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Decriminalization of Sex Work Among Top HIV-Prevention Strategies

The decriminalization of sex work is among one of the most important steps needed in order to curtail the spread of HIV, according to the findings of a group of HIV researchers recently published in The Lancet and presented at the 20th Annual International AIDS Conference. The need to focus on marginalized populations grows as mainstream populations gain increasing access to HIV-preventative measures and drugs to treat the virus, the research explains.

_DSC7194-LThe longer sex work remains illegal, said The Lancet’s editor-in-chief Richard Horton, the longer those involved in the profession will generally go without seeking the same kinds of treatments necessary to ensure their sexual safety.

“Why should we condemn and criminalise the exchange of money for sex,” He asked. “[E]specially if the severely adverse conditions we create for such exchange hurt women and men and often fatally so?”

In a series of seven studies delving into the role sex work plays in the proliferation of the HIV virus within a country, researchers expressed their concern for sex working individuals. Given the nature of their work, Horton explained, sex workers are at risk of becoming a group for reintroducing HIV back into the general population, in spite of public health initiatives.

Of particular importance, according to Johns Hopkins University epidemiologist Stefan Baral, are male sex workers, who are woefully misunderstood by most HIV-prevention programs.

"When you think of a sex worker, the most common picture that comes to mind is a female sex worker," he elaborated. "Often what’s happened is that people want to oversimplify and generalize the epidemic. [W]e end up in a dynamic where we know very little about male sex workers."

 


Maryland To Provide Trans Health Coverage

As a result of a settlement to a legal claim filed on behalf of Sailor Holobaugh, the state of Maryland will now provide nondiscriminatory health coverage for its transgender employees. Holobaugh, a transgender man and neurological clinical research assistant at the University of Maryland, Baltimore, filed a lawsuit against the State with the help of FreeState Legal after being denied a medically necessary breast removal.

1280px-Flag_of_Maryland.svgAccording to FreeState Legal the denial of Holobaugh’s surgery resulted in language within Maryland state law allowed for the exclusion of coverage “for any ‘procedure or treatment designed to alter an individual’s physical characteristics to those of the opposite sex.’”

Maryland, in response to the lawsuit, not only removed the explicitly discriminatory provision from the books but also added a “gender dysphoria benefit” designed to cover the cost of hormones and certain medically necessary surgeries.

"This is basically a fabulous shift in policy," Holobaugh told the Baltimore Sun. "I think this will affect a large number of people, especially now that children can stay on their parents' plan until age 26 under the Affordable Care Act.”

Maryland is the third state in the country, following Oregon and California, to provide nondiscriminatory health coverage to its employees, but Maryland’s fight for trans-equality is far from finished, says Jer Welter, Managing Attorney of FreeState Legal:

“[T]here is still work to be done, including the elimination of similar transition-related care exclusions in the Maryland Medical Assistance (Medicaid) program and in policies issued by private insurers regulated by the Maryland Insurance Administration. FreeState Legal will continue to work diligently on these issues to further ensure that equal and fair health care coverage is a staple for all LGBTQ Marylanders.”

Read FreeState Legal's full press release AFTER THE JUMP...

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Researchers Eliminate HIV Virus In Human Cells

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Researchers at Temple University have successfully managed to eliminate HIV from infected human cell cultures according to a recently released study. Most current HIV treatments target the various means through which HIV integrates itself into healthy host cells in order replicate itself. The team at Temple, however, employed a form of advanced gene therapy in order to render HIV-infected cells completely HIV-free. From the team’s press release:

When deployed, a combination of a DNA-snipping enzyme called a nuclease and a targeting strand of RNA called a guide RNA (gRNA) hunt down the viral genome and excise the HIV-1 DNA. From there, the cell's gene repair machinery takes over, soldering the loose ends of the genome back together – resulting in virus-free cells.

Treatments capable of removing HIV from infected cells have long since been a goal for those within the HIV/AIDS research community. While antiretrovirals are able to suppress the viral loads in HIV positive people, interruptions in treatment give the virus the chance to proliferate, sometimes with dangerous consequences such as cardiomyopathy, kidney disease, and neurocognitive disorders.

"These problems are often exacerbated by the toxic drugs that must be taken to control the virus," explained Dr. Kamel Khalili. "Since HIV-1 is never cleared by the immune system, removal of the virus is required in order to cure the disease."

This development comes just days after a report published at the 20th International AIDS Conference announced that HIV infection rates in general have dropped here in the U.S. The one population observed to have experienced a rise in infection rates were gay and bisexual men.

Controlled tests with the gene therapy method have proven to be successful, but Khalili says that his team still faces a number of significant challenges before the treatment is ready for patient trials. In order to be completely effective the molecular agents responsible for disabling HIV’s replication process would have to be delivered to every cell in an infected individual’s body. Moreover, the strain of HIV that the treatment has proved effective against, HIV-1, is prone to mutation, further complicating the therapy’s effectiveness outside of controlled environments.

