Wednesday, 15 July 2015

Time to test and defeat HIV

You might wonder why you’re always seeing articles and news stories about HIV testing. Surely everyone knows about it by now? Well, you may not know that if you are diagnosed early and start treatment on time you can expect to live a near-normal lifespan. You can have a career, relationship and a great sex life. You can also have children who are born without HIV. There’s another really good reason to get tested – HIV treatment is now free for everyone whatever their immigration status. This means that if you do have HIV you can take medicine to keep it under control as soon as you need it. So even if your papers aren’t in order, this is no longer a reason not to test. As you might know, African people are in a high-risk group for getting HIV. In fact over a quarter of African men with HIV don’t know they have it. Africans are also more likely to get diagnosed late when treatment will be less effective. At the moment everyone is encouraged to test for HIV to give them the best chance of a long and healthy life if they are HIV positive. It’s never been easier to get a test. For instance did you know you can get your results from some HIV tests in less than a minute? There are a range of places you can get tested – from your GP surgery to a sexual health clinic to a community centre or your local church. It is now also possible to test at home. HIV postal tests are a new way to have an HIV test. The free kit can be ordered from www.tht.org.uk/postaltest and will arrive in a plain package which will fit through your letterbox. The test can detect HIV around four weeks after you have been infected. All you have to do is prick your finger so a few drops of blood appear. Then you blot your finger onto a card, pop it in the post and wait for your result. You should get it around a week later. You’ll be texted if your result is negative and phoned if you need to come in for another test. You will be given all the support you need and be linked in to a local clinic. There really is no better time to test. Treatment means HIV can be controlled and you have every chance of a long and healthy life. Ignoring HIV won’t make it go away – in fact it means it is more likely to cause problems when it is diagnosed. So for peace of mind why not order a postal testing kit today? Where can I get an HIV test? Sexual health clinics These are usually based in hospitals. You can get a full sexual health screen or you may want advice on family planning or contraception. You can also get an HIV test in a sexual health clinic. The advantage of this is that if your test is positive you will be linked straight in to HIV services and offered counselling and other support. GP surgeries Many GPs offer HIV tests at surgeries. As most of us live close to our GP surgery, a test is only a few minutes away. If you get a positive result your GP will link you in to HIV care. In the community African Institute for Social Development(AISD)www.africaninstitute.org.uk Call or text 07572604343 Is a flexible place to get a HIV test Natonally charities such as Terrence Higgins Trust offer HIV testing in all sorts of convenient community locations. This could be your local church, barber shop or community centre. These clinics offer rapid HIV tests where you may get your result in less than a minute. At home Postal tests mean you can now test for HIV in the privacy of your home. The test is posted to you and when you have completed it you just post it back to our lab. You’ll get your result around a week later – by text if it is negative and by phone if it is positive. The service is private and confidential. To order a free postal test visit: www.tht.org.uk/postaltest or call THT Direct on 0808 802 1221 to find out where to test in your area. TAGS: Family, Featured Slide, health, hiv, hiv test, hiv testing, sex, sexual health, testing

Friday, 26 September 2014

Let's Talk about HIV and black Africans in the UK

African Institute takes a closer look at the importance of talking about the impact of HIV Stigma in the black Africans in the UK. We investigate specialist opinion and GP opinion. We also promote the National HIV Testing Week so that you can get the dates saved. 



The specialist opinion

Dr Iain Reeves, consultant physician in genitourinary medicine, Homerton University Hospital NHS Foundation Trust, London
Undiagnosed HIV remains an important problem in the UK. Those who are unaware of their infection cannot access life-prolonging treatment and face a much greater risk of mortality and morbidity because of late diagnosis.
In 2012, about two-thirds of black African adults were diagnosed with a CD4 count is less than 350 , where treatment is recommended, compared with 47% overall.
In its recent report, HIV and Black African Communities in the UK, the National AIDS Trust has called for urgent action to address this health inequality.
HIV-positive people who do not know their status may also be more likely to transmit the virus to others, because they are unable to use this knowledge to modify risk behaviour and importantly, cannot take advantage of the now clearly demonstrated, very significant reduction in the risk of transmission with successful treatment.2
This may be particularly relevant for GPs, who might also be looking after members of the patient's family, or children born in countries where antenatal testing is not routine.

