Bareback Sex in the Age of Preventative Medication: Rethinking the ‘Harms’ of HIV Transmission

The experiences of people living with HIV have been transformed over recent years. Advances in medical science have made the virus a manageable chronic condition, while eliminating the risk of onward transmission for those with access to treatment, something referred to as TasP (treatment as prevention) or U=U (undetectable equals untransmissible). More recently, the availability of PrEP (pre-exposure prophylaxis), alongside PEP (post-exposure prophylaxis), through the NHS has created the conditions for condomless sexual encounters to take place without the fear of HIV transmission associated with previous decades. Despite this, the criminal law has continued to frame HIV in terms of personal responsibility and bodily autonomy within the dominant narratives of danger, disease, and out-dated science. Doctrinal law has failed to keep pace with social and scientific change. Therefore, in this article, we provide a re-examination of the criminal issues relating to HIV transmission within this new landscape, arguing that it necessitates a shift in attitude, policy and doctrine. We specifically argue that HIV transmission does not meet the appropriate harm threshold to constitute GBH and that if criminal law is ultimately about preventing or regulating harm, the ongoing criminalisation of HIV transmission is counter to that aim.

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Technologies for HIV prevention and care: challenges for health services

Revista Brasileira de Epidemiologia ◽

10.1590/1809-4503201500050008 ◽

2015 ◽

Vol 18 (suppl 1) ◽

pp. 104-119 ◽

Cited By ~ 5

Author(s):

Ivia Maksud ◽

Nilo Martinez Fernandes ◽

Sandra Lucia Filgueiras

Keyword(s):

Hiv Prevention ◽

Health Services ◽

Health Professionals ◽

Hiv Transmission ◽

Treatment As Prevention ◽

Post Exposure Prophylaxis ◽

Over The Counter ◽

Global Response ◽

Current Context ◽

Exposure Prophylaxis

ABSTRACTThis article aims to consider some relevant challenges to the provision of "new prevention technologies" in health services in a scenario where the "advances" in the global response to AIDS control are visible. We take as material for analysis the information currently available on the HIV post-exposure prophylaxis (PEP) and pre-exposure prophylaxis (PrEP), treatment as prevention (TASP) and over the counter. The methodology consisted of the survey and analysis of the Biblioteca Virtual em Saúde (BVS: MEDLINE, LILACS, WHOLIS, PAHO, SciELO) articles that addressed the issue of HIV prevention and care in the context of so-called new prevention technologies. The results of the studies show that there is assistance on the ground of clinics for the treatment of disease responses, but there are several challenges related to the sphere of prevention. The articles list some challenges regarding to management, organization of services and the attention given by health professionals to users. The current context shows evidence of the effectiveness of antiretroviral therapy in reducing the risk of HIV transmission, but the challenges for the provision of preventive technologies in health services permeate health professionals and users in their individual dimensions and health services in organizational and structural dimension. Interventions should be made available in a context of community mobilization; there should be no pressure on people to make HIV testing, antiretroviral treatment or for prevention. In the management is responsible for the training of health professionals to inform, clarify and make available to users, partners and family information about the new antiretroviral use strategies.

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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 ◽

10.3366/soma.2020.0315 ◽

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.

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986. Improvement in Administration of HIV Post-Exposure Prophylaxis in the Emergency Department Following Sexual Assault

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.1172 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S521-S522

Author(s):

Jennifer R Silva-Nash ◽

Stacie Bordelon ◽

Ryan K Dare ◽

Sherrie Searcy

Keyword(s):

