Reframing the message of sexual and reproductive health and rights for our current political environment. HIV treatment is not a cure, but it is keeping millions of people well. Start learning about it in this section. In this section we have answered some of the questions you might have if you have just found out you have HIV. Antiretroviral drugs chart A one-page reference guide to the anti-HIV drugs licensed for use in the European Union, with information on formulation, dosing, key side-effects and food restrictions.
Our award-winning series of booklets, with each title providing a comprehensive overview of one aspect of living with HIV. A range of interactive tools to support people living with HIV to get involved in decisions about their treatment and care. Short factsheets, providing a summary of key topics. Particularly useful when looking for information on a specific issue, rather than exploring a wider topic. Consistently used condoms provide significant protection against HIV, pregnancy and sexually transmitted infections STIs.
The dating with hiv gay of protection they offer against HIV and STIs is significantly better than any other single prevention method, taken in isolation, other than sexual abstinence or complete mutual monogamy between two people who have tested negative for HIV.
Despite this, the use and promotion of condoms continue to be targets for controversy and criticism, and sexual abstinence and monogamy are often promoted as superior alternatives. While condoms offer useful and vital protection, they have also become associated with promiscuity and infidelity. Museveni later asian dating monthly of being misunderstood and signed an article in The Lancet saying that condoms formed a valuable part of HIV prevention.
Therefore questions of condom efficacy have to be addressed and misapprehensions corrected. The spermatozoon can easily pass through the 'net' that is formed by the condom. These margins of uncertainty Knowing how well they protect against other STIs is important for sexual health in general and may be particularly important for people with HIV, who may be more vulnerable to the effects of certain STIs.
In other words, for every cases of HIV infection that would happen without condom use, about 15 range: The best estimate we have is that using condoms more than three-quarters of the time halves the chance of acquiring HSV-2, and may reduce the chances of genital infection with the cold sore virus HSV-1 too.
Another has found that condom use helps to prevent HPV infection progressing to cervical or penile cancer in both women and men. These are based upon observations of their use in contraception: Condoms are, however, the only method on that list that has been shown to protect against STIs as well as pregnancy. Laboratory studies and product testing have shown that reputable condoms tested in the laboratory are completely impermeable to micro-organisms as small as viruses.
In these circumstances, it is easy to see why condoms sometimes fail, even in consistent users. In addition, however, people are not consistent in their use of condoms, and may not even be consistent when they claim to be, or think they are.
Women were much less likely to report inconsistent use of condoms than never using them: For the reasons described above, there is a convention to use two different words when describing the effect of prevention interventions.
The efficacy of an intervention is how well it works in a scientific trial or when people use it as indicated, i. Because these studies involve private behaviours that investigators cannot observe directly, it is difficult to determine accurately whether an individual is a condom user and whether condoms are used consistently and correctly.
The next problem is deciding what kind of study provides truly reliable evidence. It would be unethical to mount a randomised trial of condom use because the control group would have to stop using them altogether.
The evidence we have is based on three types of trials, and each has potential weaknesses. These can be done in individuals whose characteristics are known and can be controlled for, and if the relationship truly is monogamous then infections by acute STIs and from outsiders can be ruled out.
One disadvantage is that condom use in long-term relationships, even in serodiscordant couples, is relatively rare. Another is that the HIV-positive partner will be chronically infected and so will not have the very high viral load characteristic of acute HIV infection. For these reasons, HIV transmission within long-term serodiscordant relationships, especially heterosexual ones, may be rarer than it is between casual sex partners.
Another kind of study is to conduct a prospective cohort study, looking at differences in HIV incidence between two groups of people according to their usage of condoms. There is opportunity for qualitative who is nikki bella dating too, contrasting attitudes and drivers of behaviour between people who become infected with HIV or other STIs and those who do not.
Condom efficacy against acute STIs can also be measured, if people have multiple partners, or their partners do. The weaknesses of this kind of study include the fact that condom use cannot be corroborated by partners, so self-report is likely to be even more unreliable.
A study that measures HIV incidence in condom users and non-users will be confounded, for instance, if one group has substantially fewer sexual partners than the other. For this reason and because HIV seroconversion even in high-risk populations is a relatively uncommon event, prospective cohort studies have to be large and can be quite costly.
A third kind of study is to conduct a retrospective cohort study, asking people about their condom use and contrasting HIV and STI prevalence in users and non-users, dating with hiv gay. Retrospective cohort studies are subject to greater limitations that prospective ones. For all these reasons, measuring the efficacy of condoms or indeed other established prevention methods and strategies such as serosorting can be challenging.
Nonetheless, a number of carefully conducted studies have demonstrated that consistent condom use is a highly effective means of preventing HIV transmission. When it comes to Dating sites for large women other than HIV, most epidemiologic studies of these are characterised by methodological limitations, and thus, the results across them vary widely - ranging from demonstrating no protection to demonstrating substantial protection.