"We are working on a number of strategies so we can take the construct into preclinical studies," Khalili said. "We want to eradicate every single copy of HIV-1 from the patient. That will cure AIDS. I think this technology is the way we can do it."

Watch Temple University's video announcing the research breakthrough AFTER THE JUMP...

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Department of Justice Urges States To Drop HIV Criminalization

The Civil Rights division of the U.S. Department of Justice is strongly urging legislators across the country to strike down laws that currently criminalize HIV-positive people who, often unknowingly, “certain behaviors before disclosing known HIV-positive status.”

DojHIV criminalization laws sprang up across the country in the early days of the AIDS epidemic when diagnoses and death were swift and sometimes unexpected. In a time when the exact means of transmission were misunderstood and means of treating those infected were scant, the laws were a desperate attempt to curtail the spread of the virus. More robust public health funding  was provided to the states in 1990 provided that the states criminalized HIV transmission.

Unfortunately, most of the laws regarding HIV positive individuals and their conduct haven’t managed to keep pace with the development of treatments. Put simply, the laws just don’t work. Last year the United Nations HIV/AIDS prevention task force found that in criminalizing HIV transmission these laws discouraged people from finding out their HIV statuses.

“Generally the best practice would be for states to reform these laws to eliminate HIV-specific criminal penalties except in two distinct circumstances.”

The DoJ’s guide reads:

First, states may wish to retain criminal liability when a person who knows he/she is HIV positive commits a (non-HIV specific) sex crime where there is a risk of transmission (e.g., rape or other sexual assault). The second circumstance is where the individual knows he/she is HIV positive and the evidence clearly demonstrates the individual’s intent was to transmit the virus and that the behavior engaged in had a significant risk of transmission, whether or not transmission actually occurred.

Read the Department of Justice’s Best Practices Guide to Reform HIV-Specific Criminal Laws to Align with Scientifically-Supported Factors AFTER THE JUMP...

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'New York Times' Explains Conflicting Truvada Effectiveness Stats

The New York Times has published an insightful, data-driven rundown clarifying the sometimes conflicting information concerning Truvada that’s in circulation.

IPrEx_OLE_logoThe primary point of contention, writes Josh Barro, is linked to Truvada users actually taking the drug consistently, the way it’s prescribed. iPrEx, the first large scale, randomized PrEP trial using human subjects, found that Truvada users were 44% less likely to test HIV positive at the end of the trial compared to participants given a placebo. Participants who didn’t consistently take the drug, however, did not display the same immunity:

Of 48 iPrEx subjects who were assigned to take Truvada and contracted H.I.V. anyway, just four had any detectable level of the drug in their system when they were diagnosed, indicating a 92 percent reduction in risk for people who were actually taking the medicine.

But wait, there’s more: Those four subjects who took Truvada and became infected had its active ingredients in their blood only at levels consistent with taking the drug twice a week. That is, in the study, there were zeroapparent cases of subjects taking their pills daily and contracting H.I.V.

iPrEx’s sample size was relatively small sample size of 2,500 people and the fact that only 18% of participants were shown to have taken the drug daily made it difficult for researchers to claim 100% efficacy.

But by looking at the handful of infections among people taking their pills less than daily, the iPrEx researchers were able to build a statistical model of how the risk of infection declines as the number of pills taken weekly rises. In 2012, they estimated that actually taking Truvada every day produces a 99 percent reduction in the risk of H.I.V. infection, despite not directly observing any such infections.

The general consensus within the HIV/AIDS research community is that Truvada is, in fact, helpful in the prevention of contracting the, but doctors remain wary of putting a precise percentage on current studies.


Read through a an in-depth iPrEx fact sheet AFTER THE JUMP...

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Lebanese Police Conducting Torturous 'Gay Tests' On Suspected Gay Men

Members of the Lebanon police force’s “Moral Protection Bureau” alleged to be carrying out physical tests on men suspected to be homosexual, according to the Independent.

Screenshot 2014-07-17 08.21.08The tests, which include forcible anal probing, have been banned in the country, and are considered to be humiliating and degrading treatment by the Human Rights Watch.

While homosexuality remains illegal in Lebanon, the physical testing practices suspected of being used are considered a form of torture, and are illegal. A doctor, hired by the police to investigate the sexualities of five Lebanese and Syrian men, is said to have conducted the “test” at the authority's behest.

“We are asking the Order of Physicians to sue him [the doctor] for professional misconduct,” attorney Saghieh told The Daily Star, expressing concern that there were more unreported cases. “There are many sanctions available, so it is up to the people who are hearing this case to decide on what is adequate.”


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