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.

French study reveals the growing complexity of medical needs as people with HIV age

Keith Alcorn (aidsmap)
Published: 25 October 2016

The complexity of the needs of people living with HIV will continue to increase as the population ages, and clinicians need to go beyond thinking about co-morbidities to consider multi-morbidities – clusters of medical conditions which complicate one another – when caring for these people, Dr Edouard Battegay of University Hospital Zurich told the International Congress on Drug Therapy in HIV Infection (HIV Glasgow) on Tuesday.

Following analysis of multi-morbidity in the general population, University of Zurich researchers found that medical conditions tended to cluster into eight groups, and that individuals tended to fall into one of these clusters. For example, they found a strong relationship between dementia, depression and hip fracture, but much less frequent overlap between coronary heart disease and hip fracture and depression. Instead, people suffering from cardiovascular problems tended also to suffer frequently from thyroid dysfunction and chronic obstructive pulmonary disease.

These patterns of clustering indicate which groups of specialists might need to work together more frequently, and who needs to be involved in the care of people with HIV.

Dr Battegay suggested that among people living with HIV, a number of clusters of multi-morbidity present with greater frequency, such as HIV infection, depression and pain, or HIV, depression and non-adherence. HIV and hypertension overlap with cardiovascular disease, and may also overlap with pain. Further research is needed to examine these clusters of multiple morbidity, so as to help in the development of algorithms for the management of multiple morbidity, such as those recently issued by the European AIDS Clinical Society.

Research from France also presented at the conference showed that by the time people living with HIV reach middle age, a high proportion already have complex medical problems requiring multidisciplinary management. The study found that just over half were at high risk for serious kidney disease, 46% were at high or very high risk of a cardiovascular event in the next five years and 56% had hypertension.

Investigators from the Aquitaine regional cohort wanted to establish a clear understanding of the evolving medical needs of HIV-positive patients in the modern antiretroviral therapy era. They therefore analysed cross-sectional data gathered from patients enrolled in the prospective ANRS CO3 Aquitaine cohort to see how the spectrum of health problems observed in HIV-positive patients changed between 2004 and 2014.

A total of 2138 patients had study visits in both 2004 and 2014. Most (71%) were male, 40% were men who have sex with men and the median age in 2014 was 52 years. Sixty-two per cent of the cohort was over 50 years of age in 2014.

HIV markers improved over the ten years of the study. The proportion of patients with an undetectable viral load increased from 51% in 2004 to 91% in 2014 (p < 0.0001). This was accompanied by a significant increase in the proportion of patients with a CD4 cell count above 500 cells/mm3, from 44% in 2004 to 72% in 2014.

However, there was a significant increase in the proportion of patients diagnosed with age-related co-morbidities and taking therapy for these ailments.

Prevalence of chronic kidney disease increased from 4% to 18%; fractures from 1% to 7%; cardiovascular disease events from 4% to 14%; use of blood thinning agents from 1% to 8%; therapy with aspirin from 1% to 8%; hypertension from 19% to 56%; diabetes from 8% to 19%; use of anti-diabetic therapy from 2% to 6%; prevalence of elevated lipids from 14% to 54% and use of statins from 9% to 24% (all comparisons, p < 0.0001).

Of particular concern, the proportion of patients with a Framingham High Risk score (5-10%) for cardiovascular disease increased from 13.1% to 26.5%, while the proportion with a Framingham score above 10%, indicating a risk of one in ten or more of having a cardiovascular event – either stroke or heart attack – in the next five years had jumped from 5.3% to 19.9%. In other words, one in five of the cohort are now at very high risk of a cardiovascular event, compared to one in twenty ten years ago.

Similarly, the proportion of patients with the highest risk of kidney disease, as measured on the D:A:D renal risk score had risen from 29.9% in 2004 to 50.5% in 2014, indicating the importance of selecting antiretroviral regimens that minimise the risk of further loss of kidney function.

Reference

Bonnet F et al. HIV patients today and 10 years ago: do they have the same needs? Results from cross-sectional analysis of ANRS CO3 Aquitaine cohort. HIV Glasgow, abstract 0212, 2016.

ARV/CART shortage for HIV+ patients concern

What appeared to be some issues regarding HIV positive patients accessing antiretroviral drugs via the regional health authorities’ network linked to the Ministry of Health and type five health centres is real as drug shortages become more pronounced. For the past three months or so several emails to GLBTQ Jamaica alongside Facebook comments and face to face discussions etc. have revealed a trend from persons being told to buy their medications at selected pharmacies with their National Health Fund, NHF cards to trying Drugserv; although the meds costs anywhere from $300 to $500+ per bottle with the card they also are short on stock, owing to the fact that persons were used to gaining said meds by the aforementioned clinic systems and via social worker departments and dispensaries located there instead of pharmacies so the pharmacies do not replenish stocks as fast I was made to understand.

