Changes In Viral Suppression Over Time Reveal Disparities in HIV Care

Sustained viral suppression over the course of a year may be a better measure than the most recent viral load test result when it comes to understanding access to and engagement in HIV care, according a study by Centers for Disease Control and Prevention (CDC) researchers presented at the 2017 Conference on Retroviruses and Opportunistic Infections this week in Seattle.

The researchers found that overall, 48% of people had viral load below 200 copies/mL on the all tests they received during 2014, while 8% never fell below this level. But there were substantial disparities based on sex, race/ethnicity, and age.

Durable viral suppression among people with HIV in a community is an important public health indicator. People with low viral load are protected from disease progression and those with undetectable levels are essentially unable to transmit the virus to others.

Nicole Crepaz from the CDC and colleagues examined the proportion of people with durable viral suppression, those who never achieved viral suppression, and changes in viral load status over time among participants in the National HIV Surveillance System.

The most common measure of viral suppression used in surveillance studies and research on the HIV continuum of care is a single most recent viral load test being below 200 copies/mL, the researchers noted as background. But this does not capture viral load dynamics over time. While most antiretroviral therapy trials use 50 copies/mL as the cut-off for undetectable viral load -- indicating successful treatment -- epidemiology studies often use the higher cut-off, which suggests that people are in care and on treatment, even if they don't manage to maintain full viral suppression.

This analysis used National HIV Surveillance System data reported by 33 jurisdictions, representing 70% of all people diagnosed with HIV in the U.S. It included adults (age 13 or older) who were diagnosed with HIV by the end of 2013 and still alive at the end of 2014. Results were calculated for all individuals who met these criteria, as well as for the subset of people who had at least two viral load tests in 2014, taken as an indicator of being in HIV care.

Results
Among the 630,965 people diagnosed with HIV in 2014, just over half (54%) had 2 or more viral load tests, 14% had 1 test, and 32% had no tests during the year.

Looking at just the 92,309 people who had only a single viral load test in 2014, 76% showed viral suppression at that point in time.

Looking at the entire group, 57% had HIV RNA below 200 copies/mL on their last viral load test in 2014.

Fewer people -- 48% -- had durable viral suppression according to all tests during the year (or a single test in 2014 and their last test in 2013).

These results suggest that relying on a single viral load test could over-estimate durable viral suppression by 20%.
8% of tested individuals were never virally suppressed during 2014; the researchers suggested that the third of diagnosed people who had no viral load tests during 2014 were probably not receiving regular HIV care and likely were not suppressed either.

Looking at changes in viral load status over the year among the 339,515 people who had two or more tests during 2014, and therefore were assumed to be receiving HIV care:

o 75% showed viral suppression on both their first and last tests;

o 11% improved, going from unsuppressed to suppressed;

o 4% worsened, going from suppressed to unsuppressed;

o 10% had unsuppressed virus on both their first and last tests;
The results revealed some notable demographic disparities.
Women overall were less likely to achieve durable viral suppression than men (44% vs 49%).
Women and men infected through injection drug use (41% and 38%, respectively) were less likely to be consistently suppressed than men who have sex with men (53%).
Outcomes varied by age, with the youngest group (13-24 years) being less likely than the oldest group (over 55 years) to have durable suppression (33% vs 53%, respectively).
Conversely, black participants were more likely to have never achieved viral suppression in 2014 than Hispanics/Latinos or whites in almost every transmission category.

For example, among gay and bisexual men, the respective proportions with persistent unsuppressed virus were 12%, 6% and 4%.
White gay men were the least likely of all groups to never achieve viral suppression.

"Disparities by sex, race/ethnicity, and age indicate [the] need for intensified efforts to reduce viral load and HIV transmission in the US, " the researchers concluded. But Crepaz also pointed out the good news that viral suppression was more likely to improve than to worsen over time.

2/15/17

Source

N Crepaz, T Tang, G Mars, et al. Viral Load Dynamics Among Persons Diagnosed with HIV: United States, 2014. Conference on Retroviruses and Opportunistic Infections. Seattle, February 13-16, 2017. Abstract 31.

Taking Atripla Three Days a Week Maintains Undetectable HIV Viral Load, Pilot Study Finds

Taking efavirenz/tenofovir/emtricitabine (Atripla) three days a week maintained an undetectable viral load for at least 24 weeks in people who were already virally suppressed for at least two years, according to a small, proof-of-concept study presented at ASM Microbe 2016 in Boston, Massachusetts.

Baseline Characteristics

The study, conducted in Spain, followed 61 individuals living with HIV (88.5% male and 11.5% female) who were stable on efavirenz/tenofovir/emtricitabine and had a viral load below 37 copies/mL for at least two years before study enrollment. All participants had a CD4 count above 350 at the start of the study, and none had previously documented virologic failure, though a single viral load blip between 50 and 200 copies/mL was allowed for study inclusion, according to lead study author Esteban Martinez, M.D., Ph.D.

Participants also had no evidence of resistance to efavirenz (Sustiva, Stocrin), tenofovir disoproxil fumarate (TDF, Viread) or emtricitabine (FTC, Emtriva).

The volunteers were randomized to either continue taking efavirenz/tenofovir/emtricitabine once a day or reduce their regimen to three days a week (Mondays, Wednesdays and Fridays), about half in each group.

Viral load was measured at baseline, 12 weeks and 24 weeks, but more thoroughly for the three-day group at 1, 2, 4, 6 and 8 weeks.

Most of the study cohort was male (89%); roughly two-thirds were Caucasian, while the rest of the volunteers were Hispanic; and three-quarters of the study participants were men who have sex with men. Mean age was roughly 48 years.

Results

After 24 weeks, there were zero treatment failures in either study arm, and with 333 viral load tests in total, none were above 37 copies/mL, suggesting that taking antiretroviral therapy (at least in this case of efavirenz/tenofovir/emtricitabine) three days a week could be a feasible option to maintain undetectable viral loads.

Adherence was measured by standard questionnaire and pill counting, and the overall adherence rate was fine, according to Martinez. The researchers were worried the three-day group would not be able to adjust to the new schedule, and at times, patients missed one dose, but each of them managed to maintain the new schedule using smartphone calendars or other equivalents, he said.

