Terrence Higgins Trust, generally considered the UK's leading HIV and AIDS organization, and the largest in Europe, is promoting treatment as prevention, including for gay men, on its new “It Starts With Me” campaign.

"England", it says, “can halt HIV within a generation”.  The campaign is the largest scale by THT to date, running until Spring 2015. Read their press release here. 

Cary James, Head of Health Improvement Programmes at Terrence Higgins Trust says “While a cure or vaccine for HIV remains stubbornly out of reach, what many gay men don’t realise is that medical advances mean it is now within our community’s grasp to stop the virus in its tracks. By getting as many people with HIV as possible tested and on effective treatment, we should see new infection rates fall rapidly

Says the campaign website “We are at the start of a new era in stopping the spread of HIV. We know that the combination of regular testing, HIV treatment and condom use is the key to success.

You can be part of something that changes HIV history. You are the key to stopping HIV in your own life and in the community.”

This kind of strategy marks a transition from what was commonly called poz prevention  - a concept that essentially suggested that HIVers maintaining good sexual and emotional health were better placed to make sound decisions and in doing so, help reduce new infections – to a more direct approach which stresses the benefits of treating HIV to both improve health and reduce viral load, and thus make transmission much less likely.

The campaign makes no specific mention of when to start treatment, although treatment as prevention advocates routinely suggest the earlier the better, not only as a prevention technique, but primarily because the weight of evidence now suggests it produces better health outcomes for the HIVer.

Current UK guidelines recommend treatment for all individuals with CD4 counts below 350, but if a patient with a CD4 cell count above 350 wishes to start treatment, this decision should be respected and treatment be started.

On the issue of infectivity, gay mens' sexual health sites, in the absence of hard data relating to MSM, are currently all over the map. THT says what most experts believe, that “Someone on treatment has an extremely low risk of passing on HIV if their viral load has been undetectable for six month and they are free from sexually transmitted infections. Unlike other sites, there is thankfully no talk here about that perennial red herring, virus in the semen, which tends to be found only in “trivial” amounts according to leading researcher Myron Cohen.

Using the slogan “We Can Stop HIV” the THT campaign is also interesting for drawing on issues of community solidarity and GIPA. Not that this hasn’t been employed before, but more traditional poz prevention campaigns like HIV Stops With Me worried some critics with the perception that they sent mixed messages about personal and shared responsibility. The THT campaign seems to avoid that trap.

One "off" note: the THT website includes the “official” recommendation that all gay and bisexual men test at least once a year. It's arguable that for sexually active men with multiple partners that isn’t nearly enough. Vancouver’s Health Initiative for Men (HIM) for instance says “guys who are more at risk should test every three months.”  We concur with the latter recommendations.

In Canada, only B.C. has adopted treatment as prevention strategies  in the form of test and treat and is enjoying some success in reducing new infections as are other jurisdictions such as New York, San Francisco and Washington, D.C. The issue of the efficacy of TasP for MSM is a controversial area, though, as it has been difficult to reduce incidence in that population.  Dr Julio Montaner, the leading proponent of TasP maintains the issue is not whether TasP works in MSM but how much.

Toronto, Canada – A Tanzanian youth, with links to a Toronto-based charitable organisation, was today announced as having created the winning logo design for AIDS 2014 - the 20th International AIDS Conference – being held in Melbourne, Australia in July 2014. This follows a global competition for youth aged between 10 and 30 years old launched by the International AIDS Society. 

Yohana Haule (21) is a young artist who has been working with the organisation Africa’s Children-Africa’s Future (AC-AF) since October 2011 through their office in Dar es Salaam. AC-AF first met Yohana at his secondary school graduation. Current Executive Director, Dave Christie and founder of AC-AF, Gita Jaffe, were attending as guests of the school and another youth in their programming. Drawn to Yohana’s talent, he would become the first recipient of the AC-AF Youth Leadership Award. The award looks to strengthen the youths’ skills to develop promising talent into concrete actions that can help the youth achieve their dreams. Since then, he has become the resident artist for the organisation, producing artwork used in programming resources for children and in awareness materials currently being used in Canada.

As Christie explains, “This is an incredible achievement for a young man from Dar es Salaam who, like many youth in Tanzania, has faced many hardships to get to where he is today. When we first met Yohana, we were not only struck by his talent, but by the messages that he was portraying through his art. One of the first images he showed to us was a depiction of the roles women play in Tanzania – both in the strength they bring to the country but the burdens they also face. In Sub-Saharan Africa, the burden on women in the AIDS epidemic is particularly harsh, and here was a young man willing to confront some of those issues.”

