We won’t end the HIV epidemic until we help the most vulnerable

How do we reduce rates concentrated among black and Latino men who have sex with men? Or meet the needs of HIV-positive patients caught between insurance plans or places to live? To end the epidemic, we must start where we began — by focusing on those most affected, uniting advocacy efforts, pushing for a cross-sector response and focusing on the social determinants of health.

As someone who has spent the better part of my professional career as both an advocate and HIV public health expert, I’ve been reflecting on the decades-long fight for gay rights sparked by people who gathered together at Stonewall in 1969 to demand change for the LGBTQ+ community and put an end to years of discrimination. Not long after, the AIDS epidemic swept across the country, closely intertwining the movement for increased LGBTQ+ rights with the AIDS response. Gay rights groups were relentless in pushing for increased government attention and funding as thousands died from the disease. Activists organized “buyers clubs,” lobbied for faster FDA approval of promising drugs and countered the fear and discrimination people living with AIDS faced.

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Healthcare providers should discuss U=U with all their HIV-positive patients

From aidsmap.com

Healthcare providers should inform all patients with HIV they cannot transmit HIV to a sexual partner when their viral load is undetectable, argue the authors of  a strongly worded comment in The Lancet HIV. The authors note that despite overwhelming scientific data supporting the undetectable = untransmittable (U=U) message, significant numbers of healthcare providers do not educate their patients about U=U when telling them their viral load is undetectable.

“Providers caring for patients with HIV should universally inform their patients about U=U as part of their routine care,” write Dr Sarah Calabrese of George Washington University and Professor Ken Mayer of the Harvard Medical School and Fenway Institute. “Conveying benefits and risks surrounding any treatment is fundamental to patients’ decision making, and this HIV treatment benefit should be no exception.”

Read the article on aidsmap.com.

Why are we so coy about sex education for gay teens?

From theguardian.com

Society likes to keep gay teens sexless. It likes to maintain that gay content (even something non-sexual, like the representation of gay parents) is inappropriate for children’s TV or books. Those who complain say it’s too adult – implying that queerness, essentially, is all about sex, while straightness is just what a normal relationship looks like. It’s a weird dichotomy: straight people holding hands are non-sexual, while queer people holding hands is somehow the same as broadcasting pornography. The message is clear across all media: gays have to be kept sexless because they’re already too much about sex.

Read the full article by novelist Lev Rosen.

Experts debate if HIV prevention pill contributes to rise in other STDs

Prevention program manager Adam Weaver talks about sexually transmitted diseases in the testing room at Palmetto Community Care in North Charleston

From postandcourier.com

The STD explosion has led to a debate over a possible connection since the introduction of the HIV prevention pill.

PrEP is not a cure for HIV, and it also is not 100 percent effective, but, taken as directed at the same time once a day, it comes pretty close — up to 99 percent successful in preventing HIV, according to Palmetto Community Care, formerly Lowcountry AIDS Services, in North Charleston.

The drumbeat of safe sex practices hasn’t changed among health officials. Abstinence, using condoms and being in a monogamous relationship are still the best ways to help prevent STD infections.

But the naked truth is people don’t always follow that advice.

“After they start taking PrEP, we don’t see a great shift in risk behavior,” said Aaron O’Brien with Roper Hospital’s Ryan White Wellness Center.

Aaron O’Brien, quality and development manager of Roper Hospital’s Ryan White Wellness Center.

He puts condom users into two groups: those who use them regularly and those who don’t, and, based on his talks with patients, that doesn’t change much once they start taking the pill.

Adam Weaver, prevention program manager at Palmetto Community Care, agrees with O’Brien.

“What we are finding is that the people we are putting on PrEP aren’t changing their condom use,” he said.

They also don’t believe PrEP’s introduction, in and of itself, contributed to the explosion in STDs.

They say it has more to do with better reporting since people taking PrEP must check in with their doctor or provider every three months or so for regular testing.

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Stop blaming PrEP for the increase in STI rates

From LGBTQ Nation

In an interview with the Los Angeles Blade about the new study, lead author Phillip Hammack, a professor at the University of California, Santa Cruz, debunked the notion.

“Our data don’t support the idea that we can attribute the rise in STIs to PrEP use, at least not in a direct manner. I personally don’t think that’s what’s happening,” said Hammack.

Instead, Hammack points at the rise of dating apps like Grindr, and a decrease in fear towards contracting HIV, as more likely causes.

“I would speculate it has more to do with a culture shift about sex,” said Hammack. “More people are having sex today. We’re in sort of a quiet sexual revolution when it comes to new identities, new labels, and sexual behavior.”

On the down side, the study also showed that only 4% of men who have sex with men are using PrEP. What’s more, many gay and bisexual men aged 18-25 aren’t getting annual HIV tests. 25% of men who have sex with men in that age range have never gotten an HIV test.

“I worry especially about younger men who didn’t grow up with the concerns of HIV that men of older generations did,” said Hammack in the William Institute press release on the study. “The low rate of HIV testing probably reflects a degree of complacency and cultural amnesia about AIDS.”

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Opinion: Why don’t more Americans use PrEP?

From the New York Times

Truvada was approved by the Food and Drug Administration in 2012. But over six years later, the United States is failing miserably in expanding its use. Less than 10 percent of the 1.2 million Americans who might benefit from PrEP are actually getting it. The major reason is quite clear: pricing. With a list price over $20,000 a year, Truvada, the only PrEP drug available in the United States, is simply too expensive to become the public health tool it should be.

[…] The disparities in PrEP access are astounding: Its use in black and Hispanic populations is a small fraction of that among whites. In the South, where a majority of H.I.V. infections occur, use is half what it is in the Northeast. Women use PrEP at drastically lower rates than men, and while there’s no national data on PrEP and transgender Americans, it’s almost certainly underused. The issue of PrEP access has become an issue of privilege.

The ability of PrEP to greatly reduce new H.I.V. infections is no longer in question. In New South Wales, Australia, a program providing free access to PrEP led to a drop in H.I.V. diagnoses in the most vulnerable communities by a third in just six months, one of the fastest declines recorded since the global AIDS crisis began.

Read the full article on New York Times online.

Opinion: We need to talk about how Grindr is affecting gay men’s mental health

I’m a gay psychiatrist. Here’s why I went on Grindr to survey men.

When I open the Grindr app on my smartphone, I see there’s a 26-year-old man with tanned abs just 200 feet away. He’s called “looking4now,” and his profile explains that he wants sex at his place as soon as possible.

Scrolling down, I find 100 similar profiles within a one-mile radius of my apartment in Boston. I can filter them by body type, sexual position (top, bottom, or versatile), and HIV status.

As a gay psychiatrist who studies gender and sexuality, I’m thrilled with the huge strides we’ve made over the past decade to bring gay relationships into the mainstream. The Supreme Court ruled that same-sex marriage is a constitutional right. Today in Boston, two men can walk down the street holding hands without consequence.

But I’m worried by the rise of the underground digital bathhouse. Apps like Grindr, with 3 million daily active users, and others like Scruff and Jack’d, are designed to help gay men solicit sex, often anonymously, online. I am all for sexual liberation, but I can’t stop wondering if these apps also have a negative effect on gay men’s mental health.

Since there’s little published research on the men using Grindr, I decided to conduct an informal survey and ask men why they’re on the app so much and how it’s affecting their relationships and mental health. I created a profile identifying myself as a medical writer looking to talk to men about their experiences. I received about 50 responses (including propositions).

It’s a small sample size, but enough to give us some clues about how Grindr is affecting gay men. And it doesn’t look good.

Read the full article on Vox.