajectory of the HIV pandemic among MSM.

scholarly journals Past dynamics of HIV transmission among men who have sex with men in Montreal, Canada: a mathematical modelling study

2021 ◽  
Author(s):  
Rachael M Milwid ◽  
Yiqing Xia ◽  
Carla Doyle ◽  
Joseph Cox ◽  
Gilles Lambert ◽  
...  
Keyword(s):  
Hiv Transmission ◽  
Age Groups ◽  
Population Level ◽  
Hiv Infections ◽  
Hiv Incidence ◽  
Agent Based ◽  
Treatment And Prevention ◽  
Sex With Men ◽  
Hiv Acquisition

Background: Gay, bisexual, and other men who have sex with men (gbMSM) experience disproportionate risks of HIV acquisition/transmission. In 2017, Montréal became the first Canadian Fast-Track city, setting the 2030 goal of zero new HIV infections. To inform local elimination efforts, we estimate the evolving role of prevention/risk behaviours and HIV transmission dynamics among gbMSM in Montréal between 1975-2019. Methods: Data from local bio-behavioural surveys were analyzed to develop, parameterize, and calibrate an agent-based model of sexual HIV transmission. Partnership dynamics, the HIV natural history, and treatment and prevention strategies were considered. The model simulations were analyzed to estimate the fraction of HIV acquisitions/transmissions attributable to specific age-groups and unmet prevention needs. Results: The model-estimated HIV incidence peaked in 1985 (2.2%; 90%CrI: 1.3-2.8%) and decreased to 0.1% (90%CrI: 0.04-0.3%) in 2019. Between 1990-2017, the majority of HIV acquisitions/transmissions occurred among men aged 25-44 years, and men aged 35-44 thereafter. The unmet prevention needs of men with >10 annual anal sex partners contributed 92-94% of transmissions and 63-73% of acquisitions annually. The primary stage of HIV played an increasing role over time, contributing to 12%-27% of annual transmissions over 1990-2019. In 2019, approximately 75% of transmission events occurred from men who had discontinued, or never initiated ART. Conclusions: The evolving HIV landscape has contributed to the recent low HIV incidence among MSM in Montréal. The shifting dynamics identified in this study highlight the need for continued population-level surveillance to identify unmet prevention needs and core groups on which to prioritize elimination efforts.

scholarly journals HIV Treatment as Prevention: Contradictory Perspectives from Dynamic Mathematical Models

2014 ◽  
Vol 2014 ◽  
pp. 1-9
Author(s):  
Jing Wu ◽  
Jessie L. Norris ◽  
Yujiang Jia ◽  
Ning Wang
Keyword(s):  
Mathematical Models ◽  
Hiv Transmission ◽  
Dynamic Models ◽  
Hiv Infections ◽  
Hiv Treatment ◽  
Treatment As Prevention ◽  
Poor Countries ◽  
Input Variables ◽  
Hiv Treatment As Prevention ◽  
Preventive Effects

The preventative effects of antiretroviral therapy for people with HIV have been debated since they were first raised. Models commenced studying the preventive effects of treatment in the 1990s, prior to initial public reports. However, the outcomes of the preventive effects of antiretroviral use were not consistent. Some outcomes of dynamic models were based on unfeasible assumptions, such as no consideration of drug resistance, behavior disinhibition, or economic inputs in poor countries, and unrealistic input variables, for example, overstated initiation time, adherence, coverage, and efficacy of treatment. This paper reviewed dynamic mathematical models to ascertain the complex effects of ART on HIV transmission. This review discusses more conservative inputs and outcomes relative to antiretroviral use in HIV infections in dynamic mathematical models. ART alone cannot eliminate HIV transmission.

