Prime Minister Cameron on HIV in MSM – Science or Madness ?

“Whom the gods would destroy, they first make mad”.  –  spoken by Prometheus, in The Masque of Pandora (1875) by Henry Wadsworth Longfellow

The  BBC  reports   at   :  http://www.bbc.co.uk/news/uk-15511081

30 October 2011 Last updated at 13:04 GMT

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David Cameron
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David Cameron has threatened to withhold UK aid from governments that do not reform legislation banning homosexuality.

The UK prime minister said he raised the issue with some of the states involved at the Commonwealth Heads of Government Meeting in Perth, Australia.

Human rights reform in the Commonwealth was one issue that leaders failed to reach agreement on at the summit.

Mr Cameron says those receiving UK aid should “adhere to proper human rights”…….

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The  article  does  not  specifically  state   if  by  banning  homosexuality  Mr.  Cameron  means  removing  legislation  against  sodomy.

In Jamaica there  is  no legislation against homosexuality –  the  law  bans  sodomy  and  other  unnatural  acts.

” Prevention  is  better  than  cure” and  there  is  no  cure  for  AIDS . 

National  efforts  must  therefore  emphasize  prevention.  In  medicine  primary  prevention  is  informed  by  epidemiology  the branch of medicine that deals with the incidence, distribution, and possible control of diseases and other factors relating to health. It seeks  to  determine who gets  a  disease, when the disease  occurs  and  its  geographical  location.


(A) In  England  where  sodomy  is  legal  and  where  comittment  to  homosexuality  and  sodomy  is  very  strong  researchers  indicate :  a  high  and  increasing  incidence  of  HIV  in MSM

Practitioner. 2011 Apr;255(1739):25-8, 3.

Increasing uptake of HIV tests in men who have sex with men.

Source

University Hospitals of Leicester.

Abstract

In 2010, just under half of new HIV diagnoses in the UK were in men who have sex with men (MSM). This group are most at risk of acquiring and transmitting HIV in the UK. In March 2011, NICE published guidance specifically aimed at increasing uptake of HIV testing in MSM, because of the high levels of infection, high levels of recent acquisition of HIV infection and continued high-risk behaviour in this group. Delayed diagnosis of HIV confers a poor prognosis: 73% of the 516 patients with HIV who died in 2009 had been diagnosed late. An estimated 39% of MSM in 2009 were diagnosed when their immune system was below the threshold at which antiretroviral treatment should be commenced. Many of these men had seen their own GP with signs and symptoms of HIV and the opportunity to make the diagnosis had been missed. One of the most important indicators is primary HIV infection. This seroconversion illness presents with a flu-like illness often lasting more than two weeks with a rash, sore throat and lymphadenopathy. An HIV test should be performed straightaway on all MSM presenting with these features. The benefits of increased testing and early diagnosis include reduced mortality and morbidity related to HIV and the potential to reduce onward transmission. NICE recommends that MSM have HIV tests at least annually as part of routine care, and additionally if the patient: has a new sexual partner has high-risk sexual intercourse; is diagnosed with another STI; requests a sexual health screen; or presents with an HIV indicator disease.

AIDS. 2007 Nov 12;21(17):2309-14.

Serological testing algorithm shows rising HIV incidence in a UK cohort of men who have sex with men: 10 years application.

Source

Department of HIV and Genitourinary Medicine, Brighton and Sussex University Hospitals, Eastern Road, Brighton, BN2 5BE, UK. martin.fisher@bsuh.nhs.uk

Abstract

OBJECTIVES:

To investigate whether combining clinical data with the serological testing algorithm for recent HIV seroconversion (STARHS) reliably identifies otherwise unrecognized recent infections and observe their trends.

DESIGN:

Incorporation of STARHS into routine HIV diagnosis.

METHODS:

STARHS was applied to serum collected between 1996 and 2005 at HIV diagnosis and routine clinical/laboratory markers of recent infections were determined. The recent infections were identified by conventional means, by STARHS, and by both combined.

