Easier access to public health care for HIV-infected gay men (Observer)

Ingrid Brown

HIV-infected men who have sex with men (MSMs) now experience little or no barrier in accessing services at the island's public health facilities despite Jamaica's stringent buggery laws which criminalises the practice.

This has been made possible by the Ministry of Health which recently facilitated the Jamaica Forum of Lesbians, All-Sexuals and Gays (J-FLAG) training of some 60 health-care professionals, to sensitise them on dealing with this population.

Minister of Health Dr Fenton Ferguson told the Jamaica Observer that J-FLAG has undertaken the training of a number of health professionals across the island to sensitise them on the need to better treat with this vulnerable population.

Ferguson expressed delight that J-FLAG was able to satisfactorily complete the training programme with the health-care professionals.

"That will be very helpful, as a major concern for Jamaica is the MSMs which is now consistently showing a HIV prevalence rate of 32 per cent," Ferguson said, adding that he will be reinforcing this point when he speaks at the upcoming graduation exercise for those who benefited from the training.

Meanwhile, J-FLAG said Jamaica AIDS Support (JAS) has always operated a fully functional clinic to treat its clients, including MSMs, who shy away from the island's clinics and hospitals.

According to Brian Paul, sub-regional co-ordinator of the Caribbean Forum of the Liberation and Acceptance of Genders and Sexualities (CariFLAGS) and advocate for J-FLAG over the last decade, agencies like JAS were empowered to do work with MSMs and transsexuals because the government's health system was not very embracing of diversity

given that there was a lot of hostility against lesbian, gay, bisexual, and transgender (LGBT) people.

"When you get to the gate security guards would turn you away and nurses and other administrative staff within the compound would have been hostile, and so a lot of LGBT people relied on NGOs like JAS to provide that clinical care," he told the Observer. "However, over the years with greater exposure and education, the health-care providers at all levels are now more knowledgeable on sexual diversity and because of that they are now more sensitive to the needs of the population, so we are seeing a lot

more LGBT people accessing health-care in the public sector," Paul said.

He noted that this has been the result of years of advocacy work.

"The national HIV programme has also done a lot to empower its staff and to train persons to be better equipped to deal with the population," he said.

He noted, however, that while the majority of health care providers at all levels are sensitive to the issues of diversity, there are some

who are still interacting with their own personal prejudices and stigma.

"So they may know very well that their jobs depend upon them being tolerant and embracing of diversity, but their own personal stigma and prejudices are still present. But with the advent of the HIV-redress system and with empowerment of NGOs, less and less are we hearing of reports of real discrimination," he said.

Paul said J-FLAG's recent training session with public health-care professionals included persons from deep rural Jamaica as well as the urban centres.

The training, he said, was necessary because some persons were still not sure how to deal with LGBT people.

"Those from the furthest rural parish said they had no idea about these issues and on the rare occasion if they had to deal with a gay or

lesbian client, they were figuring it out as they went along," he said.

Meanwhile, Dr Ferguson told the Observer that he recently had a major consultation with Pan Caribbean Partners Against HIV/AIDS (PANCAP) as well as a Global Fund official and a number of other high-level stakeholders to address the issues faced by the MSM population.

"It was a two-day consultation on justice for all which is focusing on those most-at-risk such as MSMs and sex workers," he said.

Dr Ferguson said Jamaica was able to secure US$19 million from Global Fund for its HIV programme.

Jamaica was initially expecting to receive $5 million for the transitional period 2013-2015, but as the alternate member on the Global Fund Board for Latin America and the Caribbean, Fenton said he engaged the international community about the need for upper-middle income countries to continue to receive support.

"We cannot afford to lose the gain of the last decade with HIV and so we are now in a position where we will be getting US$19 million from The Global Fund which I believe coming from US$5 million is significant," he said.

