Clergy Can Fight HIV On Faith-friendly Terms

An excellent article from Science Daily:

In the United States, where blacks bear a disproportionate burden of the HIV/AIDS epidemic, black religious institutions could help turn the tide. In a new study in PLoS ONE based on dozens of interviews and focus groups with 38 of Philadelphia’s most influential black clergy, physicians and public health researchers find that traditional barriers to preaching about HIV prevention could give way to faith-friendly messages about getting tested and staying on treatment.

The public health community has long struggled with how best to reduce HIV infection rates among black Americans, which is seven times that of whites. In a new paper in the journal PLoS ONE, a team of physicians and public health researchers report that African-American clergy say they are ready to join the fight against the disease by focusing on HIV testing, treatment, and social justice, a strategy that is compatible with religious teaching.

“We in public health have done a poor job of engaging African-American community leaders and particularly black clergy members in HIV prevention,” said Amy Nunn, lead author of the study and assistant professor of medicine in the Warren Alpert Medical School of Brown University. “There is a common misperception that African American churches are unwilling to address the AIDS epidemic. This paper highlights some of the historical barriers to effectively engaging African American clergy in HIV prevention and provides recommendations from clergy for how to move forward.”

The paper analyzes and distills dozens of interviews and focus group data among 38 African-Amereican pastors and imams in Philadelphia, where racial disparities in HIV infection are especially stark. Seven in 10 new infections in the city are among black residents. With uniquely deep influence in their communities, nearly all of the 27 male and 11 female clergy said they could and would preach and promote HIV testing and treatment.

That message, delivered by clergy or other influential figures, would provide a needed complement to decades of public health efforts that have emphasized risk behaviors, Nunn said. Research published and widely reported last year, for example, suggests that testing and then maintaining people on treatment could dramatically reduce new infections because treatment can give people a 96-percent lower chance of transmitting HIV.

“For decades, we’ve focused many HIV prevention efforts on reducing risky behavior,” said Nunn, who is also based at The Miriam Hospital. “Focusing on HIV testing and treatment should be the backbone of HIV prevention strategies and efforts to reduce racial disparities in HIV infection. Making HIV testing routine is the gateway to getting more individuals on treatment. African American clergy have an important role to play in routinizing HIV testing.”

The barriers clergy members face

Many religious leaders acknowledged that they’ve struggled with how best to combat the epidemic, particularly with challenges related to discussing human sexuality in church or mosque, according to the analysis in the paper.

“One time my pastor spoke to young people about sex, mentioning using protection,” the paper quotes a clergy member as saying in one example. “I was sitting in the clergy row; you could feel the heat! I was surprised he said that. Comments from the clergy highlighted they were opposed to that. It’s a tightrope walk.”

Many clergy members also said they face significant barriers to preaching about risk behaviors without still emphasizing abstinence.

“It’s my duty as a preacher to tell people to abstain,” one pastor told the research team, “but if they’re still having sex and they’re getting HIV, there has to be another way to handle this.”

What clergy can do

Many clergy members suggested couching the HIV/AIDS epidemic in social justice rather than behavioral terms, Nunn said. They also recommended focusing on HIV testing as an important means to help stem the spread of the disease and reduce the stigma.

“We need to standardize testing,” one pastor told the researchers. “One thing that we could do immediately is to encourage our congregations — everybody — to get tested. … We’re not dealing with risk factors. And we’re all going to get tested once a year. That’s the one thing that we could do that doesn’t get into our doctrine about sexuality.”

In general, many of the religious leaders said they could encourage discussion of HIV not only in main worship services, but also in ministries and community outreach activities.


FDA Panel Recommends Approval Of Preventative HIV Med

From CBS News:

In a landmark decision, an advisory panel to the Food and Drug Administration voted to recommend approval of Truvada to prevent HIV infection. The FDA is not required to the follow the panel of experts’ advice, though it typically does.

