What to know about new PrEP drugs

The drug maraviroc is safe and well-tolerated as pre-exposure prophylaxis for women

Maraviroc, a drug that is already on the market to treat HIV (brand name, Selzentry), is a CCR5 antagonist that concentrates in the genital tract and rectum, and selects for drug resistance uncommonly—making it a desirable product for PrEP, if it works.

The HPTN 069 study, which previously reported findings for men who have sex with men at CROI 2016, presented findings for women at AIDS 2016. HPTN 069 compared maraviroc-containing regiments to Truvada, making it the first randomized study of HIV PrEP regimens in U.S. women.

The study included 188 people born female over the age of 18. Participants, in the last three months, had  condomless vaginal or anal sex with at least one HIV-positive or unknown status man. The median age of participants was 35, and most were Black (65%).

People in the study received either maraviroc 300 mg; maraviroc 300 mg plus emtricitabine (FTC) 200 mg; maraviroc 300 mg plus tenofovir disoproxil fumarate (TDF) 300mg; or, Truvada (TDF 300 mg + FTC 200 mg). The study lasted 48 weeks.

Study participants were, overall, moderately adherent to the study drug regimen. At week 24, 65% of the sample had detectable study drug in their system; at week 48, 60% of the sample did. There were no new HIV infections during the study. (This study did not assess efficacy, however, so no conclusions can be made yet about how well maraviroc works to prevent HIV in women.)

All of the maraviroc-containing regimens were safe and well-tolerated, as compared to Truvada.



.Benefits of PrEP far outweigh the risks of drug resistance

One concern about PrEP is the potential for drug resistance mutations to develop if HIV infection happens during PrEP delivery (or if PrEP is given to a person who is unknowingly already HIV-positive). People with HIV who develop drug resistant mutations may be effectively limited in their future HIV treatment options. Can the risk of drug resistance be weighed against the HIV prevention benefits of PrEP—as this strategy is provided to an ever-increasing number of people all over the world?

“Resistance infections during PrEP should be weighed against the numbers of infections averted,” said Robert Grant, MD, MPH of the Gladstone Institutes and San Francisco AIDS Foundation. “Each of [these] will require life-long therapy with the attendant risk of virological treatment failure with drug resistance.”

“The risk of drug resistance during PrEP use is rare. It is very low risk,” emphasized Grant. In one review of six PrEP studies by Fonner and colleagues, out of the over 9,000 people took TDF/FTC PrEP only five drug resistant infections emerged, for an overall risk of developing FTC or TDF resistance of 0.05%.

A closer analysis of drug resistant infections in three oral TDF PrEP studies, said Grant, found that there was only one case of TDF resistance—for 53 infections that were averted overall by PrEP use. This one case of resistance that occurred happened because PrEP was give to someone in the acute (early) phase of HIV infection.

Out of five studies of oral FTC/TDF (Truvada), there were eight infections averted for every one drug resistant infection that occurred. Excluding cases of drug resistance that occurred because PrEP was given during early HIV infection, 22 infections were averted for every one case of drug resistant infection.

“Drug resistance risk during PrEP use has been low. And it mostly occurs when starting PrEP during acute HIV infection. Screening for acute infection would increase the benefits relative to drug resistance risk, by more than two-fold,” concluded Grant.

PrEP taken before and after sex—instead of daily—works well to prevent HIV

Jean-Michel Molina, of University of Paris Diderot, first presented the much-anticipated results from the IPERGAY randomized-controlled portion of the study at CROI in 2015 of “on-demand” PrEP use (i.e., PrEP taken around the times of sex, instead of once per day). Yesterday, he shared final results from the open-label portion of the study, which lasted from A total of 362 men who have sex with men participated in the open-label portion of the study. At the start of the study, men reported an average of 9.5 sex acts in the prior four weeks and seven sexual partners in the prior two months. The median follow-up time was 18.4 months with a total of 515 patient follow-up years in the study.

