U = U: awareness and associations with health outcomes among PLHIV in 25 countries

Okoli CVan de Velde NRichman B, et al

Undetectable equals untransmittable (U = U): awareness and associations with health outcomes among people living with HIV in 25 countries

Abstract:

Objectives ‘Undetectable equals Untransmittable’ (U=U) is an empowering message that may enable people living with HIV (PLHIV) to reach and maintain undetectability. We estimated the percentage of PLHIV who ever discussed U=U with their main HIV care provider, and measured associations with health-related outcomes. Secondarily, we evaluated whether the impact of the U=U message varied between those who heard it from their healthcare provider (HCP) vs from elsewhere.

Methods Data were from the 25-country 2019 Positive Perspectives Survey of PLHIV on treatment (n=2389). PLHIV were classified as having discussed U=U with their HCP if they indicated that their HCP had ever told them about U=U. Those who had not discussed U=U with their HCP but were nonetheless aware that ‘My HIV medication prevents me from passing on HIV to others’ were classified as being made aware of U=U from non-HCP sources. Multivariable logistic regression was used to measure associations between exposure to U=U messages and health outcomes.

Results Overall, 66.5% reported ever discussing U=U with their HCP, from 38.0% (South Korea) to 87.3% (Switzerland). Prevalence was lowest among heterosexual men (57.6%) and PLHIV in Asia (51.3%). Compared with those unaware of U=U, those reporting U=U discussions with their HCP had lower odds of suboptimal adherence (AOR=0.59, 95% CI 0.44 to 0.78) and higher odds of self-reported viral suppression (AOR=2.34, 95% CI 1.72 to 3.20), optimal sexual health (AOR=1.48, 95% CI 1.14 to 1.92) and reporting they ‘always shared’ their HIV status (AOR=2.99, 95% CI 1.42 to 6.28). While exposure to U=U information from non-HCP sources was beneficial too, the observed associations were attenuated relative to those seen with reported discussions with HCPs.

Conclusion HCP discussion of U=U with PLHIV was associated with favourable health outcomes. However, missed opportunities exist since a third of PLHIV reported not having any U=U discussion with their HCP. U=U discussions with PLHIV should be considered as a standard of care in clinical guidelines.

Trans and cis women and men all have similar levels of PrEP drugs in blood

nam/aidsmap, 7 September 2020

A study in which 24 trans women and 24 trans men who were taking gender-affirming hormone therapy were directly observed to take a daily dose of the standard formulation of the HIV prevention medication PrEP found that the levels of the two PrEP drugs tenofovir and emtricitabine were similar to the levels seen in similar cis men and women, and were all above levels associated with efficacy.

This study to some extent addresses concerns raised by a couple of other studies which had suggested that both levels of gender-affirming hormones and levels of PrEP could be lower in trans people taking PrEP, due to drug-drug interactions.

Phylogenetic clustering networks among heterosexual migrants with new HIV diagnoses post-migration in Australia

Phylogenetic clustering networks among heterosexual migrants with new HIV diagnoses post-migration in Australia

Rachel Sacks-Davis  et al

PLOS One

Published: September 1, 2020

https://doi.org/10.1371/journal.pone.0237469

Background:

It is estimated that approximately half of new HIV diagnoses among heterosexual migrants in Victoria, Australia, were acquired post-migration. We investigated the characteristics of phylogenetic clusters in notified cases of HIV among heterosexual migrants.

Conclusion:

Migrants appear to be at elevated risk of HIV acquisition, in part due to intimate relationships between migrants from the same country of origin, and in part due to risks associated with the broader Australian HIV epidemic. However, there was no evidence of large transmission clusters driven by heterosexual transmission between migrants. A multipronged approach to prevention of HIV among migrants is warranted.

 

SAMESH cooking class presents: Classic Egg and Bacon Pie

SAMESH, 18/09/2020

SAMESH have still not been able tor resume their face to face cooking classes for PLHIV & older LGBTIQ+ community members, so Paul is continuing to develop recipes for you to try at home.

This week he brings us is a classic easy pie that “tastes great, is quick to make, can be eaten hot or cold, and uses a few simple fillings”.

“If you love bacon & eggs you will love this pie”, says Paul.

This recipe will make 1 large or 4 individual pies.

Disparities in characteristics in accessing public Australian sexual health services between Medicare‐eligible and Medicare‐ineligible MSM

Disparities in characteristics in accessing public Australian sexual health services between Medicare‐eligible and Medicare‐ineligible men who have sex with men

Australian and New Zealand Journal of Public Health

Anysha M. Walia, Christopher K. Fairley, Catriona S. Bradshaw, Marcus Y. Chen, Eric P.F. Chow

First published: 31 August 2020
https://doi.org/10.1111/1753-6405.13029
Abstract:

Objectives: Accessible health services are a key element of effective human immunodeficiency virus (HIV) and sexually transmitted infection (STI) control. This study aimed to examine whether there were any differences in accessing sexual health services between Medicare‐eligible and Medicare‐ineligible men who have sex with men (MSM) in Melbourne, Australia.

Methods: We conducted a retrospective, cross‐sectional study of MSM attending Melbourne Sexual Health Centre between 2016 and 2019. Demographic characteristics, sexual practices, HIV testing practices and STI diagnoses were compared between Medicare‐eligible and Medicare‐ineligible MSM.

Results: We included 5,085 Medicare‐eligible and 2,786 Medicare‐ineligible MSM. Condomless anal sex in the past 12 months was more common in Medicare‐eligible compared to Medicare‐ineligible MSM (74.4% vs. 64.9%; p<0.001) although the number of partners did not differ between groups. There was no difference in prior HIV testing practices between Medicare‐eligible and Medicare‐ineligible MSM (76.1% vs. 77.7%; p=0.122). Medicare‐ineligible MSM were more likely to have anorectal chlamydia compared to Medicare‐eligible MSM (10.6% vs. 8.5%; p=0.004).

Conclusions: Medicare‐ineligible MSM have less condomless sex but a higher rate of anorectal chlamydia, suggesting they might have limited access to STI testing or may be less willing to disclose high‐risk behaviour.

Implications for public health: Scaling up access to HIV and STI testings for Medicare‐ineligible MSM is essential.

SAMESH cooking class presents: Rainbow Veggie Slice

SAMESH, 14/08/2020
SAMESH are still unable to hold their monthly cooking class for PLHIV and older LGBTIQ+ folk in person due to COVID-19, so Paul has tested another recipe for community members to try at home: a Rainbow Veggie Slice. 
 
Paul says: “This recipe has health and vegetarians in mind! It is slightly unusual in that it features a breakfast cereal as the secret ingredient – but don’t be put off, as you can’t taste it and it is a useful source of added fibre and a good binding agent for the ingredients!”
 
“The recipe suggests ‘stir fry’ veggies, but you can use any veggies of your choice”, says Paul. “And for those who can’t live without meat – add some bacon pieces or cook some bacon to have on the side.”