The Bio/Necropolitics of ACTG 076: Lessons from Pregnant Women of Colour Living with HIV for Treatment for Prevention in the Twenty-first Century

Somatechnics ◽  
2020 ◽  
Vol 10 (2) ◽  
pp. 233-253
Author(s):  
Eli Manning
Keyword(s):  
Hiv Transmission ◽  
Ethical Dilemmas ◽  
Hiv Treatment ◽  
First Century ◽  
Hiv Positive ◽  
Treatment As Prevention ◽  
People Living With Hiv ◽  
Hiv Positive Women ◽  
Aids Clinical Trials ◽  
Living With Hiv

Since the pharmaceutical turn, using HIV treatment to prevent transmission is increasingly common. Treatment as Prevention®, or TasP, has relied on HIV treatment to prevent HIV transmission, targeting people living with HIV. However, TasP is predicated on troublesome heterosexist, classist, and racist medical practices borrowed from various times and spaces that enact biopolitical and necropolitical relations. This paper discusses the debate surrounding the first clinical trial that used HIV treatment to prevent transmission from woman-to-foetus. The 1994 landmark AIDS Clinical Trials Group 076 study laid the groundwork for using HIV treatment to prevent HIV transmission, the essential precursor to TasP. By examining the concerns of HIV positive women of colour and other AIDS activists, we are able to understand the ethical dilemmas and practical consequences that still haunt today's game-changing uses of HIV treatment for prevention and to see how biopolitics and necropolitics persist in TasP.

scholarly journals Estimation of HIV incidence in two Brazilian municipalities, 2013

2016 ◽  
Vol 50 (0) ◽  
Author(s):  
Célia Landmann Szwarcwald ◽  
Orlando da Costa Ferreira Júnior ◽  
Ana Maria de Brito ◽  
Karin Regina Luhm ◽  
Clea Elisa Lopes Ribeiro ◽  
...  
Keyword(s):  
Total Population ◽  
Hiv Infections ◽  
Incidence Rates ◽  
Hiv Incidence ◽  
Female Ratio ◽  
Exposure Category ◽  
Two Cities ◽  
Population Subgroup ◽  
Sex With Men ◽  
Male To Female

ABSTRACT OBJECTIVE To estimate HIV incidence in two Brazilian municipalities, Recife and Curitiba, in the year of 2013. METHODS The method for estimating incidence was based on primary information, resulting from the Lag-Avidity laboratory test for detection of recent HIV infections, applied in a sample of the cases diagnosed in the two cities in 2013. For the estimation of the HIV incidence for the total population of the cities, the recent infections detected in the research were annualized and weighted by the inverse of the probability of HIV testing in 2013 among the infected and not diagnosed cases. After estimating HIV incidence for the total population, the incidence rates were estimated by sex, age group, and exposure category. RESULTS In Recife, 902 individuals aged 13 years and older were diagnosed with HIV infection. From these, 528 were included in the study, and the estimated proportion of recent infections was 13.1%. In Curitiba, 1,013 people aged 13 years and older were diagnosed, 497 participated in the study, and the proportion of recent infections was 10.5%. In Recife, the estimated incidence rate was 53.1/100,000 inhabitants of 13 years and older, while in Curitiba, it was 41.1/100,000, with male-to-female ratio of 3.5 and 2.4, respectively. We observed high rates of HIV incidence among men who have sex with men, of 1.47% in Recife and 0.92% in Curitiba. CONCLUSIONS The results obtained in the two cities showed that the group of men who have sex with men are disproportionately subject to a greater risk of new infections, and indicate that strategies to control the spread of the epidemic in this population subgroup are essential and urgent.

scholarly journals Pre-exposure prophylaxis for HIV-negative persons with partners living with HIV: uptake, use, and effectiveness in an open-label demonstration project in East Africa

2018 ◽  
Vol 1 ◽  
pp. 3 ◽  
Author(s):  
Renee Heffron ◽  
Kenneth Ngure ◽  
Josephine Odoyo ◽  
Nulu Bulya ◽  
Edna Tindimwebwa ◽  
...  
Keyword(s):  
Hiv Infections ◽  
Hiv Treatment ◽  
Demonstration Project ◽  
Hiv Incidence ◽  
Serodiscordant Couples ◽  
Treatment Services ◽  
Hiv Serodiscordant Couples ◽  
Exposure Prophylaxis ◽  
Living With Hiv ◽  
Hiv Negative

