Friday, September 25, 2015

paedophilia-a medical disorder can be treated not cured-{can try for gays a similar medical disorder}

German doc targets paedophiles as patients
Times of India - 11 hours ago
MUMBAI: India may soon be introduced to a new way of battling child sexual abuse—treating paedophiles. Dr Klaus Beier, director of the ...



German doc targets paedophiles as patients


MUMBAI: India may soon be introduced to a new way of battling child sexual abuse—treating paedophiles. Dr Klaus Beier, director of the Institute of Sexology and Sexual Medicine at the Charite University in Berlin and a pioneer in researching and working with paedophiles, is set to bring his programme to India. He is currently in talks with hospitals, NGOs and a big business organisation for funding. He hopes to roll out the programme in Mumbai and Pune in 2016.
The programme, currently in place in Berlin, is possibly the only one in the world working on a targeted approach to treat paedophiles. A specialist in psychosomatic medicine and a practicing sexologist for over 25 years, Beier began his project for preventing paedophilia in 2005, which was accompanied by a massive ad campaign in Berlin targeting paedophiles at risk to commit offence and providing details of where they could access help. The tagline for the ad read, "Do you like children in ways you shouldn't?"
"There is no cure for paedophilia, but it can be treated. There are many medical disorders, like, for instance, diabetes, for which there is no cure, but which can be controlled," says Beier in an interview with TOI. He calls paedophilia a sexual preference that manifests itself in adolescence and remains unchanged through life. Earlier this week, at a conference on child sexual abuse by The Foundation, a non-profit founded by actor Rahul Bose, Beier displayed pictures drawn by paedophiles, which showed sexual fantasies targeting children. The same person drew similar pictures at the age of 15 and at 45.
Data from studies in Germany and the US show that 60% of child sex offenders are not paedophiles, but are people who merely substitute children for adults. The remaining 40% are paedophiles, that is, people who are sexually attracted to children. Some paedophiles are not disturbed by their actions, and feel society should not make a big deal of that. "For these people, you have the law enforcement machinery," says Beier. "However, others are genuinely disturbed by their orientation and don't know how to deal with it. It's important that they have the option to seek help," says Beier, adding that there are paedophiles who have never abused children, but are disturbed about feeling the way they do towards children.
Paedophiles, he says, are of two kinds—those who are exclusively attracted to children and those who are attracted to both adults and children. Both kinds, says Beier, require help to deal with their orientation.
Ads on bus stops, in print, on television and on the internet helped paedophiles who had not been reported to the police to seek help voluntarily. The one-year intervention programme they went through included learning impulse control through behavioural techniques, as well as tools that improved their social functioning and, in some cases, pharmaceuticals, particularly androgen-deprivation therapy. Androgen is a male sex hormone, the deprivation of which results in reduced sexual desire. Klaus says paedophilia is virtually always exhibited in men. Of the thousands of cases he has dealt with over the years, he encountered only one woman.
While paedophiles undergoing therapy will, eventually have to live in a world where they will encounter children, much the way alcoholics live in a world where they cannot avoid seeing alcohol, the treatment helps them learn how they can avoid acting out their urges vis-a-vis children.


comment:- please try it for homosexuality ;which also comes under a very similar medical disorder 