Then there is the question of the over burdened Drugserv publicly aided pharmacies that are already pressured by crowds sometimes as early as 5 or 6am at their branches; one has to join a long line and or effectively bribe a security or others to hold a space in extreme cases (apart from knowing someone inside). They also have drug shortage challenges as the Cross Roads and Portmore branches according to checks are out on Truvada and or EFV and Atripla, the main drugs. Combivir AZT which is still prescribed for some patients is also low but seemingly not as the other items. The other rarer types and brands appear to be not as impacted as the main treatments. While the drugs are cheap it can be frustrating the wait but the technocrats who oversee these things live in unimpeded comfort as they can afford better treatment experiences in the health systems or fly to overseas centres, so who cares really?

The issue also came up for mention on radio on August 4 during the check mail section of the daily show “At Your Service” hosted by the popular Mr Darby, the persons who texted in did not want to be identified by were clear as to their frustrations. Some are stuck with repeat prescriptions unfilled or the available drugs that may also be on the slip are supplied and a reissued prescription is handed to the persons involved to go elsewhere. Also of concern are the other items some clients normally would get such as iron tablets in the form of ILV or Feso4, B-complex capsules, staggered dosages of Bactrim and certain creams such as Clotrimazole, Betnovate cream and Fluconozole for persons with skin issues as the immune systems are compromised and or may have other running conditions such as diabetes.

Strangely the HIV AIDS conference just ended and with all the powerhouses and bureaucrats who attended seemed more interested in preserving their heads in the soon to be ended Global Fund support in 2017/8 while the agitation for better drug stocks for present populations seems missing. While Africa featured in that department Jamaica did not; since the World Bank’s reclassification of Jamaica as a middle income country automatic qualifications for certain types of support come into effect. The main drugs such as Atripla (with tenofovir dixoproxil fumarate, TDF) Efivarenz and Truvada should never be short seeing they are available. The agitation that is to come on behalf of HIV patients is missing on many fronts, that it should get to the stage where patients are crying out is disturbing, when persons were assured that the drugs will be available consistently. Sometimes we have to wonder if there is any real concern about HIV positive patients given the feeling of complacency that has come to define the work.

Why aren’t said powerful HIV/LGBT outfits that control the cogs of prevention are silent on certain things? Items such as the expected switch over from tenofovir dixoproxil fumarate, TDF to tenofovir alfadamide where studies have shown better absorption of the latter in far less dosages (300mg versus 10mg) hence better CD4 and viral load results but the old generation ARVs or CART are still being dispensed. All of a sudden treatment naive patients are now the ones who can use the latter, despite the studies showing very little deleterious effects from the migration. TDF bleeds into the bloodstream so from a typical 300mg tablet maybe just over50% of that gets where it needs to go inside the cell cytoplasm. Then there is already ticklish question of adherence which can be frustrating in a sense for social and outreach workers, if not doctors and adherence staff. Persons do not take their meds on the basis of judging that they have no underline visible issues so they take chances or as a friend of mine hinted recently he is tired of swallowing pills, in other words treatment fatigue.

While the drugs maybe ‘free’ is not every impacted person can literally find the money to travel to the suggested pharmacies as they tend to be located far from the clinics the patients attend. For example in St Catherine persons from as far as Old Harbour or further are being told to go to a pharmacy in Kingston off Washington Boulevard. Again while the charge of $300 per bottle of one month’s supply the transportation cost to get there for some is debilitating as many persons are unemployed. The grants that would flow to assist persons in some sort of training or stipends for some are also all but dried up. Some persons would also be able to request basic food assistance such as rice, peas such items are becoming rare according to reports.

Why is it that the inventory systems have slipped that stocks have been allowed to go to such low levels is strange to me, persons have also been staggering their dosages to one tablet in the case of Atripla every other day so as to stretch the stock which is not recommended as yet despite a recent study citing the same drug suggesting three days dosages can provide the same results. One doctor who was contacted on the matter strongly cautioned that persons who are practicing such staggering should stop.