The HIV incidence per 100 patient-years was 0.19 during the study, for an estimated 97% relative risk reduction compared to placebo.

There was one HIV infection during the study, in a participant who was found to not have used PrEP for months. TDF/FTC were not detectable in his system at the time that he was diagnosed, and he did not develop a drug resistant mutation.

“As you may know, PrEP on-demand is recommended in France as an alternative to daily PrEP for MSM. That’s also the case in the UK, in Europe, and soon in Canada,” said Molina. (The PrEP on-demand regimen is not recommended in the United States.)

Injectable and long-acting PrEP testing is underway—with three different drugs  November 2014 to June of 2016.

Three drugs are being tested as possible long-acting PrEP agents, said Myron Cohen, MD, from the University of North Carolina School of Medicine. The first is rilpivarine, a widely available pill that is currently used to treat HIV. It has been formulated as a long-acting nanosuspension that can be injected into the muscle for long-acting PrEP.

Cohen clarified drugs formulated as nanosuspensions aren’t inherently long-acting. “It’s rather that the suspension, once injected into the muscle, is distributed into the tissues very slowly over a long period of time.”

The HPTN 076 study is currently testing the safety and acceptability of injectable rilpivarine for PrEP in 136 HIV-negative women at sites in the United States and sub-Saharan Africa.

A second possible injectable PrEP options Cohen discussed is cabotegravir (or GSK126744 LA), an antiviral similar in structure to dolutegravir. A variety of studies are currently underway to test the safety and efficacy of the cabotegravir in men and women—including the Éclair study, HPTN 077 and HPTN 083. Cohen reported that a possible future study, called HPTN 084, is “heavily in the discussion phase,” and could be an open-label study for women in sub-Saharan Africa.

Efda (MK-8591) is a new drug that is also being tested as a long-acting PrEP injection. Cohen described this agent, being developed by the pharmaceutical company Merck, as something that is “still in progress,” but so far an “exceptional agent.”

Efda is a very potent NNRTI with a long half life. Cohen said that in pill form, the antiviral is something that could be given once per week for HIV treatment. The company is currently working on how to develop it for HIV treatment and/or prevention. Cohen said that the drug’s potency would make it ideal as a the drug used in an implant—and possibly even combined with a contraceptive drug in an implant for women.

“An implant would be a whole new ball game for HIV prevention or treatment,” said Cohen. “This drug could offer something really terrific in this field.”

Rilpivarine injections have an extremely long “tail”—carrying implications for drug resistance

One new method for PrEP that is currently being investigated are long-acting injections—that might provide HIV protection for two months or more. One concern about long-acting antiretroviral injections are the drug “tails,” or how long the drug persists in the body—at levels that are below the level to be therapeutic—after an injection if a follow-up injection is not given on schedule.

Rilpivarine was detectable in plasma samples of all seven of the participants a mean of 541 days after a single dose of 1200 rilpivarine, and the drug was also detected in cervical and vaginal fluid.

“It’s clear, I think, that as we move forward with this exciting field of long-acting injectables, we really need to better characterize the terminal half-life of these products, the “tail,” so that we can better inform the management of this and avoid the potential for antiretroviral drug resistance.”

ORIGINALLY TAKEN FROM

AVAC 2017 Advocacy Fellows Program OPEN

The Advocacy Fellows Program

AVAC recently announced the call for applications for the 2017 Advocacy Fellows Program. This update serves as a reminder that Monday, 15 August 2016 is the submission deadline for this eighth year of the Advocacy Fellows Program application process. 

To read more about the Advocacy Fellows Program, the 2017 application process and required documents, please download application materials atwww.avac.org/fellows-application-materials.

HIV Treatment + PrEP Virtually Eliminates HIV Transmission

Integrating antiretroviral therapy (ART) for HIV-positive partners and Truvada pre-exposure prophylaxis (PrEP) for HIV-negative partners can nearly eliminate the risk of HIV transmission in serodiscordant couples, researchers reported at the 21st International AIDS Conference (AIDS 2016) taking place this week in Durban, South Africa.

