Monthly Archives: November 2014

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/SecondEuropeanPrEPstudyclosesplaceboarmearlyduetohigheffectiveness/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 ARTInduced 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. Emtricitabinetenofovir concentrations and preexposure 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/SecondEuropeanPrEPstudyclosesplaceboarmearlyduetohigheffectiveness/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 preexposure prophylaxis for HIV prevention: a longitudinal analysis. Lancet Infectious Diseases 13: 1021–28, 2013. 14 Grant RM et al. Uptake of preexposure 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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Special HIV testing sessions to help stop spread of infection

Special report from The Leicester Mercury:

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Special HIV testing sessions are being set up in bid to persuade people at risk of the infection to be tested.

Latest figures estimate that are 1,250 people living with HIV in Leicester and Leicester.

Celia Fisher, from Lass – Leicestershire AIDS Support Services, said: “It is estimated that one in five of these have remain undiagnosed and are therefore more likely to pass the virus on unwittingly.

“Our aim is to increase the uptake of HIV both within African communities and other communities in Leicester.

“Our experience shows that by making testing more accessible in different social and community venues it has become more acceptable to people and we always have a queue.”

The extra sessions also mark the third annual National HIV Testing week which runs until Sunday (Nov 30).

Lass, a charity set up in 1987 to provides services for people in Leicester, Leicestershire and Rutland affected by HIV and AIDS, already provides rapid testing each weekday from 9.30am-4.30pm at its base in REgent Road, Leicester.

Over the next week it will be holding extra sessions.

These include opening from 9.30am-12noon on Saturday (Nov 29) and at the Oxygen Night Club, Wharf Street from 5-8pm the same day.

Ms fisher HIV awareness co-ordinator at Lass, said: “This is an ideal opportunity for people who do not have time during the week to come along.

“We are also offering couples testing on both days – so people can come and get tested together and share their results.

We will be offering HIV Testing at Club Oxygen on Wharf Street on Saturday 29th November from 5 – 8pm.

Weekday testing is available every day at LASS from 9.30 – 4.30 – so you can drop in anytime if that suits you.

Ms Fisher said: “It is important that people who think they may be at risk from HIV are tested as soon as possible.

“The virus replicates at its fastest rate in the very early stages and is very infectious and so it spreads much more easily.”

She added: “Recent publicity has been very focused on the African community but in Leicester every community has people living with HIV.

“With the rapid testing we provide people can get the results straight away and they are with trained people who offer support to them.”

For those whose tests to prove positive there is help at hand.

Ms Fisher said: “People are living long and with the current medications the amount of virus can be very much reduced – not to zero but very low.”

For more information on National HIV Testing week events in Leicester contact Celia Fisher by e mailing celia@lass.org.uk or go to http://www.lass.org.uk

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Why are we afraid to get tested for HIV?

Consistently, this post from February 2013 is one of the most viewed on this site, we’re left to wonder why that is. Is it that people are genuinely afraid to get tested for HIV or looking for the stories of other who either have been or choose not get test for HIV?

What difference does a HIV test make to ones life? Could it be that ignorance really is bliss?

Consider this, whatever your persuasion wouldn’t it be better to know your own HIV status? – Of course people will be fearful, if you discover you have HIV it could be life changing. You’ll be entering a new social group of people, and it’s fearful of coming out as HIV positive. Thats just one view point, in practice HIV really is a manageable condition, don’t take our word for it, Google it – throw yourself at the mercy of opinions online and you’ll find there’s a lot more information out there about HIV if you know how and where to look.

A HIV diagnoses isn’t going to kill you, living a life of ignorance to the condition probably will, it’s your choice so why not take a HIV test. This week is National HIV Testing Week, if you’ve never taken a test before, we hope you’ll consider it this week.

