Milestones in 2011 in LGBT life ..............

originally Prepared and contributed by MT 

Additions and editing done 

1. People's National Party ,whose leader said that she had no objections to gays in her cabinet and that she would call for a conscience vote on the country's anti-sodomy law if selected as the country's 10th Prime Minister, won a landslide victory in national elections.

2. Two extremely anti-gay Members of Parliament, Clive Mullings & Ernest Smith, lost their seats after the December 29th 2011 general election.

3. The first gender non-conforming male elected to the country's Parliament December 29th

4. Jamaicans For Justice lambasts Bishop Herro Blair after his homophobic diatribe.

5. Prime Minister Andrew Holness calls for debate on gay issues.

6. “AIDS free World” launches first legal challenge to the buggery laws at the Inter-American Commission on Human Rights.

7. First tolerance for gays and HIV public service announcement showed on television.

8. Gleaner comes out in support of Portia Simpson Miller’s statement about gay rights and buggery law.

9. Countless amount of supportive letters and articles in media about the buggery law and having gays in the cabinet.

10. Portia Simpson Miller defends her statement about gays and buggery law she made at the National Electoral Debate.

11. Church leader, Reverend Oliver Daley, comes out in favour of buggery law repeal.

12. The Gleaner newspaper lambasts Clive Mullings for his anti-gay rhetoric at JLP rally.

13. Documentary on HIV and Jamaican gays released.

14. Opposition leader Portia Simpson-Miller publicly declared at the National Electoral Debates that she would allow a gay person to be in appointed to her cabinet, would ensure that people are not discriminated because of their sexual orientation, while suggesting she like to would bring the Buggery laws to a conscience vote in parliament and disagrees with the former prime minister’s “Not in my cabinet” statement.

15. UN Gay rights resolution passes. Could spark change in anti-gay countries like Jamaica.

16. Hilary Clinton champions Global Gay Rights at UN Summit in Geneva. Promised to take gay rights into consideration when giving foreign aid.

17. President Barack Obama directed all government agencies engaged abroad to ensure that U.S. diplomacy and aid programs "promote and protect" the rights of gays and lesbians.

18. Thanks to persons like Maurice Tomlinson we had over a dozen pro-gay, incident-free tolerance-themed public events.

19. Police Commissioner publicly declared that members of the police force should not discriminate based on sexual orientation.

20. President of the Senate, Oswald Harding, advocates for repeal of buggery law and protection based on sexual orientation.

21. Health Minister, Rudyard (Ruddy) Spenser advocates for repeal of buggery law and tolerance of gays for the fight against HIV.

22. Jamaica Gay rights activist, Maurice Tomlinson, is the 2011 recipient of the David Kato Vision and Voice Award.

23. Activists at UN demand an end to homophobic bullying in schools across the globe.

24. Pro-gay book launched at “Bookophilia” by Shirley Anderson Fletcher (sister of former first lady) who later came on television to promote the book.

25. UK Prime Minister, David Cameron, come out in support of gay rights globally and promised to redirect aid to nations with poor records on gay rights.

26. Gleaner comes out in support of buggery law repeal after David Cameron’s plea at Commonwealth Summit.

27. Coca-Cola apologizes for sponsoring event with anti-gay lyrics sung by “Sizzla”.

28. Gleaner editorial and letters to the editor in support of JFLAG’s “Unconditional Love” public Service Announcement.

29. Reggae Artiste, Mista Majah P, sings pro-tolerance song against homophobia and re-releases full album/CD. Promoted by Peter Tatchell.

30. “Unconditional Love” public service announcement calling for Jamaicans to love their gay family members launched. Rejected by TVJ and CVM but was shown on Youtube for all to see.

31. Police High Command withdraws Senior Superintendent Fitz Bailey's controversial claims about links between homosexuals and organised crime.

32. Study shows street youth more accepting of gays.

33. Swedish film crew that visited Jamaica to record a documentary on the island's human-rights situation got a first-hand look at our notorious homophobia and police excesses.

34. US embassy pledges to help reduce HIV/AIDS among locals.

35. Dancehall artistes stop direct anti-gay murder lyrics.

36. Jamaican Islamic leader in Germany expelled for calling for the death of gays.

37. Charter of rights criticised by media for not protecting gays. Ian Boyne and Elon Parkinson from CVM agrees with buggery law repeal and protection of gays by Charter.

38. Gleaner calls for gays to be protected by Charter of Fundamental Rights and Freedoms.

39. Homophobic Jamaica Labour party embarrassed when JLP councillor gets charged for buggery.

additions

40. First ever business and lifestyle exposition called PRIDE FEST, making the pink dollar more worthy

41. Record numbers of commitment ceremonies on record in recent history ........ 7 SGL females and 3 SGL males

42. The most LGBT entertainment offerings since recorded history in one year ...... 43

43. Most successful asylum cases for LGBT persons overseas ..... estimated at 24

44. 8 more LGBT blogs added to the independent media list of bloggers

45. DJ Howie celebrates 15 years in the LGBT entertainment business and is awarded by the Sankofa Mgmt team

46. Lesbian community became more visibly in voice on the media landscape .... interviews on nearly all radio stations 

additions to come where applicable 

HAPPY NEW YEAR

World AIDS Day 2011

'Getting to Zero', the world commemorates World AIDS Day. An event that was inaugurated 23 years ago today by the World Health Organisation, World AIDS Day focuses on raising money, increasing awareness, fighting prejudice, and improving education on the issue of the AIDS pandemic caused by the HIV infection.

Observed on December 1st each year, the World AIDS Campaign is the leading international organisation which plans and implements the observance of the day and provides governments, national AIDS programmes, faith organisations, community organisations, and individuals with an opportunity to raise awareness and focus attention on the AIDS pandemic worldwide.

The red ribbon used is the global symbol for solidarity with HIV-positive people and those living with AIDS.

This year's theme marks the commitment of the global community to focus on the achievement of the following three targets: zero new HIV infections, zero discrimination and zero AIDS-related deaths. World AIDS Day is important for reminding people that HIV has not gone away, and that there are many things still to be done. It also provides all of us with the opportunity — on an individual, community and political level — to take on the challenge of getting to zero.

According to UNAIDS estimates, there are now 34 million people living with HIV, including approximately 2.5 million children. During 2010, some 2.7 million people became newly infected with the virus, including an estimated 390,000 children.

Despite a significant decline in the estimated number of AIDS-related deaths over the last five years due to improved access to antiretroviral treatment and care in many regions of the world, the AIDS epidemic still claimed an estimated 1.8 million lives in 2010.

The vast majority of people with HIV and AIDS live in lower- and middle-income countries. But HIV today is a threat to men, women and children around the world. In low- and middle-income countries, less than half of those in need of antiretroviral therapy are receiving it, and too many do not have access to adequate care services.

