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How Sexual Agreements Affect HIV Risk, Relationship Satisfaction

A new study examining the relationship dynamics of gay male couples finds t...
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AIDS Drugs Given To Pregnant Women Block 99 Percent Of HIV Transmission To Breastfed Babies

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Older People With HIV Face Multiple Disadvantages, Study Finds, UK

February 24, 2011

People with HIV aged 50 and over are now set to live into later life, thanks to medical advances, but are substantially more disadvantaged than their peers in the general population. According to '50 Plus', the first national study of ageing and HIV, launched tomorrow in Vienna at AIDS 2010, the 18th International AIDS Conference, by charities Terrence Higgins Trust and Age UK for The Joseph Rowntree Foundation, they have worse health, are poorer and fear for the future.

Findings show that older people living with HIV are twice as likely to experience other long-term health problems alongside HIV, such as high blood pressure, kidney and liver problems and arthritis, with two thirds having treatment for these conditions.

This group is also financially disadvantaged in comparison to people their age without HIV. They are less likely to be working, less likely to have a financial cushion for their retirement and more reliant on state benefits. Many have serious financial worries for their future. Older people with HIV are less likely to be homeowners and more likely to live in social or private rented housing. One respondent commented: "Since I was diagnosed in 1985 I regarded this as a death warrant and ceased to make any pension provisions."

Older people with HIV state good quality health and treatment information as their highest priority, but three quarters have fears about needing health and social care in the future. One interviewee said: "I also fear that, in case I need to be cared for, the carer would be as ill-informed and prejudiced about HIV as the rest of the general public."

Designed with older people living with HIV, '50 Plus' investigated the needs and concerns of 410 people (one in 25 of all people aged 50 and over living with HIV and currently being seen for care in the UK) to raise awareness of the issues that this group face and advocate for their specific social care needs.

Terrence Higgins Trust's Head of Policy, Lisa Power, said: "As a result of effective treatment options, and our ageing population, the over 50s are now the fastest growing group of people with HIV in the UK, and there's a long way to go regarding support for this group. Older people with HIV are living with high levels of uncertainty about their future health and social care and need substantially more support than their peers.

"The information we've gathered through '50 Plus' is vital in giving us a better understanding of the unique problems that older people with HIV face on a daily basis in the UK. With this insight we can develop support services that are fully tailored to this group's needs to ensure they have the same quality of life as their peers."

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Other findings from the report show that:

- Older people with HIV are a rapidly growing and diverse group. The majority of this group are gay and bisexual men but there are also high numbers of African migrants and white heterosexuals. Some are long-term survivors whilst others have been recently infected- one in five respondents (21%) were diagnosed in the 1980s but the greatest number (41%) were diagnosed since 2000.

- Whilst older people with HIV think highly of their HIV clinicians, many report poor experiences in primary care, including discrimination, ignorance and a low standard of clinical treatment, and visit their GPs and generalist healthcare services less than older people in general. Many also fear that social care services, care homes and sheltered housing might be HIV prejudiced and/or homophobic.

- Many report feeling isolated and would like more social contact and support. Most prefer to find this through HIV organisations.

- Most were open about their HIV status in key relationships and have found reactions largely positive; however, disclosing that have HIV is still seen as risky.

In response to these research findings, Terrence Higgins Trust, Age UK and The Joseph Rowntree Foundation are calling for five specific areas of action:

- Improvements in healthcare to ensure access to good quality treatment in all settings and availability of better information to older people with HIV.

- Better employment support, money management courses and benefits advice.

- Addressing homophobia, HIV discrimination and ageism in all services, but especially in social housing, sheltered housing, care homes and health services (particularly primary care).

- Improved emotional support and opportunities for social contact, to prevent isolation.

- Greater cooperation and information sharing between organisations and services for older people, and those for people with HIV, to improve policy and practice.

Michelle Mitchell, Charity Director at Age UK, said: "This report clearly shows that the problems many of us face in later life, such as financial pressures, deteriorating health and isolation are all exacerbated by the impact of HIV on people's lives. Now people are living far longer with HIV than ever before, we need to shift the focus on support services to improving quality of life. To achieve this, it is vital that we increase awareness and understanding of the needs of this group across a range of health, social care, housing and advice services."

The full '50 Plus' report will be available from October 2010 on The Joseph Rowntree Foundation website and both Terrence Higgins Trust and Age UK will be using the findings to inform future service development.

Notes

1. '50 Plus' research was conducted through an online and paper questionnaire and 40 in-depth interviews from a sample of adults aged 50 or over with HIV across the UK in 2009. 50 Plus was based on 410 responses to an online and paper questionnaire and 40 in depth interviews from a sample of adults aged 50 and over with HIV across the UK in 2009. The questionnaire was devised with the support of a Community Advisory Panel and interviews conducted by trained community researchers living with HIV. A literature review and visits to existing ageing and HIV work in the US were also undertaken. Further data, including all statistical charts and the full literature review, is available from here.. All queries and requests for further information should be addressed to lisa.power@tht.org.uk or Lisa Power, Policy & Information Director, Terrence Higgins Trust, 314-320 Grays Inn Road, London WC1X 8DP.

