Why Don’t We Use Condoms for Oral Sex?

http://www.psmag.com/health/why-dont-we-wear-condoms-for-oral-sex-60632/
Jake Blumgart

We really should, but the numbers show that almost no one does.

I remember my 27th birthday party better than I remember most parties, mostly because of a guy who wasn’t even there. That week’s New Yorker included a feature by Jerome Groopman, who warned of a new antibiotic-resistant strain of gonorrhea colonizing the throats of hosts from Japan to Sweden: “the harbinger of a sexually transmitted global epidemic.” Everyone was talking about it. Couples clung tighter, singles tried to shrug it off, silently praying they could pair off before this latest nastiness hit our shores. The rueful consensus was that no one in attendance—no matter their gender, race, sexual proclivities, or relationship status—regularly used condoms for oral sex.

Earlier this month Michael Douglas told the Guardian that his throat cancer was “caused by something called HPV, which actually comes about from cunnilingus.” The dangers associated with the terrifying new strain of gonorrhea are greatest for those who give oral sex to men, but the risk of HPV-related oral cancers seems higher for those who go down on women. A 2012 study published by the Journal of the American Medical Association found that 10 percent of men and 3.6 percent of women have HPV in their throats. (It should be noted that the virus’ presence is not a guarantee of cancer.) Along with these sexually-transmitted infections, pretty much everything else is transmittable through oral sex: Standard-issue gonorrhea, syphilis, herpes, hepatitis B, and chlamydia, the second easiest-to-catch STI in America after HPV.

With gossipy stories about a celebrity’s cunnilingus-induced cancer sprouting from every corner of the Internet, the time seemed ripe for a more thorough, if still completely unscientific, poll of my friends. My inquiry—“Have you ever used a condom or dental dam during oral sex?”—was met with a resounding negative. Responses ranged from “Haha, I don’t think anyone actually ever does that” to “Well, no, but it’s not so dangerous as other kinds of sex” to “Blech. Rubber.”

ACCORDING TO SCIENTISTS, MY friends aren’t necessarily a pack of deviant outliers. Unprotected oral sex is inarguably safer than unsheathed anal or vaginal sex, especially in regards to HIV, and it has no reproductive repercussions. But as Tracy Clark-Floryreported in Salon last year, we’ve become complacentbecause it’s so much less-scary than other common forms of raw carnality. Sure, even the vast majority of 9th graders admit that while oral sex is safer it still includes some risk of contracting chlamydia and HIV. (Only 14 and 13 percent, respectively, thought that there was zero chance of infection.) But while we claim to know there is danger, we’ve shown our priorities with our genitalia: Everyone from U.S. teens (70 percent) to adults (82 percent) to British teens (80 percent) forgoes condoms every time they have oral sex.

Sexual and public health organizations haven’t been particularly rigorous in focusing on the issue, either. With limited resources and facing widespread sex-ed dysfunction, it makes sense to focus on the types of intercourse with the highest potential for damage. It is the norm, in many contexts, to use condoms for penetrative sex, but in 2004 the American Social Health Association (ASHA) found that about one-fourth of single adults never use condoms during vaginal sex. Other sources are even less sanguine. The National Survey of Sexual Health and Behavior only found one-fourth of vaginal intercourse protected (one-third among singles) and the numbers drop dramatically for every age bracket all the way up from 14-to-17 to 61-plus. The Centers for Disease Control (CDC) shows condom use on the rise between 2002 and 2006-to-2010, both “at first sex” and among unmarried people between the ages of 15 and 44 who had sex in the last four weeks. In the latter group 68.3 percent of men and 71.6 of women still reported “never” using condoms. (These CDC numbers refer to vaginal sex; anal or oral sexual practices were not tracked.) With numbers like those, it’s no wonder I haven’t found a single organization prioritizing safer oral sex.

“We don’t have specific campaigns right now for oral sex [and] I’ve never come across any campaigns specifically designed to oral sex,” says Angel Brown, Advocates for Youth’s senior program manager for GLBTQ Health and Rights. “A lot of our work is about making sure communities know about safer sex options, integrating them into everyday life to [ensure] protection for every single sex act, every single time.”

Most public health organizations mention in passing that condoms are a good idea during oral sex, usually as part of a generalized dictum to always use condoms for everything. But some advocates think that needs to change. The antibiotic-resistant gonorrhea Groopman describes in The New Yorker is particularly prone to breeding in the throat, where symptoms are rarely noticeable, allowing it to be easily spread. Oral cancers associated with HPV are on the march, too. Although the disease is most commonly associated with infections of the cervix, the latest data reveals oral malignancies (37.3 percent) as the most common HPV-related cancer. In the male population, they account for 78.2 percent of HPV-related cancer.

“We really haven’t thought a lot about oral sex specifically, but I think that’s changing, for no other reason than the recent attention being given to HPV and oral cancers,” says Fred Wyand, director of communications at ASHA. “We’ve always been talking about safe oral sex, but how prominent do we make it? More and more we are getting evidence that we need to talk about it pretty robustly.”

Is there a way to encourage more protective sexual norms without freaking people out? After the sexual revolution, condom use declined sharply. There were cures for everything, no worries. AIDS put an end to that: fear of death and extensive educational and activist campaigns made condom use normative for anal and vaginal sex. It would be preferable to alter norms without a deadly pandemic, but what would such a campaign look like?

SEX WORKERS ARE THE only people I’ve spoken with who have regularly used condoms while providing oral pleasure. In countries and states where sex work is legal, there are often laws requiring condom use. Nevada passed such a law in 1988 and a 1998 study in the American Journal of Public Health found no unprotected sex in the brothels under review and minimal pushback from the clientele. “However, perhaps even more critical [than the law] is the ability of sex workers to transform the condom into an acceptable part of sexual activity,” the researchers conclude. (They note a variety of ways condom use was eroticized, overcoming the resistance of all but the most mulish of clients.) “Brothel workers’ techniques to achieve condom use have applicability outside of commercial sex….”