Emergency Department ◽

Sexual Assault ◽

Hiv Transmission ◽

Post Exposure Prophylaxis ◽

Intervention Period ◽

Post Intervention ◽

Post Exposure ◽

Assault Victims ◽

Exposure Prophylaxis

Abstract Background Nonoccupational post exposure prophylaxis (nPEP) following sexual assault can prevent HIV transmission. A standardized Emergency Department (ED) protocol for evaluation, treatment, and follow up for post assault victims was implemented to improve compliance with CDC nPEP guidelines. Methods A single-center observational study of post sexual assault patients before/after implementation of an ED nPEP protocol was conducted by comparing the appropriateness of prescriptions, labs, and necessary follow up. A standardized order-set based on CDC nPEP guidelines, with involvement of an HIV pharmacist and ID clinic, was implemented during the 2018-2019 academic year. Clinical data from pre-intervention period (07/2016-06/2017) was compared to post-intervention period (07/2018-08/2019) following a 1-year washout period. Results During the study, 147 post-sexual assault patients (59 Pre, 88 Post) were included. One hundred thirty-three (90.4%) were female, 68 (46.6%) were African American and 133 (90.4%) were candidates for nPEP. Median time to presentation following assault was 12.6 hours. nPEP was offered to 40 (67.8%) and 84 (95.5%) patients (P< 0.001) and ultimately prescribed to 29 (49.2%) and 71 (80.7%) patients (P< 0.001) in pre and post periods respectively. Renal function (37.3% vs 88.6%; P< 0.001), pregnancy (39.0% vs 79.6%; P< 0.001), syphilis (3.4% vs 89.8%; P< 0.001), hepatitis B (15.3% vs 95.5%; P< 0.001) and hepatitis C (27.1% vs 94.3%) screening occurred more frequently during the post period. Labratory, nPEP Prescription and Follow up Details for Patients Prescribed nPEP Conclusion The standardization of an nPEP ED protocol for sexual assault victims resulted in increased nPEP administration, appropriateness of prescription, screening for other sexually transmitted infectious and scheduling follow up care. While guideline compliance dramatically improved, further interventions are likely warranted in this vulnerable population. Disclosures Ryan K. Dare, MD, MS, Accelerate Diagnostics, Inc (Research Grant or Support)

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What do patients consulting in a free STI center know about HIV transmission and prevention?

European Journal of Public Health ◽

10.1093/eurpub/ckz186.613 ◽

2019 ◽

Vol 29 (Supplement_4) ◽

Author(s):

C Duteil ◽

E de La Rochebrochard ◽

P Piron ◽

C Segouin ◽

P Troude

Keyword(s):

Hiv Prevention ◽

Screening Test ◽

Hiv Transmission ◽

Needle Exchange ◽

Treatment As Prevention ◽

False Beliefs ◽

Hiv Knowledge ◽

Unprotected Sexual Intercourse ◽

Prevention Messages ◽

Exposure Prophylaxis

Abstract Background Despite therapeutic progress, HIV remains a public health issue with about 6400 new HIV contaminations each year in France. HIV prevention relies on health education, early screening, treatment as prevention, post and pre-exposure prophylaxis. Patients’ visits to free sexually transmitted infections (STIs) screening centers (CeGIDD) are opportunities to spread prevention messages. This study aimed to assess level of HIV knowledge in a Parisian CeGIDD to improve prevention messages. Methods The study included patients older than 18 who came for STIs testing between August 2017 and August 2018 and who understand written French language. Data were collected by a self-administered electronic questionnaire filled in before medical consultation. It included sociodemographic data and knowledge regarding HIV transmission and prevention. Results The study included 2002 patients. The median age was 27 years and 66% were men. More than 96% of patients know that HIV transmission is possible through unprotected sexual intercourse and through needle exchange. However, some misconceptions persist: 20% of patients believe that HIV transmission is possible from using public toilets and 22% by mosquito bite. Prevention measures perceived as “absolutely or rather efficient” by patients were: using condom (97%), requesting a screening test from his partners (91%), getting screening tests regularly (90%), choosing his partners correctly (62%), having sex with few different partners (50%). Half of patients heard of post-exposure prophylaxis (51%). Conclusions Main modes of HIV transmission are well known (unprotected intercourse and needle exchange). However, false beliefs regarding prevention may lead to risk behavior (doing screening test regularly doesn’t protect against HIV) and need to be explored. Moreover, assessment of variation in level of HIV knowledge according to patient’s profile may help to target prevention message according to specific populations. Key messages Main modes of HIV transmission are well known. False beliefs regarding modes of prevention need to be explored to target HIV prevention messages.

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Mapping of HIV-1C Transmission Networks Reveals Extensive Spread of Viral Lineages Across Villages in Botswana Treatment-as-Prevention Trial

The Journal of Infectious Diseases ◽

10.1093/infdis/jiaa276 ◽

2020 ◽

Vol 222 (10) ◽

pp. 1670-1680

Author(s):

Vlad Novitsky ◽

Melissa Zahralban-Steele ◽

Sikhulile Moyo ◽

Tapiwa Nkhisang ◽

Dorcas Maruapula ◽

...