Several studies have shown that effective antiretroviral treatment dramatically lowers the risk of onward HIV transmission—a concept known as “treatment-as-prevention”—- while PrEP taken consistently reduces the risk of infection by more than 90%. Putting the two approaches together may fill any gaps that could occur, for example, if a person has recently started ART and not yet achieved an undetectable viral load. In this strategy, PrEP serves as a “bridge” until treatment is fully effective.

Jared Baeten, MD, from the University of Washington in Seattle presented findings from the Partners PrEP Demonstration Project, which looked at the real-world feasibility of ART plus PrEP for serodiscordant (mixed HIV status) heterosexual couples in Kenya and Uganda.

In the original Partners PrEP study, HIV-negative partners were randomly assigned to take tenofovir/emtricitabine (the drugs in Truvada), tenofovir alone, or a placebo. At the time World Health Organization and country guidelines recommended ART initiation based on CD4 cell count, so some of the HIV-positive partners did not start treatment.

Baeten first presented the study results at the International AIDS Society conference in 2011, showing that Truvada and tenofovir alone reduced the risk of HIV transmission by 73% and 62%, respectively.

The follow-up Partners PrEP Demonstration Project aimed to show whether integrating PrEP for negative partners plus ART for positive partners could further lower the risk. By the time this study started in November 2012 there was clear evidence that both PrEP and treatment-as-prevention worked, so all participants received ART and PrEP on an open-label (non-randomized) basis.

The demonstration project enrolled a new cohort of 1,013 serodiscordant heterosexual couples in which neither partner had ever taken antiretroviral drugs. Couples were selected using a risk algorithm that gave scores based on predictors including younger age, recent unprotected sex, male partners not being circumcised, and positive partners having a high viral load.

In two-thirds of couples, the woman was HIV-positive. Positive partners had a median CD4 count of around 400 cells/mm3 and a median viral load over 37,000 copies/mL. A majority (65%) said they’d had unprotected sex during the past month.

Upon enrollment, HIV-positive partners were offered combination ART (recommended for all positive partners in serodiscordant couples regardless of CD4 count) and HIV-negative partners were offered daily Truvada. PrEP was continued if the positive partner delayed treatment or for the first six months after ART initiation, giving time for viral load to become undetectable.

At the 2015 Conference on Retroviruses and Opportunistic Infections Baeten reported interim results, showing that two HIV-negative partners had seroconverted. Based on the HIV incidence rate in the placebo arm of the original Partners PrEP trial, the researchers estimated that 40 new infections would have been expected without ART and PrEP—a  risk reduction of 96%.

This week Baeten gave final updated results with data through June 2016. By this time 91% of positive partners had started ART, almost all of those had achieved viral suppression, and 97% of negative partners offered PrEP had accepted it. By the end of follow-up four new HIV infections had occurred, compared with 83 expected without ART or PrEP—a risk reduction of 95%.

Adherence to both ART and PrEP was found to be good during the demonstration project. A subset of HIV-negative partners on PrEP were randomly selected for drug level testing, and 82% of blood samples showed detectable tenofovir.

However, Baeten reported, none of the people who became infected used PrEP consistently, and in fact were in couples that used neither ART nor PrEP.

One negative woman had broken up with her positive partner and stopped PrEP, while a second woman had a partner who did not yet want to start treatment and she also stopped PrEP. A third woman was a sex worker who used PrEP inconsistently. The only newly infected man declined PrEP and had multiple sex partners.

“In this open-label demonstration project of integrated delivery of ART and PrEP for prevention in HIV serodiscordant couples, we observed virtual elimination of incident HIV,” the researchers concluded.

“Interventions like this could have a substantial effect on the HIV epidemic,” Baeten said at an AIDS 2016 press conference. “Both PrEP and ART are extremely important interventions that can virtually eliminate HIV transmission.”