“Female-to-male oral sex, sex workers have been doing that themselves with or without a campaign for a long time,” says Norma Jean Almodovar, sex worker rights activist and executive director at COYOTE-LA. (She says female-to-female protection wasn’t seen as essential when she worked as a prostitute.)  “It can be made part of the erotic experience. You don’t just hand a condom to a guy and say, ‘Here, put this on. I don’t want a disease.’ You’ve gotta not make it clinical, you’ve gotta make it sexy and fun. It works for sex workers; it would work for women in [other] relationships.”

How can such a message be conveyed to a society as notoriously prudish as ours? It’s hard to imagine many public health agencies going in for campaigns touting the pleasures of oral sex, even if it is protected. And fear can be a more powerful motivator: Both sex workers and their clients presumably understand the risks of sex with multiple partners, which would explain why condom usage is more accepted in that setting. (The sex workers interviewed for the 1998 study tended not to use protection with their non-client partners).

Adina Nack envisions a public campaign that would establish the medical reasons for safe oral sex, paired with sexualized imagery to draw the eye. A senior research fellow for the Council on Contemporary Families, she describes a campaign featuring photos of beautiful faces with an emphasis on licking lips and come-hither smiles. The slogans beneath would warn of the toll unprotected oral sex can take on the giver and the receiver.

“Back in the ‘70s, people never thought men would be willing to wear condoms for penile-vaginal or oral intercourse,” says Nack, who is also the author of Damaged Goods? Women Living With Incurable STDs. “Due to the effective campaigning, especially around HIV … we’ve really seen condom use rise for those types of sex. If people were really educated about what they were risking by having unprotected oral sex, I have faith in the public that enough of us would find value in protecting ourselves. Then, there’s a [better] conversation to be had about making safe oral sex fun.”

Missouri man exposed 300-plus to HIV, police say

http://edition.cnn.com/2013/09/05/justice/missouri-hiv-arrest/index.html?sr=fb090613hivarrest1130a
AnneClaire Stapleton, CNN



(CNN) -- Prosecutors in rural Missouri have charged a man with exposing his partner to HIV and say he may have exposed more than 300 other people to the virus that causes AIDS.

David Mangum told police he had at least that many unprotected sexual encounters with people he met online or in parks since he was diagnosed with HIV in 2003, Dexter, Missouri, detective Sgt. Corey Mills told CNN. Mills said it will be difficult to find and warn those people, since Mangum "usually only knew his partners' first names."

Mangum was arrested after his former partner told police that Mangum had lied to him about his status, a police affidavit states. He was arraigned Thursday morning in Stoddard County, about 160 miles south of St. Louis, with bail set at $250,000. The former partner has tested positive for HIV, according to police.

Mangum, 36, told police that between 50 and 60 of his partners lived in Stoddard County, according to court records.

Knowingly exposing someone to HIV without their consent is a felony under Missouri law that can bring prison terms up to 15 years. Infecting someone can bring a life term.

WHO issues new HIV recommendations calling for earlier treatment

http://www.who.int/mediacentre/news/releases/2013/new_hiv_recommendations_20130630/en/index.html#.UdFAEX7LVPw.facebook

Earlier, safer and simpler antiretroviral therapy can push the HIV epidemic into irreversible decline

News release

30 JUNE 2013 | GENEVA - New HIV treatment guidelines by WHO recommend offering antiretroviral therapy (ART) earlier. Recent evidence indicates that earlier ART will help people with HIV to live longer, healthier lives, and substantially reduce the risk of transmitting HIV to others. The move could avert an additional 3 million deaths and prevent 3.5 million more new HIV infections between now and 2025.

The new recommendations are presented in WHO’s "Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection", as new data reveal a total of 9.7 million people were taking these lifesaving drugs at the end of 2012.

“These guidelines represent another leap ahead in a trend of ever-higher goals and ever-greater achievements,” says WHO Director-General Dr Margaret Chan. “With nearly 10 million people now on antiretroviral therapy, we see that such prospects – unthinkable just a few years ago – can now fuel the momentum needed to push the HIV epidemic into irreversible decline.”

Call to initiate treatment at 500 CD4 cells/mm³ or less

The new recommendations encourage all countries to initiate treatment in adults living with HIV when their CD4 cell count falls to 500 cells/mm³ or less – when their immune systems are still strong. The previous WHO recommendation, set in 2010, was to offer treatment at 350 CD4 cells/mm³ or less. 90% of all countries have adopted the 2010 recommendation. A few, such as Algeria, Argentina and Brazil, are already offering treatment at 500 cells/mm3.

WHO has based its recommendation on evidence that treating people with HIV earlier, with safe, affordable, and easier-to-manage medicines can both keep them healthy and lower the amount of virus in the blood, which reduces the risk of passing it to someone else. If countries can integrate these changes within their national HIV policies, and back them up with the necessary resources, they will see significant health benefits at the public health and individual level, the report notes.

Further recommendations

The new recommendations also include providing antiretroviral therapy - irrespective of their CD4 count - to all children with HIV under 5 years of age, all pregnant and breastfeeding women with HIV, and to all HIV-positive partners where one partner in the relationship is uninfected. The Organization continues to recommend that all people with HIV with active tuberculosis or with hepatitis B disease receive antiretroviral therapy.

Another new recommendation is to offer all adults starting to take ART the same daily single fixed-dose combination pill. This combination is easier to take and safer than alternative combinations previously recommended and can be used in adults, pregnant women, adolescents and older children.