Background: Pre-exposure prophylaxis (PrEP) can provide high protection against HIV infection and is a recommended intervention for HIV-negative persons with substantial HIV risk.  Demonstration projects conducted in diverse settings worldwide illustrate practical examples of how PrEP can be delivered. This manuscript presents estimates of effectiveness and patterns of PrEP use within a two-year demonstration project of PrEP for HIV-negative members of heterosexual HIV serodiscordant couples in East Africa. Methods: The PrEP delivery model integrated PrEP into HIV treatment services, prioritizing PrEP use for HIV-negative partners within serodiscordant couples before and during the first 6 months after the partner living with HIV initiated antiretroviral therapy (ART).  We measured PrEP uptake through pharmacy records and adherence to PrEP through medication event monitoring system (MEMS) bottle caps and quantification of tenofovir in plasma among a random sample of participants. We estimated HIV infections prevented using a counterfactual cohort simulated from the placebo arm of a previous PrEP clinical trial. Results: We enrolled 1,010 HIV serodiscordant couples that were naïve to ART and PrEP.  Ninety-seven percent of HIV-negative partners initiated PrEP. Objective measures suggest high adherence: 71% of HIV-negative participants took ≥80% of expected doses, as recorded via MEMS, and 81% of plasma samples had tenofovir detected.  Four incident HIV infections were observed (incidence rate=0.24 per 100 person-years), a 95% reduction (95% CI 86-98%, p<0.0001) in HIV incidence, relative to estimated HIV incidence for the population in the absence of PrEP integrated into HIV treatment services.   Conclusions: PrEP uptake and adherence were high and incident HIV was rare in this PrEP demonstration project for African HIV-negative individuals whose partners were known to be living with HIV.  Delivery of PrEP to HIV-negative partners within HIV serodiscordant couples was feasible and should be prioritized for wide-scale implementation.

scholarly journals 1701. Added Benefits of Pre-exposure Prophylaxis Use on HIV Incidence with Minimal Changes in Efficiency in the Context of High Treatment Engagement among Men Who Have Sex with Men

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S833-S833
Author(s):  
Alyson L Singleton ◽  
Brandon D Marshall ◽  
Xiao Zang ◽  
Amy S Nunn ◽  
William C Goedel
Keyword(s):  
African American ◽  
Hiv Infection ◽  
Hiv Transmission ◽  
Treatment Engagement ◽  
Hiv Incidence ◽  
Black African ◽  
African American Msm ◽  
Sex With Men ◽  
Exposure Prophylaxis ◽  
High Treatment

