UNAIDS : HIV prevention among MSM or “sexual rights” even at the expense of the health of MSM ?

 

The  item below  was  originally  posted  on this  Blog  in September  2011.

 

The  following  is  from  the  English version  of  the  People’s  Daily  Online :

http://english.peopledaily.com.cn/90001/90782/90880/7436049.html

(A)

Gay men hit hard by HIV/AIDS

16:11, July 11, 2011

Gay and bisexual men account for around one in every three new cases of HIV in China, according to the latest official statistics released by the Ministry of Health.

About 5 percent of the group – officially termed men who have sex with men, or MSM – are living with the virus, which is a rate that is 88 times higher than the national HIV prevalence rate of 0.057 percent.

The problem is particularly acute in large urban centers, with the prevalence rate in some southwestern cities reaching almost 20 percent.

However, the statistics also show that less than half of all gay and bisexual men have access to HIV screening, while about 15 percent of those who are infected are not receiving treatment.

                                  ————  Research  ———–

(B)

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 RJFenton 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 otherSTIs 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’ssexual behavior and relationships, reduce HIV and STI incidence, and improve the health and well-being of MSM.

(C)

Clin Infect Dis. 2010 Sep 15;51(6):725-31.

Rethinking prevention of HIV type 1 infection.

Burns DNDieffenbach CWVermund SH.

Source

Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland 20892, USA. burnsda@niaid.nih.gov

Erratum in

  • Clin Infect Dis. 2010 Oct 15;51(8):995.

Abstract

Research on the prevention of human immunodeficiency virus (HIV)-1 infection is at a critical juncture. Major methodological challenges to performing prevention trials have emerged, and one after another promising biomedical interventions have failed to reduce the incidence of HIV-1 infection. Nevertheless, there is growing optimism that progress can be achieved in the near term. Mathematical modeling indicates that 2 new strategies, “test and treat” and preexposure prophylaxis, could have a major impact on the incidence of HIV-1 infection. Will our hopes be justified? We review the potential strengths and limitations of these antiretroviral “treatment as prevention” strategies and outline other new options for reducing the incidence of HIV-1 infection in the near term. By maximizing the potential of existing interventions, developing other effective strategies, and combining them in an optimal manner, we have the opportunity to bring the HIV-1 epidemic under control.

quote from article:

The human immunodeficiency virus (HIV)–1 epidemic remains out of control despite the intense efforts of clinicians, scientists, public health specialists, activists, and others for nearly 3 decades. There have been dramatic gains, particularly in treatment, but for every 2 persons who start antiretroviral therapy (ART), 5 become newly infected [1]. UNAIDS estimates that there were 2.7 million new HIV-1 infections and 2.0 million deaths due to AIDS in 2008. Decreases in some regions were offset by increases in others [2]. In North America, western Europe, and Australia, there is evidence that the epidemic is expanding in the population most affected, men who have sex with men [36].”

(D)

Eurosurveillance, Volume 15, Issue 39, 30 September 2010

Surveillance and outbreak reports

Hepatitis C virus infection in HIV-infected men who have sex with men: sustained rising incidence in Antwerp, Belgium, 2001–2009

E Bottieau ()1, L Apers1, M Van Esbroeck1, M Vandenbruaene1, E Florence1

  1. Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium

http://www.eurosurveillance.org/viewarticle.aspx?articleid=19673

Introduction

Since 2000, the prevalence and incidence of hepatitis C virus (HCV) infections have increased in human immunodeficiency virus (HIV)-infected men who have sex with men (MSM) in large cities in the Netherlands [1], United Kingdom [2], France [3], the United States [4] and Australia [5]. Although sexual transmission of HCV is known to be rather inefficient in discordant heterosexual couples, recent observations suggest that this is the most likely mode of HCV acquisition among HIV-infected MSM [1,6-8]. High prevalence of ulcerative sexually transmitted infections (STIs), mainly syphilis and lymphogranuloma venereum (LGV), has been reported in HIV/HCV co-infected MSM [9,10] suggesting that HCV infections among MSM epidemiologically follow the epidemics of syphilis (observed since the beginning of 2000 [11-13]), and of LGV (which emerged a few years later) [14-16]. Recently, rough sexual techniques such as fisting and use of recreational drugs, in particular gamma hydroxyl butyrate (GHB), have been identified as independent risk factors for HCV transmission in MSM, beside intravenous drug use (IDU) and HIV infection [1,7,17]. In addition, phylogenetic analyses have revealed a high degree of HCV clustering among HIV/HCV co-infected MSM in Amsterdam, the Netherlands [1,7] and the existence of a large, international network of HCV transmission in HIV-positive MSM has been demonstrated in several European countries [18].