Communities Health Tools Information


Thursday, September 24, 2015

prophylaxis Side-effects- Preventing HIV

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Side-effects

One consideration that applies both to PEP and to PrEP is that when antiretroviral drugs are given to people who are HIV-negative, the level of toxicity that is acceptable is lower than when drugs are used to treat a life-threatening illness.
Many countries do not recommend three-drug regimens, due to their side-effects and cost. Many countries use two NRTIs except in very high-risk exposures or when there is evidence that the transmitted virus could be drug-resistant.
A poster at the 13th Conference on Retroviruses and Opportunistic Infections (CROI) in 20061 discussed the tolerability of PEP regimens given at nine hospitals in France. The regimens compared were:
  • AZT/3TC (Combivir) plus nelfinavir (Viracept)
  • Combivir plus lopinavir/ritonavir (Kaletra)
  • Combivir plus tenofovir
  • Tenofovir/3TC plus atazanavir (Reyataz)/ritonavir (Norvir).
The regimen containing nelfinavir was significantly less well tolerated, with 34.5% of patients discontinuing a 28-day course of PEP due to side-effects, compared with an average of 20% on the other regimens.
Commentators at the poster session said they had found AZT-free regimens were better tolerated; questioned the usefulness of Kaletra due to its poor genital penetration; and aired the ever-controversial topic (in PEP terms) of whether to provide two or three drugs.
When in 2005 an HIV clinic in Boston2 switched the PEP combination it prescribed from Combivir to Truvada they found lower rates of side-effects.
A survey of occupational antiretroviral PEP among health workers in Canada3 uncovered a major hidden cost. Time off work due to side-effects of the drugs cost the health service as much as providing the drugs for the treatment. This time off work appears to have doubled, from an average of 7.0 days to 15.8 days in the year 2000, when the protease inhibitor nelfinavir was added to the regimen (previously d4T plus 3TC).
Since guidelines have changed the recommended PEP regimens, however, side-effects have become much less burdensome. One study presented at the 2010 BHIVA/BASHH conference4 showed that following a change in the recommended PEP regimen to tenofovir/FTC/boosted lopinavir (Truvada/Kaletra), drug side-effects and interactions have become rare. In this study 140 patients took Truvada/Kaletra and there was only one patient, a heavy drinker, whose PEP had to be changed (by stopping his Kaletra in the fourth week) because he had a significant rise in enzymes indicating liver damage. Nine other patients had mild disturbances in liver and kidney function but these resolved themselves. No patient who had abnormal liver or kidney function tests at baseline developed PEP-specific toxicity.
The researchers suggested that it may therefore be unnecessary to bring in most patients for monitoring of drug levels and liver and kidney function during their four weeks on PEP unless they have significantly abnormal baseline tests or the potential for drug interactions.
Another French study5 was based on 249 participants who took PEP between November 2006 and June 2008 in 10 French hospitals, mostly (82%) after sexual exposure. Tolerability could be evaluated in 188 cases. In 22 cases, PEP was discontinued for adverse effects before day 28, including two cases of skin rash related to tenofovir and one case of kidney stones ascribed to lopinavir. Two-thirds (166) of participants completed the 28 days of PEP with tolerability judged as good in 96 (58%) individuals. Among everyone who experienced at least one side-effect, 78% reported diarrhoea, 78% weakness, and 59% nausea and/or vomiting.
Compared to previous studies, the drop-out rate due to side-effects appeared to be significantly lower in people taking Truvada/Kaletra tablets than in people taking either AZT/3TC/nelfinavir, AZT/3TC/Kaletra soft-gel capsules, or tenofovir/3TC/atazanavir/ritonavir.

References

  1. Rabaud C et al. Post-exposure prophylaxis of HIV infection: comparison of tolerability of 4 PEP regimens. Thirteenth Conference on Retroviruses and Opportunistic Infections, Denver, abstract 905, 2006
  2. Mayer K et al. Tenofovir-based regimens for Non-Occupational Post-Exposure Prophylaxis (NPEP): improved tolerability and adherence compared to AZT-based regimens. Sixteenth international AIDS conference, Toronto, abstract TUPE0432, 2006
  3. McLeod A et al. Absenteeism adds significant cost to HIV needlestick prophylaxis. Fourteenth International AIDS Conference, Barcelona, abstract TuPeE5167, 2002
  4. Kober C et al. Routine monitoring of bloods for toxicity when using modern post-exposure prophylaxis (PEP) regimens may be unnecessary. Second BHIVA/BASHH Joint Conference, Manchester, abstract P98, 2010
  5. Tosini W et al. Tolerability of HIV postexposure prophylaxis with tenofovir/emtricitabine and lopinavir/ritonavir tablet formulation. AIDS 24: early online publication. DOI:10.1097/QAD.0b013e32833dfad1, August 2010
This content was checked for accuracy at the time it was written. It may have been superseded by more recent developments. NAM recommends checking whether this is the most current information when making decisions that may affect your health.

