Monthly Archives: October 2011

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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Antiretroviral Drugs Work – This Is Why You Should Take Them!

In light of yesterday’s news which reported that three people died after they stopped taking antiretroviral medicine on the advice of a religious leader, it’s important to highlight why anti-HIV drugs are significant and how essential it is to take them correctly.

HIV is a virus which attacks the immune system – the body’s defence system against infection and illness. If you have HIV, you can take drugs to reduce the level of HIV in your body. By reducing the amount of HIV in your body, you can slow or prevent damage to your immune system. These drugs are not a cure, but they can help you stay well and extend your life. Anti-HIV drugs are known as antiretroviral drugs.

HIV mainly infects cells in the immune system called CD4 cells. Over many years of HIV infection, the number of CD4 cells drops gradually but continually and the immune system is weakened. If nothing is done to slow or halt this destruction of the immune system, a condition called AIDS (Acquired Immune Deficiency Syndrome) follows, as the immune system is no longer able to fight infections. Antiretroviral drugs work by interrupting this process.

An untreated person with HIV may have thousands or even millions of HIV particles in every millilitre of blood. The aim of treatment is to reduce the amount of HIV to very low levels (this is called an ‘undetectable’ level) – below 50 copies per millilitre of blood, although some HIV treatment centres are now using tests that can measure as low as 40 copies/ml.

To provide you with the best chance of reducing the amount of HIV in your blood to very low levels, your doctor will recommend that you take a powerful combination of at least three antiretroviral drugs. Once your viral load – the amount of HIV in your blood – has dropped, your immune system should begin to recover and your ability to fight infections is likely to improve.

When you start or change a drug combination, a viral load and CD4 count will be done within the first month of treatment. This is to check that the drugs are working. Testing is generally performed every three months, although some doctors may perform tests more often to begin with and less frequently once you are well established on treatment and doing well.

Once you are on HIV treatment, you may have tests to measure liver and kidney function and fat and sugar levels in your blood, to assess the effects of the drugs on the normal workings of your body.

Your HIV care will also involve a number of other routine tests. These will be to monitor your general health and to see if your treatment is causing any side-effects.

It is very important not to miss doses of your anti-HIV drugs and to take them exactly as prescribed. If you miss doses, or you do not take the drugs as you are supposed to, the HIV in your body is more likely to develop resistance to them. This will reduce their long-term effectiveness.

The above information is taken from NAM’s “Anti-HIV Drugs” booklet which you can download from here, (or pick up a copy from LASS, next time you’re in)  Additionally, Uptodate.com has very useful information and tips for taking HIV meds, it’s always a good idea to refresh your knowledge on Adherence.

Having a daily timetable for taking medication and taking all doses exactly as prescribed is the traditional definition of adherence, also known as compliance. This may sound simple, but in the case of highly active antiretroviral treatment (HAART), it is not. The challenge only increases as people who are infected and able to access therapy face life-long treatment and side-effect management.

If some medications are not taken at the correct time interval, the drug level can either be too high (causing unnecessary toxicities or side-effects) or too low (encouraging viral resistance). From a public health standpoint, suboptimal adherence also increases both the risk of transmission and the risk of transmitting drug-resistant virus to others.

Correctly taken, highly active antiretroviral therapy (HAART) maintains a consistent attack on HIV. When drug levels in the body fluctuate, HIV is given the opportunity to reproduce. Ongoing replication permits drug-resistant viral strains to develop and this narrows future treatment options.

Beyond personal benefit, maintaining adherence and viral suppression has a public health benefit. When viral load is low, so is the likelihood of transmission to others.

For more details on adherence or HIV medicines, speak with your doctor and health care professionals.