See a previous entries:

News From the 2016 International AIDS Conference

New single-tablet HIV treatment Genvoya wins FDA approval

Tenofovir Vaginal Ring Provides Protection Against HIV in Women

First Generic Atripla Approved for Developing Nations 2009

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

I hope that the powers that be can act quickly especially owing to the present ZIK-V infections and related possibly debilitating challenges such as GBS, HIV positive patients cannot afford that kind of exposure due to staggered treatment by shortages only to lead to CD4 counts falling. Some concerns were raised recently in a space of falling CD4 counts in MSM as well prior to the shortage coming into effect. I hope some change can come soon to alleviate the problems and concerns.

here are some figures from 2014:

HIV prevalence - 1.6% Males: 2%

Females: 1.3%

Estimated number of people living with HIV

Total: 29,000

Women: 11,000

Number of number of

people living with HIV under antiretroviral (ARV) drugs treatment

Total: 9,141 in 2014 (5,826 in 2010)

Adults: 8553 (5390 in 2010)

Children: 588 (436 in 2010)

ARV coverage (%): 31%

Estimated number of new infections and trend: 1,500

Overall: New HIV infections declined from 3,000 in 2000 to 1,500 in 2014, a 50% decline

Mode of transmission (2012)

- Heterosexual sex within partnership: 32%

- Casual heterosexual sex: 22%

- Sex workers, clients and partners of clients: 10%,

- MSM: 32%

- Female partners to MSM: 7%

Prevention of mother-to-child transmission coverage (number and %): 93% (74% in 2010)

Estimated number of HIV-related deaths: 1,300 people (2,400 in 2005; 46% decline)

Peace & tolerance

H

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.

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

The Hunt for Blood Continues ..... JFJ/CVCC Children’s Homes Sex-Ed Programme Under Police Investigation

So the hysteria and over reactions continue from a state perspective now as the Gleaner reported this morning, obviously those who are now crying foul where waiting to pounce on JFJ I fear as since they have been at the forefront of pointing out the flaws in governance over the years from government agencies and indeed child care facilities. It was the JFJ's public advocacy that brought to everyone's attention on the mixed populations of children in state institutions and maximum security lock-ups with adults at the same time which left successive administrations embarrassed, so what an opportune moment to capitalise on the one time the JFJ slips up on not getting the go ahead from the CDA regarding the sex ed course and to think there is hardly any damaging material contained therein as most of the 150 paged instructor's version is complementary to the very CDA and Office of the Children's Advocate:

for e. g. pages 124/5 is clear as to Sexual Offences Act et

page 109 appropriately deals with norms and attitudes"

Yet lies are told by persons like Betty Ann Blaine on television that the manual said anal sex is ok as she did on morning time on TVJ recently to push her own maligning agenda.

Now the Gleaner said:

The Police High Command has disclosed that an investigation has been launched into the allegations of unapproved sexual material being taught in some privately owned children’s homes.

The Police says among the issues being looked at into are reports of breaches of the Child Care and Protection Act and the Offences Against the Person Act.

However, the police say the matter is at a sensitive stage and that given the nature of the allegations not much can be said at this time.

The sex education programme was implemented by Jamaicans for Justice (JFJ) in six privately-run children’s homes without the permission of the youth minister, Lisa Hanna.

She has referred the manuals used by the group in its programme to the Children’s Advocate and the Attorney General to determine whether the Government can take any legal action.

An interim report from the Child Development Agency has found that there were several breaches of Jamaican regulations when the controversial sex education programme was implemented.

ENDS

The CDA interim report claims breaches were done but the hype and alarm that is being created here is totally unnecessary as far as I am concerned, sensational headlines such as those from the Gleaner have been fast and furious imputing all kinds of motives as fear takes over where good sense should prevail, homophobia indeed, stories such as "JFJ Sex-Ed Controversy Deepens … Children’s Homes Received Money For Training" suggests someone was paid to do some coercion to get the homes to accept the course when all that it was is the typical logistical costs involved in such project delivery. Yet the story did not actually have the dollar value of the "monetary contribution" which shows the tabloid journalistic nature the story has taken by the old lady from North Street.

The CDA interim report claims:

And the hypocrisy continues out there all predicated on misunderstanding, misuse and misinformation alongside clever deception in the very religious anti gay groups themselves. 