ORIGINALLY TAKEN FROM

That One Time I Didn’t Reveal My HIV Status

I heard the gay clubs in Johannesburg, South Africa would be fun—and after 10 days of solid work during a conference in Cape Town, I was ready to let loose and really enjoy myself. Normally, I am not much of a partier (and actually like to be in bed rather early!), but this time, I was on a mission. To branch out, enjoy myself, and take advantage of the fact that I was halfway around the world in a city with a well-established gay nightlife scene. I certainly did just that—but my experience left me with a burden of doubt and guilt, and wondering if I had had gone too far.

On a Friday night, I met up with some friends for dinner. As expected, the drinks were flowing. Drunk before we even reached the first club, I was ready to unleash. I immediately fell in love with the atmosphere of the first club we visited. People of every race, nationality and type were there, and everyone was friendly. The drinking continued and the dancing began.

I met a cute guy on the dance floor and I didn’t hold back. We made out, sloppily, for what seemed like hours. I didn’t care who was watching, and then I didn’t care when he left. I quickly found someone else to make out with. Hey, I was there to have a good time. If cute guys wanted to make out with my bearded face, I wasn’t going to stop them!

That night, I somehow got myself back to my hotel, alone, and passed out with my phone in my hand and Grindr turned on.

When I woke up the next morning, I started having flashbacks of the fun from the night before. And I was ready to continue the fun! I quickly texted the two dudes I made out with, after realizing that I had their contact info stored in my phone.

The guy who messaged me was gorgeous and what I envision as my “type.” We messaged a few times back and forth and agreed to meet back up at the same club later that evening—and that’s exactly what we did.I didn’t hear back, but I saw that I had some Grindr messages waiting for me. I scrolled through them until I came across one that said, “…saw you making out with someone last night, it was so passionate, I wouldn’t mind making out with you.”

I’m not much of a club person, and maybe for that reason, alcohol once again played a big part in the night. When my new friend and I decided to head back to my hotel for the night, we were both a bit intoxicated, but both knew what we were doing.

The attraction was there. Beyond the physical, we instantly connected, and it just felt like a good match. We both wanted to have sex that night. I remember him asking if I had lube, and when I went to grab it from my toiletry bag, I also grabbed a condom. He never asked about condoms, but condoms are a reality for me when it comes to sex with strangers.

I couldn’t tell if he was disappointed or not when I pulled out the condom, but he didn’t say anything in the moment. Neither did I—and the words that we should have exchanged were left unsaid. It still guts me to admit that.

I woke up the next morning and I had a sinking feeling about the previous night. To be clear, I wasn’t worried that we had done anything unsafe or that I had put him at risk for HIV. Although I’m HIV-positive, I’m on medications and maintain an undetectable viral load (which means it’s very unlikely I can transmit HIV to anyone else). On top of that, we used a condom.

I was disappointed because I wasn’t confident enough the night before to bring up my HIV-positive status. I always try to have that conversation before meeting someone in person to avoid any uncomfortable situations—especially rejection—and to make sure we’re on the same page.

I kind of have a routine around disclosure. I have specific talking points. I even penned an “open letter to my future sex partners,” which I sometimes just link people to. For me, it’s easier to just put it out there. But I didn’t do it this time.

I felt guilty of misleading this guy (who was, incidentally, still in my bed). I never outright lied about my status—but there was a lie of omission. It also made me wonder, “Shouldn’t he have asked?”

When it comes to hookups—especially those when you might never see the person again—how necessary is it to bring up HIV status if you’re confident there’s no risk of transmission? I’ve always felt I knew the answer to this question, believing that each person is responsible for his or her own self and should be open to discussing HIV prior to sex. I’ve never had to wait for anyone to ask me about my status because I was always the first to bring it up.

But this one particular occurrence had me questioning if I was being too hard on myself. If there was any sort of risky behavior that could have led to a possible HIV transmission, then that’s one thing. But this wasn’t…and there was no risk. Should I still feel guilty? In the end, I was confused but still felt as if I had deceived someone, which in a way I did, and I fully own up to that.