However, we now have enough evidence to demonstrate that condoms offer at least some and in some cases excellent protection against most STIs. Given that condoms have been promoted as the first line of defence against HIV since the beginning of the epidemic, at least in the developed world, it is perhaps surprising that a really rigorous review establishing their efficacy against HIV and STIs was not conducted till June11 when the US National Institute of Allergy and Infectious Diseases NIAID conducted a review of the evidence for their efficacy, spurred on partly by a political climate in the US which at the time was turning against the promotion of condoms and contraception, and towards abstinence and monogamy as the favoured method of protecting against STIs and pregnancy.
For persons whose sexual behaviors place them at risk for STDs, correct and consistent dating with hiv gay of the male latex condom can reduce the risk of STD transmission. However, no protective method is percent effective, and condom use cannot guarantee absolute protection against any STD. This rewording was interpreted at the time as a move away from the promotion of condoms and an attempt to appease the pro-abstinence lobby, but it lee da hae dating an accurate statement of the protection condoms offer.
The NIAID review first determined the risks of exposure to semen due to condom breakage and found that this, given that breakage dating discord quite rare, was a low risk: It also reviewed patterns of condom use amongst people in the US. Davis and Weller found 12 studies that met these criteria.
The meta-analysis noted the direction of transmission male-to-female, female-to-male, and unstated and date of study enrolment. Condom usage was classified into the following three categories: To cite one of the 12 studies in more detail, 18 researchers looked at Italian serodiscordant couples in which the male partner was HIV positive.
Annual HIV incidence was 7. Davis and Weller subsequently published another meta-analysis in19 this time of 14 studies.
The studies with the longest follow-up time, consisting mainly of studies of partners dating with hiv gay haemophiliac and transfusion patients, yielded an HIV incidence estimate of 5. In these nine studies there were only four seroconversions reported among 1. In contrast, when condoms were used inconsistently or not at all, of This is about the highest standard of proof we can expect from studies of condom efficacy. Taking Davis and Weller and Pinkerton together, one can say that the best efficacy estimates we have for the use of condoms in preventing HIV are:.
One fact that at first sight seems puzzling is that a number of studies of condom efficacy report that inconsistent use of condoms is in some cases worse than not using them at all. To take one study from Rakai, Uganda: He found that annual HIV incidence in dating boyfriend for 3 months was 1.
But he found that HIV incidence in inconsistent users was 2, dating with hiv gay. Consistent condom users had half as many cases of gonorrhoea or chlamydia as non-users — again, broadly in line with other studies. How can sometimes using condoms be worse than never using them? The confounder which distorts these figures is sexual risk behaviour. Or rather, in anal sex, as this is the transmission behaviour in question?
But there has been only one small analysis of the extent to which using condoms actually prevents HIV infection in people who have anal sex, compared with people who do not use condoms. This may be because the figures for vaginal sex are simply extrapolated to anal sex; it may also be because, in gay men at least, a lot of HIV transmission happens in casual situations where the HIV serostatus of partners cannot be assessed, and so the degree of HIV exposure risk are difficult to quantify.
A small review of condom efficacy and anal sex 22 found two studies amongst gay men and one amongst women that gave some indication of the relative effectiveness of condom use in anal sex. The one in women followed seroconversions amongst serodiscordant heterosexual couples and did ask whether they had anal intercourse. Anal intercourse was already a minority behaviour and unprotected anal intercourse even rarer, and the researchers could not directly compare seroconversion rates between women who used condoms for anal sex and ones who dating with hiv gay not.
The only large longitudinal study of condom efficacy in gay men was published back in Again, this is probably because men who never used condoms were likely to include monogamous men and ones who had less anal sex. The only later data we have relating HIV incidence among gay men to condom use come from retrospective studies of gay men diagnosed with HIV who were asked about their condom use.
The rate of new HIV diagnosis among men who attempted always to use condoms was 1. This is a retrospective epidemiological study with nothing like the same degree of rigour as the studies of HIV serodiscordant couples, but, like the MACS study, it does yield an estimate of condom efficacy somewhat but not hugely lower than the lower bounds of condom efficacy noted in the Weller and Black hookup dating and Pinkerton meta-reviews.
Is one of the reasons condoms appear somewhat less protective during anal sex that they are more likely to break? There have been plenty of studies of condom failure breakages, slipping off, etc. For instance, a Dutch study 26 of gay men, one-third of them HIV-positive, found that the overall failure rate during male-to-male anal sex was 3.
The failure rate with the use of water-based lubricants was 1. However in the yearresearchers from London's City University presented a study 2728 of gay male couples who had been randomised to use either standard or thicker condoms for anal sex and additional water-based lubricant.
