What is a rectal microbicide

What is a rectal microbicide?....click title for more
Currently in development, a microbicide is a cream or gel, or maybe a douche or an enema, that could be used to reduce a person’s risk of HIV infection vaginally or rectally. Rectal microbicides could offer both primary protection in the absence of condoms and back-up protection if a condom breaks or slips off during anal intercourse.

For those unable or unwilling to use condoms, rectal microbicides could be a safe and effective alternative means of reducing risk, especially if they were unobtrusive and/or enhanced sexual pleasure enough to motivate consistent use. Such alternatives are essential if we are to address the full spectrum of prevalent sexual practices and the basic human need for accessible, user-controlled HIV and STD prevention tools.

You will find a plethora of information on the research and development of rectal microbicdes on this site. You will also learn of advocacy actvities underway to help move the science forward and make these important prevention tools a reality for the women and men around the world who need them. Please take advantage of the presentations and other materials you find here!

Selena Blake looks at Jamaican homophobia with 'Taboo: Yardies.'

Writer, producer and director Selena Blake interviews gay and straight Jamaicans about the island nation's treatment of homosexuals in her documentary, tentatively titled 'Taboo: Yardies.'

Any doubts about how deeply homophobia is ingrained in Jamaica, West Indies, culture were put to rest in May when Prime Minister Bruce Golding told the British Broadcasting Channel that there were no homosexuals in his cabinet and none would be allowed to serve.

Click Selena's image for more on this story by the NY Daily News.

Are Gay Men Here Lesbophobes?

Hmmm, in a recent discussion I was involved in I expressed my thought that it's time gay men and lesbians in Jamaica come together ideologically and work towards understanding each other. I agree that both sectors of the LGBT community have their share of issues and idiosyncrasies but why for example our lesbian sisters just want to be by themselves?

Even at our bi weekly Gay, Lesbian & Bisexual Community (GLABCOM) meetings in Kingston and reportedly at the other three chapters it is evident that the ladies are not interested or so it seems, as the meetings are predominantly attended by men.

Gay men here have been accused of being too overbearing and intolerant of lesbian views and issues and that we (men) don't listen, many lesbians have expressed displeasure at these meetings where the males tend to out speak the them while they are trying to make a point, even at the local level socially, at regular parties the difference is clear, save and except for some gatherings.

My lesbian counterpart in the discussion said many lesbians are expressing their displeasure at the behaviour of some of our brothas and rightly so, but to then criticise the effeminacy or "realness" is just too much for me as some gay men are just that, REAL and cannot express themselves no other way.

However on the matter of my brothas being overbearing, in all fairness that's true to a certain extent and I have heard gay men also expressing their dislike for associating with lesbians.

What is this? Lesbophobia, we nuh like dem, dem nuh like we? eh eh,

(english: we don't like them, they don't like us? wow).

Is it a lack of understanding of each other's lifestyles or are we so busy being "Gay" in our own gender box that everything else seems irrelevant?

.

Another strange observation I have found is that many gay men like myself seem to have more "straight" female friends than lesbian ones and the reverse is true of lesbians in the Jamaican context.

For example a so called thug/shotta (male) will hang with a "butch" female and take her as one of the boys as opposed to socializing with an effeminate male, we see it publicly, lesbian females dressed in men's baggy jeans and smoking weed and being all "thuggy" on the corner and very few oppose it.

Strange bed-fellows in our so called homophobic environment. Personally I have many lesbian friends and in fact many of my gay brothas wonder how come I get along so easily with lesbians.

How can we begin to build the bridge between us and how can we sustain it?.

What do you think?

Howie seh so

Peace

Should AIDS Remain a Global Emergency?

A new study examines whether HIV/AIDS should still be considered a global crisis in the age of antiretroviral medications, IRIN/PlusNews reports (plusnews.org, 7/18). Published in the June 2008 issue of Population and Development Review, the study asserts that HIV incidence worldwide has peaked.

