Prevention in Focus

Spring 2017 

In case you missed it…

Valuable prevention resources from the past six months.

CATIE resources

Are you prepped for PrEP?

This webinar, presented by Dr Darrell Tan, answers the questions: What is PrEP and how effective is it, who is PrEP for, how can clients access PrEP, and how can access to PrEP be improved for people who need it?

Safer Sex Guide

This guide, developed in collaboration with the Sex Information and Education Council of Canada (SIECCAN) and CATIE gives tips on how to prevent the common sexually transmitted infections (STIs) and explains how to make sex safer.

Sexually Transmitted Infections (Key Messages for Clients)

CATIE, in partnership with SIECCAN, has created key messages for clients about seven common STIs: chlamydia, genital herpes, gonorrhea, hepatitis A, hepatitis B, human papillomavirus (HPV) and syphilis.

These key messages provide information on transmission, prevention, testing and care, and have been incorporated into CATIE’s existing STI fact sheets for service providers.

The Resonance Project Community Report

The Resonance Project is a national community-based research project to understand more about how gay men and their service providers understand, perceive and integrate these new prevention approaches in Canada. Over 80 gay men and 30 service providers took part in the research. The report explores many key issues related to how biomedical aspects of HIV are being taken up by gay men and their service providers.

Hepatitis C's Impact on Canadian Immigrants and Newcomers

The objective of this webinar is to create a better understanding of hepatitis C issues and challenges unique to immigrants and newcomers to Canada. It was co-hosted by CATIE’s Hepatitis C Ethnocultural Program in collaboration with Toronto South Local Immigration Partnership (TSLIP Kensington-Chinatown hub) and presented by Dr. Jordan Feld from the University Health Network and Bill Sinclair from St. Stephen’s Community House. It is for newcomer and healthcare service providers, and focuses on key hepatitis C trends, access to care, and treatment barriers for immigrants and newcomers to Canada.

CATIE News

Negligible Risk: Updated results from two studies continue to show that antiretroviral treatment and an undetectable viral load is a highly effective HIV prevention strategy

Successful antiretroviral treatment (ART) can reduce the amount of HIV in the bodily fluids (the viral load) to below the levels that tests can detect (undetectable). Interim analyses from two important studies—HPTN 052 in 2011 and PARTNER in 2014—clearly demonstrated that ART and an undetectable viral load is a highly effective HIV prevention strategy for heterosexual and gay male serodiscordant couples. Updated findings from the two studies reaffirmed that successful ART can dramatically reduce the risk of HIV transmission through both anal and vaginal sex.

Canada’s progress towards global HIV testing, care and treatment goals

The Public Health Agency of Canada (PHAC) has embraced the 90-90-90 HIV testing, care and treatment targets set by UNAIDS. To help Canadians be aware of the progress that has been made in the effort to reach the UNAIDS goals, scientists at PHAC, in cooperation with Provincial and Territorial Ministries and Departments of Health, have developed a report, released on World AIDS Day 2016, which summarizes Canada’s progress in reaching the 90-90-90 targets.

HIV diagnosis followed by initiation of treatment on the same day

A research team at the San Francisco General Hospital has developed a program called RAPID that overcomes common barriers to the rapid initiation of HIV treatment. An evaluation of RAPID has found that 95% of participants who entered the program were able to initiate ART within 24 hours of a positive HIV test result. Furthermore, participants were able to achieve a very low viral load in a relatively short period after initiating and continuing to take ART.

British team studies initiation of treatment shortly after HIV diagnosis

A team of researchers in London, England, reviewed the medical records of men whose acute HIV infection was diagnosed at a sexual health clinic. The team found that most of the men (77%) initiated ART at their first clinic visit. Furthermore, they found that 99% of participants had an undetectable viral load within six months of initiating ART. Participants whose ART consisted of a regimen that included integrase inhibitors tended to achieve an undetectable viral load faster than participants who used regimens without such drugs.

Going beyond current ideas about the cascade of HIV care

The HIV treatment cascade (or the HIV care continuum) involves the steps between receiving a positive test result and achieving and maintaining an undetectable viral load. Scientists in France have recently noted that while the cascade of HIV care as it is currently envisaged is useful, it does not provide a complete picture of what is occurring in the continuum of care because the cascade “does not provide any information on the elapsed time between the different steps of the care continuum, and between becoming HIV-infected and reaching [an undetectable viral load].”

The French scientists conducted extensive analyses to estimate the extent of France’s HIV epidemic, the distribution of people within the cascade of care, and delays moving from one part of the cascade to the next. They found that, overall, 52% of HIV-positive people had an undetectable viral load. However, the French scientists went beyond the usual analyses of the cascade and they found that there were significant delays moving from one step of the cascade to the next. Among gay and bisexual men and heterosexual women the gap between HIV infection and achieving an undetectable viral load was about six years. Among people who injected street drugs the gap was nearly 10 years.

Patient navigators for hepatitis C patients found useful in New York City

Researchers with the New York Department of Health and Mental Hygiene have been trying to find ways to increase awareness of hepatitis C virus (HCV) and testing for it among people at high risk for this infection.