Wednesday, September 23, 2015

Putting a number on it: The risk from an exposure to HIV

Prevention in Focus

Fall 2012 

Putting a number on it: The risk from an exposure to HIV

By James Wilton
Service providers working in HIV prevention are often asked by their patients and clients about the risk of HIV transmission from an exposure to HIV through sex. What do the latest studies tell us about this risk? And how should we interpret and communicate the results?

Challenges in calculating a number

It isn’t easy for researchers to calculate the risk of transmission from an exposure to HIV through sex. To do this effectively, a group of HIV-negative individuals need to be followed over time and their exposures to HIV—both the number of times they are exposed and the types of exposure—need to be tracked.
As you can imagine, accurately tracking the number of times a person is exposed to HIV is very difficult. Researchers ask HIV-negative individuals enrolled in these studies to report how many times they have had sex in a given period of time, what type of sex they had, how often they used condoms and the HIV status of their partner(s). Because a person may have trouble remembering their sexual behaviour or may not want to tell the whole truth, this reporting is often inaccurate.
Furthermore, a person does not always know the HIV status of their partner(s). For this reason, researchers usually enroll HIV-negative individuals who are in stable relationships with an HIV-positive partner (also known as serodiscordant couples). Researchers can then conclude that any unprotected sex reported by a study participant counts as an exposure to HIV.
Several studies have aimed to estimate the average risk of HIV transmission from a specific type of unprotected sex (for example, vaginal/anal/oral; insertive/receptive). Due to the difficulties of calculating this risk, these studies have produced a wide range of numbers. To come up with a more accurate estimate for each type of unprotected sex, some researchers have combined the results of individual studies into what is known as a meta-analysis.

All exposures are not equal

The results of several meta-analyses suggest that some types of sex carry on average a higher risk of HIV transmission than others. Below are estimates from meta-analyses that have combined the results of studies conducted in high-income countries. For types of sex where meta-analysis estimates do not exist, numbers from individual studies are provided.

Anal sex

A meta-analysis exploring the risk of HIV transmission through unprotected anal sex was published in 2010.1 The analysis, based on the results of four studies, estimated the risk through receptive anal sex (receiving the penis into the anus, also known as bottoming) to be 1.4%. (This means that an average of one transmission occurred for every 71 exposures.) This risk was similar regardless of whether the receptive partner was a man or woman.
No meta-analysis estimates currently exist for insertive anal sex (inserting the penis into the anus, also known as topping) but two individual studies were conducted to calculate this risk. The first, published in 1999, calculated the risk to be 0.06% (equivalent to one transmission per 1,667 exposures).2 However, due to the design of the study, this number likely underestimated the risk of HIV transmission. The second study, published in 2010, was better designed and estimated the risk to be 0.11% (or 1 transmission per 909 exposures) for circumcised men and 0.62% (1 transmission per 161 exposures) for uncircumcised men.3

Vaginal sex

A meta-analysis of 10 studies exploring the risk of transmission through vaginal sex was published in 2009.4 It estimated the risk of HIV transmission through receptive vaginal sex (receiving the penis in the vagina) to be 0.08% (equivalent to 1 transmission per 1,250 exposures).
A meta-analysis of three studies exploring the risk from insertive vaginal sex (inserting the penis into the vagina) was estimated to be 0.04% (equivalent to 1 transmission per 2,500 exposures).4

Oral sex

No meta-analysis estimates exist for oral sex (vaginal or penile) because too few good-quality studies have been completed. This is because it is difficult to find people whose only risk of HIV transmission is unprotected oral sex. A review of the studies that are available was published in 2008 and concluded that vaginal and penile oral sex pose a “low but non-zero transmission probability.”5
In the three studies aimed at calculating the risk of HIV transmission from one act of oral sex, no transmissions were observed among three different populations—lesbian serodiscordant couples, heterosexual serodiscordant couples and single gay men—who reported unprotected oral sex as their only risk for HIV transmission. However, these studies enrolled only a small number of people and followed them for only a short period of time, which may explain the lack of HIV transmissions and makes it impossible to conclude that the risk from oral sex is zero.
Risk of HIV transmission from different types of unprotected sex

Number of individual studies
Range of estimates
Meta-analysis estimate
Receptive anal
4
0.4%-3.38%
1.4%
Insertive anal
2
0.06%-0.62%
-
Receptive vaginal
10
0.018%-0.150%
0.08%
Insertive vaginal
3
0.03%-0.09%
0.04%

Interpreting the numbers—what additional information needs to be provided?