According to lead author John Bongaarts, the study—called “Has the HIV Epidemic Peaked?”—shows that although HIV/AIDS constitutes just 5 percent of disease prevalence in low- and middle-income countries, the epidemic receives about a quarter of global health aid. According to the article, Bongaarts says that HIV/AIDS funding would be better spent on inexpensive interventions to fight other diseases with immunizations, mosquito nets and family planning.

“AIDS should now be treated like any other disease, and the world community should look at its investments in health and prepare the most cost-effective interventions,” said Bongaarts. “I’m not advocating less money for AIDS treatment, but I want more spent on AIDS prevention and other diseases. We can save lives for a few dollars.”

Homophobia in Africa Deters HIV Education

AIDS activists warned at a meeting in Cameroon that violence against gay people in Africa jeopardizes efforts to combat HIV across all demographics, IRIN reports (irinnews.org 7/23).

Thirty-eight of the 53 African nations still consider homosexuality an offence deserving imprisonment. It is estimated that HIV infections are four to five times higher for men who have sex with men (MSM) than the population overall.

Dr. Steave Nemande, the president of the human rights organization Alternatives Cameroun, believes that by criminalizing homosexuality “social homophobia is legitimized and it increases fear among MSM, who take further risks to live their sexual life in secret.”

'Jamaican men are poppy shows'

UWI lecturer says males are pursuing wrong priorities
published: Thursday July 24, 2008
Athaliah Reynolds, Staff Reporter

Declaring that Jamaican men are in trouble, Father's Inc chairman and university lecturer, Dr Herbert Gayle, says the country needs to readjust how males and females are socialised if it is to be saved from its downward drift.

Gayle, who is a lecturer in the Department of Sociology, Psychology and Social Work at the University of the West Indies (UWI), Mona, yesterday said Jamaican men were destroying themselves.

FULL ARTICLE HERE

Gay asylum seekers to be discussed at Lib Dem conference

By Jessica Wilkins

Rights for LGBT asylum seekers will be one of the primary focuses at the Lib Dem conference to be held in Bournemouth in September.
The DELGA, the Lib Dem gay group, is calling for equal rights for the LGBT community.
It put forward the motion to discuss the state of LGBT asylum seekers facing deportation from the UK.

They plan to argue the idea that LGBT asylum seekers can be deported on the grounds they act on their sexuality "discreetly" at home is "an inappropriate message for a the British government to send in the 21st century."
DELGA secretary Drian Trett said the motion "was on the preliminary list for the conference."
While the motion is not set in stone, its hoped that it will be discussed in detail the Lib Dem conference.
Mr Trett said the DELGA would be campaigning for better protection of LGBT asylum seekers in the UK.

Rights for gay asylum seekers was an issue at London's Pride march last month.
Harriet Harman, Labour's Deputy Leader and Minister for Equality, was booed by the Pride crowd while delivering her speech.

Some Pride London marchers felt the Labour government was exposing LGBT asylum seekers to possible torture, imprisonment and execution by deporting them from Britain

Human rights groups lash PM

LOCAL human rights groups are taking Prime Minister Bruce Golding to task over a recommendation he made in Parliament on Tuesday, to allow for majority verdicts to decide cases of non-capital murder.

The Independent Jamaica Council of Human Rights (IJCHR), in a press release yesterday, said the categories of capital and non-capital murder were abolished in 2005 following amendments to the Offences Against the Person Act.

"The [IJCHR] is perplexed by this proposal. the circumstances that defined the former categories of capital and non-capital murder are now only considered after conviction, during the sentence hearing, and then only by the trial judge. Therefore, a majority verdict is impossible," the release said.


GOMES... says her organisation is trying to determine whether the prime minister's suggested reform is applicable
Similar sentiments were expressed by chairman of Jamaicans for Justice (JFJ), Dr Carolyn Gomes, who said her organisation was trying to determine whether the prime minister's suggested reform was applicable.