RESULTS:

Of 1526 infections diagnosed, 812 were new. Of these, 604 were in men who have sex with men (MSM); 208 in heterosexuals; 88% had serum available for STARHS, which identified 88 incident infections that would otherwise have been unrecognized (12% of all new infections, 34% of all recent infections). Of these, 88% reported recent high-risk sex; 47% reported seroconversion symptoms. STARHS confirmed recent infections in 71 of 74 (96%) known to be infected within 6 months by conventional methods. Combining both approaches, recent infections increased over time from 26% (1996) to 45% (2005) [P < 0.001]. STARHS results from 3% new diagnoses and 8% previous diagnoses were deemed false incident (associated with antiretroviral therapy, advanced disease or undetectable viral load). False incident results were only inexplicable in two individuals.

CONCLUSION:

Adjunctive use of STARHS with clinical data identified a high and increasing proportion of new HIV diagnoses as recent infections, confirming significant ongoing transmission. Since 2002, 50% of new diagnoses among MSM were recent infections. Identification of additional recent infections by STARHS enables effective intervention that may benefit the individual and reduce onward transmission.

(B)  Researchers  from  Emory  University  indicate  that  there  has  been  a  re-emergence  of the  HIV  epidemic  among  MSM  in  Australia, Canada, France, Germany, Netherlands, Spain, United Kingdom, and United States) from 1996-2005.

Ann Epidemiol. 2009 Jun;19(6):423-31.

Reemergence of the HIV epidemic among men who have sex with men in North America, Western Europe, and Australia, 1996-2005.

Source

Department of Epidemiology, Emory University, Rollins School of Public Health, Atlanta, GA 30322, USA. Patrick.sullivan@emory.edu

Abstract

PURPOSE:

To describe and contextualize changes in rates of human immunodeficiency virus (HIV) notifications in men who have sex with men (MSM) in eight countries (Australia, Canada, France, Germany, Netherlands, Spain, United Kingdom, and United States) from 1996-2005.

METHODS:

We analyzed trends in HIV notification rates from 1996-2000 and 2000-2005 by generalized linear regression and estimated annual percentage change (EAPC) in rates of HIV notifications. To interpret trends, we visually examined graphs of primary and secondary syphilis reports among MSM and the prevalence of recent HIV testing.

RESULTS:

The rate of HIV notifications among MSM declined 5.2% per year (95% confidence interval [CI]: -5.8%, -4.7%) from 1996-2000, and increased 3.3% per year (95% CI: +2.9%,+3.7%) from 2000-2005. During the period of increasing HIV diagnoses, increases in primary and secondary syphilis diagnoses occurred among MSM, but recent HIV testing among MSM did not seem to increase.

CONCLUSIONS:

After declining in the second half of the 1990s, HIV notification rates for MSM increased beginning in 2000. Increased HIV notifications in MSM are not wholly explained by changes in HIV testing. Urgent efforts are required to develop effective HIV prevention interventions for MSM, and implement them broadly in these countries.

(C) –  Research  in France  indicates  that  in the  context  of  sodomy  being  legal  since 1791  and  with  access  to  effective therapy  HIV  is  “out  of  control”  among  MSM   in  that  country

Lancet Infect Dis. 2010 Oct;10(10):682-7. Epub 2010 Sep 9.

Population-based HIV-1 incidence in France, 2003-08: a modelling analysis.

Le Vu S, Le Strat Y, Barin F, Pillonel J, Cazein F, Bousquet V, Brunet S, Thierry D, Semaille C, Meyer L, Desenclos JC.

Source

Institut de Veille Sanitaire, Saint-Maurice, France. s.levu@invs.sante.fr

Erratum in

  • Lancet Infect Dis. 2011 Mar;11(3):159.

Abstract

BACKGROUND:

Routine national incidence testing with enzyme immunoassay for recent HIV-1 infections (EIA-RI) has been done in France since January, 2003. From the reported number of HIV infections diagnosed as recent, and accounting for testing patterns and under-reporting, we aimed to estimate the incidence of HIV infection in France in 2003-08.