The Caribbean, one of the regions of the world that is most affected by the HIV/AIDS pandemic, reduced the number of new HIV infections by a third from 2001 levels and by more than 25 per cent in Dominican Republic and Jamaica.

However, we are still ranked amongst the highest in the world with an estimated 240,000 people living with HIV and AIDS in the Caribbean at the end of 2009 and an estimated 17,000 newly affected and 12,000 new deaths.

In two countries in this region — The Bahamas and Haiti — more than two per cent of the adult population is living with HIV. These statistics are only rivalled by those of sub-Saharan Africa, making the Caribbean the second most affected region in the world.

Overall, the main route of HIV transmission in the Caribbean is through sexual intercourse. Much of this transmission is associated with commercial sex, but the virus is also spreading in the general population. Cultural and behavioural patterns (such as early initiation of sexual acts and taboos related to sex and sexuality), gender inequalities, lack of confidentiality, stigmatisation, and economic need are some of the factors influencing vulnerability to HIV and AIDS in the Caribbean. As a result, AIDS is now one of the leading causes of death in some of these countries, with Haiti being the worst affected. An estimated 7,500 lives are lost each year to AIDS in Haiti, and thousands of children have been orphaned by the epidemic.

This year, we are asking you to Be Aware. Being aware means finding out the facts about HIV and using this knowledge to protect yourself and others. Promote awareness amongst friends, family members and loved ones; take part in AIDS awareness initiatives and ensure that the message is passed on to all, so that we may be one step closer to reaching zero.

A recent survey in the men who have sex with men population by the Ministry of Health already however suggests we have cause for some serious concerns as preliminary estimates suggest the infection rate will pass the 2007 31% figure despite the presence of a national program that was expected to impact behaviour change overall but what seems to be very little targeted work on the ground by the advocacy structure that being Jamaica AIDS Support and its offspring Jamaica Forum for Lesbians Allsexuals and Gays with very little presence in the community in terms of front line and beat foot patrols then it is no wonder we may see these high figures and to think both organizations are headed by gay men, what does that say about interest and reasons for existence? Is it possible to get to zero or let alone just reduced rates with this kind of aloofness? I think not, we need to get real.

 World AIDS Day 2011 Concerns by glbtqja4 

Meanwhile a full paged ad appeared in the Gleaner (partially scanned seen below) today from an organization I presume named The Isaachar Foundation of whom we know very little about so far except it is chaired by Dr Wayne West who is aligned to the Lawyers' Christian Fellowship and The Coalition for the Defence of Life, Isaachar with their motto "Confronting The Culture ... one mind at a time" of course here seems to be sizing up the high infection rates in the men who have sex with men populations as their fault, they also made reference to France having no sodomy laws since 1791 while having staggering rates of infection.

If one is to be honest and so righteous as these religious pundits claim to be then why not contextualize the points, there must be some cultural as well as other specific factors that contribute to such rises, not just a broad brush of msms simply because they want to impose a theocratic way of doing business and dictating how others should live. This surprise ad had no contact information provided or any logo or reference as to who they really are. Clearly as we have been seeing with the posturings of the leading voices of the religious right they now have new allies coming to their aid or are they consolidating? then what about freedom of choice? Nuff tings lie ahead people.


also see: 

More effective HIV/AIDS prevention message needed

Peace and tolerance

H 

(pamphlet photos from the MOH National Program)

No to buggery! - Young candidates oppose relaxing laws, but want more education on subject

UPDATE 22.11.11 8:12pm please listen before reading below.

 UK/commonwealth Aid Matter & The New Developments, no aid cuts but redirecting, ethical problems on our part - 22.11.11 by glbtqja5 

BY HG HELPS Editor-at-Large helpsh@jamaicaobserver.com

FOUR aspiring politicians have come out against relaxing buggery laws in Jamaica, although they believe, collectively, that there should be national dialogue on the subject.

The four — the Jamaica Labour Party’s Paula Kerr-Jarrett, who will represent the party in Hanover East and Collin Virgo, the candidate in Manchester South, as well as the People’s National Party’s candidate in St Mary West, Jolyan Silvera and his colleague in St Andrew North East, John-Paul White — are all, based upon religious considerations, against the act of buggery. However, they argue that discussions should be held on the subject with the people as a whole, to determine whether or not Jamaica should continue to enforce buggery related laws.

Jamaica Labour Party (JLP) candidate for Manchester South, Collin Virgo (left) states his view on the buggery law while his JLP colleague, Paula Kerr-Jarrret, who will contest the East Hanover seat, as well as People’s National Party candidates Jolyan Silvera (3rd left), who will be running in St Mary West, and John-Paul White (St Andrew North East), listen at yesterday’s Observer Monday Exchange. (Photo: Naphtali Junior)

Read more: http://www.jamaicaobserver.com/news/No-to-buggery-#ixzz1eRXbFI3s


The four were guests at yesterday’s Observer Monday Exchange at the newspaper’s Beechwood Avenue headquarters in St Andrew.

The subject arose from revelations at a conference on HIV/AIDS being held in The Bahamas, which showed that countries without buggery laws had a lower HIV prevalence rate among homosexual men, than countries with such laws.

“I was brought up as a Christian. I am a practising Christian, and I know that there are a lot of things that are in the Bible as well as just generally, morally, the approach to it is not acceptable,” said Kerr-Jarrett.

“We need to educate our people in Jamaica more before laws are changed, because if you remove something, a void is created, and before anything is done there ought to be a blitz of education on the subject,” she added.

Virgo, who will challenge veteran member of parliament Michael Peart, said that the matter of buggery was a delicate one which requires solid discussion.

“The constituency where I am from, that is not something that you would be able to sell to them right now,” Virgo said.

“I come from a very strong Christian constituency, which has one of the largest concentration of Seventh-day Adventists in the country, and that's the church I grew up in.

“I don’t get the feeling that they (constituents) are going to be highly supportive of that one. To be an elected representative of the people is not going to be my responsibility to force my view on them. I will encourage dialogue, but at the end of the day, changing the law will not allow the problems to be solved,” he said.

“Knowledge and some level of exposure will cause it to be changed. If there isn’t acceptance by a significant portion of the people of Jamaica, changing the laws will not solve the problems,” Virgo added.

Both PNP representatives also echoed similar sentiments that buggery was immoral and an effort should be made to clarify issues surrounding the subject.

For Silvera, who is going up against JLP powerhouse Robert Montague, buggery has no place in the society.

“I grew up in a Christian home and I have my morals intact. But this is where we are today and this is reality,” Silvera said.

“We do have to engage, and we have to sit down and talk ,and take certain things into consideration, because at the end of the day, the Bible is ambiguous, there are double meanings every chapter you read.

“We are a civil society, and if buggery has to be brought to the table to be talked about, I don’t think I would have a problem listening. But at the end of the day I know where I stand, because I have Christian beliefs. I think the law should stay, but I am open for discussions. We would be a bit premature as a country to open it up presently,” Silvera said.