"We don't have a full position on that and there may be some problems with it because, as we understand, the law was altered to remove the distinction. It is supposed to be applicable when a person is charged and the verdict is arrived at, then the judge pronounces sentence on the basis of his assessment of the evidence. So we need to study that some more to see whether it is workable, and if it is workable, then whether or not we are in support of it," the JFJ chairman said.

On Tuesday, Golding announced in Parliament several new measures to be implemented by the Government to tackle the nation's soaring crime rate, including provisions for a majority of nine jurors out of 12 to decide on non-capital murders.

Golding also announced that criminal suspects could be detained for up to 72 hours without being charged, and that persons arrested and charged for serious crimes could be denied bail for up to 60 days. Both measures, however, drew the ire of the IJCHR.

"The council continues to reject the proposal for the detention of a person for any period without due regard to the provisions of the Constitution - particularly those in section 15(3), including the right to a trial within a reasonable period of time or to release.

".The imposition of a mandatory remand undermines the constitutional provision of the presumption of innocence and the discretion of the judges, it mandates a judge to 'sentence' a person to 60 days imprisonment, without a trial or proof of wrongdoing - in breach of several rights guaranteed by the constitution," the release said.

Gomes said, however, that the JFJ was 'palpably relieved' at the rule allowing for detention for up to 72 hours.
"We don't have any objection to that; we are very relieved that it is not the suggested 28 days without charge. We are quite happy with the oversight of assistant commissioner (to authorise the detention), we would hope that this would mean that we would now get the police to actually follow the rules," Gomes said.

She, however, said the JFJ had not yet taken a position on the 60-day period for detention without bail.

The IJCHR also described as breaching the constitutional mandate against mandatory imprisonment, the Government's decision to impose a minimum mandatory imprisonment period of 10 years for persons on gun-related crimes.

Both Gomes and the IJCHR were in support of the use of DNA evidence, but said this depended largely on how the evidence was gathered
and safeguarded.

Reactive - Human rights group says legislation won't guarantee catching criminals

published: Wednesday July 23, 2008

One of Jamaica's human rights groups yesterday described the Government's new anti-crime plan as reactive, saying it neglects how to ensure that criminals are caught.
"All of these legislation kick in after the person has been caught," said Yvonne McCalla Sobers, convenor of Families Against State Terrorism, adding that the problem was with "catching the people".

But McCalla Sobers said she felt more comfortable with the Government's proposal to detain criminal suspects for 72 hours instead of the 28 days that was being considered.
However, she wants to know whether the Government would prescribe penalties for police personnel who breach a detainee's rights.

Click Text above/below or post title for full article

Prime Minister Bruce Golding outlining the new crime-fighting measures in the House of Representatives yesterday.
PRIME Minister Bruce Golding yesterday promised tough new legislative measures to reduce crime, including a minimum 10-year sentence for gun crimes.

Peace

CALL TO ACTION TROOPS!! - JAMAICA HOUSE LIVE

THE PRIME MINISTER'S CALL IN PROGRAM AIRES EVERY LAST WEDNESDAY FROM 8:30 TO 9:30 pm ON RJR FM, NATIONWIDE RADIO, HOT 102 FM, KLAS FM, ROOTS FM, BESS 100FM AND IRIE FM.

The Prime Minister may be reached at the following numbers during the programme:

960-7739, 960-9853, 968-2019, 926-7527.
JAMAICA TOLL FREE: 1-888-991-7785

A link to Jamaicans in the Diaspora is being facilitated by the Jamaica National Building Society.
The numbers from the United Kingdom are 207-708-6670 and 207-708-6672.
The numbers from the United States and Canada are 954-535-5761 and 305-597-7940 and 1-888-532-1754 respectively.

