By Micheal Ighodaro
From AVAC: Global Advocacy for HIV Prevention
December 10, 2015
black hands
Written by AVAC staffer Micheal Ighodaro, this was first published by the International AIDS Society (IAS).
I was infected with HIV as an adolescent in the streets of Nigeria. As an openly gay man coming from a country like mine, I can tell you first-hand that without addressing human rights we cannot address HIV.
I knew I was gay when I was seven years old. My mum always knew but she always tried to hide it. I remember when I first asked her what the meaning of gay was she told me, "It means evil." She locked me up in my room for a whole day for asking her what the meaning of gay was. She took me from church to church and to witch doctors who tried to cure me of what she believed I was.
She did this for three years and realized that all she had been doing was not working and that I really was gay. She and my dad hated me so much that my dad asked me to leave the house. I left home when I was seventeen and dropped out of my final year of high school because my dad was not going to pay my fees anymore. I traveled from city to city in Nigeria doing things that I am not really proud of, just so I could get the next meal.
Apart from Bisi Alimi -- who was living in the UK and openly gay and HIV positive -- no one was openly out as gay and living with HIV in Nigeria because of the stigma and discrimination. I had no idea that I had HIV or that I could contract HIV as a gay man due to lack of information. I lost some of my friends who would still be alive today if it weren't for the stigma they experienced. It felt like no one was interested in us, gay men living with HIV. It seemed like we were almost left to die. Today, I am really happy for the treatment and prevention that is available now and that many gay men like myself, can live longer and healthier lives.
However, we still have over 79 countries where it is illegal to be gay, bisexual, transgender or intersex. These laws make it almost impossible for us to access HIV prevention and treatment services, which is a direct attack on our basic human rights.
LGBTI populations still face the highest risk of getting HIV in Syria and Afghanistan LGBTI populations face heightened discrimination from ISIS and other religious groups and in most cases are sentenced to death. Many of us are now refugees and asylum seekers in different countries.
As a person who has experienced the discrimination that comes from being gay in my own country, I must ask the question: How far have we gone in protecting the rights of vulnerable populations? This question remains to be answered and goes even beyond the legal rights of LGBTI -- it's about the rights of sex workers, trans diverse persons, people who use drugs, and people living with HIV.
All the recent scientific success we have had in the fight against HIV will come to nothing if we continue to have laws that take away the right of individuals to access life-saving care they need. On this International Human Rights Day, I ask that you stand with me in solidarity for all those who have experienced an attack on their human rights. We should and must do better.
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More Viewpoints Related to HIV/AIDS Among Gay Men
The US Centers for Disease Control (CDC) has found that oral pre-exposure prophylaxis (PrEP) using a combined tenofovir/FTC (Truvada) pill is still effective against HIV with the M184V resistance mutation, which confers complete resistance to FTC (emtricitabine,Emtriva) and to its sister drug 3TC (lamivudine, Epivir).
In animal studies, five monkeys given oral Truvada PrEP, and then challenged vaginally with a form of HIV that had the M184V mutation and which was adapted to infect monkeys (SHIV), remained uninfected after 14 once-a-week exposures to the virus. In contrast five animals not given PrEP and challenged with SHIV with M184V were infected.
One out of five animals challenged with a non-resistant, wild-type virus was infected after 14 challenges when the same PrEP regimen was used.
The PrEP regimen used was intermittent: a once-a-week dose ofTruvada was given three days before the challenge with SHIV, and then another dose two hours afterwards, in line with previous animal data, which found that this was the most effective regimen.
CDC researcher Gerardo Garcia-Lerma said that the potential of PrEP to create resistance, and whether it would fail with resistant virus, were crucial research questions. This particularly applies to the M184V mutation, which is one of the most common HIV resistance mutations and was found to arise in two subjects in the iPrEx PrEP trial who took Truvada while, unbeknownst to them, they had acute HIV infection.
There is thus concern about what would happen if Truvada PrEP gave rise to an increase in the proportion of people with HIV with the M184V resistance mutation.
Garcia-Lerma said that the CDC study showed that “exposure to drug-resistant viruses does not necessarily associate with failure of PrEP.”
Fitness assays showed that the strain of SHIV with M184V used in the study replicated 30 times less efficiently and was four times less infectious than the non-resistant virus used (because of this, the dose of PrEP used against the M184V-mutant virus was lower). Furthermore the virus, while completely resistant to FTC, was two to four times more sensitive to tenofovir than wild-type, non-resistant virus.
In other PrEP trials in animals, Truvada was seen to be more effective than tenofovir alone when used as oral PrEP, and animals with M184V are effectively only taking tenofovir as an active drug. Garcia-Lerma speculated that the hypersensitivity to tenofovir seen was compensating for the missing antiviral effect of FTC, which was why Truvada was just as effective in animals with M184V virus.
He also, when questioned, speculated that keeping up the dose of FTC, even if it had no antiviral effect, could serve to maintain the M184V mutation and this useful tenofovir hypersensitivity. However he agreed that repeating the study using tenofovir alone would be necessary to prove this hypothesis.