METHODS:

We analysed reports from the French National Institute for Public Health Surveillance for patients who were newly diagnosed with HIV between January, 2003, and December, 2008. Missing data were imputed with multiple imputation. Patients were classified with non-recent or recent infection on the basis of an EIA-RI test, which was calibrated with serial measurements from HIV seroconverters from the French ANRS-PRIMO cohort. We used an adapted stratified extrapolation approach to calculate the number of new HIV infections in men who have sex with men (MSM), injecting drug users (IDUs), and heterosexual men and women by nationality. Population sizes were obtained from the national census and national behavioural studies.

FINDINGS:

After accounting for under-reporting, there were 6480 (95% CI 6190-6780) new diagnoses of HIV infection in France in 2008. We estimate that there were 6940 (6200-7690) new HIV infections in 2008, suggesting an HIV incidence of 17 per 100 000 person-years. In 2008, there were 3550 (3040-4050) new infections in heterosexuals (incidence of 9 per 100 000 person-years), 3320 (2830-3810) in MSM (incidence of 1006 per 100 000 person-years), and 70 (0-190) in IDUs (incidence of 86 per 100 000 person-years). Overall HIV incidence decreased between 2003 and 2008 (p<0·0001), but remained comparatively high and stable in MSM.

INTERPRETATION:

In France, HIV transmission disproportionately affects certain risk groups and seems to be out of control in the MSM population. Incidence should be tracked to monitor transmission dynamics in the various population risk groups and to help to target and assess prevention strategies.

FUNDING:

French National Institute for Public Health Surveillance (InVS) and French National Agency for Research on AIDS and Viral Hepatitis (ANRS).

Copyright © 2010 Elsevier Ltd. All rights reserved.

(D) Australian  researchers  indicate similar  findings  to  the  French in the  context  of   sodomy being  legal  and  HAART   readily  available


Incidence of HIV among men who have sex with men in France

Sean R Hosein a, David P Wilson b

We thank Stéphane Le Vu and colleagues1 for presenting surveillance findings and insightful analyses of data for HIV-1 incidence in France. Incidence is the most important epidemiological measure of the extent of spread of infection in a population, but it is very difficult and costly to calculate. The approach used by Le Vu and colleagues adds substantial value for accurately understanding epidemic trajectories. Importantly, they show a persistent and high incidence of HIV among men who have sex with men (MSM) in France, a situation they describe as “out of control”, whereas HIV incidence has declined in all other major population groups. They also note that this high HIV incidence among MSM is occurring against a background of substantial uptake of highly active antiretroviral therapy (HAART), with which 92% of treated patients achieving a plasma viral load of fewer than 500 copies/mL. Our study in Sydney suggests that the infectiousness of HIV among MSM with HIV has not decreased fromlevels that existed before HAART.2 Data from a study in Amsterdam also suggest that HIV incidence has remained relatively high among MSM despite the widespread availability of HAART.3

The treatment as prevention strategy aims to reduce community viral load and assumes that this will reduce HIV transmission at the population level. Ecological studies and limited retrospective analyses suggest that treatment might have a preventative role for heterosexuals and people who inject drugs;4 however, it might be too optimistic to assume that this strategy can be effectively applied to MSM because of higher biological transmission rates and the sexual milieu of MSM. As explained by Le Vu and colleagues, such a milieu includes a high HIV prevalence, together with increased rates of unprotected anal sex with more partners and increased prevalence of sexually transmitted infections. Thus, merely intensifying a treatment as a prevention strategy for MSM without addressing other co-existing issues at the individual or community level is not going to lead to sustained changes to HIV epidemics.Intensified research into the experiences of sexually-active MSM, how HIV risk is perceived, and the reasons for taking such risks would usefully complement analyses of incidence for informing effective public health strategies. The findings of Le Vu and colleagues call for well-funded, creative, and thoughtful approaches to improve the sexual health of MSM so that thedevastation of HIV can be remedies.

( E) Researchers  from  the  Centers  for  Disease  Control  (CDC) indicate that the incidence  of   HIV in MSM in the USA  has  been  increasing  for  the  last two  decades.

AIDS Behav.2011 Apr;15 Suppl 1:S9-17.Sexual health, HIV, and sexually transmitted infections among gay, bisexual, and other men who have sex with men in the United States.

