Most HIV-positive people who are on antiretroviral treatment have a near zero chance of transmitting the virus to others during unprotected sex, a European study has found.
In a finding that could dramatically change the lives of HIV-positive people and public health policies in Australia, a study of 282 gay men on treatment with undetectable levels of the virus in their blood, found that none of them transmitted it to their partners through unprotected sex over one year.
While a previous 2010 study of mainly heterosexual couples showed that having an undetectable viral load reduced the risk of transmitting the virus to an HIV-negative partner by 96 per cent, this is the first study to look at the risk in gay men, who make up about 80 per cent of the HIV-positive population in Australia.
HIV experts said that although the latest data presented from the PARTNER study at a US conference this week suggested an ”extremely low and possibly zero risk” of transmission among people with undetectable levels of the virus, it was too early to tell people that they could abandon condoms.
However, they said the study boosted hopes that a strategy of ”treatment as prevention” could play a major role in stemming the spread of HIV in Australia in coming decades and should prompt the federal government to explore more home-based testing so people know their status and can be treated earlier.
Professor Andrew Grulich, of the Kirby Institute, said that while some Australian states including NSW and Victoria had already introduced more rapid HIV testing to encourage people to know their HIV status, Australia should follow the US and allow tests to be sold over the counter in pharmacies for home-based use.
”I think home-based testing absolutely has a place in the testing response in Australia because treatment as prevention critically depends on people with HIV being diagnosed as early as possible, so they know they are infected and can take action to reduce their infectivity before they have any unsafe sex with anybody they could pass it on to,” he said.
Head of infectious diseases at the Alfred Hospital in Melbourne, Professor Sharon Lewin, said a ”treatment as prevention” strategy was promising because about 90 per cent of people on antiretroviral treatment have undetectable levels of the virus in their blood when they have tests, usually at six monthly intervals.
But she said limiting the spread of the virus was complex because about 8000 of the 33,000 people living with HIV in Australia do not know they are infected.
”It’s thought that about 50 per cent of new infections come from people who don’t know they are infected,” Professor Lewin said.
Furthermore, she said only about half of the 25,000 people who know they are HIV positive are receiving antiretroviral treatment for a range of reasons, including a historical requirement for people to show a certain amount of immune system damage to receive subsidised treatment.President of the National Association of People Living with HIV and AIDS Robert Mitchell welcomed the results of the PARTNER study which will continue to examine the risk of transmission among heterosexual and homosexual couples until 2017.
”These results provide further evidence of the powerful impact that HIV treatment has on preventing HIV transmission. It is important that every effort is made to alert people with HIV and their doctors to these latest findings, particularly as this study is the first of its kind to include a significant number of gay couples,” he said.
7 March 2014 News Release
JAKARTA, Indonesia – The Board of the Global Fund approved strategic, financial and operational components of a new approach to funding that offers more predictability, more flexibility, more inclusive country dialogue and a greater impact to defeat AIDS, TB and malaria.
At a meeting that concluded today, the Board approved final elements of the new funding model, opening the way for its full implementation to begin this month. Following a decision in November 2011 to “evolve the funding model,” the Board, its Committees and Global Fund staff have spent more than two years devising, refining and preparing a transition to the new funding model, coordinating closely with partners on each step.
“We are moving forward with a model that will enable our partners to reach more people with the information and services they need,” said Dr. Nafsiah Mboi, Chair of the Board of the Global Fund. “Working with partners, we are supporting the most effective methods to defeat AIDS, TB and malaria.”
The Board approved an updated comprehensive funding policy and an initial allocation of $10.2 billion for grants during 2014-2016. Ten percent, or close to US$1 billion, will go to “incentive” funding, to encourage ambitious plans.
With a more strategic approach based on national plans, the new funding model will support countries in planning how to control these epidemics and to provide care and treatment to people affected by them, including strengthening of health systems. The new funding model relies on strong country dialogue to bring partners together to best decide how to maximize impact, and to look at how all available resources can serve a country’s objectives.
Available funding for health interventions does not meet the full demand in many countries. The Global Fund encourages ambitious national strategic plans to defeat HIV, TB and malaria, and is aware that focusing on maximum impact can in the future achieve more than seems possible today. To enable long-term sustainability, the Global Fund is encouraging greater investment and long-term financing in countries all over the world.