Gay Men Divided Over Use of HIV Prevention Drug Truvada in the US

By DAVID CRARY AP National Writer

It's the Truvada conundrum: A drug hailed as a lifesaver for many people infected by HIV is at the heart of a rancorous debate among gay men, AIDS activists and health professionals over its potential for protecting uninfected men who engage in gay sex without using condoms.

Many doctors and activists see immense promise for such preventive use of Truvada, and are campaigning hard to raise awareness of it as a crucial step toward reducing new HIV infections, which now total about 50,000 a year in the U.S. Recent efforts range from think-tank forums and informational websites to a festive event at a New York City bar featuring popular drag queens.

Yet others — despite mounting evidence of Truvada's effectiveness — say such efforts are reckless, tempting some condom users to abandon that layer of protection and exposing them to an array of other sexually transmitted infections aside from HIV.

"If something comes along that's better than condoms, I'm all for it, but Truvada is not that," said Michael Weinstein, president of the AIDS Healthcare Foundation. "Let's be honest: It's a party drug."

Even as gay-rights organizations celebrate collective progress in the fight to legalize same-sex marriage, the less-publicized Truvada debate has fueled bitter divisions within the gay community. Some who use the drug say they've felt shamed by some who don't, and there's now a lively backlash by users and their allies, including promotion of a "Truvada Whore" T-shirt.

"The discussion can torch emotions like a flame-thrower on a fuel depot," wrote Steve Ramos of the Dallas Voice as the gay-oriented publication reported on the debate in March.

Truvada, produced by California-based Gilead Sciences, has been around for a decade, serving as one of the key drugs used in combination with others as the basic treatment for people who have the AIDS-causing virus HIV. However, the drug took on a more contentious aspect in 2012 when the Food and Drug Administration approved it for pre-exposure prophylaxis, or PrEP — in other words, for use to prevent people from getting sexually transmitted HIV in the first place.

Since then, critics have warned that many gay men won't heed Truvada's once-a-day regimen and complained of its high cost — roughly $13,000 a year. Truvada's proponents say most insurance plans — including Medicaid programs — now cover prescriptions for it, and they cite studies showing that the blue pill, if taken diligently, can reduce the risk of getting HIV by more than 90 percent.

Dr. Demetre Daskalakis, medical director of the ambulatory HIV program at New York's Mount Sinai Hospital, served on the FDA panel that recommended approving Truvada for preventive purposes and is among many doctors who hope that doubts about it fade.

"For folks who are having a significant amount of unprotected sex, it's a slam dunk — not only giving them protective medicine, but engaging them in testing, a whole package of regular health care," he said.

Yet Daskalakis says that out of his large clientele, only about 25 men are taking Truvada for prevention.

"There's some interesting social pushback," he said. "I've spoken to some of my patients who'd totally be candidates but are hesitant to do it. They don't want to be labeled as people on the drug because there's a social stigma."

Daskalakis is dismayed by groups like the Los Angeles-based AIDS Healthcare Foundation — one of the country's leading HIV/AIDS service providers — which suggest that prescribing Truvada for prevention means condoning condomless sex.

"I find some of that opposition irresponsible," Daskalakis said. "If some men don't want to use condoms, they won't. You have to deal with it by acknowledging that sometimes unprotected sex happens, and you can still prevent HIV infections."

To date, preventive use of Truvada appears to be limited, due partly to misgivings among some gay men and partly to lack of awareness.

According to Gilead, 1,774 people starting using Truvada for prevention between January 2011 and March 2013 — nearly half of them women. The company said more recent figures aren't available, but health officials in several cities said they see no signs of a major surge in usage.

"Out of our thousands of patients, we have about 20 on PrEP," said Dr. Robert Winn, medical director at Philadelphia's Mazzoni Center, which serves many gay clients.

"Many ask about it, few take it," Winn said. "The number one reason for that gap is the commitment of having to take it every day."

Weinstein, the AIDS Healthcare Foundation leader, takes heart from the low usage figures, saying they bear out his reservations about Truvada. He says he's undeterred by criticism of his insistence that condomless sex — even in the Truvada era — should be discouraged among gay men with multiple partners.