HIV testing

HIV testing broadly falls into two strategies: diagnosing someone with symptoms as part of a set of investigations, and diagnosing asymptomatic individuals in a more routine testing approach.
The 'Time to Test' report summarised the findings of a number of studies investigating routine, opt-out HIV testing conducted outside traditional sexual health settings.3
The main finding from these studies was that routine HIV testing was generally very acceptable to most patients across all settings, including primary care.
The RHIVA2 study, conducted in primary care in inner London, also demonstrated the feasibility of routine, near-patient HIV testing as part of a new patient check when people register with a general practice.4
Concerns about the feasibility and acceptability of routine testing are more often voiced by healthcare staff, often focusing on lack of resources, training and fear of giving a positive result. Some of these fears are based on misconceptions about pretest counselling.
A simple pretest discussion, where a patient is made aware that an HIV test is being carried out as part of routine practice, with an opportunity to withdraw consent, is all that is required.
This approach also removes the risk of patients feeling they are being targeted because of their ethnicity or other characteristics.
Including an HIV test as part of a set of investigations for a particular presenting problem is easily done, especially when blood tests are already planned.
However, it does require thinking about the condition and making an HIV test part of the usual order set, when clinicians may not have it at the forefront of their minds.
For example, acute HIV infection presents as a viral illness and GPs are likely to see many of these individuals. In a study in south London, a significant proportion of those investigated for infectious mononucleosis in fact had acute HIV infection.5
A list of illnesses and other conditions where HIV may be part of the differential or important to exclude can be found in the UK national HIV testing guidelines.6
The use of audit, or case review, to investigate missed opportunities to test for HIV, for example when someone is diagnosed with an opportunistic infection as an inpatient, may also be a helpful tool for reflection and changing practice.7
GPs should be clear about support and treatment services available to newly diagnosed patients.
Support around testing should be readily available from local GUM/sexual health services and there must be pathways for rapid access to HIV care. The support that can be provided by voluntary sector agencies is also invaluable.
How to make HIV testing more acceptable
  • Display confidentiality statements in areas where patients can see them - for example, in the waiting room, on the practice website, in clinic rooms. Confidentiality needs to be observed by all staff.
  • Put up posters explaining the HIV test is offered routinely in the practice, regardless of background.
  • Offer HIV testing to all new patients when they register - this is deemed cost-effective in areas where diagnosed HIV prevalence is >2 per 1,000 population. It also avoids the problem of targeting or stereotyping certain demographics.
  • Include HIV and hepatitis B tests in NHS checks, especially for those who are at risk. This helps to normalise HIV testing.

The GP opinion

Dr Richard Ma, GP with an interest in sexual health, London
GPs often consider gay men or men who have sex with men (MSM) as a key risk group in the context of HIV testing. Despite being a risk group, current evidence suggests there may be unmet needs when it comes to HIV testing for black Africans.
According to 2012 data from the Health Protection Agency (now Public Health England), almost 31,800 black African men and women were living with HIV in the UK.
This represents an overall prevalence of 26 per 1,000 for African-born men and 51 per 1,000 for African-born women. Of the 1,522 black Africans who were newly diagnosed with HIV in 2012, 66% of men and 61% of women were diagnosed at a late stage of infection.1
Newly diagnosed black Africans reported that in the 12 months preceding their diagnosis, 76% had presented to healthcare services and 15% to inpatient services.8
An audit conducted by the British HIV Association found there had been missed opportunities for earlier HIV diagnosis in a quarter of newly diagnosed individuals.9

