Have HIV diagnoses in Ireland jumped 75% this year?

There were 491 new HIV diagnoses reported in Ireland in 2015. That’s more than in any previous year and an increase of about 30% from the number reported in 2014.

That’s a significant and worrying rise in new diagnoses, urgently deserving of a serious response.

But for the Irish Times that unprecedented 30% rise wasn’t dramatic enough. Citing preliminary figures from the first few months of 2016 the IT reported an even more alarming 75% increase in reported diagnoses compared to last year!

The first appearance of this figure was an headline in early April that declared “HIV cases up by 75% this year, HSE report finds.” Another IT article from mid-June repeated the claim of “an increase of 75 per cent,” as did yet another article just yesterday.

This figure has been echoed uncritically by other sources, as in a June 24 post at theoutmost.com (the web presence of Dublin’s month gay lifestyle magazine GCN) that reported that new diagnoses had “increased by 75% in the first three months of this year alone.”

Other outlets made similar claims though phrased differently. TheJournal.ie breathlessly reported in May that new diagnoses “almost doubled in the first four months of 2016,” although they seemed confused about the numbers, describing an increase from 106 to 175 as “about 40%” (it’s actually 65%). The Irish Examiner at least got the math right with the same figures.

So is it true? Are this year’s figures showing an increase more than twice the already huge increase from last year?

In a word, no.

Continue reading Have HIV diagnoses in Ireland jumped 75% this year?

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“Public health witch hunt” targets HIV+ men in Czech Republic

I’ve not had much time to post since the end of last year, but wanted to post briefly about this really disturbing story out of the Czech Republic. I first heard about this from a post on Tuesday by Edwin J Bernard at the HIV Justice Network’s website, and yesterday J. Lester Feder wrote an article for BuzzFeed that added some new details.

This quote from the BuzzFeed piece sums up the broad facts:

A public health department in the Czech Republic has launched criminal investigations against 30 HIV-positive men whom it alleges had unprotected sex in violation of the country’s laws that make it a crime to expose someone else to HIV.

There are no complainants in the case, nor any evidence anyone has contracted HIV from the 30 men under investigation. The sole evidence against the men is that they contracted other sexually transmitted infections (STI) — like gonorrhea or syphilis — after testing HIV-positive, which the health department contends is proof they had condomless sex in violation of the law.

The articles linked above explain what’s known about this situation. A number of civil society organisations are working to support HIV advocates in the Czech Republic and to encourage action from EU bodies. The European AIDS Treatment Group has started an online petition to the European Commission that you can sign if you’d like to show your support.

Tenofovir resistance and “super HIV”

Last week The Lancet Infectious Diseases journal published an article about the TenoRes study—a review of data from numerous countries about resistance to Tenofovir among people with HIV who had experienced treatment failure.

Tenofovir is one of the most widely prescribed drugs used to treat HIV around the world. It is available on its own and in various combination pills, including Truvada (and its generic equivalents). Developing resistance to Tenofovir reduces the available treatment options for a person with HIV, so understanding the circumstances of why this occurs and how to prevent it is very important.

Unfortunately, as is often the case, the headlines (and stories) in reports about this study were often alarmist and misleading.

Continue reading Tenofovir resistance and “super HIV”

Sex, drugs & sanctimony (part 2)

It seems I haven’t posted anything here for over a month now! I didn’t mean to take an extended break, but I did have some lovely holidays. I have a few things I want to share when I have a chance to write them up, but in the meantime, here’s the second part of the (now quite old) stuff I’d written about some (then) recent articles about sex and drug use among gay and bisexual men…

In a previous post I discussed an article by Charles Kaiser about methamphetamine use in the gay community in the US. This post looks at a piece by Matt Cain in the UK Independent, which was, at the time, the latest in a spate of mainstream reports about “chemsex” in London.

“Chemsex” is a broad term which (to quote the authors of an excellent study on the subject) refers to “sex that occurs between men under the influence of drugs, which are taken immediately preceding and/or during the sexual session.” While that in itself isn’t exactly a new thing, the increase in the popularity of particular drugs (especially meth, GHB and mephedrone) and of injection use in recent years are distinctive and reason for increased concern.

Some of the better contributions to the discussion about chemsex have made sincere efforts to feature the voices of men who actually participate in the scene and to avoid making simplistic and reductive conclusions about a phenomenon that is complex and multifaceted. Cain, though, seem perfectly confident in his ability to discern exactly what’s going on.

He admits “there’s a lack of reliable statistics,” that it’s “difficult to obtain reliable evidence for the link between chemsex and rising rates of HIV,” and, of course, that he himself has “never been attracted to chemsex.” Not to worry though: he has a couple of friends who are into chemsex!

