#pre-exposure prophylaxis

[manispecialtycenter]

Exploring Alternative Methods of Std Prevention

In a world where awareness about sexually transmitted diseases (STDs) is crucial, it’s essential to stay informed about the various prevention methods available. Conventional methods like using condoms and practicing safe sex are well-known, but there’s a growing interest in alternative approaches to STD prevention.

[jcsmicasereports]

POFF SHOOTS OF PrEP ( Pre Exposure Prophylaxis for HIV) Clinics by Saraswathi Lakkasani MD in Journal of Clinical Case Reports Medical Images and Health Sciences

Introduction

HIV preexposure prophylaxis (PrEP), is use of antiretroviral medications to prevent acquisition of HIV infection, in a HIV negative person who has on going risk of acquiring HIV. This strategy has proven effective in several recently published reports. The regimen if used optimally has HIV reduction record of 99%. However, there are several positive unforeseen benefits in this strategy. In this observational study we are presenting some additional benefits we observed in our Prep Clinic.

We are reporting the findings of our on-going PrEP Clinic for your perusal. Saint Michaels Medical Center is a 150 to 200 bedded community hospital, at Newark, New Jersey. We follow more than 200 PrEP clients in our Prep Clinic. We follow the state mandated protocol for induction and follow up.

Observation Results

So far there is no seroconversion to HIV after starting PrEP. Two of our clients had successful full term, normal pregnancies with sero negative healthy babies. Statistically significant number of STI’s (sexually transmitted Infections) were diagnosed and successfully treated and Significant number of unimmunized clients for Hepatitis B and A were identified and immunized. One case of uncontrolled diabetes and one hypercalcemia were identified at the initial visit and referred to the respective specialist. One patient was found to have anal mass, six months into the program, being pursued by colorectal surgeon.

Conclusion

Among the risk groups benefited by PrEP, the use of PrEP has increased by 500%. The average age group of clients falls between 25 to 35 who are in good health and with very few comorbidities who may or may not come to Primary care clinics on regular basis.

PrEP clinics gives an excellent opportunity to detect, diagnose and treat some of the commonly missed but treatable medical issues. The demand will be increasing in future. Our findings may be the tip of an iceberg.

[molovesbooks]

thank you, tumblr dad!

ask a nurse/doctor or anyone else who works in hospitals/healthcare places if you need more info on this! (ideally even the janitors and cleaning staff should know some stuff, at least that's what we do in my hospital in Europe)

also, PrEP and PEP are definitely safe, but the side effects can be pretty severe, just be warned. definitely, definitely take them if you are or think you might be in any way at risk (some insurance companies in multiple European countries will cover the cost or at least a big part of it), but have your healthcare provider or a trusted internet source explain the entire thing to you in detail! our tumblr dad gave a great comprehensive overview, but please do some more research if any of it applied to you!

If you can, it's definitely worth looking at the product monograph of whatever you're being prescribed (or even the instruction leaflet), but if you're struggling with that for any reason, ask a trusted person in your life to look over it with you. I've had enough doctors not tell me everything I thought relevant.

(If you want, you can ask me too)

My dear lgbt+ kids,

Let's talk about PrEP and PEP.

PrEP is short for pre-exposure prophylaxis. It's a safe* and highly effective medicine (pills or shots) you can take to reduce your chances of getting HIV. When taken as prescribed, it reduces the risk of getting HIV from sex by about 99% and the risk of getting it from drug injection by at least 74% (Source)

PrEP may be the right choice for you if you have an ongoing risk of HIV exposure. For example, if you:

have frequently changing sexual partners, or

are a sex worker, or

do not consistently use condoms, or

have an HIV-positive partner, or

have been diagnosed with another sexually transmitted disease, or

have used multiple courses of PEP (see below), or

inject drugs and share needles, syringes, or other drug injection equipment (for example, cookers).

Even if none of these apply to you, PrEP could still be helpful for you - talk to a healthcare professional about your individual situation.

Some more important info:

Teenagers can take PrEP if they are at risk!

Before beginning PrEP, you must take a test to make sure you are currently HIV-negative.

PrEP takes some time to work (about 7 days for anal sex, about 21 days for vaginal sex or drug use).

It's not the right choice if you think you may already have been exposed to HIV - if you think you have been exposed within the last 72 hours, ask for PEP right away.

PrEP is much less effective when not taken as prescribed.

PEP is short for post-exposure prophylaxis. It's medicine for emergency situations. You can take it after possible exposure to HIV (e.g if a condom broke or after sexual assault). It's safe* and highly effective but only if taken within 72 hours of exposure - when it comes to PEP, every hour counts! Don't wait, talk right away to a health care provider, an emergency room doctor, or an urgent care provider.

PEP is not a substitute for condoms and doesn't provide ongoing protection.

*While they are safe, PrEP and PEP can have side effects (such as nausea). In almost all cases, these side effects aren’t life-threatening. They usually go away on their own or can be easily treated. Talk to a healthcare professional if you are concerned about side effects.

With all my love,

Your Tumblr Dad

[erdkuttam]

Embracing Hope and Unity: A Reflection on World AIDS Day

As we come together on December 1st to observe World AIDS Day, it’s not just a day on the calendar; it’s a powerful reminder of solidarity, compassion, and the ongoing fight against HIV/AIDS. In this blog post, we’ll delve into the significance of World AIDS Day, the progress made, and the importance of continuing our collective efforts. International Men’s Day: A Tribute to Men’s…

[reasonsforhope]

"A large clinical trial in South Africa and Uganda has shown that a twice-yearly injection of a new pre-exposure prophylaxis drug gives young women total protection from HIV infection.

The trial tested whether the six-month injection of lenacapavir would provide better protection against HIV infection than two other drugs, both daily pills. All three medications are pre-exposure prophylaxis (or PrEP) drugs.

Physician-scientist Linda-Gail Bekker, principal investigator for the South African part of the study, tells Nadine Dreyer what makes this breakthough so significant and what to expect next.

Tell us about the trial and what it set out to achieve

The Purpose 1 trial with 5,000 participants took place at three sites in Uganda and 25 sites in South Africa to test the efficacy of lenacapavir and two other drugs.

Lenacapavir (Len LA) is a fusion capside inhibitor. It interferes with the HIV capsid, a protein shell that protects HIV’s genetic material and enzymes needed for replication. It is administered just under the skin, once every six months.

The randomised controlled trial, sponsored by the drug developers Gilead Sciences, tested several things.

The first was whether a six-monthly injection of lenacapavir was safe and would provide better protection against HIV infection as PrEP for women between the ages of 16 and 25 years than Truvada F/TDF, a daily PrEP pill in wide use that has been available for more than a decade.

Secondly, the trial also tested whether Descovy F/TAF, a newer daily pill, was as effective as F/TDF...

The trial had three arms. Young women were randomly assigned to one of the arms in a 2:2:1 ratio (Len LA: F/TAF oral: F/TDF oral) in a double blinded fashion. This means neither the participants nor the researchers knew which treatment participants were receiving until the clinical trial was over.

In eastern and southern Africa, young women are the population who bear the brunt of new HIV infections. They also find a daily PrEP regimen challenging to maintain, for a number of social and structural reasons.

During the randomised phase of the trial none of the 2,134 women who received lenacapavir contracted HIV. There was 100 percent efficiency.