The role of early diagnosis

Earlier diagnosis of HIV can save lives because antiretroviral treatment can rapidly suppress HIV disease, resulting in reduced infectiousness as well as near-normal life expectancy.
This is why NICE has recommended expanded HIV testing for MSM and black Africans.10
According to the NICE costing template, a shift of 1% of patients being diagnosed at an earlier stage could produce savings of about £0.22m a year for MSM and £0.27m a year for black Africans in England.
There appears to be plenty of opportunities for more HIV testing to be carried out in general practice.
For example, there is evidence to suggest that black Africans attend general practice, especially those who have had undiagnosed HIV.11
Opt-out testing for HIV was also broadly acceptable to a sample of patients in one study which included MSM and black Africans.12
We understand that special issues, such as stigma about HIV in black African communities, may deter people from having HIV tests. Black Africans are also less likely to find support in their own communities.
MSM and black Africans mention a perceived lack of confidentiality as one of the main barriers to test for HIV in general practice settings.
Some clinicians may find it difficult to offer HIV testing opportunistically to black Africans for fear of perceived racial stereotyping. There may also be perceived difficulties for those who test positive, for example, lack of support, problems within the community, immigration problems and entitlement to HIV care.
References and on going national campaign logo
1. Public Health England. HIV in the United Kingdom: 2013 Report. London, PHE, November 2013.
2. Cohen M, Chen Q, McCauley M et al. Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med 2011; 365: 493-505.
3. Health Protection Agency. Time to test for HIV: Expanding HIV testing in healthcare and community services in England. London, HPA, September 2011.
4. Leber W, McMullen H, Marlin N et al. Point-of-care HIV testing in primary care and early detection of HIV (RHIVA2): a cluster randomised controlled trial. Lancet 2013; 382: S7 (conference abstract).
5. Hsu D, Ruf M, O'Shea S et al. Diagnosing HIV infection in patients presenting with glandular fever-like illness in primary care: are we missing primary HIV infection? HIV Medicine 2013; 14: 60-3.
6. British HIV Association, British Association of Sexual Health and HIV, British Infection Society. UK National Guidelines for HIV Testing 2008.
7. Whittle A, Wellesley R, Griffiths C et al. Increasing opportunities for HIV diagnosis in primary care: a borough-wide evaluation of HIV testing and pre-diagnosis care in general practice. British HIV Association Spring Conference April 2013. Oral abstract O2.
8. Burns FM, Johnson AM, Nazroo J et al. Missed opportunities for earlier HIV diagnosis within primary and secondary healthcare settings in the UK. AIDS 2008; 22(1): 115-22.
9. Ellis S, Curtis H, Ong EL. HIV diagnoses and missed opportunities. Results of the British HIV Association (BHIVA) National Audit 2010. Clin Med 2012; 12(5): 430-4.
11. Rice B, Delpech V, Sadler KE et al. HIV testing in black Africans living in England. Epidemiol Infect 2013; 141(8): 1741-8 doi: 10.1017/S095026881200221X
12. Glew S, Pollard A, Hughes L. Public attitudes towards opt-out testing for HIV in primary care: a qualitative study. Br J Gen Pract 2014; doi: 10.3399/bjgp14X677103
Resources

Friday, 3 January 2014

HIV a Global Epidemy with its Challenges in 2014

Global HIV and AIDS Epidemic

The history of HIV and AIDS is a short one. As recently as the 1970s, no one was aware of this deadly illness. Since then the global HIV/AIDS epidemic has become one of the greatest threats to human health and development. At the same time, much has been learnt about the science of HIV and AIDS, as well as how to prevent and treat the disease.




There is still no cure for HIV but HIV treatment has improved enormously since the mid-1990s. HIV-positive people who take a combination of three antiretroviral drugs can expect to recover their health and live for many years without developing AIDS, as long as they keep taking the drugs every day.



HIV statistics for the end of 2011 indicate that around 34 million people are living with HIV, the virus that causes AIDS. Each year around 2.5 million more people become infected with HIV and 1.7 million die of AIDS. Although HIV and AIDS is found in all parts of the world, some areas are more afflicted than others.



Countries and Regions

The worst affected region is sub-Saharan Africa, where in a few countries more than one in five adults is infected with HIV. The epidemic is spreading most rapidly in Eastern Europe and Central Asia, where the number of people living with HIV increased by 250 percent between 2001 and 2010. Many Western countries, such as the UK, have increasing rates of HIV transmission through heterosexual sex. In America, where more than a million people are living with HIV, heterosexual sex accounts for one third of new diagnoses. In the Caribbean countries and Latin America annual new infections are declining, but stigma of high-risk groups remains a problem.