"There's an element in the gay community that espouses 'anything goes,' that is for sexual freedom and not giving an inch," he said. "But demonizing me or AHF isn't going to shut us up."

Another Truvada skeptic is Richard Weinmeyer, a research associate with the American Medical Association's Ethics Group. In an article in February in Bioethics Forum, Weinmeyer — expressing his personal views — argued that preventive use of Truvada could encourage sexual irresponsibility.

"Personal responsibility for one's actions has simply been thrown out the window in a community in which we are too often concerned about stigma and moral judgment," he wrote. "We dare not speak against the reckless behavior of others because we wring our hands over the omnipresent worry that we will shame one another."

The article drew some harsh online criticism; readers called it "puritanical" and "fear-mongering." But Weinmeyer raised a topic that's a visceral part of the debate — the concept of gay-on-gay "shaming" in which men using Truvada as PrEP are stigmatized.

New York psychotherapist Damon Jacobs, an enthusiastic Truvada user since 2011, has encountered the shaming syndrome as he encourages more gay men to learn about the drug's preventive capabilities. Since co-founding an informational web site called PrEP-o-licious.org, Jacobs says he's heard from men distressed by reactions they faced after broaching the possibility of taking Truvada.

"They'd email me about the names they were called — the 'Truvada whore' syndrome," Jacobs said. "They'd talk with their friends about responsible condomless sex, and they'd get shamed. They'd get seen as a slut."

The U.S. Centers for Disease Control and Prevention offers extensive information about PrEP on its web site.

"Strong research evidence indicates that PrEP, when used consistently, is safe and effective for reducing the risk of acquiring HIV sexually," it says.

However, Jacobs says other wings of the medical establishment should be more active in disseminating that message, both to gay men and to doctors.

"A lot of doctors are still under the belief that if they give their patients PrEP, they'll go out and have condomless sex," Jacobs said. "What they don't understand is that gay men are already doing that."

At the Fenway Institute in Boston — which specializes in gay, lesbian and transgender health — many doctors initially had misgivings about PrEP, but have overcome them, according to Dr. Kenneth Mayer, the institute's medical research director.

"There definitely were apprehensions at the beginning — would it increase risk-taking behavior, would people take it regularly," Mayer said. "More recently, the questions are not whether it's a good idea, but the optimal way to provide it, and which patients are the best candidates."

"I don't have an issue with people voicing concerns about it, but we have proof it works," said Mayer, who hopes high-level federal officials get more involved in the public discussion.

Another challenge is raising awareness of PrEP in black communities with high HIV infection rates.

"We have young minority men becoming infected at disproportionately alarming rates, and now we have something that could avert this," said Lynnette Ford of GMHC, a New York City AIDS service organization. "But there's not a lot of information out there in communities that need it most."

Demetre Daskalakis, the Mount Sinai doctor, said the Truvada debate recalls the way birth control was viewed in some quarters in the 1960s — as an accessory to promiscuity.

"Anyone who takes Truvada, someone is looking at them and saying they're licentious," Daskalakis said. "When this becomes more normalized, we'll be fine."

————

Online: CDC fact sheet: http://www.cdc.gov/hiv/pdf/prevention—PrEP—factsheet.pdf

Higher pill burden is associated with poorer adherence to HIV therapy and reduced chances of achieving an undetectable viral load

AIDSmap

Lower pill burden is associated with higher rates of adherence to HIV treatment and better virological outcomes, according to the results of a meta-analysis published in the online edition ofClinical Infectious Diseases. The research also showed that adherence was better with once-daily regimens compared to twice-daily treatment, but once-daily therapy did not have any advantages in terms of virological suppression.

“Higher pill burden was associated with both lower adherence and worse virologic suppression in both twice-daily and once-daily subgroups,” comment the authors. “Adherence was higher with once-daily ART [antiretroviral therapy] regimens than twice-daily regimens…however, this difference was minimal and did not translate into better treatment outcomes.”