I told him about my status that morning. It didn’t go well. There was a lot of anger, and I had to quickly put up my defenses and go into survival mode.

I had to stop being me and turn into the knower of all things HIV, opening myself up to any questions he had. I accepted his anger—believing that was the right thing to do. I didn’t question why he didn’t ask me, but instead took the blame and insisted on being an open book. I was in South Africa, a country at the epicenter of the HIV epidemic, and had previously learned that many gay men there aren’t keen on talking openly about HIV.

I left South Africa to go home, but I continued the conversation with him. Unfortunately, it never fully turned into a conversation about HIV stigma, the realities of disclosure or even preventative measures, but instead was more reassurance conversation that everything was going to be OK after our experience together. He was pissed, and rightfully so. But in the end, we still continue to talk, and I’m even going to see him again on a future planned trip to South Africa.

Did we both learn something from our experience? I hope we each take something away from our shared experience—and are able to incorporate that into future sexual interactions with others.

What I take away is a new appreciation for the fact that disclosure isn’t easy. Sometimes there’s still shame, and stigma, that comes from HIV. Until we learn to fully accept ourselves for who we are, HIV status and all, disclosing to someone will never be easy.

Originally taken from

HIV Prevention Ring for Women More Than 75% Effective, New Analyses Show

Dapivirine ring (Photo: International Partnership for Microbicides)

“Across multiple analyses, we see a statistically significant relationship between ring use and HIV protection,” said Elizabeth R. Brown, ScD, from the Fred Hutchinson Cancer Research Center and University of Washington in Seattle, who presented the ASPIRE Study data at the conference on Tuesday.The vaginal dapivirine ring prevented 56% of HIV infections, and possibly provided HIV risk reduction between 75% and 92% for women who used the ring consistently, new analyses of the ASPIRE Study data show.

The vaginal ring, which is inserted into the vagina and slowly releases the antiretroviral dapivirine over a month, is the first HIV-prevention product designed specifically for women. If it were approved for use, it would be an alternative antiretroviral-based HIV-prevention method along with Truvada-based PrEP.“These results suggest the ring use is associated with at least a 56%, and potentially 75% or greater protection against HIV when used consistently,” she said.

“People need [PrEP] options,” said Roy Gulick, from Weill Cornell Medicine. “One approach is probably not going to work for everyone. Some people may prefer pills, some people may prefer injections, some people may prefer rings. I think we have the room for lots of different approaches, and I think that’s how we’ll be successful.”

Earlier results of the ASPIRE Study and The Ring Study, which were presented at the 2016 Conference on Retroviruses and Opportunistic Infections (CROI), showed that the ring reduced HIV infection risk by 27% and 31%, respectively. The modest, though significant, HIV risk reduction seen in these studies was likely due to adherence issues—with women possibly removing the rings and putting them back in place between study visits. These earlier efficacy analyses did not take into account whether or not people in the study used the ring, and at what level they used it.

The HIV risk reduction estimation reported today is based on new analyses of women in ASPIRE who used the rings most consistently (based on the amount of residual drug remaining on the rings when they were returned). Because the drug in the ring is released slowly over the 28-day lifespan of the ring, it was possible for researchers to estimate how often women in the study used the rings—without having to rely on self-report data.

The analyses presented at AIDS 2016 included 2,359 women and data from more than 12,000 returned rings.

In the placebo arm, there were a total of 50 HIV infections over 1,089 person-years of follow up for an incidence rate of 4.6%. There was no statistically significant difference between this incidence rate and the incidence rate among people who were non-adherent (3.6%). The risk reduction estimate for the “non-adherent” group relative to placebo was 31%.

Risk reduction improved, and HIV-incidence declined, in groups of people who returned the rings with less drug in them (indicating that they had higher adherence). Among people with “low to high” adherence, who returned rings with less than 23.5 mg of drug, there were 14 HIV infections, with an incidence rate of 1.9% and a risk reduction of 56%. Among people who with “medium to high” adherence, and returned rings with less than 22 mg of drug, there were seven HIV infections for an incidence rate of 1.5% and a risk reduction estimate of 65%.

