Compiled & edited by Gus Cairns
American pupils at schools with free condom schemes have less sex and if they
do, have it more safely, a US study reports.
Authority figures ranging from George Bush to Catholic bishops have deplored the issue of free condoms, particularly to young people, as a way of controlling HIV, sexually-transmitted diseases and pregnancy. A key assumption has been that if you give young people the means to have safer sex, they will have more sex, and thus cancel out the effect of the condoms.
The survey from Massachusetts indicates the opposite. Only one in five pupils in this relatively liberal state had access to free condoms at school. Even then, they usually had to ask for them from the school clinic or a PE teacher. Nonetheless when pupils in schools providing condoms were compared with condomless ones, it was found that 42 per cent reported ever having sex, compared with 49 per cent in schools without condoms. They also had less sex if they did have it; 30 per cent of pupils in condom-providing schools had had sex in the three months previous to the survey compared with 35 per cent in condomless schools.
The difference in sexual behaviour may not have been due to the condom availability but to the sex education that came with it. 78 per cent of pupils at schools dispensing condoms attended a presentation featuring a speaker with HIV/Aids compared to 46 per cent of those without condom programmes.
The Department of Health’s Independent Advisory Group on Sexual Health
and HIV has criticised the ministry’s slow implementation of the National
Sexual Health and HIV Strategy.
The Group says that waiting lists at GUM clinics must be brought down urgently.
They found an average waiting time for GUM appointments of 12 days at present
for men, with an extreme of seven weeks. One clinic in Bristol was forced to
turn away 400 people a week due to lack of capacity. The government has responded
with a 50 per cent increase in the £10m GUM budget.
To put this in perspective, the 6,500 people newly diagnosed with HIV alone this year will cost £100m a year to treat.
Roche Products Ltd has stopped further development of its ‘second generation’ fusion
inhibitor drug T-1249. This leaves a group of patients with multi-drug resistance
stranded.
Roche said the reason it was stopping T-1249 development was because of formulation difficulties. The drug is a successor to the injectable fusion inhibitor T-20 (Fuzeon®) and had sounded promising. It only needed to be injected once a day against T-20’s twice-daily schedule, and tackled HIV that had become resistant to T-20.
However trial participants said taking the drug was ‘like injecting toothpaste’ and Roche decided it was not worth spending more money on improving the formulation.
It is thought that the disappointing sales results of Fuzeon contributed to this decision. At £12,000 a year, Fuzeon costs four times as much as most HIV drugs and so far only handfuls of patients are taking it as opposed to the thousands Roche was hoping for. It was forecast to bring in £250m-£400m profit but last year only managed £21m.
Three pieces of news this month all cleared the way for greater access to hepatitis C treatment, in particular for people with HIV.
On 7 February Roche Products announced the results of their large APRICOT clinical trial of their hepatitis C treatments Pegasys (pegylated interferon) and Copegus (ribavirin) in people co-infected with HIV and hep C. Forty per cent of people treated with the drugs cleared the hep C virus from their system, compared with 12 per cent who got conventional interferon and ribavirin.
Secondly, the UK’s National Institute for Clinical Excellence (NICE) has decided that treating chronic hepatitis C with the latest combination therapy is cost effective.
This should make hep C treatment more consistently available. NICE estimates that even if demand does not increase, the cost of treating all those currently seeking hep C treatment will be over £10m a year. Given that only 10 per cent of people with hep C in the UK know it at present, costs will inevitably rise.
However this cost should be compared with the cost of treating HIV, which currently runs at about £500m a year and is increasing.
Thirdly, a body of experts had laid down international guidelines for treating HIV/hep C co-infected people.
The guidelines recommend that when hep C treatment stands a good chance of working, which generally means before liver damage is too far advanced, it should be attempted before HIV therapy is started and before a person’s CD4 count has gone below 350. If on the other hand the person’s CD4 count is below 200, then the guidelines say that HIV therapy should be given first.
The guidelines also suggest that in some cases no hepatitis treatment might be better than some. New hepatitis C drugs are likely to be available in 2-3 years time and the guidelines say that if people’s livers are not doing too badly, it might be better to wait till then.
They also say that if the hep C viral load has not fallen at least 100-fold after 12 weeks of therapy, it isn’t going to work, and patients should be spared more of an uncomfortable (and expensive) treatment.
A group of scientists affiliated to World Health Organisation (WHO) has comprehensively refuted the idea that much of the HIV epidemic in Africa was caused, not by sex, but by doctors and nurses using unsterilised needles.
US researcher David Gisselquist caused controversy last year when he said that up to two-thirds of African HIV cases might be due to unsafe injections (see ‘A needle in an Aidstack’, Positive Nation June 2003).
Gisselquist used studies from the late 80s to show that people with HIV were more likely to report having had injections than to have had multiple sexual partners.
However, in a paper published in The Lancet medical journal, the WHO scientists say that re-using needles is more common in Asia than in Africa. Even where needles are re-used there are normally attempts at washing or sterilising them which, while substandard, eliminate most of the risk of HIV.
Gisselquist also drew attention to a reported 5-6 per cent HIV infection rate among South African children aged 5-14, which he said could not all be due to children born with HIV living to that age, or to sexual abuse.
However the WHO scientists say that the South African study which found such high rates was flawed. Generally the HIV rate among children that age is one-tenth the rate among over-14s, and these nearly all represent survivors born with HIV.
The HIV rate starts to climb steeply after the age of 15 in young women and a few years later in men. If injections were to blame there would be a steady increase of HIV infections during childhood, not a sudden increase around adolescence.
The WHO point to the studies that suggest that circumcision in men has a protective effect against HIV. The studies published suggest that circumcised men are 60 per cent less likely to catch HIV. There is no way to explain this difference if HIV is not largely spread sexually, the WHO authors conclude.
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Young gay clinic opens