Risk of HIV transmission through condomless sex in serodifferent gay couples with the HIV-positive partner taking suppressive antiretroviral therapy (PARTNER)

Risk of HIV transmission through condomless sex in serodifferent gay couples with the HIV-positive partner taking suppressive antiretroviral therapy (PARTNER): final results of a multicentre, prospective, observational study

The Lancet, Published Online May 2, 2019

Background

The level of evidence for HIV transmission risk through condomless sex in serodifferent gay couples with the HIV-positive partner taking virally suppressive antiretroviral therapy (ART) is limited compared with the evidence available for transmission risk in heterosexual couples. The aim of the second phase of the PARTNER study (PARTNER2) was to provide precise estimates of transmission risk in gay serodifferent partnerships.
Findings
Between Sept 15, 2010, and July 31, 2017, 972 gay couples were enrolled, of which 782 provided 1593 eligible couple-years of follow-up with a median follow-up of 2·0 years (IQR 1·1–3·5). At baseline, median age for HIV-positive partners was 40 years (IQR 33–46) and couples reported condomless sex for a median of 1·0 years (IQR 0·4–2·9). During eligible couple-years of follow-up, couples reported condomless anal sex a total of 76 088 times. 288 (37%) of 777 HIV-negative men reported condomless sex with other partners. 15 new HIV infections occurred during eligible couple-years of follow-up, but none were phylogenetically linked within-couple transmissions, resulting in an HIV transmission rate of zero (upper 95% CI 0·23 per 100 couple-years of follow-up).

Interpretation

Our results provide a similar level of evidence on viral suppression and HIV transmission risk for gay men to that previously generated for heterosexual couples and suggest that the risk of HIV transmission in gay couples through condomless sex when HIV viral load is suppressed is effectively zero. Our findings support the message of the U=U (undetectable equals untransmittable) campaign, and the benefits of early testing and treatment for HIV.

 

Updated blood borne virus guidelines for health professionals in SA

SA Health, 11 April 2019

The ‘Australian National Guidelines for the Management of Healthcare Workers Living with Blood Borne Viruses and Healthcare Workers who Perform Exposure Prone Procedures at Risk of Exposure to Blood Borne Viruses’ have been updated. They can be viewed on the Commonwealth Department of Health website.

The guidelines are in two parts:

Part A provides information and recommendations for all healthcare workers, in particular:

  • healthcare workers who perform exposure prone procedures
  • healthcare workers living with a blood borne virus, and
  • doctors treating healthcare workers with a blood borne virus.

Part B provides information and recommendations for public health authorities including, but not limited to, hospitals and jurisdictional health departments, when managing or investigating a situation where a healthcare worker with a blood borne virus was not compliant with these guidelines and/or may have placed a patient(s) at risk of infection.

 

 

Liver cancer death rate rising: study

SBS News, 9/4/19

The rate of liver cancer deaths and diagnoses has increased substantially in the past three decades, yet researchers say little has been done to help Australians most at risk.

While it is considered a relatively rare type of cancer – nearly 2000 people were diagnosed in 2014 – the high mortality rate and increasing incidence of diagnosis has been concerning, researcher Barbara de Graaff says.

Rates were highest in the Northern Territory, mostly due to a higher prevalence of hepatitis B and C.

What to know about bipolar disorder and sex

Medical News Today, 

Bipolar disorder causes a person to experience intense shifts in moods, sometimes from a manic state to a depressed state, for example. These shifts can occur with changes in sexual desire, confidence, or sexual function.

Though the symptoms vary from person to person, bipolar disorder can disrupt several aspects of a person’s life, including their sexuality.

In this article, we discuss sexual symptoms of bipolar disorder and ways to manage them.

Smoking and HIV: what are the risks and what harm reduction strategies do we have at our disposal?

AIDS Res Ther. 2018 Dec 12;15(1):26. doi: 10.1186/s12981-018-0213-z.

Abstract

The World Health Organization estimates that smoking poses one of the greatest global health risks in the general population. Rates of current smoking among people living with HIV (PLHIV) are 2-3 times that of the general population, which contributes to the higher incidence of non-AIDS-related morbidity and mortality in PLHIV.

Given the benefit of smoking cessation, strategies to assist individuals who smoke to quit should be a primary focus in modern HIV care.

Tobacco harm reduction focuses on reducing health risk without necessarily requiring abstinence. However, there remains uncertainty about the safety, policy and familiarity of specific approaches, particularly the use of vaporised nicotine products. Evidence suggests that vaporised nicotine products may help smokers stop smoking and are not associated with any serious side-effects. However, there is the need for further safety and efficacy data surrounding interventions to assist quitting in the general population, as well as in PLHIV specifically.

In addition, official support for vaping as a harm reduction strategy varies by jurisdiction and this determines whether medical practitioners can prescribe vaporised products and whether patients can access vaporised nicotine products. When caring for PLHIV who smoke, healthcare workers should follow general guidelines to assist with smoking cessation.

These include: asking the patient about their smoking status; assessing the patient’s readiness to quit and their nicotine dependence; advising the patient to stop smoking; assisting the patient in their attempt to stop smoking through referral, counselling, pharmacotherapy, self-help resources and/or health education; and arranging follow-up with the patient to evaluate their progress.

Are We Blinded by Desire? Relationship Motivation and Sexual Risk-Taking Intentions during Condom Negotiation

The Journal of Sex Research, Shayna Skakoon-Sparling & Kenneth M. Cramer (2019) DOI: 10.1080/00224499.2019.1579888

ABSTRACT

Effective condom negotiation skills support better sexual health for both men and women. The current study explored relationship motivation (motivation to establish and maintain long-term romantic relationships), gender, and sexual orientation as factors influencing the condom negotiation process.

Participants (177 heterosexual women, 157 heterosexual men, and 106 men who have sex with men) read a vignette describing an encounter with a hypothetical new sexual/romantic partner and responded to embedded items and scales.

Stronger relationship motivation predicted increased willingness to have condomless sex among women who perceived greater familiarity with the hypothetical partner. Gender and sexual orientation predicted different preferences for condom insistence strategies.

The findings suggest that there are a number of conditions that make it more difficult to recognize risk during a sexual encounter and demonstrate how the process of condom negotiation can be impacted by gender, sexual orientation, and relationship motivation.