The Check Hep C program in New York City, which used patient navigators to support participants through medical evaluation, preparation for antiviral treatment, and treatment adherence, was implemented at four community-based organizations. Results showed that over half of treatment-eligible candidates initiated treatment during the program period, and of these, 93% completed treatment and 91% were cured. This suggests that patient navigational services are “successful at overcoming previously observed barriers to cure among HCV-infected individuals.”

Canadian resources

Summary: Measuring Canada's progress on the 90-90-90 HIV targets

This report from the Public Health Agency of Canada provides an update on Canada's progress towards reaching the UNAIDS 90-90-90 target. The 2020 global targets are that 90% of all people living with HIV know their status, 90% of those diagnosed receive antiretroviral treatment, and 90% of those on treatment achieve viral suppression.

HIV in Canada: Surveillance summary tables, 2014-2015

The Public Health Agency of Canada publishes HIV/AIDS surveillance data annually in the HIV/AIDS in Canada: Surveillance Report.  Due to on-going enhancements to surveillance infrastructure, this year a set of surveillance summary tables is provided as an overview of HIV case surveillance in Canada for 2014–2015, instead of a full report.  Specifically, these tables present the number of HIV cases in Canada for 2014–15, by province/territory, sex, age group, exposure category and race/ethnicity. The number of infants exposed to HIV perinatally and their current status is also presented.

HIV in Canada

The Public Health Agency of Canada has released a new infographic with the latest HIV statistics. This infographic shows that new HIV cases are on the decline, but the number of people living with HIV in Canada continues to rise. An estimated 65,040 people were living with HIV in Canada in 2014 compared to the estimated 60,500 for 2011.

Undoing Stigma: Proceedings of the 11th Annual Gay Men's Health Summit

This is a report on the 2015 annual Gay Men’s Health Summit held in BC. The Summit examined the impact of stigma on the lives of gay men. Stigma is a multi-level construct, enacted at individual, interpersonal, and structural scales. The report explores the ways in which stigma negatively impacts the opportunities and well-being of the stigmatized. It provides a summary of the Summit proceedings and offers readers tools and frameworks for resisting stigma and addressing its negative impact on the lives of gay men. 

Emerging Prevention Technologies and Canada's African, Caribbean and Black Communities

This resource, from the Canadian HIV/AIDS Black, Caribbean and African Network (CHABAC), provides service providers with an overview of what we know about biomedical approaches to HIV prevention, and highlights ways in which biomedical strategies are perceived as relevant or not for African, Caribbean and Black communities.

PrEP and women: what you need to know

This brochure, from the Women and HIV/AIDS Initiative (WHAI) in Ontario, provides information on pre-exposure prophylaxis (PrEP) for women, including sections on coverage for PrEP, the effectiveness of PrEP, how women can start PrEP and where women should to go for more information.

Report on hepatitis B and C in Canada: 2013

This report from the Public Health Agency of Canada summarizes surveillance data on cases and rates of hepatitis B virus (HBV) and hepatitis C virus (HCV) infection in Canada, reported from 2005 to 2013. Cases are reported to the Canadian Notifiable Disease Surveillance System by provincial and territorial health authorities. Although not feasible for HCV due to provincial/territorial reporting practices, data for HBV are summarized separately for acute and chronic infection where possible. Information about acute HBV offers valuable insight into current transmission trends and patterns while cases of chronic HBV infection represent the potential burden of disease in Canada.

CIHR Canadian HIV Trials Network Coinfection and Concurrent Diseases Core Research Group: 2016 Updated Canadian HIV/Hepatitis C Adult Guidelines for Management and Treatment

Hepatitis C virus coinfection occurs in 20–30% of Canadians living with HIV and is responsible for a heavy burden of morbidity and mortality. These guidelines update national standards for management of HCV-HIV co-infected adults in the Canadian context with evolving evidence for, and accessibility of, effective and tolerable direct-acting antiviral therapies. The document is geared towards clinicians, but also provides valuable information for epidemiologists, social scientists, basic scientists, health policy experts, and people living with HIV and HCV.

Guide québécois de dépistage des infections transmissibles sexuellement et par le sang (Available in French only)

The Quebec Guide to Sexually Transmitted Infections and Blood Testing from the Ministry of Health and Social Services of Quebec is a tool for the implementation of the Quebec National Public Health Program. It promotes anchoring of the guiding principles of the National Public Health Program in practice and supports the provision of services. Taking into account the legislative framework and ethical principles, the Guide brings together the technical and scientific information necessary to carry out the screening intervention. Its recommendations are based on the most recent scientific evidence.

Guide québécois de dépistage des ITSS : Supplément – Dépistage du VIH dans les points de service à l'aide de trousses de dépistage rapide (Available in French only)

This supplement to the Quebec Guide to Sexually Transmitted Infections and Blood Testing provides an overall picture of screening for HIV infection in Quebec and presents the characteristics of HIV rapid screening kits and how to use them. It identifies the people likely to benefit from their use and changes to the counselling process usually offered during HIV testing. It also details the interpretation of the test results and discusses the documentation of care and obligations under the Quebec Public Health Act.

