The ultimate man: positive engagement with men

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The ultimate man positive engagement with men

• C Mazhude
• The National African HIV Conference March 2008

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Acknowledgements

• Health Protection Agency (HPA) most of the
  epidemiological slides have been acquired from
  the HPA website, with thanks.
• For more info please visit www.hpa.org.uk

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HIV Therapy -The Success Story

• Decreased mortality and Morbidity
• Resistance
• Improved tolerability
• And more drugs than ever
• Treating for long term success

4
EuroSIDA AIDS and Death Since Introduction of
HAART
Morbidity and Mortality Across Europe, Israel,
and Argentina 10,000 Patients
100
100
Percentage of patients on HAART Combined rate of
AIDS and death
80
60
Patients ()
10
Combined AIDS and Death Rates
40
20
1
0
Sept 1994
Sept 1999 -March 2000
Sept 2000 -March 2001
Sept 1998 -March 1999
March 1995
Sept 1995 -March 1996
March 1996 - Sept 1996
Sept 1996 -March 1997
March 1997 -Sept 1997
March 1995 - Sept 1995
Sept 1997 -March 1998
March 1998 -Sept 1998
March 2000 -Sept 2000
Sept 2001 -onward
March 1999 - Sept 1999
March 2001 - Sept 2001
Mocroft A, et al. Lancet. 200336222-29.
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Resistance

• Goal of therapy undetectable viral load even in
  highly experienced

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Approved antiretrovirals
Combivir
DDC
3TC
Delavirdine
Abacavir
Nevirapine
DDI
AZT
d4T
Trizivir
Efavirenz
1987
1991
1992
1994
1995
1996
1997
1998
1999
2000
1988
1989
1990
2001
Kaletra
Nelfinavir
RTI
Saquinavir HG
Saquinavri SG
Tenofovir
NNRTI
Ritonavir
Amprenavir
PI
Indinavir
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New Antiretrovirals in Development 2007

• NRTIs/NtRTIs
• Amdoxovir (DAPD)
• Apricitabine (AVX754)
• Compound X
• Dexelvucitabine(D-d4FC)
• Racivir ( FTC)
• SN1212
• Protease inhibitors
• Brecanavir (GW640385)
• Darunavir (TMC114)
• P-1946

• NNRTIs
• BILR 355 BS
• CSIC
• DAPY/DATA
• Etravirine (TMC125)
• TMC120 (microbicide)
• TMC278
• UC781
• Integrase inhibitors
• GS-9137
• MK-0518
• Maturation inhibitors
• PA-457

• Entry inhibitors
• BMS-488043
• Maraviroc
• NB-2, NB-64
• PRO140
• TNX-355
• Vicriviroc
• KRH-3955
• KRH-3140
• TRI-999
• TRI-1144

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Better tolerability
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How well have these benefits been realised within
the African communities?
10
(No Transcript)
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The African population in the UK

• 0.8 of the UK population is black African
• Largest communities
• Nigeria and Ghana (established)
• Zimbabwe, Uganda, DRC, Somalia (newer
  communities, recent migration and asylum)

• 78 live in London
• 510 of the population
• Younger age profile than the indigenous
  population
• Religion
• 69 Christian
• 20 Muslim

Office for National Statistics March 2005
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The African issues.

• The numbers
• Prevalent undiagnosed
• Late diagnoses
• Men

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HIV diagnoses among black and minority ethnic
populations by ethnic sub-group
4500
Black African
Black Caribbean
4000
Indian/Pakistani/Bangladeshi
3500
Other
3000
2500
Number of diagnoses
2000
1500
1000
500
0
1
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
Year
1Numbers will rise, for recent years, as further
reports are received.
Data source Adapted from HPA. HPA Nov 2005. HPA
website 2005 Nov 1-35 HIV/AIDS diagnosis
reports, England, Wales and Northern Ireland.
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Percentage of ethnic populations living with
diagnosed HIV aged 15 to 59, England 2006
Annual survey of HIV-infected persons
accessing care and ONS 2004 population estimates
(based on 2001 census)
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and

• 24 800 PLWH born in SSA 2006
• There has been a gt5x increase in heterosexual
  transmission within the UK in last 10 years
• 36 (22-53) men vs 23 women unaware of HIV
  status
• Improving uptake of HIV testing in GUM clinics

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Uptake and outcome of HIV testing in sub-Saharan
African (SSA) or UK born heterosexuals attending
sentinel GUM clinics, E, W NI

• 1 Previously undiagnosed HIV infection includes
  those diagnosed at the clinic attendance and
  those remaining undiagnosed after the clinic
  attendance but excludes those diagnosed earlier.

• Unlinked anonymous surveillance in 15 GUM clinics

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Diagnosed HIV-infected black Africans and black
Caribbeans accessing care by exposure category,
England, Wales Northern Ireland
Annual survey of HIV-infected persons
accessing care
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Late presentations
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Africans with HIV continue to present with
advanced disease in the era of HAART
19981999
19821985
African

Non

African

Non
African
African




(143)
(243)
(259)
(215)









188
380
CD4 count
277
440





35
13
AIDS
15
9















Burns F et al. AIDS 2001 15 2453-2455


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Late HIV diagnoses and AIDS at HIV diagnosis
among black Africans and black Caribbeans, UK
2006

• HIV/AIDS and death reports, surveillance of CD4
  cell counts in HIV-infected persons

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Figure 4 Estimated late diagnosis by prevention
group England, Wales and Northern Ireland
(1997-2006)
CD4 cell count less than 200 cells/mm3 within
30 days of diagnosis
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Estimated prompt and late HIV diagnosis among
HIV-infected black Africans and black Caribbeans
with associated short-term mortality, UK

• 1 Prompt diagnosis CD4 count 200 cells/mm3
  within 30 days of diagnosis.
• 2 Late diagnosis CD4 count lt200 cells/mm3 within
  30 days of diagnosis.
• 3 Numbers of new HIV diagnoses from 2003 onwards
  are adjusted for reporting delays.
• 4 Percentage of patients known to have died
  within a year of diagnosis - further reports to
  be received for 2006.

• HIV/AIDS diagnoses, death reports and
  surveillance of CD4 cell counts in HIV-infected
  persons

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SE London Clinic
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Risks of delayed diagnosis

• Higher risk of AIDS
• Poorer survival
• Higher risk of non-AIDS illnesses
• Higher risk of treatment failure, detrimental
  viral evolution
• Immune restoration is poorer
• Increased toxicity
• Increased risk of HIV transmission

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The key issues (for men)

• Reduce the number of prevalent undiagnosed
• Earlier diagnosis
• Reduce rates of new infections

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The message

• Need to know HIV status

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How do we engage African men?

• How do we access men?
• How do we make information more accessible?
• How do we make services more accessible?
• How do we get men to prioritise health The
  Ultimate Man?