“Advances like these allow children and pregnant women to access treatment earlier and more safely, and move us closer to our goal of an AIDS-free generation,” said UNICEF Executive Director, Anthony Lake. “Now, we must accelerate our efforts, investing in innovations that allow us to test new born babies faster and giving them the appropriate treatment so that they enjoy the best possible start in life.”

The Organization is further encouraging countries to enhance the ways they deliver HIV services, for example by linking them more closely with other health services, such as those for tuberculosis, maternal and child health, sexual and reproductive health, and treatment for drug dependence.

“The new WHO guidelines are very timely in view of the rapid progress we have made in expanding programmes for prevention and treatment,” says Dr Mark Dybul, Executive Director of the Global Fund to Fight AIDS, Tuberculosis and Malaria. “This is an example of how the Global Fund and the WHO work together to support countries as we move towards removing HIV as a threat to public health." Since its creation in 2002, the Global Fund has supported more than 1,000 programmes in 151 countries, providing HIV treatment for 4.2 million people.

Challenges remain

Challenges still remain. Alongside the new treatment guidelines, a treatment progress update by WHO, UNAIDS, UNICEF identified areas in need of attention.

While the number of all eligible children on ART has increased by 10% between 2011 and 2012, this is still too slow compared to the 20% increase in adults. A further complication is that many key populations such as people who inject drugs, men who have sex with men, transgender people and sex workers, continue to face legal and cultural barriers that prevent them getting treatment that otherwise would be more easily available. Another factor that needs to be addressed is the significant proportion of people who, for many reasons, ‘drop out’ of treatment.

Data reinforces feasibility of recommendations

Despite this, the Global update on HIV treatment: results, impact and opportunitiescontains encouraging data that reinforces the feasibility of the new WHO recommendation on earlier ART, which would expand the global number of people eligible for antiretroviral therapy to 26 million.

Between 2011 and 2012, the largest acceleration ever of people enrolled on ART was achieved, with an extra 1.6 million people benefitting from antiretroviral therapy, increasing the total to 9.7 million people. Furthermore, increased coverage of treatment occurred in every region of the world, with Africa leading. Four out of 5 people who started treatment in 2012 were living in sub-Saharan Africa.

“Today nearly 10 million people have access to lifesaving treatment. This is a true development triumph,” says Michel Sidibé, Executive Director of the Joint United Nations Programme on HIV/AIDS (UNAIDS). “But we now have a new challenge - ensuring that all 26 million people eligible for treatment have access - not one person less. Any new HIV infection or AIDS-related death due to lack of access to antiretroviral therapy is unacceptable.”

Today’s recommendations were released by WHO on the opening day of the International AIDS Society 2013 conference in Kuala Lumpur. Among those endorsing the recommendations at the launch were representatives from countries, where such earlier ART intervention is already national policy, along with development agencies who are providing technical and financial support.

The International AIDS Society conference is held every two years and attracts leading scientists, clinicians, public health experts and community leaders to examine the latest developments in HIV-related research, and to explore how scientific advances can inform the global response to HIV/AIDS.

Note to editors:

The recommended treatment is now a combination of three antiretroviral drugs: tenofovir and lamivudine (or emtricitabine) and efavirenz, as a single pill, given once daily.

For more information please contact:

Mr Glenn Thomas
Communications Officer, WHO
Telephone: +41 22 791 3983
Mobile: +41 79 509 0677
E-mail: thomasg@who.int

Post-Transplant and Off Drugs, H.I.V. Patients Are Apparently Virus-Free

http://www.nytimes.com/2013/07/04/health/post-transplant-and-off-drugs-hiv-patients-are-apparently-virus-free.html?ref=global-home
DONALD G. McNEIL Jr.

Two H.I.V.-infected patients in Boston who had bone-marrow transplants for blood cancers have apparently been virus-free for weeks since their antiretroviral drugs were stopped, researchers at an international AIDS conference announced Wednesday.

The patients’ success echoes that ofTimothy Ray Brown, the famous “Berlin patient” who has shown no signs of resurgent virus in the five years since he got a bone-marrow transplant from a donor with a rare mutation conferring resistance to H.I.V.

The Boston cases, as with Mr. Brown’s, are of no practical use to the 34 million people in the world who have H.I.V. but neither blood cancer or access to premier cancer-treatment hospitals.

But AIDS experts still find the Boston cases exciting because they are another step in the long and so-far-fruitless search for a cure. They offer encouragement to ambitious future projects to genetically re-engineer infected patients’ cells to be infection-resistant. At least two teams are already experimenting with variants on this idea, said Dr. Steven G. Deeks, an AIDs researcher at the University of California at San Francisco Medical School.

Dr. Françoise Barré-Sinoussi, a discoverer of the virus that causes AIDS and the president of the International AIDS Society meeting now in Kuala Lumpur, Malaysia, called the findings about the Boston patients “very interesting and very encouraging.” The announcement about the cases was made at the society’s annual conference.

Mr. Brown is sometimes referred to as the “first H.I.V. cure.”

But there are important differences between his case and those of the Boston patients. For example, no AIDS expert, including the doctors from Brigham and Women’s Hospital in Boston following the two patients, is using the word “cured” to describe their status.

The technique used on them involves severely weakening the immune system before a marrow transplant. It is so dangerous that it is unethical to perform it on anyone not already at risk of dying from cancer, especially because most people with H.I.V. can live relatively normal lives by taking a daily antiretroviral cocktail.

“But we cannot speak about ‘cure,'  ” she added. “The follow-up has been very short.”

One patient stopped taking antiretroviral drugs seven weeks ago. For the other, it has been 15 weeks. No virus or antibodies to the virus have been found in their blood or other tissues since.