Check out my extended podcast on this matter in great detail as I pull together some of the discourse on radio and otherwise to show the clear deceptive agenda of these so called Christian groups.

also see 

More Overreaction to the Jamaicans for Justice Sex Education Course & Media Senationalism 

Hardened Positions by Religious Fanatics & Their LGBT Detractors Will Only Leave More Blood on the Floor

Anti Gay Voice & 'Child Rights' Advocate Betty-Ann Blaine Taken to Task on Public Advocacy

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

Peace and tolerance

H

Gay Lobby May Have Lost Potential Allies (Gleaner Letter) Indeed

Indeed we have been losing some allies as evidenced by once seemingly tolerant commentators, persons on the ground and even some of my blog readers have turned on me in a sense with far more caustic responses and dismissals of any suggestion for dialogue or a truce while the dust hopefully settles. 

The talkshow circuit has been bombarded by a coordinated effort by the same groups especially POWER 106FM's "Justice" hosted by JLP senator and former judge with some anti gay sentiments Marlene Malahoo Forte, callers have been stressing the perceived stifling of freedom of speech more so than the obvious conflict of interest posed by Professor Bain's testimony when it was the imperative that is the issue not the content of his affidavit per say. Even prior to the Bain matter she hosted the anti gay group JCHS on her show where she asked among other things: 

“............Do you know what was the basis of that, what it is about anal penetration that would cause lawmakers in their wisdom of yesteryear to say this is something that we need to say not at all?” the JCHS rep dodged the direct question completely by answering from a script I dare say, using terms she couldn't bother to explain to the listening audience.

“One of the things that people confuse is that they try to suggest that anal penetration is sex and it is my understanding that the intestine is not a sex organ it can’t procreate, buggery, it is the misuse of the anus ......it can do physical harm to the recipient in terms of the sphincter muscle going, people say you’re not gonna get HIV AIDS if you use a condom but the person being penetrated has on a condom is at risk and harm because the insides of the intestine were not never meant withstand the types of friction from that type of penetration, it tears easily and then you end up with a myriad of sexually transmitted diseases including HIV which is most easily transmitted in this type of environment, it must be noted that HIV is not only an epidemic it is a pandemic ........ The buggery law must remain as a danger sign because it does harm not only to the individual but to society and the world at large ..........”

Nice run to not let Mrs Forte come in with any rejoinder while deliberately avoiding the direct question, I am shocked however that Mrs Forte allowed her such a long run but I guess fairness must be shown since “freedom of speech” is about to be quashed in the eyes of the JCHS. My mind runs to an older interview with Mrs Forte and Dane Lewis in June 2013 where the same HIV is a gay disease ploy was used in a set of trick questions, she asked for eg about containing conduct if after the buggery law in its present form what would obtain to which Mr Lewis answered “........... Does the state have a right to legislate what consenting adults do in private regardless of their sexual orientation.....If we address that first then we can begin to talk about where that threshold is and so I speak about consenting adults when we talk about threshold........... Protecting our most vulnerable which would be our young people.” He also called for the non discrimination clause that was removed in draft from the Charter of Rights.

But it seems the wind as turned into a storm as the centrepiece of the Professor Bain issue which is the conflict of interest has been lost or clouded deliberately by fanatical religious voices making the rest of the church looking stupid and selective about certain issues as crime, kidnapped kids and the indigent do not get the same kind of erratic response from these powerful voices not to mention the millions the Gleaner especially may be raking in from the groups protesting from full paged advertisements yet people are hungry.

The letter writer has echoed my point on the hardened positions now taken and there may be no end in sight for now in terms of tolerance or the state of affairs pre May 18, 2014 when the story broke.

Here is the letter in part:

THE EDITOR, Sir:

I have been in a running email debate with Jeff Cobham. He convinced me that the University of the West Indies had no other option. Now, Gordon Robinson has reopened that aspect of the case.

However, there are two other things I have been saying to Jeff. There is now a growing belief among the Jamaican man in the street that, no matter how important and learned you are, no matter how well you have served, if you say or do anything that can be interpreted as being harmful to the aims of the LGBT lobby, you can be hounded out of your job and punished in any way that they can find to punish you. I think that this is an unfortunate impression to have developed and does more harm to their cause than good.

I have been listening to persons among whom I circulate, and there is a feeling of resentment. A conviction that "de byman dem wah fi tek ova everyting! Yuh cyaan even talk de trute dat dem a de chief spredda a AIDS. Nuh care if yuh a big doctor an gi dem facks!"

This opinion is given with disgust, even loathing. It marks lost ground because the general opinion had been slowly shifting in the direction of greater tolerance, into one of "mek dem gwaan! As long as dem nuh ovado de public nuffness!"

HARDENED RESISTANCE

We have moved towards the obligatory "not in my cabinet!" To the more reasoned attitude of Portia Simpson, who, by her actions, was using her personal popularity and influence to help change attitudes.

