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HIV incidence in gay men unchanged in England and Wales, despite more testing

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A paper in The Lancet Infectious Diseases by scientists from the UK’s Medical Research Council and the Health Protection Agency (HPA) has calculated that the number of gay men in England and Wales who become infected with HIV each year remained unchanged between 2001 and 2010. This is despite a considerable increase in testing and, they estimate, a 40% reduction in the proportion of gay men with HIV who are undiagnosed.

The paper concludes that, in England and Wales at least, the proportion of gay men with HIV who are on treatment and with undetectable viral loads is currently too low to bring about a decline in annual HIV incidence in this population. This is in contrast to declines in diagnosis, and claims of declines in incidence, seen in places such as San Francisco, the province of British Columbia in Canada, and some locales in South Africa.

As well as extending HIV testing to non-traditional settings and urging gay men to test more frequently, the authors conclude that “the initiation of treatment on diagnosis, regardless of CD4 count might well be necessary to achieve control of HIV transmission”, and welcome the new BHIVA treatment guidelines’recommendation “that clinicians discuss the benefits of early treatment uptake as a prophylaxis to protect sexual partners” as a step towards this.

Calculating incidence

The paper is a mathematical model. It uses available data on diagnoses, CD4 counts at diagnosis, and the proportion of people on antiretroviral therapy (ART) to make estimates of the true annual number of infections (annual incidence) in gay men, the number undiagnosed, average time gap between infection and diagnosis, the distribution of CD4 counts among diagnosed and undiagnosed men and the proportion who are on treatment and with an undetectable viral load.

Although mathematical models are always estimates, in this case surveillance data from the UK are of good enough quality to make them quite robust, though because by definition fewer very recent infections are diagnosed, incidence estimates for the last two years are less certain than for previous years.

The incidence rate is not the same as the new diagnosis rate in HIV, because of the time lag between infection and diagnosis. If the number or frequency of HIV tests go up, the number of diagnoses will tend to go up, since more long-term undiagnosed infections will be identified. The researchers got round this problem by using CD4 count at diagnosis – available for the majority of diagnosed people in England and Wales – as a surrogate for the time delay between infection and diagnosis, given that CD4 counts in people with untreated HIV tend to decline at an even rate over time.

Results – diagnosed and undiagnosed

The number of diagnoses in gay men in England and Wales increased from about 1800 in 2001 to 2600 in 2010. However by adjusting this for CD4 count at diagnosis, the researchers estimated that the true annual total of HIV infections in gay men had remained virtually unchanged, from 2200 in 2001 to about 2300 in 2010. There was an increase in incidence to about 2700 a year in 2003-4, due to increased rates of sex without condoms in gay men, but this has reduced since.

This reduction is due, the researchers say, to more gay men taking tests and to a shorter period between HIV infection and diagnosis. The number of HIV tests taken by gay men in sexual health clinics has grown nearly fourfold, from 16,000 in 2001 to 59,300 in 2010. As a result, the estimated time between infection and diagnosis has shrunk from four years to 3.2 years during this time, and the proportion of gay men with HIV who are undiagnosed from 37 to 22%.

The reason it has not shrunk more, say the authors, is due to gay men not testing often enough. Last year, study co-author Valerie Delpech of the HPA told the IAPAC Prevention Summit that only an estimated 10 to 15% of gay men took an HIV test every year, and that two-thirds of gay men who had had a test at a clinic had, two years later, not returned to that clinic for another one.

Because there are (as of 2010) 3.2 years’ worth of undiagnosed infections in the population, the total number of gay men with HIV who are undiagnosed in England and Wales was estimated as 7690 in 2010. This was only a small increase from 7370 in 2001 and represents a 16% decline from 9140 in 2004-5, again due to more testing.

The proportion of gay men with HIV who are undiagnosed has gone down by 40% while the number has scarcely changed because total HIV prevalence and the number of UK gay men living with HIV has grown over the same period.

Results – implications for treatment

In 2001, at HIV diagnosis, about 65% of gay men had a CD4 count under 500 cells/mm3, 40% under 350 cells/mm3, and 18% under 200 cells/mm3. Ten years later, the proportion in these three categories had only fallen by about 5%. This means that less than 40% of gay men would currently be advised, under treatment guidelines, to begin taking antiretroviral therapy (ART) for treatment reasons as soon as they are diagnosed.

