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In this issue

Gus Cairns
Published: 15 July 2011

Welcome to (sadly) the last monthly issue of HTU, or the first quarterly one, according to definition.

We have some meaty and thought-provoking pieces in this issue. Nothing is more complex (and gets people arguing quite so much) than what we should be doing in HIV prevention (see Where next for HIV prevention?).

As the Health Protection Agency points out, home-grown infections, especially in gay men, remain stubbornly high in the UK. In the last few years we’ve accumulated evidence that new strategies such as pre-exposure prophylaxis (PrEP), circumcision and the use of HIV treatment as prevention can work – at least in clinical trials. If anything, however, these new options have only served to add to the confusion in the prevention field about the most effective strategy.

Even amongst sensible people who don’t think the answer is to ban sex outside (heterosexual) marriage, you get different, passionately held and often diametrically opposing opinions on how to prevent HIV in this country. According to who you talk to, current HIV prevention isn’t working and:

a) it would if we threw enough money at it;

b) we should stop pussyfooting around and tell people to stop barebacking;

c) we should forget trying to change people’s behaviour and concentrate on diagnosing as many as possible and putting them all on treatment;

d) we should do c) but add in PrEP for HIV-negative people too.    

In reality, we will probably need to combine a number of different approaches: but exactly what we should combine, using what evidence, in what proportions; how much money we should give each component; and how we’ll know if we’re doing better are nightmarishly complex questions. How to answer these while spending, preferably, less money is more than enough to tax the brains of NHS commissioners anywhere.

Anal cancer, on the other hand, you might think was a less complex issue (see Everything okay down there?). Squeamish subject, yes, but even if the HPV vaccine isn’t going to work for you, surely you can avoid this cancer if you get checked regularly?

The answer is yes, you probably can, but we don’t actually know if screening works. And, if it does, we can’t show it’s cost-effective, which means your HIV or other doctor is unlikely to proactively suggest it. So you have to. Back in the early days of the epidemic, all HIV treatment was like this, because we didn’t know what worked.

The issue of anal cancer prevention is, then, surprisingly similar to the one of HIV prevention. The NHS thinks: “We haven’t done enough studies and we don’t want to waste money on things that aren’t going to work.” So that leaves it up to the individual, whether that involves demanding an anal screen, demanding PEP, or simply taking responsibility into their own hands and using a condom. Or not having anal sex, despite the shapely butt on this issue’s cover. Life’s hard, eh?

We’re preparing for the International AIDS Society conference now, which we’ll report on in the next issue. Have a good summer.

This content was checked for accuracy at the time it was written. It may have been superseded by more recent developments. NAM recommends checking whether this is the most current information when making decisions that may affect your health.
Community Consensus Statement on Access to HIV Treatment and its Use for Prevention

Together, we can make it happen

We can end HIV soon if people have equal access to HIV drugs as treatment and as PrEP, and have free choice over whether to take them.

Launched today, the Community Consensus Statement is a basic set of principles aimed at making sure that happens.

The Community Consensus Statement is a joint initiative of AVAC, EATG, MSMGF, GNP+, HIV i-Base, the International HIV/AIDS Alliance, ITPC and NAM/aidsmap
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This content was checked for accuracy at the time it was written. It may have been superseded by more recent developments. NAM recommends checking whether this is the most current information when making decisions that may affect your health.

NAM’s information is intended to support, rather than replace, consultation with a healthcare professional. Talk to your doctor or another member of your healthcare team for advice tailored to your situation.