Understanding U=U for women living with HIV

ICASO, September 2018

Since its announcement, Undetectable equals Untransmittable (U=U) has
become a call to action to assert that when someone living with HIV has an
undetectable viral load they cannot transmit HIV. Additionally, the U=U message
is evolving to challenge notions of HIV infectivity, vulnerability and stigma.

The science behind the U=U message provides the evidence that we can reduce the anxiety related to the sexual transmission of the HIV virus with confidence.

To contribute to getting this message out, ICASO produced a Community Brief on U=U. This community brief explains why it is so important to understand what ‘U=U’ means for women. The brief documents the experiences and needs of individual women living with HIV from all over the world. Important questions still remain that need to be answered to make the U=U message relevant, understandable and more meaningful to women in their diversity.

  • Download the community brief in English here

‘People are scared’: the fight against a deadly virus no one has heard of

Guardian Australia, Tue 24 Apr 2018 

An Aboriginal woman – we’ll call her B – is sitting in a dry creek bed outside her community and telling the world “this is a very bad disease. But we have to talk in a way not to shame people. Not telling them straight out. Telling them gently and quietly.”

B is talking about a sickness that has killed her family member and is a potential tragedy facing Aboriginal communities in central Australia, who have the world’s highest rates of a fatal, human immune virus for which there is no current cure, no treatment and no coordinated public health response.

Human T-lymphotropic virus type 1 (HTLV-1) is transmitted through sexual contact, blood transfusion and from mother to child by breastfeeding. It can cause a rapidly fatal form of leukaemia. Some people die within weeks of diagnosis. HTLV-1 also causes inflammation of the spinal cord leading to paralysis, severe lung disease known as bronchiectasis and other inflammatory disease.

In five communities around Alice Springs, more than 45% of adults tested have the virus, a rate thousands of times higher than for non-Indigenous Australians.

Clinical Practice Guidelines: Pregnancy Care (2018 Edition)

Australian Government Department of Health, February 2018

Modules 1 and 2 of the Antenatal Care Guidelines have now been combined and updated to form a single set of consolidated guidelines that were renamed Pregnancy Care Guidelines and publicly released in February 2018. 

The Pregnancy Care Guidelines are designed to support Australian maternity services to provide high-quality, evidence-based antenatal care to healthy pregnant women. They are intended for all health professionals who contribute to antenatal care including midwives, obstetricians, general practitioners, practice nurses, maternal and child health nurses, Aboriginal and Torres Strait Islander health workers and allied health professionals. They are implemented at national, state, territory and local levels to provide consistency of antenatal care in Australia and ensure maternity services provide high-quality, evidence-based maternity care. The Pregnancy Care Guidelines cover a wide range of topics including routine physical examinations, screening tests and social and lifestyle advice for women with an uncomplicated pregnancy.

Guidelines:

Clinical Practice Guidelines – Pregnancy Care (PDF 5747 KB)
Clinical Practice Guidelines – Pregnancy Care (Word 3615 KB)

Accompanying documents:

Clinical Practice Guidelines – Pregnancy Care – Short-form guidelines (PDF 1979 KB)
Clinical Practice Guidelines – Pregnancy Care – Short-form guidelines (Word 1330 KB)

Clinical Practice Guidelines – Pregnancy Care – Administrative Report (PDF 1758 KB)
Clinical Practice Guidelines – Pregnancy Care – Administrative Report (Word 1150 KB)

Clinical Practice Guidelines – Pregnancy Care – Linking evidence to recommendations (PDF 2183 KB)
Clinical Practice Guidelines – Pregnancy Care – Linking evidence to recommendations (Word 1259 KB)
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Clinical Practice Guidelines – Pregnancy Care – Economic analyses (PDF 1804 KB)
Clinical Practice Guidelines – Pregnancy Care – Economic analyses (Word 1298 KB)

PEP after Non-Occupational and Occupational Exposure to HIV: Australian Guidelines revised

Our apologies to those who tried to access SASHA while it was down. The technical difficulties have now been resolved.

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Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine, August 2016

The Second edition of the Post-Exposure Prophylaxis after Non-Occupational and Occupational Exposure to HIV: Australian National Guidelines is now available.

These guidelines outline the management of individuals who have been exposed (or suspect they have been exposed) to HIV in non-occupational and occupational settings.

There are currently no data from randomised controlled trials of the use of post-exposure prophylaxis (PEP) and evidence for use has been extrapolated from animal data, mother to child transmission, occupational exposure and small prospective studies of PEP regimens in HIV-negative men. Accordingly, assumptions are made about the direction of management.

Every presentation for PEP should be assessed on a case-by-case basis, balancing the potential harms and benefits of treatment.

Recommendations following non-occupational exposure have been updated, and information about PEP in the context of pre-exposure prophylaxis (PrEP), PEP and children, renal disease, and gender identity and history has been added.

  • Download the revised guidelines (PDF) here
  • Updates to the supplementary documents, as well as a navigable website for the guidelines, will soon be available. At present, the 2013 literature review and checklist are still available, linked below:

    PEP Checklist (2013)

    Literature Review (2013)

 

Decision-making about infant feeding among African women living with HIV in the UK

“It pains me because as a woman you have to breastfeed your baby”: decision-making about infant feeding among African women living with HIV in the UK

Sex Transm Infect 2016;92:331-336 doi:10.1136/sextrans-2015-052224

Abstract

Objectives UK guidance advises HIV-positive women to abstain from breast feeding. Although this eliminates the risk of postnatal vertical transmission of HIV, the impact of replacement feeding on mothers is often overlooked. This qualitative study examines, for the first time in the UK, decision-making about infant feeding among African women living with HIV.

Methods Between 2010 and 2011, we conducted semistructured interviews with 23 HIV-positive African women who were pregnant or had recently given birth. We recruited participants from three HIV antenatal clinics in London.

Results Women highlighted the cultural importance of breast feeding in African communities and the social pressure to breast feed, also describing fears that replacement feeding would signify their HIV status. Participants had significant concerns about physical and psychological effects of replacement feeding on their child and felt their identity as good mothers was compromised by not breast feeding. However, almost all chose to refrain from breast feeding, driven by the desire to minimise vertical transmission risk. Participants’ resilience was strengthened by financial assistance with replacement feeding, examples of healthy formula-fed children and support from partners, family, peers and professionals.

Conclusions The decision to avoid breast feeding came at considerable emotional cost to participants. Professionals should be aware of the difficulties encountered by HIV-positive women in refraining from breast feeding, especially those from migrant African communities where breast feeding is culturally normative. Appropriate financial and emotional support increases women’s capacity to adhere to their infant-feeding decisions and may reduce the emotional impact.

Read article (open access) here