Day 3 of the conference and PrEP of course has been the 'hot topic'
This oral abstract session was a reminder that there is more to prevention than antiretrovirals however.
First up, Kelly Kilburn gave evidence from the HPTN 068 study in South Africa where a third of women experienced physical violence by a partner. And there are direct correlations between this and HIV transmission.
The experiment involved 2,533 women between the ages of 13 to 20 years. They were randomly assigned to one of two groups where one group of girls (or their parents) received approximately $10 USD if they attended at least 80% of school days in the past month. Participants then completed a self interview and HIV and HSV-2 test each visit and at 12, 24 and 36 months following. The questionnaire was able to distinguish between sexual and physical intimate partner violence (IPV).
The conclusion was that the conditional cash transfers had no significant effect on sexual IPV, HIV or HSV-2 acquisition. There was however a significant risk reduction for physical IPV by 34%. It was interesting to note that there was 95% attendance in both arms of the study and that the cash payment had no effect at all on school attendance but may have given the young person the independence from a violent intimate partner.
I took a few interesting points from Shona Dalal of the World Health organisation that will be useful to my practice. She presented a systematic review of HIV partner notification services. Assisted versus passive notification where there were varying types of active notification - contract, provider or dual referral approaches. Contract is where the HIV positive client enters into a contract to disclose their status within a certain time frame and advise their partner to have HIV testing. Provider is where the provider confidentially contacts the HIV positive clients partner and offers voluntary testing. Dual referral is where the provider accompanies the HIV positive client to assist whilst they disclose their status and voluntarily offer HIV testing services.
With all types of notification if it didn't occur within a week it was less likely to occur. There were very few reports of harm and there was increased linkage to care and treatment among partners.
There was a talk from Sean Allen regarding a change in the policy of syringe distribution in Baltimore, MD from 1 syringe given for 1 returned to as many given as required. The number of syringes distributed doubled but the average number of HIV infections per month reduced.
Also covered in this session were male circumcision and its effect on transmissions to women of sexually transmitted diseases. And also community based distribution of oral HIV testing kits aiding the early diagnosis and treatment of men in Zambia.
Phew - what a session!