Compiled and edited by Gus Cairns
 illustration: mike tice; visit: www.michaeltice.com |
HIV prevention experts would do better to encourage some gay men to go bungee-jumping than lecture them to use condoms, a recent report claims.
The report by the Kinsey sexual research institute in the USA suggests that around 10-20 per cent of gay and heterosexual men have their brains ‘wired up’ differently so that, unlike the majority, they respond to stress, guilt and depression by getting more, rather than less, horny.
This would mean that HIV prevention messages, could have the effect of sparking off the exact risky behaviour they mean to prevent.
John Bancroft, Kinsey Institute director, said: “For most of us, the way our bodies are set up probably makes it easier to do the right thing.” Past studies show that about 45 per cent of people have less sexual appetite when depressed or stressed, and that about 40 per cent will show no change. But a minority feel more aroused.
Frank Farley is a US psychologist who categorises such people as ‘type T’ or risk-taking personalities. “These people don’t want safe,” he said. “Safe takes the thrill out of it.” Because of this, he added, a better way to help type T people protect their sexual health would be to encourage them to seek thrills elsewhere, like going mountaineering or bungee-jumping. GC
The new fusion inhibitor drug T-20 (enfuvirtide or Fuzeon®) is being fully licensed throughout the EU this month. The price of the injectable drug will be £1,196 a month - which at over £14,000 a year makes it more than twice as expensive as any other HIV drug.
Despite this, health academics in the UK have calculated that T-20 is cost-effective when weighed against likely deaths and hospital admissions in similar patients who are not receiving the drug.
Dr Mike Youle told the 9th European Aids conference in Warsaw on 25-29 October that the cost of T-20 treatment and associated care was £23,200 per ‘Quality Adjusted Life Year’ (QALY). The UK National Institute for Clinical Excellence generally approves drugs for NHS prescription that cost less than £30,000 per QALY.
However, the uptake of T-20 so far has been lower than manufacturer Roche Products was expecting. So far approximately 60 patients are taking the drug in the UK, in contrast to a forecast of several hundred by the end of this year and 1,000 in 2004.
Concerns have been expressed that physicians are prescribing T-20 inappropriately as a ‘last resort’ drug for people resistant to all other HIV treatments.
“This is an inappropriate use of the drug,” said a spokesman for Roche. “The studies that established the effectiveness of Fuzeon also showed that it was best used when patients had at least two other drugs they could respond to.” GC
Piercings could lay you open to HIV
Four per cent of the HIV positive men in the study reported being ‘active’ orally as their only risk factor. But they all had (healed) genital piercings. The investigators comment: “Breaches in skin integrity [such as] piercing of the genitals may constitute a breach even when the skin has apparently healed, as the presence of metal may cause ongoing subclinical inflammation.” |
An epidemic of hepatitis C (HCV) is occurring among gay men in London. This was the stark conclusion given to the autumn BHIVA conference.
Dr Mark Nelson, senior HIV consultant at London’s Chelsea and Westminster Hospital, said that he was shocked by the high numbers of acute seroconvertors of HCV he had treated so far this year.
In a short period of time the hospital had seen 52 gay men who had the virus. The main mode of infection was unprotected anal sex; when cases were analysed, the one risk factor that stood out head and shoulders above others was ‘barebacking’.
Moreover, the drug treatments available for HCV are “toxic, expensive and not very effective,” Dr Nelson said.
There is now increasing proof that HCV can be transmitted sexually, he explained, though at a lower rate than human papilloma virus (which causes genital warts) or HIV. The older a person is and the more sexual partners they have, the higher the risk of acquiring the deadly disease.
There is as much as a five per cent risk of an HCV positive person passing on the virus sexually to their partner in the long-term if they do not use condoms.
As regards mode of transmission of HCV, it is estimated that 45 per cent is spread through sharing needles by intravenous drug users, 15 per cent sexually or by sharing toothbrushes or razors, and the reasons for as much as 40 per cent of transmission of the disease remains unknown.
Among people with HCV, between 20 and 65 per cent were also infected with HIV, and high risk sexual behaviour, such as barebacking, increased the chances of passing on the disease. MF
See also ‘Hepatitis C - Reasons for Hope’ on page 40.
‘Very little new HIV infection in children’
Dr Pat Tookey, of the Institute of Child Health, explained that 4,350 children had been exposed to HIV by being conceived by HIV positive mothers in the UK up to September 2003. In the two years 1992-3, 155 of these children were infected with HIV and only 90 definitely uninfected. But in 2000-1, 65 children were infected and 570 definitely uninfected. Far more children are being born to HIV positive mothers now, and because of this hospital admissions of children due to HIV illnesses have not gone down much. Dr Mike Sharland said that 496 children were treated for HIV in the UK in 2000 and 443 in 2001. MF |
Resistance to anti-HIV drugs among people in Britain taking them has increased considerably over the last year.
A meeting held prior to the British HIV Association (BHIVA) conference in October heard that 13 per cent of patients taking HIV treatment had resistance to all three classes of HIV drugs.
However a study published in AIDS Journal on 27 October revealed even higher rates of resistance in France: no less than one in four French patients taking HIV treatment has some resistance to all three classes of HIV drugs.
About 80 per cent of patients failing HIV therapy in both countries have resistance to at least one drug, predominantly in the nucleoside class.
Dr David Dunn, of the Medical Research Council, explained that the transmission of HIV resistance to at least one drug, is also a growing problem in the UK. It had risen from less than 10 per cent among people newly infected in 1997 to over 20 per cent of people diagnosed in 2002/3. “Newly-diagnosed white gay men in Britain were the group most at risk,” he said.
However Dr Deenan Pillay of the new National HIV Drug Resistance Database told Positive Nation that transmission of HIV, resistant to all three drug classes, was still a rare event. “HIV resistant to all three classes has consistently only been found in one per cent of UK patients who have never taken treatment,” he said.
Dr Margaret Johnson, who is Chairman-elect of BHIVA, told the conference that treatment failure in the UK is actually quite uncommon, averaging 3.4 per cent.
“The reason people change therapy is not usually because the drugs don’t work,” Dr Johnson said, “but rather because they have nasty side effects or are inconvenient to fit into a daily lifestyle. It is therefore important for doctors to identify problems with adherence and tolerability in each individual in advance,” she added. MF
It has generally been thought that the risk of HIV transmission during male/male
oral sex is very low - and almost non-existent if you are the insertive partner,
ie the one ‘being done’. But you could be at considerably more
risk if you have a ‘PA’ or other genital piercing according to
a study by Australian researchers.
There has been a much lower proportion of new HIV infections in children of
HIV positive mothers in this country in the last few years.