Philadelphia FIGHT (Field Initiating Group for HIV Trials) is a comprehensive AIDS service organization providing education, advocacy and research on potential treatments and vaccines. FIGHT was formed as a partnership of individuals living with HIV/AIDS and clinicians, who joined together to improve the lives of people living with HIV. They produce educational videos via “The AIDS Library” and serves the community through delivery of information on HIV, such as treatments, nutrition, and history of the pandemic, and referrals to regional and national resources.

The following videos are a 30 minute presentation on How HIV Meds work,

How HIV Meds Work Part 1: HIV Life Cycle

How HIV Meds Work Part 2: Drug Classes

How HIV Meds Work Part 3: Timing

Source material for this article via NAM, BBC News, Uptodate.com, Avert.com, Bupa and Philadelphia FIGHT

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Pill Box Organisers Increase HIV Patients’ Adherence & Improve Viral Suppression

Inexpensive pill box organisers are an easy, successful, and cost-effective tool to help patients take their medications as prescribed, according to a study of low-income urban residents living with HIV infection.

“Clinicians and pharmacists can meaningfully improve treatment outcomes with simple and inexpensive strategies, such as pill box organisers, to help people organize how they take medication,” said senior author David Bangsberg, MD, MPH, of UCSF.

Incomplete adherence to HIV therapy is the most common cause of incomplete viral suppression, drug resistance, disease progression, and death among people living with HIV/AIDS. The subjects of this study, who were recruited from homeless shelters, free food programs, and single-room occupancy hotels, are thought to be at elevated risk for poor adherence partly because of the high rates of substance abuse, untreated mental illness, and unstable housing.

Patients in this difficult-to-treat population were given inexpensive pill box organisers to use with their antiretroviral medications. Study organisers made a total of 3,170 unannounced visits every three to six weeks to the subjects’ places of residence and compared the number of pills remaining in the patients’ possession with the number that would be expected to remain if the patients were perfectly compliant with the treatment regimen.

Pill box organisers were associated with a 4 percent improvement in adherence, 0.12 log reduction in HIV viral load, and an estimated 11 percent reduction in the risk of progression to clinical AIDS. As pill boxes are low cost, this intervention was highly cost-effective.

“While this population has often been regarded as having difficulty with adherence,” the authors write, “adherence problems are by no means limited to patients with low socioeconomic status.” Lead author Maya Petersen, PhD, from the Berkeley School of Public Health, adds, “Incomplete adherence is a major problem that prevents people from realizing the full benefits of a wide range of treatments for chronic diseases, such as hypertension and diabetes mellitus. Thus, the findings of this study have the potential to inform a wide range of diseases, not just HIV.

“It would be interesting to explore whether changes in packaging or delivery of antiretrovirals and other drugs could be used to reproduce the benefits of pill box organiser use. One model to consider is oral contraceptive therapy, which is routinely dispensed using labeled blister packs, a kind of pre-packaged version of a pill box. Antiretroviral regimens are generally more complicated, but a modification of this general model at either a pharmacy or manufacturer level might be possible, with wide-ranging patient benefits.”

Original Article adapted by ScienceDaily from materials provided by Infectious Diseases Society of America,

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Blind Faith: HIV Prayer Cure Claims Three Deaths

At least three people in London with HIV have died after they stopped taking life saving drugs on the advice of their Evangelical Christian pastors.

The women died after attending churches in London where they were encouraged to stop taking the antiretroviral drugs in the belief that God would heal them, their friends and a leading HIV doctor said.

Responding to the BBC London investigation, Lord Fowler, the former health minister responsible for the famous Aids awareness campaign of the 1980s, condemned the practice.

“It’s just wrong, bad advice that should be confronted,” said the Tory peer, who chaired last month’s House of Lords committee into HIV.

Jane Iwu, 48, from Newham, east London, described one case, saying: “I know of a friend who had been to a pastor. She told her to stop taking her medication – that God is a healer and has healed her.”

“This lady believed it. She stopped taking her medication. She passed away,” said Ms Iwu, who has HIV herself.  Meanwhile, the director of a leading HIV research centre in east London said she had dealt with a separate case in which a person with HIV died as a result of advice from a pastor.