Wolitski RJ, Fenton KA.

Source

Division of HIV/AIDS Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton RD NE (E-35), Atlanta, GA 30333, USA. RWolitski@cdc.gov

Abstract

The sexual health of gay, bisexual, and other men who have sex with men (MSM) in the United States is not getting better despite considerable social, political and human rights advances. Instead of improving, HIV and sexually transmitted infections (STIs) remain disproportionately high among MSM and have been increasing for almost two decades. The disproportionate and worsening burden of HIV and other STIs among MSM requires an urgent re-assessment of what we have been doing as a nation to reduce these infections, how we have been doing it, and the scale of our efforts. A sexual health approach has the potential to improve our understanding of MSM’s sexual behavior and relationships, reduce HIV and STI incidence, and improve the health and well-being of MSM.

(F)  Researchers  from John Hopkins  Bloomberg  report  that  ” MSM have a markedly greater risk of being infected with HIV compared with general population samples from low- and middle-income countries in the Americas, Asia, and Africa”.

PLoS Med. 2007 Dec;4(12):e339.

Elevated risk for HIV infection among men who have sex with men in low- and middle-income countries 2000-2006: a systematic review.

Baral S, Sifakis F, Cleghorn F, Beyrer C.

Source

Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America.

Abstract

BACKGROUND:

Recent reports of high HIV infection rates among men who have sex with men (MSM) from Asia, Africa, Latin America, and the former Soviet Union (FSU) suggest high levels of HIV transmission among MSM in low- and middle-income countries. To investigate the global epidemic of HIV among MSM and the relationship of MSM outbreaks to general populations, we conducted a comprehensive review of HIV studies among MSM in low- and middle-income countries and performed a meta-analysis of reported MSM and reproductive-age adult HIV prevalence data.

METHODS AND FINDINGS:

A comprehensive review of the literature was conducted using systematic methodology. Data regarding HIV prevalence and total sample size was sequestered from each of the studies that met inclusion criteria and aggregate values for each country were calculated. Pooled odds ratio (OR) estimates were stratified by factors including HIV prevalence of the country, Joint United Nations Programme on HIV/AIDS (UNAIDS)-classified level of HIV epidemic, geographic region, and whether or not injection drug users (IDUs) played a significant role in given epidemic. Pooled ORs were stratified by prevalence level; very low-prevalence countries had an overall MSM OR of 58.4 (95% CI 56.3-60.6); low-prevalence countries, 14.4 (95% CI 13.8-14.9); and medium- to high-prevalence countries, 9.6 (95% CI 9.0-10.2). Significant differences in ORs for HIV infection among MSM in were seen when comparing low- and middle-income countries; low-income countries had an OR of 7.8 (95% CI 7.2-8.4), whereas middle-income countries had an OR of 23.4 (95% CI 22.8-24.0). Stratifying the pooled ORs by whether the country had a substantial component of IDU spread resulted in an OR of 12.8 (95% CI 12.3-13.4) in countries where IDU transmission was prevalent, and 24.4 (95% CI 23.7-25.2) where it was not. By region, the OR for MSM in the Americas was 33.3 (95% CI 32.3-34.2); 18.7 (95% CI 17.7-19.7) for Asia; 3.8 (95% CI 3.3-4.3) for Africa; and 1.3 (95% CI 1.1-1.6) for the low- and middle-income countries of Europe.

CONCLUSIONS:

MSM have a markedly greater risk of being infected with HIV compared with general population samples from low- and middle-income countries in the Americas, Asia, and Africa. ORs for HIV infection in MSM are elevated across prevalence levels by country and decrease as general population prevalence increases, but remain 9-fold higher in medium-high prevalence settings. MSM from low- and middle-income countries are in urgent need of prevention and care, and appear to be both understudied and underserved.

               

Is  Prime Minister  Cameron’s policy  position on  HIV  in  MSM  science  or  madness  ?

 
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1 Response to Prime Minister Cameron on HIV in MSM – Science or Madness ?

  1. Henry Fulmer says:

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