In a series of votes, a Food and Drug Administration advisory panel recommended approval of the daily pill Truvada for healthy people who are at high risk of contracting HIV, including gay and bisexual men and heterosexual couples with one HIV-positive partner.

A final decision on Truvada is expected by June 15, but the FDA doesn’t confirm such action dates and says the review of the application is ongoing, a spokesperson told CBS News.

“I think this is a huge milestone,” Dr. Robert Grant, associate director of the Center for AIDS Research at the University of California, San Francisco, who led the panel’s research, told CBS News medical correspondent Dr. Jon LaPook. “I think we are in an era for the first time when we can see the end of the AIDS epidemic.”

Gilead Sciences Inc., based in Foster City, Calif., has marketed Truvada since 2004 as a treatment for people who are infected with the virus. The medication is a combination of two older HIV drugs, Emtriva and Viread. Doctors usually prescribe it as part of a drug cocktail to repress the virus.

Since Truvada is already on the market to manage HIV, some doctors have prescribed it as a preventive measure. FDA approval would allow Gilead Sciences to formally market its drug for that use.

While panelists ultimately backed Truvada for prevention, Thursday’s 12-hour meeting highlighted concerns created by the first drug to prevent HIV. In particular, the panel debated whether Truvada might lead to reduced use of condoms, the most reliable defense against HIV. The experts also questioned the drug’s effectiveness in women, who have shown much lower rates of protection in studies.

The panel struggled to outline steps that would ensure patients take the pill every day. In clinical trials, patients who didn’t take their medication diligently were not protected, and patients in the real world are even more likely to forget than those in studies.

“The trouble is adherence, but I don’t think it’s our charge to judge whether people will take the medicine,” said Dr. Tom Giordano of Baylor College of Medicine, who voted in favor of the drug. “I think our charge is to judge whether it works when it’s taken and whether the risks outweigh the benefits.”

My view: This also allows sero-discordant couples- one HIV+, one not- an extra layer of protection. It may also help adherence if two persons are taking the same meds (or at least having to share a daily regimen) in the same household. That in itself is worth it….

 Full story here

Study: Preventative HIV Dosing Could Be Cost-Effective

Science Daily reports that giving preventative doses of the HIV drug Truvada to high-risk groups could prove to be cost-effective:

A once-a-day pill to help prevent HIV infection could significantly reduce the spread of AIDS, but only makes economic sense if used in select, high-risk groups, Stanford University researchers conclude in a new study.

The researchers looked at the cost-effectiveness of the combination drug tenofovir-emtricitabine, which was found in a landmark 2010 trial to reduce an individual’s risk of HIV infection by 44 percent when taken daily. Patients who were particularly faithful about taking the drug reduced their risk to an even greater extent — by 73 percent.

The results generated so much interest that the Stanford researchers decided to see if it would be cost-effective to prescribe the pill daily in large populations, a prevention technique known as pre-exposure prophylaxis, or PrEP. They created an economic model focused on men who have sex with other men, or MSM, as they account for more than half of the estimated 56,000 new infections annually in the United States, according to the Centers for Disease Control and Prevention.

“Promoting PrEP to all men who have sex with men could be prohibitively expensive,” said Jessie Juusola, a PhD candidate in management science and engineering in the School of Engineering and first author of the study. “Adopting it for men who have sex with men at high risk of acquiring HIV, however, is an investment with good value that does not break the bank.”

Although getting Congress to pass this- the same Congress who killed needle-exchange- is far from realistic. Even though (maybe even especially because) it makes sense.

HIV 2fer: Early Treatment Works and Truvada Prevents

HIV DataToday’s HIV News shelf is crowded. Two stories on the HIV front involve good news about early HIV treatment and Pre-Exposure Prophylaxis(PrEP) to reduce infection rates among high-risk persons.

A study (popularly known as the Setpoint Study) finds that people newly-infected with HIV-1 who immediately start anti-retroviral therapy are more likely to have beneficial medical outcomes than those who wait until CD4 counts fall below medically acceptable levels (currently 350-500 depending who you talk to).