Toronto has strong links to the International AIDS Conference having hosted the 16th conference in 2006. As a legacy to that conference, the Global AIDS Initiative was established by the City of Toronto, to fund programming concerning HIV and AIDS undertaken by organisations working in sub-Saharan Africa. For the last two years, AC-AF has been part of the coalition of organisations utilising these funds for its work in Tanzania with children and youth. As a result of the budget passed in January at City Hall, this funding will end in August 2013. Although the financial legacy of AIDS 2006 is coming to an end, the work that the City of Toronto has enabled AC-AF to undertake, including with Yohana, will ensure that the contribution of the people of Toronto will have a lasting impact on AIDS 2014.

For AC-AF, this provides a moment of pride in the accomplishments of the youth they work with. At the heart of their programmes and ethos is a continual focus on the potential of children and youth. As Christie explains, “Our programming does not look to just help children; it is aimed at ensuring children and youth help themselves, both now and in the future. They need encouragement to increase their independence, ensuring that they can support themselves, their families and their community, while fulfilling their dreams. Yohana exemplifies this. Although we are able to provide him with some of the initial opportunities, it is ultimately his effort and talent that has brought him this recognition by the International AIDS Society.”

Yohana will continue to work with AC-AF before travelling to Australia in July 2014 to be officially thanked at the conference for his design. This will be the first time that he has travelled outside of Tanzania.

For more information about Africa’s Children-Africa’s Future (AC-AF) visit: www.ac.af.com.

For more information about the AIDS 2014 conference visit: www.aids2014.org.

Every now and then I catch myself speaking or laughing and I will hear my father’s voice. And as much as I hate it, I can’t deny that I am my father’s son. From the shape of my eyes and nose to the bad varicose veins on my legs….I was definitely made of his genes. And for the past few years I have been thinking about him. Wondering where he is and what he has been doing.

Because my father is 17 years older than me, he would be of the generation that would find computers and facebook a little intimidating. Hell…I can remember when I first started working with them back in the 80’s at The Tampa Tribune. Those black screens with the space-aged green fonts seemed like something out of a movie (“War Games” to be exact). So, he would probably have shied away from ever actually using a computer to find his son. And most likely he didn’t want to find me at all.

You see, my father was a longshoreman. He wasn’t a big man. He was actually kind of thin and spry. Don’t get me wrong…he was strong, but not that big in stature. The last time I saw him was Thanksgiving of 1991 at his mother’s house. By this time in my life, I had already come out to everyone in my family. I was living a gay lifestyle and working in gay bars. My father had even come to pick me up a couple times when I was stranded after a drag show at Rene’s (the popular black gay bar in Tampa). So, it was no big deal that I was in drag or had a boyfriend. He had even gone to school with a well known drag queen in town named Zara. But what happened at that Thanksgiving dinner would change our relationship forever.

My earliest memory of my father was my fifth birthday. My grandmother, Carrie, had told me that he had called and said he was going to come see me for my birthday. I remember taking a bath that afternoon. I never wanted to take a bath back then, but I wanted to look good for my father. I put on my Sunday best. I would run and go peek out the front window every time I heard a car go by. This went on for hours. I remember my grandmother making me come and eat a late lunch because he still had not arrived. Then it was getting later in the day. I had tried watching “Underdog” and a couple of other cartoons to keep myself busy until he arrived.

Finally it was after 5 PM and I decided to go wait on the porch. I remember rocking in the chair. It was really warm out and the gnats were swamping the yard. I sat there and waited all day until the sun went down. My father never showed up. This would become a long series of disappointments my father would supply throughout my life.

A few years earlier before that dinner, I was living with my gay cousin Michael and a friend, Godfrey (who went by the drag name Apollonia). Michael (who was also a drag performer named “Michelle Holiday”) had lost his job and was pretending to go to work everyday. Apollonia survived off her drag shows and her boyfriend. I was working as a DJ and drag performer. I happened to call Michael at his job at McDonald’s because my uncle Herb need him to come pick him up and was informed he no longer worked there and would I ask him to return the uniform. After confronting Michael, I told him and Godfrey that I was moving out. We were going to lose the apartment if we didn’t have the rent. Michael was unable to get another job immediately so I moved in with my friend Christie Matthews. Apparently, Michael and Godfrey went to my father and Uncle Herb and told them that I had moved out and left them with the rent.  My father and Herb gave them the rest of the rent and I guess my father started harboring ill will towards me.

