Wednesday, 29 January 2014

Is PReP our next line of defence against HIV?

I am genuinely frightened of HIV.

Being gay brings inherent complications and I think the one that troubles me the most is having to live with the knowledge that I am part of a group which is at higher risk of being infected with HIV because of our sexual practices and because of the existing prevalence of HIV within our group.

The idea that I could, through something as fantastic and wonderful as sex, be infected with a virus hell-bent on curtailing or at best dominating the rest of my life is terrifying.

Even when I use condoms, get tested, do all the right things, it’s there in the back of my mind.  What if the condom splits? What if I still manage, somehow to contract it even if it doesn’t?  I’m not saying it’s a completely rational fear, but it’s real enough to me to be ever-present and a bit a mood killer.

I am aware that I am beginning to sound paranoid and irrational.  Not every gay man has HIV. Not every unprotected sex session leads to HIV.  HIV is, for those lucky enough to be born in a place with access to the right health care, a manageable disease that people can and do live with for a long, long time.

But you can hardly blame me.  At every given opportunity, rightly so, I am reminded by health care professionals, the media, even my family and friends that I should protect myself against HIV, because it is a threat.

But we can and are trying to reduce that threat.

Taken from the pages of The Proud Study:

“PrEP (Pre-Exposure Prophylaxis) is a new way to reduce the risk of getting HIV. It involves HIV negative people taking a daily tablet that contains drugs commonly used to treat HIV.”

Now this is a pretty extraordinary claim and what do extraordinary claims require? Extraordinary evidence.  Now that, in my opinion, doesn’t exist - yet.  But what evidence does exist is very exciting.

Taken from the CDC webpage:

“In November 2010, the National Institutes of Health (NIH) announced the results of the iPrEx clinical trial, a large, multi-country research study examining PrEP among MSM. The study found that daily oral use of TDF/FTC provided an average of 44% additional protection to MSM who also received a comprehensive package of prevention services that included monthly HIV testing, condom provision, and management of other sexually transmitted infections.

“TDF2, conducted in partnership with the Botswana Ministry of Health, found that once-daily TDF/FTC reduced the risk of acquiring HIV infection by 62 percent overall in the study population of uninfected heterosexually-active men and women.

“Partners PrEP found that two separate antiretroviral regimens – TDF/FTC in combination and tenofovir alone – when provided to uninfected persons whose partners have HIV infection (sero-discordant couples) significantly reduced HIV acquisition (by 75 percent and 67 percent, respectively). Participants in the TDF/FTC group with detectable levels of the medication experienced a 90 percent reduction in risk for HIV infection; in the tenofovir- only group, the presence of medication in the blood was associated with an 86 percent reduction in risk.”

Now those numbers vary WILDLY and more importantly to note, they are reliant on participants practising safe sex and being responsible with their sexual health.  That said, this regime could have the potential to give people that extra level of security and reduce the rate of infection.

This all sounds great, but there are legitimate concerns about how a drug that reduces the chances of HIV infection would effect infection rates of other STDs.  Will people be less likely to use condoms?  Will people have more sex? Will people have a higher number of other sexually transmitted infections?

Well The Proud Study aims to look at just this issue.  It will look at the impact of taking PrEP on men by asking them to keep diaries over two years.  This is taking place at many sites across the country and is recruiting for volunteers.  If you’re interested, you should head over to their site.

In earlier conversations, I drew the comparison to women’s contraception and I think that comparison still holds for me, but not in terms of rights, in terms of control.  Women were given control over their bodies by being given the right to use any number of contraceptive devices and drugs.  Condoms and drugs give me control over my body by giving me defences against HIV and anti-retroviral therapy would help me keep that control, should those defences fail.

For me, this presents an opportunity for me to take even more control over my sexual health.  Whilst I will continue to practise safe sex, should this come to fruition, I could have further confidence that I am safe and that I can enjoy what I’m doing with whoever I’m doing it with.

It’s missing the point to think that this is about the right to have unprotected sex.  This is about reducing the threat of the things that want to hurt us by using every weapon at our disposal and giving all of us the opportunity to live our lives without the looming shadow of HIV. 

More importantly, it’s not about us, the ones with access, that can manage and control it, it’s about them; the ones that are dying.  

If this regime works and if we keep on developing better defences, build the walls higher, spread them further, encompass us all and lock it out, maybe we could starve it to death. 

Saturday, 11 January 2014

Academies still give me the creeps...

It terrifies me the idea of private organisations funding schools and skewing curricula to produce people that are either aligned to their goals and ways of thinking or even worse, are ideal employees for their companies. 

On the surface this seems like almost a positive thing; vocational and targetted training giving people the skills to get the jobs available in their local community. 

But then the more I think about it, the more I worry that it's a slippery slope to people being born in an area or into a family in a particular social demographic having only schools available that train them to do the jobs that people in their area or social demographic have come to be expected to do and then it starts sounding scarily like a caste system.

I know that it is an extreme extrapolation, but even by letting one organisation open a school targetted at a particular group of people in the hopes that you can train them for a particular job, you are limiting their right to self determination - or at the very least deterring them from exercising it.

But then maybe I am being completely paranoid.