CALL IN AND AIR YOUR VIEWS, LET YOUR VOICE BE HEARD

NATIONWIDE RADIO LIVE LINK: http://www.nationwideradiojm.com/
(CLICK THE RADIO DIAL ON SCREEN, MEDIAPLAYER SHOULD START STREAMS)

LOVE 101FM LIVE LINK: http://www.lovefm.org/newlove101/flashindex.html
(CLICK LISTEN NOW AT THE TOP OF THE PAGE)

JIS LIVE STREAM: http://www.jis.gov.jm/

Because families are defined by love not gender

"Because families are defined by love not gender.
Because hatred is not a family value.
Because equal rights are not special rights." - Anonymous

from Barbados Gays & Lesbians Against Discrimination

Lesbos islanders lose court case over use of "lesbian"

A court in Athens today rejected a law suit from some residents of the island of Lesbos that attempted to stop homosexual women from using the word 'lesbian' to define themselves.

Three islanders took gay rights group OLKE, the Homosexual and Lesbian Community of Greece, to court to get a ban on anyone except islanders and their descendants using the term lesbian.

The court ruled that they do not have sole claim to the word.

The Greek island, home to the 6th Century BC poet Sappho, who wrote about female same-sex love, lends its name to the term 'lesbian.'

"My sister can't say she is a Lesbian," islander and plaintiff Dimitris Lambrou told AP at the start of the case last month.

"Our geographical designation has been usurped by certain ladies who have no connection whatsoever with Lesbos."

Andrea Gilbert, spokesperson for Athens Pride 2008 and a member of OLKE, has drawn attention to the amount of money from tourism that lesbians bring to the island when visiting Eressos, the birthplace of Sappho.

She told PinkNews.co.uk:

"The claim is based in serious prejudice and hatred, a ridiculous claim that most Greeks find laughable.

"However, the underlying homophobia and reactionary sentiment is no laughing matter."

Mr Lambrou said they will take their case to the European courts.

"The word lesbian has been associated with gay women for the past few decades but we have been Lesbians for thousands of years," he said.

Antilles to appeal against court ruling on same-sex couples

The Netherlands Antilles has said it will appeal against a court ruling that established same-sex couples have the same rights there as they do in Holland.

The case concerned a health company that refused to accept a lesbian couple.

Like Aruba, the Netherlands Antilles is self-governing, but it remains a constituent country of the Kingdom of the Netherlands, forming a commonwealth with the State of the Netherlands.

The appeal will test the extent to which the Antilles can make their own decisions about social policy and will argue that the Dutch ideas about marriage should not take primacy.

Gay marriage is legal in the Netherlands but not on the Antilles or Aruba, but a court ruling last year forced them to recognise marriages performed in Holland.

The decision followed a row over a same-sex couple who were denied the right to register their union in Aruba.

Aruba refused to recognise same-sex marriages in 2005 although it did legalise homosexual relations between consenting adults in private.

The Netherlands Antilles was scheduled to disband on December 15, 2008, but the process has been postponed.

Two islands, Curaçao and Sint Maarten, are likely to become constituent countries of the Kingdom of the Netherlands while three others would become part of a Dutch province.

From Yarflex

Click here for direct link to site

Gareth Henry, who was until January 2008, the co-chair for the Jamaica Forum for Lesbians, All-sexuals and Gays (JFLAG), filed a refugee claim in Canada recently.

Henry, who reported to Xtra that his memories of violence and brutality are too painful to dwell on, launched the 'Call For Love' campaign in Canada, on Valentines Day this year.

Calling for the protection of queers in Jamaica, the campaign mirrors like initiatives around the world and was introduced in Toronto, Canada by PRIDE, Egale Canada and the Metropolitan Community Church of Toronto. A wreath was delivered to the Jamaican Consulate in Toronto as part of the launch activities; in memory of those queers murdered on the island.

"I came to Canada on January 26, basically fleeing for my life," Henry told Xtra. He was initially invited to be this year's international grand marshal for Toronto's Pride celebration in June, but intensified and increasing threats on his own life, forced him to leave Jamaica early.

Henry, 30, who had been at the lead of JFLAG for 10 years had grown accustomed to harassment and even beatings, often at the hands of police, but in November 2007 he became devastated as he received one more threat close to his gated community home.