As for White, the son of a former preacher, education is the key to handling matters related to buggery.

“I am also from a spiritual and Christian background, but we need to educate the country more,” he said.

“When a person hears about buggery, he associates it with, based on our socialisation, things to do with homosexual activities.

“As representatives, we really need to seek the opinion of those we represent, and based on the majority of those opinions, we take it into the Houses of Parliament.,” he said.

“My biggest concern about the law has more to do with a health point of view and the transmission of diseases associated with such activities, especially in a society where the cost of health care is really expensive,” White said.


also see on my sister blog GLBTQJA on Wordpress new developments on the UK front:

Minister confirms UK will redirect aid, not cut it, for human rights violations

Andrew Mitchell (photo) said the policy had been wrongly reported as a threat to cut aid

The government has confirmed plans to redirect aid away from overseas governments who fail to recognise human rights, but has said it will still ensure aid reaches those in need.

Some African states reacted angrily to Secretary of State for International Development Andrew Mitchell’s comments that aid would be redirected away from governments to other bodies, believing that overall aid would be cut unless anti-gay laws were repealed.

Now that we have the smoke cleared several questions come to mind:

1) were we too quick to jump the gun locally?

2) were our advocates using the original report as a tag along to unethically promote decriminalization of buggery on a false footing?


Although the debate is on in earnest the advocates should never have in effect mislead the nation and should have sought to clarify the position before diving head on with coalition teams at that participating knowing or unknowingly. How can we have any moral authority to ask the nation for any dialogue or present our arguments on the strength of a farce in a sense to bolster our call for the buggery law to be removed?

True representation for any group must be above board and must be untestable ethically speaking and have some moral soundness, after all our detractors will judge us on that as they do already condemn us because of our “nastiness” we cannot go making demands and calls for acceptance on shaky ground.

Too many double standards? or are the British now backpedaling too seeing the furor the whole thing has caused?

Suffice it to say some with say cutting aid versus redirecting it is the same but let us remember aid comes in many forms and tranches.


also see posts and hear previous audio commentary: 

Not Ready For Gays ……. Gay Marriage smoke screen reintroduced ……………. political dodging

and

On The UK Aid Removal and Holness's Reponse ........ 06.11.11 by glbtqja6

Peace and tolerance

H

Buggery laws choking HIV control ..... Lower prevalence rate in men in countries without restrictions

Ingrid Brown

NASSAU, The Bahamas — Michel de Groulard, regional programme adviser of UNAIDS Caribbean Regional Support Team said that data has shown a significantly lower HIV prevalence rate among gay men in Caribbean countries without buggery laws.

According to de Groulard, the HIV prevalence rate among men who have sex with men (MSM) in three Caribbean countries without buggery laws namely Bahamas, Haiti and Suriname was less than 10 per cent in all cases.

This he said is in comparison to Jamaica, Trinidad & Tobago and Guyana where the prevalence rate is more than 20 per cent for these countries with buggery laws.

Pointing to The Bahamas which repealed its buggery laws inn 1991, de Groulard said that the prevalence rate now stands at 8 per cent among gay men. This is despite Bahamas having the highest prevalence rate in the Caribbean.

However in Jamaica, where the buggery laws remain firmly on the books, de Groulard said that the prevalence rate among gay men is a whopping 32 per cent.

"We see correlation for countries which have decriminalised because when you compare them to those who continue to criminalise there is a significant difference," Groulard told the Observer.

He was however unable to say how, if any, decriminalising of homosexuality has impacted the incidents of HIV in countries like The Bahamas, since there are no available data.

Groulard said that while it is easy to determine what per centage of a population is infected, it is more challenging to determine when they were infected, thus determining if this would have been before or after buggeery laws are repealed.

"There are methods to do it but it is expensive and complicated so most countries do not do it," he said.

Dr Peter Figueroa, the former head of Jamaica's national HIV programme said that the HIV prevalence rate among Jamaican men who have sex with men continues to be unacceptably high.

Dr Figueroa was addressing delegates at the 2011 Caribbean HIV Conference now underway at the Atlantis, Paradise Island, The Bahamas where delegates from more than 30 Caribbean countries have come together to chart the way forward in the fight against the disease.

Pointing to a Jamaican study conducted in 2007 with 201 men who have sex with men and another conducted this year with 453 men, the epidemiologist said that only 75 per cent of these men reported using condom at last anal sex.

According to Dr Figueroa, the study further revealed that 34 per cent of MSM had two or more female partners in the last 12 months while 56 per cent of them said they were bisexuals.

The homeless, victims of violence and those of lower socio economic status were twice as likely to become infected with the disease.

"What was worrying in 2011 survey was that 18 per cent said they had no chance of getting HIV and 40 per cent said they had little chance of getting the disease," he said.

HIV prevalence remains high among persons engaging in sex for money with 11 per cent reporting that they had paid for sex and 21 per cent saying they were paid for sex.

Pointing to reasons why the HIV prevalence rate was so high, Dr Figueroa chalked it down to high rate of commercial and transactional sex.

"Many of them are vulnerable, homeless, poor and have no family support and limited education," he said.

Dr Figueroa said that there is a need to empower and support these men to take more responsibility for safe sex.

"We need to provide a much more supportive environment starting from policies to actual programmes, and dealing with discrimination when it takes place," he said.

He said that he purpose of the research is to get closer contact with MSM in order to better improve prevention efforts and to get persons to seek treament earlier.

Meanwhile, policy and advocacy coordinator of the Caribbean Vulnerbale Communities Coalition (CVC) Ivan Cruickshank said that despite the rising levels of infections among vulnerable groups such as sex workers, MSM, prisoners and socially excluded youth, Caribbean states have chosen to focus almost exclusively on targetting the wider population. Such countries, he said continues to develop generalised responses rather than tailored programming.

"Moreover while Caribbean governments often commit on paper and in rhetoric to working with marginalised groups, in private government officials and ministers continue to express resentment to working with these populations," he said

He added that while most governments of the region have committed to report to the United Nations against targets, they fail to report 70 per cent of all data on sex workers and men who have sex with men.

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

BY INGRID BROWN

NASSAU, Bahamas — Former head of Jamaica's National HIV programme Dr Peter Figueroa has said that the number of new HIV infections continue to rise in the Caribbean although the epidemic appears to have peaked. Dr Figueroa was addressing participants pulled from 30 Caribbean governments, private sector, civil society and the HIV-infected and affected population who are attending the 2011 Caribbean HIV Conference now underway at Atlantis on Paradise Island, Bahamas.

Prof. J. Peter Figueroa, The University of the West Indies at Mona, Jamaica, addresses the Plenary Session I on the HIV Epidemic in the Caribbean.
Photo Credit: Steve Shapiro/2011 Caribbean HIV Conference

US Virgin Islands Delegate to Congress Dr Donna M Christensen (left) is presented with a plaque by actress and AIDS activist Sheryl Lee Ralph at the 2011 Caribbean HIV Conference now underway in The Bahamas. (Photos: Steve Shapiro)

Dr Figueroa said it is a wonder the epidemic has peaked given the many factors that continue to push the new infections rates up such as unprotected sex among heterosexuals, unprotected anal intercourse and high rates of bisexuality.

