Fiscal Impact of EU Migrants in Austria, Germany, the Netherlands and the UK

This study was undertaken to estimate some aspects of the net fiscal impact of EU migrants in four EU countries Austria, Germany, the Netherlands and the United Kingdom. The report outlines the role of Fiscal Impact of EU Migrants in Selected Countries migrants from EU countries as participants in the labour market, as taxpayers and as benefit recipients also. The fiscal contribution of EU foreigners has increased substantially in the past several years. Compared to 2009, inn 2013 EU migrants paid 31% more in direct taxes as their wages increased and more EU workers found employment opportunities in Austria, Germany, the Netherlands, and the UK. As migration accelerated, EU foreigners also paid 44% more on indirect taxes, as they spent more onconsumer purchases. EU foreigners in Austria, Germany, the Netherlands and the UK received 35% more benefits than they did in 2009, due to the overall expansion of the welfare state in addition to the inflow of EU migrants

Highlights from the 9th IAS conference on HIV science, 23-26 July 2017, Paris, France

The 9th International AIDS Society Conference on HIV Science (IAS 2017) took place at the Palais des Congrès, in Paris, France, from 23 to 26 July 2017, chaired by Linda-Gail Bekker and Jean-François Delfraissy. It was organised by the International AIDS Society (IAS) in partnership with ANRS (the French national agency for research on AIDS and viral hepatitis), bringing together more than 6000 leading scientists, researchers and HIV professionals from around the world. The Conference featured more than 1800 abstracts selected for oral and poster presentations out of over 4300 submissions, in addition to plenary sessions and satellite symposia. Prevention was high on the agenda of this year's Conference. Data relevant to children, adolescents and adults with HIV on recent advances in the understanding of viral–host interactions, targeting of the HIV reservoir, new oral and long-acting antiretroviral drugs, strategies for simplification of treatment regimens, immune-based therapies, pre-exposure prophylaxis (PrEP) to HIV, prevention of mother-to-child transmission, prophylactic and therapeutic vaccines, as well as comorbidities including hepatitis, were presented with an emphasis on translating science into practice and policies

Having children outside a heterosexual relationship: options for persons living with HIV

The file attached to this record is the author's final peer reviewed version. The Publisher's final version can be found by following the DOI link.This article presents information about the social, legal and medical issues that medical and non-medical practitioners in the UK should consider in order to signpost options for people living with HIV (PLWH) who are not in a heterosexual relationship and want to become parents. Despite significant medical advances, increased medical awareness amongst HIV practitioners, and the ability to live a full life with HIV, stigma still exists around PLWH wanting to have children. There is a lack of awareness amongst the general public and the non-specialist medical community, about the realities of living with HIV, and the options available to become a parent. Vertical transmission rates in the UK are very low (<0.5%) [1]. Despite this, even amongst PLWH it is evident that stigma surrounding parenting with HIV is real, with almost 50% of HIV-positive respondents in a European study saying that having HIV would be a barrier to them deciding to have a family [2]. Irrespective of their sexual orientation, HIV-positive parents and prospective parents may bear not only the brunt of an historical HIV stigma, but also the negative discourses that surround lesbian, gay, bisexual or transgendered/gender diverse (LGBT) parenting, despite the legal advances over the past decade. First steps to breaking down this stigma are to increase public awareness around the realities of living with HIV, and awareness among PLWH that being a parent is an option for them. In 2016 in London, the UNAIDS 90-90-90 target was achieved for the first time. England came close to meeting that target, with 88% of those living with HIV being diagnosed, 96% of those on HIV treatment and 97% of them having an undetectable viral load [3]. Most PLWH taking antiretroviral medication therefore have undetectable levels of HIV in blood, meaning they cannot transmit HIV via sexual fluids [4]. Despite this, parenting is not always routinely discussed with PLWH. A recent study in London HIV clinics found that very few clinicians spoke with HIV-positive gay men about the possibility of having children [5]. Misconceptions about HIV transmission risk and medico-legal issues concerning reproduction may, thus, be rarely addressed. Education is also key to challenging stigma, and supporting the medical profession to better advise HIV-positive patients is critical, as a medical appointment is often the first opportunity that people who are newly diagnosed have to think about future options

Asked to be a sperm donor: disclosure dilemmas of gay men living with HIV

Previous research has documented the various challenges people living with HIV face as they navigate intimate relationships, including what is often referred to as disclosure. In studies of gay, bisexual and other men who have sex with men, the issue of telling or not telling others about an HIV-positive status has been examined primarily in relation to communication with sexual partners, with few studies focusing on other aspects of intimacy. Drawing on interviews with gay men living with HIV, conducted in four clinics in London, this article explores the narratives of men who have been asked by female friends about the possibility of being a sperm donor. The narratives highlight layers of complexity which have received little attention, not only in research on HIV but also in studies of sperm donation and co-parenting. The article advances dialogue between these two largely separate bodies of work. Our data suggest that reluctance to share an HIV-positive status with others can be an important factor in deciding how to answer the 'sperm donor question'. Examining reproductive relationships of a specific kind - those based on friendships between women and gay men - the article develops the understanding of how secrecy about HIV shapes intimate lives

Discussing parenthood with gay men diagnosed with HIV: a qualitative study of patient and healthcare practitioner perspectives.