Due to the outstanding results, the researchers asked the ethics committee to extend the study to three years, Martinez said. When asked about patient satisfaction, Martinez noted that all three-day patients were extremely satisfied and no one wanted to go back to once-daily dosing. In fact, participants in the control arm wanted to switch to three-day arm.

Data on participants' viral reservoirs were not included in the study poster presented at ASM Microbe 2016. However, Martinez noted that the reservoirs were measured using total and integrated DNA, and all patient reservoirs remained stable throughout the study.

When asked how applicable these results would be to current clinical care given the reduced use of efavirenz, Martinez stated that while the use of efavirenz is decreasing in first-world countries, it is still widely used in developing countries. At the very least, this confirms the potential for therapy doses to be farther apart than once a day, Martinez concluded.

Study: Use Politicians, Employers In New 'Strategy' To Address Attitudes Towards Gays

As the reporting on the awareness and attitudes study as commissioned by JFLAG last year continued to be shared in a drip drop format public commentators are asking where is the actual study document as released in previous said study? for the public to fully review; a question I concur with as denotes a feeling of controlling what is sent out to the public more so than openness. 

Sometimes I wonder yet still if the good folks at JFLAG are thinking? and understand how they are perceived by the public whose minds there is need to engage and change from homo-negativity.

the 2012 document

The Gleaner carried this:

Jamaican employers and politicians have more "positive and open" attitudes towards some gay issues than the general public, and interests groups such as the gay lobby are being encouraged to leverage that perception to their benefit.

Market Research Services Ltd made the recommendation in the 2015 Awareness, Attitude & Perception Survey about Issues Related to Same-Sex Relationships, conducted for Jamaica's leading gay lobby, the Jamaica Forum of Lesbians, All-Sexuals and Gays (J-FLAG).

The survey of employers, politicians, and members of the general public was done between June and July last year.

RESULTS POSITIVE
It has returned some results which the researchers believe are "positive" and can be used by J-FLAG to develop a "strategy" to address the general negative attitudes towards same-sex issues.

For example, employers (39 per cent) and politicians (42 per cent) appeared to be more open to the idea of expanding the meaning of sexual intercourse than the general public.

The level of tolerance is also higher among politicians and employers than the members of the general public.

Meanwhile, although the majority of employers and politicians shared the view that gays experience the 'same emotions' as heterosexuals, the majority of the general public disagreed.

The researchers say the favourable results should prompt "J-Flag and other similar interest groups to consider first engaging employers and politicians in discussions".

"These entities (employers and politicians) are opinion leaders and influencers on the general public. Positive attitudes among these groups may be leveraged to advantageously impact attitudes among the general public," Market Researchers Services argued.

The survey involved a sample group of 1,003 comprising 33 politicians, 28 employers, and 942 people from the general populace.


It covered all parishes and has a margin of error of plus/minus three per cent.

ENDS

But with politicians dithering yet still on the matter I wonder if during the engagement they only answered the questions to suit the thrust of the study so as not to be blamed for encouraging pervasive homophobia and then avoid being accused of double standards.

Recent utterances however has shown any sensible person with common sense that they have two mouths.

Also see:

New opposition spokesman on Justice says referendum not needed to amend Buggery Law

Homosexuality is sinful but should not be criminal says former Information Minister

No To Gays! - Adventists Urge Government To Keep God In Deliberations On Buggery Law

As the referendum is pending let us see where things go.

Peace & tolerance

H

60% of the general public said they would prevent their children from having gay friends

Coming off the fiasco that was the guidance counsellors and selective contact with LGBT students and sadly the J knew these results when such a fiasco unfolded this would have been good data to counteract the shouting match that ensued while opening the eyes of all of us. The release of the results is a little late in coming but let us see where this takes us; but the thrust for evidenced based advocacy is commendable and serves to prove what we all already know, including anti gay activists.

photo from archives

The Gleaner reported:

A study conducted by the Jamaica Forum of Lesbians, All-Sexuals and Gays (J-FLAG) shows that Jamaicans would be uncomfortable with their children being taught by gay and lesbian teachers.

The study, entitled Awareness, Attitude & Perception Survey about Issues Related to Same Sex Relationships was undertaken in 2015.

It sampled members of the general public, politicians and employers who gave their perceptions of same sex unions and practices.

Almost 80 per cent of the public signalled that they would be uncomfortable if their child's teacher was gay or lesbian.

The politicians who were interviewed showed the same level of discomfort.

Almost 60 percent expressed that they would be uncomfortable with both gay and lesbian teachers for their children.

The study also showed that Jamaicans do not want their children in the company of gays.

Almost 60 per cent of the general public said they would prevent their children from having gay friends, 43 per cent of employers said the same and almost 50 per cent of the politicians objected to gay peers for their children.

Despite the intolerance of gays in the education system and within peer groups, the survey showed that some Jamaicans have a willingness to love their gay children the same as their heterosexual children.

Of the three groups of people who were interviewed, politicians and employers said they would allow their gay children around their heterosexual children.

However over 40 per cent of the general public indicated that they would not allow their gay children to interact with their heterosexual children.

ENDS

Clearly there is a lot of work left to be done in as far as changing hearts and minds outside of buggery law reform. I am not surprised as people just still seem to think that homosexuality is some contagious disease or something or just by exposure to materials or persons there is some virus to spread; if that were so we'll all be gay by now, I am sure we all handle money at some time.

Also see from sister blog GLBTQ Jamaica:

Education Minister dismisses counsellors LGBT students issue, says it’s a 'minority' matter

Truth or Not: Guidance counsellors not discriminatory

Peace & tolerance

H

WPA Position Statement on Gender Identity and Same-Sex Orientation, Attraction, and Behaviours

Background

Recent controversies in many countries suggest a need for clarity on same-sex orientation, attraction, and behaviour (formerly referred to as homosexuality).

Along with other international organisations, World Psychiatric Association (WPA) considers sexual orientation to be innate and determined by biological, psychological, developmental, and social factors.

Over 50 years ago, Kinsey et al (1948) documented a diversity of sexual behaviours among people. Surprisingly for the time, he described that for over 10% of individuals this included same-sex sexual behaviours. Subsequent population research has demonstrated approximately 4% of people identify with a same-sex sexual orientation (e.g., gay, lesbian, and bisexual orientations). Another 0.5% identify with a gender identity other than the gender assigned at birth (e.g., transgender) (Gates 2011). Globally, this equates to over 250 million individuals.