The past decade has witnessed important improvements in antiretroviral treatment. Overall, drugs are now less toxic and better tolerated than in the past. Pill burden has also been reduced and dosing schedules simplified. Two fixed-dose pills (Atripla and Stribild) are now available, providing potent HIV therapy in a single tablet.

A meta-analysis of randomised trials published in 2009 showed that once-daily treatment was associated with higher rates of adherence compared to twice-daily therapy, but that rates of virologic suppression did not differ greatly between the treatment strategies.

More randomised trials have been published since then. An international team of investigators therefore re-visited the questions of whether pill burden and dosing schedule have an impact on adherence and virologic suppression.

Randomised-controlled trials comparing once- and twice-daily therapy published or presented before 31 March 2013 were eligible for inclusion in the analysis. The study populations could include people who had not taken treatment before (treatment naive); treatment-experienced people switching treatment with an undetectable viral load; or treatment-experienced people switching treatment with detectable viraemia.

A total of 19 studies including 6312 people met the inclusion criteria. The studies were conducted between 2004 and 2011. Most (18/19, 95%) were published in peer-reviewed journals. Seven studies (37%) included treatment-naive patients, nine (47%) monitored patients who switched treatment with an undetectable viral load and three (16%) evaluated treatment-experienced individuals who changed treatment when their viral load was detectable.

The median duration of follow-up was 48 weeks, and 17 studies (89%) reported on both adherence and virologic suppression. The majority of studies (eleven, 58%) used MEMS (Medication Event Monitoring System) to assess adherence. The remaining eight studies used pill count.

However, the authors note that none of the studies included fixed-dose single pill therapies.

Higher pill burden was associated with lower rates of adherence (p = 0.004). But when the results were stratified by treatment strategy, the association between adherence and pill burden was only significant for twice-daily combinations (p = 0.001).

There was also a significant association between higher pill burden and reduced chances of achieving virologic suppression (p < 0.0001). This was the case for both once-daily (p = 0.005) and twice-daily (p = 0.0003) regimens.

Turning to dosing schedule, adherence was higher with once-daily regimens compared to twice-daily therapy (weighted mean difference [WMD] = 2.51%; 95% CI, 1.20%-3.83%, p = 0.0002). The adherence advantage of once-daily treatment was apparent in treatment-naive individuals (WMD = 3.94%; 95% CI, 1.42%-6.47%, p = 0.0002), as well as people switching therapy with detectable viraemia (WMD = 5.28%; 95% CI, 0.60%-9.96%, p = 0.03) and also people who changed treatment with an undetectable viral load (WMD = 0.95%; 95% CI, 0.36%-1.54%, p = 0.002). The difference between these sub-groups was significant (p = 0.02).

Virologic outcomes did not differ significantly between once- and twice-daily regimens. The investigators believe there are several possible explanations for this finding. These include the relatively small difference in adherence rates between once-and twice-daily regimens; the short period of follow-up in many studies; and the high levels of adherence support provided in clinical trials. “For all these reasons,” write the investigators, “the difference in virologic suppression that we found between once- and twice-daily ART regimens may be understated.”

They conclude that once-daily treatment is associated with better adherence, and that higher pill burden is associated with poor virologic outcomes.

The authors believe their findings are of significance to health systems which are looking at ways of reducing costs. Single tablet HIV therapy and fixed-dose combinations are marketed at a premium, but the investigators believe “separating out the single-tablet regimens and or/fixed-dose combinations into their constituents is not likely to have a major detrimental impact on virological outcomes (provided that the overall pill burden does not increase dramatically).”

Reference

Nachega JB et al. Lower pill burden and once-daily dosing antiretroviral treatment regimens for HIV infection: a meta-analysis of randomized controlled trials. Clin Infect Dis, published online ahead of print, 22 January 2014.