Some clients may see these numbers and think their risk of HIV transmission is low. Therefore, caution is needed when interpreting them. If these numbers are provided to clients, they should be accompanied by information that helps shed light on why the risk may be higher than it seems.

Transmission can occur after one exposure.

It is important to emphasize that a person could become infected from having unprotected sex once or a person could have unprotected sex many times and not become infected, regardless of how low or high the risk per exposure is.
A risk of 1% would mean that an average of one infection would occur if 100 HIV-negative people were exposed to HIV through a certain type of sex. It does not mean that a person needs to be exposed 100 times for HIV infection to occur.

These are estimates of average risk in the absence of biological factors that increase risk.

The numbers in the table above are rough estimates. They are averages and do not represent the risk from all exposures to HIV through a certain type of sex.
We know that no two exposures to HIV are exactly the same. Research shows that, in addition to the type of sex that led to the exposure, several factors can increase or decrease the risk that an exposure to HIV leads to infection. These include the presence of sexually transmitted infections (STIs), a high viral load, a man being uncircumcised, a woman menstruating, other bleeding and activities that can cause tearing and inflammation, such as rough sex, longer sex, douching, enemas before anal sex, and tooth brushing, flossing or dental work before oral sex. Each exposure to HIV carries a unique risk of transmission that depends on the type of sex and a combination of biological factors.
The risk of HIV transmission may be much higher than these averages if biological risk factors are present. For example, research shows that STIs and some vaginal conditions, such as bacterial vaginosis, can increase the risk of HIV transmission by up to 8 times.6,7,8 As a result, the risk of an HIV-negative woman becoming infected through unprotected receptive vaginal sex could be closer to 1% (1 transmission per 100 exposures) if she has a vaginal STI. 
We also know that for every 10-fold increase in viral load, the risk of HIV transmission increases by 2 to 3 times.9,10 Research suggests the extremely high viral load during acute HIV infection (the first few weeks after becoming infected with HIV) can increase the risk of HIV transmission by up to 26-fold.11,12 Therefore, unprotected sex with an HIV-positive person who has acute HIV infection could carry a transmission risk of up to 2% (the equivalent of 1 transmission per 50 exposures) for receptive vaginal sex and over 20% (equivalent to 1 transmission per 5 exposures) for receptive anal sex.

The more exposures, the greater the risk.

Although the risk of HIV transmission from a single exposure may seem low to some people, this risk increases over multiple exposures. In other words, a person who is exposed to HIV more often has a greater overall risk of HIV transmission than someone who is exposed less often.
If a woman has unprotected vaginal sex 100 times with a man who is HIV-positive, the cumulative risk is approximately 10% and may be higher if biological risk factors are present.

Differences in risk

Information on how risky certain types of unprotected sex are compared to others may help people make more informed decisions about the type of sex they are having.

Based on the meta-analysis estimates, we can draw several conclusions:
  • Receptive anal sex carries a much higher risk of HIV infection than receptive vaginal sex.
    Research shows that the risk of HIV transmission from receptive anal sex is up to 18 times higher than from receptive vaginal sex.
  • Receptive anal sex is riskier than insertive anal sex.
    Research suggests the risk of HIV transmission from receptive anal sex is 3 to 23 times higher than from insertive anal sex.
  • Receptive vaginal sex is riskier than insertive vaginal sex.
    The risk from receptive vaginal sex is about twice as high as that from insertive vaginal sex.
  • It is unclear exactly how much less risky oral sex is compared to vaginal and anal sex.

