Ethics of pre-exposure prophylaxis in high-risk HIV patients

Pre-exposure prophylaxis (PrEP) is the daily use of antiretrovirals to prevent human immunodeficiency virus (HIV) transmission in uninfected people at high risk of infection, including men who have sex with men and serodiscordant heterosexual couples. PrEP has the potential benefit of reducing the human population’s viral load, and unlike barrier protection, PrEP allows for individual control over HIV exposure. However, ethical concerns have been raised around this intervention’s risk of serious side effects. These side effect risks may not be justifiable given PrEP’s modest benefit and the existence of standard HIV prevention: condoms, counseling, and education. Critics of this preventative approach also worry that PrEP promotes unsafe sexual practices such as sex without barrier protection. However, this discussion is harmful to the underserviced at-risk groups targeted by PrEP, and prohibition of PrEP for this reason is unjustified in a society that allows women to access oral contraceptives despite the risk of adopting unsafe sexual practices. To ensure the safety of high-risk HIV groups, future clinical trials of PrEP should compare this intervention to the standard of prevention rather than placebo, and stigma mitigation strategies must be implemented at the policy level.

Amyl Nitrites and Sexual Behavior

This paper looked into the abuse of inhalable nitrites, mainly amyl nitrites, commonly known by the street name of poppers. This paper compiled several studies of nitrite inhalant abuse and the risk associated with the sexual practices that may concur. The paper explores first, the history and true intentions of nitrite inhalants, then the increasing abuse mainly within the homosexual community, and the legitimacy of the link of nitrites and the HIV/AIDS epidemic. Various studies discussed in the paper will show that there is no legitimate link between poppers increasing the chance of HIV/AIDS but it is the unsafe sexual practices that occur with poppers that lead to various sexually transmitted diseases. The dangers of inhalable nitrites come from legal loopholes, use with other drugs such as Viagra, and the nature of unsafe sexual practices mostly within the homosexual community.

Incidence of putative HIV superinfection and sexual practices among HIV-infected men who have sex with men

Objectives: To determine the upper limit for the incidence of clinically important HIV superinfection among HIV-infected men who have sex with men (MSM) and its relationship with engagement in unsafe sexual practices. Methods: This was a retrospective cohort and nested case-control study. Electronic files of all HIV-infected MSM not on antiretroviral therapy were reviewed. Those clients with sudden, unexplained and sustained declines in CD4 T-cell counts and increases in plasma HIV RNA were considered as being putatively superinfected with HIV and were recruited as cases, whereas those without these features were recruited as controls (four per case) to answer a self-administered questionnaire. Results: Ten cases were identified from 145 eligible MSM (7%, 95% confidence interval 3–11%), comprising a rate of 3.6 per 100 person-years at risk. Cases had an annual decline in CD4 T-cell counts of 201 cells µL–1 compared with 9 cells µL–1 for controls. There were no statistically significant differences between cases and controls with regard to sexual practices that may have exposed them to acquisition of HIV superinfection (P-value ≥ 0.4), nor in their perceptions or beliefs of HIV superinfection (P-value ≥ 0.3). Only a minority reported no previous knowledge of HIV superinfection (17%, 5/30). Overall, both cases and controls were engaging frequently in unsafe sexual practices with casual partners who were HIV infected (80 and 52%, respectively; P-value = 0.4) or whose HIV serostatus was unknown (40 and 50%, respectively; P-value = 1.0). Conclusions: Despite considerable unsafe sexual practices occurring among this cohort of sexually active MSM the incidence of clinically significant HIV superinfection was likely to be less than 4% per year.

Homoseksualitas: Tinjauan Kesehatan Reproduksi

The issue of homosexuality brings about various viewpoints that are controversial from any aspect. In terms of health, for example, many people link homosexuality as being the cause of the spread of HIV/AIDS, even though homosexuals themselves do not accept this accusation. In this article, Budi Wahyuni endeavours to look more "fairly" at this issue. According to her, HIV/AIDS and other sexually transmitted diseases are caused by unsafe sexual practices. Among those sexual acts vulnerable to the spread of sexually trans mitted diseases are oral sex, anal sex and masturbation, whether they are done by homosexuals or heterosexuals.