New HIV Drug Class Shows Promise

Cenicriviroc, an investigational antiretroviral from the new dual CCR5/CCR2 inhibitor class (photo), performed well in a Phase II trial, although with a high drop-out rate because of a complicated dosing. Investigators are currently developing a simplified regimen to mitigate that problem. Presenting their findings at the 14th European AIDS Conference in Brussels, researchers recruited 143 treatment-naive people with HIV for this double-blind/double-dummy study.

The participants were randomly assigned to take Truvada (tenofovir/emtricitabine) plus either 100 milligrams or 200 mg of cenicriviroc or 600 mg of Sustiva (efavirenz). Because cenicriviroc was only available as a 50 mg pill at the time of the study, participants took four pills (which were either cenicriviroc or a placebo) in the morning, one pill (efavirenz or a placebo) at bedtime and one Truvada at a time of their choosing.

This dosing schedule appeared to contribute to the high rate of dropouts: 29 percent in the 100 mg of cenicriviroc group left the study prematurely, compared with 27 percent in the 200 mg cenicriviroc group and 39 percent in the Sustiva group. Twenty-one percent of the Sustiva arm dropped out because of adverse events, compared with none in the 100 mg cenicriviroc arm and 2 percent in the 200 mg arm.

At 24 weeks, 76 percent in the 100 mg arm reached an undetectable viral load, compared with 73 percent in the 200 mg arm and 71 percent in the Sustiva group. By 48 weeks, these numbers had dropped considerably, mostly because of all the dropouts. The respective rates of a fully suppressed viral load considering all those initially assigned to each group was 68, 64 and 50 percent.

The CCR2 receptor latches onto a cytokine called MCP-1, which promotes inflammation. Tests found that those taking cenicriviroc had lower levels of MCP-1, which showed that the drug was successfully blocking the CCR2 receptor.

There was also evidence that levels of soluble CD14, which is an indicator of inflammation, dropped at the 24-week mark among those taking cenicriviroc; meanwhile it rose in those taking Sustiva. By 48 weeks the levels in the cenicriviroc arm rose again and reached a plateau around the level found at the beginning of the study. Meanwhile, the CD14 levels continued on an upward swing among those taking Sustiva.

To read the aidsmap story, click here.

To read the conference abstract, click here.

Very Early HIV Treatment May Limit "Seeding" of Latent HIV Reservoirs, Study Finds

Early HIV treatment, specifically during acute HIV infection, can limit the virus from forming HIV reservoirs in central memory CD4+ cells, according to study results presented at CROI 2013 in Atlanta, Ga.

Researchers in Thailand screened 52,767 patients for HIV using both nucleic acid tests (NAT) and enzyme-linked immunosorbent assay (ELISA) tests. Only 89 were identified as having acute HIV infection. Of these, 75 were enrolled in the study within three days and then started on antiretroviral therapy within an additional two days.

Lead author Jintanat Ananworanich, M.D., presented findings on the first 68 participants. The median age was 29 and 91% were men who have sex with men. The median duration of infection at baseline was only 15 days.

The patients were separated into three groups by Fiebig stage:

There were 24 patients characterized as Fiebig 1, meaning they tested positive for HIV RNA within 15 days of infection, but negative for p24 antigen and negative on a third generation ELISA test.

Only 7 patients were characterized as Fiebig 2, meaning they tested positive for HIV RNA and p24 antigen within 20 days of infection, but negative on a third-generation ELISA test.

The majority, 36 patients, were characterized as Fiebig 3, meaning they tested positive for HIV RNA and p24 antigen, as well as positive on a third generation ELISA test, within 25 days of infection, but negative on a Western blot.

At the time of diagnosis, Fiebig 1 patients had the lowest levels of median HIV DNA compared to the Fiebig 2 and 3 groups. "As the Fiebig stage progresses, there's more seeding of the reservoir," Ananworanich stated. Notably, 92% of the Fiebig 1 group had undetectable integrated HIV DNA in their peripheral blood mononuclear cells (PBMCs), compared to 29% of Fiebig 2 and 53% of Fiebig 3.