“I’ve only seen that once, but it has happened,” said Prof Jane Anderson, director of the Centre for the Study of Sexual Health and HIV, in Hackney.

“We see patients quite often who will come having expressed the belief that if they pray frequently enough, their HIV will somehow be cured,” she added.  “We have seen people who choose not to take the tablets at all so sometimes die.”

Lord Fowler condemned pastors giving this advice, saying: “It’s dangerous to the public and dangerous in terms of public health.”   “It’s irresponsible,” he said, suggesting pastors should instead “come off the air on it, look at things much more seriously, and not give this completely wrong advice to the public”.

HIV prevention charity African Health Policy Network (AHPN) says a growing number of London churches have been telling people the power of prayer will “cure” their infections.

“This is happening through a number of churches. We’re hearing about more cases of this,” AHPN chief Francis Kaikumba said.

AHPN said it believed the Synagogue Church Of All Nations (SCOAN), which has UK headquarters in Southwark, south London, may be involved in such practices.

The church is headed by Pastor T B Joshua, Nigeria’s third richest clergyman, according to a recent Forbes richlist.

The church’s website, which was set up in Lagos, Nigeria, shows photos of people the church claims have been “cured” of HIV through prayer.

In one example, the church’s website claims: “Mrs Badmus proudly displays her two different medical records confirming she is 100% free from HIV-Aids following the prayer of Pastor T B Joshua.”

“HIV-Aids healing” is listed on the church’s website among “miracles” it says it can perform.

“Cancer healing” and “baby miracles” are also advertised.

The church’s UK website promotes a monthly “prayer line” for which it says: “If you are having a medical condition, it is important you bring a medical report for record and testimony purposes.”

It has posted videos on the internet showing its services in south London, in which participants who claim to have arthritis, asthma and schizophrenia say they have been healed after being sprayed with “anointing water” provided by the church.

Mary Buhari, 44 , from central London, told the BBC she had had a phone conversation with a representative of the church, in which she was told she could be cured of HIV.

“I was told they can cure any illness on Earth through prayer, including HIV,” she said.

However, when asked by BBC London if it claimed its pastors can cure HIV, SCOAN responded: “We are not the healer. God is the healer. Never a sickness God cannot heal. Never a disease God cannot cure.

“We don’t ask people to stop taking medication,” the church added. “Doctors treat; God heals.”

The recent House of Lords committee report into HIV awareness said faith groups’ approaches to supporting people with HIV had improved but more needed to be done.

“It is essential that faith leaders engage with HIV as an issue and provide effective and truthful support and communication around the subject,” it said.

A Department of Health spokesman responded to the report saying: “Over 60 recommendations were made and we will be responding to Parliament in the next few months.”

Jane Iwu and Mary Buhari had their identities changed in this article, at their request.

Original Article by By Andy Dangerfield at BBC News

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New MSM Panel report from Sigma Research

This month Sigma Research have undertaken the ninth monthly survey in the Sigma Panel of gay men, bisexual men and other men that have sex with men (MSM) in England and released the fifth Insight BLAST – their fast feedback mechanism to get essential planning data into the public domain.

Insight Blasts have a short turnaround for analysis and output to health
promoters developing and delivering sexual health interventions with, or for
men who have sex with men. The fifth Insight Blast is about “STI screening before your next sexual partner”. It describes how recently MSM have had an asymptomatic STI screen, why they had their last STI screen, and the perceived costs and benefits of screening for STIs when you have no symptoms. The data was collected as part of the eighth Sigma Panel questionnaire in August 2011.

This new Insight Blast and the first four – addressing “HIV testing”: “The
next sexual partner”; “Alternatives to unprotected anal intercourse”; and
“Notifying former sex partners about STI diagnoses” – are all available via
their homepage or at http://www.sigmapanel.org.uk

At http://www.sigmaresearch.org.uk you will also find a
link to the second EMIS Community Report.