Psychiatrists have a social responsibility to advocate for a reduction in social inequalities for all individuals, including inequalities related to gender identity and sexual orientation.

Despite an unfortunate history of perpetuating stigma and discrimination, it has been decades since modern medicine abandoned pathologising same-sex orientation and behaviour (APA 1980) The World Health Organization (WHO) accepts same-sex orientation as a normal variant of human sexuality (WHO 1992). The United Nations Human Rights Council (2012) values Lesbian Gay Bisexual and Transgender (LGBT) rights. In two major diagnostic and classification systems (International Classification of Diseases (ICD-10) and DSM-5), same sex sexual orientation, attraction, and behaviour and gender identity are not seen as pathologies (WHO 1993, APA 2013).

There is considerable research evidence to suggest that sexual behaviours and sexual fluidity depend upon a number of factors (Ventriglio et al 2016). Furthermore, it has been shown conclusively that LGBT individuals show higher than expected rates of psychiatric disorders (Levounis et al 2012, Kalra et al 2015), and once their rights and equality are recognised these rates start to drop (Gonzales 2014, Hatzenbuehler et al 2009, 2012, Padula et al 2015)

People with diverse sexual orientations and gender identities may have grounds for exploring therapeutic options to help them live more comfortably, reduce distress, cope with structural discrimination, and develop a greater degree of acceptance of their sexual orientation or gender identity. Such principles apply to any individual who experiences distress relating to an aspect of their identity, including heterosexual individuals.

WPA believes strongly in evidence-based treatment. There is no sound scientific evidence that innate sexual orientation can be changed. Furthermore, so-called treatments of homosexuality can create a setting in which prejudice and discrimination flourish, and they can be potentially harmful (Rao and Jacob 2012). The provision of any intervention purporting to “treat” something that is not a disorder is wholly unethical.

Action

1. The World Psychiatric Association (WPA) holds the view that lesbian, gay, bisexual, and transgender individuals are and should be regarded as valued members of society, who have exactly the same rights and responsibilities as all other citizens. This includes equal access to healthcare and the rights and responsibilities that go along with living in a civilised society.

2. WPA recognises the universality of same-sex expression, across cultures. It holds the position that a same-sex sexual orientation per se does not imply objective psychological dysfunction or impairment in judgement, stability, or vocational capabilities.

3. WPA considers same-sex attraction, orientation, and behaviour as normal variants of human sexuality. It recognises the multi-factorial causation of human sexuality, orientation, behaviour, and lifestyle. It acknowledges the lack of scientific efficacy of treatments that attempt to change sexual orientation and highlights the harm and adverse effects of such “therapies”.

4. WPA acknowledges the social stigma and consequent discrimination of people with same-sex sexual orientation and transgender gender identity. It recognises that the difficulties they face are a significant cause of their distress and calls for the provision of adequate mental health support.

5. WPA supports the need to de-criminalise same–sex sexual orientation and behaviour and transgender gender identity, and to recognise LGBT rights to include human, civil, and political rights. It also supports anti-bullying legislation; anti-discrimination student, employment, and housing laws; immigration equality; equal age of consent laws; and hate crime laws providing enhanced criminal penalties for prejudice-motivated violence against LGBT people.

6) WPA emphasises the need for research on and the development of evidence-based medical and social interventions that support the mental health of lesbian, gay, bisexual, and transgender individuals

References

1. American Psychiatric Association (1980). Diagnostic and Statistical Manual of Mental Disorders (3rd edition). Washington, DC: APA.

2. American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders (DSM-5) (5th edition). Washington, DC: APA.

3. Gates GJ (2011). How many people are lesbian, gay, bisexual and transgender? Accessed March 4, 2016. Available at:http://williamsinstitute.law.ucla.edu/wp-content/uploads/Gates-How-Many-People-LGBT-Apr-2011.pdf

4. Gonzales, G (2014). Same-sex marriage — a prescription for better health. New England Journal of Medicine 370: 1373-1376.

5. Hatzenbuehler ML, Keyes KM, Hasin D. (2009). State-level policies and psychiatric morbidity in lesbian, gay and bisexual populations. American Journal of Public Health, 99: 2275-2281.

6. Hatzenbuehler ML, O’Cleingh C, Grasso C, Meyer K, Safren S, Bradford J (2012). Effect of same sex marriage laws on health care use and expenditures in sexual minority men: a quasi-natural experiment. American Journal of Public Health, 102: 285-291.

7. Kalra G, Ventriglio A, Bhugra D (2015). Sexuality and mental health: issues and what next? International Review of Psychiatry, 27: 463-469.

8. Kinsey AC, Pomeroy CB, Martin CE (1948). Sexual Behavior in the Male. Bloomington, IN: Indiana University Press.

9. Levounis P, Drescher J, Barber ME (2012). The LGBT Casebook. Washington, DC: APA.

10. Padula William V, Heru S, Campbell JD (2015). Societal Implications of Health Insurance Coverage for Medically Necessary Services in the US Transgender Population: A Cost-Effectiveness Analysis. Journal of General Internal Medicine: 1-8.

11. Rao TSS, Jacob KS (2012). Homosexuality and India. Indian Journal of Psychiatry, 54: 1-3.

12. United Nations Human Rights Office of the High Commissioner (2012). Born Free and Equal: Sexual Orientation and Gender identity in International Human Rights Law. New York and Geneva: Office of the High Commissioner United Nations Human Rights; 2 Available from:http://www.ohchr.org/Documents/.....EqualLowRes.pdf. [Last accessed on 2013 Dec 31]

13. Ventriglio A, Kalra G, Bhugra D (2016). Sexual minorities and sexual fluidity. Discussion paper (available from authors).

14. World Health Organization (WHO) (1992). International Classification of Disease 10: Classification of Behavioural and Mental Disorders. Geneva: WHO.