Keyword(s):

Hiv Transmission ◽

Full Length ◽

Treatment As Prevention ◽

People Living With Hiv ◽

Genome Sequences ◽

Transmission Networks ◽

Combination Prevention ◽

Prevention Project ◽

Prevention Interventions ◽

Hiv 1

Abstract Background Phylogenetic mapping of HIV-1 lineages circulating across defined geographical locations is promising for better understanding HIV transmission networks to design optimal prevention interventions. Methods We obtained near full-length HIV-1 genome sequences from people living with HIV (PLWH), including participants on antiretroviral treatment in the Botswana Combination Prevention Project, conducted in 30 Botswana communities in 2013–2018. Phylogenetic relationships among viral sequences were estimated by maximum likelihood. Results We obtained 6078 near full-length HIV-1C genome sequences from 6075 PLWH. We identified 984 phylogenetically distinct HIV-1 lineages (molecular HIV clusters) circulating in Botswana by mid-2018, with 2–27 members per cluster. Of these, dyads accounted for 62%, approximately 32% (n = 316) were found in single communities, and 68% (n = 668) were spread across multiple communities. Men in clusters were approximately 3 years older than women (median age 42 years, vs 39 years; P < .0001). In 65% of clusters, men were older than women, while in 35% of clusters women were older than men. The majority of identified viral lineages were spread across multiple communities. Conclusions A large number of circulating phylogenetically distinct HIV-1C lineages (molecular HIV clusters) suggests highly diversified HIV transmission networks across Botswana communities by 2018.

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Challenges and potential barriers to the uptake of antiretroviral-based prevention in Asia and the Pacific region

Sexual Health ◽

10.1071/sh13094 ◽

2014 ◽

Vol 11 (2) ◽

pp. 126 ◽

Cited By ~ 9

Author(s):

Ying-Ru Lo ◽

Masaya Kato ◽

Nittaya Phanuphak ◽

Masami Fujita ◽

Duong Bui Duc ◽

...

Keyword(s):

Hiv Transmission ◽

Sub Saharan Africa ◽

Treatment As Prevention ◽

The Pacific ◽

Prep Implementation ◽

Sub Saharan ◽

Hiv Acquisition ◽

Operational Issues ◽

Exposure Prophylaxis ◽

Firm Evidence

Evidence has emerged over the past few years on the effectiveness of antiretroviral-based prevention technologies to prevent (i) HIV transmission while decreasing morbidity and mortality in HIV-infected persons, and (ii) HIV acquisition in HIV-uninfected individuals through pre-exposure prophylaxis (PrEP). Only few of the planned studies on treatment as prevention (TasP) are conducted in Asia. TasP might be more feasible and effective in concentrated rather than in generalised epidemics, as resources for HIV testing and antiretroviral treatment could focus on confined and much smaller populations than in the generalised epidemics observed in sub-Saharan Africa. Several countries such as Cambodia, China, Thailand and Vietnam, are now paving the way to success. Similar challenges arise for both TasP and PrEP. However, the operational issues for PrEP are amplified by the need for frequent retesting and ensuring adherence. This paper describes challenges for the implementation of antiretroviral-based prevention and makes the case that TasP and PrEP implementation research in Asia is much needed to provide insights into the feasibility of these interventions in populations where firm evidence of ‘real world’ effectiveness is still lacking.

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Post-exposure prophylaxis

International Journal of STD & AIDS ◽

10.1258/095646202762226137 ◽

2002 ◽

Vol 13 (1_suppl) ◽

pp. 30-34 ◽

Cited By ~ 6

Author(s):

◽

Marchina E Van Der Ende ◽

Rosa M Regez ◽

Gerrit Schreij ◽

Jan T M Van Der Meer ◽

...

Keyword(s):

The Netherlands ◽

Hiv Transmission ◽

Standard Procedure ◽

High Plasma ◽

Antiretroviral Drugs ◽

Post Exposure Prophylaxis ◽

Serious Adverse Events ◽

Post Exposure ◽

Occupational Setting ◽

Exposure Prophylaxis

The mean risk of acquiring HIV after an occupational exposure, injecting drug use or sexual exposure varies from <0.1 to 3%. A high plasma HIV-RNA of the source increases the risk of each of the exposures. Other factors, such as the volume of the inoculum involved to which the individual was exposed, other sexually transmitted diseases and ruptures of mucous membranes are associated with a higher risk of HIV transmission. Based on the calculated risk, post-exposure prophylaxis (PEP) should be recommended. In the Netherlands, prescription of PEP in the occupational setting is a standard procedure and has proved to be feasible. This was associated with a high percentage (62%) of mild and reversible toxicity and a small percentage (2%) of serious adverse events related to antiretroviral drugs, i.e. nephrolithiasis (due to indinavir) and toxic hepatitis (due to nevirapine). In The Netherlands so far no HIV-seroconversions have been recorded after an occupational accident.

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Biomedical prevention: what is the current status?