LASS

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For some people the idea of being tested for HIV is as simple as making a note in a calendar, an entry which sits comfortably beneath a dentist appointment and above a mother’s birthday. For others, the idea of making that appointment, or taking that long walk to the clinic, is one of the most nerve-wracking experiences they can imagine. However, in an age where the numbers of people diagnosed with HIV are increasing, has our natural fear of the unknown become a luxury we simply can’t afford?

Many years ago it was a scary disease. We called it AIDS and it became a name associated with sin and death. The massive number of infections, particularly in the gay community, were staggering, and as the death toll slowly crept up, nations across the world panicked. It’s impossible for any society to come through such a dark time and emerge unscathed…

View original post 1,860 more words

Young, British, and Living With HIV

sexeducation

“I remember not getting out of bed other than to use the loo. My friend had to stay with me just to make sure I was eating,” says ​Niyi Maximus Crown, a 25-year-old man who was diagnosed HIV positive in December 2011. “I didn’t even recognize my own thinking voice. I felt like I was going to be single for the rest of my life. The feelings of worthlessness made me angry and I started to hate myself.”

Last week, ​Public Health England (PHE) released its ​latest report on HIV. “In the UK there are 107,800 people living with HIV,” says Eleanor Briggs, Assistant Director of Policy and Campaigns at National AIDS Trust. In London, almost one in eight gay and bisexual men are HIV positive. Based on the stats from PHE, Briggs adds, “We can say about a third of people living with HIV infection, both diagnosed and undiagnosed, were resident in London.”

What’s more frightening is that PHE estimates that 24 percent of the people in the UK with HIV are currently undiagnosed.

Brandon Wardell Is a 22-Year-Old Comic Who’s Already Done an Album with Bob Odenkirk

Early diagnosis of HIV is crucial. Briggs states that a late diagnosis can mean treatment becomes less effective, reducing a person’s lifespan. Medication also helps stop the spread of HIV by lowering the amount of HIV virus in a positive person to undetectable levels so they are ​unlikely to pass it on.

And yet few people are talking honestly about HIV. In terms of everyday knowledge on the gay scene, HIV exists somewhere in limbo between the grim ​tombstone adverts of the 80s, statistics that get bounced around annually from numerous health organizations and the raw realities of chemsex-fuelled bareback sessions. The subject usually makes an appearance in the media once a year when ​World AIDS Day rolls around. A leading HIV consultant ​told the BBC that there’s a “complete lack of awareness” of the risks among many gay men in the UK.

As gay venues up and down the country prepare to mark World Aids Day (on December 1) with fundraising events for various LGBT charities, though, how many people do you know are comfortable with talking openly about being HIV positive? Do you even know anyone that’s openly HIV positive?

The truth is that, as a community, we still drive people who live with HIV into the closet. It’s not surprising that most gay men feel they want to keep their status private. Many struggled during their lives to come out as gay to their friends, families or work colleagues, and they may not even be out in all aspects of their lives. Having to then deal with the stigma that still exists around being HIV positive is akin to having to deal with a second coming out and, once again, another round of judgement and shame.

A few HIV negative people share their thoughts. “If you get HIV from unprotected sex you deserve it,” said one. Many might privately agree with him. But does that mean they deserve to feel forever alienated by society?

Niyi is better known in London’s gay clubs as Maximus Crown. He is one of the only DJs that is publicly out about being HIV positive, which is a big deal. The UK gay scene has very few openly HIV positive DJs, drag queens or promoters. But Niyi didn’t really have the choice of whether he should put his status out there—his best friend at the time decided to go public with it on Facebook for him.

“My best friend stayed with me every day to make sure that I wasn’t alone, didn’t starve or try and kill myself,” Niyi recalls. “Six months later I decided to distance myself from him because I started to notice things about our friendship that I wasn’t OK with. To get back at me he went onto the Facebook event page for a party I was booked to DJ at and posted a series of comments about me being HIV positive.”

The comments included accusations that Niyi had been having unprotected sex while aware he was HIV positive. “When it happened I wasn’t angry, I just wanted to log out of the universe. If I could have closed my eyes and stopped existing I would have, but it forced me to own my status, which in turn made me more comfortable discussing it publicly.”

