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Changing the HIV outlook

April 11, 2014

The recent Unusual Risks research into the insurance needs of HIV Positive people shows that 78% of the people they surveyed are now aware of HIV Life Assurance. This is a rise from 20% in the previous year’s survey. This, together with the increased availability of products, is great news. One might think that this increased awareness would be replicated in increased action by people who are HIV Negative at higher risk of infection to protect themselves against it – ie a general better understanding of the issue as a whole. Sadly this does not appear to be the case.

Recent Lancet  and London School of Hygiene and Tropical Medicine reports show that many more of London’s men who have sex with men (MSM) are engaging in high-risk practices, including crystal meth use, putting them at risk of infection with HIV, hepatitis C (HCV), and a range of other STIs. In 2011, there was a record high 3010 new HIV infections in MSM in the UK, of which 1296 were in London. At the Dean Street Clinic in Soho, 511 new cases of HIV were diagnosed, with most (482) in MSM.

Injection of crystal meth or mephedrone to get a bigger high—known as slamming—is increasing, taking place at sex parties where many people often share equipment without sterilising it. While most slammers inject the drugs dissolved in water, some are withdrawing their blood with a needle, adding either crystal meth or mephedrone to that blood, and then re-injecting it into themselves or someone else. Users can then be high for days, reinjecting and having sex with multiple partners without protection. In 2011, 30% of the users of mephedrone and crystal meth visiting Dean Street were injecting these drugs. In 2012, this increased to 80%. Of these, 70% reported needle sharing. The result is a perfect storm for transmission of both HIV and HCV.

In another part of the forest, in 2012, the US Food and Drug Administration approved a combination pill of tenofovir and emtricitabine for pre-exposure prophylaxis (PrEP) for HIV. The once-daily drug was approved to reduce the risk of sexually acquired HIV infection in high-risk negative individuals. One of the most comprehensive analyses of prescriptions for PrEP in the USA produced some interesting findings. It found that of the 1774 people that had used PrEP 48% were women, and the users were widely spread across the USA. It seems pretty obvious to me that this drug will have significant impact across all those at risk of HIV – rather than being confined to MSM. Indeed, given that PrEP will have no impact, of itself, on HCV infection it might be better to target groups who do NOT engage in needle sharing. In the UK, this includes some black African heterosexual men and women, who have among the highest HIV rates.

That said, it is early days in this research. In the UK, the PROUD study pilot is currently recruiting patients. It is designed to assess the effectiveness of PrEP in preventing HIV-infection in high-risk, HIV-negative MSM. A big worry is that the use of PrEP could see reduced condom use, despite the risk of other sexually transmitted infections, including HCV. The PROUD trial plans to address this issue by checking whether behaviour in the first 12 months of follow-up differs between those with and without PrEP. Some will get the drug, others will not get it for 12 months. Change is rarely as straightforward as it appears….. What will the HIV and HCV infection rate map look like in 10 years time?

 

Written by Richard Walsh – first published in Cover magazine, 10th March 2014. (click here for Cover article )

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