The Board also approved a revised disclosure policy for the Office of the Inspector General, building further upon a policy of a high degree of transparency. The revised policy calls for publicly releasing all reports the Office of the Inspector General, including those on internal operations at the Global Fund.
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Global Fund News Release
KIGALI, Rwanda – The Government of Rwanda and the Global Fund are taking the lead on an innovative approach to health financing that is expected to significantly contribute to improving the efficiency of the fight against HIV in Rwanda and achieve greater impact.
A new grant agreement signed today will be used to implement Rwanda’s national strategic plan for HIV (2013-2018) with sharply reduced oversight. Rwanda and the Global Fund designed this new approach that is aligned with existing national systems and strategy, ties future disbursements directly to outcome and impact indicators, and lessens administrative burden and cost, in a framework of harmonization and mutual accountability.
It is the first time that the Global Fund is using this approach, and Rwanda has been chosen to pioneer this innovative model, because of its track record of success in health program and financial management.
Rwanda has emerged as a special success story for global health, having built a health care system, by coordinating development partners around one national plan, to give all citizens access to quality care. It has made tremendous gains against HIV and AIDS, and has already achieved a more than 50 percent reduction in HIV incidence rate among the adult population since 2000. If the current trends continue, Rwanda will go beyond the Millennium Development Goal target. As His Excellency President Paul Kagame said “MDGs are a ceiling not an end.”
Under the terms of the agreement signed here today, Rwanda and the Global Fund agreed that future disbursements will be directly tied to achievement of key outcome and impact indicators. This new flexible, Performance Based system emphasizes mutual accountability and greater country ownership of the national response.
“This is a great approach,” said Dr. Agnes Binagwaho, Minister of Health of Rwanda, adding that it is testimony to the achievements Rwanda has made in managing grant funding, and the partnership we enjoy with the Global Fund. We are confident that we will sustain the universal access to treatment and care, reduce new infections by two-thirds, and halve the number of AIDS deaths in the next five years.
The agreement, which includes funding of US$204 million, gives more flexibility on how funds are spent, and allows for savings to be re-invested in the national response. Grant funds will be part of a joint investment framework with financial assistance from the Government of Rwanda and other development partners.
Under the agreement, Rwanda will continue to monitor the achievement of universal access to HIV treatment and care for people living with HIV, and the reduction of new infections for key affected populations. The Global Fund will jointly verify the results with Rwanda.
“The main idea of this approach is to empower high-performing countries like Rwanda to further invest for higher impact,” said Dr. Nafsiah Mboi, Chair of the Board of the Global Fund. “They have proved this is possible, building on an outstanding HIV program, a robust HIV and AIDS national strategic plan, and strong financial and monitoring systems. We are proud to be their partners, and admire their accomplishments.”
The Global Fund will be looking into extending the approach to other countries, and also consider it for tuberculosis and malaria grants.
Global Fund News Release
CAPE TOWN, South Africa –Mark Dybul, Executive Director of the Global Fund, said the paternalism overshadowing relations between rich countries and poor in global health is giving way to an era of partnership that owes much to the vision of Nelson Mandela.
In a closing speech at the 17th International Conference on AIDS and sexually transmitted diseases in Africa (ICASA), Dr. Dybul paid a rousing tribute to the late South African leader, saying Mandela “broke the silence on HIV in Africa and he broke the silence on HIV in the world.”
“This week, let us finally end the paternalism in the world,” said Dr. Dybul.
Instead, he urged everyone to embrace Mandela’s vision for a world where every human being was a master of his or her destiny. A meeting of the International AIDS Society in Durban in 2000, which Mandela addressed, was widely seen as a turning point in the fight for wide access to treatment for HIV and opened the way to the creation of the Global Fund two years later.
The theme of the ICASA conference in Cape Town was entitled “Now More Than Ever: Targeting Zero,” underscoring a mood of growing optimism that the HIV pandemic can be turned into a low-level endemic that no longer poses a public health risk.
Dr. Dybul also called for the next ICASA meeting to add tuberculosis — the leading cause of death among those with HIV — to its name so that the disease “receives the emphasis it deserves.”
“HIV and TB are like two evil twins and we have the power and the responsibility to release them and we have the power and the responsibility to defeat them,” he said.
The time was long gone for “people from somewhere else” to tell countries in Africa how to tackle the AIDS, tuberculosis and malaria. “Your results have shattered the paternalistic myths of what should and can be done,” Dr. Dybul said.