"We need to reduce the numbers by 25 per cent... we are doing well with mortality but not as well with new infections and social impact on persons infected," he said.

Meanwhile, Dr Figueroa said the HIV prevalence rates are much higher in countries which continue to criminalise homosexuality.

"We still have a serious problem with men who sleep with men and we have to provide a more supportive environment," he said, adding that Governments need to examine their policies and repeal buggery laws.

The HIV burden varies considerably between and within countries in the Caribbean, with Cuba having the lowest prevalence rate of 0.1 per cent while Bahamas has the highest in the region at 3.1 per cent.
The adult HIV prevalence rate in the Caribbean is about one per cent higher than in any other world region outside of sub-Saharan Africa.

Unprotected sex between men and women, especially paid sex, is thought to be the main mode of HIV transmission in the Caribbean.

High HIV infection levels have been found among female sex workers in the region with nine per cent in Jamaica, four per cent in Dominican Republic and 27 per cent in Guyana.

In Jamaica, an estimated 32 per cent of men who have sex with men are living with HIV.
Prime Minister of the Bahamas Hubert Ingraham, in addressing the opening ceremony of the three-day conference, said Bahamas recognised early the value of treating HIV and AIDS even before the discovery of the drugs in use today.
He said sustainable high-quality prevention treatment, care and support services that are accessible by all residents off the Bahamas living with or affected by HIV regardless of legal status or ability to pay, is the basic mission of the National HIV programme.

"Care is provided for all who need it, irrespective of immigration status and this includes clinical care and support, diagnostic testing and antiretroviral treatment.

Notwithstanding the decline in new cases and a major reduction in mother-to-child transmission and decreasing mortality, the prime minister said AIDS remains a leading cause of death among Bahamian men and women.
The USA, he said, also recently approved the Caribbean HIV/AIDS Training Initiative (CHART-II) for implementation of a regional approach to mitigate the impact of HIV/AIDS in 12 Caribbean Regional Partnership Framework (PF) countries: Antigua and Barbuda, the Bahamas, Barbados, Belize, Dominica, Grenada, Jamaica, St Kitts and Nevis, St Lucia, St Vincent and the Grenadines, Trinidad and Tobago, and Suriname.

The goal of CHART-II is to improve HIV/AIDS-related health service delivery outcomes through the development of continuing education programmes, integrating pre-service and in-service training of the health workforce.
Despite the progress made in some areas, Ingraham said the total number of people living with HIV continues to rise.
"As we move forward in treating HIV/AIDS in the region, we acknowledge that there are still significant challenges in accessing vulnerable and at-risk individuals for diagnosis, care and treatment," he said.

Reports today, he said, record a shift in the distribution of new HIV/AIDS cases by race/ethnicity. Additionally, the largest proportional increase in the disease is occurring in cases attributed to heterosexual transmission. He said there are some notable success stories of survival rates with Bahamas having six young people who were born HIV positive still living relatively normal life.

"One is currently a student in college, and at least two of the others have produced children of their own," he said.
The best hope for containment of HIV/AIDS, he said, is a reduction in the number of new infections. "We must scale up the prevention activities that have proven successful if we are to reverse the AIDS pandemic, while at the same time providing treatment and care of people living with HIV/AIDS," he said.

Meanwhile, Claudette Pious, convenor of Children First, said the intervention of its "bashy bus" programme has contributed to the reduction in forced sex among adolescents from 60 per cent in 2006 to 38 per cent in 2008.
The mean age of sexual initiations has also increased from 14.9 for females to 17.1, and for males, from 11.8 years to 13.9 The programme, she explained, serves over 47,250 young people annually, providing them access to free Voluntary Counselling and Testing.

The concept for the 'bashy bus' was born out of the problem of school-children having sex on the public buses. The programme utilises cultural approaches and edutainment to encourage behaviour change among the youths. Service is taken to the beneficiaries 'pon the corner' ' in d streetz', ' pon the endz' and in rural Jamaica in a bashy colourful and jazzy mobile unit.

Pro-Gay Bully Ignoring Grave Health Impact (Gleaner)

Marc Ramsay, 

British Prime Minister David Cameron's comments threatening to withhold aid from developing Commonwealth countries which do not repeal laws criminalising homosexuality caught the attention of many.

Regardless of your moral position on homosexuality, withholding aid from a developing country to force them to change their legislation because of external contrary moral positions has the potential to be harmful.

My choice of words is very deliberate - the PM has put forward a moral position on homosexuality, which he is seeking to impose on certain Commonwealth states. He cannot say that no country has the right to impose its morals on others through legislation to defend that position. He is using aid, of all options, to impose his moral position - unequivocally his moral position is that homosexual acts should not be illegal, criminalised, or subjected to legislative sanction.

So firmly does he hold to this position that he is willing to impose sanctions on developing countries. As we debate this issue, let us bear in mind that moral neutrality is a myth, and thus weigh each side on its merits.

Ordinarily such comments would give rise to arguments as to whether morality should be legislated. However, since PM Cameron has made it clear that certain moral positions can be the subject of sanctions in international policy, the question is, rather, whether his threat is right on a balance of outcomes. I use the word 'right' in the secular sense of the word, questioning whether the urgency and moral duty expressed by the British prime minister are well founded based on an assessment of the consequences.

Certainly, foreign governments have not been as outspoken about garrison politics; the virtual dictatorship between the JLPNP in Jamaica; the imbalance between rich and poor; the lack of disclosure on campaign financing, and so on. Is this threat worth it?

Rights can be restricted

The first question is what is the negative outcome of withholding legal homosexual sex from citizens in countries such as Jamaica. The right to choose one's lifestyle is as applicable to homosexuality as it is to the use of narcotics such as marijuana, or tobacco or alcohol. All three are restricted in the United Kingdom to varying degrees. While the basis is the negative outcomes, based on medical, psychological and sociological study, authorities in the UK have been more open to data on the effects of marijuana, tobacco, or alcohol than they have been on data on the negative outcomes of the homosexual lifestyle.

They have also considered the sociological implications, which do not necessarily harm the person in a conclusive medical sense, but could have harmful effects on the fabric of society. Thus, they banned smoking indoors in England in 2007, restricted alcohol intoxication levels in certain spheres, and banned marijuana despite the human right to choose one's lifestyle. They will raid a private dwelling home in London to seize marijuana on those same grounds, violating various human rights on grounds they will argue are legitimate. So there is no blanket ban on restricting the right to choose, provided there are legitimate grounds.

