MSM 2003HIV positive 17 % 2005HIV positive 28 % 2007HIV positive 32 %
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MSM • 2003 HIV positive 17 % • 2005 HIV positive 28 % • 2007 HIV positive 32 %
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Transcript of MSM 2003HIV positive 17 % 2005HIV positive 28 % 2007HIV positive 32 %
MSM
• 2003 HIV positive 17 %
• 2005 HIV positive 28 %
• 2007 HIV positive 32 %
HIV prevalence among MSWBangkok, Chiang Mai and Phuket, 2005–2007
18.9
27
11.4
15.514.4
19.3
0
5
10
15
20
25
30
35
40
2005 2007
HIV
Pre
va
len
ce
(%
)
BANGKOK CHIANGMAI
PUKET
0.70.6
0.5 0.5 0.5 0.5 0.5 0.5
0.7
1.21.3
1.6
3.0
3.7
2.9
3.5
2.4
2.01.9
0.0
0.5
1.0
1.5
2.0
2.5
3.0
3.5
4.0
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
Per
cen
t S
ero
pre
vale
nce
Per
cen
t S
ero
pre
vale
nce
YearYearSources: Army Institute of Pathology
Armed Forces Research Institute of Medical Sciences, RTA
HIV-1 Seroprevalence of Royal Thai Army Conscripts, 1991-2009
HIV-1 Incidence among RTA Conscripts from 2005 – 2009
Year No Conscripts No anti-HIV-1 positives
Prevalence
(%)
No Samples
for BED CEIA (%)
Estimated Incidence
2005
(Nov) 29,614 151 0-51 150 (99.3) 0.14
2006 57,564 298 0.52 286 (96.0) 0.19
2007 58,016 288 0.50 286 (99.3) 0.20
2008 61,475 307 0.50 297 (96.7) 0.26
2009 61,835 331 0.54 309 (93.4) 0.25
Sources: Armed Forces Research Institute of Medical Sciences, RTA
0.14
0.20
0.17
0.21
0.20
0.28 0.270.25
0.27
0.00
0.05
0.10
0.15
0.20
0.25
0.30
Nov, 05 May, 06 Nov, 06 May, 07 Nov, 07 May, 08 Nov, 08 May, 09 Nov, 09
Per
cent
inci
denc
e
Year
HIV Incidences at Time of Entry into Royal Thai
Army, 2005-2009
Sources: Armed Forces Research Institute of Medical Sciences, RTA
0
0.05
0.1
0.15
0.2
0.25
0.3
0.35
0.4
Year
HIV Incidence rate 0.08 0.05 0.09 0.15 0.18 0.26
lower limit 0.05 0.03 0.05 0.1 0.12 0.18
upper limit 0.11 0.08 0.12 0.19 0.24 0.34
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
Median HIV Prevalence and BED Adjusted Incidence among ANC Pregnant Women in Sentinel Provinces
1.51
0.6
0.760.840.87
1.081.05
1.06
1.35
1.38
0
0.2
0.4
0.6
0.8
1
1.2
1.4
1.6
Year
Median prevalence
(% per year)
BED adjusted incidence
(% per year)
0
0.5
1
1.5
2
2.5
3
3.5
Year
HIV Incidence rate 2.26 0 0.39 1.69 0.76 0.48
lower limit 1.44 0 0.1 1.06 0.39 0.2
upper limit 3.08 0 0.67 2.31 1.12 0.76
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
Median HIV Prevalence and BED Adjusted Incidence among Direct Sex Workers
10.8
4.374.27
6.56.477.467.07
11.56
13.31
15.72
0
2
4
6
8
10
12
14
16
18
Year
Median prevalence
(% per year)
BED adjusted incidence
(% per year)
0
0.2
0.4
0.6
0.8
1
1.2
Year
HIV Incidence rate 0.24 0.34 0.42 0.73 0.67 0.3
lower limit 0.12 0.18 0.21 0.47 0.4 0.13
upper limit 0.37 0.5 0.62 0.99 0.94 0.46
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
Median HIV Prevalence and BED Adjusted Incidence among indirect Sex Workers
4.28
1.42
2.65
3.273
3.88
4.35
3.35
5.02
4.92
0
1
2
3
4
5
6
Year
Median prevalence
(% per year)
BED adjusted incidence
(% per year)
BED-CEIA Results
Group risk
%Recent case of HIV in BED Project
2004 2005 2006 2007 2008 2009
ANC 3.74 2.99 4.56 5.39 6.25 5.87
DCSW 4.02 1.57 1.53 3.68 2.78 2.27
ICSW 1.94 2.83 3.49 4.08 3.47 5.87
Total 9.7 7.4 9.59 13.16 12.5 14.02
BED-CEIA Results (cont.)%Recent case of HIV in BED Project
6.25%(36)5.39% (41)
4.56% (21)
3.74% (27)
2.99% (19)
5.87%(31)
1.53% (7)
3.68% (28)
4.02% (29)
1.57% (10)
2.78%(16)2.27%(12)1.94% (14)
4.08% (31)
3.49% (16)2.83% (18)
5.87%(31)
3.47%(20)
14.02% (74)
12.5% (72)
13.16% (100)
9.59% (44)9.7% (70)
7.4% (47)
0
2
4
6
8
10
12
14
16
2004 2005 2006 2007 2008 2009
Year
%Recent
ANCDCSWICSWTOTAL
11
11
Improving HIV prevention
1. Do better with the strategies that we already have
2. Develop new biomedical technologies to prevent HIV
3. Adopt a more comprehensive approach to HIV prevention
July 3, 2012 FDA approved home HIV test
1313
Turning to antiretrovirals for prevention
The use of antiretrovirals for prevention by…
1. HIV-positive individuals to reduce their risk of transmitting HIV
– Treatment as prevention
2. HIV-negative individuals to reduce their risk of infection
– Post-exposure prophylaxis (PEP)– Pre-exposure prophylaxis (PrEP)
What is pre-exposure prophylaxis (PrEP)?
• Pre Before (and after)
• Exposure When a fluid containing HIV comes into contact with mucous membranes or non-intact skin
• Prophylaxis An action taken to prevent infection or disease
14
151515
How does PrEP work?
• Infection does not occur instantly after an exposure to HIV• The virus needs to spread throughout
the body• This may take up to 3 days after the
exposure
• The “window of opportunity” for PrEP• The brief period of time - after an
exposure - where HIV has not yet spread throughout the body
• During this time, PrEP may be able to stop HIV from causing an infection
1616
What does the research say about PrEP?
iPrEx TDF2 Partners PrEP
Men who have sex with men (MSM) and trans women
Heterosexual men and women Serodiscordant heterosexual couples
Daily Truvada pill Daily Truvada pill Daily Viread pillDaily Truvada pill
44% 63% 62% (Viread)73% (Truvada)
73% 78% -
• Nausea • Headache• Decrease in kidney function and bone density• Drug resistance
• Nausea• Vomiting• Dizziness
• Nausea• Diarrhea