“This is very welcome news,” said Frank J. Oldham, NAPWA President and CEO. “The study supplies scientific confirmation of something we at NAPWA have always believed: the closer we can come to bringing all people living with HIV into treatment, and the earlier they start treatment, the better. We already knew this is true for populations as a whole: more and earlier treatment means fewer new infections. Now we know that – on the whole – it’s also better for individuals already infected.”

The news on the HIV front just keeps getting better. The setpoint study follows on the heels of a groundbreaking study which provides proof of HIV treatment as prevention: HIV-infected persons on medication with undetectable viral levels are 96% less likely to pass on the virus.

It also accompanies Gilead’s application to offer Truvada as the first drug marketed to prevent HIV:

Gilead Sciences Inc. announced that it has submitted a supplemental New Drug Application (sNDA) to the U.S. Food and Drug Administration (FDA)for the approval of once-daily Truvada (emtricitabine/tenofovir disoproxil fumarate) for pre-exposure prophylaxis (PrEP) to reduce the risk of HIV-1 infection among uninfected adults. Truvada was approved by the FDA in 2004 for the treatment of HIV-1 infection and is currently the most-prescribed antiretroviral treatment in the United States.

If the sNDA is approved, Truvada would be the first agent indicated for uninfected individuals to reduce the risk of acquiring HIV through sex, a prevention approach called PrEP. The sNDA is based on the results of two large placebo-controlled trials of Truvada as PrEP, sponsored by the U.S. National Institutes of Health (NIH) and the University of Washington. Several other clinical studies support the use of Truvada for HIV risk reduction.

“The data from these large-scale clinical trials suggest that Truvada may have a role to play in meeting the urgent public health need to reduce new HIV infections,” said John C. Martin, PhD, Chairman and Chief Executive Officer of Gilead Sciences. “Gilead is proud to have played a part in helping to define the use of Truvada as a potential new prevention tool and we commend the many institutions, investigators and study volunteers for their commitment to advancing this important area of research.”

Truvada is not currently labeled to reduce the risk of infection, it is labeled only for HIV treatment.

This could be an important step in slowing HIV. Around 50,000 people are still being infected with HIV every year in the U.S. according to the CDC. More than half of new infections (61%) occur among men who have sex with men, and nearly a quarter (23%) occur among women.

If Truvada can be given to high-risk persons (which includes negative partners in a sero-discordant relationship) and insurance companies will pay for it, it may, along with the groundswell of early treatment science, start a trend of slowing the progression of HIV in this country.

But only if we can get more high-risk people in for testing and treatment….

When was your last HIV test?

Study: Simple Changes To Dating Sites Could Lower STD’s, HIV

Simple Changes to Dating Websites Could Decrease Spread of HIV and Sexually Transmitted Diseases

A study released today recommends eight ways to reduce transmission of HIV and other sexually transmitted diseases (STDs) among men who meet male sex partners online.

Owners of popular dating and “hook-up” websites and users of those websites, along with HIV and STD program directors, agreed that a few simple measures could have a major impact on the spread of sexually transmitted diseases.

Among the online measures supported by a majority of those surveyed:

• Including “safe sex” as a profile option and allowing users to search for partners by such characteristics
• Providing directories of STD testing locations
• Sending automatic reminders to get an HIV/STD test at regular intervals chosen by users
• Having chat-rooms and other areas for HIV+ men looking for other HIV+ men
• Providing e-cards to notify partners of a potential exposure to STDs
• Posting videos that show men discussing safe sex, HIV status, and related issues
• Providing access to sexual health experts

“Finding sex and love online is here to stay,” said Dan Wohlfeiler, one of the study’s authors working with the California HIV/STD Prevention Training Center for this project. “This shows how we can work with the website owners to turn the internet into a force for the health of their users.”

In California, gay and bisexual men who were diagnosed with syphilis or gonorrhea most frequently reported the Internet as where they met sex partners.