Normally, when a patient stops the drugs, the virus bounces back in less than a month, but each person is different.

“It could come back in a week, or in six months,” said Dr. Timothy Henrich, a doctor overseeing the two patients. “Only time will tell.”

The process the two patients underwent is risky – a third patient in the study died when his cancer returned – but somewhat less so than the procedure done on Mr. Brown.

Mr. Brown had leukemia. The three Boston patients had lymphoma.

The Boston patients’ bone marrow, where new blood cells are made, was only partially destroyed by drugs before they were given new marrow from matching donors — a process that carries a 15 to 20 percent risk of death, Dr. Henrich said.

Mr. Brown’s marrow was completely obliterated by drugs and whole-body radiation, a procedure that kills 40 percent of the patients, and he had it done twice.

Mr. Brown’s new marrow came from a donor who was a close genetic match and had a rare mutation that makes a person virtually impervious to infection with H.I.V.

The mutation, known as delta 32, creates CD4 cells — the white blood cells that the virus attacks — lacking a CCR5 surface receptor, the “door” that the virus uses to enter the cell.

The donors for the Boston patients did not have the delta 32 mutation.

Unlike Mr. Brown, the Boston patients stayed on antiretroviral therapy throughout the lengthy transplant process and for years afterward. The drugs prevent the virus from replicating itself.

“The idea was to protect the new donor cells from becoming infected,” Dr. Henrich explained.

During that time, in a phenomenon known as graft-versus-host disease, the new cells were attacking their old, chemotherapy-weakened counterparts and clearing them from the body, a process that takes about nine months, Dr. Henrich said.

Because only the old cells were infected with H.I.V., the hope was that graft-versus-host disease would “mop up” all the viral reservoirs.

But runaway graft-versus-host disease can be fatal, so the two patients were intermittently on and off immunosuppressive drugs and steroids to control it.

One immunosuppressive drug, sirolimus, may also have helped kill off H.I.V., he said.

It is known to prevent retroviruses like H.I.V. from replicating.

The two patients had transplants between two and five years ago. They had months of tests on their blood and tissues to make sure no H.I.V. or antibodies to it were found, before Dr. Henrich and his research partner, Dr. Daniel Kuritzkes, proposed stopping the antiretroviral treatment.

For such tests, doctors remove immune cells and “activate” them with chemicals to make them reproduce. If any virus is hiding in the cells’ DNA, it is “spit out” and can be detected.

But doctors can never be sure that they have tested all the reservoirs where dormant virus might hide. It is relatively easy, for example, to sample rectal but not brain tissue.

Since the patients stopped taking antiretrovirals, they “feel great and are leading completely normal lives,” Dr. Henrich said.

That distinguishes them from Mr. Brown, who has survived virus-free for more than five years but still has weakness and pain from his grueling anticancer regimen.

AIDS specialists are interested in the Boston patients because they offer new insights into how the immune system can be used to attack the virus.

Dr. Anthony S. Fauci, the director of the National Institute of Allergy and Infectious Diseases, said it was “conceivable and maybe even likely” that their H.I.V. was permanently gone.

If so, he said, it would show that it is not necessary to find a matching donor who also had the delta-32 mutation.

Dr. Deeks, the AIDS researcher in California, said the cases raise the question of when to say an H.I.V. patient has been “cured.”

“Should we wait six months to see if the virus rebounds?” he asked. “Or will we have to wait up to five years, as oncologists tend to do with cancer?”

Dr. Barré-Sinoussi said she might eventually prefer to adopt the term oncologists use: “in remission.”

Sudahkah kamu Test HIV?

http://www.odhaberhaksehat.org/2013/sudahkah-kamu-test-hiv/
by ayu

“waduh.. kemarin gw habis ML sama pacar lupa pakai kondom. gimanaya..” kata Budi pada sahabatnya “emangnya setiap ML gak pakai kondom gitu?” sahabat balik bertanya

“yah..enggak pernah. gw pengen ajak pasangan cek HIV deh.. gimana caranya ya?“  dengan wajah bingung budi kembali bertanya “nih, baca artikel dibawah ini yuk..”

Apa sih Test HIV Itu?

Tes HIV memberi tahu kita apakah kita terinfeksi HIV, virus penyebab AIDS. Kebanyakan tes ini mencari antibodi terhadap HIV. Antibodi adalah protein yang dibuat oleh sistem kekebalan tubuhuntuk menyerang kuman tertentu. Antibodi terhadap semua kuman berbeda, jadi bila ditemukan antibodi terhadap HIV dalam darah kita, artinya kita terinfeksi HIV. Ada juga jenis tes lain yang mencari tanda bahwa virus sendiri ada di dalam darah, tetapi tes macam ini belum tersedia di Indonesia.

Bagaimana Proses Tes HIV?