Fast forward to 1991 and my father shows up to Thanksgiving dinner at his mother’s house with his current girlfriend. Grandma Sally always had a big meal at the holidays. Even my adopted gay brother Anthony Evans was invited. Now, my dad showing up with his girlfriend doesn’t sound like a problem, but his ex-wife, Teresa and the kids were there. I noticed that he had been drinking before he got there. He was very abrupt with me when he arrived. But like most dysfunctional family dinners, the main event was saved while we were eating.  My father proceeded to tell me that I had ruined his name (since I am a junior), I needed to go out and get a real job and stop hanging around all those faggots before I caught something.

Ironically, the year before I had received my diagnosis of being HIV+. I had no intention of sharing that fact with anyone in my family. I already felt like an outsider since I left home at 16. At the time when my father verbally attacked me at the dinner table, it seemed to have come out of nowhere. I was told later that he was still mad at me for moving out on Michael and Godfrey and felt that I was irresponsible. But this was laughable, coming from a man who didn’t have a permanent residence himself.  I sat and listened for about ten minutes and then I went off.

“You gotta lotta nerve! You ain’t got a pot to piss in or a window to throw it out of!” I said.

He gave the same look he did when he punched me in 1980 when I stopped him from beating on Teresa in their kitchen. I remember sitting on the floor after the hit and singing “We Shall Overcome” and him cursing at me. So, I guess he was about to hit me again, but my grandmother wasn’t having it. She threw him out of her house on that Thanksgiving. And that would be the last time I saw my father.

When I describe my parents, I always say that they seemed like my older brother and sister who were always in trouble. Mainly because I was raised my mother’s mother until she died in 1982. It’s funny how life can be like a stacked set of dominoes. You do one thing and it changes so many others’ lives.

My mother was the only girl out of three children. So, my grandmother kept her under lock and key. She was very strict with her and wanted her to go to school to become a teacher. But it was the 60’s and my mother had other plans. She wanted to see Jimi Hendrix live. She wanted to be a part of the Psychedelic Movement. So she got pregnant on purpose and my father was the poor victim. He really loved her and she ran off with a boyfriend shortly after having me. He didn’t know anything about raising a child. So, he took me to the one place he knew I would be safe and loved….my mother’s mother.

Unfortunately for him and all the rest of the women he came in contact with from then on, he would never truly fall in love again. He would become an abusive and womanizing man that had kids all over town.

So, on April 22^nd, 2013 I opened up my facebook account and found a message from a girl named Lakiria. It read: “Miss Teresa misses you and loves you. Please call her.” At first I was going to ignore it, but then I noticed the number had an 813 area code. That’s Tampa. So, I called it.

The joy in Teresa’s voice was so wonderful to hear. Apparently she and my brothers had been searching for me for a while. My step brother, Adrian and his girlfriend, Lakiria came across my facebook profile and decided to write me. I cannot tell you the emotions that overcame me when I started talking with Theresa, my brother Adrian, my brother Anton, my brother Anthony and my Uncle Rudolph.  They were all so glad to finally reconnect with me. It had been 21 years since I had spoken to or seen any of them.

But it was a bittersweet opening conversation with Teresa. You see, my father had died in 2006. So, I finally had my answer. The man that I had despised for all these year was gone. But of course a part of me wishes that I had worked things out or at least got to tell him that I am married now. I believe I have found my purpose in life. I have a family of friends who love me and believe in me. I have a life that I am proud of. But this conversation was reaffirming to hear.  My real family still loves me and they are proud of me. Teresa even told me that she has been walking around the house singing “Bitch You Look Fierce”. Her and Lakira are now the biggest Jade Elektra fans.

My father’s death left so many questions. I wonder if he ever got to see any of my accomplishments. Did he ever hear any of my records? Did he ever see me in a movie or on television? Did he ever know that I really understood him and why he did the things that he did? Would he have embraced me if I had told him that I was HIV+? 

Well, a part of me thinks he would have. Teresa told me that he died of AIDS.

A part of me was shocked, but not surprised. For as many women he had slept with it wasn’t surprising at all. But my Uncle Rudolph shed some more light on something else I had no idea about. My father, like my mother had started doing heavy drugs and was shooting up. And at his funeral, the family discovered that he had three daughters that we knew nothing about. And since he got around - a lot - there’s no telling how many more are out there.

