There are a lot of new test technologies in the pipeline: both new types of tests in the works, such as rapid syphilis tests or point-of-care HIV viral load testing, and new ways to use existing tests, such as self-testing or online testing.
As testing options increase, we need to think about where they will have the most impact. I learned about this from helping implement a new test technology called pooled nucleic acid amplification testing (pooled NAAT) at six clinics in Vancouver in 2009, as part of a research study to determine the impact of this new type of test on gay men’s lives. With pooled NAAT, blood samples that are negative on a routine screen for HIV antibodies are automatically tested for HIV RNA. This shortens the HIV window period to 10-12 days and means that individuals with very early or acute infection – when HIV viral load and chances of transmission are high – can be diagnosed at a time when standard tests are negative.
There is a quiet tension that exists surrounding HIV and infant feeding. Although practices and recommendations vary around the world, breastfeeding is not recommended for infants born to an HIV-positive woman or trans man in Canada. Instead, HIV-positive parents are counselled to feed their infants with formula.
But I don’t think it is by any means a closed case, even in Canada. The truth is, the debate about HIV and infant feeding (particularly in Canada) has never been more complex. Like so many discussions related to HIV today, scientific advances are changing the way we talk about and consider possibilities. New questions about treatment as prevention, pre-exposure prophylaxis (PrEP), and even levels of ‘risk’ seem to emerge every day.
Le 1er décembre, la Journée mondiale du sida, l’Honorable Jane Philpott, ministre de la Santé du Canada, a déclaré que notre pays appuyait les objectifs de traitement de l’ONUSIDA qui visent à mettre fin à l’épidémie mondiale de sida dès 2030. La même journée, le premier ministre Justin Trudeau a fait une déclaration qui, en partie, disait « nous sommes maintenant à un moment où nous pouvons envisager un avenir exempt de cette terrible maladie ».
Combien de personnes sont-elles infectées par le VIH chaque jour au Canada? À quoi ressemble le taux d’infection au VIH dans des populations spécifiques?
Chaque année, les rapports de surveillance nous indiquent combien de Canadiens ont reçu un diagnostic de VIH. Par contre, étant donné qu’une grande partie des Canadiens séropositifs n’ont pas reçu de diagnostic, ces chiffres ne nous donnent pas un portrait exact.
In response to mounting evidence of the prevention benefits of pre-exposure prophylaxis (PrEP) use by HIV-negative gay and bisexual men, a discussion recently emerged on social media about the perceived exclusion of trans men1 who have sex with men from PrEP research studies.
In fact, trans men participate in many HIV prevention research studies, whether or not they are identified as trans when results are reported. Some do not identify as trans, but rather as men of trans experience or transitioned men, and are happy to check the “male” box without qualification. Other studies have explicitly included trans men and allowed them to self-identify. Regardless, some were upset that when results were reported, PrEP effectiveness among trans men was not addressed. In response, a number of well-intentioned non-trans men voiced their support for greater inclusion of trans men in biomedical and other HIV prevention research. While these statements are a testament to the progress gay and bisexual men’s communities are making in embracing men of trans experience, I feel compelled to offer a reality check about the inclusion of trans men in HIV prevention research.
Recent developments in prevention are pointing to worrying gaps in the community-based approach to HIV prevention in Canada.
Perhaps we have been used to having only a single prevention technology on our books for so long – think condoms – that our ducks are not always in a row when new ones like PrEP come along. Thus potholes in our response become apparent – and none leap in to fix them.
After a series of somewhat inconclusive PrEP trials, whose results were marred by adherence issues, the results of more stringent trials like the PROUD and IPERGAY studies are in, and they are good. So good, in fact, that it would now be foolish not to put PrEP right at the front of the shelf that features ways to stay HIV-negative.
Le Blogue de CATIE présente des perspectives et opinions des personnes et organismes qui travaillent ou collaborent bénévolement à la réponse du Canada au VIH et à l’hépatite C.