"I was stopped in traffic when a man got out of his car and came over to me and said, 'Gareth, we know who you are and we're going to kill you and burn JFLAG down. "I was really devastated by that threat," he says.

"I went for the very first time to live with my partner. But I didn't want to get him in trouble so I was basically living in solitary confinement. I was living in fear. I was being totally crippled by fear. If I heard someone on the outside I could not sleep. I said to myself, "Nobody should live this way. I'm not in prison. I need to break free.' I had exhausted all possible options."

As part of the 'Call For Love' campaign launch, a letter was also delivered to the Jamaican Consulate in Toronto. It pleaded with the Jamaican Government to ensure police, "uphold their sworn duty to equally protect and serve all Jamaican citizens." Valentines day was selected for the launch, as it represents the anniversary of Henry nearly being beaten to death by a mob in Kingston, Jamaica.

Henry disclosed to Xtra, the reality in Jamaica that sees Homophobia being a deeply entrenched philosophy of hate that stems from encouragement of such by: the establishment; politicians, religious leaders, media, police and entertainers. Each one of these groups mentioned, fights against repealing Jamaica’s anti-sodomy laws that can send a gay man to jail for up to 10 years if convicted of having anal sex.

Horror stories of many vicious attacks carried out on queer people he was once acquainted with, were recounted by Henry to Xtra. And according to Human Rights Watch, on January 29 2008, the most recent acts of violence against queers saw a mob break into a home of four gay men in Jamaica, leaving three in hospital, one with severe wounds from a machete and a fourth man still missing and presumed dead as he is thought to have jumped off a cliff to escape the mob.

None of the perpetrators of any of these crimes have ever been brought to justice and Henry says Canadians can help to achieve change in Jamaica by pressuring their own government. He also works now with the Stop Murder Music Canada, a coalition of groups bent on stopping the distribution and display of homophobic dancehall music and artists in Canada.

"I remember in 2003 one of our friends was at this dance and this song was being played, 'Boom Bye Bye Inna Batty Bwoy Head,' by Buju Banton. When the song was finished playing our friend Kitty was lying on the ground with three shots to his head and that was the end of it. Nothing happened. Nobody knew who shot him."

Henry will use his position as international grand marshal at Pride, to persuade Canadians to join the fight against Jamaican homophobia.

"If I'm denied refugee status I'll call my mother and tell her, 'I'm coming home. I won't live long,'" he says.

Posted by yardFlex at March 10, 2008 10:57 AM

Donna Smith on Homophobic Violence (Flashback)

JAMAICA
Taking a Stand Against Homophobic Violence

By Zadie Neufville
KINGSTON (IPS) - Jamaican homosexuals battered by violence and discriminatory laws hope to benefit from public defender Howard Hamilton's willingness to stand up for anyone whose constitutional rights have been violated.

With more than 38 homosexuals killed here since 1980 and hundreds of alleged homosexuals viciously beaten, driven from their homes and jobs, the Jamaica Forum of Lesbians, All-Sexuals and Gays (J-FLAG) has been lobbying for a constitutional amendment that would grant them equal protection under the law.

But that could be a long time coming. So for now, their hopes of justice hinge on Hamilton.

''Where their constitutional rights have been breached and where one's right to life is affected,'' Hamilton says, that person is entitled to the full protection of the law.

He notes that while there is no legal protection from discrimination because of sexual orientation, they can seek protection under various statutes.

''Violence of any kind, whether it be against homosexuals, cannot be tolerated in civilised society,'' he says.

Under the 1962 constitution, discrimination because of race, creed, and religion is forbidden. But there is no protection from abuse because of gender or sexual orientation. Hamilton, as public defender and ombudsman, must protect the rights of all citizens but says he is unable to advocate the freedom of expression of homosexuals because homosexuality is against the law.