By comparison, 16 of the 1,068 women (or 1.5%) who took Truvada (F/TDF) and 39 of 2,136 (1.8%) who received Descovy (F/TAF) contracted the HIV virus...

What is the significance of these trials?

This breakthrough gives great hope that we have a proven, highly effective prevention tool to protect people from HIV.

There were 1.3 million new HIV infections globally in the past year. Although that’s fewer than the 2 million infections seen in 2010, it is clear that at this rate we are not going to meet the HIV new infection target that UNAIDS set for 2025 (fewer than 500,000 globally) or potentially even the goal to end Aids by 2030...

For young people, the daily decision to take a pill or use a condom or take a pill at the time of sexual intercourse can be very challenging.

HIV scientists and activists hope that young people may find that having to make this “prevention decision” only twice a year may reduce unpredictability and barriers.

For a young woman who struggles to get to an appointment at a clinic in a town or who can’t keep pills without facing stigma or violence, an injection just twice a year is the option that could keep her free of HIV.

What happens now?

The plan is that the Purpose 1 trial will go on but now in an “open label” phase. This means that study participants will be “unblinded”: they will be told whether they have been in the “injectable” or oral TDF or oral TAF groups.

They will be offered the choice of PrEP they would prefer as the trial continues.

A sister trial is also under way: Purpose 2 is being conducted in a number of regions including some sites in Africa among cisgender men, and transgender and nonbinary people who have sex with men.

It’s important to conduct trials among different groups because we have seen differences in effectiveness. Whether the sex is anal or vaginal is important and may have an impact on effectiveness.

How long until the drug is rolled out?

We have read in a Gilead Sciences press statement that within the next couple of months [from July 2024] the company will submit the dossier with all the results to a number of country regulators, particularly the Ugandan and South African regulators.

The World Health Organization will also review the data and may issue recommendations.

We hope then that this new drug will be adopted into WHO and country guidelines.

We also hope we may begin to see the drug being tested in more studies to understand better how to incorporate it into real world settings.

Price is a critical factor to ensure access and distribution in the public sector where it is badly needed.

Gilead Sciences has said it will offer licences to companies that make generic drugs, which is another critical way to get prices down.

In an ideal world, governments will be able to purchase this affordably and it will be offered to all who want it and need protection against HIV."

-via The Conversation, July 3, 2024

[topbestsexologistindelhi]

Discover the top premature ejaculation treatment with the best sexologist in Delhi for effective and reliable solutions.

[telomeke]

Text description for image post at the start of this thread–

Tweet by Omasilachi Amanda Ifeoluwa Chinda @‌amandachinda_ posted 5 June 2019:

If after sex and the person says "I forgot to tell you I am HIV positive" What will be your reaction?

‌

Reply tweeted by senbonzakura-Valencia @‌meister_kwame:

I would rush to the hospital. There is treatment for HIV within the first 3 days. So many people don't know this

‌

This was followed by another post on Post-Exposure Prophylaxis (PEP) by senbonzakura-Valencia @‌meister_kwame with the message:

Hope this saves someone

The information on Post-Exposure Prophylaxis (PEP) that accompanied the tweet:

Post-Exposure Prophylaxis (PEP) – Last Reviewed: May 10, 2019 Key Points • Post-exposure prophylaxis (PEP) means taking HIV medicines very soon after a possible exposure to HIV to prevent becoming infected with HIV. • PEP is intended for emergency situations. It is not meant for regular use by people who may be exposed to HIV frequently. • PEP must be started within 72 hours (3 days) after a possible exposure to HIV. The sooner you start PEP after a possible HIV exposure, the better. • If you are prescribed PEP, you will take HIV medicines every day for 28 days.

‌

Reply to @‌meister_kwame tweeted by Ikechukwu @‌Iakaluka:

Very important information you just dropped. Must confess I never knew there was treatment for HIV within the first 3 days… Will surely spread this information

‌

Reply tweeted by Visit My Youtube Channel @‌naalaryea:

It's not a treatment o, it's a prophylactic measure. There's still no treatment for HIV.

‌

Reply to @‌naalaryea tweeted by senbonzakura-Valencia @‌meister_kwame

Yh but it prevents the virus from taking hold in your system. After 3 days the virus is permanent

‌

Reply tweeted by mich @‌mooochellee:

Great info but also: - HIV+ individuals can be virally suppressed (will not transmit virus) if taking antiretroviral therapy (ART) correctly - Yes def go to the hospital to get PEP if you're exposed. But note that not all HIV+ people will transmit HIV

‌

[batmanisagatewaydrug]

wait, what's the difference between hpv and hiv and aids? i thought hiv was just aids and hpv was like. another term for hiv please 😭

okay. before I do this. I do want to remind everyone that this kind of info is incredibly easy to seek for yourself, with the help of simple search times like "what is hpv" or "hiv wikipedia," and I do really encourage doing that! learning how to seek out information is an important skill!

but god I am going to do this anyway, here we go.

HPV is human papillomavirus, an extremely common viral infection that virtually every sexually active person will contract at some point in their life. there are nearly 200 stains of HPV, nearly all of which are harmless, but there are 2 that can (but don't always) cause genital warts and 13 that can (but don't always) cause cancers of the cervix, anus, vagina, vulva, penis, and throat. roughly 90% of cases of HPV clear up and go away on their own within two years of contraction without ever causing any health problems; the majority of people who have it will be asymptomatic the entire time and may never know they have it.

HIV is human immunodeficiency virus, a virus that attacks and drastically weakens the immune system when untreated. it is considered an STI but is not spread exclusively through sexual contact, as it can also be transmitted via unclean syringes shared between people as well as from parents to children via childbirth or breastfeeding. while HIV can be fatal, usually when it develops into AIDS, as I posted about earlier tonight proper medicine and management can allow people with HIV can live full, healthy lives and even completely negate their risk of transmitting HIV.

it's also important to discuss PrEP (pre-exposure prophylaxis), which can be taken by people who do not have HIV to drastically reduce their risk of contracting it, and PEP (post-exposure prophylaxis) which can be taken for 28 days starting up to 72 hours after potential exposure to HIV to greatly reduce the risk of the virus taking hold.

AIDS is acquired immunodeficiency syndrome. AIDS develops when HIV is left untreated and progresses over years, when the immune system has been severely depleted. at this point people are very prone to what are known as "opportunistic" infections and cancers, further health complications that their immune system is unable to fight off as it ordinarily would. people with AIDS often deal with a state of constant fatigue, fever, chills, weakness, inflammation, and weight loss.

so, you know. slightly different things!

[southeastasianists]

It was the mid-1980s when Paul Toh came of age as a gay man, decades before smartphones and dating apps made sex a lot more accessible right at your fingertips. Toh has been diagnosed with HIV since 1989. 

Now semi-retired with his own business distributing antiretroviral therapy medication and HIV pre-exposure prophylaxis (PrEP), the 59-year-old said that in those days, cruising in public parks, toilets, and back alleys of dirty shophouses along pre-cleanup Singapore River for sex was par for the course. 

Unsurprisingly, cruising in public made gay men easy targets for police officers. “They started going to these cruising grounds undercover, with the explicit intention of entrapping and arresting gay men,” Toh added.

