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Briefing Document #13

Briefing Document Archive

Emerging Issues on HIV/AIDS - December 25, 2024

Update:

Well this briefing document is my Christmas present to everyone, particularly as it circulates on December 25/98! We are at the end of 1998 and looking ahead to 1999, hopefully it will be another year of scientific discoveries and effective treatments. Merry Christmas and Happy New Year. Laurie

‘Morning After Pill’ for HIV Prevention?

Recently much attention has been focused on a project taking place in San Francisco, which has raised many questions about HIV prevention and transmission. In the past few months, there has been much media focus on vaccines being tested for HIV, such as the new AIDSVAX. Although these are essential strides in our fight against HIV, many people may have overlooked a new form of possible HIV prevention which will be described in the following section.

Most people are aware of the morning after pill available to women which is effective, up to 72 following intercourse, in preventing pregnancy. Now there is information emerging on a so-called ‘morning after pill’ which is currently being studied, which has demonstrated strong results in the realm of HIV prevention.

What is this new treatment?

According to Gala (1998) the ‘morning after pill’ is known as "post-exposure prophylaxis or PEP" (p. 7). PEP is the anti-HIV treatment which has been made available recently to health-care workers and victims of sexual assault who may have been exposed to HIV (Gala, 1998). Over the past year, PEP has been offered (free of charge) through a project in San Francisco in an effort to target high risk groups who are at risk for HIV infection.

According to the article, PEP was a project initiated by the city of San Francisco and the AIDS Research Institute at the University of California. This project was started in 1997 and provides patients who are at high risk for HIV infection immediately following possible exposure:

  • a 28 day regiment of treatment;
  • at least two anti-HIV drugs; &
  • intensive counseling program.

The hope of this PEP project is to eliminate and stop the virus before it enters into the body’s immune system. Current participants received a 28 day regiment of the treatment prophylaxis in a controlled environment, as well as a minimum of two anti-HIV drugs. The counseling program is focused on identifying high risk behaviors and outlining ways to reduce and/ or eliminate the risk of HIV infection for participants in the future. Through this intensive intervention, if PEP demonstrates positive results, the benefits could provide some well needed options for people today. One benefit from this project is that it will increase awareness of participants in order to prevent a future incident(s) of high risk behavior, and to educate participants of safer alternatives, thereby reducing the need for PEP.

Study Supporting this Initiative:

Health Care Workers:

One recent study found that when PEP was administered to health care workers at risk for HIV infections through occupational hazards:

  • HIV infections were cut by 81%
  • intervention had to take place within 72 hours of exposure in order to be effective

How was this program publicized?

This project has been kept fairly quiet, with advertisement only originally occurring through word of mouth &/or publications directed at gay communities.

Present-Day San Francisco Project:

This project currently has an enrolment list of 215 participants, who are primarily Caucasian gay men who have been exposed through unsafe sexual practices (Gala, 1998).

Since the initiation of this project no participants have tested positive for HIV infection.

Future Plans:

PEP project coordinators are hoping to expand the project in the future to provide services to more diverse populations including the following:

  • gay black men
  • gay Hispanic men
  • other groups considered at high risk for HIV infection

Costs:

The current program is accompanied by an initially high price. According to PEP’s public health director, Dr. Katz, the costs are broken down as follows:

$500 - $1, 000 per patient for four weeks of drug therapy

Yet how can we compare the costs of this preventative treatment, when we are aware that the cost for drug-treatment therapy for people living with HIV/ AIDS is nearly $15,000/mth for an indefinite amount of time. Gala (1998) estimated that for a person living with HIV/AIDS on drug-therapy can cost "between $150,000 to $200,000 for a person with HIV for a lifetime of care" (p. 7).

Conclusion:

According to oragnizers of PEP, they feel that this product should be available to everyone who is at risk for HIV infection, particularly if it can be effective. The director of the AIDS Reseach Institute in San Fransico, Dr. Coates, stated that "this is an elegant and important way of targeting those individuals who are exposing themselves, or exposing others, to HIV . . . if there is an opportunity to avoid infection, it should be offered to everyone" (Gala, 1998, p. 7).

Fears:

  • With more information surfacing about PEP, there is fear that people will stop practicising safer sex.
  • The other fear is that this is a fairly new project, and no definitive statistics have emerged.
  • Recent information emerging from this short-term project (to date one year) may paint an inaccurate picture for our society, particularly at a time when people are eager to find new hope in our fight against HIV/AIDS.