BACKGROUND: Research on HIV and reproduction has focused largely on women and heterosexual men. This article examines whether it is relevant to address parenthood in HIV care with gay men and what ways of doing so are most appropriate. METHODS: Qualitative interviews were conducted at four London clinics with 25 men living with HIV, aged 20-45, who did not have children, and 16 HIV clinicians. A thematic analysis identified potential reasons why parenthood was rarely discussed with gay men in HIV care. RESULTS: Two sets of ideas contributed to a lack of conversations about parenthood: clinicians' ideas about what matters to gay men and men's ideas about what it means to be HIV-positive. Both sets of ideas largely excluded having children, with patients and practitioners similarly unlikely to raise the topic of parenthood in the clinic. Contrary to what clinician commonly assumed, many men expressed interest in receiving more information, highlighting the importance of reassuring people upon diagnosis that it is possible to become parents while living with HIV. CONCLUSIONS: Parenting desires and intentions were rarely discussed with men in HIV care. Our findings illuminate the potentially beneficial effects of emphasising that having children is a possibility at diagnosis, regardless of patients' gender or sexuality. Conveying this information seems meaningful, not only to men who want to become parents in the future but also to others, as it appears to alleviate fears about mortality and ill health.British HIV Association Isaac Newton Trust Leverhulme Trust (ECF-2018-146) Wellcome Trust (100606/Z/12/Z

Chronic Obstructive Pulmonary Disease in People with HIV: an Evidence-Based Review

HIV co-infection is a risk factor for the development of COPD. HIV enhances the deleterious effects of exposures such as tobacco smoking, as well as interacting with other drivers of COPD such as pulmonary tuberculosis, air pollution and biomass fuel burning. Recent work demonstrates that HIV also contributes independently to COPD pathogenesis by promoting oxidative stress, chronic inflammation, abnormal innate and adaptive immune responses, microbial dysbiosis, and epigenetic alterations within the lung. Consequently, people with HIV develop COPD younger, more often, and with faster rates of lung function decline compared to seronegative individuals. They may also have distinct patterns of lung function abnormalities compared to other etiotypes of COPD. Understanding the natural and pathogenetic history of HIV-associated COPD is important as its assessment, prevention and treatment are currently extrapolated from the general population. Whilst smoking cessation remains vital, further understanding may help guide unique management strategies for HIV-associated COPD. In this review, we explore its epidemiology and pathophysiology and discuss prevention and treatment approaches in this increasingly common disease

Can HIV‐positive gay men become parents? How men living with HIV and HIV clinicians talk about the possibility of having children

Funder: Isaac Newton TrustFunder: British HIV AssociationAbstract: It is now established that people living with HIV who have an undetectable viral load and adhere to antiretroviral treatment cannot transmit HIV to their sexual partners. Previous research has shown that ‘being undetectable’ changes how HIV‐positive gay men experience their sex lives. But how does it affect gay men’s reproductive behaviours? And what influence does it have on views about parenthood at a time when gay fatherhood has become more socially accepted and publicly visible? Drawing on qualitative interviews with patients and clinicians at four HIV clinics in London, we identify differences in how interviewees talked about the possibility of having children for HIV‐positive men. Both groups, unprompted, frequently referred to sperm washing as a method enabling safe conception. However, whereas clinicians talked about sperm washing as an historical technique, which is no longer necessary, patients spoke of it as a current tool. The men rarely mentioned being undetectable as relevant to parenthood and, when prompted, some said that they did not fully understand the mechanics of HIV transmission. Our findings offer new insights into how biomedical knowledge is incorporated into people’s understandings of living with HIV, raising important questions about how the meanings of being undetectable are communicated

Can HIV‐positive gay men become parents? How men living with HIV and HIV clinicians talk about the possibility of having children