The researchers conducted separate “length-adjusted” analyses, to take into consideration the amount of time that women had the ring in their possession before they were provided a new one (which could vary by +/- two weeks). Using these analyses, Brown reported that risk reduction was higher—up to 75%—for people with better adherence.

In a final set of analyses, the researchers looked at rings used over time by women who seroconverted during the study, to see if there was a relation between adherence (as measured by residual drug) and HIV infection. They found a dose-response relationship. In other words, HIV infections were more likely to happen when the ring was not used or used inconsistently. Consistent use was associated with the lowest incidence rate (0.4%) and the highest estimation of HIV risk reduction (92%).

“I think many of us had really waited and were really keen to hear this data—and we’re excited about these new results of high efficacy. This is great news,” said Nono Simelela, from the South Africa Ministry of Health.

Women who participated in ASPIRE have the option of enrolling in a one-year open-label continuation study called HOPE which will provide the dapivirine ring to participants.

This open-label study (and The Ring Study’s open-label continuation, called DREAM) will gather additional data on the ring’s safety and also investigate how women use the ring when they know there is no chance of receiving a placebo ring.

ORIGINALLY TAKEN FROM

Unfaithful Partner Wants Another Chance

So while researching about infidelity, I came across this article that captured my attention. This is worth sharing.

HIV disclosure - church family

HIV was first known to be a killer disease. Arguably that's the reason why it's still scary to most people because of how it was introduced to the world - a deadly pandemic. Fear was immediately attached to HIV making people, world over afraid of getting it. Even decades later, there are still people who are frightened to the bone about HIV. Just the word scares many off.

The sad truth is everyone globally it's either you are affected or infected by HIV and that's a good enough reason for people to let the guard down a bit. In a WhatsApp conversation I had with a follower from Pretoria, we spoke about fasting vs ARV. After sharing with her my expert opinion, I ask this follower to pray about it coupled with talking to a youth pastor from church. Just by the response, I later realised that, the religious sector in Southern Africa still has a discriminatory stereotype against people living with HIV.

Shockingly, church leaders and congregates wear the adulterous spectacle owing to the believe that HIV is one of the-so-called incurable deadly disease that God sent as punishment to the world for sinning. I am disgusted by this attitude honestly.

Back to the agenda of this blogspot, allow me to share the steps one should take when disclosing their HIV status to someone in church esp the pastor. Please note, from the extensive research I did, I managed to combine points to come up with this.

GENERAL GUIDELINES

Here are some things to think about when you’re considering telling someone that you’re HIV-positive:

• Know why you want to tell them. What do you want from them?
• Anticipate their reaction. What’s the best you can hope for? The worst you might have to deal with?
• Prepare by informing yourself about HIV disease. You may want to leave articles or a hotline phone number for the person you tell.
• Get support. Talk it over with someone you trust, and come up with a plan.
• Accept the reaction. You can’t control how others will deal with your news.

All that matters at the end of the day is that, you become a free bird once you share with your church family.

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CD4 count vs VIRAL load

Ever wondered what CD4 count is? or what is it with numbers when it comes to HIV? 

They say doctors use two key tests to assess the strength of your immune system - a CD4 cell count and a viral load test. HIV damages your immune system even though you may look and feel well. That’s why new guidelines recommend that everyone with HIV starts treatment whatever their CD4 count.

Viral load explained

The viral load test shows how active HIV is in your body.

The test for viral load measures how many particles of HIV are circulating in the blood. The results are given as the number of ‘copies’ of HIV per millilitre of blood - for example 200 copies/ml. Your viral load test results can fluctuate a lot if you’re not taking HIV treatment. Looking at the trend over a number of months may be more useful than comparing two test results.