Indigenous Communities and HIV Disclosure to Sexual Partners: Questions and Answers

While the criminal law is a blunt instrument to deal with complex issues such as disclosure or the root causes for HIV in Indigenous communities, it is the law in Canada, and it is important for people to know about it so they can make informed decisions about their sexual life.

This brochure, from the Canadian Aboriginal AIDS Network (CAAN) and the Canadian HIV/AIDS Legal Network, provides important information about the law in Canada as it relates to HIV disclosure.

The Canadian Consensus Statement

Prepared by CATIE, CTAC and PositiveLite.com in consultation with leaders and community-based organizations throughout Canada involved in the HIV response, this Consensus Statement was launched at AIDS 2016. With its launch, Canada’s community-based service and healthcare providers look to answer the global call to end the HIV epidemic on the health and prevention benefits of HIV antiretroviral medications and HIV testing.

The Canadian Consensus Statement identifies commitments and principles to inform policy and practice in Canada’s response to HIV. The Statement provides a road map for achieving the UNAIDS global target to end HIV. It can be endorsed at hivconsensusvih.ca.

Association québécoise pour la promotion de la santé des personnes utilisatrices de drogues (AQPSUD): New harm reduction guidelines for service providers in Québec (Available in French only)

This guide from the Association québécoise pour la promotion de la santé des personnes utilisatrices de drogues (AQPSUD) in partnership with the Projet franco-québécois en réduction des risques : prévention, innovation et expertise, is for service providers working with people who inject or inhale drugs. The guide outlines new practices and strategies in harm reduction with the goal of improving services offered in Quebec to people who use drugs. The guide is available only in French.

Addressing HPV-related cancer risk among men who have sex with men (MSM): A guide for health care providers

This guide from the Sex Information and Education Council of Canada (SIECCAN) is for healthcare providers with gay men and other men who have sex with men (MSM) clients in their practice. The guide gives information on: human papilloma virus (HPV), HPV-related cancers among MSM and the need for HPV vaccination in this population; communicating with MSM about HPV and HPV-related cancer prevention; and conducting a sexual history/sexually transmitted infection risk assessment with MSM clients.

HPV-related cancers among men who have sex with men: what you need to know to reduce your risk

This fact sheet from SIECCAN provides information on HPV-related cancers among men who have sex with men (MSM) and how they can reduce their risk. As a resource for sexually active MSM, it discusses ways to reduce risk for HPV, including getting vaccinated with the HPV vaccine and using condoms.

International resources

Undetectable = Untransmittable

The Prevention Access Campaign has developed resources to address the latest research on undetectable viral load and sexual HIV transmission. The web campaign includes a consensus statement on the risk of sexual HIV transmission from a person living with HIV who is on antiretroviral therapy (ART) and has achieved an undetectable viral load.

Updated Guidelines for Antiretroviral Postexposure Prophylaxis After Sexual, Injection Drug Use, or Other Nonoccupational Exposure to HIV—United States, 2016

This document updates the 2005 U.S. Department of Health and Human Services (DHHS) recommendations for nPEP use to reduce the risk for HIV infection after non-occupational exposures to blood, genital secretions, and other body fluids that might contain HIV. It updates the 2005 DHHS nPEP recommendations in response to new information regarding clinical experience for delivering nPEP, including using newer antiretroviral regimens and their side-effect profiles and cost-effectiveness of nPEP to prevent HIV infection for different exposure types.

Consolidated guidelines on HIV prevention, diagnosis, treatment and care for key populations

In this new consolidated guidelines document on HIV prevention, diagnosis, treatment and care for key populations, the World Health Organization (WHO) brings together all existing guidance relevant to five key populations – men who have sex with men, people who inject drugs, people in prisons and other closed settings, sex workers and transgender people – and updates selected guidance and recommendations.

Antiretroviral Drugs for Treatment and Prevention of HIV Infection in Adults: 2016 Recommendations of the International Antiviral Society–USA Panel

This revision of the recommendations from the International Antiviral Society–USA Panel discusses the latest developments in uses of antiretroviral drugs, summarizing current knowledge on the following: when to start therapy, including optimal initial treatment regimens; antiretroviral therapy (ART) for patients with opportunistic infections; when and how to switch ART; laboratory monitoring; engagement in care and ART adherence; and prevention of HIV infection.

PrEP and HIV prevention: a quick primer on a hot topic

Stopping the transmission of HIV is not solely the job of either people with HIV or those who are HIV negative. Medication can both treat and prevent HIV. This short video from TheBody.com explains treatment as prevention and pre-exposure prophylaxis (PrEP).

The Global State of Harm Reduction 2016

This flagship biennial report from Harm Reduction International provides insight into harm reduction services around the world. The new data in this report show a slowdown in the provision of harm reduction services for people who use drugs, with no new countries introducing needle and syringe programs since 2014. Along with this, there has been a rise in injecting stimulants across all regions of the world, and a dramatic increase in overdose deaths.