Earlier in the day, Edwin Cameron, who serves as a justice on South Africa’s constitutional court, said stigma was one of the biggest obstacles to defeating the HIV pandemic.
“Stigma remains the most intractably resistant force in the epidemic,” Justice Cameron said. “It spreads blame, fear, inhibition, inaction and silence.”
Justice Cameron, who became the first senior official in South Africa to state in public that he was living with HIV, said men who have sex with men were shamefully treated in Africa: “Thirty-eight countries in Africa still persecute those who, like me, are oriented towards our same sex.”
The chair of the ICASA conference, Robert Soudré, said African countries could not continue to rely indefinitely on external support for HIV treatment.
“More than 80 percent of medicines are financed from external sources and that cannot continue,” said Soudré. “Our countries will have to make available their own resources and governments will have to rely above all on themselves.”
He added: “Zero stigma is what we should aim to achieve everywhere in the world, but also on our African continent.”
Dr. Dybul said although there was no single “silver bullet” that could end the HIV pandemic it was essential to deal with strongholds of infection among young women and girls; men who have sex with men; sex workers; people who inject drugs and prisoners.
“If we are going to address this epidemic we must deal with the strongholds. We must have our tools available for the most vulnerable and that means creating an inclusive human family,” he said.
“Let’s end silver bullet approaches to this epidemic and let’s just end the epidemic.”
Global Fund News Release
14 January 2014
GENEVA — UNAIDS and the Global Fund to Fight AIDS, Tuberculosis and Malaria express deep concern that access to HIV services for lesbian, gay, bisexual and transgender (LGBT) people will be severely affected by a new law in Nigeria––further criminalizing LGBT people, organizations and activities, as well as people who support them.
The new law could prevent access to essential HIV services for LGBT people who may be at high risk of HIV infection, undermining the success of the Presidential Comprehensive Response Plan for HIV/AIDS which was launched by President Goodluck Jonathan less than a year ago.
The health, development and human rights implications of the new law are potentially far-reaching. Homosexuality is already criminalized in Nigeria. The new law further criminalizes LGBT people, organizations and activities. The law states: “A person who registers, operates or participates in gay clubs, societies and organisation, or directly or indirectly makes public show of same sex amorous relationship in Nigeria commits an offence and is liable to conviction to a term of 10 years imprisonment.”
The law also criminalizes any individuals or group of people who support “the registration, operation and sustenance of gay clubs, societies and organisations, processions or meetings in Nigeria.” The conviction is also 10 years imprisonment.
The provisions of the law could lead to increased homophobia, discrimination, denial of HIV services and violence based on real or perceived sexual orientation and gender identity. It could also be used against organizations working to provide HIV prevention and treatment services to LGBT people.
Nigeria has the second largest HIV epidemic globally––in 2012 there were an estimated 3.4 million people living with HIV in Nigeria. In 2010, national HIV prevalence in Nigeria was estimated at 4 percent among the general population and 17 percent among men who have sex with men.
In the 2011 United Nations Political Declaration on HIV/AIDS, all UN Member States committed to removing legal barriers and passing laws to protect populations vulnerable to HIV.
UNAIDS and the Global Fund call for an urgent review of the constitutionality of the law in light of the serious public health and human rights implications and urge Nigeria to put comprehensive measures in place to protect the ongoing delivery of HIV services to LGBT people in Nigeria without fear of arrest or other reprisals. UNAIDS and the Global Fund will continue to work with the Nigerian authorities and civil society organisations to ensure continued and safe access to HIV services for all people in Nigeria.
UNAIDS and the Global Fund urge all governments to protect the human rights of lesbian, gay, bisexual and transgender people, through repealing criminal laws against adult consensual same sex sexual conduct; implementing laws to protect them from violence and discrimination; promoting campaigns that address homophobia and transphobia; and ensuring that adequate health services are provided to address their needs.
Global Health News
Pacific Friends of the Global Fund to Fight AIDS, Tuberculosis and Malaria is a high-level advocacy organisation which seeks to mobilise regional awareness of the serious threat posed by HIV & AIDS, tuberculosis and malaria to societies and economies in the Pacific. In pursuing its goals Pacific Friends has a specific interest in highlighting the need to protect the rights of women and children in the Pacific.