The ultra-aggressive moves of these lobby groups seem to have hardened resistance to their agenda, including important human rights aspects.

And then there is Dr Brendan Bain, who seems to have been painted by some as a person who could not really show the necessary love and care for the patients he served because of his belief that their sexual behaviour was immoral. Which, all who know him is far from true.

In ending, I want to ask: If a coalition of prostitutes sued the Government in an effort to decriminalise their practice (a direction in which some states seem to be moving), would the new head of CHART be at risk of losing his job if he testified that the activity involved in the 'profession' was a public health hazard?

Would the human-rights organisations who have joined the LGBT lobby be as whole-hearted in their support of his removal?

KEITH NOEL
keithanoel@gmail.com

ENDS

also see:

Lessons to learn from The Professor Bain Matter (Leighton Levy's turn from a previous tolerant posture) 

Pro-Bain Protesters To Meet With UWI Today

Buggery the only thing that makes church butts sore?

Don't give up on the church, pastor tells gays (Observer)

Is Freedom Of Expression At Risk? asks JFLAG advocate

Ian Boyne: Bain exercised terribly poor strategic judgement ....

Professor's Bain's Testimony Threatened Foreign Funding (Gleaner letter) .

Jamaica Coalition for a Healthy Society continues its “HIV is a gay disease” campaign with more deception added

my latest podcast:

Gay Marriage Smoke Screen, False Dichotomies and Religious Fanatics 05.06.14

What kinds of strategies can be employed to extend an olive branch to persons changing their minds on tolerance altogether?

Peace and tolerance

H

Jamaican Bar Association - Remarks on termination of contract of Professor Bain by UWI

In light of the Bain matter and my own review of the materials since the last seven days of the story breaking I think it is important we get the best voices on this so here is the JBA'a press release in full, also here the recent audio/radio discourse below.

THE JAMAICAN BAR ASSOCIATION 

President: Donovan C. Walker 78-80 Harbour Street 

Vice President: Sherry-Ann McGregor Kingston, Jamaica W.I. 

Secretary: Althea McBean Telephone: (876) 967-3394 

Treasurer: Jacqueline Cummings 967-9034 

Fax: (876) 967-3783 

E-mail: jba@flowja.com 

Website: www.jambar.org 

MEDIA RELEASE – 23RD

May, 2014 

The Termination of contractual arrangements by UWI with Professor Brendan 

Bain as director of CHART . 

May 23, 2014 

The Jamaican Bar Association (“Jambar”) notes with concern a statement published by the University of the West Indies (“UWI”) on its website dated May 20, 2014 wherein UWI sought to explain and justify the termination of Professor Brendan Bain (“Bain”). 

As we understand, in summary, the events and facts leading up to the termination of Bain 

by UWI are as follows:- 

1. Bain is a medical doctor practicing in that field for over 30 years. During that time Bain has come to be regarded as a pioneer and leading expert in the Caribbean as regards clinical infectious disease (in particular HIV and AIDS in the Caribbean region). At all relevant times Bain was the Director of Caribbean HIV/AIDS Regional Training (CHART) Centre (“CHART”). Bain is regarded as an expert in the field of HIV and AIDS in the Caribbean region. 

2. In 2010 a case was filed in the Belize Supreme Court (Caleb Orozco and the United Belize Advocacy Movement Vs. The Attorney general Of Belize) (“the Orozco Case”). 

The claimants in the Orozco case brought an action challenging the constitutionality of 

Section 53 of the Criminal Code of Belize. 

3. In that case Bain prepared and submitted an expert report dated August 7, 2012 (the “Bain report”). The Bain report is some 52 pages containing a 14 page report as well as 7 exhibits attached thereto. 

4. In the Orozco Case Bain presented the Bain report in his capacity as an expert in his own right and based on his years of experience. Bain expressly disassociated the Bain report from UWI and/or CHART and/or any other entity.  

5. On its website the UWI statement reads (inter alia) “…the issue in question arose about two years ago in {the Orozco Case}. Bain provided a Statement on behalf of a group of churches seeking to retain the 1861 Law. Many authorities familiar with the Brief presented believe that Professor Bain’s testimony supported arguments for retention of the law…. This opinion is shared by the lesbian, gay and other groups who are served by CHART… For the last year, there has been considerable controversy surrounding the appropriateness of Professor Brendan Bain serving as Director of CHART…”. 