Tes yang paling lazim untuk HIV adalah tes darah. Sekarang juga ada tes yang dapat mencari antibodi dalam air seni, atau dalam cairan yang diambil dari dalam mulut (bukan air liur), digesekkan dari dalam pipi. Tes yang sering dipakai sekarang disebut tes cepat atau rapid test, yang mampu menyediakan hasil dalam 20-30 menit setelah contoh darah atau cairan lain diambil. Untuk tes darah, contoh darah kita diambil dengan jarum suntik sekali pakai, atau tetes darah diambil setelah jari kita ditusuk dengan jarum sekali pakai. Jika hasil tes pertama ‘reaktif’ (positif), hal ini menunjukkan kemungkinan kita terinfeksi HIV. Tetapi tes harus diulang sekali (jika kita mempunyai gejala penyakit HIV) atau dua kali dengan cara berbeda untuk memastikan hasilnya benar, dan dapat dinyatakan ‘positif’. Ini biasanya dilakukan oleh tempat tes tanpa kita diketahui. Hasil juga dapat dilaporkan sebagai ‘non-reaktif’ (negatif). Kadang laboratorium juga melaporkan angka non-reaktif (mis. non-reaktif, 0,34).  Angka ini tidak ada relevansi sama sekali dan sebaiknya diabaikan. Sebelum darah diambil, kita wajib diberi konseling oleh seorang konselor yang terlatih. Di antara yang lain, konseling ini akan memberi informasi dasar tentang HIV dan AIDS. Bgmn Manfaat dan kerugian kita mengetahui apakah kita terinfeksi, dan bagaimana kita akan bereaksi jika nanti hasilnya positif Setelah itu, kita diminta menyetujui sebelum darah diambil (sering disebut informed consent). Kita juga wajib diberi konseling lagi oleh konselor yang sama saat hasilnya sudah ada. Hasilnya hanya boleh diberikan pada kita, dan tidak boleh diberikan pada orang lain tanpa persetujuan kita. Tempat melaksanakan tes bertanggung jawab untuk menjamin nama kita dan hasil tes tidak diketahui orang lain. Namun, jika kita di bawah umur, orang tua atau wali kita boleh mewakili kita. Sayangnya, di Indonesia, tidak jelas berapa sebenarnya usia ‘di bawah umur’. Hasil tes tidak wajib dilaporkan ke pemerintah. Ada beberapa tempat tes yang tidak mewajibkan kita memberi nama atau identifikasi. Ini disebut tes tanpa nama atau anonim.

Bagaimana Kita Dapat Dites?

Semua rumah sakit rujukan AIDS (hampir 200 di seluruh Indonesia) dan satelitnya menyediakan layanan tes HIV. Sering kali di klinik disebut VCT (voluntary counseling and testing). Daftar rumah sakit rujukan dapat dilihat di banyak situs situswww.spiritia.or.id atau www.aidsindonesia.or.idSelain itu ada beberapa klinik lain yang menyediakan tes HIV, dan tes juga dapat dilakukan di beberapa laboratorium swasta. walau sering kali lab swasta tersebut tidak menyediakan konseling, pastikan kita mendapat informasinya. Tes HIV di RS kadang disediakan tanpa biaya, tetapi biasa harganya sesuai dgn kebijakan RS.

Siapa Sebaiknya Dites? Kita dapat terinfeksi HIV tanpa mengetahuinya. Kita mungkin tidak merasa sakit atau mempunyai keluhan. Tetapi kita tetap bisa menularkan orang lain. Siapa pun yang aktif secara seksual atau memakai jarum suntik secara bergantian sebaiknya tes HIV secara berkala.

Kapan Sebaiknya Kita Dites?

Jika kita menjadi terinfeksi HIV, biasanya sistem kekebalan tubuh baru membentuk antibodi tiga minggu hingga tiga bulan setelah kita terpajan. Masa ini disebut masa jendela. Jadi, jika kita merasa kita terpajan, atau melakukan perilaku berisiko tertular HIV, kita sebaiknya menunggu tiga bulan setelah peristiwa berisiko sebelum kita dites. Kita juga dapat langsung tes, dan mengulangi tes tiga bulan setelah peristiwa (bukan setelah tes pertama). Selama masa jendela ini, tes antibodi akan menunjukkan hasil non-reaktif (negatif), tetapi walaupun begitu, jika kita sudah terinfeksi kita dapat menularkan orang lain.Sebetulnya, selama masa awal infeksi ini, daya menular kita paling tinggi sehingga kita lebih mungkin menularkan orang lain kalau kita berperilaku berisiko. Menurut pedoman Kemenkes RI, hasil tes HIV yang non-reaktif tiga bulan atau lebih setelah peristiwa berisiko berarti kita tidak terinfeksi HIV, atau dalam kata lain, kita HIV-negatif.

Ada Tes yang Memberi Hasil Lebih Cepat? Tes viral load mencari potongan genetik HIV. Bibit ini terbentuk sebelum sistem kekebalan tubuh membentuk antibodi. Tes viral load tidak biasa dipakai untuk menentukan apakah seseorang terinfeksi, karena tes tersebut jauh lebih mahal dibandingkan tes antibodi. Selain itu, tingkat hasil yang salah lebih tinggi, sehingga tes viral load ini tidak disetujui oleh Kemenkes sebagai alat diagnosis HIV untuk orang dewasa di Indonesia.

Apa Artinya Jika Kita Positif?

Hasil positif atau reaktif berarti kita mempunyai antibodi terhadap HIV, dan itu berarti kita terinfeksi HIV. Hasil tes seharusnya disampaikan kepada kita oleh konselor, yang akan memberi tahu kita apa dampak pada kehidupan kita, dan bagaimana kita dapat memperoleh layanan dan dukungan kesehatan serta emosional. Hasil positif bukan berarti kita AIDS. Banyak orang yang positif tetap sehat untuk beberapa tahun, dan tidak tentu langsung perlu memakai obat apa pun. Penerimaan diagnosis HIV sering kali sangat sulit. Namun kita tidak sendiri, dan bertemu dengan teman senasib dapat sangat membantu pada saat itu. Di beberapa daerah, teman-teman Odha sudah membentuk kelompok dukungan sebaya (KDS) untuk memudahkan proses ini. Minta dirujuk pada KDS terdekat oleh petugas klinik VCT. Atau kami juga bisa menjadi sahabat kalian saat kalian mengetahui status HIV.

Apakah Kita Dapat Mempercayai Hasil Tes?