Police raids in nightlife establishments with gay clientele also became common, with prominent gay discotheque Niche having its liquor license withdrawn by the police in 1989 and the Rascals incident of 30 May 1993, in which multiple patrons were arrested for not having their NRICs on them. This came to be remembered by veteran activists as Singapore’s Stonewall. 

Fear about the spread of AIDS was part of the reason why police intensified their clamp down on queer spaces. In April 1987, Singapore experienced its first AIDS-related death. And one year later, the Director of Public Affairs of the Singapore Police Department said in a Straits Times article that “homosexual activities have been strongly linked to the dreaded AIDS disease,” making it an “added reason in the public interest for police to disallow homosexuals to convert places licensed for entertainment into places where they can congregate.”

Iris’ Work of Fighting Stigma

76-year-old health advisor Iris Verghese was among the first health workers to rise to the occasion when Singapore reported its first HIV/AIDS cases. 

“I knew just as little about HIV/AIDS as everyone else,” said the retired nurse, who first joined Middle Road Hospital, a now-defunct treatment centre for sexually transmitted diseases, in 1974. As part of her job, Verghese was tasked with contact tracing people who had sexually transmitted infections. 

The job brought Verghese to brothels and nightclubs in Geylang’s red-light district, which meant she was no stranger to serving society’s Others with kindness. 

“A lot of it has to do with my faith.”

“I thought about my role models like Jesus and Mother Teresa—they didn’t care what illness you had. If they could hang out with people with leprosy, then who am I to refuse to care for those with HIV/AIDS?”

Verghese’s work is well-documented, and everyone has given her the accolades she deserves—from President Halimah Yacob to the Roman Catholic Archdiocese of Singapore to the Straits Times, which named her an everyday hero in 2019.

Plague, a 15-minute short film by Singaporean filmmaker Boo Junfeng, captures the emotional gravity of the care work performed by Verghese and health workers like herself. 

The emotionally-stirring film is inspired by Verghese’s work with HIV/AIDS patients in the ’80s and offers a look into the life of Jamie, a patient who stopped coming to the clinic for treatment and counselling.

In the film’s climax, set in the patient’s HDB flat, Verghese tries to dissuade Jamie from inflicting internalised stigma. Jamie insists on using disposable plastic cups and utensils and cleaning every surface he touches for fear of passing the virus to his loved ones.

Wanting to prove that HIV/AIDS is not transmissible through saliva, Verghese takes Jamie’s plastic cup and drinks from it. She then hands him a regular glass, beckoning for him to drink from it, only for him to swipe it away, breaking the glass and cutting himself in the process. 

Thus comes the true test of Verghese’s dedication to her profession as she steels herself to the drastically heightened risk. Now that her patient is bleeding, she is dealing no longer just with saliva, but with blood carrying the virus. 

In our interview, Verghese recalled many incidents like these. One that stuck with me was her counselling session with Singapore’s first HIV patient, a young gay professional, in 1985. “As I listened to him and gave him a hug, he broke down and cried,” she said. “He said he felt so good afterwards.”

Safe Sex Outreach in the 80s

“Things were very different in the ’80s and ’90s,” said Professor Roy Chan, Founding President of Action for AIDS Singapore (AfA). AfA is a non-government organisation founded in 1988 to fight HIV/AIDS infection in Singapore. 

“There was no internet then. When we set up AfA, we had to rely on word of mouth, phone calls, faxes, pagers, and so on. Mobilisation was not as easy then, but we overcame the obstacles we faced. It was very much more hands-on in those days,” Chan recalled. 

Chan set up AfA as a non-governmental organisation in 1988 to respond to the needs of people living with HIV/AIDS, regardless of their sexual orientation or gender identity, as well as to advocate for greater action and awareness around HIV/AIDS. 

AfA was also one of the first community groups in Singapore that served the needs of LGBTQ+ individuals—namely men who have sex with men—disproportionately affected by HIV/AIDS. 

“Back then, people didn’t have as much access to the internet as we do today, meaning that accurate information on HIV/AIDS was much harder to come by, making education efforts vital,” Chan recalled. “On the flip side, no internet meant the gay nightlife scene was more vibrant than what it is today.” 

Since the gay community in the 1980s and 1990s did not have the internet and mobile phone apps to meet other people online, they had to go to physical spaces to fulfil their need for connection, whether it was nightlife establishments or cruising grounds.

Gay clubs were hence crucial in AfA’s outreach programs on safe sex practices back in the ’80s—even if it meant risking the possibility of police raids.

Back then, there were very few places in Singapore where gay men felt safe enough to gather in abundance, making gay clubs a viable hub for outreach and education.

AfA’s outreach efforts endure today in the form of the Mobile Testing Van initiative on weekends. The van, parked outside popular gay nightlife spots in Singapore, aims to bring HIV testing closer to the public, bridging the fear and stigma of walking into a stand-alone clinic to get tested.

The Consequence of Outreach

The people brave enough to put themselves out there to serve a larger cause were but a small minority, especially given the cultural milieu of the time. 

“There was so much that was unknown about HIV/AIDS even among the medical community, much less the general public,” said Verghese.

“Even at Middle Road Hospital, two doctors resigned, and twenty-five nurses asked to be transferred out.”

AfA’s awareness campaigns and fundraiser drives drew a lot of publicity—and no doubt some backlash.

Still, beneath all the headlines and the star power lent by high-profile celebrity allies was the silence surrounding individual HIV/AIDS cases. 

“It was all very hush-hush. People didn’t want to talk about it. No one wanted to know who died of AIDS,” Verghese shared when I asked if the atmosphere in the 90s was similar to that depicted in films and drama series such as The Normal Heart and Pose. 

The shows portrayed the HIV/AIDS crisis in the disease’s epicentre in New York as being a time of deaths and countless funerals attended by surviving gay men. 

One exception to this veil of silence was Paddy Chew, the first Singaporean person to come out publicly as being a person living with HIV/AIDS. 

Chew—well-known for his one-man autobiographical play Completely With/Out Character—told Verghese and her husband that he wanted no crying at his funeral. 

“He asked me to arrange his funeral such that his ashes will be thrown into the sea from a Singapore Armed Forces boat,” said Verghese. She and Chew’s close friends were instructed to be dressed in their party best, with helium balloons that were to be released out at sea. 

“There was one helium balloon that drifted away from the other balloons. To me, that felt like it was Paddy’s soul saying goodbye to us one last time.”

A Tale of Two HIV Diagnoses

Perhaps by coincidence—or not, since Verghese was one of the very few nurses dedicated to caring for HIV/AIDS patients at the time—Toh’s then-partner was also one of Verghese’s patients. 

“My then-partner Freddie and I handled our HIV diagnoses very differently, but of course, we also came from very different backgrounds and life experiences,” said Toh. 

“I found out about my status because an ex-lover of mine had come down with pneumocystis pneumonia (PCP). I flew to Sydney for a diagnosis so that I wouldn’t be registered in the local system here if I was found to be positive.” 

On the other hand, Freddie found out about his HIV-positive status because he was a regular blood donor. Not only was his diagnosis inevitably recorded in the national registry, but Freddie also ran into legal trouble. He was charged in court for false disclosure of his sexual activity. 

