{"id":1160,"date":"2016-02-23T15:55:38","date_gmt":"2016-02-23T15:55:38","guid":{"rendered":"https:\/\/blogs.bmj.com\/sti\/?p=1160"},"modified":"2016-02-23T15:55:38","modified_gmt":"2016-02-23T15:55:38","slug":"inadequacy-of-treatment-as-prevention-strategy-for-combating-hiv-in-young-us-msm","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/sti\/2016\/02\/23\/inadequacy-of-treatment-as-prevention-strategy-for-combating-hiv-in-young-us-msm\/","title":{"rendered":"Inadequacy of \u2018treatment as prevention\u2019 strategy for combating HIV in young US MSM"},"content":{"rendered":"<p>The secret of containing the HIV epidemic is the successful engagement of key populations, we are told. In the case of the US that evidently\u00a0includes young MSM (YMSM), amongst others.\u00a0 The scale of the task that confronts public health interventions aimed at prevention in this\u00a0group\u00a0is brought out in a recent study by <a href=\"https:\/\/archpedi.jamanetwork.com\/article.aspx?articleid=2474392\">Wilson &amp; Hightow-Weidmann<\/a>\u00a0 (W&amp;H) who investigate the behavioural and social correlates of not achieving virological suppression.<\/p>\n<p>If we take the HIV-infected population of the US\u00a0as a whole, the relative\u00a0impact on HIV onward transmission of the segment\u00a0of the population that is infected, but not virologically suppressed (VL+), is critical to the control of the epidemic.\u00a0 This is\u00a0on account of\u00a0the large\u00a0proportion of total transmissions attributable to\u00a0it.\u00a0\u00a0One recent modeling study discussed in this blog (<a href=\"https:\/\/blogs.bmj.com\/sti\/2015\/03\/25\/retention-in-care-rather-than-diagnosis-may-prove-the-ultimate-challenge-for-us-hiv-response\/\">Skarbinski &amp; Mermin {STI\/blogs)<\/a> (S&amp;M)) has estimated the proportion of onward transmission attributable to VL+ at 61.3%, as\u00a0against to 30.2% attributable to the undiagnosed.\u00a0 (This model also takes account of the greater HIV infectivity of the non-virologically suppressed, through the impact of this is debated (<a href=\"https:\/\/blogs.bmj.com\/sti\/2015\/06\/12\/increased-hiv-infectivity-in-the-acute-phase-of-infection-may-be-a-less-important-factor-in-hiv-transmission-than-we-thought\/\">Increased HIV infectivity (STIs\/blog)<\/a>).<\/p>\n<p>So one can imagine the impact on onward transmission of failure to achieve virological suppression among YMSM, given that\u00a0the proportion of HIV diagnosed who are VL+ is estimated by W&amp;H at c.70%.\u00a0\u00a0Further to this, W&amp;H consider a factor that\u00a0contributes an additional importance to the low level of viral suppression.\u00a0 The headline statistic of their study is that the VL+ are considerably more likely to engage in risky sexual behavior than the rest.\u00a0 Data obtained from the 20 US adolescent clinics that feature in the study show rates of condomless anal intercourse (CAI) for VL+ at <strong>54.7<\/strong>%, as against <strong>44.4%<\/strong> for VL-, and rates of serodiscordant CAI at <strong>34.9<\/strong>%, as against <strong>25%<\/strong>.\u00a0 Other correlates of being VL+ are drug abuse, daily alcohol use and unemployment, suggesting a pattern or relative social marginalization that would tend to make this group harder to engage.<\/p>\n<p>In their conclusions, W&amp;H highlight the inadequacies of treatment as prevention as the sole risk reduction method.\u00a0 A more underlying issue would seem to be retention in care and engagement with services, for socially marginalized populations.<\/p>\n<p><a href=\"http:\/\/sti.bmj.com\/content\/early\/2011\/12\/08\/sextrans-2011-050160.short?g=w_sti_ahead_tab\">Sherer (STIs)<\/a> analyses the structural factors which make this particularly a problem for the US.\u00a0 Access to sexual health services has been improved by the Affordable Care Act.\u00a0 However, there remains considerable debate about how this will affect publically funded STD clinics which seem to have been financially squeezed in recent years.