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Testing people with conditions suggesting HIV could pick up more recent infections, Europe-wide study finds

A pilot study in 14 European countries, in which groups of patients presenting with one of eight conditions strongly associated with HIV were routinely tested for HIV in various medical settings, found an HIV prevalence rate of 1.8%. This is far in excess of national rates and of the 0.1% prevalence rate suggested by the US Centres for Disease Control for routine HIV testing of the population, and suggests targeting people with these so-called indicator conditions (ICs) for HIV testing could be an efficient way of detecting infection.

The study found relatively high CD4 counts and a high prevalence in patients presenting with mononucleosis-like illness. These symptoms are usually caused by Epstein-Barr virus but may also be due to HIV seroconversion. This suggests that testing for indicator conditions might be a good way of detecting more people in early HIV infection.

The HIDES I study arose from the HIV in Europe conference in 2007, which debated how to improve HIV testing rates and reduce the amount of undiagnosed HIV in the region.

One method suggested was to draw up a list of indicator conditions (ICs) associated with HIV probability of HIV infection and recommend that people presenting of these should be routinely tested.

HIDES I drew up a shortlist of eight ICs and sent out a call to healthcare centres in Europe to participate in the study to test the feasibility and acceptability of routine IC-driven HIV testing.. This would involve them routinely test all patients consecutively presenting with a specific IC.

The eight conditions chosen were:

  • Acute STIs
  • Hepatitis B or C
  • Malignant lymphoma of any type
  • Anal or cervical intraepithelial neoplasia (HPV disease) grade 2 or above
  • Unexplained low platelets (thrombocytopenia) or neutrophils (neutropenia) for more than four weeks
  • Herpes zoster (shingles) in people under 65
  • Seborrhoeic dermatitis or exanthema (sudden rash)
  • Mononucleosis-like illness.

Results: demographics

Seventeen centres in 14 European countries spread over the whole continent from UK to Ukraine participated in HIDES I. They conducted 39 separate surveys on HIV testing in patients presenting with ICs between September 2009 and February 2011. There were one to six surveys conducted in each centre and between three to six surveys conducted for each indicator condition.

Altogether, 3588 patients were tested for HIV. They had an average age of 36, which varied according to condition from 24 for mononucleosis to 53 for lymphoma. Fifty-five per cent were men and a quite high proportion (36%) had had a previous HIV test.

Sex, age, sexuality and previous testing rates varied by European region. Patients were youngest (average 33) in northern Europe (UK, Netherlands, Denmark, Sweden) and oldest (43) in southern Europe (Italy and Spain). Roughly two-thirds were male in all European regions apart from northern Europe, where 44% were male.

Only two per cent of patients in eastern Europe (Belarus, Ukraine, Bosnia, Croatia, Poland) said they were gay compared with approximately 40% in south and west central Europe (Germany, Austria, Belgium) and 45% in northern Europe; and only 13% in eastern Europe had had a previous HIV test compared with 36% in southern, 45% in west central, and 60% in northern Europe.

Results: HIV diagnoses

There were 66 new HIV diagnoses (1.8% of patients). Eighty-three per cent of those diagnosed were male, 58% of them were gay, 42% heterosexual and 9% had injected drugs. The prevalence of newly-diagnosed HIV varied widely from 0.6% in northern Europe to 6.5% in southern.

It also varied widely per IC. Not unexpectedly the highest HIV diagnosis rate was in surveys involving STIs (4%) but it was not much lower in mononucleosis-like illness (3.8%), neutro/thrombocytopenia (3.2%), shingles (2.9%) and dermatitis/rash (2.1%).

In contrast HIV prevalence was only 0.4% in cervical/anal dysplasia and hepatitis B/C and 0.3% in lymphoma, possibly because the individuals with these diseases who have HIV are more likely to have already been diagnosed. These rates are still above the 0.1% rate considered cost-effective for routine testing, though.