More than 3000 users, 82 state and local HIV and STD Program directors and 18 owners of dating and “hook-up “ websites completed the survey.

Jen Hecht, Education Director at STOP AIDS Project and co-author, said “Since all three groups agree these strategies are important, can be done, and would be used, we need to be getting them online now.”

The study also found a number of strategies with less support. Website owners expressed skepticism about health department staff going online to notify users that they might have been exposed to an STD. In contrast, a majority of HIV and STD prevention directors and users thought this strategy was important. The authors are planning follow-up meetings with owners to further understand their concerns.“We have rising rates of STDs among gay and bisexual men and turning that around means everyone needs to take responsibility for their sexual health,” said Bill Smith, Executive Director of the National Coalition of STD Directors (NCSD). “This study shows how public health professionals, as well the users and owners of sex seeking websites, can band together to make a real difference in securing the sexual health of gay men.”

The study, entitled “How Can We Improve HIV and STD Prevention Online for MSM” funded by amfAR, the Foundation for AIDS Research, was co-authored by H. Fisher Raymond and Willi McFarland at the San Francisco Department of Public Health. The results have been posted today at

Voting For HIV

I am a member of NAPWA, the National Association of People With AIDS/HIV.  As a member, I receive their monthly email newsletter, which has a lot of information regarding HIV, tips for self-care, advocacy and political activism. Frank Oldham, the President and CEO had a column this month that really put some things in perspective for me.

It’s been a pretty interesting election year. NAPWA, as a 501(c)(3) charitable corporation, is not permitted to support or oppose individual candidates or political parties, so we can’t name names – but we can share our general observation that some of this year’s candidates would be pretty grand entertainment if there weren’t a real chance they might get elected.

It’s also been one of the nastiest campaign seasons in recent memory, and a lot of us just want it to end and go away. Here are some reasons to get to the polls and vote anyway.

· Defend the Health Care Reform Act.

Imagine a world where insurance companies can’t ask about preexisting conditions and use our answers to deny us coverage or cover us differently! We’ll have to wait until 2014 for full implementation of that, but it’s in the new law, and candidates who will defend the law against attempts to repeal it outright or amend it out of existence deserve our support. So do incumbent candidates who knew they were risking their seats but voted for the bill anyway; they took a big risk for us.

· The next Congress will – or won’t – fund implementation of the National HIV/AIDS Strategy.

The Obama Administration’s National HIV/AIDS Strategy (NHAS) seeks to reduce the number of new HIV infections, increase access to care and optimize health outcomes, and reduce HIV-related health disparities. All of which is very good news for people living with HIV. It doesn’t mean much, though, if Congressional funding priorities are being set by folks who think anyone who doesn’t look like them is not the “real America.” Simply by being HIV-positive, we don’t look like them. We don’t want a Congress full of elected representatives chanting, “We shouldn’t be spending money on NHAS, ‘they’ wouldn’t have HIV if ‘they’ hadn’t been doing bad things.”

· The next Congress will set the agenda for young people’s HIV-awareness and prevention education.

We’ve seen the lack of results from abstinence-only curricula. Even the current Congress is gradually moving from ideology-driven abstinence-only approaches to evidence-based, frank sex education, and it is saving the lives of our young people. We don’t want to go back.

· There are critical HIV funding needs right now.

State AIDS Drugs Assistance Programs (ADAPs) are in crisis because of the recession which started in 2008. Programs for HIV-positive people with multiple medical or life issues – homelessness, addiction, mental illness – are also finding funds harder and harder to come by. Find out where your candidates stand on HIV services, and vote for those who support funding for them.

The votes of people living with HIV/AIDS are needed now more than ever before! As the leader of NAPWA and an African-American gay man living with AIDS, I know that so much progress and the fruits of hard-fought battles for our health care, protecting Ryan White Care Act services, and our rights as American citizens are at risk right now!

So let’s be sure to know our candidates and choose well. Next issue (November 5), we’ll look at the election results. Win or lose, we’ll all feel better if we did our research and voted our values.