The writing group was led by Professor Dinesh Bhugra and constituted Drs Kristen Eckstrand (USA), Petros Levounis (USA),Anindya Kar(India), Kenneth R Javate (Philippines)

Jamaica’s Out Gay Author Marlon James’ wins Man Booker Prize, Source of Jamaican Gay Pride

Source: Outcaribe

Marlon James is Jamaica’s first openly gay author, but more than that, he is one of the most prolific and recognized Caribbean authors of this generation. He is a critically acclaimed novelist and professor who lives in Minneapolis/St Paul, Minnesota and his third novel, “A Brief History of Seven Killings”, was just awarded the prestigious Man Booker Prize for 2015. The Man Booker Prize for Fiction is a literary prize awarded each year for the best original novel published in English.

In continuing discussions with some of the Caribbean’s out personalities, Out Caribe recently had the opportunity to ask Marlon a few questions, and we are more than happy to share the discussion below:

Out Caribe (OC): You came out publicly in the New York Times in March this year. Why then? And why the New York Times?

Marlon James (MJ): There was no real plan. NY Times contacted me about writing a personal essay, with the subhead “Voyage of the Will,” and that’s really what came out. Sure, it’s a coming out, but for me the bigger story was me realizing that I didn’t have to accept my reality as it was, that I could write my way from one reality to the next, and that I had what it took to do so.

OC: How were you feeling in the first moments of it going live to the world?

MJ: It was strange. Once I write something it’s really no longer mine, but it was still a shock to see how quickly it was co-opted, discussed, attacked, celebrated, refuted, embraced etc. After a while I had to just shut myself off from all the noise, because good or bad one can get lost in all that.

OC: Pride events are growing across the Caribbean – Curacao, Dominican Republic, Suriname and now even Jamaica. What are your thoughts on that?

MJ: They should grow even more. I still think that for people who wont budge on these issues, “A Day Without the Gay,” where LGBT people and their allies would just not show up for work one day would be powerful. And because it’s LGBT AND straight allies, nobody could tell who is who!

OC: For individuals like yourself that leave their home country and gain global recognition and fame – do you think that hurts or helps the region‘s LGBT right
movement?

MJ: I really don’t know, but I’m sure there are people who have a strong opinion on it. I do know that people like myself and Stacey would rather a profile where kids from all over, including Jamaica can feel inspired and appreciated, than no profile at all. Everything helps. I’m not in the business of judging what helps and what doesn’t and who gets to decide that

OC: Are you surprised that the Caribbean Gay Icons who’ve made huge global names
for themselves are all from Jamaica and live abroad?

MJ: Is that true? I’m not sure. And remember Caribbean means more than anglo. There is no Anglo Caribbean Ricky Martin, no anglo Reinaldo Arenas, no Wilson Cruz.

OC: Many refer to you as a Caribbean Gay Icon – does that resonate with you?

MJ: Not really. Any more than Black Icon resonates with a prominent Black personality. I love that I’m inspiring people, especially writers, but I’m too busy working.

OC: Do you believe your global status and achievements makes you immune to most
kinds of homophobia? Are you intimidated by the Caribbean region as an out gay
man?

MJ: Of course I’m intimidated, but I’m also protected by social and artistic privilege. You can be immune if you’re a Rex Nettleford, or a rich gay dude, but for a poor or middle class person, not so much. And nobody is ever really immune. Gay men are still getting shot in the face in New York, there is still too much stigma against HIV for no reason. Job discrimination. Some stores want a legal right to discriminate. It isn’t over.

OC: You’ve been living in the United States for almost 10 years, but visit your home in
Jamaica frequently. How has the island and the experience of it changed for you?

MJ: Here’s the thing about Jamaica. Every time I return, it’s exactly as I left it. A sentence like that gains its power from staying vague. You know what I mean, everybody knows what I mean, but you can’t really explain it

OC: You just signed deals with both HBO and BBC to develop a series based on your
best selling book, A Brief History of Seven Killings. Apart from delivering incredible
storytelling on significant elements of times in Jamaica in the 70s and 80s, some of
the stories also feature lots of gay sex. What was the response to those moments
like? Any plans on filming in Jamaica for authenticity?

MJ: People have been strangely quiet about it, on both sides of the Atlantic. Maybe that [is] just because it a good sex scene. As for filming I Jamaica, that’s really up to Jamaica. Authenticity is the job not of the country but a skillful art director. All that New York grit that you saw in the 70’s was shot in Vancouver.

OC: What next can we expect from Marlon James?
MJ: More work, a series of books, and hopefully some TV shows.

Given this recent award, it’s highly likely that we’ll be seeing a lot more work from this history maker.

Congratulations, Marlon.

And from me here at Gay Jamaica Watch/GLBTQ Jamaica.

additional discussion on Nationwide radio:

Paper on LGBT Situation in Jamaica Launched

also see: 

Govt Advances Plans to Establish National Human Rights Institute ... 2015

JFLAG had a press conference as reported on Nationwide radio on their midday news where they asked for some considerations about the previously announced human rights institute by the justice minister but I would have preferred this in June when the announcement was done and not so many months later and in the middle of an election campaign at that, this is just going to be drowned out by all the shenanigans of the internal politics that now obtains. Anyway see what you make of it as the introduction in part says below, to download the PDF go here.

National Human Rights Institutions (NHRIs) are State bodies with a constitutional and/or legislative mandate to protect and promote human rights. They are part of the State apparatus and are funded by the State1. Their function as enumerated by the Paris Principles is to protect and promote the human rights secured by international law within the domestic sphere of Member States of the United Nations. 

This paper seeks to question how the establishment of such an institution will impact the human rights situation within Jamaica, particularly for the Lesbian, Gay, Bisexual and Transgender (LGBT) community. 

The paper will consider the Paris Principles which outline the operational framework, roles and responsibilities of NHRIs and make a determination as to whether there are any current spaces in which such an institution can be regarded as existing within the Jamaican context. It will then set out the situation of human rights abuses faced by the LGBT community and the legal framework within which these abuses are committed, often times with impunity. Finally, there will be an analysis of the possible formation of a Jamaican NHRI and how that will address the concerns of the LGBT community, with a view to making useful recommendations concerning the establishment of this body within our legal framework.