He’s seen them “plagued by depression, anxiety and paranoia” after weekends of partying, and one shared a story of passing out and waking up to find someone having sex with him, so he asked them to bring him along to a party to see first-hand what goes on.

Not surprisingly what he saw—men “thrashing around, twitching and gurning, unable to maintain an erection without taking Viagra” some of whom “appeared to be possessed and desperate”—left him “very sad but also slightly hopeless.” While these are scenes (and feelings) that would be familiar to many people who’ve attended such parties, they come off as a rather shallow and lurid and are not terribly illuminating for someone trying to understand “chemsex culture” as Cain claims to he want to.

Really, what could drive men to be involved in the sad and hopeless world Cain describes? Well Cain—like all too many who comment on this phenomenon—thinks he knows. In his 20s he “battled a serious problem with binge-drinking and drink-fuelled sex,” so extrapolating from his own experiences he believes “the chemsex phenomenon is a direct result of the lingering shame many of us still feel about our sexuality.”

Much as he tries to spin his views as compassionate and sympathetic, he cannot stop referring to men who might enjoy mixing drugs and sex in ways that pathologise them. Echoing Kaiser, he constantly attributes an unconscious motivation to “self-destruct” to men involved in the scene.

He briefly flirts with the idea that it might be possible to use drugs in a way that isn’t utterly destructive, or that one might have positive motivations for pursuing these kinds of pleasures. He quickly waves that away with a series of dramatic quotes from a friend who had recently left the scene: a “dark underworld” full of “loneliness and paranoia”… an inescapable cycle of binging and recovery and “before you know it you’re in hell.”

Other than one brief quote from an interviewee in the new film “Chemsex” (who explains that, believe it or not, sex on drugs can be really fun!) Cain fails to convey anything appealing about the chemsex scene at all, or any sense of why anyone would ever fall into it in the first place. In his view it’s a dismal world filled with people like the characters in his latest novel who “punish themselves with either drink, drugs, dangerous sex or abusive relationships.”

The temptation to reduce a phenomenon like the use of drugs in sexual situations to simple, easily grasped explanations is easy to understand. We see a phenomenon with specific characteristics and we think there must be a common reason that people might be drawn to participate. But that risks overlooking and obscuring the range of experiences of men in the chemsex scene. Quoting from the summary of the Sigma study cited earlier:

Chemsex is a diverse and complex phenomenon – a behaviour in which a wide variety of men engage,
at different times, at different points in their lives, in different spaces, with a range of drugs and with complex consequences. There is no set formula for chemsex – what behaviour men engage in, and the reasons for their use of drugs in sex, are specific to each individual.

Any serious attempt to grapple with the meaning, the impact, the causes of chemsex should start with that insight and work hard to suppress the urge to offer a simple or single explanation. Cain’s own experiences with alcohol and sex might give him some useful empathy or insight, instead they become the basis for an “explanation” of why men use drugs during sex that ignores the breadth of experiences of men in that scene. While his interpretation may make sense for some, for many others it’s more likely to annoy and alienate than to provide any help if their drug usage becomes a problem.

Next: Some writing about sex and drugs that isn’t so awful!

South Africa approves PrEP

A quick post to note some excellent news from South Africa…

The Medicines Control Council announced that it has approved the use of once daily oral tenofovir and emtricitabine as pre-exposure prophylaxis (PrEP) for HIV. This makes South Africa the third country in the world to approve PrEP after the US and France.

Though many of the news stories are referring to the brand name Truvada, the approval is not for a specific branded pill but for the combination of the drugs in Truvada, which are available in generic form at greatly reduced cost in South Africa.

Exciting as this news it, it is only the first step towards making PrEP widely available in that country. Enormous hurdles remain:

Yet with this vital new development in the fight against Aids it is now more crucial than ever that remaining barriers to accessing PrEP are removed. Fundamentally this means educating South Africans that PrEP exists and may help them personally and making sure that PrEP can be feasibly delivered in public healthcare settings.

Around the world we know that knowledge about PrEP is still limited. We must make sure in South Africa that all people at risk of HIV are told accurately what PrEP can do, how it should be taken and where it can be accessed.

Equally, we must make sure that nurses have the necessary skills and tools to be able to roll out PrEP in public healthcare settings across South Africa. South Africa’s Anova Health Institute, in collaboration with the Desmond Tutu HIV Foundation, is currently implementing the largest state sector housed demonstration project for the use of PrEP. This project, taking place in Cape Town and Johannesburg, will gain the vital experience necessary to enable the department of health to take PrEP to scale.

Sex, drugs & sanctimony (part 1)

The next couple of posts are responses to articles that were published in October. Although they’re not as timely as they would have been if I’d posted them sooner, they reflect my attempts to think through both the phenomena the articles address and the ways those phenomena are discussed in the media.