Source:

Gala (1998). You have 72 hours: morning after pill stirs controversy. The Gala Occasion, 7, 3, November, p. 7.

International Information

In the last briefing document, I gave an overview of what issues are of major concern globally. I feel that it is important to get a better sense of the distribution of HIV internationally.

  • An estimated 11 men, women and children are infected each minute of 1998.
  • There was an increase in HIV infection globally in 1998 of 10% - despite much information stating that it is not increasing.
  • HIV has not been overcome anywhere in the world, with 5.8 million new infections in 1998 & 2.5 million deaths due to HIV-related causes.
  • The cumulative number of deaths since the onset of the pandemic now stands at 13.9 million individuals.

Africa:

  • In the Sub-Saharan Africa, approximately 21.5 million adults and 1 million children are living with HIV/AIDS.
  • The number of women in Africa infected with HIV is climbing - with 60-80% of infected women contracting HIV through monogamous relationship - infected by their one life-time partner (husband).
  • 40% of children under 16 are orphaned.
  • TB is rapidly infecting people living with HIV in Africa - with an estimated 11.7 million co-infected with TB and HIV.

(ICAD, 1998, p. 1).

Asia and the Pacific:

  • Recently, more discussion re: HIV is emerging from this region, particularly from Southern and Eastern Asia.
  • Over 7 million people are infected with HIV - in an area with roughly half the worlds population.
  • The number of HIV infected injection drug users is growing rapidly - in India infection rates now exceed 7% and in Myanmar nearly two -thirds of IDUs have HIV.
  • In Cambodia, 7% of military workers tested positive for HIV, and 43% of sex trade workers tested positive.

(ICAD, 1998, p. 1).

Latin America and the Caribbean:

  • More than 1.7 million people are living with HIV/AIDS in these regions.
  • The majority of infections are found in marginalized groups, with injection drug users, bisexual and homosexual males presently at the forefront.
  • Heterosexual transmission is increasing in Latin America, and it is the primary route of infection in the Caribbean.
  • In Mexico, up to 30% of men who have sex with men may be infected with HIV.
  • HIV prevalence in Argentina and Brazil is close to 50% among injection drug users.

(ICAD, 1998, p. 1).

Industrialized Countries of North America, Europe, Australia, and New Zealand:

  • Combined, these countries have 1.4 million people living with HIV.
  • The numbers of HIV infections remain relatively stable, with availability of drug treatment very efficient.

(ICAD, 1998, p. 1).

Eastern Europe and the Commonwealth of Independent States:

  • HIV is increasing rapidly in this region - there are now 270,000 people living with HIV - with an increase of approximately 30% over the past year alone.
  • The highest rate of HIV infection is among injection drug users - with Ukraine being the worst country effected.

(ICAD, 1998, p. 1).

Source:

Interagency Coalition on AIDS and Development (1998). AIDS in the World. Ottawa, ON. Available at: [email protected][Online].

STD’s - How they affect HIV infection rates

In a recent article from the Globe and Mail, research demonstrating the increased risk for HIV infection for people who have STDs was highlighted. The research outlined the following risk factors:

  • how often you have sex with a person living with HIV;
  • how long that sex lasts each time;
  • hidden risks: the virulence of the HIV strain a sex partner is infected with;
  • whether you hd sex when that person was particularly infectious;
  • bad luck; &
  • highest risk: having a sexually transmitted disease first (Silversides, 1998, p. A23).

In Canada last year, 21.7% of new HIV infections were found among heterosexuals. However, people with STD have a two- to fivefold increased risk for HIV infection. The risk is the highest with herpes or syphilis that cause ulceration. If STDs are treated, the risk of HIV infection is reduced.

Study:

A randomized, controlled trial in Tanzania found that:

  • when symptomatic STDs in six communities were treated, a 38% drop in HIV infections was found;
  • these results were compared with six matched communities where STDs were not treated &
  • there were no changes in sexual behavior or condom use.

Study results:

  • treating STDs led to reduced risk for HIV transmission; &
  • STDs interfere with what is known as mucosal immunity.

Source:

Silversides, A. (1998). People with STDs face higher risk of AIDS. The Globe and Mail, December 1, p. A23.

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