Although it is known how to prevent and treat HIV and AIDS, too few people have access to the necessary services. Most rich countries and ten low- and middle-income countries, for example Botswana, Cambodia, Cuba and Rwanda, have achieved universal treatment access. Although access to treatment remains a challenge, improvements are being seen. For the first time, in 2011, more than half of people in need of antiretroviral drugs were receiving them, with coverage reaching 54 percent; yet only 28 percent of children have access to HIV treatment. Whilst access to prevention tools such as HIV education, condoms, clean needles and programmes to prevent mother-to-child transmission is improving in some countries, access remains inadequate for many people.



Global Challenges

Explore the global HIV and AIDS epidemic topics to find out how HIV affects different groups of people, including prisoners, women and orphans; regional and country approaches to HIV; and a more detailed focus on major HIV and AIDS issues, including HIV and AIDS funding and HIV stigma and discrimination

sources
http://www.avert.org/global-hiv-aids-epidemic.htm

Nottingham and the region join both the www.startswithme.org.uk and www.africanhealthsurvey.com to stop HIV spead in England as the African Institute for Social Development(AISD) step up the campaign.

In 2014, a lot will be achieved through in Nottingham as the African Institute community researchers take the roads of the city to continue encouraging HIV testing uptake among African Communities. This research will be published at the end of the year for more information or to take part please visit www.nottingham.ac.uk/health4u. This project is a partnership of  University of Nottingham, African Institute for Social Development(AISD) and the University of Suisserland in Lugano  

Sunday, 5 May 2013

AISD SUPPORTS "IT STARTS WITH ME" CAMPAIGN



HIV spread in England 'could 

be halted within generation'

Campaign posterThe campaign will run for two years

There are around 100,000 people living with HIV in England and about 1000 in Nottingham/shire. One person in four does not know they have it.
People in African communities and men who have sex with men(msm) make up three-quarters of cases.
Focused screening and information for high-risk groups could end the epidemic, experts say.
The new It Starts With Me campaign, created by the Terrence Higgins Trust, in Partnership with the African Institute for Social Development(AISD) and many other partners across the country urges people in high-risk groups to get tested for HIV at least every 12 months, and more frequently if they have symptoms or have put themselves at risk by having unprotected sex, for example.
Effective treatment
Sir Nick Partridge, chief executive at the trust, said: "While a cure or vaccine for HIV remains stubbornly out of reach, what many people don't realise is that medical advances mean it is now within our grasp to stop the virus in its tracks.
"By getting as many people with HIV as possible tested and on effective treatment, we should see new infection rates fall rapidly."
He said that to succeed people need to understand that HIV is just as relevant an issue today as it was in 1982.
"Someone, somewhere in the UK is diagnosed with HIV every 90 minutes. Each and every one of us has a responsibility to keep ourselves and each other safe."
"We can now stop HIV as HIV testing is getting easier and free, combine with free Treatment for all regardless of their immigration status and regular and appropriate condom use these are ways to start the stoppage of  HIV in our community" Said Mr Amdani Juma, the Director of the African Institute for Social Development(AISD). AISD is an African Community Based Organisation(CBO) in Nottingham City and it is part of HIV Prevention England(HPE) in the East Midlands region.  

Tuesday, 15 January 2013

Challenging New Family Reunion Rules in the UK


  • Immigration Rules affect Africans British, European on daily basis:
This article would answer the many queries presented by our clients that we  have been sending africans to Immigration Services and Solicitors for.

The rules present a massive challenge to African newly married couples and families who are living separately and would like to join their sponsor farther or mother already in the UK. While employment is getting less and less and  living costs are rising for many families, it is even harder and dearer if two parents are living separately. The African Institute supports those who are calling on the UK Government to look again at the new family reunion rules in the UK which some MPs believe as irrational and discriminatory. the are threatening to use both administrative and european courts route.

