Dr Adam Bourne, Associated Professor, Australian Research Centre in Sex, Health and Society, Latrobe University, Melbourne VIC, Australian delivered an interesting talk on global PrEP use within the MSM community and the stigma associated with taking PrEP called "sl*t shamming". To tackle this perception, Dr. Bourne highlighted the importance of a "good sex life" within the MSM community and mentioned various lived experience PrEP studies, one found that 76% of the PrEP participants since taking PrEP are now happier with there sex life. At a clinic level this reminds us that a "good sex life" is a key motivator and if discussed with every client will help increase PrEP use and help address the associated “sl*t Shamming” stigma associated with PrEP.
ASHM Report Back
Clinical posts from members and guests of the Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM) from various international medical and scientific conferences on HIV, AIDS, viral hepatitis, and sexual health.
So having digested all the scrumptious brain teasing morsels at yesterday’s info picnic what was on the menu for Day 2 at #EACS2017?
To begin the day Dr Roy Gulick, Professor of Medicine and Chief of the Division of Infectious Diseases at Weill Medical College of Cornell University (also see Mark Ryan’s post) presented the Future of HIV Therapy. He began by summarising approved ART first line regimens in 2017 and the world-wide opinion to start at all CD4 counts whenever the patient is ready. He discussed the developments of ART properties in terms of
1) Antiretroviral activity - mentioning the future of two new classes of drugs HIV Maturation Inhibitors and HIV Capsid Inhibitors,
2) Safety and tolerability- giving TDF -> TAF switch as an example of similar viralogical efficacy but improvements in renal and bone markers.
3) Convenience- recapping the history of ART with many daily pills to the current single tablet regimes and then the possibilities in the future of new co-formulations with longer half-lives lending themselves of less frequent dosing, and long acting methods in the form of injectables and subdermal implants.
4) Access and Cost – Highlighting the numbers of people living with HIV globally and improvements in those accessing treatment as the cost of ARV’s decreases.
5) Life expectancy as those with HIV live longer and healthier lives and in closing stated “possibly longer than the general population … apparently getting healthier is good for you”
Day 1 @ #EACS2017 did not disappoint! Much like colourful displays of gelato in Milan’s exquisite restaurants the conference proved to be a veritable feast of tasty information and similar to the difficulty in picking your ice cream flavour so was the conundrum of choosing what session to attend!
To begin the day I started at the WAVE (Women Against Viruses in Europe) Workshop. I listened to a very empowering speech given by Justyna Kopeć a Polish lady diagnosed with HIV 20 years ago who’s talk was entitled “The longest relationship I ever had”. She highlighted at least 3 occasions when her diagnosis was missed between 1993 and 1997 which included participating in an anonymous HIV testing at university in which she did not collect her result, vising the gynaecologist with several recurrent vaginal infections and a GP visit for continued weight loss without dieting. She talked about her journey of hope as new drugs came on the market at the time of her diagnoses, fear of dying, fear of treatment, fear of a daily routine, and trust in her doctors, trust in her family and friends and trust in science and in patient centred care. She also talked about the changes over time for young women newly diagnosed in today's era in terms of pregnancy and living long enough to watch those children grow. This session was a great reminder that HIV can affect anyone. As a nurse I often see clients for HPV wart treatments and other symptoms such as vaginal candida and it reminded me of the importance of thinking of underlying reasons for persisting infections, accurate history taking (as people are transient between services and indeed countries) and not to overlook HIV as a possibility for someone who is not in the forefront of my mind as “high risk”. Justyna closed with the statement “HIV testing should be a standard procedure among ALL sexually active people”.
Please also see the post from Emma Clements
Sophie Flavell and John White spoke about STI testing and screening.
Important take home messages for me in this session were:
- don’t forget that for MSM with high risk behaviour Hep C is sexually transmitted ie make sure you include it in STI screen in high risk populations
- consider using doxycycline 200mg as a stat dose as PEP for chlamydia and syphilis (70% reduction in infections)
- pooled testing (3 samples in one pot)for chlamydia/gonorrhoea NAAT is currently not funded but saves money and will form part of the future in STI testing
Hello from the 16th European AIDS conference in Milan.
This morning I attended a very interesting workshop organised by WAVE, Women against Viruses in Europe, where numerous aspects of caring for women with HIV were presented and discussed.
The session started with a very powerful and insightful presentation by Justyna Kopec who has just celebrated her 20th anniversary of living with HIV. She discussed her journey to diagnosis and disclosed a number of lost opportunities to an earlier diagnosis (eg testing and then never returning for results) and highlighted that staff at her 'clinic' were integral to her feeling supported throughout her life living with HIV. This was a really excellent presentation to kick off with to remind us all to keep patients are at the centre of their care. (see Catherine Orr’s notes from this session here)
Following was an analysis of the models of care for HIV positive Women in Europe split into West, Central and Eastern areas by Dr Annette Haberl from Germany, Dr Cristiana Oprea from Romania and Dr Inga Iatysheva from Russia, respectively. There is a huge amount of detail surrounding the variations in HIV care in each country and all face similar challenges in varying degrees i.e. coordination of allied specialist services such as gynaecology, psychology and social supports, or lack of integrated services, particularly in less economically enabled countries; barriers to accessing care surrounding child care responsibilities; lack of gender autonomy; fear of stigma.
I noted that nurse led models of care for women living with HIV did not come up in discussion from any of the 3 speakers; the analysis may have not drilled down to this level but nurse led models of care could be useful in resource poor environments particularly. Additionally, further research as a high priority area was raised, and 2 speakers suggested that WAVE could be the right platform to assist coordinate research, exchange experience and create expert advisory groups.