Prime Minister PJ Patterson vowed last year that he would make no changes to anti-homosexual legislation. This remains a significant obstacle to J-FLAG's hopes for constitutional reform. Any amendment to the constitution is likely to take years - a freedom of information act has been in the works since 1993- and with anti-gay sentiments high, no government is willing to take the risk, says Steve, a media professional who asked not to be identified by surname for fear of coming to harm if he is known to be a gay man.

Patterson's stance has found favour with many, but it has put Jamaica in the international spotlight. The Country's position is in breach of United Nations human rights regulations to which the country is a signatory and according to Hamilton, the country has to uphold the regulations it signed.

Hamilton's is a position that won't sit well in a society where homophobia is institutionalised and where homosexuals are constantly targeted for abuse and discrimination. Donna Smith, J-FLAG spokesperson, says anti-gay statements by Governor General Howard Cooke, the head of state, indicate just how deep-rooted homophobia is in Jamaican society. Cooke has sanctioned the exclusion of gays from the boys scouts.

"Those persons are not the type of persons we wish to be a part of the scout movement," Cooke, referring to gays, told a local newspaper.

The human rights group Amnesty International, in a recent report on hate crimes, listed Jamaica as one of three Caribbean nations with laws that promote discrimination against homosexuals.

According to Amnesty, ''Laws that treat homosexuals as criminals lend support to a climate of prejudice which increases the risk of attacks (and) other abuses.'' Amnesty also highlighted the case of four men arrested on charges of gross indecency at Kingston's International airport in November 1996 and who were held naked in full view of the public for more than 24 hours.

The men were reportedly taken to the rape unit, where they were sexually assaulted. Later, they were made to clean cells and toilets with their bare hands at the Kingston remand centre and their cells were left unlocked so other prisoners could beat them.

It is cases like these that Hamilton will most likely look at, and even he admits there is a tough fight ahead.

The police admit intolerance among their own ranks, with many arrests and illegal home invasions designed to cause embarrassment. With victims reluctant to come forward out of fear of humiliation and further violence, many won't press charges, J-FLAG concedes.

But the first order of business for Hamilton is to find out who was responsible for the deaths of 16, and injuries to more than 40, alleged homosexuals in 1997, in the worst single case of anti-gay violence.

That was when prison officials, in an attempt to fight the spread of HIV/AIDS in prisons, announced their intention to distribute condoms. In response to the allegations of sex in the prisons, inmates at the St. Catherine District Prison and Kingston's General Penitentiary, two of the island's largest jails, rioted after warders walked off their jobs incensed by what some described as ''a homosexuality label.'' The case remains of great interest to Amnesty, the group says, because no one has been held accountable for the incident. Former prison doctor Raymouth Notice blames the riot on over crowding, poverty, and politics. Over crowding, he says, leads to rape and secret homosexual relationships.

According to J-FLAG, alleged homosexuals in the inner city are particularly at risk. Last year, one man was shot to death even as he sought refuge in a churchyard in central Kingston. In the past few weeks, a group of university students were severely beaten in central Jamaica, and in another incident, police were just on time to prevent the deaths of two young men at the hands of a mob.

The problem stems from the existence of laws that outlaw homosexual relationships and give the public "license" to abuse homosexuals, Smith says.

Pointing to section 76 of the 137-year-old buggery law in the Offences Against the Person Act, Smith notes that consenting adults can be imprisoned for to 10 years with hard labour if they are caught in the act.

J-FLAG wants the laws repealed or the constitution amended to give homosexuals the rights afforded every other Jamaican. It's a life and death situation, Smith says, because in Jamaica, homosexuality is not only against the law, it is also seen as abnormal and wicked, and in light of highly publicised cases of rape and buggery of minors, an unwanted part of society.

J-FLAG's actions have earned the ire of many influential locals including radio talk show host and attorney-at-law Antoinette Haughton, who says she believes that homosexuals who desire freedom of expression should live outside Jamaica.