Hasil tes antibodi untuk HIV adalah benar untuk lebih dari 99,5% tes. Sebelum kita diberi hasil positif, tes diulang sebagai konfirmasi. Ada beberapa keadaan khusus yang dapat memberi hasil yang salah atau tidak jelas. Bayi yang dilahirkan oleh ibu yang HIV-positif dapat menunjukkan hasil positif untuk beberapa bulan karena antibodi ibu dialihkan ke bayi yang baru lahir. Walaupun bayi sebenarnya tidak terinfeksi, dia mempunyai antibodi terhadap HIV dan hasil tes dapat reaktif sampai dia berusia 18 bulan. Tes lain, misalnya tes viral load, harus dipakai jika hasil yang benar dibutuhkan lebih cepat. Orang yang baru terinfeksi dapat menunjukkan hasil negatif (non-reaktif) jika dia dites terlalu dini (dalam masa jendela) sejak terinfeksi dengan HIV. Ibu hamil mungkin menunjukkan hasil palsu atau tidak jelas akibat perubahan pada sistem kekebalan tubuhnya.

Tes HIV biasanya mencari antibodi terhadap HIV dalam darah atau cairan tubuh lain. Bila kita terinfeksi HIV, sistem kekebalan tubuh kita membuat antibodi ini untuk melawan HIV. Biasanya dibutuhkan tiga minggu hingga tiga bulan untuk membentuk antibodi tersebut. Selama masa jendela ini, tes kita tidak akan menunjukkan hasil positif walaupun kita terinfeksi. Tes HIV biasa juga tidak memberi hasil yang benar untuk bayi yang baru lahir pada ibu yang terinfeksi HIV. Hasil tes yang positif (reaktif) berarti kita terinfeksi HIV, tetapi tidak berarti kita AIDS. Jika kita memang HIV-positif, sebaiknya kita belajar tentang HIV, dan mempertimbangkan bagaimana kita dapat melindungi kesehatan kita. Sudahkah kamu cek HIV?

Prevention Benefits of HIV Treatment

http://www.cdc.gov/hiv/prevention/research/tap/index.html

Summary

To realize the full prevention benefit of treating HIV infection, we should keep in mind four overarching tenets:

• HIV testing is the foundation for both prevention and care efforts.
• Early identification of infection empowers individuals to take action that benefits both their own health and the public health.
• Early treatment of infected persons substantially reduces their risk of transmitting HIV to others.
• The prevention benefit of treatment can only be realized with effective treatment, which requires linkage to and retention in care, and adherence to antiretroviral therapy.

• Introduction

  The advent in 1996 of potent combination antiretroviral therapy (ART), sometimes called HAART (highly active antiretroviral therapy) or cART (effective combination antiretroviral therapy), changed the course of the HIV epidemic.¹ These “cocktails” of three or more antiretroviral drugs used in combination gave patients and scientists new hope for fighting the epidemic,² and have significantly improved life expectancy—to decades rather than months.^1,3
  For many years, scientists believed that treating HIV-infected persons also significantly reduced their risk of transmitting the infection to sexual and drug-using partners who did not have the virus. The circumstantial evidence was substantial, but no one had conducted a randomized clinical trial— the gold standard for proving an intervention works. That changed in 2011 with the publication of findings from the HIV Prevention Trials Network (HPTN) 052 study, a randomized clinical trial designed in part to evaluate whether the early initiation of ART can prevent the sexual transmission of HIV among heterosexual couples in which one partner is HIV-infected and the other is not. This landmark study validated that early HIV treatment has a profound prevention benefit: results showed that the risk of transmitting HIV to an uninfected partner was reduced by 96%.⁴
  As a concept and a strategy, treating HIV-infected persons to improve their health and to reduce the risk of onward transmission—sometimes called treatment as prevention— refers to the personal and public health benefits of using ART to continuously suppress HIV viral load in the blood and genital fluids, which decreases the risk of transmitting the virus to others. The practice has been used since the mid- 1990s to prevent mother-to-child, or perinatal, transmission of the virus. Research published in 1994 showed that zidovudine, more commonly known as AZT, when given to HIV-infected pregnant women and to their newborns reduced the risk of perinatal transmission from about 25% to 8%⁵. Since then, routinely testing pregnant women and treating infected mothers with ART during pregnancy, delivery, and while breastfeeding, when practiced according to recommendations, has reduced the mother’s risk of transmitting HIV to her child by 90%.⁶  In one study, women who received at least 14 days of ART reduced the risk of transmitting HIV to their babies to less than 1%.⁷

  Putting Treatment as Prevention in Perspective

  Treatment by itself is not going to solve the global HIV epidemic. On the domestic front, controlling and ultimately ending the epidemic will require a combination of scientifically proven HIV prevention tools as highlighted in the National HIV/AIDS Strategy, including
  • Focusing on science-based HIV prevention efforts by supporting and expanding targeted use of high-impact HIV prevention approaches.
  • Making better investments by intensifying HIV prevention in the communities where HIV is most heavily concentrated.
  • Increasing access to HIV screening and medical care, including through
    • boosting federal investments for AIDS Drug Assistance Programs (ADAPs) to expand access to life-saving medications, and
    • implementing the Affordable Care Act, which will increase health coverage for thousands of Americans living with HIV.
  • Sustaining a shared response to the domestic epidemic through the support of HIV prevention efforts across all levels of society, including federal, state, and local governments, faith-based communities, and the private sector.
  Providing treatment to people living with HIV infection to improve their health must always be the first priority. Getting an HIV test is the first step to identifying persons with HIV infection and the pivotal entry point into the medical care system for both treatment and prevention. More than 1.1 million persons in the United States are living with HIV, and almost 1 in 5 (18.1%) do not know they are infected.⁸ By lowering the level of virus in the body, early ART helps people with HIV live longer, healthier lives and also lowers their chances of transmitting HIV to others. Although observational data had suggested that ART significantly reduces viral load and the risk of sexual transmission of HIV in heterosexual couples where one partner is infected and the other is not,^9,10 it was the HPTN 052 study that definitively showed that early treatment of HIV-infected persons dramatically cuts the rate of new infections. Studies of communities with high concentrations of injection drug users (IDUs) and men who have sex with men (MSM) have shown that as ART use increased within the community, the community’s viral load declined, as did rates of new HIV diagnoses.^11,12However, it is critical to remember that the prevention benefit of treatment is not 100%, and there has been at least one report of HIV transmission from a person with suppressed viral load to an uninfected sexual partner.¹³ 
  
