{"id":1233,"date":"2016-12-07T15:53:07","date_gmt":"2016-12-07T15:53:07","guid":{"rendered":"https:\/\/blogs.bmj.com\/sti\/?p=1233"},"modified":"2016-12-08T11:45:05","modified_gmt":"2016-12-08T11:45:05","slug":"unaids-2016-report-how-a-life-cycle-approach-can-help-the-world-get-on-the-fast-track-to-hiv-prevention","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/sti\/2016\/12\/07\/unaids-2016-report-how-a-life-cycle-approach-can-help-the-world-get-on-the-fast-track-to-hiv-prevention\/","title":{"rendered":"UNAIDS 2016 Report: How a \u2018life-cycle\u2019 approach can help the world \u2018get on the fast track\u2019 to HIV prevention"},"content":{"rendered":"<p><a href=\"http:\/\/www.unaids.org\/sites\/default\/files\/media_asset\/Get-on-the-Fast-Track_en.pdf\"><span style=\"color: #0000ff;font-family: Times New Roman\">&#8216;Get on the Fast Track: a Life-cycle Approach to HIV&#8217;<\/span><\/a><span style=\"color: #000000;font-family: Times New Roman\"> is the latest UNAIDS report, following on from the UN Assembly\u2019s 2016 declaration of commitment to \u2018Fast Track\u2019 goals for ending the HIV\/AIDS epidemic. The major theme of the \u2018life-cycle\u2019 appears to owe much to the findings of the South African CAPRISA study \u2013 above all, the idea of a transmission cycle between younger (<\/span><span style=\"color: #000000;font-family: Times New Roman\">\u2264<\/span><span style=\"color: #000000;font-family: Times New Roman\">25 year-old) women and older (<\/span><span style=\"color: #000000;font-family: Times New Roman\">&gt;25 year-old) men.<\/span><span style=\"color: #000000;font-family: Times New Roman\">\u00a0 <\/span><span style=\"color: #000000;font-family: Times New Roman\">Broadly, phylogenetic analysis reveals that the prevailing pattern of transmission is as follows.<\/span><span style=\"color: #000000;font-family: Times New Roman\">\u00a0 <\/span><span style=\"color: #000000;font-family: Times New Roman\">Younger women appear to get infected through casual relationships with considerably older men, who have, in turn, been infected by their longer-term partners; in time, the younger women grow up and form longer-term relationships \u2013 and the cycle is repeated.<\/span><span style=\"color: #000000;font-family: Times New Roman\">\u00a0 <\/span><span style=\"color: #000000;font-family: Times New Roman\">The former group \u2013 younger (\u2264<\/span><span style=\"color: #000000;font-family: Times New Roman\">25 year-old) women \u2013 appear to be <\/span><span style=\"color: #000000;font-family: Times New Roman\">more vulnerable to infection than men of the equivalent age due to complex social factors, and have recently seen only c. 6% declines in annual incidence; older (&gt;25 year-old) men have incidence rates that have remained obstinately high despite all recent efforts to reduce them.<\/span><span style=\"color: #000000;font-family: Times New Roman\">\u00a0 <\/span><span style=\"color: #000000;font-family: Times New Roman\">These are best explained by poor rates of testing, integration into treatment, and viral suppression making them a potential risk to non-HIV-infected partners. <\/span><\/p>\n<p><span style=\"color: #000000;font-family: Times New Roman\">Diagnosing a problem is one thing; framing the solution quite another.<\/span><span style=\"color: #000000;font-family: Times New Roman\">\u00a0 <\/span><span style=\"color: #000000;font-family: Times New Roman\">In case of the younger women, the dominant factors appear to be structural and societal \u2013 e.g. gender inequalities.<\/span><span style=\"color: #000000;font-family: Times New Roman\">\u00a0 <\/span><span style=\"color: #000000;font-family: Times New Roman\">These are difficult to address without major social and political\u00a0change.<\/span><span style=\"color: #000000;font-family: Times New Roman\">\u00a0 <\/span><span style=\"color: #000000;font-family: Times New Roman\">The authors suggest a number of prevention tools, including sexual education in schools, the introduction of pre-exposure prophylaxis (PrEP), and social transfers.