Asian Biomedicine ◽

10.2478/abm-2010-0089 ◽

2010 ◽

Vol 4 (5) ◽

pp. 679-682

Author(s):

David D. Celentano ◽

Wendy W. Davis ◽

Chris C. Beyrer

Keyword(s):

Male Circumcision ◽

Hiv Transmission ◽

Sub Saharan Africa ◽

Current Status ◽

Post Exposure Prophylaxis ◽

Biomedical Hiv Prevention ◽

Hiv Prevention Strategies ◽

Biomedical Prevention ◽

Sub Saharan ◽

Exposure Prophylaxis

Abstract Biomedical HIV prevention strategies for primary or secondary prevention of HIV transmission can be seen as an adjunct to behavioral prevention approaches. These interventions include vaccination, female controlled vaginal microbicides, male circumcision, treatment of sexually transmitted infections that cause genital ulceration, Pre-Exposure Prophylaxis (PREP) and Post-Exposure Prophylaxis (PEP). This article reviews results from recent randomized controlled trials of novel biomedical prevention approaches and discusses interpretation of the results. The only intervention consistently demonstrating reductions in HIV transmission was adult male circumcision in Sub-Saharan Africa. Results of PREP trials will be available in the next several years.

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Knowledge of PEP and PrEP among people living with HIV/aids in Brazil

10.21203/rs.3.rs-52570/v3 ◽

2021 ◽

Author(s):

Laelson Rochelle Milanês Sousa ◽

Henrique Ciabotti Elias ◽

Nilo Martinez Fernandes ◽

Elucir Gir ◽

Renata Karina Reis

Keyword(s):

Viral Load ◽

Secondary Prevention ◽

Educational Interventions ◽

Sexual Partners ◽

Post Exposure Prophylaxis ◽

People Living With Hiv ◽

Factors Associated ◽

Exposure Prophylaxis ◽

Living With Hiv ◽

Hiv Aids

Abstract Background: Pre-Exposure Prophylaxis (PrEP) and Post-Exposure Prophylaxis (PEP) are key to preventing sexual transmission of HIV, whose sexual partners are at high risk of acquiring HIV. We aimed to determine the factors associated with PrEP and PEP's knowledge as secondary prevention among people living with HIV/AIDS.Method: Cross-sectional analytical study carried out among people living with HIV/AIDS treated at five specialized services in the city of Ribeirão Preto, São Paulo, Brazil. Data were collected from July 2016 to July 2017. Individual interviews were conducted. We used multivariable logistic regression to determine factors associated with knowing PrEP and PEP. Results: Of the 397 participants, 140 (35.26%) were heterosexual women aged 40 to 49 years (36.2%).Participants with less than 11 years of study (adjusted odds: 0.29; 95% CI: 0.13-0.60); who did not have a low viral load or did not know their viral load (adjusted odds: 0.29; 95% CI: 0.09-0.83) and those with casual partners (adjusted odds: 0.29; 95% CI: 0.09- 0.83) were less likely to know about the PrEP. MSM (adjusted odds: 2.88; 95% CI: 1.59-5.3) and those who used alcohol during sexual intercourse (adjusted odds: 1.7; 95% CI: 1.0-2.8) were more likely to know about the PEP.Conclusions: The knowledge about PEP and PrEP is low in Brazil. This may undermine secondary prevention efforts. Educational interventions to raise awareness of these prevention methods are needed among people living with HIV and who have HIV-negative sexual partners.

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HIV Transmission Prevention

10.1093/med/9780190493097.003.0004 ◽

2017 ◽

Author(s):

Carolyn Chu ◽

Christopher M. Bositis

Keyword(s):

Hiv Transmission ◽

Hiv Infections ◽

Risk Groups ◽

Antiviral Drugs ◽

Antiretroviral Drugs ◽

Post Exposure Prophylaxis ◽

Needle Exchange Programs ◽

Hiv Acquisition ◽

Exposure Prophylaxis ◽

Prevention Of Hiv

The prevention of HIV transmission involves a number of behavioral, structural, and biomedical interventions. Behavioral methods include education about sexual health, drug use, and risk reduction, as well as specific messages for at-risk populations who are HIV positive. Needle exchange programs and consistent use of condoms have proven effective for prevention of HIV infection. Post-exposure prophylaxis against HIV with antiviral drugs is often recommended in occupational health care and non-occupational settings. Voluntary male circumcision also reduces the risk of HIV acquisition. The treatment of pregnant women who are HIV infected can effectively eliminate mother-to-child transmission of the virus. Recently, the use of antiretroviral drugs for pre-exposure prophylaxis has proven highly effective in preventing HIV infections in high-risk groups including men who have sex with men. Promising therapies that likely will be available in the future include injectable antiviral drugs, vaginal microbicides, and HIV vaccines.

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