Source:
Terrence Higgins Trust
Age UK
The Joseph Rowntree Foundation (JRF)


Future HIV Vaccines: If We Build It, Will They Come?

February 16, 2011

On the eve of the world's biggest AIDS conference this month in Austria, a new research review shows many people wouldn't get inoculated against HIV even if a vaccine was developed.

The authoritative review -- published in this month's edition of the journal AIDS -- was led by Peter A. Newman, associate professor at the University of Toronto's Factor-Inwentash Faculty of Social Work. Newman and PhD candidate Carmen Logie drew conclusions from 30 previous research papers involving nearly 12,000 people on the topic of HIV vaccine acceptability.

"One might assume that if an HIV vaccine was available, many people would line up to be vaccinated. However, the research strongly indicates this is not the case," says Newman, Canada Research Chair in Health and Social Justice. "The availability of a vaccine alone is not enough to ensure that people will be inoculated."

Newman and Logie's meta-analysis of existing literature identified several factors that could influence people's willingness to be inoculated with an HIV vaccine. Among them:

    * The effectiveness of a vaccine: The research showed people would be far less likely to take an HIV vaccine if it was only 50 per cent effective in protecting against HIV infection:
          o If a vaccine was 50 per cent effective in protecting against HIV, only 40 per cent of people said they would accept it
          o If a vaccine was 100 per cent effective, 74 per cent of people said they would accept it

    * Risk perception: The research showed many people do not see themselves as being "at risk" of contracting the disease -- even if they are -- and so would not consider being inoculated against HIV.
    * Structural factors: The research showed that factors such as cost and access to vaccines would prevent some people from seeking inoculation.

Additional but less influential factors included fear of side effects and fear of vaccines.

"If we want a future HIV vaccine to be acceptable and accessible to people, we need to address these factors now, before the vaccine is publicly available," says Newman. "Otherwise, we'll get to the point where we've got a safe and reasonably effective vaccine but the public is not prepared or able to receive it."

Logie says the research indicates a growing need for public education. People need to understand what scientists mean when they talk about a vaccine's efficacy, she says.

"The research shows that some people are highly suspicious of vaccines that are less than 100 per cent effective, but the fact is, not every vaccine is 100 per cent effective. That's something the public needs to understand," she says.

There must be more education and awareness around the benefits of vaccines and the continuing risk of HIV, particularly in young people, says Newman. "It's a challenge to have people weigh the very miniscule risks of getting a vaccine against the far greater risks of HIV." And governments need to consider what can be done to address "structural barriers" such as cost for vaccines and making them easily accessible.

"The research has clearly identified factors that would influence people's decisions around HIV vaccinations," says Newman. "Now, we have to ask ourselves, 'which of those factors can we begin to address, and how?'"

Story Source:

    The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by University of Toronto, via EurekAlert!, a service of AAAS.


How Sexual Agreements Affect HIV Risk, Relationship Satisfaction

February 10, 2011

A new study examining the relationship dynamics of gay male couples finds that couples make "sexual agreements" -- rules about whether sex with outside partners is allowed -- primarily because they want to strengthen and improve their relationship rather than for protection against HIV. Published in the journal AIDS Care, the study explores how sexual agreements affect both HIV risk and a relationship's satisfaction and quality, and contains insights for HIV prevention.

Gay couples' top reasons for establishing sexual agreements were to build trust in the relationship, promote honesty between partners and to protect the relationship, according to the study, led by Colleen Hoff, professor of sexuality studies at San Francisco State University.

"We found that gay couples are interested in building healthy, satisfying and loving relationships," Hoff said. "These desires, when nurtured, can lead to strong relationships. Yet the reality is that a broken sexual agreement, or one that isn't clear to either partner, can make both partners vulnerable to HIV."

Widespread among gay couples, sexual agreements can include conditions limiting when, where, how often and with whom outside sex is permitted and whether safe sex is practiced.

Hoff and colleagues surveyed 566 gay male couples in the San Francisco Bay Area and found that 99 percent had sexual agreements. Specifically, 45 percent had monogamous agreements, 47 percent had open agreements and 8 percent of couples had discrepant agreements where partners reported a different understanding of whether they have an open or monogamous agreement.

"Discrepant couples were particularly concerning in terms of HIV risk," Hoff said. "When there isn't consensus on what the agreement is, one partner could be involved in risky behavior outside of the relationship and the other partner may be unaware of the resulting risk of unprotected sex within the relationship."