The researchers calculated that, because more undiagnosed infections are recent ones, only 20% ofundiagnosed gay men had a CD4 count under 350 cells/mm3 and only 45% under 500 cells/mm3. Further decreasing the proportion of gay men with HIV who are undiagnosed, and raising or abolishing the CD4 threshold for treatment initiation, would therefore have considerable cost implications for the National Health Service in England and Wales.

Conclusions

In many ways, the UK’s response to HIV has been excellent. The proportion of gay men with a CD4 count under 350 cells/mm3 who are on ART has increased from 75% in 2001 to 84% in 2010; 65% of all patients in care, including the untreated, have undetectable viral loads; and annual loss to follow-up of those attending care is under 5%.

In the US, in contrast, it is estimated that there are more gay men who are diagnosed but not taking ART than there are undiagnosed, and that only 28% of people with HIV are virally suppressed. But gay men in other countries test more frequently: as an accompanying editorial by Reuben Granich of UNAIDS points out, the 22% of gay men who remain undiagnosed in the UK is not as good as an estimated 14% in Vancouver and only 6% in San Francisco.

Because most of those with detectable viral loads in the UK are undiagnosed, it is estimated by the HPA that up to 50% of HIV infections in gay men here could be being transmitted by men in primary HIV infection and another 35% by undiagnosed men with long-term infection. The authors conclude that treatment initiation at diagnosis, earlier, more targeted testing, and better primary HIV prevention all need to be part of any national HIV prevention plan for England and Wales.

References

Birrell PJ et al. HIV incidence in men who have sex with men in England and Wales 2001-2010: a nationwide population study. The Lancet Infectious Diseases, early online edition:http://dx.doi.org/10.1016/S1473-3099(12)70341-9. See abstract here. 2013.

Granich R HIV in MSM in England and Wales: back to the drawing board? The Lancet, early online edition: http://dx.doi.org/10.1016/S1473-3099(13)70035-5. See first few lines here. 2013.

Original Article by Gus Cairns at aidsmap

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The Need for A HIV Strategy

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By the end of 2012 it is estimated that there will be 100,000 people living with
HIV in the UK.  HIV diagnoses remain stubbornly high.  The two communities most affected are gay and bisexual men and African men and women.

Approximately one in twenty gay and bisexual men and one in twenty African men and women in the UK are living with HIV. In 2010, 3,000 gay and bisexual men were newly diagnosed with HIV; this is the highest number of gay and bisexual men newly diagnosed with HIV ever reported in a single year.

In the same year, half of all people diagnosed were diagnosed late; people diagnosed late have a ten-fold increased risk of death within one year of HIV
diagnosis compared to those diagnosed promptly. And still nearly a quarter of people living with HIV in the UK are unaware of their status. This is of real
concern given that the majority of transmissions come from people who are themselves unaware that they have HIV.

Advances in treatment have seen enormous improvements in quality of life and life expectancy for people living with HIV. In 2010, 85% of people on treatment had an undetectable viral load within a year of starting medication, a marker of
successful treatment. However, this success in treatment has not been matched by improvements in social support for people living with HIV. Many still  experience stigma and discrimination, live in poverty and cannot access the psychological support they need.

Although HIV remains one of the most serious infectious diseases affecting the UK, public understanding and knowledge of HIV is poor and getting worse. Recent Ipsos MORI research commissioned by NAT revealed that only one in
three adults were able to correctly identify all the ways HIV is and is not transmitted from a list of options, with almost a fifth mentioning one incorrect
method such as spitting or sharing a glass. One in five were unaware that HIV is transmitted through sex without a condom between a man and woman.

The research also showed a link between poor knowledge about HIV and negative and judgemental attitudes towards people living with HIV. There is
clearly still a need to improve awareness among the public, both to prevent the spread of HIV – each new infection costs the UK over a quarter of a million
pounds in direct lifetime medical costs alone – and to prevent misconceptions which fuel stigma and discrimination.

Despite this situation, there is no strategy for HIV in England – the last national strategy for sexual health and HIV came to an end in 2010. Over 90% of people living with HIV in the UK live in England, and yet England is the only country within the UK not to have a strategy.

Would you like to know more? Read the National AIDS Trust HIV Strategy.

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Record numbers of UK gay men test positive for HIV

 

  • Almost half of new cases are gay or bisexual males
  • Up to 10,000 unaware of their infection, says study

The number of gay men being diagnosed with HIV has reached a record high in the UK, according to the Health Protection Agency (HPA).

