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The NHS urgently needs to make PrEP available

preptabs

Two European studies of pre-exposure prophylaxis (PrEP), PROUD1 and IPERGAY2, reported early results in October 2014. Both studies showed that PrEP was so effective at preventing HIV transmission that everyone in these studies has now been offered PrEP. The comparison arms, which respectively offered delayed PrEP or a placebo, have been closed.

In light of this news, together with data on continued high rates of new infections3, the NHS urgently needs to make PrEP available.

Although an NHS England process to evaluate PrEP is underway, any decision to provide PrEP will probably not be implemented until early 2017, which is too long to wait. We are calling for earlier access to PrEP. The NHS must speed up its evaluation process and make PrEP available as soon as possible. Furthermore, we call for interim arrangements to be agreed now for provision of PrEP to those at the highest risk of acquiring HIV.

What is PrEP?

PrEP stands for Pre-Exposure Prophylaxis. It involves a person who doesn’t have HIV taking pills regularly to reduce their risk of HIV infection. Several studies show that PrEP works.

PrEP is currently only available in the UK to people enrolled in the PROUD study,4 but has been available in the US since 2012.

Why do we need PrEP?

There are now over 100,000 people living with HIV in the UK. 5 We need to improve HIV prevention.

Tens of thousands of HIV transmissions have been prevented by condom use.6  However many people do not use condoms all of the time and each year there are thousands of new infections. PrEP has the potential to prevent new infections among some of those at greatest risk of acquiring HIV.

Condom use will remain a core strategy in HIV prevention. PrEP gives people who already find it difficult to consistently use condoms an additional way to protect their health.

Due to the high rate of HIV infections, there is a particular need for the NHS to make PrEP available to gay men. However it should be available to all people who are at high risk of acquiring HIV.

How effective is PrEP?

Research suggests that PrEP is as effective as condoms in preventing HIV transmission, as long as the pills are taken regularly, as directed. Evidence from a large international study suggests that gay men who maintained at least four doses a week had 96% fewer infections.7 8 Preliminary results from separate studies of PrEP in the UK9 and France10 both show that PrEP substantially reduces infections among gay men. Full results are expected early in 2015. PrEP has also proven effective for heterosexual couples in which one partner is HIV positive and not on HIV treatment.11

PrEP does not prevent other sexually transmitted infections or pregnancy. It allows someone to protect their own health, irrespective of whether their partner uses a condom. Because it is taken several hours before sex, it does not rely on decision-making at the time of sex.

Why take HIV treatment to avoid taking HIV treatment?

People living with HIV need to take lifelong treatment. PrEP consists of fewer drugs and people only need to take it during periods when they are at risk of HIV. Many people find that their sexual behaviour changes over time, for example when they begin or end a relationship.

Does PrEP have side-effects?

Any medicine can have side-effects, so taking PrEP is a serious decision. The drugs in PrEP have been used as part of HIV treatment for many years. This has shown that they have a low risk of serious side-effects. Most people taking PrEP don’t report side-effects. Some people have stomach problems, headaches and tiredness during the first month but these usually go away. People taking PrEP have regular check-ups at a clinic.

Does PrEP mean people take more risks?

The full results of the PROUD study will help us understand the impact of PrEP on condom use among gay men in the UK. But other studies of PrEP have consistently reported that being on PrEP did not result in people adopting riskier behaviours. 12 13  14 Instead it gives people who already find it difficult to consistently use condoms a way to protect their health.

                                                        