Conclusion

Although it’s impossible to provide a client with their exact risk of HIV transmission from an exposure, some studies have managed to estimate an average risk for different types of sex. It's important to provide clients with additional information to help them interpret the findings. Here are some key messages:
  1. These numbers
    • are challenging to calculate and should therefore be considered rough estimates
    • do not represent the risk of transmission from all exposures to HIV
    • represent the average risk of transmission in the absence of biological factors that can increase risk (such as STIs and a high viral load)
    • are most relevant to people in stable monogamous serodiscordant relationships
  1. These numbers may seem low but
    • HIV transmission can occur after a single exposure
    • the risk may be much higher if certain biological risk factors, such as STIs or a high viral load, are present
    • as more exposures to HIV occur, the overall risk of transmission increases
    • most HIV transmissions in Canada occur through unprotected anal and vaginal sex
  1. There are several ways of reducing the risk of HIV transmission from an exposure, such as post-exposure prophylaxis (PEP), using antiretroviral treatment to reduce viral load, circumcision, treatment for STIs and vaginal conditions, or engaging in lower-risk activities.
  1. There is no way to reduce the risk of HIV transmission to zero after an exposure occurs. Taking measures to avoid an exposure in the first place (for example, through the correct use of condoms or other barrier methods, or by ensuring a partner has the same HIV status) can help reduce the overall risk of HIV transmission.
References
  • 1. Baggaley RF, White RG, Boily M-C. HIV transmission risk through anal intercourse: systematic review, meta-analysis and implications for HIV prevention. International Journal of Epidemiology. 2010 Aug;39(4):1048–63.
  • 2. Vittinghoff E, Douglas J, Judson F et al. Per-contact risk of human immunodeficiency virus transmission between male sexual partners. American Journal of Epidemiology. 1999 Aug 1;150(3):306–11.
  • 3. Jin F, Jansson J, Law M et al. Per-contact probability of HIV transmission in homosexual men in Sydney in the era of HAART. AIDS. 2010 Mar 27;24(6):907–13.
  • 4. a. b. Boily M-C, Baggaley RF, Wang L et al. Heterosexual risk of HIV-1 infection per sexual act: systematic review and meta-analysis of observational studies. Lancet Infectious Diseases. 2009 Feb;9(2):118–29.
  • 5. Baggaley RF, White RG, Boily M-C. Systematic review of orogenital HIV-1 transmission probabilities. International Journal of Epidemiology. 2008 Dec;37(6):1255–65.
  • 6. Ward H, Rönn M. Contribution of sexually transmitted infections to the sexual transmission of HIV. Current Opinion in HIV and AIDS. 2010 Jul;5(4):305–10.
  • 7. Atashili J, Poole C, Ndumbe PM et al. Bacterial vaginosis and HIV acquisition: a meta-analysis of published studies. AIDS. 2008 Jul 31;22(12):1493–501.
  • 8. Cohen CR, Lingappa JR, Baeten JM et al. Bacterial vaginosis associated with increased risk of female-to-male HIV-1 transmission: a prospective cohort analysis among African couples. PLoS Medicine. 2012 Jun;9(6):e1001251.
  • 9. Wawer MJ, Gray RH, Sewankambo NK et al. Rates of HIV-1 transmission per coital act, by stage of HIV-1 infection, in Rakai, Uganda. Journal of Infectious Diseases. 2005 May 1;191(9):1403–9.
  • 10. Baeten JM, Kahle E, Lingappa JR et al. Genital HIV-1 RNA predicts risk of heterosexual HIV-1 transmission. Science Translational Medicine. 2011 Apr 6;3(77):77ra29.
  • 11. Wawer MJ, Gray RH, Sewankambo NK et al. Rates of HIV-1 transmission per coital act, by stage of HIV-1 infection, in Rakai, Uganda. Journal of Infectious Diseases. 2005 May 1;191(9):1403–9.
  • 12. Hollingsworth TD, Anderson RM, Fraser C. HIV-1 transmission, by stage of infection. Journal of Infectious Diseases. 2008 Sep 1;198(5):687–93.

About the author(s)

James Wilton is the Project Coordinator of the Biomedical Science of HIV Prevention Project at CATIE. James has an undergraduate degree in Microbiology and Immunology from the University of British Columbia.