To put the kids in order of age…..it would be me, Von, Jerome, Anton, Anthony. These are the brothers I knew about. We didn’t have the same mothers, but there was no denying that were Alfonso King’s children. Out of protest of not having a father around when I was growing up, I changed the spelling of my name in grade school. Then it became my professional name when I started acting and modeling.

I guess the thing that I regret the most with both my parents is that I never got to tell them that I forgave them. They were two young 17 year olds who were making the best decisions that they could at the time. They had no idea that what they did that day I was conceived would change the rest of so many lives in the aftermath. And although many have said they were horrible parents, they taught me a very valuable lesson……how not to live. I just never got the chance to tell them that I loved them regardless of the mistakes.

This article first appeared on the CATIE website here.

Une version française est disponible ici. 

What is the STOP HIV AIDS Project?

“We can prevent the late diagnosis of HIV/AIDS.”

One of the key markers of success for the Vancouver STOP Project is the expansion of opportunities for HIV testing and early diagnosis for all people in Vancouver. To reach specific populations disproportionately affected by HIV, including gay men, people who use injection drugs, sex workers, refugees, immigrants and Aboriginal people, the Vancouver STOP Project expanded the number of settings that now routinely offer HIV testing to clients – either with standard blood- draw tests or rapid, point-of-care tests. In many of these sites, HIV testing was not previously available or testing rates were low. Access to testing has been expanded in primary healthcare centres, mental health and addictions services, supportive housing, in the justice system and in other settings.

The small Targeted Testing Team identified, collaborated with, trained and supported 88 sites to introduce the routine offer of HIV testing as part of their complement of services. In some settings, such as primary healthcare centres where clinicians were already accustomed to ordering blood work and delivering difficult diagnoses, the change has been relatively smooth. In other venues, such as dental clinics and mental health and addictions services where HIV testing has traditionally not been offered, in part due to significant structural barriers, it’s been more challenging.

Across all sites, ongoing and responsive support has been critical to the success of this project. Nurse educators from the Targeted Testing Team return to sites every few months to offer additional support and to help reduce barriers to embedding testing in health services. Importantly, they also provide updates on each site’s testing trends, which demonstrates to the staff how many tests they have done, the number of new diagnoses and possibly, what impact the initiative is having in Vancouver.

According to Misty Bath, a former nurse educator on the team, the team works hard to ensure that clinicians know there is support for them when one of their patients is diagnosed with HIV. When a person tests positive for HIV, clinicians can draw on the expertise of the STOP Outreach Team or Vancouver Coastal Health Communicable Disease Control to offer specialized diagnosis and linkage to care services.

In addition to supporting others to offer expanded testing opportunities, the Targeted Testing Team hosts HIV testing events at universities, and staffs micro-clinics in bathhouses and a mobile outreach van that travels to outdoor sex venues frequented by gay men and other men who have sex with men.

The team has made significant inroads in normalizing HIV testing both among clinicians and among the people for whom they provide care. According to Bath, “There’s still a lot that we can do to sustain improvements in testing.” As part of this drive, the team is currently working closely with First Nation communities located within Vancouver Coastal Health to increase the availability of testing for Aboriginal people closer to home.

What is the program

The targeted testing initiative is a new project developed and led by the Vancouver STOP Project. It aims to ensure that people who are at high risk for HIV have easy access to testing and, for those who test HIV-positive, that they are diagnosed early and linked to appropriate care and support. It accomplishes this through the implementation of the routine offer of HIV testing at sites that have never offered testing and at sites that had not been optimally offering testing, but that are frequented by people who are at high risk for HIV. Some sites offer standard blood-draw test while others offer a blended standard and rapid test, both with pre-and post-test counselling.

In the last two years, through this initiative, access to testing has been expanded in 88 sites, including primary healthcare centres, abortion and youth clinics, mental health and addictions services, the justice system, supportive housing, First Nation communities within Vancouver Coastal Health’s region, and in bathhouses and at outdoor sex venues frequented by gay men. For many of these sites, the implementation of HIV testing was a significant change to their practice. Managing and supporting this change was, therefore, an important component of successful implementation.  

This initiative is led by a group of nurse educators and a program manager known as the Targeted Testing Team. This group is a smaller part of the STOP Outreach Team, an interdisciplinary clinical team responsible for improving engagement and linkage to care for people with some of the most complex barriers to care. For more information on this, please see the Programming Connection case study on the STOP Outreach Team.

