Roundups Sexuality

Sexual Health Roundup: HIV Vaccine May Be a Decade Away and Men May Have to Choose Between Baldness and Erections

Martha Kempner

Scientists now believe an HIV-vaccine that works could be just ten years away; the state of Georgia is adopting a "treatment as prevention" strategy; and the popular anti-baldness medicine, Propecia, has been found to have sexual side effects that last long after men stop taking the drug. 

Scientist Say HIV Vaccine May be a Decade Away

Next week, public health experts from around the world will gather in Washington, D.C. for the International AIDS Society’s annual conference. One of the more exciting things they will learn is that scientists now believe a vaccine for HIV is not only possible but may be less than a decade away. 

The search for a vaccine that could prevent infection began almost as soon as scientists discovered HIV (Human Immunodeficiency Virus) as the cause of the AIDS (Acquired Immune Deficiency Syndrome) but the years since have seen mostly false hopes and set-backs, leading some to wonder whether a vaccine was even possible. In 1984 then-Secretary of Health Margaret Heckler predicted in a press conference that a vaccine for HIV was less than two years away. She was, unfortunately, very mistaken. 

Scientists have found HIV to be a very difficult virus to pinpoint because it is constantly changing and there are so many different strains infecting people in different parts of the world. Dr. Barton Haynes, who will present on the current status of vaccine research at the AIDS conference, says, “The virus is far more crafty than we ever thought.” This may be the reason behind a string of failed vaccine attempts that culminated in 2007 with trials of a vaccine created by Merck which was found actually to increase the risk of acquiring the virus in certain populations. 

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The latest news, however, is more hopeful. Two other vaccines tested, ALVAC and AIDSVAX, were both unsuccessful when tested alone but a 2009 study in Thailand of the two vaccines tested together found that the combination cut HIV infection by 31.2 percent. Though this is not enough for the combination to be considered effective (mathematical modeling says to impact the epidemic, a vaccine must cut infection by at least 50 percent), the science behind the reduction is significant. ALVAC is a weakened canary pox virus used to sneak three HIV genes into the body and AIDSVAX carried an HIV surface protein. Scientist found that “men and women who were vaccinated made antibodies to a specific region of the virus’s outer coat, suggesting this region provides an important vaccine target.”

Another vaccine that scientists are excited about uses weakened versions of a common cold virus and a smallpox virus. This was found to protect monkeys from a virulent strain of HIV. Moreover, “animals that did become infected after repeated exposure also had low levels of virus in their blood.”

Scientists believe that versions of these vaccines will be ready for large-scale efficacy studies in 2016.   

Georgia to Adopt a Treatment as Prevention Plan for HIV

While we wait for these new vaccines to become available, however, public health experts must work on other ways to prevent the spread of HIV which continues to be a problem worldwide (there were 2.7 million new infections in 2010 alone). Officials in the state of Georgia are planning to adopt a “treatment as prevention” strategy which starts HIV-positive individuals on drug therapy as soon as they are infected rather than waiting until the virus weakens their immune system or they experience symptoms which could be many years later. Starting the drugs sooner reduces the amount of the virus in a person’s system which not only keeps them healthier but can also make it less likely that they will transmit the virus to others through sex or other behaviors. Georgia has one of the highest HIV infection rates in the country; according to the state’s director of health protection it regularly ranks between 4th and 6th for new HIV and AIDS infections per year. The state estimates that more than 40,000 Georgians are living with HIV and that there 1,200 new HIV infections and 750 AIDS cases each year.

Though scientists believe this kind of new approach could reduce these numbers, there are obstacles to the strategy and not everyone is on board. Most notably, it’s expensive. Early intervention is touted as saving money in the long-term — by preventing people from getting AIDS-related illnesses that require lengthy hospital stays — but in the short-term it will likely mean an additional 10.4 million dollars in treatment costs per year. The change will mean that more individuals will qualify for HIV drug assistance which is funded by the state and federal governments. Some question whether the state is prepared to meet that increased demand noting that George already has a waiting list of several hundred people for its HIV drug assistance programs. 

Others are worried that getting HIV-positive individuals who feel perfectly healthy to comply with a drug regimen will be challenging. The state estimates that about 55 percent of Georgians who are diagnosed with HIV do not follow-up with regular lab testing to track the infection’s progress (though this estimate is thought by others to be high). Experts suggest that this lack of follow-up may be due to the high cost of treatment and lack of access to care (especially in poor and rural areas) as well as the difficulties of facing a life-altering diagnosis.

Still, experts agree that earlier treatment is important as research has shown that the disease can do damage to major organs such as the liver and heart even before a person feels sick. Moreover, the reason that drug regimens were not started earlier in the past was that health care providers feared the side effects and the toxicity of the drugs that were available. Today’s drugs are gentler on the body which makes it possible for people to start them sooner.  

According to the Atlanta Journal-Constitution, the new Georgia guidelines will not be mandatory, but in the past, guidelines have been widely accepted by infectious disease specialists and HIV physicians.

Men Who Use Propecia Might Have to Choose between Baldness and Impotence

Which would you rather have, an erection and orgasm or a full head of hair? Men who use or are considering using the hair-loss medication Propecia might just have to choose. The medication treats male-pattern baldness by blocking the hormone dihydrotestosterone (DHT) which can cause hair loss on the scalp. However, in many men it also causes sexual side effects that might not go away even after they stop taking the medication.

Propecia — like Viagra — is the result of one of those happy accidents for pharmaceutical companies in which a drug made to treat one issue is found to have another — very profitable — use. It is the twin of the drug Proscar which was developed to treat enlarged prostates. Trials found that one of the “side effects” of the drug was that bald men began to grow hair on their scalp. Unfortunately, other less happy side effects include erectile dysfunction, low libido, trouble having orgasms, and shrinking and painful genitals.

Though once men stop taking the drug their baldness will return, new findings suggest that the same is not true of their sexual functioning. A new study published in the Journal of Sexual Medicine found these side effects may last months to even a year after men stop taking the drug. Researchers surveyed 54 men under age 40 who reported experiencing side effects for three months or more after stopping the medication. In addition to the sexual problems, some men “also reported neurological problems like depression, anxiety and cognitive haziness.” According to the study, for 96 percent of the men, the sexual problems lasted more than a year after they stopped taking the drugs. Moreover, for 89 percent of the men the sexual side effects were severe enough to be considered sexual dysfunction. Researchers note that none of the men had sexual, medical, or psychiatric complaints before taking Propecia.

This adds to a growing body of post-market evidence on sexual dysfunction related to Propecia and Proscar that led the FDA to demand a labeling change earlier this year in order to warn users of these side effects and of the likelihood such side effects could last even after they stopped taking the drug. 

The new research does have its limitation given that only 54 men participated in the study and most were recruited from an internet forum called which was designed for men experiencing sexual side effects from the drug. Despite the inherent bias of the sample, the researchers stand by their results. One explained:  “Our findings make me suspicious that this drug may have done permanent damage to these men.” He went on to argue that even if these lasting side effects are only in a small proportion of men who take the drug, prescriptions for it have been so popular it is likely that they affect several thousand men around the world at least.  

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