By week 12 after starting treatment, the median HIV DNA levels of those in the Fiebig 3 group mirrored levels seen in patients who have been on treatment for five years. By week 48, the Fiebig 3 group had HIV DNA levels similar to elite controllers. Interestingly, the Fiebig 1 group had HIV DNA levels similar to elite controllers throughout 96 weeks of treatment. In terms of integrated HIV DNA, 93% of all groups achieved undetectable levels by week 48.

To attempt to determine where HIV established and maintained its reservoirs, the researchers ran additional tests, including leukapheresis, a procedure that separates white blood cells from blood samples. After 24 weeks of treatment, integrated HIV DNA was detected in CD4+ cells, but not PBMCs, B cells or CD8 cells. 

However, even within the CD4+ cell subset, only two out of five patients had detectable levels.

The researchers looked even further into the subsets of memory CD4+ cells to possibly identify the reservoir location. They found that central memory T cells had low infection frequencies when compared to transitional memory and effector memory T cells. 

Anaworanich pointed out that in chronically infected HIV patients, the central memory T cells show higher frequencies of infection and typically rank first or second as a reservoir site. 

Her team's finding that the reservoir in the Thai patients, after early treatment, is actually in the transitional memory and effector memory T cells could lead to new strategies in reservoir eradication, she said.

While these results are promising, Anaworanich noted that the sample size was small and that they had yet to determine the levels of replication-competent virus in these patients. The next steps could include analytical treatment interruption to identify correlates of a functional cure or a therapeutic vaccine.

World AIDS Day - decline in AIDS-related deaths in the Caribbean

The Caribbean Saturday December 1 joined the rest of the global community in observing World AIDS Day indicating that while there had been a drastic decline in the number of new infections, the region should not relax its efforts in dealing with the deadly virus.

Caribbean countries were observing the day with a number of activities and a report by UNAIDS notes that the number of children born with the virus declined significantly in the Caribbean during the period 2009 and 2011.

The report noted that the Caribbean, which has the second highest incidence of HIV/AIDS after sub-Saharan Africa, also recorded the highest decline in AIDS-related deaths of any region between 2005 and 2011. The number of children born with the deadly HIV declined significantly in the Caribbean during the period 2009 and 2011, according to the 2012 global report by UNAIDS.

In his message to mark the occasion, St. Kitts-Nevis Prime Minister Dr. Denzil Douglas, who has lead responsibility for health in the quasi Caribbean Community (CARICOM) cabinet, said that there is no doubt that significant inroads have been made to reverse the spread of AIDS throughout the world.

“The Caribbean has made many advances. Indeed the UNAIDS report for 2012, singles out this region as having the sharpest declines in number of new HIV infections since 2001 with a drop of more than 42 per cent.

“There are other positive indicators evidenced by the increased numbers of our people receiving treatment, reduced number of people dying from AIDS and greater investments on the part of our governments in both treatment and prevention, among others,” Dr. Douglas said.

He said in this regard, the Pan Caribbean Partnership against HIV and AIDS (PANCAP) embracing governments, civil society, regional and international partners, networks of people living with HIV and vulnerable communities, must be commended for its leadership role.

“But it is still a long walk to zero – possible though it is a walk, to which PANCAP is committed. As I recall, it was at a UNAIDS/PANCAP Advocacy Forum in 2005, when partners in developing their advocacy strategy, envisioned a Caribbean without AIDS.

“A Caribbean without AIDS is possible, but the PANCAP agenda must be reshaped by human rights to reduce stigma and discrimination taking centre stage. Sustainable social development and equity for all require increased community and political engagement, Hence, there is much more to be done in getting to zero,” he added.