One in 20 gay men and men who occasionally have sex with men are HIV positive in the UK – and in London, the ratio is as high as one in 12. Part of the reason for the observed rise is increased testing, but, says the HPA, it is also clear that too many men are unaware that they have HIV and are unknowingly infecting others.

“About 8,000 to 10,000 gay men are HIV positive and unaware of their status,” said Dr Valerie Delpech, the HPA’s head of HIV surveillance.

According to the HPA’s annual report, released on Thursday in advance of World Aids Day on Saturday, 3,010 men who have sex with men were newly diagnosed with HIV in 2011 – 47.9% of all new diagnoses in the UK. The numbers have remained high since 2007.

Men who have tested positive and been put on drug treatment, which can keep them healthy and give them a normal lifespan, are unlikely to be infectious. Trials have shown that treatment has a role to play in preventing the spread of the epidemic – the drugs reduce the levels of virus in somebody with HIV to such a low level that they are unlikely to transmit the infection to a sexual partner.

The HPA and organisations for those diagnosed with HIV are all advocating regular testing for anybody at risk. Gay men and other men who have sex with men should take an annual test, they say – and if they have new or casual partners, they should be tested every three months.

Living a long and healthy life with HIV depends on starting treatment early. “People are still starting late: they are infected for three to five years before they are diagnosed,” said Delpech. People who are diagnosed as HIV positive late are at 10 times the risk of dying within a year of discovering they have the infection. They are also more likely to infect people while they remain unaware of their status.

The black African community in Britain also faces a higher risk than average, with 37 out of every 1,000 living with HIV last year. Far more men and women in the black African community are diagnosed late than gay men – 68% and 61% respectively, compared with 35%.

The HPA is recommending safe-sex programmes promoting condom use and annual HIV testing as a priority for this community as well as for men who have sex with men. They want NHS clinicians to take every opportunity to offer testing to those at higher risk.

The total number of people in the UK living with HIV climbs steadily every year because treatment is keeping more people alive. Including both diagnosed and undiagnosed cases, it has now reached 96,000, with a total of 6,280 new diagnoses in 2011.

Nearly half of all new diagnoses were acquired heterosexually. More than half of all new UK infections were acquired while the subject was in Britain, compared with 27% in 2002: the small drop in new infections last year, from 6,400 in 2010 to 6,280 last year, was because of the drop in the number of people who had been infected abroad.

Deborah Jack, chief executive of the National Aids Trust, said: “What is striking about the HPA’s data is how it really shows both our successes and our shortcomings in tackling HIV in the UK. On the one hand, we can hail treatment as a real success story. Treatment is effective, people diagnosed with HIV can access it easily and it is working in keeping the virus under control.

“However, when it comes to increasing the uptake of testing – the gateway to treatment – our services are patchy, inconsistent and ultimately we are still failing to make any significant headway in tackling the high rates of undiagnosed HIV.

“A quarter of people living with HIV are unaware they have the virus. As long as this figure remains high, new infections will continue to occur. We must increase our efforts in encouraging people to test and making sure that the health service is taking advantage of every single avenue in offering an opportunity to test – something that isn’t happening at the moment.”

Sir Nick Partridge, the chief executive of the HIV/Aids charity the Terrence Higgins Trust, spoke up for safe sex and said that testing could add 40 years to a person’s life. “HIV is an entirely preventable condition, yet each year we see thousands more people across the UK receive this life-changing diagnosis,” he said. “While there is still no cure and no vaccine, that doesn’t mean we need to accept its continuing march.”

Original Story via Sarah Boseley, health editor at The Guardian

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HIV Awareness “Drops Off Radar”

Listen to this article instead:


It’s claimed infection rates are still high and many people don’t understand what it’s like living with the illness.

Figures from the Health Protection Agency (HPA) show there were nearly 6,000 confirmed cases in adults across the UK in 2011.

In the last five years nearly 3,500 16 to 24-year-olds have been diagnosed.

Paul Steinberg is a sexual health expert based in Lambeth, south London.

He said: “I think it’s a fair point to say awareness of HIV generally has dropped off the radar for a lot of people in this country.”

Paul believes the medical advances made in treating HIV over the past decade have led to people becoming more complacent and taking more risks.

He also says the increased focus on other, more common, STIs like chlamydia and gonorrhea means young people aren’t as educated as they should be on HIV.

“If someone is diagnosed with chlamydia then we can give them some antibiotics and they will be cured,” he said.

