CROI 2015 Program and Abstracts

Abstract Listing

Oral Abstracts

There is therefore need to better understand the impact of HAART optimization on cancer burden and picture in LMIC. In doing this there must be tools and means for assessing the potential impact of optimized care in LMIC. This may include implementation of interventions that incorporate strategies for both ADC and NADC. Research aimed at understanding local situation but also answering global questions on HIV and cancers at this point can best be done in LMIC. The critical requirement for this undertaking in LMIC must emphasize infrastructure and human capacity development in these countries.

Session S-3 Symposium

Room 6AB

4:00 pm– 6:00 pm Current Imperatives in HIV Prevention and Treatment 72 How Has HIV Prevention Affected the Spread of Other Sexually Transmitted Infections? Marie Laga Institute of Tropical Medicine, Antwerp, Belgium

At the start of the HIV epidemic in the early 80’s, rates of other STI were high among MSM, SW and even general population in many parts of the world. Because AIDS was deadly without cure at the time, attention to primary prevention resulted in sexual behavior change including more condom use. During the late 80thies and 90thies, STI prevalence rates declined substantially. When ART became available and later, evidence emerged that ART can also prevent HIV transmission, the epidemiology of STI changed again. Among MSM in Western countries for example, rates of classic STI (syphilis, gonorrhea) increased since early 2000, and outbreaks of “old” STI ( LGV) or “new” STI (Hepatitis C ) were described. The possible role of the different HIV prevention strategies on the patterns of STI in different populations will be analyzed and discussed in this presentation. 73 HIV Risks and Vulnerabilities Among Gay Men and Other MenWho Have Sex With Men Across Sub-Saharan Africa Stefan Baral Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, US In the context of the generalized HIV epidemics across Sub-Saharan Africa, it is often proposed that key populations with specific HIV acquisition and transmission risk factors are less relevant because HIV transmission is sustained among reproductive age adults with average HIV acquisition and transmission risks. While some countries in Western and Northern Africa have concentrated epidemics, the continental countries in Southern and Eastern Africa all have generalized epidemics, a categorization independent of the burden of disease among key poplations including gay men and other men who have sex men (MSM). However, the past decade has witnessed an improved understanding of both the presence of communities of gay men and other MSM across Sub-Saharan as well as their HIV-related risks and vulnerabilities. Where there are data among MSM, they suggest a complex mixture of individual level, network level, and structural risks for both the acquisition and transmission of HIV. Together, these risks manifest in high prevalence, and where measured, high HIV incidence among young men who have sex with men. Moreover, where phylogenetic data are available characterizing HIV transmission clusters, they often suggest overlap of the circulating strains among MSM with those among other reproductive age men and women. Moreover, there are complex structural determinants of HIV risks including widespread social stigma manifesting in fear of seeking health care, targeted violence, and further criminalization of same-sex practices and even homosexuality as a sexual orientation. These social constructs often result in a data paradox where we know the least about the HIV-risks and vulnerabilities in the places with the most stigma. Moving forward necessitates a combined effort of academia, community, government, and implementing partners. Improved epidemiologic inputs to inform better mathematical models characterizing population attributable fraction are crucial given the limited investment into the HIV-related needs of these men. Concurrently, adding HIV prevention and treatment options combined with enhanced implementation to improve coverage of existing and future programs is important in changing the trajectory of these HIV epidemics. Lastly, building the evidence base of the adverse public health consequences associated with widespread stigma and increasingly punitive legal contexts may facilitate successful advocacy for the changing of these laws by local champions. 74 An Expanded Behavioral Paradigm for Treatment and Prevention of HIV-1 Thomas J. Coates University of California Los Angeles, Los Angeles, CA, US This presentation will address the social and behavioral priorities for prevention and treatment of HIV-1 infection. The approach presented will be based on the premises that (1) Social and behavioral strategies are necessary and essential, but not sufficient for preventing and treating HIV-1 infection; (2) The major advances in prevention and treatment of other infectious and chronic diseases have come about through policy, legislative, and systemic interventions, rather than those focused only on the individual; and (3) The social and behavioral agenda needs to include all of the behaviors (testing, access to care, maintenance in care, adherence to treatment) in comprehensive intervnetions that also include the organization of many actors and systems essential in facilitating prevention or improving treatment. Social and behavioral strategies for achieving high coverage, acceptability, and effectiveness will be presented. 75 Social Protection, Financial Incentives, and Prevention of HIV DavidWilson World Bank, Washington, DC, US Background: Social protection may be defined as public actions to reduce extreme poverty and vulnerability. Cash transfers (CTs) are an important and growing element of social protection and may be conditional (CCTs) which are contingent on specified actions or behaviors or unconditional (UCTs) which are not contigent. A review of the literature identified over 50 randomized controlled trials (RCTs) evaluating the effects of RCTs on education, health and income, including sexually transmitted infections (STIs) and HIV. Three World Bank RCTs with biomarker endpoints show that cash transfers reduce STI and HIV infection. In Tanzania, people offered up to $60 each annually to stay STI-free had 25 percent lower STI prevalence (De Walque et al 2012). In Malawi, girls and parents offered up to $15 monthly to stay in school had 60% lower HIV prevalence - whether they stayed in school or not (Ozler et al, 2012). In Lesotho, adolescents offered a lottery ticket to win up to $50 or $100 every four months if they stayed STI and HIV-free had a 25% lower HIV incidence - 33% lower among girls and 31% in the $100 arm (De Walque et al 2012). Discussion: These studies are promising, but have methodological challenges. Tanzania and Malawi used STI and HIV prevalence, respectively. Two NIH HPTN studies reporting soon will provide decisive evidence. Questions to be answered include: (i) is the evidence robust enough? (2) Are cash transfers scalable and sustainable? (3) How durable are the effects, after cash transfers end? (4) Are there opportunities to combine cash transfers with other proven interventions, such as PrEP among the highest risk populations, including key populations and young women in hotspots in hyper-endemic countries?

Oral Abstracts

123

CROI 2015