THE PARIS PRINCIPLES
A PUTATIVE NHRI FRAMEWORK

The Paris Principles were adopted by the United Nations General Assembly in its 44th session on the 4th of March 1994. They established the minimum operational standard for NHRIs within several guidelines. The implications of these guidelines will be considered in order to weigh the possibility and merit of having an NHRI within the Jamaican jurisdiction. The first and second principles read as follow:

1. A national institution shall be vested with competence to promote and protect human rights. 

2. A national institution shall be given as broad a mandate as possible, which shall be clearly set forth in a constitutional or legislative text, specifying its composition and its sphere of competence. The first establishes the broad mandate of an NHRI.

The promotion and protection of human rights go beyond the duty on States to respect the rights of the citizen; the latter is generally framed as a duty of non-interference. Protection involves positive action by the State to ensure observance of the right by both State and non-State actors and promotion involves making persons aware of their rights and how to access them. 

The second principle requires the State to actually go through the process of lawmaking or constitutional amendment. This is an important step as a legislative or constitutional basis gives the NHRI legitimacy and some measure of credibility and accountability. Such a body cannot act outside of the four corners of its lawmaking document. This would mean Parliament would have to go through the rigorous process of drafting legislation and having public consultation. Even more so, if the method to be taken is by way of a constitutional amendment. 

Section 49 of the Jamaican Constitution outlines the varied and lengthy procedures for constitutional amendment.

How the EU can promote LGBT rights in the ACP group

also see: Despite opposition, EU Parliament votes for LGBTI rights/trans identity depathologization in gender equality strategy from sister blog GLBTQJA, I however came across this publication excerpted below sent to me via email.

The Cotonou Agreement, the core of political and trade relations between the European Union and the group of African, Caribbean, and Pacific (ACP) states revealed a major issue related to the LGBT (Lesbian, Gay, Bisexual, Transgender) rights. In more than half of ACP states (49 out of 79) homosexuality is illegal and is punished with up to 14 years in jail. In five countries, it warrants the death penalty. 

view here

Promoting democracy and respect for human rights, the EU has immediately expressed concern regarding the dissimilar views and practices between the agreed parties. Although member states differ in particular legislation, all 28 recognise homosexuality and LGBT rights, which are protected under the EU treaties. Capital punishment is prohibited in the EU, per Article 2 of the Charter of Fundamental Rights of the European Union. Any partnership between EU and ACP states cannot be legitimised without consensus regarding essential human
 and therefore LGBT rights. 

To this end, the EU strives to affect change in the domestic policies of its Cotonou partners which would elevate the legal status and norms regarding their LGBT communities. One way in which the EU could promote its values beyond its borders is through positive conditionality within the framework of the Cotonou Agreement. Political dialogue benefits all parties involved and is the surest approach to foster acceptance of the LGBT community in the ACP group. The message promoted by EU representatives did not resonate with the heads of ACP states, especially in the case of Uganda and Nigeria, which recently adopted new anti-LGBT legislation, expanding the criminalisation of it, and obliging anyone who might be aware of a LGBT person to report it to the authorities.

“Human rights and minority rights are universal, and we cannot accept these laws. It is time for the EU to look at the restrictive measures available under the Cotonou Agreement. Trampling human rights should come with economic consequences.” 

Olle Schmidt MEP, Member of the ACP-EU delegation and Member of the LGBT Intergroup.

Should the EU use sanctions?

Sanctions are used in the belief that economic restrictions weaken target regime access to the vital resources necessary to sustain their political power and domestic order.
When the regime’s coercive power is undermined by public opinion and contested by elites who benefitted from the status quo ante,it is expected that human rights conditions will improve.

The overwhelming majority of sanctions research concludes that sanctions are a largely ineffective policy tool of compelling compliance. Outlined in “Basic Principles on the Use of Restrictive Measures (Sanctions)”, the EU identifies sanctions as a last-resort instrument to ‘name and shame’ its targets. The EU takes care to minimise public suffering by issuing ‘smart’ sanctions targeting individuals wielding political or economic power. However, these elites are able to evade the costly effects of sanctions by deflecting them downward, funnelling the burden disproportionately upon average citizens.

Sanctions would undermine the Cotonou Agreement

A fundamental principle of the Cotonou Agreement is recognition of equality of partnership among EU and ACP countries.

Dictating terms and punishing non compliance neither serves European interests nor aspirations. Public opinion in ACP countries is resolutely in opposition to LGBT rights. They will, in time,come to accept the LGBT community as equal citizens not by force, but of their own volition. The EU cannot expect ACP governments to adhere to foreign demands that are unpopular among their domestic constituencies. Economically punishing ACP countries for human rights violations will impede and reverse progress toward the Agreement’s objectives of eradicating poverty and integrating those countries into the global economy. Sanctions yield an array of unintended and damaging consequences, including an increase in poverty and unemployment as well as deterioration of public health.
Sanctions increase human rights violations.

Political leaders in targeted states perceive and publicly represent sanctions as an affront to sovereignty and national unity. Facing an external threat, they are able to divert public attention and rally it against the sender. Under these conditions, leaders are able to exploit sanctions to broaden their base of support and justify further crackdown against the domestic opposition minority.

A study of the human rights effects of economic sanctions from 1981 to 2000 finds that so-called ‘smart’ human rights sanctions increase the rate of disappearances, extra-judicial killings, political imprisonment, and torture; the scope of the sanctions is positively correlated with the harm caused. Additionally, sanctions produce even more harmful effects when issued multilaterally.

Sanctions would not improve LGBT status

For the use of sanctions to be justified, the EU needs to have a reasonable probability of success. There is little reason to believe that sanctions would stimulate recognition of LGBT rights. The EU must wrest with the fact that regimes discriminating against the LGBT community are reflecting the broad popular sentiment. A 2014 Pew survey finds that 98% of Ghanaians, 93% of Ugandans, 88% of Kenyans, and 85% of Nigerians consider homosexuality immoral.

An ACP government that caves to sanctions would galvanise a majority of the population against the regime. Sanctions undermine the political stability necessary to affect human rights conditions.

For the human rights status to improve for LGBT people in
ACP countries, the people’s hearts and minds must first be won. Economic punishments and threats thereof will not attract any audience to European values and norms.

Conclusions

Before levying sanctions, the EU should thoroughly assess the extent by which LGBT rights violations impede collaborating to attain the objectives of the Cotonou Agreement. Furthermore, the Article 8 of the Agreement clearly specifies a dialogue, which implies a positive level of negotiation that may not result in tangible policy change.