“Although HIV is not a death sentence any more, if someone does get diagnosed it’s a long-term, long-lasting condition.

“It’s not the same as having chlamydia or gonorrhea which can be treated.”

Infection myths

Sarah, which is not her real name, is 25 and was born with HIV.

She agrees there are too many young people who don’t know enough about the virus.

Sarah’s been doing work with the charity Body and Soul, which has launched a campaign called Life In My Shoes to challenge people’s misunderstandings of HIV.

The Department of Health recently announced £8m would be spent on raising awareness of HIV in England over the next three years.

The bulk of that money will be given to The Terrence Higgins Trust, one of the UK’s leading sexual health charities.

Genevieve Edwards from the Trust agreed more work needed to be done.

She said: “There’s a new generation who haven’t had basic training.

“The government is funding us to target our campaigns for those most at risk, which are gay and black and African communities.

“However, it’s true to say much more can be done for the population as a whole and generally young people.”

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Migrants ‘most at risk of TB and HIV’

Almost three-quarters of reported cases of tuberculosis (TB) in 2010 occurred in non-UK born residents, a new report shows.

The Health Protection Agency’s (HPA) second report on migrant health also reveals that almost 60 per cent of newly diagnosed cases of HIV involved people who were born abroad.

And 61 per cent of cases of malaria in the UK involved non-UK born residents who had travelled abroad to visit friends or relatives.

Overall, the report indicates that the greatest burden of reported infectious diseases affect a small proportion of non-UK born residents, who accounted for about 12 per cent of people living in the UK in 2010.

Dr Jane Jones, consultant epidemiologist and head of the HPA’s travel and migrant health section, said: ‘The majority of non-UK born residents do not have infectious diseases but some are at higher risk than UK born residents because of their exposures and their life experiences prior to, during and after migration.’

The expert pointed out that timely identification of people who are at risk and early diagnosis of infection can help to improve outcomes.

She also emphasised: ‘It is important to remember that risk to non-UK born residents does not end on arrival in the UK.’

The HPA recently advised holidaymakers – including those visiting family overseas – to remember to take anti-malaria tablets when going to countries where the disease is prevalent.

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World AIDS Day 2011: LASS In The News – ITV1 Julie’s Real Story and Our Free Rapid HIV Testing Service!

We are pleased publish our local advert to promote HIV testing, in our office location in Leicester Town Centre, on Regent Road.

This advert speaks with 15 languages internationally.  This advert cost marginally and considerably less than the Governments 1987 “Tombstone” Advert.

Our message is clear, it is better to know your own HIV status and you can get a HIV test at LASS, and have the result within a minute!

Our team of volunteers have specialist training to provide a free and confidential test, we also have a fantastic support team to provide after-care and further information if required.  We also have established network links so we can refer to more specialist agencies all around Leicester, Leicestershire and Rutland so you can be sure to get expert advice for your needs.

We also have a support group called LhivE, a group of people from Leicester, Leicestershire & Rutland who are living with HIV.  Living with HIV brings a whole set of its own issues and LhivE demonstrate that people living with HIV can lead fulfilling and safe lives with choices.

We hope you like our new advert and hope that you’ll feel comfortable to contact us if you would like a free and confidential test.

The city of Leicester has the fastest-rising HIV rate in the east Midlands and the sixth-highest in the country.

Meanwhile, in 2009/10, national research demonstrated that community testing was effective in delivering tests to those at risk, preventing late diagnosis and thereby reducing onward transmission. As there was no such community testing service in Leicester, we set about creating one!

It is the training of our volunteers which makes the project unique as a method of engaging with specific African communities which are considered to have a high need.  As well as delivering courses to train volunteers to carry out tests among Zimbabwean and Congolese community groups, we also provide a safe and confidential place for people to receive a test.

Our volunteers have created a 50-second advert promoting the value of knowing your HIV status in 15 languages.

We have delivered more than 400 tests, more than half of which are to the BME communities in the region.  While the first phase of the project involved delivering tests only from our building, funding has ensured  we can use our van to take testing to more venues across Leicester, Leicestershire & Rutland.

We were delighted to be highly commended by the Charity Awards, the UK charity sector’s most prestigious awards scheme earlier this year, after being short-listed in the Healthcare & Medical Research category.   This means we have been judged to be of the best 32 Charities in the whole country. Our sincere thanks go to all our service users, volunteers, staff and people in partner organisations who are the real reason we have achieved such a magnificent accolade. Community based HIV testing and our advertisement for this service were the basis of for our application.