The team successfully expanded access to HIV testing and diagnosis in in three ways. The team:

 1. provides training and support to clinicians and service providers whose clientele is drawn from high prevalence populations

 2. offers regular workshops on rapid testing and the introduction of routine testing for clinicians wanting to build their skills

 3. provides HIV testing clinics in non-traditional outreach settings such as bathhouses and outdoor sex venues

To read more go here. 

This report by Gus Cairns first appeared on aidsmap.com here. 

The US National Institute of Allergy and Infectious Diseases (NIAID) has announced that it is discontinuing the HVTN 505 HIV vaccine trial. This trial, which started in July 2009, has involved 2,504 gay and transgender volunteers in 19 US cities. Since the successful conclusion of the RV144 vaccine trial in September 2009, HVTN 505, as a randomised, placebo-controlled phase IIb trial, has been the only ongoing HIV vaccine trial large enough to be a true test of vaccine efficacy.

NIAID stopped administering injections when the trial‘s independent data and safety monitoring board (DSMB) found during a scheduled interim review that there was no sign that the vaccine regimen was preventing HIV infection, nor any sign that it was reducing viral load among vaccine recipients who became infected with HIV.

The DSMB found that there were actually more HIV infections in volunteers receiving vaccine than placebo, but it is important to emphasise that this difference was not statistically significant and may have been due to chance. Statistically speaking, the vaccine had zero efficacy.

The HVTN 505 study was testing an investigational ‘prime-boost’ vaccine regimen developed by NIAID’s Vaccine Research Center. It involved a series of four injections. The first two, at the start of the study and four weeks later, consisted of a length of DNA – artificial genetic material – that ‘coded’ for proteins found on the surface and inside the HIV virus. The idea was to sensitise the immune system to the specific HIV genetic sequences.

The third injection, at eight weeks, involved a vector. This means the same HIV genetic material was wrapped inside the shell of a different virus, an adenovirus, one of the types that cause common colds. In this case the viral shell was altered so that it could not cause illness. The idea of a vector is that it causes a ‘fake infection’: the viruses can carry the genetic material through the cellular membrane and into the interior of immune-system cells. The two investigational vaccines tested in HVTN 505 cannot cause HIV infection because neither contains live or weakened versions of HIV.

The reason behind a prime-boost design is that it is thought to be the best safe way to stimulate both branches of the adaptive immune system: antibodies, which stop viruses getting into cells in the first place, and CD8 cells or cytotoxic T-lymphocytes (CTLs), which kill off virus-infected cells. Researchers hoped that if a prime-boost vaccine were successful, it might prevent infection altogether in the majority of people, but in the minority who were still infected, it might kill off enough virus-infected cells to permanently contain HIV replication and produce a consistently low HIV viral load.

The fourth injection, at 24 weeks, involved an injection of the viral vector alone, without any HIV genetic material. This was to gauge the level of immune response to the adenovirus shell rather than to the HIV material it contained. This is important because in one of the previous vaccine efficacy trials, the STEP study, the vaccine actually made people with high levels of pre-existing immunity to the adenovirus vector more, rather than less, vulnerable to HIV. In the case of HVTN 505, volunteers were required to have no pre-existing immunity to ad5, the adenovirus vector used.

In its April 22 interim review, the DSMB looked at volunteers who were diagnosed with HIV infection after having been in the study a minimum of 28 weeks and found that 27 HIV infections had occurred among the vaccine recipients and 21 among placebo vaccine recipients. Twenty-eight weeks was chosen because by this time the vaccine, if it worked, would have stimulated a sufficiently strong protective immune response. Including volunteers who had become infected less than 28 weeks after enrolment, there were 41 cases of HIV infection in volunteers receiving vaccine regimen and 30 cases in those receiving placebo.

Additionally, the DSMB found that viral load among the 30 volunteers who acquired HIV infection at least 28 weeks after entering the study, and who had been followed for at least 20 weeks after diagnosis, was no lower in vaccine than in placebo recipients. Study volunteers are being asked to report to their specific clinic sites over the next few weeks to find out whether they received the investigational vaccines or placebo. Individuals who became HIV-infected during the trial were referred to local services for appropriate medical care and treatment.

The HVTN 505 study will continue follow-up with study participants to further evaluate the trial data, and especially to see if the greater number of vaccine recipients who were infected is in any way significant.

For more information about the HVTN 505 study, please see the updated Questions and Answers page here.

To learn about what other vaccine trials are currently taking place, visit IAVI’s vaccine database here or AVAC’s summary here.