  
Mr Juma argues that immigration pressures
can lead to health inequalities and families
perform well where both parents are involved
in securing right balance on regular contacts
that  allow security,love, education, income
and other social benefits where two parents
 play a role and create a full and sound child. 
  • Primary sponsor: Galloway, George
  • Sponsors:
      That this House notes that the new family immigration rules impose a minimum earnings requirement of 18,600, with an additional 3,800 for the first child and 2,400 for each additional child, in respect of partners and children from outside the EU seeking to join their partners and parents resident in the UK; further notes that the sponsoring partner is subject to enforced separation in that she or he is required to work in the UK for at least six months before the application can be made; further notes that the new immigration rules are to be challenged in the Administrative Court in Birmingham from 5 to 8 February 2013; believes that the new immigration rules are irrational and discriminate against British citizens, those settled in the UK and those with refugee or humanitarian protection leave on grounds including gender and race-ethnicity; further believes that the new rules are preventing British and settled families on lower incomes from being reunitedand enjoying family life with their non-EEA family members contrary to the European Convention on Human Rights and other international instruments; and calls on the Government immediately to withdraw that aspect of the new family immigration rules which impose the minimum earnings requirement reverting back to the predecessor rule which adequately ensured that there was no recourse to public funds.

    Wednesday, 18 July 2012

    HIV 30 years on, Challege snd Opportunity in 2012

     HIV/AIDS Challenge and Opportnity for Africans

    The African Institute for Social Development(AISD) looking at HIV/AIDS 30 years on, the challenge and the opportunity in the eyes of global efforts.

    This is the time to make real diffrence in prevention work, testing and getting every person living with HIV to be assessed and get treatment, be empowered and move on in a fulfilling and productive life.
                                                               African Institute Events 2012
    'Much has been achieved in HIV prevention technologies, medical advances and treatment but Africans need a chance to access those and need a new world of educated, empowered african men and women with healthy children. A world that doesn't stigmatised people against HIV status' as reported by Amdani Juma, the African Institute Director.  

    The Challenge

    In the 30 years since HIV/AIDS was first discovered, the disease has become a devastating pandemic, taking the lives of 30 million people around the world. In 2010 alone, HIV/AIDS killed 1.8 million people, 1.2 million of whom were living in sub-Saharan Africa. Though life-saving antiretroviral treatment is available, access is not yet widespread; of the estimated 14.2 million HIV-positive individuals in need of treatment, nearly 8 million are not currently able to access it.
    Even more troublesome, new HIV infections continue to outpace those added onto antiretroviral treatment. More than 390,000 infants and children were newly infected with HIV in 2010, and 2.7 million total new HIV infections occurred in the same year—a rate that has held relatively constant since 2006.
    Because individuals in their most productive years (15-49 years old) are most commonly infected with HIV/AIDS, the disease has a wide socioeconomic impact that threatens development progress in many poor countries, especially those in sub-Saharan Africa. 14.8 million children in the region have already lost one or more parents to the disease. In South Africa alone, 1.9 million children have been orphaned due to AIDS, exacerbating a social dynamic that is already deeply challenged by crime, violence and unemployment. HIV/AIDS targets people during their most productive years, making economic progress in many sub-Saharan African countries even more of a challenge. Some estimates suggest that annual GDP growth in highly affected countries can be 2-4% lower than in countries with the absence of AIDS.
    In 2005, world leaders at the G8 summit in Gleneagles and at the U.N. World Summit in New York pledged to reach universal access to prevention, care and treatment by 2010. Though this target was not achieved, leaders recommitted to the fight against AIDS in 2011 by agreeing to work toward achieving universal access to HIV prevention, treatment, care and support by 2015. Delivering these essential services will require a strengthening of health systems, especially in Africa, which is home to two-thirds of those requiring antiretroviral (ARV) treatment, but only 3% of the global health care workers to provide it.