“Because of how the entire trial turned out, Freddie was sentenced to imprisonment for twice the expected duration. It affected his entire outlook in life, feeling like he was being framed by a bigger power with an agenda, with the whole world against him,” said Toh, who cared for Freddie until he passed in 2008. 

Toh, on the other hand, took his diagnosis as an opportunity to re-evaluate his life and make the most of the eight years that the doctor told him back in 1989 he had left to live. 

“When I received my diagnosis, the only thing in my mind was this: it is the quality of life that matters, not the quantity.” And so, the two spent the next few years of their lives travelling the world, making their remaining years as meaningful as they could be. 

Anything for a Chance at Life

Maximising his remaining years did not stop at travel for Toh. Having managed to get his hands on antiretroviral therapy in Sydney in the form of azidothymidine (AZT), he went on to look for more effective forms of medication while the technology was being developed in real-time. Toh wanted to help other HIV patients like himself. 

In 1994, Toh joined the Asia Pacific Network of People with HIV/AIDS (APN+), a regional network advocating for the improvement of the lives of people with HIV/AIDS in the Asia-Pacific region, later becoming a Board member and secretariat.

“North America and Europe were progressing swiftly in their battle against HIV/AIDS thanks to the work of activists there putting pressure on their governments and the medical community to channel funding towards the research and development of suitable treatment for HIV/AIDS,” said Toh.

“In Asia, however, it’s a different story. We had to be street smart in our advocacy while also looking elsewhere for allies.”

This meant looking to donors in the West who could be persuaded to recognise the importance of HIV/AIDS advocacy in Asia.

“I was very lucky to have the opportunity to be one of the first few Asians who had access to HAART, said Toh. 

HAART (Highly active antiretroviral therapy) is a triple-combination of antiretroviral drugs discovered in 1996 by Professor David Ho. Toh had been invited to attend the 11th International Conference on AIDS in Vancouver, Canada, where the discovery of this triple cocktail was announced. 

Within three months of beginning HAART treatment in 1996, Toh saw his health improving tremendously, with his CD4 count—a measure for the immune system of PLHIV—increasing exponentially and his viral load becoming undetectable within the fourth month. 

Although Toh already had a supply of free antiretroviral medication from his healthcare provider in Sydney, he continued to look elsewhere for alternative sources for patients who were unable to afford the patented medication. 

“Unlike Taiwan, Hong Kong, and South Korea, where medication for HIV/AIDS was provided to patients for free, Singapore was the only Asian Tiger which did not do so,” said Toh. 

“Meanwhile, pharmaceutical companies in developing countries like Brazil, India, and Thailand were manufacturing their own generic antiretroviral medication in spite of patent laws, making it more affordable.”

While still not free, MOH announced in 2020 that HIV medication would become subsidised.

Singapore’s Very Own ‘Buyers Club’

With patented HIV/AIDS medication in the ’80s continuing to be inaccessible to many who needed it, buyers clubs—similar to the one featured in the 2013 film Dallas Buyers Club—would soon emerge worldwide, including Singapore. 

“The funny thing was that Australia had easy access to HIV/AIDS medication, so there was a lot of stock available in Sydney,” said Verghese. A family vacation down under in 1987 turned into an informal research trip for her to network and gather the information that she needed to perform her job optimally. 

During her trip, she met HIV researcher Dr David Cooper, who brought her to Albion Street Centre (now known as The Albion Centre), which specialises in HIV/AIDS management. 

Through her newfound contacts, Verghese managed to get her hands on some of the unused stocks of medication in Sydney back to Singapore for her support group. 

“We even got the help of the Singapore Airlines flight attendants to pool together their unused baggage allowance to bring this medication back,” she recounted with a laugh. 

Antiretroviral medication was not the only asset that Verghese brought back. She learned a lot about the virus from the professionals she met in Sydney, allowing her to move faster than the national response and gather the information needed to tend to her patients. 

A Ground Up Initiative

“George Yeo was actually very impressed with what we were doing,” recounted Verghese. “He wanted to meet with the community to learn more about our efforts and arranged a closed-door meeting with us.”

The meeting was the culmination of months of sending letters to Yeo, the Minister of Health at the time. The dialogue session was held to discuss the government’s rule that mandated the bodies of AIDS sufferers to be buried or cremated within twenty-four hours of dying. 

This rule was finally lifted in December 2000, after four years of advocacy by AfA.

They argued that the policy was outdated, having been implemented in the mid-1980s when hardly anything was known about HIV/AIDS. 

“I think we’ve certainly had to prove ourselves as an organisation over the years,” Chan said. “There might have been concerns among some who thought of us as a gay rights organisation, or misconceptions that AfA worked solely on issues that concern gay people.”

“But we’ve proven ourselves over the years to be a serious and effective organisation tackling HIV/AIDS and sexual health with clear metrics of success, and the results and continued support from the government speak for themselves,” added Prof Chan. 

Toh, who served as AfA’s Executive Director from 2007-2009, concurs. 

“Actually, not many people know this, but MOH has been quite supportive of AfA over the years. Even during my term, they would hold closed-door discussions with us, intently wanting to work with us on eliminating HIV/AIDS,” said Toh. He reckoned that MOH did not want to be publicly seen as supporting something considered by society as ‘morally corrupt’ no matter how beneficial it is to wider society. 

The Fruits of Our Predecessors’ Labour Are Not Handed on a Silver Plate

The history of HIV/AIDS and its role in fomenting community-building among the LGBTQ+ community has always been a topic of fascination for me.

I can only imagine what it must have been like to see everyone in your social circles and communities succumbing, one by one, to an unknown disease. 

Covid-19 provided the closest representation of the tumultuous and uncertain time in the ’80s.

In the midst of writing this, however, the comparison became a much closer one. Monkeypox is now affecting men who have sex with men more than the rest of the general population. 

“It’s not the same thing,” Chan said, cautioning against making blanket comparisons between monkeypox and HIV/AIDS.

“For starters,” he intoned, “monkeypox is not an unknown disease. We’ve known about monkeypox for decades, so it is nothing close to HIV back in the ’80s.”

Admittedly, life is easier for a gay man like me, who came of age at a time when HIV/AIDS is no longer considered a significant threat. 

With common knowledge of medication as well as preventative measures like safer sex and pre and post-exposure prophylaxis (PrEP and PEP), it is easy for me and my peers to take for granted the freedoms that we now enjoy, thanks to decades of advocacy and destigmatisation. 

But as Prof Chan said, “It is important not to be complacent. The freedoms and advancements we have today were not handed on a silver platter. Earlier generations had to fight very hard for all of these things.”

[covid-safer-hotties]

Also preserved on our archive

By Robert Pearl, M.D.

In the late 1970s and early ‘80s, a mysterious illness spread through America’s overlooked communities, mainly affecting intravenous drug users and homosexual men.

The disease, which caused a sudden and devastating collapse of the immune system, was unlike anything doctors had seen before. Patients arrived at hospitals with rare infections like Kaposi’s sarcoma and fungal pneumonia.

But despite the rising number of cases, public health officials remained silent for years. Few Americans saw it as a national emergency, especially since the disease seemed confined to society’s fringes, at least initially.

By the time the government and public fully grasped the threat in 1986—following Dr. C. Everett Koop’s “Surgeon General’s Report on AIDS”—tens of thousands of Americans had already died.