Executive Director of the Caribbean Broadcast Media Partnership on HIV/AIDS, (CBMP) Dr. Allyson Leacock said while the UNAIDS Global Report 2012 shows signs of progress in the HIV epidemic, “we should not see this as a time for relaxing our efforts.

“In fact, as we struggle for more financial resources for sustainability and counter the AIDS fatigue that is so evident in the malaise to many AIDS programmes, initiatives such as ours are even more important to be sustained.”

She said that adult HIV prevalence in the Caribbean remains higher than in any other world region outside of sub-Saharan Africa.

“We still have people to reach and work to do. We know we have to sustain our training efforts with our colleague reporters, producers and editors to enhance our coverage of this complex epidemic so media coverage is always accurate and effective,” she said of the CBMP that groups 112 television and radio broadcasters in 24 countries.

Leacock said that a comprehensive approach to HIV/AIDS in the Caribbean must include well-coordinated media campaigns as well as on-the-ground programmes.

In their message, a dozen Caribbean civil society organizations (CSO) that met recently in Jamaica said there was a need to regroup in the face of the changing tide of the HIV epidemic and its attendant change in available resources for the Caribbean.

“Ultimately, it was the disturbing emergence of increasing inequality these actions bring that threatens to erode all the developmental gains these HIV advocates have worked so hard to address as foot soldiers in these multiple struggles with the epidemic in the region.

“HIV exposes the reality that no matter how high we raise the tide in our societies, ignoring inequality will erode the gains of development for everyone and create insecurity in our nations,” the CSO’s said, adding in rising to meet that challenge, we hold on to the core belief that the role of governance, public policy and civil society organisations are to make the Caribbean a better, more liveable place, that we must leave it a better place for our children”.

Read more:

Meanwhile:

HEALTH Minister Dr Fenton Ferguson has urged Jamaican's to be aware of their HIV status as country joins the rest of the world in observing World Aids Day.

" If we are to move towards no new infections, it is important that we all know our HIV status. Firstly, if we know our status we can protect our partners and babies from becoming infected. Secondly, if we know our status, we can get the treatment we need and live longer, more fulfilling and productive lives. Thirdly, if we know our status, we can get the psychological and other support we need to manage this illness and fourthly, if we know our status, we can be proactive in assisting others who may need our support to manage their health and we can become advocates in our communities to assist others thereby playing a role in reducing the national prevalence," Dr Ferguson said in his message.

Pointing out that only 50 per cent of the estimated 32,000 Jamaicans living with HIV know their status, Dr Ferguson said such a situation is not sustainable.

"HIV testing is offered free of cost in the public sector. Let us make a dent in that 50 per cent and help Jamaica to achieve its development goal as outlined in Vision 2030, for the country to be the place of choice to live, work, raise families and do business," he urged.

The Caribbean is second only to Sub-Saharan Africa in terms of the prevalence of HIV and AIDS. But Dr Ferguson said the region has "been seeing significant improvements in the rate of HIV and AIDS".

"According to UNAIDS' Global AIDS Response Progress Reporting 2012, the Caribbean has recorded a 25 per cent reduction which is the highest decline in AIDS related deaths between 2005 and 2011 compared to other regions.

"I am happy to note that Jamaica is among these statistics. We have come a far way during this period with respect to our achievements in the area of HIV and AIDS. Since 2006, there have been significant declines in a number of areas. The number of reported AIDS deaths has decreased since the introduction of public access to ARVs. Three hundred and thirty-three (333) AIDS deaths (197 males and 136 females) were reported in 2010 compared to 665 in 2004. This represents a 50 per cent decrease in AIDS deaths since the inception of Universal Access to ARVs in 2004, and a 46 per cent decrease when compared to 2000 (617 AIDS deaths)," he explained.

HIV/AIDS Deaths Dip ..but ......................

WORLD AIDS Day is being recognised today under the theme, 'On a mission to zero new HIV infections', and Jamaica is celebrating significant declines in the rate of the disease in the island.