"They want to corrupt our children and tell them it's OK to live immoral and nasty lives," she says. It is a view supported by the traditional churches and recently verbalised by evangelist Errol Hall when he told his congregation that homosexuals should come and have him lay his hand on them and ''cast out the demons.'' ''They believe homosexuals are the way they are because they choose to be. Why would someone choose to be something that is scorned and hated?'' Smith scoffs.

Jamaica's homophobia came to international attention in 1993 with Dancehall star Buju Banton released 'Boom Bye Bye', promoting a bullet to the head for homosexuals.

Another musical group, TOK, has released an anti-homosexual song, 'Chi Chi Man', which is being promoted in the United States. It advocates killing homosexuals by ''full them with copper shots.'' Until recently, fear of violence and discrimination meant J-FLAG had no face. But Smith, a lesbian, says ''Jamaicans need to see that their brothers, sisters, cousins are or can be gay.'' She believes that many parents disown homosexual children because of the violence that fuels homophobia. It is also the reason local human rights groups give for not offering their support to homosexuals.

Jamaica's acute homophobia is also stalling the Ministry of Health's safe sex and HIV/AIDS education campaign, forcing Chief Medical Officer Peter Figueroa to call for the buggery laws to be repealed.

It is a position Notice, the former prison doctor, supports because the law prevents the adequate care and counselling of victims of prison rapes, and hampers HIV/AIDS education and prevention programmes among inmates. (END/IPS

New Guidelines for Treating and Avoiding Opportunistic Infections

by David Evans
Despite the fact that HIV is now perceived as “manageable,” opportunistic infections (OIs) remain a threat, especially for those who are unaware of their HIV status and those out of HIV treatment options. In this AIDSmeds interview, National Institutes of Health (NIH) scientist Henry Masur, MD, explains the Department of Health and Human Services’ recently revised OI prevention and treatment guidelines. They help health care providers and patients steer clear of—and treat—these life-threatening illnesses.How often do we hear today that HIV is a “chronic manageable disease”?

