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HIV/AIDS
Published in Patricia G. Melloy, Viruses and Society, 2023
The development of pre-exposure prophylaxis, also known as PrEP, has been another game changer in HIV prevention strategy. PrEP was approved in 2013, after a clinical trial in 2010 with men who have sex with men indicated that there was a 44% reduction in HIV-negative individuals acquiring HIV from an HIV-positive partner if the PrEP regimen was used (UNAIDS 2021a; Lostroh 2019; Grant et al. 2010). PrEP typically involves two antiretroviral drugs (Gulick and Flexner 2019). This research also informed recommendations released in 2012 for what are known as “serodiscordant” or “discordant” couples, where one partner is HIV positive and the other is HIV negative (UNAIDS 2021a).
Different faces of governance
Published in Kevin Dew, Public Health, Personal Health and Pills, 2018
Asha Persson (2016) utilises the concept of pharmaceutical citizenship in her research on the re-imagining of HIV in a time of treatment-as-prevention. Pharmaceutical citizenship alludes to the idea that pharmacological treatment can be pivotal to citizenship that is, to a person being able to engage actively in society. In the case of HIV, trials have shown a near 100 per cent reduction in the sexual transmission of the infection in heterosexual serodiscordant couples (where one partner is HIV-positive and the other is not) as a result of effective antiretroviral treatment. Antiretroviral treatment thus, has the potential to reconfigure HIV from being one of the most contagious infections to one that is harmless; from a public health perspective, advocating for adherence to antiretroviral treatment becomes a major plank in eliminating the infection. At an interpersonal level, issues of trust change for serodiscordant couples. For the uninfected partner, unprotected sex could now be a reasonable risk as long as the infected partner could be trusted to take the medications (Persson 2016). Safe sex is transformed as medication is the focus of prophylaxis, as opposed to the use of condoms. The stigma of HIV infection is lessened as aspects of sexual belonging are restored (Persson 2016).
Providing sexual health services for men
Published in Laura Serrant-Green, John McLuskey, Alan White, The Sexual Health of Men, 2018
Laura Serrant-Green, John McLuskey, Alan White
However, sexual health for HIV-positive men is more than just STI screening. Issues related to HIV disclosure, risk reduction in serodiscordant relationships and hepatitis co-infection are amongst the issues unique to those with HIV.58 An increased rate of sexual problems is also seen in HIV-positive men, warranting more specific sexual health services for this population.59-61 Although an intervention currently unsupported by empirical research, targeted screening for anal intraepithelial neoplasia (AIN) may be another issue for consideration in the future.62,63 In addition, the contentious topics of HIV super-infection and sexual transmission of drug-resistant strains of HIV provide further support for informed discussions by specialist HIV sexual health providers.
Pleasure and PrEP: A Systematic Review of Studies Examining Pleasure, Sexual Satisfaction, and PrEP
Published in The Journal of Sex Research, 2022
Christine M. Curley, Aviana O. Rosen, Colleen B. Mistler, Lisa A. Eaton
Sexual pleasure can be separated into physical pleasure and emotional intimacy. Likewise, sexual satisfaction goals include satisfying both physical and emotional needs and desires (Gamarel & Golub, 2020). Condom use is still often recommended for people using PrEP, as PrEP does not protect against sexually transmitted infections (STIs). However, condoms may not always be utilized as for many, HIV prevention is the primary concern, particularly for HIV serodiscordant couples in committed monogamous relationships. In the literal sense, by eliminating the necessity to use condoms to protect against HIV transmission, PrEP removes a physical barrier to sexual pleasure, thereby increasing physical sexual satisfaction (Mabire et al., 2019). Condoms are experienced as “totally different from skin,” skin being preferred (p. 6). Men also discussed the awkwardness of condoms; including putting them on, maintaining an erection, and worry over whether a condom stayed on and intact during sexual intercourse. Several remarked how PrEP removed these negative thoughts when engaging in sexual activities. Couples in committed relationships referred to PrEP as allowing them to return to “live sex,” despite being in a serodiscordant relationship (Nakku‐Joloba et al., 2019). Comments culled from a Facebook discussion group of gay and bisexual MSM reflected that sex on PrEP was seen as more natural, providing deeper sensation than sex with condoms (da Silva-Brandao & Ianni, 2020). In one study, PrEP adoption was associated with higher sexual satisfaction scores for MSM in relationships (Gamarel & Golub, 2020).
Deterrents and motivators of HIV testing among young Black men who have sex with men in North Carolina
Published in AIDS Care, 2021
Megan Threats, Donte T. Boyd, José E. Diaz, Oluwamuyiwa Winifred Adebayo
Social support was a motivator for obtaining HIV testing among participants. The quotes in Table 3 illustrate the power of support within YBMSM social networks to serve as a motivator for testing and to overcome the structural deterrents such as intersectional stigma that may prevent YBMSM from engaging in HIV testing. Social support encompassed informational, instrumental, and appraisal support received from friends, family members, and romantic partners. Informational support included receiving information about HIV testing locations, HIV testing options (e.g., self-testing kit), and health care provider recommendations. Informational support exchanged within serodiscordant relationships (e.g., romantic and/or sexual partners) was commonly discussed by participants living with HIV, and participants who were HIV-negative. Appraisal support involved the encouragement to get tested for HIV, particularly by other Black MSM, especially Black MSM living with HIV. Instrumental support included getting tested with a romantic partner or friends, being transported to an HIV testing location by a romantic partner or friend and being shown how to conduct a rapid HIV self-test. One participant who was uncomfortable utilizing HIV testing at a local venue describes how his friend showed him how to use an HIV self-testing kit (Table 3). The quotes in Table 3 illustrate the power of support within YBMSM social networks to serve as a motivator for testing and to overcome the structural barriers such as intersectional stigma that may prevent YBMSM from engaging in HIV testing.
Prevention of HIV transmission with sperm washing within fertile serodiscordant couples undergoing non-stimulated intrauterine insemination
Published in AIDS Care, 2021
Waldemar de Almeida Pereira de Carvalho, Edir Catafesta, Itatiana Ferreira Rodart, Silvio Takata, Denise Lotufo Estevam, Caio Parente Barbosa
Serodiscordant couples are often more seeking for medical advice and assistance with reproduction due to the risk of viral transmission to partner and offspring. The use of sperm preparation techniques, such as simple semen washing, isolates spermatozoa from seminal fluid, allowing that the HIV-negative sperm fractions are used for either stimulated and non-stimulated intrauterine insemination (IUI), or in vitro fertilization (IVF), preventing the risk of HIV transmission. A recent meta-analysis concluded that no HIV transmission occurred in near 12 thousand cycles of assisted reproduction using semen washing. In addition, uninfected females did not seroconverted even when their partners failed to present plasma viral suppression at the time of semen washing. Vertical transmission rate to offspring was 0%, and clinical pregnancy was achieved in more than half couples (Zafer et al., 2016).