The main risk of applying sanctions is creating a hostile environment for cooperation, which could produce results on the opposite spectrum of those anticipated. It can be expected that, although sanctions would have immediate, short-term results, they would fail to produce significant social change in the long run, since they would be addressing (i) political institutions, not society as a whole, and (ii) the result of certain social prejudices and tensions, not their cause. It should also be seen what the outcome of applying sanctions in other fields was (e.g. arms trade, drugs,organised crime), in contrast to positive conditionality. 

As a solution, EU actions in the fight against sexual and gender discrimination would be more successful by appealing to dialogue. In this manner, the level of the approach would be enlarged, incorporating the engagement with not only the governments, but also with civil society actors and NGOs.

“Recent moves to criminalise homosexuality and to impose severe prison sentences on lesbian, gay, bisexual, transgender and intersex (LGBTI) people constitute an unacceptable violation of the basic rights of individuals. Additionally, appropriate measures should be taken against countries who continue to criminalise homosexuality or pass even more repressive laws. LGBTI rights are human rights!”

Martin Schulz, European Parliament President, Fourth EU-Africa Summit, 2014

Some Previous posts:
African, Caribbean & Pacific Countries refuse to include declaration of gay rights in Brussels. 2010

African, Caribbean & Pacific issue declaration to EU "To refrain from any attempts to impose its values which are not freely shared"  2010

European Parliament consents to EU-ACP partnership with reservations on missing sexual orientation discrimination clauses 2013

Historic EU-Africa Summit overshadowed by anti-LGBT laws 2014

EU Parliament human rights report addresses LGBTI criminalisation, trans rights and same-sex unions worldwide

Uganda and Nigeria: European Parliament calls for targeted sanctions over new laws

European Parliament: Include LGBT non-discrimination clause in future agreement with African, Caribbean & Pacific States

Miami-based Max-Arthur Mantle debut novel BATTY BWOY taps Jamaica’s homophobia

February 2015

Miami, Florida.

Miami-based Max-Arthur Mantle debut novel BATTY BWOY taps Jamaica’s homophobia

In Jamaica, being gay is a death sentence. “Boom bye, bye inna batty bwoy head” has replaced the country’s motto “Out of many, one people.”

Time magazine noted Jamaica the worst place in the Americas for LGBT people and one of the most homophobic places in the world. 

BATTY BWOY is a semi-fiction bildungsroman set in Jamaica and America. The title is a reappropriation of the derogatory Jamaican epithet used to describe gay, bisexual and effeminate men or those presumed to be gay or bisexual.

BATTY BWOY is a chronological narrative covering the life of a gay black Jamaican as he battles harsh socio-economic conditions, overcoming some and defeated by others then finds hope.

Max-Arthur Mantle is a Jamaican-born writer. He migrated to America in 1992. He studied journalism and photography at Howard University in Washington, DC and served in the US military (Navy). For ten years, he had been an internationally published fashion photographer, garnering editorials, covers and a photo book, BEACH BOYS, published in 2012 by Bruno Gmunder Verlag GmbH (Berlin, Germany). After a three year hiatus from shooting to focus on writing, BATTY BWOY is the first of a trilogy. Max-Arthur Mantle lives in Miami, Florida.

BATTY BWOY will be published in April 2015. The autographed hardcover edition will be available exclusively at www.maxarthurmantle.net, where you can order via email at maxarthurmantle@yahoo.com. The cost is US$29.95, plus US$5.95 for shipping in the USA and additional charges for international shipping. The paperback and ebook editions will be available thereafter at Amazon. 

For additional information please visit www.maxarthurmantle.net. 

###

World Health Organization, WHO Urging Gay Men To Take Antiretrovirals, Says HIV Cases High In Group

download/read the report HERE 

Let me just be clear I am having mixed feelings about this new call.

The World Health Organization (WHO) is urging all sexually active gay men to take antiretroviral drugs to reduce the spread of human immunodeficiency virus (HIV). Problem is are we sure what are the side effects when one stops taking these system altering drugs that go to the core of the immune systems and metabolic areas?

According to a BBC report, the organisation says the move may help prevent a million new HIV infections over 10 years.

Officials warn rates of HIV among gay men remain high across the globe.

However, activists suggest this could discourage the use of condoms - one of the best methods to stop the virus spreading. The "chemical condom" psychological concern is real as persons may abandon such traditional practices for safer sex and instead latch on to a "take a pill" get a thrill philosophy abandoning any care and vigilance for reducing risk. When is it for example is one to take these pills prior to sex, immediately, two hours how long before and how long after if one is on let's see an orgy or a multiple day sexual activity?

The vagueness of this call is disturbing to me and I wonder if this is another way to make money for drug companies or extend the life of the cogs of HIV prevention so careers can be saved, was it really ever about finding a cure of different treatment that would or could lead to less drugs?

According to the WHO report, men who have sex with men are 19 times more likely to have HIV than the general population.

Health experts say offering antiretroviral drugs to all at-risk men - known as pre-exposure prophylaxis - will provide an additional way to prevent infection, together with condom use. I supported the concept at first but after seeing the new push and some of whom who are behind it I like many other gay men worldwide are questioning its veracity and relevance and indeed necessity when so much other research is out there such as the German patient and the bone marrow transplant etc.

When taken consistently by people at high risk, studies show the medication can reduce the chances of getting HIV by up to 92 per cent.

Scientists say encouraging this group of men to take these pills could lead to a 25 per cent reduction in new cases across the globe.

So a pill can stop transmission and at how much percentage of coverage, will persons who use PrEP still need to use a condom?

The BBC report also said:

'Exciting approach'

Health experts say offering antiretroviral drugs to all at-risk men - known as pre-exposure prophylaxis - will provide an additional way to prevent infection, together with condom use.

When taken consistently by people at high risk, studies show the medication can reduce the chances of getting HIV by up to 92%.

And scientists say encouraging this group of men to take these pills could lead to a 25% reduction in new cases across the globe.

Dr Rosemary Gillespie, of the Terrence Higgins Trust, said: "We already know if someone has HIV, using treatment drastically reduces the likelihood of them passing it on, as does using condoms.