Over the whole group, more than half of those diagnosed with HIV(52%) had been tested for it before, with a median time from their previous HIV test of 19 months. Their average CD4 count was 400. This may indicate that offering an HIV test as standard when ICs are diagnosed may detect more cases of early HIV infection, though presenter Ann Sullivan of London’s Chelsea and Westminster Hospital did not split this analysis into European regions. It is possible that the relatively high amount of recent infections may be driven by tests given to people presenting with STIs who might have tested anyway.

HIDES 1 found that 20% of patients had presented to healthcare with one of the ICs in the preceding five years and 4.6% had presented more than once.

Next steps

The HIDES project now intends to conduct a larger HIDES 2 study involving 12 indicator conditions, in order to establish better HIV prevalence figures for each. It also intends to conduct a separate audit of whether patients in Europe who present with ICs are offered HIV tests. Finally they intend to develop, in collaboration with the European Centre for Disease Control and the World Health Organization, a set of guidelines for HIV testing targeted at indicator conditions.

HIDES investigator Jens Lundgren commented from the audience that although HIDES 1 was a pilot study, its results were important because many physicians had been sceptical that using ICs to guide HIV testing would find higher than average rates of HIV or be cost-effective. These results showed that it was an efficient way to find undiagnosed HIV.

Original Article by Gus Cairns at NAM

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Discussions with a Dietitian: Sugary Foods

Each month, a registered dietician from the NHS, visits LASS to offer helpful advice and information on food nutrition and healthy eating for people who live with HIV.  Our next session “Sugary Foods” will be on Friday, 21st October 2011 from 12:00pm.  This is an opportunity to ask questions and speak with the dietitian directly about any concerns you may have.

What we eat affects our overall health. Food can help the body to fight infections. It also provides energy so that we can carry on leading active lives.

Eating healthily can prevent weight loss or weight gain. It can lower blood sugar and cholesterol levels, which helps to prevent diabetes and heart disease. Food can also help control some of the side-effects of medication.

This means that good nutrition is an important part of living well with HIV.

The challenge of change

When we first found out we had HIV, some of us realised that our diet was really unhealthy. But the thought of having to completely change our eating habits filled us with dread. It seemed such a big change.

But by making small, gradual changes, such as swapping white bread for brown, or by eating one piece of fruit each morning, it’s possible to start eating better. You could use THT’s ‘planning and managing change tool’ to help you.

What should we eat?

So what does eating healthily actually mean? For us it means eating like this.

Lots of:

  • fruit and vegetables
  • bread, cereals, potatoes and other carbohydrates

Moderate amounts of:

  • meat, fish and other proteins, such as eggs
  • milk and diary products

Less of:

  • foods that are high in fat, sugar and/or salt.
 Food type What we should know
Fruit and vegetables Ideally we should eat at least five portions of fruit and vegetables a day with a mix of different colours. They don’t have to be fresh; frozen or canned are fine too.
Bread, cereals, potatoes and other carbohydrates Carbs should form the core of your meals. If you eat wholemeal, brown and high-fibre versions, they’ll keep you going for longer.
Meat, fish and other proteins, such as eggs Keep meat as lean as possible by cutting off visible fat and skin off the meat.
Milk and diary products Choose low fat versions where possible.
Foods high in fat High fat foods include butter, margarine, crisps, cakes and biscuits.
Food high in sugar Sugary foods include sweets, jam, cakes, puddings and most fizzy drinks.
Foods high in salt Check the labels on food for salt or sodium content.

 Get help from your clinic’s dietician

Most HIV clinics have a specialist dietician or nutritionist. If you ask to see one, they can give you detailed advice tailored to your needs and circumstances. They can also give you advice on taking vitamins and supplements or why not come to LASS on Friday 21st for our talk.

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