Funder: Isaac Newton TrustFunder: British HIV AssociationAbstract: It is now established that people living with HIV who have an undetectable viral load and adhere to antiretroviral treatment cannot transmit HIV to their sexual partners. Previous research has shown that ‘being undetectable’ changes how HIV‐positive gay men experience their sex lives. But how does it affect gay men’s reproductive behaviours? And what influence does it have on views about parenthood at a time when gay fatherhood has become more socially accepted and publicly visible? Drawing on qualitative interviews with patients and clinicians at four HIV clinics in London, we identify differences in how interviewees talked about the possibility of having children for HIV‐positive men. Both groups, unprompted, frequently referred to sperm washing as a method enabling safe conception. However, whereas clinicians talked about sperm washing as an historical technique, which is no longer necessary, patients spoke of it as a current tool. The men rarely mentioned being undetectable as relevant to parenthood and, when prompted, some said that they did not fully understand the mechanics of HIV transmission. Our findings offer new insights into how biomedical knowledge is incorporated into people’s understandings of living with HIV, raising important questions about how the meanings of being undetectable are communicated

Perspectives of People With HIV on Implementing Long-acting Cabotegravir Plus Rilpivirine in Clinics and Community Settings in the United Kingdom: Results From the Antisexist, Antiracist, Antiageist Implementing Long-acting Novel Antiretrovirals Study

Introduction: The equity-focused Implementing Long-Acting Novel Antiretrovirals study evaluated feasibility, acceptability, appropriateness of delivering on-label 2-monthly cabotegravir and rilpivirine (CAB + RPV) injections for human immunodeficiency virus (HIV)-1 therapy in clinics and community settings. Methods: The study, which mandated inclusive recruitment, was conducted May–December 2022 at 6 UK sites. Injections were delivered in clinic (month [M] 1–6) and in clinic or community setting according to patient choice (M6–12). Surveys were completed at baseline, M4, and M12 using validated measures for feasibility (FIM), acceptability (AIM), and appropriateness (IAM). Primary endpoint: proportion of participants agreeing that the injection and community setting were feasible (FIM ≥4) at M12. Fourteen participants completed interviews at baseline and M12. Results: Community settings offered by sites included: home visits (n = 3), HIV support organizations (n = 2), and community clinic (n = 1). Of 114 participants, 54% were female, 70% racially minoritized, and 40% aged ≥50 years. A total of 27/114 chose to receive injections in community settings. FIM/AIM/IAM scores at M12 were high for the injection (79.0–87.4%) and lower for the community setting (44.2–47.4%) overall. Subgroup analyses indicated differences in scores by gender and ethnicity. Among those who attended the community, FIM/AIM/IAM scores for the community setting at M12 were high (73.1–80.8%). Concerns about stigma, inconvenience, and losing access to trusted clinicians negatively influenced perceptions of receiving injections at community settings, amongst other factors. Conclusions: CAB + RPV injections were considered highly feasible, acceptable, and appropriate; however, few chose community delivery. Those that chose community delivery found it highly acceptable and feasible. Further exploration of CAB + RPV delivery in alternative community sites not offered (eg, primary care, pharmacies) is warranted. ClinicalTrials.gov: NCT0529415

Changes in Inflammatory and Atherogenesis Biomarkers With the 2-Drug Regimen Dolutegravir Plus Lamivudine in Antiretroviral Therapy-Experienced, Virologically Suppressed People With HIV-1: A Systematic Literature Review

Background: The 2-drug regimen dolutegravir plus lamivudine has demonstrated long-term noninferior efficacy vs 3-/4-drug regimens (3/4DRs) in phase 3 trials. This systematic literature review summarizes clinical trial and real-world evidence evaluating impact of dolutegravir plus lamivudine on inflammatory and atherogenesis biomarkers in people with human immunodeficiency virus type 1 (PWH). Methods: Using Ovid MEDLINE, Embase, PubMed, and Cochrane library databases and conference proceedings, we searched for studies published from 1 January 2013 to 14 July 2021, reporting changes in inflammatory and atherogenesis biomarkers with dolutegravir plus lamivudine in antiretroviral therapy-experienced, virologically suppressed PWH aged 6518 years. Results: Four records representing 2 randomized controlled trials (RCTs) and 6 records of real-world evidence met eligibility criteria. All real-world studies evaluated CD4+/CD8+\u2005ratio, while only 1 assessed inflammatory biomarkers. Across both RCTs, no consistent pattern of change in biomarkers was observed between dolutegravir/lamivudine and 3/4DR comparators. There were significant changes in soluble CD14 favoring dolutegravir/lamivudine in TANGO at weeks 48 and 144 and SALSA at week 48, and in interleukin-6 favoring the control group in TANGO at weeks 48 and 144. In the real-world study evaluating inflammatory biomarkers, median soluble CD14 significantly decreased 48 weeks postswitch to dolutegravir plus lamivudine (P\u2005&lt;\u2005.001), while other biomarkers remained stable. In all 6 real-world studies, increases in CD4+/CD8+\u2005ratio were reported after switch to dolutegravir plus lamivudine (follow-up, 12-60 months). Conclusions: Results show that dolutegravir plus lamivudine has a comparable impact on inflammatory and atherogenesis biomarkers vs 3/4DRs, with no consistent pattern of change after switch in virologically suppressed PWH