Transcript HIV Prevention & Harm Reduction

Harm Reduction
IN
HIV Prevention
Harm Reduction & HIV Prevention
PEP
Vaccines
PrEP
Microbicides
Where are we now?
No Magic Bullet
10 Best Things in HIV Prevention
1.
2.
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10.
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)
Over 1million condoms
distributed through the LA
County STD program alone
each year
Challenges to condom use?
Male Controlled
Power Dynamics
Trust / Empowerment/Fidelity
Myths – Can you really use one?
Religion / Culture
PEP
post-exposure prophylaxis

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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.
PEP
post-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.
PrEP
pre-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).
PrEP
pre-exposure prophylaxis

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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.
Vaccines
Mimic
Simulates
Responds
Attacks
Vaccines
Two Approaches to develop a vaccine
1)
2)
Stimulates cellular immunity
Stimulates humoral immunity
What if we had a female controlled
method of HIV and/or
STD Prevention?
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.
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…..
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
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.”
The Product Pipeline in 2008
3 products
3 products
30+ products
Laboratory
Testing
2-6 Years
6 products
Phase I
(safety)
Phase II
(safety)
Phase III
(efficacy)
1 to 6
Months
Up to 2
Years
2 to 4
Years
25 – 40
people
200-400
people
3,000-10,000
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
Where are we now?
No Magic Bullet
Traci Bivens-Davis
Common Ground
The Westside HIV Community Center
[email protected]
(310) 314-5480 ext 111