Each couple was provided with nine condoms and completed a questionnaire after each sexual act. The researchers found that condoms broke for the same reasons as previously identified in studies among heterosexual couples: Use of additional inappropriate lubricant oil-based or saliva was also associated with condom breakage.
Penis length was also associated with condom breakage, yet girth was not. The study found no significant differences between the two types of condoms with respect to breakage or slippage. Condoms were more likely to slip if lubricant was placed on the penis under the condom. A low incidence of breakage was reported for both condom types during appropriate use. Here, it found four studies that reported reductions in gonorrhoea associated with condom use, though only one study measured consistent and correct condom use.
This may well have therefore underestimated the degree of protection offered by condoms. The only prospective study was one from in which the incidence of gonorrhoea in sailors who were clients of the same group of sex workers elite dating site canada studied.
For simplicity, this page may be cited as www. We may therefore be sorely tempted to misuse that power in furthering a personal prejudice or social goal -- why not provide that extra oomph by extending the umbrella of science over a personal preference in ethics or politics? But we cannot, lest we lose the very respect that tempted us in the first place.
The three studies compared Confounding factors. It is not, of course, up to the media to decide what is good or bad science. The media was reporting what it heard from scientists [about cold fusion]. Only a tiny fraction of all scientific research is ever covered by the popular media, however, and most scientists go through their entire career without once encountering a reporter. New results and ideas are argued in the halls of research institutions, presented at scientific meetings, published in scholarly journals, all out of the public view.
Voodoo science , by contrast, is usually pitched directly to the media, circumventing the normal process of scientific review and debate. Renal and Urology News August 19, It is not sufficient to rely on circumcision alone to prevent HIV transmission. A traveller came to a farmhouse and offered to make the occupants Nail Soup in return for a night's shelter. He threw a large nail in a pot of boiling water.
But he said - "A nail must be combined with other soup ingredients, such as onions, carrots, meat and seasonings. It is not sufficient to rely on the nail alone to make Nail Soup. In the morning he went on his way, refreshed after a night in a comfortable bed, minus the nail, with some gold coins in his pocket and the thanks of the family ringing in his ears for the wonderful nail that made such delicious Nail Soup. So it will be when mass circumcision has been "rolled out" and if there is any dent at all in HIV transmission.
The Roman senator Cato was in the habit of ending every speech on any subject with those words - it helped that "must be destroyed" was a single splendid Latin word, "delenda". Eventually the Senate agreed to destroy Carthage, with disastrous consequences for Rome. Recently, several studies have been published, most from Africa, one from India, claiming to show a link between having an intact penis and a higher risk of HIV infection.
They tend to have two things in common - flawed work, and a passage near the end saying " Therefore, universal male circumcision should be considered as a preventive measure against HIV infection " or words to that effect.
The latest study is the most careful so far to avoid the mistakes of its predecessors, but it still falls far short of justifying mass circumcision campagns of men in Africa, let alone Routine Infant Circumcision.
It claims to have found a less protective effect than the one before it. However that selection could in turn be affected by circumcision status. Adolescent circumcision may delay the age of onset of intercourse in societies where women won't have intercourse with intact men, unlike women in non-circumcising societies which in turn would affect their chance of contracting HIV and being excluded from the study before it began.
The lower HIV rate may have merely been a result of circumcised men having taken risks for longer than the intact men, and hence being more likely to have some immunity to HIV when they entered the study. With those precautions, the correlation between circumcision status and HIV acquisition fell to 1.
The circumcised men were more likely to be married and to have more than one wife, less likely to have ever been with a sex worker, or with more than three sex workers. These factors could well account for the difference. The authors maintain that "because participants did not know their HIV-1 status at the time of our visit, bias from this source would seem unlikely.
All would know their circumcision status. There are thus unknown ways in which men might non-randomly "include themselves out". This study - unlike others - found no effect of age of circumcision on HIV acquistion, even if the circumcision took place after sexual activity began and after HIV was prevalent.
This suggests that circumcision itself is not the key factor. An unexplored area is what else the churches advocated or required beside circumcision. Since the church circumcisions occur on the eighth day after birth, it seems likely they model themselves on Judaism: As controls on "psychic" research are tightened, the effects found steadily diminish, and when control is complete, the effects vanish.
We see a similar effect here. These results are certainly consistent with the null hypothesis, that circumcision has no effect on HIV acquisition: Yet as usual, this study advocates that "male circumcision should be seriously considered as an intervention to slow the spread of HIV-1 in uncircumcised populations".