  For persons living with or at risk for HIV infection, emphasizing these fundamental safeguards will continue to be crucial:
  • Knowing their HIV status through routine testing.
  • Getting into care soon after HIV diagnosis and starting antiretroviral treatment.
  • Remaining in care and staying on HIV treatment.
  • Modifying behaviors that reduce the probability of getting or spreading HIV—such as using condoms properly and consistently, reducing numbers of partners, and avoiding sharing needles and syringes.

  Test and Treat

  The ability of antiretroviral drugs to prevent secondary transmission of HIV from an infected person to an uninfected sexual or drug-using partner has led to several proposed “test-and-treat” strategies. Test-and-treat programs are based on the premise that the rate of new HIV infections will be maximally reduced by using aggressive methods to test and diagnose all people living with HIV infection, treat them with ART regardless of CD4 cell count or viral load at diagnosis, and link them to care. In one study, mathematical modeling suggested that a universal test-and-treat-strategy in which all adults aged 15 years or older are tested annually could control the South African epidemic, reducing both HIV incidence and mortality to less than 1 case per 1,000 people per year within 10 years of full implementation of the strategy—and reducing prevalence of HIV infection to less than 1% within 50 years.¹⁴ Other investigators have not been as optimistic about the ultimate benefits of this strategy. Only 50% of persons in the United States with HIV remain in care,^15,16 and about 18% do not know they are infected; these persons may contribute to the onward transmission of HIV. In addition to expanding testing and treating HIV infection earlier, overcoming the challenges of undiagnosed infection and poor engagement in care will result in better care of HIV-infected populations and reduced numbers of new HIV infections.^{17, 18}

  Challenges and the Future of HIV Prevention

  The landmark HPTN 052 clinical trial was conducted almost solely among heterosexual couples who, as part of the study, received frequent counseling related to HIV, sexually transmitted diseases (STDs), and family planning. Results of a recent observational study of more than 38,000 serodiscordant heterosexual couples across China showed that treating the HIV-infected partner reduced the risk of transmitting HIV to the uninfected partner by 26%—a much more modest effect than that found in the HPTN 052 study couples. Unlike the couples enrolled in HPTN 052, the couples in China were not part of an intensive study, and data were not available on sexual risk factors, adherence to antiretroviral treatment, or virological treatment outcome measures.¹⁹ Additional data are needed to estimate the prevention benefit of treatment for other populations, such as MSM, IDUs, and persons with acute or primary HIV infection,²⁰ and in other settings such as North America and during routine clinical care.
  As HIV treatment has evolved from a complicated regimen of numerous pills taken several times a day with severe side effects to a now once-daily pill with few side effects, some persons living with HIV may have become complacent about maintaining safer sex and safer injection use practices. Since HIV treatment became widely available in developed countries, several studies have shown a resurgence of HIV infections and increases in STDs, in particular syphilis, and especially among MSM.²¹ Some studies have cautioned that the prevention benefits of effective ART would be offset by risk compensation, meaning that increases in risky sexual and injection-drug-use behavior might be observed as effective ART is widely disseminated.^22-24 However, results of one meta-analysis demonstrated that HIV-positive persons receiving ART, compared with those not receiving ART, did not show increased sexual risk behavior, even when therapy resulted in an undetectable viral load.²⁵ Yet, persons with HIV who believe that using ART or having a suppressed viral load protects them against transmitting HIV may be more likely to engage in unprotected sex or other risky behaviors. These behaviors might be amenable to change through prevention messages and other effective approaches.^25-28 Making sure that preventive behaviors are sustained in communities facing higher risk of HIV infection is crucial.²⁹
  The future of HIV prevention will be shaped by operational and implementation research on the efficacy of combination prevention strategies, of which treatment may be one component.^30-32 Providing treatment to all HIV-infected persons will be an important step—a recommendation that is included in the current Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents.³³ The Department of Health and Human Services panel based its recommendations primarily on mounting evidence showing the harmful impact of ongoing HIV replication on AIDS and non-AIDS disease progression. In addition, the updated recommendations reflect emerging data showing the benefit of effective ART in preventing secondary transmission of HIV. Although the panel agrees that this public health benefit of ART is significant, its recommendations on when to begin ART are based primarily on the benefit of treatment to the HIV-infected individual.³³ If treatment is to achieve its full prevention potential, current gaps in the HIV prevention, treatment, and care continuum must be narrowed or closed. Considerable changes in the US health care delivery system will be required to accommodate the increased demand for services that expanded testing, treatment, and linkage and retention in care will bring.³⁴
  Now that early ART of HIV-infected persons has been shown to be very effective at preventing secondary transmission of HIV among individuals, the current goal is to determine the extent to which ART can be used broadly and effectively to reduce the spread of HIV within a population. At least two community randomized trials that use ART as their basis are planned,³⁵ and the results could determine the conclusive benefit of this successful intervention.³⁶
  Still, resource constraints, logistical hurdles, emergence of drug-resistant viral strains, adherence to therapy regimens, and risk compensation remain concerns that scientists, health care providers, policy makers, and communities must confront if the individual and public health benefits of treatment are to be fully realized.³⁷