A high viral load will usually – but not always – mean a low CD4 count. Knowing what is going on with your immune system can help you make decisions about lifestyle and treatment.

What’s happening inside you after infection?

When you first get HIV, your body starts to produce antibodies to fight it off.

You may feel ill for a while at this stage. This is often called 'seroconversion illness' because it coincides with the time that blood (‘sero’) tests for antibodies to HIV become (‘conversion’) positive.

Once seroconversion has taken place, you may stay well for a number of years without treatment. But there will be some signs of damage being done to your immune system.

As you can see on the graphic above, you will also be infectious during this period, even though you may not be aware you have HIV. That’s why it is so important to get diagnosed early, so you can start treatment as soon as possible – before too much damage has been done to your immune system.

The strength of your immune system can be detected by laboratory tests. Doctors will use two key tests at your regular clinic appointments - a CD4 cell count and a viral load test.

What is the CD4 cell count?

This test gives a rough indication of the strength of your immune system.

A normal CD4 cell count in an HIV-negative man is between 400 and 1600 per cubic millimetre of blood (but doctors normally just give a figure, e.g. 500). CD4 cell counts in HIV-negative women tend to be a little higher, between 500 and 1700.

Soon after infection with HIV, your CD4 cell count probably dropped sharply, before stabilising at around 500 to 600. Even while you are well and have no obvious symptoms of HIV, millions of CD4 cells are infected by HIV and lost every day, and millions more are produced to replace them. General illness can also have an impact on your CD4 count, which may subsequently rise again.

Without treatment, an HIV-positive person’s CD4 cell count will fall over time (see the graphic above).

Starting treatment – new guidelines

UNAIDS treatment guidelines have been changed to say that anyone with HIV who is ready to commit to treatment should start regardless of their CD4 count. This reflects the findings of the START study.

START found that people who waited to start treatment until their CD4 count dropped to 350 (which is when people were previously advised to start) had a much higher chance of developing AIDS-related illnesses such as cancers.

Starting treatment also reduces the chances that you will pass on HIV.

HIV criminalisation - increases transmission 2

Last week I touched on the reasons why criminalisation of HIV is disadvantageous to women. Today, I will just wrap up on how criminalisation of HIV causes more harm than good.

6. Women are more likely to be prosecuted:
Since women are more likely to know their HIV status, they are also more likely to be prosecuted for HIV exposure and transmission, since knowledge of one’s HIV positive status is often a necessary element for prosecution. At the same time, women are least likely to have access to legal services and, thus, a fair trial. The burden of proof and the biased application of the law further increase women’s risks of being charged, prosecuted and found ‘guilty’ of HIV exposure or transmission.

7. Some women might be prosecuted for mother-to-child transmission:
Some laws criminalizing HIV transmission or exposure are drafted broadly enough to include transmission during pregnancy or breastfeeding. For millions of women, living with HIV – but often denied access to family planning, reproductive health services, or medicines that prevent perinatal transmission of HIV – this effectively makes pregnancy, intended or not, a criminal offense. Further, it is increasingly recognized that in many middle and low-income settings, breastfeeding is the best option for child survival and well-being, despite the possibility of HIV transmission. There are many more effective ways to prevent perinatal transmission of HIV, beginning with supporting the rights of all women to make informed decisions about pregnancy and providing them with sexual and reproductive information and services; preventing HIV in women and girls in the first place; preventing unwanted pregnancies among all women; and providing effective medication and healthcare services to prevent perinatal transmission for HIV positive women, who wish to have children, or who are pregnant.

8. Women will be more vulnerable to HIV transmission:
Existing barriers limiting women’s access to information, resources and services, including gender inequalities and inequities, will be compounded by the fear of prosecution for HIV exposure or transmission. The gendered access to health information and services, combined with the fear of being criminalized for exposing or transmitting HIV to someone, will place women in an even lesser position of power to negotiate conditions of sex, as negotiating condom use may be perceived as ‘proof’ of knowledge of an HIV positive diagnosis.