Looking back on this and other public health crises, it’s clear that medical science alone isn’t enough to save lives. To prevent similar tragedies, public health leaders and elected officials must first understand the role denial plays in people’s perception of medical threats. They must then develop effective strategies to overcome it.

The Psychological Basis For Denial Denial is a powerful, usually unconscious defense mechanism that shields individuals from uncomfortable or distressing realities. By repressing objective facts or experiences—especially those that provoke fear or anxiety—people can maintain a sense of stability in the face of overwhelming threats.

Historically, denial was vital to daily life. With little protection against illnesses like smallpox, tuberculosis or plague, people would have been immobilized by fear if not for the ability to repress reality. Denial, mixed with superstition, took the place of facts, allowing society to function despite the ever-present risks of death and disability.

Today, even with tremendous advances in medical knowledge and technology, denial continues to influence individual behavior with detrimental consequences.

For example, more than 46 million Americans use tobacco products, despite their links to cancer, heart disease and respiratory illness. Similarly, tens of millions of people refuse vaccinations, disregarding scientific consensus and exposing themselves—and their communities—to preventable diseases. Denial extends to cancer screenings, as well. Surveys show that 50% of women over 40 skip their annual mammograms, and 23% have never had one. Meanwhile, about 30% of adults between 50 and 75 are not up to date on colorectal cancer screenings, and 20% have never been screened.

These examples demonstrate how denial leads individuals to make choices that jeopardize their health, even when life-saving interventions are readily available.

A Pattern of Denial: How Inaction Fuels Public Health Crises When individual denial scales up to the collective level, it fuels widespread inaction and worsens public health crises. Throughout modern medical history, Americans have repeatedly underestimated or dismissed emerging health threats until the consequences became impossible to ignore.

Early warnings of the HIV/AIDS epidemic were largely ignored, as the stigma surrounding affected populations made it easier for the broader public to deny the severity of the crisis. Even within at-risk populations, the lengthy delay between infection and symptoms created a false sense of security, leading to risky behaviors. This collective denial allowed the virus to spread unchecked, resulting in millions of deaths worldwide and a public health challenge that persists in the United States today.

Even now, four decades after the virus was identified, only 36% of the 1.2 million Americans at high risk for HIV take PrEP (Pre-Exposure Prophylaxis), a medication that is 99% effective in preventing the disease.

Chronic diseases like hypertension and diabetes mirror this pattern of denial. The long gap between early signs and life-threatening complications—such as heart attack, stroke and kidney failure—leads people to underestimate the risks and neglect preventive care. This inaction increases morbidity, mortality and healthcare costs.

Whether the issue is an infectious disease or a chronic illness, denial causes harm. It allows medical problems to take root, it delays care and it leads to tens of thousands preventable deaths each year.

The Unseen Parallels: COVID-19 And Mpox Our nation’s responses to COVID-19 and mpox (formerly known as monkeypox) similarly illustrate how denial hampers effective management of public health emergencies.

By March 2020, as COVID-19 began to spread, millions of Americans dismissed it as just another winter virus, no worse than the flu. Even as deaths rose exponentially, elected officials and much of the public failed to recognize the growing threat. Critical containment measures—such as travel restrictions, widespread testing and social distancing—were delayed. This collective denial, fueled by misinformation and political ideology, allowed the virus to take root across the country.

By the time the severity of the pandemic was undeniable, hospitals and health systems were overwhelmed. The opportunity to prevent widespread devastation had passed. More than 1 million American lives were lost, and the economic and social consequences continue today.

Mpox presents the most recent example of this troubling pattern. On August 14, the World Health Organization declared mpox a global health emergency after identifying rapid spread of the Clade 1b variant across several African nations. This strain is significantly more lethal than previous variants, having already caused over 500 deaths in the Democratic Republic of Congo, primarily among women and children under 15. Unlike earlier outbreaks associated mainly with same-sex transmission, Clade 1b spreads through both heterosexual contact and close family interactions, increasing its reach and putting everyone at risk.

Despite these alarming developments, awareness and concern about mpox remains low in the United States. International aid has been limited, and vaccination efforts have fallen far behind the growing threat. As a result, by the time the WHO issued its emergency declaration, only 65,000 vaccine doses had been distributed across Africa, where more than 10 million people are at risk. Already, cases have appeared in Sweden and Thailand, and the U.S. may soon follow.

Even with the added danger of the new variant and the proven efficacy of the JYNNEOS vaccine, only one in four high-risk individuals in the United States has been vaccinated against mpox. Our slow and delayed response to Covid-19, mpox, HIV/AIDS and nearly-all chronic diseases demonstrate how widespread denial is, the lives it continues to claim and the urgent need to address this hidden defense mechanism. The best way to overcome denial—both individually and collectively—is to bring the risks into clear focus. Simply warning people about the dangers isn’t enough. Strong leadership is crucial in breaking through this subconscious barrier.

Lessons To Learn, Actions To Take Dr. C. Everett Koop’s public health campaign on AIDS in the 1980s demonstrated how clear, consistent messaging can shift public perception and drive action. Similarly, former Surgeon General Luther L. Terry’s landmark 1964 report on smoking educated the public about the dangers of tobacco. His report spurred subsequent efforts, including higher taxes on tobacco products, restrictions on smoking in public places and health campaigns using vivid imagery of blackened lungs—leading to a significant decline in smoking rates.

Unfortunately, government agencies often fall short, hampered by bureaucratic delays and overly cautious communications.

Officials tend to wait until all details are certain, avoid acknowledging uncertainties, and seek consensus among committee members before recommending actions. Instead of being transparent, they focus on delivering the least risky advice for their agencies. People, in turn, distrust and fail to heed the recommendations.

Early in the COVID-19 pandemic, and more recently with mpox, officials hesitated to admit how little they knew about the emerging crises. Their reluctance further eroded public trust in government agencies. In reality, people are more capable of handling the truth than they’re often given credit for. When they have access to all the facts, they usually make the right decisions for themselves and their families. Ironically, if public health officials focused on educating people about the risks and benefits of different options—rather than issuing directives—more people would listen and more lives would be saved.

With viral threats increasing and chronic diseases on the rise, now is the time for public health leaders and elected officials to change tactics. Americans want and deserve the facts: what scientists know, what remains unclear and the best estimates of actual risk.

[mariacallous]

Since it was first identified in 1983, HIV has infected more than 85 million people and caused some 40 million deaths worldwide.

While medication known as pre-exposure prophylaxis, or PrEP, can significantly reduce the risk of getting HIV, it has to be taken every day to be effective. A vaccine to provide lasting protection has eluded researchers for decades. Now, there may finally be a viable strategy for making one.

An experimental vaccine developed at Duke University triggered an elusive type of broadly neutralizing antibody in a small group of people enrolled in a 2019 clinical trial. The findings were published today in the scientific journal Cell.

“This is one of the most pivotal studies in the HIV vaccine field to date,” says Glenda Gray, an HIV expert and the president and CEO of the South African Medical Research Council, who was not involved in the study.

A few years ago, a team from Scripps Research and the International AIDS Vaccine Initiative (IAVI) showed that it was possible to stimulate the precursor cells needed to make these rare antibodies in people. The Duke study goes a step further to generate these antibodies, albeit at low levels.