References

  1. http://www.proud.mrc.ac.uk/PDF/PROUD%20Statement%20161014.pdf
  2. http://www.aidsmap.com/Second-European-PrEP-study-closes-placebo-arm-early-due-to-higheffectiveness/page/2917367/
  3. Public Health England. HIV in the United Kingdom: 2014 Report. London: Public Health England. November 2014.
  4. For more information, http://www.proud.mrc.ac.uk
  5. Public Health England. HIV in the United Kingdom: 2014 London: Public Health England. November 2014.
  6. Phillips AN et al. Increased HIV Incidence in Men Who Have Sex with Men Despite High Levels of ART-Induced Viral Suppression: Analysis of an Extensively Documented Epidemic. PLoS ONE 8(2): e55312. doi:10.1371/journal.pone.0055312.
  7. Grant RM et al. Preexposure Chemoprophylaxis for HIV Prevention in Men Who Have Sex with Men. New England Journal of Medicine 363:2587-2599, 2010.
  8. Anderson PL et al. Emtricitabine-tenofovir concentrations and pre-exposure prophylaxis efficacy in men who have sex with men. Science Translational Medicine 4: 151ra125, 2012.
  9. http://www.proud.mrc.ac.uk/PDF/PROUD%20Statement%20161014.pdf
  10. http://www.aidsmap.com/Second-European-PrEP-study-closes-placebo-arm-early-due-to-higheffectiveness/page/2917367/
  11. Baeten JM et al. Antiretroviral Prophylaxis for HIV Prevention in Heterosexual Men and Women. New England Journal of Medicine 367: 399-410, 2012.
  12. Marcus JL et al. No Evidence of Sexual Risk Compensation in the iPrEx Trial of Daily Oral HIV Preexposure PLoS ONE 8: e81997, 2013.
  13. Mugwanya KK et al. Sexual behaviour of heterosexual men and women receiving antiretroviral pre-exposure prophylaxis for HIV prevention: a longitudinal analysis. Lancet Infectious Diseases 13: 1021–28, 2013. 14 Grant RM et al. Uptake of pre-exposure prophylaxis, sexual practices, and HIV incidence in men and transgender women who have sex with men: a cohort study. Lancet Infectious Diseases 14: 820-829, 2014.

Via NAM

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HIV in the UK: 76% diagnosed, 90% on treatment, 90% undetectable

HIV test

UK achieves two out of three UNAIDS targets, but undiagnosed infection remains a major problem

The UK’s annual epidemiological report, released yesterday, shows that the country already provides HIV treatment to 90% of people attending clinical services and that 90% of those on treatment have an undetectable viral load. But the country has a long way to go in ensuring that people with HIV are aware of their HIV status – only 76% of people living with HIV have been diagnosed. The problem is particularly acute in black African communities, as only 62% of African heterosexual men and 69% of African heterosexual women living with HIV have been diagnosed.

The figures can be compared to the ambitious targets announced by UNAIDS (the Joint United Nations Programme on HIV and AIDS) earlier in the year: for 90% of all people living with HIV to know their status, 90% of those to be on treatment and 90% of those to have an undetectable viral load. If these figures could be achieved by 2020, the global AIDS epidemic would be over by 2030, UNAIDS said.

The UK appears to have achieved two out of three of the targets, but has a significant problem due to the high rates of undiagnosed infection. Overall, 61% of all people living with HIV in the UK have an undetectable viral load. This contrasts with the 73% that would be achieved if all three of UNAIDS’ 90/90/90 targets were accomplished.

New diagnoses, overall prevalence

Public Health England reports that 6000 people were newly diagnosed with HIV in the United Kingdom in 2013. The overall figure is lower than that seen a decade ago, due to fewer diagnoses among heterosexual men and women born in high-prevalence African countries. Among gay men, the number of diagnoses is as high as ever, with 3250 cases reported in 2013. An estimated 30% of the gay men diagnosed in 2013 were recently infected with HIV (within six months of their diagnosis).

There are now almost 110,000 people living with HIV in the country, including 26,000 who don’t know they have it. This can be broken down into risk groups:

  • Gay, bisexual and other men who have sex with men (43,500 people; prevalence of 5.9%).
  • Black African heterosexual women (25,100 people; prevalence of 7.1%).
  • Black African heterosexual men (13,600 people; prevalence of 4.1%).
  • Heterosexual women of other ethnicities (10,300 people; prevalence of 0.06%).
  • Heterosexual men of other ethnicities (10,200 people; prevalence of 0.06%).
  • People who inject drugs (2400 people; prevalence of 0.7%).

High rates of undiagnosed infection, especially in black African communities

Overall, 24% of people living with HIV are unaware that they have it. The rates of undiagnosed infection are lowest among gay men (16%) and people who inject drugs (10%).

In relation to black African people, it’s worth noting that in previous epidemiological reports the description of a person as ‘black African’ primarily depended on whether they were born in an African country. In contrast, the new report focuses on a person’s ethnicity, so that someone born in the UK to Nigerian parents is considered in the ‘African’ category. As a result of this and other methodological changes, some of the figures for undiagnosed infection are not directly comparable to previous years’ – and paint a more worrying picture.

In 2013, 31% of black African heterosexual women and 38% of black African heterosexual men who had HIV were unaware of their infection. Rates of undiagnosed infection were somewhat lower among heterosexual people of other ethnicities: 27% in men and 23% in women.

The report also shows that rates of undiagnosed infection are far worse outside London, compared to the capital. Outside London, 41% and 49% of African men and women were undiagnosed. In London, 10% and 13% were undiagnosed. There is some fuzziness to these estimates: the true values could be up to 10% higher or lower than the figures given here. But a clear geographic difference would still be observed. This could reflect stronger community networks and more accessible health services, including targeted prevention, in the capital.