\u00a0\u00a0However, r<\/span><span style=\"color: #000000;font-family: Times New Roman\">ecent trials of PrEP in sub-Saharan Africa do not bode well for this intervention (<\/span><span lang=\"EN-US\"><a href=\"https:\/\/blogs.bmj.com\/sti\/wp-admin\/post.php?post=1045&amp;action=edit\"><span lang=\"EN-GB\"><span style=\"color: #0000ff;font-family: Times New Roman\">STI\/blogs\/&#8217;Failed PrEP trial&#8217;<\/span><\/span><\/a><\/span><span style=\"color: #000000;font-family: Times New Roman\">; <\/span><span lang=\"EN-US\"><a href=\"https:\/\/blogs.bmj.com\/sti\/wp-admin\/post.php?post=1171&amp;action=edit\"><span lang=\"EN-GB\"><span style=\"color: #0000ff;font-family: Times New Roman\">STI\/blogs\/<\/span><\/span><\/a><span lang=\"EN-GB\"><span style=\"color: #0000ff;font-family: Times New Roman\">&#8216;Another<\/span><\/span><a href=\"https:\/\/blogs.bmj.com\/sti\/wp-admin\/post.php?post=1171&amp;action=edit\"><span lang=\"EN-GB\"><span style=\"color: #0000ff;font-family: Times New Roman\"> failed PrEP trial&#8217;<\/span><\/span><\/a><\/span><span style=\"color: #000000;font-family: Times New Roman\">); while the evidence for the effectiveness of sexuality education and \u2018social transfers\u2019 is far from conclusive (<\/span><a href=\"https:\/\/blogs.bmj.com\/sti\/2016\/12\/07\/school-based-sexuality-programmes-fail-to-demonstrate-an-influence-on-sti-and-pregnancy-outcomes\/\"><span style=\"color: #0563c1;font-family: Calibri\">School-based Sexuality Programmes\/STI\/blogs<\/span><\/a>; <span lang=\"EN-US\"><a href=\"http:\/\/www.jiasociety.org\/index.php\/jias\/article\/view\/19218?search=Galarraga%20and%20Sosa-Rubi\"><span style=\"color: #0000ff;font-family: Times New Roman\">STI\/Galarraga &amp; Sosa-Rubi<\/span><\/a>;<\/span> <span lang=\"EN-US\"><a href=\"http:\/\/sti.bmj.com\/content\/89\/Suppl_1\/A49.3.abstract?sid=8223d516-cb93-4588-9206-01c447d67e2b\"><span style=\"color: #0000ff;font-family: Times New Roman\">STI\/Minnis &amp; Padian<\/span><\/a>; <a href=\"http:\/\/sti.bmj.com\/content\/87\/Suppl_1\/A57.2.abstract?sid=8223d516-cb93-4588-9206-01c447d67e2b\"><span style=\"color: #0000ff;font-family: Times New Roman\">STI\/Khan &amp; Khan<\/span><\/a><\/span><span lang=\"EN-US\" style=\"margin: 0px;color: #333333;line-height: 115%;font-family: 'Georgia','serif';font-size: 9.5pt\">).\u00a0\u00a0<\/span><span lang=\"EN-US\"><span style=\"color: #000000;font-family: Times New Roman\">However, in the case of the other group &#8211; i.e. o<\/span><\/span><span style=\"color: #000000;font-family: Times New Roman\">lder men \u2013 the obstacles to HIV prevention (poor rates of testing and viral suppression) may be less intractable, and the report proposes a number of very practical measures that could help, including: distribution of self-test kits through female partners attending ante-natal clinics (<\/span><span lang=\"EN-US\"><a href=\"https:\/\/blogs.bmj.com\/sti\/wp-admin\/post.php?post=1230&amp;action=edit\"><span lang=\"EN-GB\"><span style=\"color: #0000ff;font-family: Times New Roman\">STI\/blogs\/&#8217;Partner-delivered STI testing&#8217;<\/span><\/span><\/a><\/span><span style=\"color: #000000;font-family: Times New Roman\">); simplifying ART regimens so individuals have to take just one tablet a day; shifting from CD4 count testing to viral load testing.<\/span><\/p>\n<p><span style=\"color: #000000;font-family: Times New Roman\">The report also has much to say about other phases of the life-cycle, as well as about \u2018key populations\u2019 (estimated 45% of new infections).