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Harm Reduction IN HIV Prevention

Harm Reduction IN HIV Prevention. Harm Reduction & HIV Prevention. Where are we now?. No Magic Bullet. 10 Best Things in HIV Prevention. Demonstrations that HIV prevention is possible & requires radical, behavioral change. Knowledge of what doesn’t work Male & Female Condom

dorothy-williamson
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Harm Reduction IN HIV Prevention

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  1. Harm Reduction IN HIV Prevention

  2. Harm Reduction & HIV Prevention

  3. Where are we now? No Magic Bullet

  4. 10 Best Things in HIV Prevention • Demonstrations that HIV prevention is possible & requires radical, behavioral change. • Knowledge of what doesn’t work • Male & Female Condom • Varied behavioral options – delay, reduction in # of partners • HIV Test • Prevention of Mother-To-Child Transmission • Access to clean needles for IV Drug use; treatment, substitution therapy • Male Circumcision • Treatment for HIV (we think) • Pre-exposure Prophylaxis (we hope)

  5. Over 1million condoms distributed through the LA County STD program alone each year

  6. Challenges to condom use? Male Controlled Power Dynamics Trust / Empowerment/Fidelity Myths – Can you really use one? Religion / Culture

  7. PEPpost-exposure prophylaxis • Uses a course of antiretroviral drugs which is thought to reduce the risk of HIV after events with high risk of exposure to HIV (e.g., unprotected anal or vaginal sex, needle stick pricks, or the sharing of needles.) • Ideally should begin within an hour of possible infection and no longer than 72 hours after exposure. Is not 100% effective; it cannot guarantee that exposure to HIV will not become a case of HIV infection.

  8. PEPpost-exposure prophylaxis The medications used in PEP depend on the exposure to HIV. Situations considered serious exposure are : • Exposure to a large amount of blood; • Blood came in contact with cuts or open sores on the skin; • Blood was visible on a needle that stuck someone; and • Exposure to blood from someone who has a high viral load (a large amount of virus in the blood). For serious exposures, the U.S. Public Health Service recommends using a combination of three approved ARVs for four weeks. For less serious exposure, the guidelines recommend four weeks of treatment with two drugs: AZT and 3TC.

  9. PrEPpre-exposure prophylaxis Comprehensive prevention approach that includes an array of already proven methods (i.e. male and female condoms, syringe exchange, male circumcision and PEP).

  10. PrEPpre-exposure prophylaxis • PrEP is one of several HIV prevention strategies being tested in clinical trials today. • Results from initial trials are expected over the next two years.

  11. Vaccines Mimic Simulates Responds Attacks

  12. Vaccines Two Approaches to develop a vaccine • Stimulates cellular immunity • Stimulates humoral immunity

  13. What if we had a female controlled method of HIV and/or STD Prevention?

  14. Microbicide: a new type of product being developed that people could use vaginally or rectally to protect themselves from HIV and possibly other sexually transmitted infections.

  15. If a Microbicide were available it : • could be produced in many forms, including gels, creams, suppositories, films, or as a sponge or ring that releases the active ingredient over time. • would be the most important innovation in reproductive health since the Pill. But most Important…..

  16. Potential Public Health Impact If a 60% effective product Offered to 73 lower income countries Is used by 20% people reached by health care during 50% of unprotected sex acts = 2.5 million HIV infections averted in 3 years including women, men and children

  17. Expected protection Regulators will look for 40-60% protectiveness Promoted as a back-up to condoms, not as a replacement. “Use a microbicide with your condom for added pleasure and protection.” “Use a male or female condom every time you have sex; if you absolutely can’t use a condom, use a microbicide.”

  18. The Product Pipeline in 2008 3 products 3 products 6 products 30+ products Laboratory Testing 2-6 Years Phase I (safety) 1 to 6 Months Phase II (safety) Up to 2 Years Phase III (efficacy) 2 to 4 Years 200-400 people 3,000-10,000 people 25 – 40 people Simultaneous studies in some cases: HIV+, penile & rectal safety 10 or more years Source: Alliance Pipeline Update, first week of every month - http://www.microbicide.org/publications

  19. Where are we now? No Magic Bullet

  20. Traci Bivens-Davis Common Ground The Westside HIV Community Center tbivens@commongroundwestside.org (310) 314-5480 ext 111

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