    The Opportunity

    We are at a critical moment in the fight against HIV/AIDS. The world has made incredible progress in its efforts to understand, prevent and treat this disease, and progress has been particularly rapid during the last ten years. But by the end of 2010 more than 6.6 million people were on life-saving antiretroviral treatment, up from just 300,000 in 2002; of that 6.6 million more than 5 million were living in sub-Saharan Africa. Botswana, Rwanda, and Namibia have already achieved universal access to ARVs, while Benin, Guinea, Kenya, Lesotho, Senegal, South Africa, Swaziland, Togo, Zambia, and Zimbabwe have coverage rates between 50 to 80% and are making progress towards universal access.
    Though we have not made enough progress on the prevention of HIV, we now have impactful new data and technologies to help us better prevent new infections in the years to come. More sophisticated treatment regimens now make it possible to prevent the transmission of HIV from mother-to-child in as many as 98% of cases. Nearly half of all pregnant women with HIV can now receive ARV prophylaxis for PMTCT and a global effort co-led by UNAIDS and the US Office of the Global AIDS Coordinator (OGAC) has called for leadership from the 22 highest-burden MTCT countries to help virtually eliminate transmission from mother-to-child by 2015.
    New research over the last two years has also provided groundbreaking data on two fronts: the impact of treatment as prevention, and the role of male circumcision in prevention strategies. The HPTN 052 clinical trial showed that treatment acts as prevention, reducing the likelihood of an HIV-positive individual on treatment passing HIV on to others by up to 96%. Voluntary medical male circumcision, another powerful tool, was shown to reduce the likelihood of HIV infection by up to 60%. Combination prevention, including treatment-as-prevention and other strategies such as PMTCT, the ABC strategy to prevent sexual transmission (Abstain, Be faithful, & correct and consistent use of Condoms), male circumcision, and reduction of unsafe blood and medical injections, will play a central role in moving us towards ending the pandemic.
    Now, for the first time in history, the world can look ahead to the beginning of the end of the AIDS pandemic. We have the tools necessary to achieve an AIDS-free generation if we focus our efforts on three interim goals: virtual elimination of mother-to-child transmission by 2015, expansion of antiretroviral treatment to 15 million people by 2015, and implementation of innovative prevention techniques to stop new infections. To bend the curve of the AIDS pandemic, these goals cannot be achieved in isolation from one another, nor can their achievement be the sole responsibility of a small number of donor countries. Only when working in parallel--through the broad support of donors, African governments, international organizations, and the private sector--will the beginning of the end of AIDS become a reality.
    During a time of financial austerity and economic crisis in many parts of the world, it is essential for both donor and recipient countries to reaffirm their commitments to combating HIV/AIDS while making strategic investments. From 2002 to 2009, global funding for HIV/AIDS increased dramatically from $800 million to $6.8 billion annually, and these international investments are paying off: the Global Fund to Fight AIDS, Tuberculosis, and Malaria has helped 3.3 million people receive ARV treatment and conducted 190 million HIV counseling and testing sessions, while the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) has directly supported 3.9 million people on ARV treatment and reached more than 13 million people with care services, including more than 4.1 million orphans as of 2011.
    Sustaining our current progress, with an aim towards beginning to end AIDS, will require increased focus on prevention, expanded ARV treatment, and continued scientific research. At this critical juncture, it is imperative for all of us to make strategic investments and to keep an eye on the finish line.


    For more information,
    please visit AISD at: http://www.africaninstitute.org.uk/ or call on +44(0)7834459076
    Campaign with us and learn more about HIV info http://www.idoitright.co.uk/
    To get HIV information and advice, call free on 0800 0967 500
    Text: 07860 002 014 start your text with INFO

    Thursday, 31 May 2012

    PrEP Technologies Tried in Africa as HIV Prevention Method

    African Institute looks at a study of PrEPs technologies in Africa. It is a new technology that provides to couples of mixed HIV status where one partner is living with HIV and the other has no HIV but both partners want to have sex without using condoms for protection. We encourage our readers to read these new studies and technologies being introduced and realise that no perfect single intervention should be taken in isolation. We believe that condoms offer better protection with no side effects. If the PrEP becomes a popular way of prevention in the developed world that will only add into the HIV treatment bill and the probabilities are that no many countries will afford to offer those to the entire population that needs PrEP and manage to also pay for other treatments due to side effects caused by PrEP. 'We, therefore, think that both male and female condoms provide great prevention against HIV virus and fight the stigma attached to the virus.' said Mr Amdani Juma, the AISD Director                     Photo Gordon Brown in Kenya 