Only one consequence of not repealing

Thus the only negative outcome of maintaining the anti-homosexual laws is restricting the individual's right to choose, a right which is not without legal restriction on legitimate grounds such as medical, psychological or sociological harm to the individual or society. Several studies, including those conducted by Professors Jones and Yarhouse, research published in the Journal of Sex and Marital Therapy in 2011, and Dr N. Whitehead in the Journal of Human Sexuality in 2011, show that like the choice to possess or smoke marijuana, an individual can not only choose whether or not to have homosexual sex, but also change their homosexual orientation without psychological distress.

Thus the right to choose homosexual sex is not a sacred genetic right, but is open to restriction, provided there are legitimate grounds.

Negative consequences

On the other hand, there are scientific arguments which show conclusive medical, psychological and sociological grounds for negative outcomes of homosexual sex. The negative outcomes of homosexual sex and the homosexual lifestyle are not myths of religious fanatics or ignorant homophobes.

An article by Dr John R. Diggs titled 'The Health Risks of Gay Sex' provides a good starting point, referencing several studies conducted by the scientific community. Diggs concluded: "Sexual relationships between members of the same sex expose gays, lesbians and bisexuals to extreme risks of sexually transmitted infections, physical injuries, mental disorders and even a shortened lifespan."

The article cites 129 scientific studies, not conducted by Christians, or homophobes, or narrow-minded developing countries. But there is more. In 2004, WebMD reported a CDC study that showed homosexual sex forms a bridge for HIV to pass to women. This is due to the high levels of promiscuity, high levels of HIV infection, and the high percentage of homosexual males who also have sex with women.

In fact, homosexual practitioners have a significantly higher incidence of anal cancer, chlamydia trachomatis, cryptosporidium, Giardia lamblia, herpes simplex virus, HIV, HPV, Isospora belli, microsporidia, gonorrhoea, viral hepatitis types B & C, syphilis, according to research published by the Medical Clinics of North America and even the LGBTHealthChannel.

Other studies show that homosexual practitioners also have a higher incidence of haemorrhoids, anal fissures, anorectal trauma, hepatitis A, Giardia lamblia, Entamoeba histolytica, Epstein-Barr virus, Neisseria meningitides, shigellosis, salmonellosis, pediculosis, scabies and campylobacter, retained foreign bodies, and exclusive diseases such as herpes Type 8.

There are also serious mental health consequences. There are other alarming facts. A New York Times article by Erica Goode in 2001 revealed that the practice of anal sex increased in the homosexual community, while condom use has declined 20 per cent and multi-partner sex over seven years, despite billions of US dollars spent on HIV-prevention campaigns.

Furthermore, social and legal approval will lead to more sexual activity. This not only has the medical consequences already discussed, but also economic consequences. As a 2002 study by Michael Hamrick for the Corporate Resource Council shows, the health-care costs resulting from homosexual promiscuity are substantial.

In the Jamaican context, already burdened by free health care, the costs borne by the Jamaican taxpayer will be significantly higher.

In light of the brief summary I have provided, a balanced look at Prime Minister Cameron's threat reveals that there may be a lot more to lose if Jamaica is forced to repeal those 'anti-homosexual' laws. Not only could the country face sanctions from the United Kingdom prior to repealing the laws, but there are other consequences to the homosexual individual, women who may come in contact with them, and the wider society that may outweigh the restriction of homosexuals' right to choose their lifestyle.

These negative consequences may even lead one to conclude that it is necessary and fair to restrict any right to homosexual activity, as necessary and fair as restricting marijuana, alcohol, or tobacco use.

Nevertheless, if PM Cameron has his way, sovereign nations will have no right to choose.

ENDS

here is my response in audio on the mistake of saying homosexuality is illegal in Jamaica .....and a brief look at the Irish Sexual Offences Act.

Homosexuality is Not Illegal in Jamaica .... Buggery is despite the persons gender 12.11.11 by glbtqja6

Peace and tolerance


H

Cell-to-cell spread of HIV keeps viral reservoir going despite ART

An infected cell, outlined by the green fluorescent HIV it contains, transmits HIV to uninfected target cells (in red). Photo: Benjamin K. Chen, Mount Sinai School of Medicine

Keith Alcorn

The presence of very low levels of HIV in the blood despite treatment with highly potent antiretroviral regimens could be explained by cell-to-cell spread of the virus that overwhelms drug concentrations within cells, according to new research from the laboratory of US Nobel prize winner David Baltimore.



The study, published today in the journal Nature, is an attempt to explain why, despite reducing HIV replication to very low levels, highly potent regimens that target several different steps in the HIV life cycle cannot shut down HIV replication altogether.



The findings imply that the development of drug delivery methods that can raise drug concentrations within cells vulnerable to HIV infection could stop this process – and gradually shrink the reservoir of HIV-infected cells that maintain infection within the body. This would aid efforts to cure HIV infection, although it is unlikely to cure HIV infection alone.



Researchers at the California Institute of Technology compared the effects of the drugs in one of the most potent antiretroviral combinations (tenofovir, emtricitabine and efavirenz) on suppressing HIV spread in cell cultures.



They found that cell-free infection – where cells become infected by virions that have been released from other cells – was efficiently prevented by tenofovir and efavirenz. In the presence of tenofovir cell-free infection declined thirty-fold.



However, infections that occurred by the transfer of virus through direct contact between cells were much less affected by the presence of drug. At the highest drug concentrations, the transmission rate due to cell-to-cell infection was six times higher than the rate of cell-free infection.



"We saw that with cell-to-cell infection, you wind up with a lot more virus infecting a single cell," explained Alex Sigal, a postdoctoral scholar in Baltimore's laboratory and lead author of the study. "When this happens, the chance of at least a single virus getting past the drugs is much larger."



In fact, they found that whereas cell-free infection might transmit one virus, in the presence of tenofovir or efavirenz respectively, an average of 75 and 175 viruses were being transferred from one cell to another when direct transfer took place.



"And you only need one virus to infect a cell and keep the cycle going, forming a reservoir of infection," said Sigal.



Furthermore, once infection became established as a result of cell-to-cell transfer, the number of infected cells in the test tube kept growing despite tenofovir concentrations similar to those achieved by normal dosing. It was only when tenofovir concentrations were at their peak that the number of infected cells began to decline slightly with each cycle of virus replication.



This finding implies that getting more drug into cells, and keeping it there, would limit replication as a result of cell-to-cell spread, but it’s unclear at this stage whether higher drug levels would stop it in the first place.



Determining the location of viral reservoirs in the body, as well as mechanisms that maintain it, are important parts of the search for an HIV cure. Eliminating the reservoir, or at least finding ways of keeping it from spurring new rounds of HIV replication, will be essential because, at the moment, the reservoir of infected cells is enough to cause a huge rebound in viral load within weeks of stopping antiretroviral treatment.



"It's important to determine whether or not cell-to-cell replication is causing a reservoir, particularly in terms of finding a cure," said Sigal. "You can't treat it the same way as you would a latent reservoir."