<\/span><span style=\"color: #000000;font-family: Times New Roman\">\u00a0 <\/span><span style=\"color: #000000;font-family: Times New Roman\">Regarding the latter, the authors report the stability, or even rise, in new infections amongst sex-workers, drug-users and MSM. They emphasize the negative impact of criminalization of key populations and same-sex relations (73 countries) (see <\/span><a href=\"https:\/\/blogs.bmj.com\/sti\/2013\/04\/02\/hiv-criminalization-do-service-providers-have-a-responsibility-to-protect-sexual-third-parties-or-public-health\/\"><span style=\"color: #0000ff;font-family: Times New Roman\">STI\/blog\/&#8217;HIV criminalization&#8217;\/<\/span><\/a><span style=\"color: #000000;font-family: Times New Roman\">; <\/span><a href=\"https:\/\/blogs.bmj.com\/sti\/2016\/02\/10\/health-professionals-violate-human-rights-of-sex-workers-in-kenya\/\"><span style=\"color: #0000ff;font-family: Times New Roman\">STI\/blog\/&#8217;Health workers violate human rights&#8217;<\/span><\/a><span style=\"color: #000000;font-family: Times New Roman\">), the very low levels of domestic funding (on average, only 12% of total spending on MSM prevention), and the relatively young age of many in the \u2018key populations\u2019.<\/span><span style=\"color: #000000;font-family: Times New Roman\">\u00a0 <\/span><span style=\"color: #000000;font-family: Times New Roman\">The authors recommend \u2018comprehensive\u2019 programmes for these populations incorporating access to a range of health care programmes, such as the <\/span><a href=\"http:\/\/www.hivsharespace.net\/system\/files\/Red%20Umbrella%20National%20Sex%20Work%20Programme%20Evaluation_presentation%202015.pdf\"><span style=\"color: #0000ff;font-family: Times New Roman\">Red Umbrella programme<\/span><\/a><span style=\"color: #000000;font-family: Times New Roman\"> for sex workers in South African, and the <\/span><a href=\"http:\/\/www.pubpdf.com\/pub\/27431469\/How-Peru-introduced-a-plan-for-comprehensive-HIV-prevention-and-care-for-transwomen\"><span style=\"color: #0000ff;font-family: Times New Roman\">&#8216;Targeted Strategy Plan&#8217;<\/span><\/a><span style=\"color: #000000;font-family: Times New Roman\"> for the transgender population in Lima, Peru.<\/span><\/p>\n<p><span style=\"color: #000000;font-family: Times New Roman\">\u00a0<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"<p>&#8216;Get on the Fast Track: a Life-cycle Approach to HIV&#8217; is the latest UNAIDS report, following on from the UN Assembly\u2019s 2016 declaration of commitment to \u2018Fast Track\u2019 goals for ending the HIV\/AIDS epidemic. The major theme of the \u2018life-cycle\u2019 appears to owe much to the findings of the South African CAPRISA study \u2013 above [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/sti\/2016\/12\/07\/unaids-2016-report-how-a-life-cycle-approach-can-help-the-world-get-on-the-fast-track-to-hiv-prevention\/\">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":[264,2274,2012,13992,4369,1642,2795],"tags":[],"class_list":["post-1233","post","type-post","status-publish","format-standard","hentry","category-health-policy","category-hiv-epidemiology","category-hiv-infection","category-hiv-prevention","category-hiv-retention-in-care","category-hiv-testing","category-international-report"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.6 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>UNAIDS 2016 Report: How a \u2018life-cycle\u2019 approach can help the world \u2018get on the fast track\u2019 to HIV prevention - 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\/12\/07\/unaids-2016-report-how-a-life-cycle-approach-can-help-the-world-get-on-the-fast-track-to-hiv-prevention\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"UNAIDS 2016 Report: How a \u2018life-cycle\u2019 approach can help the world \u2018get on the fast track\u2019 to HIV prevention - Sexually Transmitted Infections\" \/>\n<meta property=\"og:description\" content=\"&#8216;Get on the Fast Track: a Life-cycle Approach to HIV&#8217; is the latest UNAIDS report, following on from the UN Assembly\u2019s 2016 declaration of commitment to \u2018Fast Track\u2019 goals for ending the HIV\/AIDS epidemic. 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