WIDESPREAD TESTING IS URGENTLY NEEDED – Health Protection Agency.

The Health Protection Agency (HPA) predicts that unless more focus is given to HIV prevention and routine testing, more people could become infected.

It is 30 years since the first case of HIV was formally diagnosed, and since then there have been several major breakthroughs in medical treatment resulting in longer life expectancy for those infected by the virus.

But some medical experts now believe because of the success of anti viral drugs in prolonging the lives of carriers, it has led to complacency.

HPA figures show that in the last three decades 115,000 people have been diagnosed with HIV in the UK alone, with 27,000 people having gone on to develop full-blown Aids – and 20,000 of those having since died.

We need a complete and wholesome approach to treating HIV and most importantly help prevent its spread – Dr Rupert Whitaker, a long-standing HIV survivor

But what is worrying the medical profession and campaign pressure groups is that, despite all the medical advances over the last three decades, the number of HIV cases in the UK is expected to rise next year to 100,000 and some of those cases will be people who do not yet realise they have been infected by the virus.

Dr Valerie Delpech, Head of HIV surveillance at the HPA, believes widespread testing is urgently needed to help get new cases diagnosed.

“It is so crucial when treating someone who is HIV positive as quickly as possible. That way their lives can be prolonged considerably,” she said.

“Provided someone is tested within the early stages of infection, so they have only had HIV for a short time, and they receive effective medication followed up by effective therapy, then their life expectancy is very good.

“In fact we can safely say HIV is no longer a life threatening illness but a chronic life long condition which if treated correctly can mean people can live to their normal life expectancy.”

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UK’s battle with HIV goes into reverse, prompting calls for more testing

The HIV 1 virus. The numbers infected with HIV within the UK are on the rise, the Health Protection Agency says. Photograph: Institut Pasteur/AFP/Getty Images

More than 100,000 people in Britain are predicted to be living with HIV by the end of this year, according to an official report that warns that the virus is on the rise again in the UK.

While there is a continuing drop in new cases among people who have acquired HIV abroad, the numbers infected within the UK are on the rise, the Health Protection Agency says in the report on Tuesday. New diagnoses of HIV in men who have sex with men have hit a record high.

New infections of the virus, which eventually causes Aids if not kept in check by drugs, had been falling in the UK but that trend seems to have levelled off, according to the agency’s annual HIV report. At the end of 2010, there were an estimated 91,500 people with HIV in the UK, up from 86,500 the previous year. The figure includes estimates for those who have not had a test and do not know they are infected – thought to be around a quarter of the total.

In 2010, according to the HPA’s data, there were 3,000 new infections among men who have sex with men, 81% of which occurred in the UK. Most of the men were white (83%) and two-thirds (67%) were born in the UK. Some had been HIV-positive for years without knowing, but a third of those who were recently infected were under 35. The figures suggest that one in 20 gay men are living with HIV, the ratio rising to one in 12 in London.

When the epidemic began 30 years ago, people with HIV swiftly became sick, developed Aids and died of infections such as pneumonia that their bodies could not fight off. Today, combinations of antiretroviral drugs keep people alive and healthy and can give them a normal lifespan as long as they stay on the medication. That means the number living with the virus continues to rise.

Of the 91,500 people estimated to have HIV in the UK, just over 40,000 of the total are men who have sex with men. Around 2,300 are injecting drug users. Of the 47,000 infected through heterosexual sex, around 19,300 were African-born women and 9,900 African-born men. The prevalence rate in the black African community is one in 32 among men and one in 15 women.

Half of those who are diagnosed with HIV have gone to a doctor years after infection, at the point when they have fallen ill. Those people have a much worse prognosis: they are 10 times more likely to die within a year of diagnosis than people who were diagnosed earlier.

In 2010, 680 HIV-positive people died, 510 of them men. Two-thirds were people who had been diagnosed late. Most died within a year of being tested.

People who have not been diagnosed risk infecting others. The HPA says that there is a need to introduce routine HIV tests around the country beyond the traditional confines of sexually transmitted infection and antenatal clinics.

There have been pilot projects in the last two years in London, Brighton, Leicester and Sheffield. Testing was successfully introduced in two general practices, the acute care units of three hospitals and two community settings without opposition from staff or patients.

