A study published in the online edition of AIDS reports that higher rates of unprotected sex are offsetting gains from earlier diagnosis and wider treatment among Dutch gay men. This follows reports earlier this year that wide use of antiretroviral therapy appeared to be stabilizing the epidemic among Danish gay men, despite higher observed rates of unsafe sex. The authors of the study attribute the increase in new infections among Dutch gay men to sexual activity by undiagnosed men.
The difference between Danish and Dutch experience is unexplained but underlines the need for an effective vaccine to backstop the highly behavior-dependent prevention interventions available today.
In a related development, the International AIDS Society (IAS) announced August 14 that 25 percent of a small study group of U.S. men with undetectable blood viral load had low but detectable semen viral load. "This finding from a US clinic," the IAS wrote, "underlines the possible risk of HIV transmission from MSM with an undetectable viral load in blood." Detectable semen viral load was found to correlate with STIs, elevated levels of a cytokine (TNF-a) associated with systemic inflammation, and unprotected anal sex with an HIV-positive partner.
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