Strategies to `wake up` virus in resting cells so that it could be cleared by antiretroviral drugs would not address cell-to-cell spread of the virus.



"For us, the next step is to look at the process on a more physiological level by looking at how HIV infects in organs such as lymph nodes where cell-to-cell transmission actually happens," said Sigal.



"We're really looking for a cure, but to get to a cure, you have to fully understand the disease first," he said.



Reference



Sigal A et al. Cell-to-cell spread of HIV permits ongoing replication despite antiretroviral therapy. Nature, advance online publication, August 17, 2011.

HIV damages B-cells as well as T-cells: new treatment targets identified

The signature effect of HIV infection, and the cause of AIDS, is disruption of the T-lymphocyte branch of the immune system and in particular the destruction of CD4+ T-helper cells.



A team of researchers at the US National Institute of Allergies and Infectious Diseases (NIAID) has now found that HIV also causes a very specific form of damage to the other half of the adaptive immune system, the B-cells, and in particular the memory B-cells, which recognise previously-experienced infections and generate antibodies against them.



By using probes to delete specific genes within B-cells, they discovered that HIV infection creates an unusual population of exhausted, non-responsive cells called tissue-like B-memory cells. In previous experiments with cells taken from HIV-negative people, they found that that these cells are characterised the activation of genes which cause the cell to produce proteins that inhibit the cell’s function and that two of these inhibitory proteins had an especially strong effect on B-cell function.



Now, in cells taken from people with HIV, they have found that, by deleting the genes that manufactured these inhibitory proteins, they could restore the anti-HIV activity of these B-cells, at least in the test tube, that this rejuvenated activity was long-lasting, and that the cells exhibited a number of other markers of increased immune activity.



Although the gene-therapy techniques used in these experiments were sophisticated and can cause unpredictable immune reactions in themselves, the inhibitory proteins thus identified could become new therapeutic targets.



Follow up HERE

Prison boss says no discrimination against HIV inmates

Dear Editor,

The article in last weekend's Sunday Observer does not paint a true picture of the status/treatment/condition of the HIV positive inmates currently being held in the various institutions of the Department of Correctional Services (DCS). I will address each of the issues:

1. HIV testing of our inmates is done on a voluntary basis and our officers/staff are not permitted to force inmates to submit to testing. Efforts are made to coax unwilling inmates to get tested, but there are many who refuse and therefore the Department does not have complete statistics on the HIV/Aids Status of all inmates in our care. Some inmates enter our institution knowing they are HIV positive, refuse testing and keep their status secret. It is only when the symptoms of Aids become obvious to our doctors that the inmate admits to his condition and by then, medication may have only limited success in prolonging that individual's life. Currently we have a total of 98 HIV positive inmates. For 2010 we had 3 AIDS related deaths. The St Catherine Adult Correctional Centre (STCACC) presently has 29 HIV cases. The majority of HIV positive inmates are located between the Tower Street Adult Correctional Centre (TSACC) and STCACC where a doctor visits at least 3 times weekly. All 3 full time medical practitioners employed to the Dept of Correctional Services have been trained in managing HIV cases and all were recently updated in May/June during a 2 day perceptorship at the Comprehensive Health Centre.

2. Every effort is made by the Department to prevent discrimination against HIV inmates. For this reason their status is kept quite confidential and only a few members of staff have access to that information. Staff members with that clearance include only very senior staff members and specially trained medical orderlies. To aid in ensuring no discrimination, inmates are not isolated or segregated but remain in general population. They are only placed in special areas if they are known homosexuals or mentally ill, not based on their HIV status. Homosexuals are segregated because of safety concerns if they are housed with the general population. Mentally ill inmates are segregated for similar reasons and also so they may be more adequately controlled and treated.

3. Your article gave the impression that our HIV patients are being neglected and singled out for poor treatment. This is untrue. In fact, even in the face or severe overcrowding in our institutions, some HIV positive inmates have cells to themselves while others (HIV and general population) are housed three (3) to a cell built for one (1). It is true that some HIV inmates do not have mattresses and sleep on the floor on improvised beds. This is also true for the general population and is not unique to HIV patients. Please note that there is also a cultural issue with many Jamaican inmates who are reluctant, or refuse, to use mattresses which have been previously used. Some inmates even reject used
mattresses donated to our institutions. Inmates prefer to get new mattresses and when issued with previously used mattresses they destroy them in the hope of getting a new one. The coverings of mattresses are frequently torn off the mattresses to leave only the sponge exposed for a host of reasons best known to them. My staff spends a lot of time and effort trying to ensure that items issued to inmates are properly cared for, and to minimize waste. The Department's budget is unable to provide new mattresses to each inmate entering our institutions. Even if our budget could cater to that wish, it would not be the best way of using scarce resources.

4. The DCS has an HIV/AIDS treatment program that is monitored and supported by the Ministry of Health. Ministry of Health guides with policy and protocol. They provide regular training opportunities for staff, and our Medical Director attends all updates sessions and most conferences, to ensure that we, as a Department are updated. They provide staff for our testing programme, lab equipment, testing kits, hardware and software for data management. They provide ALL antiretroviral medication available to the general public for the inmates. The needed medication is provided free of cost to the DCS and to the inmates from the Ministry of Health. The National HIV/STI programme experiened severe challenges in receiving supplies of two of the antiretroviral drugs for the months of January to June. These were Aluvia and Truvada. Indinavir, Combivir and Duovir were the substitutes. This shortage affected all HIV positives patients in Jamaica as well as the inmate population. The DCS however was not affected until April this year because we had adequate supplies in storage which were only depleted in April. Regular supplies resumed in late June. Our inmates were therefore actually better-off than the Jamaican population at large. Generally, it is not recommend to switch medication once you are on a particular regime unless it fails, as this can cause the development of a resistance to medication. However, we had no choice and we followed the directives the Ministry of Health sent out to all treatment sites. The allegations that medication is withheld from the inmates is not true. Some inmates are reluctant to collect their medication as they fear that their cellmates may become suspicious if they are seen taking so much medication and not know what it is for. The medical Staff resort to creative methods to disguise the medication in order to minimize the potential for discrimination if an inmate's status is revealed. So far, the DCS has had tremendous success in keeping the status of HIV/Aids inmates confidentional.

5. The Ministry of Health through its Behavior Change Team and Regional teams, as well as international agencies, have had numerous sensitisation sessions with both staff and inmates in all institutions, trying to reduce the stigma and discrimination. This has helped considerably. This year, HIV awareness was added to the programme for new DCS recruits.

6. Unfortunately, most of the HIV medication prescribed should be taken with food and the meal times in the institution do not coincide with the night dose which should be taken between 7pm and 10 pm. Efforts are made at our various institutions to make food items available to inmates after hours so that they may take their medication with a light snack.

7. Your article made mention of the poor quality of the meals provided to HIV inmates. The DCS currently provides three (3) meals per day to inmates on a limited budget. Efforts are made to supplement meals with items grown at our institutions. While there is room for improvement, it is demonstrably clear that our inmates are adequately fed. Efforts to increase the fruit and vegetables provided to inmates are ongoing.