Greater efforts to test people and prevent infection would save the NHS money, because treating people is expensive, the HPA says. Because HIV has become a chronic, manageable condition instead of a fatal illness, the costs of providing specialist treatment and care are substantial and accelerating.

“It is difficult to calculate the true expenditure on HIV in the UK. However, of the £1.9bn spent by the Department of Health on infectious diseases in England in 2009-10, an estimated 40% was allocated to the treatment of HIV and Aids. This total does not include the costs of psychosocial care or HIV testing, so in fact the total amount spent on HIV treatment is much higher,” the report says.

The amount spent on prevention, the HPA adds, was £2.9m, just 1% of the overall HIV budget in 2010. The report says: “Investing in prevention should be a priority because of its potential for cost savings. We estimate that each infection prevented would save between £280,000 and £360,000 in lifetime treatment costs.

“If the 3,640 UK-acquired HIV diagnoses made in 2010 had been prevented, between £1bn and £1.3bn lifetime treatment and clinical care costs would have been saved.”

Original Article by Sarah Boseley at The Guardian

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New HIV Diagnoses – UK National Overview 2001 – 2010

Data released last month by the Health Protection Agency shows that almost 70,000 persons were accessing HIV-related care at the end of 2010, an increase of 4,100 (6%) compared to 2009. An estimated 90% were being treated as indicated under the current national guidelines.

Men who have sex with men remain the group most at risk of becoming infected with HIV, with 3,000 new diagnoses made in 2010 – the largest ever annual number of new HIV diagnoses in this group since the HIV epidemic began.

Dr Valerie Delpech, head of HIV at the Health Protection Agency, said:

“Despite progress in delivering treatment, preventing transmission is critical to reducing HIV costs to the NHS, which were an estimated £484 million in 2010 – an increase of £49 million from the previous year.

“The best way to prevent all sexually transmitted infections, including HIV, is to practise safe sex. This means using a condom with all new sexual partners until you have both been tested and given the all-clear.”

The national HIV and AIDS new diagnoses and deaths database held at the Health Protection Agency collects demographic and epidemiological information on adults (aged 15 years and older) who are newly diagnosed with HIV within England, Wales and Northern Ireland. Further demographic and epidemiological information on new diagnoses in Scotland are collected from Health Protection Scotland and for paediatric cases from the Institute of Child Health. On a six monthly basis, this information is collated to produce the number of individuals newly diagnosed with HIV in the United Kingdom, providing an understanding of the current epidemic and at risk groups.

You can download the new HIV diagnoses national tables from here.

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People Get HIV Through Unprotected Sex, Not Because They’re Going For Fish Pedicures!

The Health Protection Agency have said today that there is a risk of catching infections like HIV and Hepatitis from fish pedicure spa’s that are popping up everywhere.

An agency spokesman said: “We have issued this guidance because there are a growing number of these spas.  When the correct hygiene procedures are followed, the risk of infection is very low”.

“However, there is still a risk of transmission of a number of infections — this does include viruses like HIV and hepatitis.”

It’s a fine line to disagree with the Health Protection Agency but LASS are in good company.  HIV expert charities like Terrence Higgins Trust and the National AIDS Trust also say the likelihood of catching HIV in this manner is “almost impossible”.

It doesn’t help when the media sensationalise stories like this and take them out of context, reporting headlines such as “Fears fish foot spa pedicures could spread HIV and hepatitis C

Deborah Jack, chief executive of NAT, has accused the HPA of “misleading” people .

She said: “There is no risk of HIV being passed on through a fish pedicure and these claims do nothing but undermine public understanding.  At a time when knowledge of HIV is declining, it is crucial for the public to be aware of the facts so they can protect themselves from real transmission risk – and not get preoccupied with sensationalist and inaccurate reports.  We are concerned the HPA’s guidance has been misleading in terms of HIV risk and we urge them to clarify their position on this as soon as possible”.

“People are contracting HIV because they aren’t using condoms, not because they’re going for fish pedicures!”

Lisa Power, policy director at THT, said: “The risk of HIV being transmitted through a fish pedicure is so small as to be almost impossible. HIV is a fragile virus once it is outside the body; it cannot be passed on via animal or insect bites.

“For transmission to occur, two successive clients would need open wounds on their feet and there would have to be huge amounts of infected blood in the water. The reality is, in this country, too many people are contracting HIV because they aren’t using condoms, not because they’re going for fish pedicures.”