    Kenyan heterosexual couples want a choice of antiretroviral prevention methods

    Michael Carter   
    Published:  May 2012
    Approximately 40% of HIV-positive people in stable relationship with an HIV-negative person in Kenya have reservations about starting antiretroviral therapy early for the purposes of prevention, investigators report in the online edition of the Journal of Acquired Immune Deficiency Syndromes.
    Willingness to use pre-exposure prophylaxis (PrEP) was high among the HIV-negative partners. However, this finding is likely to have been influenced by the fact that the study involved couples involved in a PrEP study.
    The investigators believe that their findings could have implications for the use of HIV treatment in prevention.
    A possible HIV-1 prevention strategy for serodiscordant couples that will utilize both ART [antiretroviral therapy] and PrEP is for the HIV-1-uninfected partner to use PrEP until the HIV-1 infected partner is willing and able to initiate ART,suggest the authors. Such a strategy would be cost-effective, provide HIV-1 infected partners an opportunity to decide when to start ART, and may allow a bridge period for a few months after the infected partner starts ART, when transmission may still be high because viral load is not yet suppressed.
    Antiretroviral-based strategies are among the most promising new approaches to HIV prevention.
    Research involving serodiscordant heterosexual couples showed that early antiretroviral therapy reduced the risk of transmission of the virus by 96%.
    Some research has also shown that antiretroviral drugs taken by HIV-negative people (PrEP) can reduce their risk of transmission.
    Serodiscordant couples are a priority population for the use of HIV treatment. But, before strategies for its use are developed, it is important to understand the couples preferences for and concerns about the use of antiretrovirals for this purpose.
    Investigators therefore recruited 181 serodiscordant couples in Kenya, enrolled in the Partners PrEP study, to a substudy enquiring about their willingness to use HIV treatment as prevention.
    The HIV-positive partners all had a CD4 cell count above 350 cells/mm3 and were therefore ineligible for antiretroviral therapy according to Kenyan national guidelines. The study was conducted between March and July 2011, before the publication of research showing the efficacy of PrEP in heterosexual couples and of the results from the HTPN 052 study, which showed that early HIV therapy reduced HIV risk by 96% in serodiscordant heterosexual couples.
    Both the HIV-negative and HIV-positive partners completed questionnaires.
    HIV-negative individuals were asked: If we find that PrEP works to keep people free from HIV, would you be willing to take PrEP tablets every day for the next five years?
    HIV-infected partners were asked: Would you be willing to start antiretrovirals before your CD4 count reaches 350 if it would lower your chances of giving HIV to your partner?
    Participants were asked to describe their main concerns about early HIV treatment or PrEP. They were also asked to say which of these strategies they preferred.
    Some 69% of HIV-positive men and 58% of HIV-positive woman said that they would be willing to take early treatment for the purposes of prevention.
    An overwhelming majority of HIV-negative people (94% of men and 86% of women) expressed a willingness to take PrEP.
    When asked to state a preference between the two approaches, 61% of HIV-positive men and 50% of HIV-negative women said they would prefer early HIV therapy.
    A majority of HIV-negative participants expressed a preference for PrEP (57% of men and 56% of women).
    In just over a quarter of couples (26%), both members preferred to have the HIV-negative partner take PrEP and in 22% of couples both members preferred early antiretroviral therapy for the infected partner.
    Among HIV-positive participants, the primary concerns about early treatment for prevention were side-effects (51%), stigma (21%), pill burden (19%) and fears about resistance (18%).
    A total of 14 HIV-negative people were unwilling to use PrEP. Their primary concerns were the duration of treatment (6/14), taking treatment when they were not sick (3/14), and side-effects (3/14).
    In our study, not all couples would be willing to use ART prior to the HIV-1 infected partner having clinical symptoms and a perceived need for initiation; PrEP could be a suitable alterative for these couples,conclude the authors. As antiretroviral-based HIV-1 prevention strategies are incorporated into prevention policies and programs, it will be important to understand and accommodate couples 'preferences and willingness to use antiretroviral-based HIV-1 prevention.'

    Reference: Heffron R et al. Willingness of Kenyan HIV-1 serodiscordant couples to use antiretroviral based HIV-1 prevention strategies. J Acquir Immune Defic Syndr, online edition. DOI: 10.1097/QAI.0b013e31825da73f, 2012.

    For more information,
    please visit AISD at: http://www.africaninstitute.org.uk/ or call on +44(0)7834459076
    Campaign with us and learn more about HIV info http://www.idoitright.co.uk/
    To get HIV information and advice, call free on 0800 0967 500
    Text: 07860 002 014 start your text with INFO