The study suggests that knowing what motivates gay couples to make sexual agreements could help HIV prevention programs tailor their efforts to be relevant to the whole relationship. "HIV prevention needs to take a more holistic approach that goes beyond messages about safe sex," Hoff said. "Helping gay couples learn how to negotiate robust sexual agreements and how to disclose and deal with a break in an agreement could be an effective approach to HIV prevention."

Participants in the study responded to a series of statements assessing their satisfaction with their relationship and various relationship characteristics, such as trust and intimacy. The study found no significant difference in relationship satisfaction between men in open or discrepant relationships and those in monogamous relationships. For relationship characteristics, participants' responses did vary significantly depending on the type of sexual agreement they had (open, discrepant or monogamous). Men in monogamous relationships reported greater levels of intimacy with their partner, more trust, commitment and attachment toward their partner and greater equality in the relationship.

Funded by the National Institute of Mental Health, this study is part of a five-year longitudinal study following the relationship dynamics of 566 gay couples in the context of HIV prevention.

"Relationship characteristics and motivations behind agreements among gay male couples: differences by agreement type and couple serostatus" was published in the July 2010 issue of the journal AIDS Care. In addition to Hoff, co-authors include Sean C. Beougher, Deepalika Chakravarty, Lynae A. Darbes and Torsten B. Neilands.

Colleen Hoff is professor of sexuality studies at San Francisco State University and director of the University's Center for Research on Gender and Sexuality.

Story Source:

    The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by San Francisco State University, via EurekAlert!, a service of AAAS.


Higher STD Rates Among Users of Erectile Dysfunction Drugs

February 03, 2011

Physicians who prescribe erectile dysfunction drugs for their male patients should be sure to discuss the importance of safer sex practices, even with older patients: that is an important implication of a report in the July 6 issue of Annals of Internal Medicine. The analysis of insurance records of more than 1.4 million U.S. men over 40 found that those who used ED drugs were more likely to have sexually transmitted diseases than were non-users.

"Anyone who does not practice safer sex, no matter their age, can contract an STD," says Anupam B. Jena, MD, PhD, of the Massachusetts General Hospital (MGH) Department of Medicine, the study's lead author. "Even though STDs are quite rare among older men -- on the order of 1 per 1,000 individuals -- we found that STD rates in men who used ED drugs were two to three times higher, both before and after they filled their first prescription."

Jena and his co-authors note that ED drugs have become popular since sildenafil (Viagra) was first introduced in 1998. As early as 2002 it was estimated that up to 20 percent of U.S. men over 40 had tried an ED drug. Studies have shown both that rates of STDs, including HIV/AIDS, are rising in older individuals as well as the general public and that people over 50 are much less likely than those in their 20s to use condoms during sex or be tested for HIV infection. A survey of primary care physicians found that they rarely if ever discussed reducing sexual risk factors with middle aged or older patients.

Small studies of men who have sex with men had associated the use of ED drugs with higher-risk behaviors and increased rates of STDs. But no previous study had examined the relationship between ED drugs and STD risk in a large, representative sample of privately insured older men. For the current study, the researchers examined health insurance claims records covering 1997 though 2006 from 44 large U.S. employers. For male beneficiaries over 40 who used ED drugs, the researchers collected data covering one year before and one year after the first prescription was filled. Each ED drug user was matched with five non-users randomly selected from the database, for whom claims data covering the same two-year periods was collected.

The final study group included about 40,000 men who used ED drugs and nearly 1.37 million who did not. In both the year before and the year after the first ED drug prescription, users had significantly higher rates of STDs than non-users did in matching time periods. HIV/AIDS was the most frequently reported STD in both groups, followed by chlamydia. Since the prevalence of STDs did not markedly change after ED drug therapy began, the authors note that the difference between groups probably reflects higher-risk sexual practices among users of the drugs. The data gathered could not indicate whether ED drug use itself increased STD risk, but the authors are investigating that question in a further study.

"Health care providers need to recognize that their older adult patients who are on ED drugs are already at a higher risk of having or acquiring an STD," says Dana Goldman, PhD, director of the Schaeffer Center for Health Policy and Economics at the University of Southern California (USC), the study's senior author. "Both the physicians who prescribe these drugs and the pharmacists who fill those prescriptions should counsel all patients on the importance of safer sexual practices."

Co-authors of the Annals of Internal Medicine report are Amee Kamdar, PhD, University of Chicago; Darius Lakdawalla, PhD, Schaeffer Center at USC; and Yang Lu, PhD, RAND Corporation. The study was supported by grants from the RAND Roybal Center for Health Policy Simulation, the National Institutes of Health, the Agency for Healthcare Research and Quality, and the Bing Center for Health Economics.

Story Source:

    The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by Massachusetts General Hospital, via EurekAlert!, a service of AAAS.



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