“This is a scientific feat and gives the field great hope that one can construct an HIV vaccine regimen that directs the immune response along a path that is required for protection,” Gray says.

Vaccines work by training the immune system to recognize a virus or other pathogen. They introduce something that looks like the virus—a piece of it, for example, or a weakened version of it—and by doing so, spur the body’s B cells into producing protective antibodies against it. Those antibodies stick around so that when a person later encounters the real virus, the immune system remembers and is poised to attack.

While researchers were able to produce Covid-19 vaccines in a matter of months, creating a vaccine against HIV has proven much more challenging. The problem is the unique nature of the virus. HIV mutates rapidly, meaning it can quickly outmaneuver immune defenses. It also integrates into the human genome within a few days of exposure, hiding out from the immune system.

“Parts of the virus look like our own cells, and we don’t like to make antibodies against our own selves,” says Barton Haynes, director of the Duke Human Vaccine Institute and one of the authors on the paper.

The particular antibodies that researchers are interested in are known as broadly neutralizing antibodies, which can recognize and block different versions of the virus. Because of HIV’s shape-shifting nature, there are two main types of HIV and each has several strains. An effective vaccine will need to target many of them.

Some HIV-infected individuals generate broadly neutralizing antibodies, although it often takes years of living with HIV to do so, Haynes says. Even then, people don’t make enough of them to fight off the virus. These special antibodies are made by unusual B cells that are loaded with mutations they’ve acquired over time in reaction to the virus changing inside the body. “These are weird antibodies,” Haynes says. “The body doesn’t make them easily.”

Haynes and his colleagues aimed to speed up that process in healthy, HIV-negative people. Their vaccine uses synthetic molecules that mimic a part of HIV’s outer coat, or envelope, called the membrane proximal external region. This area remains stable even as the virus mutates. Antibodies against this region can block many circulating strains of HIV.

The trial enrolled 20 healthy participants who were HIV-negative. Of those, 15 people received two of four planned doses of the investigational vaccine, and five received three doses. The trial was halted when one participant experienced an allergic reaction that was not life-threatening. The team found that the reaction was likely due to an additive in the vaccine, which they plan to remove in future testing.

Still, they found that two doses of the vaccine were enough to induce low levels of broadly neutralizing antibodies within a few weeks. Notably, B cells seemed to remain in a state of development to allow them to continue acquiring mutations, so they could evolve along with the virus. Researchers tested the antibodies on HIV samples in the lab and found that they were able to neutralize between 15 and 35 percent of them.

Jeffrey Laurence, a scientific consultant at the Foundation for AIDS Research (amfAR) and a professor of medicine at Weill Cornell Medical College, says the findings represent a step forward, but that challenges remain. “It outlines a path for vaccine development, but there’s a lot of work that needs to be done,” he says.

For one, he says, a vaccine would need to generate antibody levels that are significantly higher and able to neutralize with greater efficacy. He also says a one-dose vaccine would be ideal. “If you’re ever going to have a vaccine that’s helpful to the world, you’re going to need one dose,” he says.

Targeting more regions of the virus envelope could produce a more robust response. Haynes says the next step is designing a vaccine with at least three components, all aimed at distinct regions of the virus. The goal is to guide the B cells to become much stronger neutralizers, Haynes says. “We’re going to move forward and build on what we have learned.”

[wen-kexing-apologist]

Love in the Big City: Part Four- Regret, Rain, Love, and Loss

Well, it’s official. Love in the Big City, Part Four may have been short but it cemented itself as my favorite portion of the book. I asked @antonhur when he was so graciously answering questions what his favorite scene in the book was, and I can see why he said when they were lying in the rain in Bangkok; Late Rainy Season Vacation indeed. When I first started this book, I was talking with a few mutuals like @bengiyo and @lurkingshan wondering how I would feel about Young by the end of this book, because I was not a huge fan of his character in Part One. But I have very much enjoyed seeing his progress across these parts. I said already in my post about Part One that my biggest struggle with Young and the thing I think primarily contributes to the change in his friendship with Jaehee is that he cannot be serious, he cannot, does not allow himself to feel. And in Part Four, he’s finally admitting to it. 

“I was too late to put things back the way they’d been” “That is how my memories of him are preserved under glass, safe and pristine, forever apart from me” “I’ve no choice but to stand at arm’s length”

Part Four is my favorite part of this novel because Part Four is full of ghosts. Not only the ghost of Gyu-ho, but the ghost of all that came before. The rooftop party with Gyu-ho where he got plastered on whatever alcohol he could, where now he sits and drinks champagne, a ghost of both his relationship and the way he spent his college years. Going through Habibi’s wallet, a ghost of when he snuck a look at Hyung’s secrets all those years before. The text messages Young saw on Habibi’s phone about a family member with cancer, a ghost of his mother’s own diagnosis. Habibi himself, getting unexpectedly deep for only a moment before forcing the conversation away from anything real, a ghost of Young himself, and all the times he just could not bring himself to be open and honest with the people around him. 

Just like learning about the HIV diagnosis recontextualizes everything that came before it (see a wonderful essay about that by @twig-tea here) ending this book with the admission that his only wish a year ago was for Gyu-ho recontextualizes my understanding of how aware Young was about his own modus operandi. I operated under a much different assumption that Young didn’t know what he had until it was gone, that Young was not aware of how far his fears ran, of how distant he had made himself. I assumed Part Four was where Young starts to realize himself the way he’d behaved in the past and how that contributed to the downfall of his relationship to Gyu-ho. But now I think he knew it all along and he just didn’t trust us enough to say it until the end. Because I’m not quite sure even by the end of this book Young trusts us enough to be completely honest. 

I talked in my post for Part Three about HIV treatments and prevention methods, and mentioned Truvada, (generic name: emtricitabine-tenofovir) which is a pre-exposure prophylaxis medication that can be taken to prevent someone without HIV from getting HIV should they have an exposure. I mentioned there that at the time of Young’s relationship with Gyu-ho, Truvada was not available on the market in South Korea. But as it turns out, Teno-Em (tenofovir-emtricitibine), a generic PrEP medication, was available in Bangkok by 2015. In Part Four, Young describes going to a pharmacy and getting a generic medication, and he writes the errand in such a way as to make the whole thing seem shady. And maybe it was. But maybe he was just afraid, and that fear colored his own perceptions of what was going down: 

My expectation had been that the place would be hidden away in some seedy alley, but it was right there on the main street. The interior was almost the same as any other pharmacy. I showed the pharmacist a picture of the generic version of what I needed. The pharmacist, if he really was a pharmacist, took out a bottle of pills and explained to us, in English, how they worked. He said that taking just one a day at a set time was enough to perfectly prevent the disease. He really said the word “perfectly.” How could he be so confident? He added that taking two of the pills before risky intercourse and then a pill every twenty-four hours for two more doses was enough to prevent transmission. 

The facts are these: the pharmacy was on a main street, the pharmacy looked like a pharmacy, the pharmacist was able to explain how the medication worked, and the pill regimen for prevention was accurate to the pill regimen for PrEP. 

Could they have still been shady? Sure. But I think it is far more likely that Young and his historically terrible experiences with medicine have colored his perception of healthcare and placed doubt in his head over the legitimacy of this medication. Which, learning that Young and Gyu-ho have unprotected sex in Bangkok, makes me wonder if Young’s doubts about the pharmacy added another reason for him to let Gyu-ho go to Shanghai alone, if the meds they got in Bangkok weren’t real, if they didn’t work, then he likely gave Gyu-ho HV. 