Hepatitis C is therefore increasingly perceived as an emerging and expanding STI in HIV-infected MSM. It is well known that the clinical management of HIV/HCV co-infection is complex [6] and poses specific epidemiological challenges [7,8], hence the importance of surveying the incidence and prevalence of HCV infection in this specific group. The main purpose of this study was to quantify the rising number of new HCV infections in HIV-infected MSM in the HIV/STI reference clinic of the Institute of Tropical Medicine, Antwerp, Belgium, over the past decade. A second objective was to document the current management and clinical outcome of these co-infected patients.

(E)

Eur J Clin Microbiol Infect Dis. 2010 Aug;29(8):917-25. Epub 2010 May 28.

Lymphogranuloma venereum proctocolitis: a silent endemic disease in men who have sex with men in industrialised countries.

Source

Department of Infectious Diseases, Aalborg Hospital, Aarhus University Hospital, Hobrovej 18, Aalborg, Denmark. raquel@bisaurin.org

Abstract

Lymphogranuloma venereum (LGV) is a sexually transmitted disease (STD) caused by serovars L1-L3 of Chlamydia trachomatis. Rare in the western world prior to 2003, different outbreaks or clusters of LGV have been reported in Europe, North America and Australia among men who have sex with men (MSM) over the past few years. The majority were HIV infected MSM with high-risk sexual behaviour and a high rate of concomitant STD, including hepatitis C. Most of them presented with a proctitis syndrome and only a few with the classical bubonic form. A previously non-described serovar, L2b, has been identified as the main causative agent of the epidemic. A delay in diagnosis has been the rule because of the misleading symptomatology of LGV proctitis, the unfamiliarity of the disease to physicians, and the lack of a routine diagnostic test for LGV serovars. It is crucial to increase the awareness of the disease among physicians for prompt diagnosis and treatment, to avoid complications, and to stop ongoing transmission. It has additional public health implications since LGV may facilitate the transmission and acquisition of HIV and other STD.

Here’s  an overview of  the LGV epidemic at Wikipedia

http://en.wikipedia.org/wiki/Lymphogranuloma_venereum

LGV is primarily an infection of lymphatics and lymph nodesChlamydia trachomatis is the bacteria responsible for LGV. It gains entrance through breaks in the skin, or it can cross the epithelial cell layer of mucous membranes. The organism travels from the site of inoculation down the lymphatic channels to multiply within mononuclear phagocytes of the lymph nodes it passes.

In developed nations, it was considered rare before 2003.[6] However, a recent outbreak in the Netherlands among gay men has led to an increase of LGV in Europe and the United States.[7][8] A majority of these patients are HIV co-infected.

Since the 2004 Dutch outbreak many additional cases have been reported, leading to greater surveillance.[9] Soon after the initial Dutch report, national and international health authorities launched warning initiatives and multiple LGV cases were identified in several more European countries (Belgium, France, the UK,[10] Germany, Sweden, Italy and Switzerland) and the US and Canada. All cases reported in Amsterdam and France and a considerable percentage of LGV infections in the UK and Germany were caused by a newly discovered Chlamydia variant, L2b, a.k.a the Amsterdam variant. The L2b variant could be traced back and was isolated from anal swabs of MSM who visited the STI city clinic of San Francisco in 1981. This finding suggests that the recent LGV outbreak among MSM in industrialised countries is a slowly evolving epidemic.

The L2b serovar has also been identified in Australia.[11]

                             ———– UNAIDS  —————-

UNAIDS are a group of United Nations agencies which are supposed to  be working to eliminate HIV worldwide.. United Nation agencies  first  responsibility  is  to  the  governments  of  United Nations  member states  however  despite  overwhelming  evidence  in peer-reviewed journals    of  the risk to health of Men having Sex with Men  UNAIDS   appears  to  prioritize  LGBT activism  over  evidence-based  medicine.
On Page 123 of the document ” UNAIDS OUTLOOK 2010″ homophobia is defined as follows :

“What is homophobia?

UNAIDS describes homophobia as intolerance and contempt for those who have identities
and orientations other than heterosexual ones. It is an aversion, hatred, fear, prejudice or discrimination against homosexual men, bisexual people,transgender people,transvestites, lesbians and transsexuals. Homophobia confers a monopoly of normality on heterosexuality  , thus generating and encouraging contempt for those who diverge from the reference model.”

Should  UNAIDS be  advising  against Men having Sex with Men ?

Would  UNAIDS  be  criminally  negligent  if  the  organization did  not  advise  against  Men having Sex with Men ?

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