Some of my ideas are rough, probably not as well articulated as they could be, and I reserve the right to change my mind completely about things in the future, but I’m putting them out there anyway.

After the posts about these two specific articles, I’ll share some other articles on the topic that I think are worth looking at. So, without further ado…

The use of drugs in the gay community, especially their use during sex, is a fraught and often volatile topic. Two recent articles offer perspectives about current trends in the US and the UK.

The first, from Charles Kaiser writing in the new LA-based LGBT publication The Pride, offers a vitriolic indictment of the widespread use of crystal meth in the US gay community. The second, from Matt Cain writing in the UK Independent, is a sympathetic, if somewhat presumptuous, attempt to explain the “chemsex” phenomenon among gay men in London.

Continue reading Sex, drugs & sanctimony (part 1)

PrEP is coming, but who will get it?

One of the big concerns for European governments considering whether and how to make Truvada available as pre-exposure prophylaxis for HIV (PrEP) is the cost. The medication itself is expensive, and it also requires on-going support from medical providers. In many European countries these costs will be borne largely or entirely by state-funded health systems.

Studies have consistently found that to be cost-effective PrEP, needs to be used by those at the highest risk of acquiring HIV. How high? The World Health Organization suggests that giving PrEP to people in groups with an incidence of 3% per year would be cost effective, while estimates in the UK suggest a minimum incidence of 5%.

Although gay and bisexual men generally are at elevated risk of infection, not every gay or bisexual man is at equally significant risk of acquiring HIV. In the US, the Centers for Disease Control and Prevention recently estimated that about 1 in 4 sexually active HIV-negative gay and bisexual men would benefit from PrEP.

One of the most important results of the PROUD trial in the UK was that the men in the study who were not using PrEP had an extremely high incidence of 9%. The French IPERGAY trial also found that men in the control group had a high rate of incidence (6.75%). This meant not only that Truvada as PrEP was (yet again) confirmed to be extremely effective at preventing HIV, but, crucially, that both studies had been extremely successful at recruiting men at very high risk of acquiring HIV.

But these studies were relatively small, and it’s not clear that simply applying the same criteria used for participation in the studies on a wider scale will be as effective at targeting the right people, or what criteria will be appropriate in other countries. While people at the highest risk of infection have been shown to be the most motivated to seek out and use PrEP, cost-conscious health systems want to have an idea of where to draw the line for eligibility so that those at low risk of infection do not use resources that could benefit others more.

So how do health authorities make sure they can reach those at higher risk, that the people who most need PrEP get it first?

Continue reading PrEP is coming, but who will get it?

Blood bans & disavowal

I’ve shared a fair amount of news about changes in blood donation policies around the world. I think the policies which ban gay and bisexual men from donating are—like HIV-specific criminal laws—outdated and counterproductive, relics of an era of fear and ignorance that should be reformed.

Lifetime, and even most shorter-term, bans are not necessary or justifiable and are based in, and contribute to, bias and stigma against gay and bisexual men. I think screening procedures which assess individual risk rather than membership in “risk groups” are both fairer and more effective.

At the same time, I’ve long been made uneasy by the attitudes and motivations of many of the most active campaigners against these bans. In this perceptive new piece at Dazed & Confused, Sean Faye lays out exactly what disturbs me:

There is a pernicious tone to the rhetoric here. If some gay men feel guilt or shame at the blood deferral – perhaps it is necessary to examine the impulses behind this reaction. Where is the shame coming from? Perhaps it is a dislike for being associated with HIV because of one’s sexual identity. Similarly, asking for exceptions based on marital status has a clear implication – how could people in heteronormative, monogamous partnerships be thrown in as a high-risk group when their sexual behaviour couldn’t possibly mean they are at risk of HIV.

There’s a sexual puritanism to this that, I believe, perpetuates HIV stigma. I have seen it in my own life in discussions with friends about the blood donation deferral. Whenever the topic is raised, friends who believe they’re being right-on will sarcastically say “they don’t want my filthy blood because I’m gay”. What masquerades as righteous anger in fact has dangerous and stigmatising implications – the subtext is “that’s ridiculous, I believe I am HIV negative – as is everyone else in this room – and our blood is clean.” Not only could this read as a reinforcement of the prejudice that HIV positive people are “dirty” – it’s a form of respectability politics, an assertion that the speaker themselves should not be associated with HIV.

The whole thing is worth a read.

PrEP is coming to France

Earlier this afternoon the rather exciting news broke that beginning in December Truvada will be approved for use as pre-exposure prophylaxis (PrEP) for HIV in France. France’s Minister for Social Affairs and Health, Marisol Touraine, made the announcement that her country will become the second in the world (after the US) to approve Truvada for this use, and the first to provide it free of cost.

Continue reading PrEP is coming to France