  What CDC Is Doing

  Much of CDC’s funding supports and expands prevention services for persons living with HIV, including
  • Linkage to care and treatment, and interventions to improve retention in and re-engagement to care, prevention, and treatment for people living with HIV.
  • Referral to other medical and social services, such as substance abuse and mental health services.
  • Behavioral interventions and other risk-reduction services for HIV-positive persons and their sexual or needle-sharing partners to reduce the likelihood of HIV transmission.
  Three evidence-based interventions have proved effective in treatment settings and can be delivered by providers as brief messages during clinic visits: Partnership for Health, Options, and Positive Choice.
  CDC’s Prevention IS Care also emphasizes ongoing, brief prevention counseling to help health care providers integrate into routine care simple approaches to prevent transmission by persons living with HIV. Medical visits provide a vital opportunity to reinforce HIV prevention messages, discuss sexual and drug-related risk behaviors, diagnose and treat other STDs, review the importance of medication adherence, and foster open communication between provider and patient. 
  
  Expanded HIV testing efforts will help more people know their status so that they can get life-saving treatment and will strengthen the impact of efforts to increase adherence to treatment, particularly in areas where large numbers of persons remain undiagnosed. 
  
  Additionally, CDC and the Health Resources and Services Administration have supported studies that suggest several promising opportunities to improve retention in care, including collaborating with other service providers to identify persons poorly retained in care, enhancing outreach programs, and addressing unmet psychosocial needs

Early Treatment With Anti-HIV Drugs Stops Transmission Between Partners

http://healthland.time.com/2011/05/13/early-treatment-with-anti-hiv-drugs-stops-transmission-between-partners/
Alice Park



Researchers report yet more tantalizing data that the antiretroviral drugs doctors currently use to treat HIV infection could also be effective in preventing transmission of the virus.

In a large randomized trial involving more than 1,700 heterosexual couples — in which one person was HIV-positive and the other was not — infected people who took the anti-HIV drugs reduced their risk of transmitting the virus to their partners by 96%, compared with those who did not immediately start treatment.

The results were so stark that Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases (NIAID), which sponsored the trial, elected to release them early and stop the global study four years before its scheduled end. All study participants are now being offered antiretroviral therapy.

These results come not long after another large-scale landmark trial (read about it here) that found evidence that using antiretroviral drugs could be an effective prevention measure. That trial included nearly 2,500 HIV-negative men in six countries, who were at high risk of contracting HIV. Those who took a combination anti-HIV pill called Truvada (a combination of the drugs tenofovir and emtricitabine) were anywhere from 44% to 73% less likely to acquire HIV, depending on how faithfully they took their medication, during the study’s three-year follow-up than participants who took a placebo.

The findings add weight to the “treatment as prevention” strategy that some AIDS scientists increasingly believe, if broadly implemented, can help slow the spread of HIV and AIDS.

The latest study was carried out in 13 countries including Botswana, Brazil, India, Kenya, Malawi, South Africa, Thailand and the U.S., and mostly involved heterosexual couples. Infected partners were randomly assigned to begin receiving antiretroviral drugs immediately at the start of the study, or to wait to start treatment until their disease had progressed (signaled by a drop in the infected partner’s immune cell count below a certain threshold). All participants were also counseled on how to protect against HIV transmission and were given free condoms.

In the group that waited to start treatment, there were 27 cases of HIV transmission from the infected person to his or her partner; all occurred when the patients were not taking antiretroviral drugs. By comparison, in the group that started treatment immediately, only one such transmission occurred.

Antiretroviral drugs work by lowering patients’ “viral loads” — the amount of HIV in body — which means they have less virus to transmit.

“The latest study really is very encouraging, and indicates that earlier therapy provides additional benefits to the treated person as well as to the patients,” says Dr. Robert Grant, a professor medicine at University of California, San Francisco, who was not involved in the current trial but chaired the group that designed the Truvada study in gay men.

In a statement, Fauci said, “This new finding convincingly demonstrates that treating the infected individual — and doing so sooner rather than later — can have a major impact on reducing HIV transmission.”

However, because the trial’s population was 97% heterosexual couples, the findings are not applicable to homosexual couples.

As encouraging as the data are, though, AIDS experts aren’t quite ready to start doling out antiretroviral drugs as a prevention strategy like condoms. For one thing, the drugs require strict adherence and must be taken daily for life in order to work.

Also, they don’t work for everyone. In a follow-up to the study in high-risk, healthy gay men, scientists tested the preventive benefit of Truvada in high-risk women (read about the study here). That trial was also halted early because it found no benefit in using the drug prophylactically in women. But some pointed out that the women in that study may not have been reporting accurately how regularly they took their medications.

That doesn’t mean the anti-HIV drugs won’t be helpful in HIV prevention. It just means that these studies are only the first in what will certainly be a long line of trials that will help scientists figure out exactly when and how the medications should be used.

And, as Grant says, anti-HIV drugs are just one in a growing list of ways to prevent HIV transmission — including male circumcision and antimicrobial vaginal gels. As these strategies are increasingly implemented, allowing more people to lower their chances of acquiring infection, the overall community viral load will drop, much the way that vaccinations reduce the circulation of contagious bacteria and viruses.

That makes it possible for HIV scientists to shift their efforts from blocking transmission of HIV back to finding a cure. And studies like this one are critical to accomplishing that goal. “Now we can look forward to winning the war on HIV,” says Grant. “This is a turning point in the epidemic. There is no question in my mind about that.”