The National AIDS Trust have issued their own press release on the subject and a key point being made is the HPA’s report examines the available evidence and scientific plausibility for the transmission of blood borne viruses from person to person, via the water in the fish tank.  The HPA’s own report (which you can download from here) says “there is theoretical potential for transmission to occur” not “Pedicures could spread HIV”

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How Good is Sex Education in Schools?

A new report says that young people find their sex and relationship education lacking.  So what can be done to improve it?

A school nurse giving sex education advice to year 10 students at a school in Devon Photograph: Marc Hill / Alamy/Alamy

There was definitely a sense, says 19-year-old Andre Anderson, that the sex education teachers at his secondary school “viewed us as ‘just kids’ and thought ‘they shouldn’t be doing it, so they don’t need to know’. They tell you how a baby is made, but there were loads of teenage pregnancies around so we knew that. The media teaches you a lot about sex, but it’s like education tries to hide it from you.”

With experiences like this, it’s hardly surprising that a new study commissioned by Brook, the sexual advice service for young people, found nearly half of secondary-school pupils find their sex and relationship education (SRE) lacking, while just 6% of young people said they got the information about relationships they need from SRE lessons.

Shockingly, the study of more than 2,000 14- to 18-year-olds revealed that worrying myths still prevailed: 59% have heard that a woman can’t get pregnant if the man doesn’t ejaculate inside her, 33% have heard that you can’t get pregnant the first time you have sex and a quarter of young people have heard you can only catch HIV if you are gay. Meanwhile, one in four pupils get no SRE in school, and a quarter of those who do say they don’t think it is taught well.

Simon Blake, national director of Brook, isn’t surprised. “We are told by the young people who access our services it is too little, too late, too biological,” he says. “And what they really want is emotions, real life dilemmas and much more about relationships.”

Is it a peculiarly British affliction to be so inept when it comes to talking about sex? “We certainly do have a British approach to young people and this topic unfortunately does still get politicised, rather than it just being another area of learning.”

You only have to look at the controversy whipped up by groups such as the Christian Institute, whose recent report Too Much, Too Young complained that children were being shown “explicit” images in primary school sex education, or the Conservative MP Nadine Dorries’ recent bill to teach abstinence in schools – but only for girls – to see what a battleground SRE can become. And in the meantime, say organisations such as Brook, sex education is patchy and young people rely on their friends for information (while frighteningly, the study shows, 5% — around the same level who learn most from asking their parents – of it comes from internet porn).

Brook’s research follows a study published, last month, which found a rise, over the last two years, in the number of 16- to 19-year-olds having unprotected sex with a new partner. In that survey, 19% of young women, and 16% of young men, said they had not received any kind of sex education in school. And last year, the Health Protection Agency reported record levels of the numbers of STIs, with two thirds of the cases in young women.

It is compulsory for schools to teach the biology of reproduction, but not sex and relationships education, although government guidance is that they should as part of personal, social and health education (PHSE). “There isn’t enough curriculum time, and because it is not compulsory, sex education classes are largely left to chance,” says Blake. “We hear all the time that teachers would like to teach it better but they don’t have the training and support to do so.”

He thinks it is ridiculous that there is any controversy about sex education in primary school. “[Those lessons] are not about teaching them about sex, it’s teaching them about body parts, relationships, teaching them about being a boy or a girl, how to be nice to each other. It is shocking that there are girls starting their periods without anybody explaining it to them.”

To counteract this, Brook is launching a campaign to encourage teenagers to have their say about SRE teaching, and will present the findings to the Department of Education, which is conducting a review of PSHE, due to be published later this year.

Sophie Wilson, 17, remembers a couple of SRE lessons in primary school, then a couple during her first years in secondary school. “Those were mostly about different STIs and condoms, but there wasn’t a lot about what to do if you got an STI. There was nothing about different relationships like same-sex.” It wasn’t until she was 17 that there was a lesson on how to get tested for an STI. It would be useful, she says, if lessons could cover wider issues, such as rape or abusive relationships too.

Wilson says her SRE didn’t prepare her for adulthood. Most of the information about sex she has got comes from “my friends, from general things that have happened to them. The Sex Education show [on Channel 4] was good because it was quite direct. I guess it’s just stuff I’ve heard around.” The danger of that, she acknowledges, is you don’t know how reliable it is. “The other danger is people might think they should just get [sex] over with and see what happens and learn from experience.”

For more information see brook.org.uk

Original Article by Emine Saner at The Guardian

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