9. The most ‘vulnerable and marginalized’ women will be most affected:
‘Vulnerable and marginalized’ women, such as women in same-sex relationships, and women sex workers and drug users, often lack adequate access to HIV prevention, testing, treatment, care, and support services, primarily as a result of their existing ‘criminalized’ status. The criminalization of HIV exposure and transmission is likely to further stigmatize already ‘criminalized’ women and to constitute yet another barrier to healthcare and other services by posing a threat of double prosecution – prosecution for engaging in ‘criminal behavior’ and for HIV exposure or transmission.

10. Human rights responses to HIV are most effective:
Now, more than ever, greater attention to human rights is needed in the response to the global HIV epidemic. Criminalizing HIV exposure and transmission compromises human rights, undermines public health initiatives, and increases especially women’s risks and vulnerabilities.

HIV criminalisation - increases transmission

Its 2016!! Great. But how is the year going to be as far as HIV is concerned. There are things I am still worried about and I feel, this is the year to deal with such. There are laws in most parts of Southern Africa especially in Zimbabwe that still criminalise HIV transmission and exposure.

In Zimbabwe, criminalisation of HIV is known as willful or deliberate transmission of HIV. In the Zimbabwean law, willful transmission is defined as the failure to disclose one's status or take precautions for preventing the transmission of HIV. The law is used to prosecute people for transmitting HIV or exposing others to HIV.

 Picture taken from: www.hivjustice.net

The call to apply criminal law to HIV exposure and transmission is often driven by a well-intentioned wish to protect women, and to respond to serious concerns about the ongoing rapid spread of HIV in many countries, coupled with the perceived failure of existing HIV prevention.

This law is a deliberate way of fanning discrimination, here is why.

1. Women will be deterred from accessing HIV prevention, treatment, and care services, including HIV testing:

Many women fear violence and rejection associated with disclosure and an HIV + diagnosis. The criminalisation of HIV transmission or exposure may generate additional obstacles to healthcare for women. Prevailing stigma, discrimination and other violations of rights, including the lack of assured confidentiality, already pose a barrier to HIV prevention and testing services.

2. Women are more likely to be blamed for HIV transmission:

Women are often the first to know their HIV positive status; particularly as governments move towards provider-initiated HIV testing and counseling in pre-natal settings. Thus, women are more likely to be blamed by health staff, by their intimate partners, their partners’ families, and their communities for ‘bringing HIV into the home.

3. Women will be at greater risk of HIV-related violence and abuse:

While violence increases women’s risks of HIV transmission, women’s HIV-positive diagnosis also increases the risks of violence. The fear of violence deters women from disclosing their HIV status. Research indicates that young positive women are ten times more likely to experience violence and abuse, than their HIV negative counterparts. There are also increasing reports of women being killed by their partners for ‘bringing HIV into the family’.

4. Criminalization of HIV exposure or transmission does not protect women from coercion or violence:

Sexual violence and rape, including marital rape, place women worldwide at risk of HIV transmission. Laws against sexual violence, where they exist, are often poorly enforced. Similarly, government policies and guidelines that call for providing sexual violence survivors with necessary medical treatment, including emergency contraception to prevent pregnancy and post-exposure prophylaxis to prevent contracting HIV, are often not implemented.

5. Women’s rights to make informed sexual and reproductive choices will be further compromised:

The patriarchal context of society undermines the power of many women to make informed choices, including sexual and reproductive choices. As a result, women are often not in a position to negotiate the conditions of sex, including whether or not to engage in sex, as well as to negotiate condom use. Women also often have limited access to sexual and reproductive health and rights information to inform their choices, and to access non-discriminatory and unbiased sexual and reproductive healthcare services.

While these concerns are legitimate and must be urgently addressed, closer analysis reveals that criminalisation does not prevent new HIV transmissions or reduce women’s vulnerabilities to HIV. In fact, criminalisation harms women, rather than assists them, while negatively impacting on both public health needs and human rights protections.