\u00a0 Also about what role, if any, these clinics will continue to play in the US health system and what the implications of this will be for the accessibility of sexual health services for the socially marginalized (<a href=\"http:\/\/sti.bmj.com\/content\/87\/Suppl_1\/A334.1.abstract?sid=1a87fdfb-2b34-4be0-8a42-2c5f705218bf\">Mettenbrink &amp; Cornelis (STIs)<\/a>; <a href=\"http:\/\/sti.bmj.com\/content\/89\/Suppl_1\/A166.2.abstract?sid=2cb816e1-695e-4c4f-9d30-0097a6376e25\">Stephens &amp; Berstein (STIs)<\/a>; <a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4627523\/\">Hoover &amp; Gift<\/a>; <a href=\"http:\/\/journals.lww.com\/aidsonline\/Fulltext\/2013\/11280\/HIV_partner_services_are_associated_with_timely.16.aspx#P10\">Bocour &amp; Shepard<\/a>).<\/p>\n","protected":false},"excerpt":{"rendered":"<p>The secret of containing the HIV epidemic is the successful engagement of key populations, we are told. In the case of the US that evidently\u00a0includes young MSM (YMSM), amongst others.\u00a0 The scale of the task that confronts public health interventions aimed at prevention in this\u00a0group\u00a0is brought out in a recent study by Wilson &amp; Hightow-Weidmann\u00a0 [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/sti\/2016\/02\/23\/inadequacy-of-treatment-as-prevention-strategy-for-combating-hiv-in-young-us-msm\/\">Read More&#8230;<\/a><\/p>\n","protected":false},"author":152,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[2043,4369,4352],"tags":[],"class_list":["post-1160","post","type-post","status-publish","format-standard","hentry","category-behaviour","category-hiv-retention-in-care","category-preventative-effect-of-art"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.6 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Inadequacy of \u2018treatment as prevention\u2019 strategy for combating HIV in young US MSM - Sexually Transmitted Infections<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/sti\/2016\/02\/23\/inadequacy-of-treatment-as-prevention-strategy-for-combating-hiv-in-young-us-msm\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Inadequacy of \u2018treatment as prevention\u2019 strategy for combating HIV in young US MSM - Sexually Transmitted Infections\" \/>\n<meta property=\"og:description\" content=\"The secret of containing the HIV epidemic is the successful engagement of key populations, we are told. In the case of the US that evidently\u00a0includes young MSM (YMSM), amongst others.\u00a0 The scale of the task that confronts public health interventions aimed at prevention in this\u00a0group\u00a0is brought out in a recent study by Wilson &amp; Hightow-Weidmann\u00a0 [...]Read More...\" \/>\n<meta property=\"og:url\" content=\"https:\/\/blogs.bmj.com\/sti\/2016\/02\/23\/inadequacy-of-treatment-as-prevention-strategy-for-combating-hiv-in-young-us-msm\/\" \/>\n<meta property=\"og:site_name\" content=\"Sexually Transmitted Infections\" \/>\n<meta property=\"article:published_time\" content=\"2016-02-23T15:55:38+00:00\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"2 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/sti\\\/2016\\\/02\\\/23\\\/inadequacy-of-treatment-as-prevention-strategy-for-combating-hiv-in-young-us-msm\\\/#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/sti\\\/2016\\\/02\\\/23\\\/inadequacy-of-treatment-as-prevention-strategy-for-combating-hiv-in-young-us-msm\\\/\"},\"author\":{\"name\":\"\",\"@id\":\"\"},\"headline\":\"Inadequacy of \u2018treatment as prevention\u2019 strategy for combating HIV in young US MSM\",\"datePublished\":\"2016-02-23T15:55:38+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/sti\\\/2016\\\/02\\\/23\\\/inadequacy-of-treatment-as-prevention-strategy-for-combating-hiv-in-young-us-msm\\\/\"},\"wordCount\":484,\"publisher\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/sti\\\/#organization\"},\"articleSection\":[\"Behaviour\",\"HIV retention in care\",\"Preventative effect of ART\"],\"inLanguage\":\"en-US\"},{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/sti\\\/2016\\\/02\\\/23\\\/inadequacy-of-treatment-as-prevention-strategy-for-combating-hiv-in-young-us-msm\\\/\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/sti\\\/2016\\\/02\\\/23\\\/inadequacy-of-treatment-as-prevention-strategy-for-combating-hiv-in-young-us-msm\\\/\",\"name\":\"Inadequacy of \u2018treatment as prevention\u2019 strategy for combating HIV in young US MSM - 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