6. The UWI statement further reads and concludes “…While the University recognises the right of Bain to provide expert testimony in the manner he did, it has become increasingly evident that Bain has lost the confidence and support of a significant sector of the community which the CHART programme is expected to reach, including the loss of his leadership status in PANCAP, thereby undermining the ability of this programme to effectively deliver on its mandate. It is for this reason that the University of the West Indies has decided to terminate the contract of Professor Bain as Director of CHART...”. 

7. Jambar is further advised that by letter dated 24th

April, 2014 a coalition of various 

NGO’s and other groups wrote to Professor E. Nigel Harris demanding the “…removal of Bain from any leadership position in the CHART programme and all positions of representations of the University of the West Indies on issues of HIV and Aids…”. This letter was apparently written based on the fact that Bain submitted and prepared the Bain report in the Orozco case. 

We do not yet know if Bain was given a fair and impartial hearing by UWI before his contract was terminated, and we will therefore refrain from commenting on that issue, except to say that he is entitled to have such an opportunity. 

Firstly, our concern has to do with the reports of an apparent agenda of retaliation and retribution against Bain by persons or entities who are not pleased by the content of the Bain report. The fact is Bain is an expert in his field and whether we agree or disagree with his opinion he has provided his expert report which can be tested and challenged under the rigorous scrutiny of cross examination in the courts or (if available) other expert opinion to counter and rebut the Bain Report. 

Secondly, we note the certification in the Bain report where he states (on page 14) that based on”… my professional experience together with information from research literature related to the matter under consideration. The opinions expressed in this report are mine and should not be attributed to any institution to which I am associated…” Importantly, 

Bain further certifies that he has been “…given no instruction by any party, by any person representing a party, or by any other person with respect to this report…”. How then, in the face of this certification, has UWI concluded that the Bain report was “…given on behalf of a group of churches…”? 

Thirdly, we identify with the comments issued by the Medical Association of Jamaica (“MAJ”) where they state “…the MAJ and its members are committed to improving the health of all members of society... Our training and expertise are in science and scientific  research. The veracity of a scientific conclusion should only be challenged on the basis of science and NOT on emotion or sentiment its conclusions may evoke. Statements of fact 

are never meant to be offensive…As an expert witness, his testimony to the court is a duty to the Court, and, is the opinion of the expert himself. He is therefore obliged to discharge his testimony truthfully and professionally. Many Doctors are asked to give expert testimony to the Courts, both locally and internationally, on a variety of areas. 

We sincerely hope that our responsibility under the law to the court is not under any form of attack. …” We certainly hope not, as well. 

The legal profession routinely relies on expert testimony to advance the cases of our clients. As such we are very concerned that the actions of UWI against Bain could adversely impact on the freedom of expression by experts giving testimony in Jamaica. In civil proceedings in the Supreme Court that are governed by the Civil Procedure Rules, an expert witness has a duty “to help the court impartially on the matters relevant to his or her area of expertise” and “that duty overrides any obligations to the person by whom he or she is instructed or paid”. In giving expert evidence, the information presented to the court “must be and should be seen to be, the independent product of the expert witness uninfluenced as to form or 

content by the demands of the litigation. 

An expert witness must give independent assistance to the court by way of objective unbiased opinion in relation to matters with in the expert witness’ expertise.” 

In that context, Bain’s dismissal may cause such experts (many of whom reside in tenure at UWI) to become fearful to express their honest and considered belief as they may face adverse repercussions even when their thoughts are based on decades of study and research and independent of the office that they hold. This sort of retaliation against Bain may well be contemptuous of our system of justice as same could be considered as a wrongful interference in a judicial process. Many of us studied at UWI and have taken pride in the strong regional academic experience. 

Regretfully, the recent academic censorship and contractual termination by UWI of Bain raises serious questions in the minds of all persons who look to UWI for independent thought and creative thinking given its position as a bastion of Caribbean research and pedagogy. We are concerned that the work and worth of Professor Bain and other leaders in other academic fields can be so easily circumscribed. 

The Jamaican Bar Association calls upon Professor Nigel Harris and the leadership of UWI, if it has not done so, to give due process to Professor Bain. We remind UWI that while not all academic pursuits may lead to outcomes, hypotheses or conclusions that are desirous or popular with your constituents and donors full respect must be accorded to the process and the freedom of expression and thought that we trust will always remain a true and guarded virtue by the University of the West Indies. 

Donovan C. Walker 

President – The Jamaican Bar Association 

www.jambar.org  dcwalker@hmf.com.jm

ENDS

Here are the other discussions I think we should follow closely:

Review carefully please

Peace and tolerance

H