Abstract Background Although there is ongoing debate over the need for substantial increases in PrEP use when antiretroviral treatment confers the dual benefits of reducing HIV-related morbidity and mortality and the risk of HIV transmission, no studies to date have quantified the potential added benefits of PrEP use in settings with high treatment engagement across variable sub-epidemics in the United States. Methods We used a previously published agent-based network model to simulate HIV transmission in a dynamic network of 17,440 Black/African American and White MSM in Atlanta, Georgia from 2015 to 2024 to understand how the magnitude of reductions in HIV incidence attributable to varying levels of PrEP use (0–90%) changes in potential futures where high levels of treatment engagement (i.e. the UNAIDS ‘90-90-90’ goals and eventual ‘95-95-95’ goals) are achieved and maintained, as compared to current levels of treatment engagement in Atlanta (Figure 1). Model inputs related to HIV treatment engagement among Black/African American and White men who have sex with men in Atlanta. A comparison of current levels of treatment engagement (Panel A) to treatment engagement at ‘90-90-90’ (Panel B) and ‘95-95-95’ goals (Panel C). Results Even at achievement and maintenance of ‘90-90-90’ goals, 75% PrEP coverage reduced incidence rates by an additional 67.9% and 74.2% to 1.53 (SI: 1.39, 1.70) and 0.355 (SI: 0.316, 0.391) per 100 person-years for Black/African American and White MSM, respectively (Figure 2), compared to the same scenario with no PrEP use. Additionally, an increase from 15% PrEP coverage to 75% under ‘90-90-90’ goals only increased person-years of PrEP use per HIV infection averted, a measure of efficiency of PrEP, by 8.1% and 10.5% to 26.7 (SI: 25.6, 28.0) and 73.3 (SI: 70.6, 75.7) among Black/African American MSM and White MSM, respectively (Figure 3). Overall (Panel A) and race-stratified (Panel B and Panel C) marginal changes in HIV incidence over ten years among Black/African American and White men who have sex with men in Atlanta across scenarios of varied levels of treatment engagement among agents living with HIV infection and levels of pre-exposure prophylaxis use among HIV-uninfected agents. Note: All changes are calculated within each set of treatment scenarios relative to a scenario where no agents use pre-exposure prophylaxis. Person-years of pre-exposure prophylaxis use per HIV infection averted among Black/African American (Panel A) and White (Panel B) men who have sex with men in Atlanta across scenarios of varied levels of treatment engagement among agents living with HIV infection and levels of pre-exposure prophylaxis use among HIV-uninfected agents. Note: The number of HIV infections averted is calculated within each set of treatment scenarios relative to a scenario where no agents use pre-exposure prophylaxis. Conclusion Even in the context of high treatment engagement, substantial expansion of PrEP use still contributes to meaningful decreases in HIV incidence among MSM with minimal changes in person-years of PrEP use per HIV infection averted, particularly for Black/African American MSM. Disclosures All Authors: No reported disclosures

Enhancing Access to Safe and Secure Housing

2018 ◽  
pp. 105-142
Author(s):  
J Dickson-Gomez ◽  
K Quinn
Keyword(s):  
Treatment As Prevention ◽  
Structural Level ◽  
Housing Crisis ◽  
Response Options ◽  
Housing Status ◽  
Health Response ◽  
Persons Living With Hiv ◽  
Hiv Acquisition ◽  
Risk Of Hiv Acquisition ◽  
Living With Hiv

This chapter reviews the global pervasiveness of being homeless or unstably housed as an antecedent to risk of HIV acquisition and as a barrier to global efforts directed toward treatment as prevention. Emphasis on youth is provided, as they experience a vast disparity in this regard. Subsequently, this chapter addresses key structural-level intervention designed to provide stable living environments for persons living with HIV/AIDS. Several possible public health response options are provided, with an emphasis on feasibility and sustainability. Topics covered include the multidimensional definitions of housing status and stability, the global housing crisis and how it relates to HIV, structural interventions to address the link between housing and HIV, and future directions for research.

scholarly journals Evaluation of HIV Transmission Clusters among Natives and Foreigners Living in Italy

Viruses ◽  
2020 ◽  
Vol 12 (8) ◽  
pp. 791 ◽  
Author(s):  
Lavinia Fabeni ◽  
Maria Mercedes Santoro ◽  
Patrizia Lorenzini ◽  
Stefano Rusconi ◽  
Nicola Gianotti ◽  
...  
Keyword(s):  
Hiv Transmission ◽  
Phylogenetic Analyses ◽  
Hiv Infections ◽  
Public Health Response ◽  
Health Response ◽  
Drug Naïve ◽  
Recent Diagnosis ◽  
Sex With Men ◽  
Italian Origin ◽  
Hiv 1