Statistics from the Ministry of Health indicate that there have been significant declines in a number of areas since 2006. The number of reported AIDS deaths has decreased since the introduction of public access to antiretroviral drugs (ARVs). Three hundred and thirty-three AIDS deaths were reported in 2010, compared to 665 in 2004.

This represents a 50 per cent decrease in AIDS deaths since the inception of Universal Access to ARVs in 2004, and a 46 per cent decrease when compared to 2000.

among most successful

In his message, Health Minister Dr Fenton Ferguson said Jamaica's HIV programme has been lauded as being among the most successful in the Latin American and Caribbean region.

"Over the years, the programme has employed important and workable strategies to achieve this. Increased access to testing, improved HIV surveillance and increased awareness about HIV among the general population," he said.

Speaking at the launch of a joint workplace policy yesterday between three ministries, permanent secretary in the Ministry of Industry, Investment and Commerce, Reginald Budhan, said the stigmatisation of HIV victims has lessened.

"Much of this is obviously the result of greater public awareness and the HIV/AIDS awareness sessions held at various workplaces over the years. We are still mindful of the fact that we still have a serious problem and I think this is reflected in this year's world HIV/AIDS theme," he said.

The event which took place at the Ministry of Industry, Investment and Commerce also included the Ministry of Science, Technology, Energy &. Mining and the foreign affairs ministry.

But with the suspicious treatment failure issues since last year and the repeated reports of deaths of persons who have been adhering to their regimens with some persons on the latest anti retroviral drugs on the market including Atripla and Truvada one wonders why the silence on this issue by the non governmental organizations of the national systems via the ministry of health, why the secrecy despite the agitation on Mya 1st this year by same at the Ministry of Health offices on King Street, the protests open or otherwise towards the Global Fund and the depleting finds for local efforts in the HIV response 

Complaints have also been coming regarding the uncaring stance of some general practitioners within some NGOs who have been prescribing older regimes for HIV positive MSMs in particular  and all kinds of other side effects coming from those including older drugs such as Kaletra despite the complaints, why are doctors not really paying attention?

Is it time to change the regimes all together?

With the issues to do with MSM homelessess and a 2007 MSM survey that clearly suggested a link between that category of persons along with commercial sex work as an income generating means for that population coupled with the lack of the proper social interventions with the necessary self efficacious, personal developmental and character building interventions to deal with same in order to assist persons to be on their way to some semblance of normalcy or to re-integrate into general society after their respective homophobic or homo-negative event one wonders if getting to zero will be a realistic goal here?

The 2010/1 study results are being prepared and already the early findings seem deem.

I think we need to get real and public relations campaign overlooking the realities on the ground won't help any.

Minister of Health Dr Fenton Ferguson speaking at a function recently carried the line that buggery should be repealed for health reasons and not the genuine reasons which is privacy for consenting adults which I would much prefer, to simply be forced to capitulate in a sense due to high rates of infections in marginalised groups after all these years of dilly dallying and due to pressure from external forces is indeed sad.

My other problem with calling for buggery to be removed not as a right for persons to be who they are in terms of same gender loving men getting the freedom to practice anal sex if they so desire but the unproven and widely held beleif that the present government was funded by some invisible LGBT hand somewhere is an ethical challenge for me, do not give me or my brothers and sisters rights simply because the political establishment is basically bought for a buck.

Rights must be fought for and granted fair and square not granted due to pressure and not as a matter of principle with consequences and possible reversals later with tacit almost confirmation that HIV is a gay disease due to the high infection rates according to studies over the years and poor ground work by the very advocacies that have DIRECT access to the population especially on the social scenes but yet none of them show up to do the work needed on any consistent basis, then the public is told that MSMs do not have access to condoms, treatment and care yet six agencies including ones linked to the very anti gay groups have gotten funding to work in MSMs community and have delivered the very "lack of access" condoms."

There is just too much politics and controversy surrounding HIV/MSM work just on the face of it for me.

Peace and tolerance

H