8. Shown below are a few DCS Medical Guidelines For HIV Inmates:
a. All new inmates are counseled and offered testing on a voluntary basis, HIV positive inmates are informed and their CD4 done, based on the value of the CD4 they are placed on medication according to National Adult or Pediatric treatment guidelines for 2011.

b. Pregnant women who are positive are refered to High Risk antenatal clinics just as the general population would be and infants born to a positive female , put on medication and given formula just as the population following PMTCT guidelines.

c. On discharge from an institution they are referred to the treatment site in their community and given a months supply of antiretroviral therapy.

Yours sincerely,
Sean Prendergast
Lieutenant Colonel
Commissioner of Corrections (Acting)

Read more: http://www.jamaicaobserver.com/letters/Prison-boss-says-no-discrimination-against-HIV-inmates_9289396#ixzz1T7lRwf41

Latin America and the Caribbean makes MDG strides

LATIN America and the Caribbean has made strides towards achieving the Millennium Development Goals (MDGs), but there is still much work to be done before the 2015 target date.

The MDGs are a list of eight development objectives to which the international community agreed in 2000. They are:
•Eradicate extreme poverty and hunger
•Achieve universal primary education
•Promote gender equality and empower women
•Reduce child mortality
•Improve maternal health
•Combat HIV/AIDS, malaria and other diseases
•Ensure environmental sustainability
•Develop a global partnership for development

According to the MDGs Report 2011 which was published on Thursday, the region has made some progress in the first six goals, but is lagging in others.
The proportion of people in the region whose income is less than $1 a day moved from 29 per cent in 1990 to 26 per cent in 2005. The target is to halve, between 1990 and 2015, the proportion so defined.
“Robust growth in the first half of the decade reduced the number of people in developing countries living on less than $1.25 a day from about 1.8 billion in 1990 to 1.4 billion in 2005. At the same time, the corresponding poverty rate dropped from 46 per cent to 27 per cent,” the report said.

Despite these declines, current trends suggest that the momentum of growth in the developing world remains strong enough to sustain the progress needed to reach the global poverty-reduction target. Based on recently updated projections from the World Bank, the overall poverty rate is still expected to fall below 15 per cent by 2015, indicating that the Millennium Development Goal target can be met.”
The report found that nearly a quarter of children under age five in the developing world remain undernourished, but the proportion of those residing in Latin America and the Caribbean who were underweight in 2009 was four per cent, compared to 10 per cent in 1990.
On the subject of education, Sub-Saharan Africa was found to have the best record for improvement in primary school enrolment. For the 2008/2009 school year, he Caribbean region had a 95 per cent enrolment rate at the primary level, as against 93 per cent ten years prior.
Youth literacy in the region also improved, moving from 92 per cent in 1990 to 97 in 2009.

“Worldwide, the literacy rate of youth (aged 15 to 24) increased from 83 per cent to 89 per cent between 1990 and 2009. Southern Asia and Northern Africa chalked up the most progress, with increases of 20 and 19 percentage points, respectively. Sub-Saharan Africa showed significant improvement as well — a rise of seven percentage points. Still, it remains the region with the lowest youth literacy rate (72 per cent in 2009). In spite of overall progress, 127 million young people lacked basic reading and writing skills in 2009. Nearly 90 per cent of all illiterate youth live in just two regions: Southern Asia (65 million) and sub-Saharan Africa (47 million),” the report said.
On the subject of gender equality, the gender parity index for gross enrolment ratio in primary, secondary and tertiary level institutions for the years 1998/1999 and 2008/2009 was 97 for both sexes; 107 for girls and 108 boys; and 117 for girls and 126 for boys, respectively.

“Wide gaps remain in women’s access to paid work in at least half of all regions,” the document said. “Worldwide, the share of women in non-agricultural paid employment increased from 35 per cent in 1990 to almost 40 per cent in 2009. Progress has slowed in recent years, however, due to the financial and economic crisis of 2008-2009.”
As for the of seats held by women in single or lower houses of national parliaments, the region improved, moving from 15 per cent in 2000 to 23 per cent this year, 2011.
“Representation by women in parliament is at an all-time high, but falls shamefully short of parity.”
Latin American and the Caribbean has also made some progress in addressing the under five mortality rate. The figure per 1,000 live births in 1990 was 52, compared to 23 in 2009.
The maternal mortality rate has also reflected some decline, moving from 320 deaths per 100,000 live births in 1990, to 230 in 2000 and 170 in 2008.
However, the report said gains made in the Caribbean to reduce adolescent pregnancies during the 1990s have stalled. The number of births per 1,000 women aged 15-19 moved from 81 in 1990 to 77 in 2000, then to 69 in 2008.
This might be related to contraceptive use in the region, where, according to the report, there is a high unmet need for the commodity and inadequate family planning. The proportion of women who have an unmet need for family planning among women aged 15-49 who are married or in a union, has barely budged over the years, coming in at 19.5 per cent in 1990, 20.4 per cent in 2000 and 20.2 per cent in 2008.

New HIV infections are in general decline, led by sub-Saharan Africa. In Latin America and the Caribbean the number of new HIV infections per year per 100 people aged 15-49, was 0.09 per cent in 2001 compared to 0.08 per cent in 2009.
Treatment for HIV and AIDS has expanded quickly in the region, jumping to 38 per cent 2009, from five per cent in 2004. However, it was not good enough to meet the 2010 target for universal access.
The world is likely to surpass the drinking water target, the 2011 report said, “though more than one in 10 people may still be without access in 2015. In Latin America and the Caribbean, the proportion of the population using piped water on premises was 72 per cent in 1990 and 84 per cent in 2008. The proportion using improved sources in the same years was 13 per cent and nine per cent; while 15 per cent used unimproved sources in 1990 compared to seven per cent in 2008.

“The world is far from meeting the sanitation target. In fact, at the current rate of progress, it will take until 2049 to provide 77 per cent of the global population with flush toilets and other forms of improved sanitation. Almost half the population of developing regions and some 2.6 billion people globally were not using an improved form of sanitation in 2008,” the document said, pointing out that over 2.6 billion people still lack flush toilets and other forms of improved sanitation.
Regarding national debt, the region’s external debt service payments as a proportion of export revenues was drastically reduced from 21.8 per cent in 2000 to 6.8 in 2008 and moved marginally upward in 2009 to 7.2 per cent.

And in spite of the economic downturn global greenhouse gas emissions continue to climb. The region accounted for 1.7 billion metric tonnes of carbon dioxide emissions in 2008, up from 1 billion metric tonnes in 1990.
The MDGs are measured through 21 targets and 60 official indicators.

ENDS

However the same paper published

UN says Carib, Latin America not on target to meet MDGs

Read more:

also see the MDG flowchart to the left bottom of this blog

CD4s Above 500: HIV Treatment Need Still Unclear ... should one start ARVs?