"The idea of treatment as prevention is not new, but the idea of extending treatment to HIV-negative people from high-risk groups is.

"Pre-exposure prophylaxis is an exciting approach, and likely to be one of a number of ways in which we can reduce the spread of HIV in the future.

"However, we need to evaluate how effective it will be in preventing HIV among gay men."'Progress threatened'

She says until the results of UK trials are known, condoms and regular testing remain the best weapons against HIV and other sexually transmitted infections.

And while the number of people dying of Aids is falling sharply, the WHO says key populations need more attention.

According to the report, transgender women are almost 50 times more likely to have HIV than other adults, a level similar to that seen among people who inject drugs.

And sex workers are 14 times more likely to have HIV than the general population.

"Dr Gottfried Hirnschall of the World Health Organization said: "Failure to provide services to the people who are at greatest risk of HIV jeopardises further progress against the global epidemic and threatens the health and well-being of individuals, their families and the broader community."

ENDS

more questions:

Where are the psycho social developmental pieces to this?

We are just reduced to penis sticking or penis taking sex crazed folks?

Where are the cognitive engaging activities especially for young homeless MSM who are facing other challenges for survival? 

What about promoting healthier relationships between men who have sex with men?

Is abstinence out the window now, even for adolescent gay persons so as to delay sex until thy find the right partner?

I have said it before and I will say it again all we are to these HIV prevention specialists are statistics and targets to be met we seem not to have a mind or can have healthy normal lives in their eyes so we are reduced to only interested in sex. Hardly any discussion around person-hood, healthy socialization, acceptance or those kinds of self affirming issues or development.

MSM Global Forum (MSM activist professional club as I see it) gladly jumped on the bandwagon even without questioning or mentioning some of the psycho-social considerations that MUST be aligned with HIV prevention, our homeless MSM/Trans population has proven that beyond the shadow of a doubt:

The MSMGF said in its release: (some positive sections highlighted in yellow)

"The guidelines aim to: provide a comprehensive package of evidence-based HIV-related recommendations for all key populations; increase awareness of the needs of and issues important to key populations; improve access, coverage, and uptake of effective and acceptable services; and catalyze greater national and global commitment to adequate funding and services. The new guidelines describe numerous important interventions that, in combination with one another, represent a comprehensive continuum of services. Guidelines include:
Explicit language around the correct and consistent use of condoms with condom-compatible lubricants;
A new recommendation on offering pre-exposure prophylaxis (PrEP) for MSM as an additional HIV prevention option; and

Considerations for offering PEP to key populations in need.
Moreover, the MSMGF applauds the emphasis on the importance of human rights and health equity. 

The guidelines stress:
Access to HIV prevention, treatment, care, and support as fundamental to realizing the universal right to health;
Enhanced community empowerment of key populations through the implementation of interventions, including interventions designed to prevent and address violence; and Review and revision of laws to promote the implementation and enforcement of anti-discrimination and to protect the rights of key populations.

The MSMGF commends the 2014 Consolidated Guidelines for considering elements common to all key populations as well as highlighting specific issues and risks unique to each group, including for the first time separate sections and recommendations for transgender people. The MSMGF staff was intensely involved in the development of these guidelines, serving on the guidelines development group and steering group, as well as conducting a study commissioned by the WHO on the values and preferences of MSM regarding use of antiretroviral therapy as prevention.

“Implementation of the recommendations contained in these guidelines must incorporate a deeper and more nuanced understanding of the drivers of HIV vulnerability, including the role of structural factors play in stopping key populations from seeking out and accessing health services, particularly the stigma among many health care providers toward members of key populations,” said MSMGF Executive Director Dr. George Ayala.

“We are pleased that the new guidelines have responded to evidence on the health benefits of PrEP,” said Dr Ayala. “However, the PrEP recommendations for MSM and transgender people are fraught with challenges that need urgent attention. The MSMGF’s values and preferences study indicated potential complications of PrEP roll out among MSM in settings where basic HIV services like condoms, lubricants, and HIV treatment are difficult to obtain, or where basic services not already guaranteed to those who need and want them. In addition, MSM worldwide are worried about potential side effects and costs, and targeted education campaigns are needed to clarify PrEP’s implications. The guidelines’ recommendation on PrEP must be tempered by the needs and concerns of MSM on the ground, especially in resource-limited settings.”

The MSMGF looks forward to engaging with the WHO and other stakeholders in order to disseminate the guidelines and support their use by departments of health for national programming, and by community-based organizations for advocacy and service provision."

ENDS

So even the gate keepers have hugged this up wholesale with lip service to empowerment once again, we have seen this before.

also see

YOUNG MSM/TRANSGENDER WANT TO BE TREATED AS CITIZENS NOT POTENTIAL HIV/AIDS VICTIMS

Gay Men Are Receptive to Sexual Health Info on Hookup Sites says Scottish Study

German Study: Gay men who discuss HIV status with sexual partners are less likely to acquire HIV
St. Kitts and Nevis PM Douglas defends PANCAP’s Justice For All programme

Continued oversight or deliberate overlooking of Jamaican SGL Women in HIV Prevention?

Jamaica Increasing Funding For HIV/AIDS Programmes

13,328 Jamaican MSM Reached by HIV Prevention says report on National HIV Program ........ but

New Efforts To Halt Spread Of HIV Among Gay Jamaica Men

Concerns for HIV prevalence rate in MSM in Jamaica & connected matters

Health Minister Ferguson on WAD '13 & FBOs fear of a Buggery repeal with future parachuted gay marriage rights

Incestuous messes, poor NGO monitoring & ever deepening mistrust about "gay rights"

Why did CVCC & JFJ not Fund a Project/Home for Homeless LGBT Youth in New Kingston instead of the Children’s Home Fiasco ...........

YOUNG MSM/TRANSGENDER WANT TO BE TREATED AS CITIZENS NOT POTENTIAL HIV/AIDS VICTIMS from March 2014

HIV and MSM community: Should we care? — Pt 2

Layered Stigma among Health Facility and Social Services Staff toward Most-at-Risk Populations in Jamaica

Big AIDS fight boost - Ja gets US$3.8 million from US$7-b fund

2007 MSM Study Reminder

New HIV infections rising in region, Unprotected straight, anal and bisexual intercourse blamed 2011

Review condom policy for prisoners

Continued oversight of same gender loving women in HIV response

Peace and tolerance needed indeed

H

Marijuana May Have Potential as an HIV Treatment

(edited) from source

As marijuana continues to gain legal status in some U.S. states, and possible decriminalization here in Jamaica and from which we have already developed other products for glaucoma and so forth evidence is emerging that it may be able to help in the fight against HIV -- but legal restrictions are making it difficult for scientists to find out for certain.