Young talked about stains in this part, about permanency- the soy sauce on the mattress, the crack in the toilet and he talked about fleeting things- immediately losing the shape of Habibi’s face when he stepped outside the door, the lantern burning up and turning to ash with all the dreams, all the wishes Young had, or just the one. Regret seems to hold a permanent place in Young’s spirit, as does loss. Love is something I think he thought did not exist, or if it did then it was fleeting. He loved Jaehee and lost her, his first boyfriend died, the obsession he had over Hyung could only be described as dickmatized. But when he gave away Gyu-ho’s love, when he let Gyu-ho go to Shanghai alone, it was one of the few times in the entire novel we saw Young grieve. He fully collapsed under the weight of it all, barely leaving bed, not having the energy to maintain his typical routines, trying to root out the memories of Gyu-ho in his head by writing him out, and killing him over and over and over again. 

I find myself stuck, thinking about what is perhaps my favorite line in the book: 

“Sometimes his very existence to me is the existence of love itself”

Gyu-ho’s existence is Young’s idea of love; to kill Gyu-ho, to remove him from existence is to kill Young’s idea of love. “The made-up Gyu-ho in my writing got hurt or died many times, and is always resurrected, as if love saves his life- whereas the real Gyu-ho lives and breathes and keeps moving on.” Young’s regret is a permanency in his life, just as his love for Gyu-ho is a permanency. All he wished for was Gyu-ho, but Young’s inability to be honest, deeply, emotionally honest, all the fear, all the emptiness, all the pain got in the way. I am not a person who minds a melancholy end, regret, remorse, grief, love. These are all a part of life. The only thing I hope is that one day Young can lay down in the pouring rain and feel peace the way Gyu-ho did that day in Bangkok.

[snarp]

Toward a Radically Simple Multi-Modal Nasal Spray for Preventing Respiratory Infections

https://onlinelibrary.wiley.com/doi/10.1002/adma.202406348

Joseph, John et al. “Toward a Radically Simple Multi-Modal Nasal Spray for Preventing Respiratory Infections.” Advanced materials (Deerfield Beach, Fla.), e2406348. 24 Sep. 2024, doi:10.1002/adma.202406348

Abstract: Nasal sprays for pre-exposure prophylaxis against respiratory infections show limited protection (20-70%), largely due to their single mechanism of action-either neutralizing pathogens or blocking their entry at the nasal lining, and a failure to maximize the capture of respiratory droplets, allowing them to potentially rebound and reach deeper airways. This report introduces the Pathogen Capture and Neutralizing Spray (PCANS), which utilizes a multi-modal approach to enhance efficacy. PCANS coats the nasal cavity, capturing large respiratory droplets from the air, and serving as a physical barrier against a broad spectrum of viruses and bacteria, while rapidly neutralizing them with over 99.99% effectiveness. [...]

Someone send me the full text of this please

[batboyblog]

Transgender teen boys and nonbinary youth who were assigned female at birth are at least as likely as cisgender girls to become pregnant, but they don’t always receive appropriate sex education. A health organization is looking to change that, with help from a grant from the U.S. Department of Health and Human Services. The grant of $698,736 went to the Center for Innovative Public Health Research, based in San Clemente, Calif. The center will take a sexual health program designed to be inclusive of lesbian, gay, and bisexual youth and adapt it to reach transmasculine and nonbinary teens. The new program will be known as #TranscendentHealth. “Youth who are assigned female at birth (AFAB) and identify as non-binary or as trans boys are at risk for negative sexual health outcomes yet are effectively excluded from sexual health programs because gender-diverse youth do not experience the cisgender, heteronormative teen sexual education messaging available to them as salient or applicable,” says a description of the program on the center’s website. “This lack of programming is likely contributing to obstacles to sexual health: Data suggest that AFAB trans-identified youth may be less likely to use condoms when having sex with people who have penises and are at least as likely as cisgender girls to be pregnant,” it continues. #TranscendentHealth seeks to address this with inclusive education and support, plus promotion of condom use. The needs of youth vary across the nation, depending on the region and whether they live in an urban or a rural setting, so the program will be tailored to meet those different needs. Such a program is needed more than ever now that some states are preventing teens from accessing sexual health information and gender-affirming care, the description notes. The program will be based on the center’s work with Girl2Girl, a project designed to provide sexual health info to gay, lesbian, and bi cisgender teen girls through text messaging. It was associated with higher condom use in penile-vaginal sex as well as higher use of other types of contraception, according to the center. To adapt this into a trans-inclusive program, the center will convene focus groups to identify the factors that affect sexual health decisions among AFAB trans and nonbinary youth. It will monitor how these young people respond to the material and will ultimately test its effectiveness among 700 teens. The goals include increased use of condoms and other means of contraception, uptake of testing for HIV and other sexually transmitted infections, and, where needed, use of pre-exposure prophylaxis to prevent HIV transmission. The work began in September and will continue through June 30, 2027.

Boys, please have safe sex out there.

[warningsine]

A large clinical trial in South Africa and Uganda has shown that a twice-yearly injection of a new pre-exposure prophylaxis drug gives young women total protection from HIV infection.

The trial tested whether the six-month injection of lenacapavir would provide better protection against HIV infection than two other drugs, both daily pills. All three medications are pre-exposure prophylaxis (or PrEP) drugs.

Physician-scientist Linda-Gail Bekker, principal investigator for the South African part of the study, tells Nadine Dreyer what makes this breakthough so significant and what to expect next.

Tell us about the trial and what it set out to achieve

The Purpose 1 trial with 5,000 participants took place at three sites in Uganda and 25 sites in South Africa to test the efficacy of lenacapavir and two other drugs.

Lenacapavir (Len LA) is a fusion capside inhibitor. It interferes with the HIV capsid, a protein shell that protects HIV’s genetic material and enzymes needed for replication. It is administered just under the skin, once every six months.

The randomised controlled trial, sponsored by the drug developers Gilead Sciences, tested several things.

The first was whether a six-monthly injection of lenacapavir was safe and would provide better protection against HIV infection as PrEP for women between the ages of 16 and 25 years than Truvada F/TDF, a daily PrEP pill in wide use that has been available for more than a decade.

Secondly, the trial also tested whether Descovy F/TAF, a newer daily pill, was as effective as F/TDF. The newer F/TAF has superior pharmacokinetic properties to F/TDF. Pharmacokinetic refers to the movement of a drug into, through, and out of the body. F/TAF is a smaller pill and is in use among men and transgender women in high-income countries.

The trial had three arms. Young women were randomly assigned to one of the arms in a 2:2:1 ratio (Len LA: F/TAF oral: F/TDF oral) in a double blinded fashion. This means neither the participants nor the researchers knew which treatment participants were receiving until the clinical trial was over.

In eastern and southern Africa, young women are the population who bear the brunt of new HIV infections. They also find a daily PrEP regimen challenging to maintain, for a number of social and structural reasons.

During the randomised phase of the trial none of the 2,134 women who received lenacapavir contracted HIV. There was 100 percent efficiency.

