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To Reduce HIV Risk Among Men Who Have Sex With Men, Better Interventions Are Needed

March 04, 2012

Although a cognitive-behavioral intervention to encourage men who have sex with men to reduce their substance use and sexual risk behavior (as both are linked) was partially successful, a similar reduction was achieved in comparison groups who did not receive the intervention suggesting that better methods for changing behaviors are needed. These are the findings of a paper by Gordon Mansergh from the Centers for Disease Control and Prevention, Georgia, USA, and colleagues and published in this week's PLoS Medicine.

1686 men in Chicago, Los Angeles, New York City, and San Francisco enrolled in the trial. Most men were randomized to receive a cognitive-behavioral intervention (six group sessions focused on reducing substance use and sexual risk behavior) or an attention-control comparison (six group sessions of videos and discussion of issues unrelated to substance use, sexual risk, and HIV/AIDS). Another group (not randomized) received HIV counseling and testing only. The authors found that all participants reported high-risk behavior during the 3 months before enrolling in the study: 67% reported unprotected anal sex and 77% reported substance use during their most recent anal sex encounter with a man who was not their primary partner. However, after one year, unprotected anal sex as reported by all participants reduced by 32% and all three groups reported similar reductions in other risk behaviors at 3, 6 and 12 months follow up.

The authors say that their results for reducing sexual risk behavior of substance-using men who have sex with men are consistent with results of intervention trials for other populations. The authors caution, however, that the brief counseling used in this study is especially effective for people who are ready for a change, such as MSM willing to enrol in an intervention trial of this type. And by just being in the trial, participants may have self-reported reduced risk behavior. They conclude: "More explicit debate is needed in the behavioral intervention field about appropriate scientific designs and methods. As HIV prevention increasingly competes for behavior-change attention alongside other "chronic" diseases and mental health issues, new approaches may better resonate with at-risk groups."



Tags: HIV Risk, Sex with Men

HIV Virus Hides In The Brain

March 04, 2012

Studies of the spinal fluid of patients given anti-HIV drugs have resulted in new findings suggesting that the brain can act as a hiding place for the HIV virus. Around 10% of patients showed traces of the virus in their spinal fluid but not in their blood a larger proportion than previously realised, reveals a thesis from the University of Gothenburg, Sweden.

We now have effective anti-HIV drugs that can stop the immune system from being compromised and prevent AIDS. Although these drugs effectively prevent the virus from multiplying, the HIV virus also infects the brain and can cause damage if the infection is not treated.

"Antiviral treatment in the brain is complicated by a number of factors, partly because it is surrounded by a protective barrier that affects how well medicines get in," says Arvid Edén, doctor and researcher at the Institute of Biomedicine at the Sahlgrenska Academy. "This means that the brain can act as a reservoir where treatment of the virus may be less effective."

The thesis includes a study of 15 patients who had been effectively medicated for several years. 60% of them showed signs of inflammation in their spinal fluid, albeit at lower levels than without treatment.

"In another study of around 70 patients who had also received anti-HIV drugs, we found HIV in the spinal fluid of around 10% of the patients, even though the virus was not measurable in the blood, which is a significantly higher proportion than previously realised," explains Edén.

The results of both studies would suggest that current HIV treatment cannot entirely suppress the effects of the virus in the brain, although it is not clear whether the residual inflammation or small quantities of virus in the spinal fluid in some of the patients entail a risk of future complications.

"In my opinion, we need to take into account the effects in the brain when developing new drugs and treatment strategies for HIV infection," says Edén.

HIV

HIV, human immunodeficiency virus, belongs to the retrovirus family and takes two forms, HIV-1 and HIV-2, which can be transmitted through blood, semen and other secretions and bodily fluids. In the acute phase, patients suffer from fever, swollen lymph glands and rashes. These symptoms do recede, but AIDS develops after a long period of infection. Attempts to produce an HIV vaccine have been ongoing since the 1980s, but have yet to be successful.

Source: University of Gothenburg


Tags: HIV Risk, Sex with Men


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