We aimed at evaluating the characteristics of HIV-1 molecular transmission clusters (MTCs) among natives and migrants living in Italy, diagnosed between 1998 and 2018. Phylogenetic analyses were performed on HIV-1 polymerase (pol) sequences to characterise subtypes and identify MTCs, divided into small (SMTCs, 2–3 sequences), medium (MMTCs, 4–9 sequences) and large (LMTCs, ≥10 sequences). Among 3499 drug-naïve individuals enrolled in the Italian Cohort Naive Antiretroviral (ICONA) cohort (2804 natives; 695 migrants), 726 (20.8%; 644 natives, 82 migrants) were involved in 228 MTCs (6 LMTCs, 36 MMTCs, 186 SMTCs). Migrants contributed 14.4% to SMTCs, 7.6% to MMTCs and 7.1% to LMTCs, respectively. HIV-1 non-B subtypes were found in 51 MTCs; noteworthy was that non-B infections involved in MTCs were more commonly found in natives (n = 47) than in migrants (n = 4). Factors such as Italian origin, being men who have sex with men (MSM), younger age, more recent diagnosis and a higher CD4 count were significantly associated with MTCs. Our findings show that HIV-1 clustering transmission among newly diagnosed individuals living in Italy is prevalently driven by natives, mainly MSM, with a more recent diagnosis and frequently infected with HIV-1 non-B subtypes. These results can contribute to monitoring of the HIV epidemic and guiding the public health response to prevent new HIV infections.

scholarly journals Global travel and HIV/STI epidemics among MSM: what does the future hold?

Sexual Health ◽  
2017 ◽  
Vol 14 (1) ◽  
pp. 51 ◽  
Author(s):  
Veronica C. Lee ◽  
Patrick S. Sullivan ◽  
Stefan D. Baral
Keyword(s):  
Hiv Transmission ◽  
Sex Partners ◽  
Emerging Trends ◽  
Online Tools ◽  
Sex With Men ◽  
Hiv Acquisition ◽  
Disease Epidemics ◽  
Living With Hiv ◽  
Global Travel ◽  
Sexual Risk Behaviours

Infectious disease epidemics occur within dynamic systems and environments that shape risk and, ultimately, the spread of infectious diseases. Gay men and other men who have sex with men (MSM) are disproportionately impacted by HIV everywhere in the world. Several emerging trends present risks for sustained or increased HIV acquisition and transmission, and the growth of global travel in the context of emerging online platforms for social/sexual networking is discussed here. Four factors associated with travel that could potentiate HIV transmission are highlighted: different patterns of sexual risk behaviours during travel; the growth of online tools to meet sex partners more efficiently; the global heterogeneity of HIV strains; and the potential for diassortative mixing of men from high- and low-HIV prevalence areas. Prevention tools and services must rise to these challenges, and innovative mobile applications and programs have played, and will continue to play, an important role in supporting MSM at risk for or living with HIV during their periods of travel.

HIV pre-exposure prophylaxis and treatment as prevention: a review of awareness and acceptability among men who have sex with men in the Asia-Pacific region and the Americas

Sexual Health ◽  
2014 ◽  
Vol 11 (2) ◽  
pp. 166 ◽  
Author(s):  
Martin Holt
Keyword(s):  
The United States ◽  
Hiv Treatment ◽  
Asia Pacific ◽  
Treatment As Prevention ◽  
Pacific Region ◽  
Asia Pacific Region ◽  
Acceptability Research ◽  
Prevention Trials ◽  
Sex With Men ◽  
Exposure Prophylaxis

This review assesses acceptability research for HIV pre-exposure prophylaxis (PrEP) and treatment as prevention (TasP) among men who have sex with men (MSM) in the Asia-Pacific region and the Americas, evaluating awareness and attitudes. There has been limited research on the acceptability of PrEP outside the United States and no research to date evaluating the acceptability of TasP since the findings of the HIV Prevention Trials Network 052 trial were released. Existing research suggests that PrEP is reasonably acceptable to MSM, but few men are likely to perceive the need for it. Studies of HIV treatment optimism suggest that MSM are likely to be sceptical of TasP.

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