By comparison, 16 of the 1,068 women (or 1.5%) who took Truvada (F/TDF) and 39 of 2,136 (1.8%) who received Descovy (F/TAF) contracted the HIV virus.

The results at a recent independent data safety monitoring board review led to the recommendation that the trial’s “blinded” phase should be stopped and all participants should be offered a choice of PrEP.

This board is an independent committee of experts who are put in place at the start of a clinical trial. They see the unblinded data at stipulated times during the trial to monitor progress and safety. They ensure that a trial does not continue if there is harm or a clear benefit in one arm over others.

What is the significance of these trials?

This breakthrough gives great hope that we have a proven, highly effective prevention tool to protect people from HIV.

There were 1.3 million new HIV infections globally in the past year. Although that’s fewer than the 2 million infections seen in 2010, it is clear that at this rate we are not going to meet the HIV new infection target that UNAIDS set for 2025 (fewer than 500,000 globally) or potentially even the goal to end Aids by 2030.

PrEP is not the only prevention tool.

PrEP should be provided alongside HIV self-testing, access to condoms, screening and treatment for sexually transmitted infections and access to contraception for women of childbearing potential.

In addition, young men should be offered medical male circumcision for health reasons.

But despite these options, we haven’t quite got to the point where we have been able to stop new infections, particularly among young people.

For young people, the daily decision to take a pill or use a condom or take a pill at the time of sexual intercourse can be very challenging.

HIV scientists and activists hope that young people may find that having to make this “prevention decision” only twice a year may reduce unpredictability and barriers.

For a young woman who struggles to get to an appointment at a clinic in a town or who can’t keep pills without facing stigma or violence, an injection just twice a year is the option that could keep her free of HIV.

What happens now?

The plan is that the Purpose 1 trial will go on but now in an “open label” phase. This means that study participants will be “unblinded”: they will be told whether they have been in the “injectable” or oral TDF or oral TAF groups.

They will be offered the choice of PrEP they would prefer as the trial continues.

A sister trial is also under way: Purpose 2 is being conducted in a number of regions including some sites in Africa among cisgender men, and transgender and nonbinary people who have sex with men.

It’s important to conduct trials among different groups because we have seen differences in effectiveness. Whether the sex is anal or vaginal is important and may have an impact on effectiveness.

How long until the drug is rolled out?

We have read in a Gilead Sciences press statement that within the next couple of months the company will submit the dossier with all the results to a number of country regulators, particularly the Ugandan and South African regulators.

The World Health Organization will also review the data and may issue recommendations.

We hope then that this new drug will be adopted into WHO and country guidelines.

We also hope we may begin to see the drug being tested in more studies to understand better how to incorporate it into real world settings.

Price is a critical factor to ensure access and distribution in the public sector where it is badly needed.

Gilead Sciences has said it will offer licences to companies that make generic drugs, which is another critical way to get prices down.

In an ideal world, governments will be able to purchase this affordably and it will be offered to all who want it and need protection against HIV.

[reasonsforhope]

"Since it was first identified in 1983, HIV has infected more than 85 million people and caused some 40 million deaths worldwide.

While medication known as pre-exposure prophylaxis, or PrEP, can significantly reduce the risk of getting HIV, it has to be taken every day to be effective. A vaccine to provide lasting protection has eluded researchers for decades. Now, there may finally be a viable strategy for making one.

An experimental vaccine developed at Duke University triggered an elusive type of broadly neutralizing antibody in a small group of people enrolled in a 2019 clinical trial. The findings were published today [May 17, 2024] in the scientific journal Cell.

“This is one of the most pivotal studies in the HIV vaccine field to date,” says Glenda Gray, an HIV expert and the president and CEO of the South African Medical Research Council, who was not involved in the study.

A few years ago, a team from Scripps Research and the International AIDS Vaccine Initiative (IAVI) showed that it was possible to stimulate the precursor cells needed to make these rare antibodies in people. The Duke study goes a step further to generate these antibodies, albeit at low levels.

“This is a scientific feat and gives the field great hope that one can construct an HIV vaccine regimen that directs the immune response along a path that is required for protection,” Gray says.

-via WIRED, May 17, 2024. Article continues below.

Vaccines work by training the immune system to recognize a virus or other pathogen. They introduce something that looks like the virus—a piece of it, for example, or a weakened version of it—and by doing so, spur the body’s B cells into producing protective antibodies against it. Those antibodies stick around so that when a person later encounters the real virus, the immune system remembers and is poised to attack.

While researchers were able to produce Covid-19 vaccines in a matter of months, creating a vaccine against HIV has proven much more challenging. The problem is the unique nature of the virus. HIV mutates rapidly, meaning it can quickly outmaneuver immune defenses. It also integrates into the human genome within a few days of exposure, hiding out from the immune system.

“Parts of the virus look like our own cells, and we don’t like to make antibodies against our own selves,” says Barton Haynes, director of the Duke Human Vaccine Institute and one of the authors on the paper.

The particular antibodies that researchers are interested in are known as broadly neutralizing antibodies, which can recognize and block different versions of the virus. Because of HIV’s shape-shifting nature, there are two main types of HIV and each has several strains. An effective vaccine will need to target many of them.

Some HIV-infected individuals generate broadly neutralizing antibodies, although it often takes years of living with HIV to do so, Haynes says. Even then, people don’t make enough of them to fight off the virus. These special antibodies are made by unusual B cells that are loaded with mutations they’ve acquired over time in reaction to the virus changing inside the body. “These are weird antibodies,” Haynes says. “The body doesn’t make them easily.”

Haynes and his colleagues aimed to speed up that process in healthy, HIV-negative people. Their vaccine uses synthetic molecules that mimic a part of HIV’s outer coat, or envelope, called the membrane proximal external region. This area remains stable even as the virus mutates. Antibodies against this region can block many circulating strains of HIV.

The trial enrolled 20 healthy participants who were HIV-negative. Of those, 15 people received two of four planned doses of the investigational vaccine, and five received three doses. The trial was halted when one participant experienced an allergic reaction that was not life-threatening. The team found that the reaction was likely due to an additive in the vaccine, which they plan to remove in future testing.

Still, they found that two doses of the vaccine were enough to induce low levels of broadly neutralizing antibodies within a few weeks. Notably, B cells seemed to remain in a state of development to allow them to continue acquiring mutations, so they could evolve along with the virus. Researchers tested the antibodies on HIV samples in the lab and found that they were able to neutralize between 15 and 35 percent of them.

Jeffrey Laurence, a scientific consultant at the Foundation for AIDS Research (amfAR) and a professor of medicine at Weill Cornell Medical College, says the findings represent a step forward, but that challenges remain. “It outlines a path for vaccine development, but there’s a lot of work that needs to be done,” he says.

For one, he says, a vaccine would need to generate antibody levels that are significantly higher and able to neutralize with greater efficacy. He also says a one-dose vaccine would be ideal. “If you’re ever going to have a vaccine that’s helpful to the world, you’re going to need one dose,” he says.

Targeting more regions of the virus envelope could produce a more robust response. Haynes says the next step is designing a vaccine with at least three components, all aimed at distinct regions of the virus. The goal is to guide the B cells to become much stronger neutralizers, Haynes says. “We’re going to move forward and build on what we have learned.”

-via WIRED, May 17, 2024