Tetrahydrocannabinol (THC), the main active ingredient in marijuana, could help prevent HIV from spreading throughout the body, according to a recent study. 

Modulation of Gut-Specific Mechanisms by Chronic Δ9-Tetrahydrocannabinol Administration in Male Rhesus Macaques Infected with Simian Immunodeficiency Virus: A Systems Biology Analysis

To cite this article:

MolinaPatricia E., AmedeeAngela M., LeCapitaineNicole J., ZabaletaJovanny, MohanMahesh, WinsauerPeter J., Vande StouweCurtis, McGoeyRobin R., AutenMatthew W., LaMotteLynn, ChandraLawrance C., and BirkeLeslie L.. AIDS Research and Human Retroviruses. -Not available-, ahead of print. doi:10.1089/aid.2013.0182.

ABSTRACT

Our studies have demonstrated that chronic Δ9-tetrahydrocannabinol (THC) administration results in a generalized attenuation of viral load and tissue inflammation in simian immunodeficiency virus (SIV)-infected male rhesus macaques. Gut-associated lymphoid tissue is an important site for HIV replication and inflammation that can impact disease progression. We used a systems approach to examine the duodenal immune environment in 4- to 6-year-old male rhesus monkeys inoculated intravenously with SIVMAC251 after 17 months of chronic THC administration (0.18–0.32 mg/kg, intramuscularly, twice daily). 

Duodenal tissue samples excised from chronic THC- (N=4) and vehicle (VEH)-treated (N=4) subjects at 5 months postinoculation showed lower viral load, increased duodenal integrin beta 7+(β7) CD4+ and CD8+ central memory T cells, and a significant preferential increase in Th2 cytokine expression. Gene array analysis identified six genes that were differentially expressed in intestinal samples of the THC/SIV animals when compared to those differentially expressed between VEH/SIV and uninfected controls. These genes were identified as having significant participation in (1) apoptosis, (2) cell survival, proliferation, and morphogenesis, and (3) energy and substrate metabolic processes. 

Additional analysis comparing the duodenal gene expression in THC/SIV vs. VEH/SIV animals identified 93 differentially expressed genes that participate in processes involved in muscle contraction, protein folding, cytoskeleton remodeling, cell adhesion, and cell signaling. Immunohistochemical staining showed attenuated apoptosis in epithelial crypt cells of THC/SIV subjects. Our results indicate that chronic THC administration modulated duodenal T cell populations, favored a pro-Th2 cytokine balance, and decreased intestinal apoptosis. These findings reveal novel mechanisms that may potentially contribute to cannabinoid-mediated disease modulation.

download full text PDF HERE

A team of Louisiana State University researchers is behind the findings, which it reached by studying a group of macaque monkeys infected with SIV, the simian form of HIV. After the monkeys received a daily injection of THC for 17 months, researchers saw a dramatic decrease in the damage to the monkey's duodenum (part of the small intestine) and an increased population of healthy cells near the damaged tissue compared to macaques who didn't get THC treatment.

"It adds to the picture and it builds a little bit more information around the potential mechanisms that might be playing a role in the modulation of infection," said Patricia Molina, M.D., Ph.D., lead author of the study.

Molina's study is in line with science that isresearching the gut as a key area of importance in fighting HIV. Also, research suggests that THC could be helpful in preventing infected cells from entering the brain, and that cannabis may have beneficial properties for those with advanced HIV. Several studies have also pointed to marijuana's ability to ameliorate common side effects of HIV and treatment, like loss of appetite and pain.

Q: Has medical marijuana been studied in HIV/AIDS patients?

Yes. Although foot-dragging by federal authorities delayed needed research for years, two clinical trials have been completed and more are underway. Other information is available from observational studies. Results thus far have been consistently positive. A landmark study conducted at San Francisco General Hospital looked at the safety of medical marijuana use by patients on stable ART regimens and showed no adverse effects on viral load, CD4, or CD8 counts, while the patients using marijuana gained more weight than those receiving a placebo.1 An observational study published in January 2005 found that patients experiencing ART-related nausea adhered to their drug regimens more consistently if they used marijuana.2 A study published in the journal Neurology in February 2007 reported that smoked marijuana "effectively relieved chronic pain from HIV-associated sensory neuropathy," with few side effects.3

Q: I've heard that marijuana may be harmful to the immune system. Is it a danger to people with HIV/AIDS?

Such claims are based on test tube studies, often using enormous doses, rather than on studies of actual patients. In the San Francisco General Hospital study described above, patients using medical marijuana not only showed no signs of immunological damage, they actually gained more CD4 and CD8 cells than those receiving a placebo.

Q: What do leading HIV/AIDS experts say about medical marijuana?

Leading HIV/AIDS organizations overwhelmingly believe seriously ill patients should be allowed to use medical marijuana without fear of arrest. The American Academy of HIV Medicine has stated, "When appropriately prescribed and monitored, marijuana/cannabis can provide immeasurable benefits for the health and well-being of our patients."4 Other supportive organizations include AIDS Action, Gay Men's Health Crisis, National Association of People With AIDS, AIDS Project Los Angeles, AIDS Foundation of Chicago, Test Positive, Aware Network, AIDS Project Rhode Island, the New York State AIDS Advisory Council, Project Inform, San Francisco AIDS Foundation, and many others.

Finding out whether marijuana has medicinal benefits for people living with HIV may prove difficult, as the substance is still classified as a Schedule I drug -- the most restrictive of the five categories outlined by the Controlled Substances Act. As a result, scientists who want to use marijuana in their research often have trouble getting funding, and the federal government controls access to the small legal supply of "research" marijuana and THC.

Mathew Rodriguez is the community editor for TheBody.com and TheBodyPRO.com.

Follow Mathew on Twitter: @mathewrodriguez.