The implication is that HIV is no longer dangerous and that it’s relatively easy to treat. But according to Dr. Masur, a lead author of the guidelines, about one-third of people who test positive for HIV in many U.S. cities do so only after they already have AIDS and require treatment for a life-threatening opportunistic infection (OI)—or are in immediate danger of experiencing one. So it can be misleading to consider HIV and its related illnesses a thing of the past.The newly revised Department of Health and Human Services’ Guidelines for Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents includes an entirely new section on the prevention and treatment of hepatitis B virus (HBV). The guidelines also include sections dedicated to the prevention and management of immune reconstitution inflammatory syndrome (IRIS)—a flare of potentially dangerous symptoms mimicking OIs that can occur when antiretroviral treatment is started by people with low CD4 counts and whose immunity to infections is rapidly restored. These updated guidelines will be vital for all health care providers treating people at risk for OIs, particularly those doctors who treat HIV less frequently.AIDSmeds: Rates of OIs are way down because of the widespread use of combination antiretroviral therapy. So why update the OI prevention and treatment guidelines now? Maybe a better question is: Why have these guidelines at all?Henry Masur: Yes, the incidence of OIs has declined dramatically. But it’s also true that there are an estimated 40,000 to 60,000 new cases of HIV [in the United States] per year. Those numbers haven’t changed substantially in the last two and a half decades. In most cities, 30 percent of people are diagnosed with HIV when their CD4 count is already below 200—it’s 65 percent where I live in Washington, DC—and many are finding out that they’re positive after being diagnosed with Pneumocystis pneumonia [PCP], toxoplasmosis or cytomegalovirus [CMV] in emergency rooms. So there are still a substantial number of people who develop OIs. We’re really dealing with two populations who develop OIs. One is a population that has good access to care and the other is a population that doesn’t. Even in those who have good access to care, drug resistance may develop due to poor adherence and other factors, drug options can then run out and people find themselves at risk for OIs. So [finding] strategies to prevent OIs, including immunization, and management strategies are important.Tell us about the major updates to the guidelines.In terms of diagnosis, the guidelines provide new information about the utility of new tests such as PCR or BDNA tests for Hepatitis C, Hepatitis B, CMV, and tuberculosis.We also highlight new drugs for OIs, including the antifungals voriconazole [Vfend] and posaconazole [Noxafil]. The question is, When should they be used? There are also new drugs for hepatitis B, which were not included in the 2002 version of the guidelines, so we make recommendations regarding those drugs, too.We’re seeing more and more immigrants in this country with HIV and HIV-positive U.S. citizens traveling abroad. In turn, we’re seeing more and more parasitic diseases. So there’s a new section focusing on protozoal infections and complications in the immigrant population and travelers. While I don’t think these infections are huge public health burdens in the U.S., busy health care providers will likely have to deal with them.There are a number of new sections on IRIS in the revised guidelines. How common is IRIS? What should patients and health care providers be looking for?Many HIV-positive people with low CD4 counts starting therapy for the first time experience IRIS, but it’s not always a problem. If you were to do a CT or an MRI study every two weeks in a group of people taking antiretroviral therapy for the first time, I’m sure you could find some lymph nodes that have changed in size—a sign of IRIS—but that is not usually clinically important. The question is, What is clinically important—and that clearly depends on what active diseases, or infections without symptoms, you’ve had in the past.If you’ve had cryptococcal meningitis, toxoplasmosis or even progressive multifocal leukoencephalopathy [PML] in the past, a bad flare can occur when you start antiretrovirals. People can also have a latent infection, such as Cryptococcus or Mycobacterium tuberculosis, that hasn’t caused symptoms but may cause problems once the immune system begins responding to HIV treatment.We don’t have the tools or the knowledge to predict which patients with low CD4 cell counts starting therapy will develop a severe episode of IRIS. We also don’t yet know if we should manage flares by simply monitoring our patients, prescribing steroids or stopping antiretrovirals altogether—which is usually not something you want to do.I know it’s frustrating for the people who have questions about IRIS, but unfortunately we don’t have many data-driven answers.Again, we’re talking about more and more people finding out that they’re HIV positive in emergency rooms. What is the NIH doing to make sure that health care providers, especially those in hospital emergency departments, are aware of these guidelines?We try to work with different professional societies so that they know that these guidelines exist. A major issue facing emergency medicine providers is deciding whether to deal with a health issue in the ER or elsewhere. There’s a lot of effort to make all health care providers, particularly those in emergency rooms, aware of the importance of HIV testing, the complexities of this disease and how essential it is to get infectious disease providers involved early.Any final words?We really appreciate the interest, because I think these guidelines are important. It is interesting that already 80,000 people have downloaded this document. Even without much publicity, people are looking at it and using it.The new guidelines are co-published by the NIH, the Centers for Disease Control and Prevention (CDC) and the HIV Medicine Association of the Infectious Diseases Society of America (HIVMA/IDSA). Click here to download the document.

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Pride Week forum 2008 - Canada

Gareth Henry, Co-Chair of the Jamaica Forum for Lesbians, Allsexuals and Gays (JFLAG), noted that while progress may seem slow in Canada, things are very different in Jamaica, where the gay community is essentially excluded from society. "We're at the stage where we're talking about basic human rights for gays and lesbians," Henry told the group.

A gay community activist for the past 10 years, Henry said that in his home country, people must often flee for their lives because of their sexual orientation. In fact, he noted that 13 of his friends had been murdered in Jamaica between 2003 and 2007, simply because they were gay. He also reported that no one has ever been arrested for these murders, since there is scant regard for the lives of gays and lesbians in Jamaica.

"It's not easy to accept that you're not accepted because you're different," he said. "But, I believe strongly in what I'm doing."
Henry moved to Toronto in early 2008, following years of ongoing death threats and attacks. "Here [in Canada] we have a lot of freedoms, but there is a lot more to be done. I've experienced homophobia here too," he reported.
He pointed out that laws can't necessarily change attitudes, so it's important to make the laws meaningful. "Don't be complacent," he warned. "Things can change again."

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