If you’re diagnosed with HIV and have a CD4 cell count above 500, should you start antiretroviral (ARV) therapy immediately? An Australian study suggests that even though there may be some immunologic benefits to starting therapy earlier than is currently recommended—once the CD4 count drops below 500—the jury is still out on whether this translates into important clinical benefits.

more on how cd4s work

Despite more than 25 years of ARV research and the successful development of more than two dozen medications, scientists have not been able to determine the ideal time to begin therapy. Several studies have concluded that HIV treatment is best started before a person’s CD4 count falls below 350.

Some studies, conducted during the past five years, suggest that starting therapy even earlier—when the CD4 count is between 350 and 500—further increases the chances of disease-free survival. Less is known about the potential benefits of initiating therapy earlier still, when the CD4 count is above 500.
A large clinical trial, called the Strategic Timing of Antiretroviral Treatment (START) study, is being conducted to explore the safety and effectiveness of beginning treatment when the CD4 count is above 350 cells. Preliminary data, however, are not expected for at least another few years.

In the meantime, HIV-positive people and their health care providers are on the lookout for smaller observational and retrospective studies, such as the one recently published online by the Journal of Acquired Immune Deficiency Syndromes and based on data from Stephen Wright and his colleagues with the Australian HIV Observational Database.


Wright’s group looked at the outcomes of 432 people living with HIV who started ARV therapy with a CD4 count above 350 and had been followed for six years (72 months). For their analysis, the researchers divided the study volunteers into three groups: those who started treatment with a CD4 count between 350 and 500, those who started treatment with a CD4 count between 501 and 650 and those who started treatment with a CD4 count above 650.

Twelve months after beginning treatment, all study volunteers had CD4s above 500. Average CD4 counts, after a year of ARV therapy, were 596 among those who started with CD4s between 250 and 500, 717 among those who started treatment with CD4s between 501 and 650, and 881 among those who started treatment with a CD4 count in excess of 650.

After six years, CD4 counts were comparable between the three groups. Among those in the lowest pre-treatment CD4 group, the average CD4 cell count was 689. In the middle- and high-pretreatment CD4 groups, the average CD4 count after three years was 746 and 742, respectively.

Wright’s team also sought to determine whether there was a survival advantage between the three groups. Comparing their Australian data with those of another study, the researchers documented a modest 8 percent expected reduction in the risk of death among those who started treatment with more than 650 CD4s and a 4 percent expected reduction in the risk of death among those who started treatment with 501 to 650 CD4s, compared with those who started treatment with CD4s between 350 and 500. It is important to note, however, that the estimated number of deaths in these three groups were very low, which translated into very small differences in the absolute risk of death between those in the two highest CD4 groups compared with those starting with CD4s between 350 and 500.

“Our analysis suggests that patients who start [ARV therapy] at CD4 counts [greater than] 650 have better preserved immune function, but only to a relatively modest degree,” the authors conclude. “Furthermore the extent to which this might be expected to result in better clinical outcomes is uncertain.”

Abacavir Should (Again) Be a “Preferred” HIV Treatment Option ... previously downgraded to first line

Researchers of a new study, published online June 24 in the Journal of Acquired Immune Deficiency Syndromes, found similar rates of treatment success in people taking abacavir plus lamivudine (Epzicom), compared with people taking tenofovir plus emtricitabine (Truvada). Moreover, they conclude that abacavir should once again be listed as a “preferred” option in HIV treatment guidelines.

Three landmark studies during the past three years resulted in the down-grading of abacavir in U.S. HIV treatment guidelines from a “preferred” antiretroviral (ARV) agent for first-line therapy, notably when used in the combination tablet Epzicom, to an “alternative” agent.

Two of those studies, SMART and D:A:D, suggested that people taking abacavir had a higher rate of heart attacks than people on other nucleoside reverse transcriptase inhibitors (NRTIs). A third study, ACTG 5202, found that people on an Epizcom-inclusive regimen for first-line therapy were more likely to experience treatment failure upon starting therapy with a high viral load (over 100,000 copies), compared with people taking a Truvada-inclusive regimen.

Though other studies found no association between abacavir and heart attacks, nor lower efficacy in people starting treatment with high viral loads, the panel of experts and community activists who write U.S. guidelines voted to downgrade Epzicom in 2008. Truvada, however, has remained the preferred NRTI option.

Given the mixed results of these various studies, several European guidelines committees decided not to follow suit and kept Epzicom—branded as Kivexa in Europe—as a preferred regimen. The competing studies and differing guidelines have led to confusion as to the best use of Epizcom in people starting treatment for the first time.

In hopes of clarifying the efficacy of abacavir compared with tenofovir—less concern exists for lamivudine or emtricitabine, as both drugs are very similar—Darrell Tan, MD, from the University of Toronto, and his Canadian colleagues, examined the medical records of 1,764 HIV-positive people who started HIV treatment between 2000 and 2010. Anearlier look at the data in a smaller group of people was reported in 2010 at the International AIDS Conference in Vienna.

The Canadian Institutes of Health funded the study, and no conflicts of interest with Epzicom’s manufacturer, ViiV Healthcare, were reported.

For the study, Tan’s group directly compared people starting a regimen including abacavir and lamivudine—either separately as Ziagen and Epivir or as Epzicom—with those starting a regimen including tenofovir and emtricitabine—either separately as Viread and Emtriva, or together as Truvada. After Atripla, a combination tablet containing tenofovir, emtricitabine and efavirenz, became available in Canada in 2007, those taking the three-in-one tablet were included in the tenofovir group.

Tan found that when multiple variables were considered, people taking an abacavir regimen were no more likely to experience treatment failure than those taking a tenofovir regimen. This held true even in people who started treatment with viral loads over 100,000.

What’s more, the rate at which people were able to suppress their virus over the first few months of treatment—another way of looking at the potency of the treatment regimen—was equivalent between the two groups.

Lastly, people taking abacavir were no more likely to switch or stop treatment for reasons other than virological failure than people taking tenofovir.

Tan’s team acknowledges that a primary difference between ACTG 5202 and their study is the fact that people in ACTG 5202 were randomized to receive either abacavir or tenofovir, whereas in their study no randomization occurred. This means that there might have been reasons that a person’s provider chose one of the regimens over the other and that these reasons could have affected Tan’s study results. Because of this, the authors state that their study cannot say conclusively that abacavir and tenofovir are equivalent in terms of efficacy.

Other features of the Canadian study, however, were similar to ACTG 5202, and the Canadian study’s results are similar to a different clinical trial, the HEAT study, which found that abacavir was equivalent to tenofovir, even in people with high viral loads. Therefore, the authors conclude: “These results support the use of either NRTI backbone in the initial therapy of ART-naïve patients, and would support continuing [abacavir/lamivudine] as a ‘preferred’ NRTI option.”