Another way to consider undiagnosed infection is to look at rates of late diagnosis – people diagnosed with a CD4 cell count below 350 cells/mm3. Rates of late diagnosis were highest among heterosexual men (62%) and heterosexual women (51%), with black Africans especially likely to be diagnosed late. The lowest rate of late diagnosis was seen in gay men (31%). Across all groups, older people and non-Londoners were more likely to be diagnosed late.

But progress has been made over the past decade – the overall rate of late diagnosis has gone down from 57 to 42%.

A higher uptake of HIV testing, including more frequent testing, is needed to improve the figures on undiagnosed infection and late diagnosis. The report shows that, at sexual health clinics, 86% of gay male patients take an HIV test, but only 77% of heterosexual men and 67% of heterosexual women do so. Whereas guidelines recommend that all people attending sexual health clinics are offered an HIV test, only one-in-seven clinics test at least 80% of their heterosexual patients. Public Health England recommends that clinics review their policies and training protocols.

But while PHE has been able to collect data on HIV testing in sexual health clinics, none are available for testing in GP surgeries, in other medical settings, or in community settings. A significant improvement in the proportion of people living with HIV who are diagnosed is thought unlikely to occur without improved provision of testing in non-specialist settings, as recommended in guidelines. The report notes that less than one in five of the black-African population attended a sexual health clinic in the previous five years.

“Reductions in undiagnosed infection can be achieved through increasing testing coverage in STI clinics, the introduction and consolidation of HIV testing in a variety of different medical services, in addition to further development of community testing, including self-sampling,” PHE comment.

Quality of care for people living with HIV

Considering the next stages of the ‘treatment cascade’ and the National Health Service’s performance in relation to UNAIDS’ targets, the report shows that 90% of people were linked to care within a month of their diagnosis (98% within three months). Moreover, 95% of those who received care in 2012 were retained in care in 2013. Results did not vary according to age, gender, ethnicity, sexuality or geographical area.

Further, 90% of people in care received antiretroviral therapy (up from 69% in 2004). This includes 92% of those with a CD4 cell count below 350 cells/mm3. Of all people taking treatment, 90% had an undetectable viral load, below 200 cells/ml.

Generally there was equality in treatment outcomes, although younger people were less likely to be taking therapy. Moreover, people in both the youngest (15-24 years) and the oldest (over 50) age groups were less likely to have an undetectable viral load.

Guidelines recommend that clinicians discuss treatment as prevention with patients, and give them the option to start treatment early for this reason. Probably as a result, average CD4 cell counts when starting treatment have risen in recent years. In 2013, 25% began treatment with a CD4 cell count between 350 and 500 cells/mm3, and a further 26% did so above 500 cells/mm3.

Article via NAM

For your full copy of the report, click here

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Tory warns sex health cash cuts could lead to rise in HIV cases

Tory councillor Roy Webb is concerned about the impact of spending cuts on sexual health services.

Tory councillor Roy Webb is concerned about the impact of spending cuts on sexual health services.

FEARS of an increase in HIV infection rates in Derby if cuts proposed by the city council go ahead have been voiced.

Tory opposition councillor Roy Webb’s comments came after a letter opposing one of the cuts was sent to the authority by us, Leicestershire Aids Support Services.

The authority is proposing to cut £430,000 from the sexual health budget in the 2014-15 financial year.  The mooted cut was included in its recent consultation on how it will find £9 million of savings on top of £20 million already found.

It says the move would involve “ending service contracts for specialist sexual health promotion services,” and renegotiating contracts for “sexually transmitted infections and pregnancy testing”.

The document adds that the council wants to “refocus free oral emergency contraception to under-18s available to pharmacy outlets only”.  The city council was, on Friday, asked for more details but said it was unable to provide them.

But Mark Tittley, cabinet member for adults and health, said that, if the cuts went ahead, the council “would still continue to fulfil our statutory and moral duty to provide open access sexual health services to all within our community who need them, including people affected by HIV/Aids”.

Mr Webb, who is shadow cabinet member for health and adult care, said part of the cuts would hit Derbyshire Positive Support which gives confidential, stigma-free, support to people with HIV, and their families.

He said: “The withdrawal of contract funding for Derbyshire Positive Support may well, if it follows the national trend, increase infection rates as it has in areas where similar services have been decommissioned.”

A letter to the council from Leicestershire AIDS Support Services carries another warning.