It is hard to escape the conclusion that this line was written before the study began. It tests the uptake of HIV by foreskin tissue with that of uterine cervical tissue - rather than vaginal, labial or clitero-preputial mucosa, or the mucosa of the male glans for example - for no apparent reason. One reason could be that cervical tissue was easier to obtain, via hysterectomy. The dead foreskin and cervical tissue was subjected to an extraordinary amount of processing before it was even ready to be inoculated with HIV or HIV genes.
The experimenters may answer that since the cervical and foreskin tissues were subjected to the same processing, any experimenter effects would be cancelled out - but, since they are different tissues, how does anyone know that?
They use skin from the outside of their sample foreskins as a surrogate for the shaft skin of circumcised men, but fail to take into account that only very low and tight circumcisions will result in a shaft covered only in skin: Doubtless this study will now be cited again and again as proof that live HIV is more likely to infect live intact men than live circumcised men - even though no live penile tissue and no circumcised penile tissue was involved in the experiments.
The paper again proposes mass circumcision as an HIV preventative measure, considering only "acceptablity and operational feasibility," not ethics. It throws a sop to the false sense of security this would engender, recommending. National Prevention Information Network September 17, During the four-year study, 53 men acquired HIV.
There was no evidence that circumcision reduced the HIV risk among gay men in general. But in looking at the men who predominantly took the insertive role in intercourse, there was an 85 percent reduction in the risk of HIV infection if they were circumcised.
That's pathetically few to be drawing any statistical conclusions from, and then only of correlation, not causation. Were any of these men circumcised for religious reasons?
Factors like that might selectively influence their behaviour, putting them at less risk. So circumcising insertive men could readily increase HIV transmission to their partners.
Yet already this study is being touted as a reason for gay men to get circumcised. Studies that claim to find a correlation between intactness and HIV transmission are not uncommonly misreported in a way that plays up the "protective effect".
In one particularly glaring case, a study that found no statistical signficance was widely reported as finding a protective effect. The study Gray R et al. Male circumcision and the risks of female HIV and sexually transmitted infections acquisition in Rakai, Uganda. After 30 months if the pattern of the rest of the study was followed , infection rates were 7 per person-years for the wives of circumcised men and 10 for the wives of intact men.
In real terms, it can be back-calculated that 8 of the wives of circumcised men were infected. If 11 had been, the rate would be the same for both, and that difference of three infections in 30 months is too few to be considered significant. But the study was widely reported by Reuters as showing that all wives of intact men were infected, compared with only 44 wives of circumcised men, as if these were just the small infected samples of two much larger and equal samples.
This makes the supposed protective effect look much greater. See the garbled report and the relevant part of a more accurate report. If your results are bad, ask the computer to go back and see if any particular subgroups behaved differently.
You might find that your drug works very well in Chinese women aged fifty-two to sixty-one. This is commonly called " data-mining " This cartoon illustrates the principle. In the following study, the vast majority of the men showed no correlation between intactness and HIV.
The Journal of Infectious Diseases impact factor: Lee Warner, Khalil G. Newman, Maurizio Macaluso, Patrick S. Sullivan, and Emily J. Male circumcision has received international attention as an intervention for reducing HIV infection among high-risk heterosexualmen; however, few US studies have evaluated its association with the risk of HIV infection. We analyzed visit records for heterosexual African American men who underwent HIV testing while attending sexually transmitted disease STD clinics in Baltimore, Maryland, from to We used multivariable binomial regression to evaluate associations between circumcision and the risk of HIV infection among visits by patients with known and unknown HIV exposure.
Among visits by [ ] patients [ fewer than 50 of whom were intact ] with known HIV exposure, circumcision was significantly associated with lower HIV prevalence Circumcision was associated with substantially reduced HIV risk in patients with known HIV exposure , suggesting that results of other studies demonstrating reduced HIV risk for circumcision among heterosexual men likely can be generalized to the US context. A failed prediction is a very solid sign that a pattern is phony.
A pattern allows you to make a prediction: A false pattern has no predictive power: Elites TV December 18, A total of men and women participated. In males, preference for being or becoming circumcised was associated with inconsistent condom use and increased lifetime number of sexual partners. Preference for circumcision was increased with understanding [ i.
Raw figures for circumcision vs HIV are not given. A total of males over the age of 15 were administered questionnaires and provided specimens for HIV testing.
HIV prevalence among circumcised males was Blacks were less likely to be circumcised When the data are further stratified by age of circumcision, there is a slight protective effect [ correlation ] between early circumcision and HIV among Blacks, OR: Conclusion In general, circumcision offers slight protection. The effect is much stronger in other racial groups than in blacks. This racial difference cannot be explained by age of circumcision.
To investigate the nature of male circumcision and its relationship to HIV infection. Chi-square tests and Wilcoxon rank sum tests were used to identify factors associated with circumcision and HIV status, followed by a logistic regression model. One-third of the men
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