Post-Exposure Prophylaxis (PEP)


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Post-Exposure Prophylaxis (PEP)

PEP 1, 2, 3 PEP involves taking anti-HIV drugs as soon as possible after having been exposed. To be effective, PEP must begin within 72 hours of exposure, before the virus has time to rapidly replicate in your body. PEP consists of 2-3 antiretroviral medication taken for 28 days. You can get PEP from your doctor's office, emergency rooms, urgent care clinics, or a local HIV clinic. The medications have serious side effects that can make it difficult to finish the program. PEP is not 100 percent effective, it does guarantee someone exposed to HIV will not become infected with HIV.

Can I prevent HIV After I've Been Exposed?

Yes. Post-exposure prophylaxis (PEP) involves taking anti-HIV medications as soon as possible (within 3 days) after you may have been exposed to HIV to try to reduce the chance of becoming HIV positive. PEP is a month-long course of emergency medication taken to try to keep HIV from making copies of itself and spreading through your body. PEP is used by health care workers who have been exposed to HIV-infected fluids on the job or anyone who may have been exposed through unprotected sex, needle-sharing injection drug use, or sexual assault. If you think you were exposed to HIV, go immediately to a clinic or emergency room and ask for PEP.
PEP must begin within 72 hours of exposure, before the virus has time to make too many copies of itself in your body. PEP consists of 2-3 antiretroviral medications and must be taken for 28 days. Your doctor will determine what treatment is right for you based on how you were exposed to HIV. You will be asked to return for follow-up appointments and additional HIV testing. (Talk to your healthcare provider about the recommended follow-up schedule for you.)
PEP is safe but may cause side effects like nausea in some people. These side effects can be treated and are not life threatening. PEP is not 100% effective; it does not guarantee that someone exposed to HIV will not become infected with HIV.

WHO NEEDS PEP?

PEP is used for anyone who may have been exposed to HIV during a single high-risk event.
Healthcare workers are evaluated for PEP if they are exposed after:
  • Getting cut or stuck with a needle that was used to draw blood from a person who may have HIV infection
  • Getting blood or other body fluids that may have lots of HIV in their eyes or mouth
  • Getting blood or other body fluids that may have lots of HIV on their skin when it is chapped, scraped, or affected by certain rashes
The risk of getting HIV infection in these ways is extremely low—fewer than 1 in 100 for all exposures.
PEP can also be used to treat people who may have been exposed to HIV during a single high-risk event unrelated to work (e.g., during episodes of unprotected sex, needle-sharing injection drug use, or sexual assault).
Keep in mind that PEP should only be used in uncommon situations right after a potential HIV exposure. PEP is not intended for long-term use. It is not a substitute for regular use of other proven HIV prevention methods, such as pre-exposure prophylaxis (PrEP), correct and consistent condom use or use of sterile injection equipment.
Because PEP is not 100% effective, you should continue to use condoms with sex partners while taking PEP and should not share injection equipment with others. This will help avoid spreading the virus to others if you become infected. If you have repeated exposures to HIV, you should consider PrEP.

Where Can I Get PEP?

You can request PEP at many places, including your doctor’s office, emergency rooms, urgent care clinics, or a local HIV clinic. If your provider has questions about PEP, they can contact the CDC-supported Clinical Consultation Center at (888) 448-4911 (the service is available seven days per week from 9 a.m. – 2 a.m. EST). The CCC’s PEP Quick Guide and other resources are available online.

Who Pays for PEP?

Antiretroviral medications are expensive, and many people cannot pay for them out of pocket. If you are a healthcare worker who was exposed to HIV on the job, your workplace health insurance or workers’ compensation will usually pay for oPEP. If you are prescribed nPEP after sexual assault, you may qualify for partial or total reimbursement for medications and clinical care costs through the Office for Victims of Crime funded by the U.S. Department of Justice (see the contact information for each state). If you are prescribed nPEP for another reason, and you cannot get insurance coverage (private, employer-based, Medicaid, or Medicare), your healthcare provider can help you apply for free antiretroviral medications through the patient assistance programs of the drug manufacturers. Online applications can be faxed to the company, or some companies have special phone lines. These can be handled urgently in many cases to avoid delay in getting medicine. Learn more about patient assistance programs and co-pay programs for PEP.

Additional Resources

Last revised: 09/21/2015