It says: “Cuts will increase the likelihood of early death, and ill-health resulting in high levels of need for costly social care support and can be avoided by maintaining effective local services.”

Mr Webb added that, having met with a “public health official”, it was clear that any savings made in the budget were not going to be used to improve services elsewhere but “just used to support the council’s budget position”.

He said: “I think this a dangerous position to take as the on-going health and social care cost of failing to support these services could be much more expensive than keeping them.”

Mr Tittley said: “It is important to note that if these proposals are accepted by the council, we will still continue to fulfil our statutory and moral duty to provide open access sexual health services to all within our community who need them, including people affected by HIV/Aids.”

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Many older people with HIV ‘face age-related stigma’

elderly-kissing

Many older people with HIV say they are stigmatised because of their age, leaving them feeling isolated and afraid, a study suggests.

Researchers at Keele University say HIV is still widely seen as a disease of young people.

They say older women, in particular, fear they will be seen as “undignified” or “sexually irresponsible”.

Many in the study also expressed fears over the uncertain impact of the disease as they moved into old age.

Thirty years on from the discovery of the Aids virus, the public health warnings that followed, including the “tombstone” adverts, still have a powerful resonance for those who saw them.

They helped to shape perceptions of a disease seen then as a death sentence.

Now advances in treatment mean people with HIV can have near-normal life-expectancy.

And that has had a huge impact on the types of patient needing treatment.

‘Lazarus effect’
Dr David Asboe, a consultant in HIV medicine at Chelsea and Westminster hospital, recalls the desperate outlook for patients he looked after 20 years ago – usually young gay men.

“We knew that once patients had an Aids diagnosis that would be uniformly fatal. The average life expectancy was approximately two years,” he says.

“But in the mid-1990s we had effective treatment and suddenly it changed very quickly, there really was this Lazarus effect.”

Today, half the people Dr Asboe sees are aged over 50. Some are in their mid-80s. They include gay men and heterosexual men and women. Some were infected in the UK, some overseas.

A significant proportion, he says, acquired HIV recently. He says there seems to be a myth that as people get older they might somehow be protected. That, he emphasises, is not true.

Dr Asboe, who is also chairman of the British HIV association, has been involved with the HIV and Later Life (Hall) study based at Keele University, which has looked at the social and psychological impact of the virus for people over 50.

This is a growing cohort. According to the Health Protection Agency, in 2011 more than one in five adults accessing HIV care in the UK were over 50. In 2002 it was one in nine.

The researchers used focus groups, surveys and life-history interviews with 76 older people in the London area living with the virus.

Dr Dana Rosenfeld, who led the project, says there was an “immense knowledge gap” in this field. She says it has revealed a sense of anxiety about how they may be perceived.

“A lot of the people to whom we spoke, particularly but not exclusively the women, spoke of their sense that they would be seen as undignified, that having HIV in later life would be read as sexually irresponsible.

“And there was a real sense that particularly in later life HIV status would be read in very stigmatised ways.”

That was a worry for 63-year-old Adrienne Steed from Blackburn, who was diagnosed with HIV 11 years ago, infected by a long-term partner.

He had died two years previously of liver cancer. She did not know he had had HIV so when she started having symptoms it did not occur to her – or to the doctors she saw – that she could be carrying the infection.

“It was a terrible shock to me and something I remember to this day. I had no idea I was HIV-positive. It was the last thing on my mind,” she says.

It took four years until she felt able to tell her son.

“During that time I experienced what it’s like to live as an invisible woman with this big secret that you couldn’t tell anybody.

“It was a horrible time. It’s the stigma. You feel ashamed of yourself even though you’ve got nothing to be ashamed of.

“People don’t realise you can contract it from a loving partner who might not even know that they have it themselves.”

Now she helps others through a blog and local support group, so – as she puts it – they don’t have to live with what can feel like a “dirty secret”.

“Once they’ve spoken to me it normalises it a bit more,” she says.

“They think, ‘Oh she doesn’t look too bad. She’s nearly 64, she’s active, she’s still laughing. There must be some hope there.'”

The Hall study found the experience of ageing with HIV was heavily influenced by community.

Older gay men were more likely to know other people with the virus, and to know more about support organisations.

Black African heterosexual men and women had also lived with the spectre of HIV for years, but were less likely than gay men to disclose their status to others, the study said.

Many white heterosexuals, meanwhile, felt they were a “minority within a minority”, and that their family and friends would be shocked by their HIV status.

Most of those who took part in the survey felt lucky to have survived into later life, but many were troubled by uncertainty over the physical impact of the virus or side-effects of treatment for this – the first generation to age with HIV.

via bbc

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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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