If you are old enough to remember ​the campaigns of the 80s, then safer sex and the issues around HIV would have been drummed into your consciousness. But with the advent of combination therapy and the dramatic development of antiretroviral drugs that revolutionized care over the last fifteen years, AIDS-related deaths dropped substantially. Between 2001 and 2011, the rate of new infections ​dropped by 20 percent.

As the number of deaths fell, though, so too did government resources that educated people about HIV. Schools barely touched on the subject. To most people, it was seen as a disease that only affected poorer countries. It’s no wonder that the number of infections in young people has risen comparatively steeply compared to other age groups. As the ​United Nations Population Fund say, young people remain at the centre of the HIV epidemic in terms of rates of infection, vulnerability, impact, and potential for change. The young have grown up in a world changed by AIDS, but so many still lack the correct knowledge about how to prevent HIV infection. ​

For many recently infected guys, getting their head around living with HIV is one of the biggest challenges.

James Hanson-McCormick, 24, who was 18 when he was diagnosed with HIV said “I had no idea what HIV was or how it was contracted. I have had six years to think about my status, and not a single day goes by without me thinking about it. It’s so hard. I wish I knew more [then], I wish I had been better educated and that I knew enough to try and prevent it happening.”

It might sound naïve, but James isn’t alone in his experience. ​Luke Alexander is from Oldbury, a small town outside Birmingham, and was diagnosed HIV positive in June 2013. He was 18. “If I was in a sexual relationship with a guy when I was 15 or 16 it was monogamous,” he tells me. “When I hit 18 I treated myself to a fancy phone and discovered these apps and clubs. You’re new to everything and people say ‘download this’ and you find people want to hook up with you. It’s validation. You become quite promiscuous.”

Luke’s candidness took me aback. “I became incredibly egotistical and quite narcissistic,” he admits. “Add drugs and alcohol into the equation and it becomes quite a habit. One thing led to another and I didn’t take any precautions.”

Will Harris, Head of Media for ​Terrence Higgins Trust, says that while research shows that most gay men use condoms most of the time, it only takes one instance of unprotected sex for HIV to be passed on. “Condom use has to be consistent… It’s basic human nature to under-estimate risk, so our community needs to keep finding ways to reinforce the message that ‘He looks fine, it’ll probably be OK’ won’t give you the protection that a condom will.”

Earlier this year, Luke ​made headlines when he went on ITV’s This Morning to discuss his HIV status. “I never heard anything about HIV in school,” he said. “You can become a bit reckless when you come of age, but it’s far worse if you have no basis of knowledge to refer to.”

Like James, Luke’s ​sex and relationship education in school was virtually non-existent. “It lasted a few hours. If people weren’t there, they didn’t receive it. While they stressed the importance of contraception, it was for pregnancy. When I asked about anal sex, they said, ‘We don’t recommend it.’ I felt embarrassed. I just wanted to hear their perspective.”

Harris agrees that the education system has failed in this regard, saying that:

“Young gay men are generally frozen out by the current approach to sex education in schools.”

“The past is the past, though, and you can’t change that,” James reasons. “The great thing now is I’m healthy and happy. I’ve been on meds for five years now and doing so well. My health, in general, is alright.”

But living with HIV isn’t just about monitoring your physical wellbeing. The emotional strain of the constant check-ups and coming to terms with the virus can also present its own psychological strain.”Physically I’m fine,” James says. “I do suffer with depression, but that’s down to several things—not just my HIV. Sometimes it’s difficult juggling lots of meds every day. Often my depression gets bad and tells me I’m worthless and to not take it. But I have faith in medicine that one day there will be a cure.” His biggest wish is more altruistic still: “More knowledge and understanding around HIV and AIDS.”

For many recently infected guys, getting their head around living with HIV is one of the biggest challenges. Stigma is a major issue.

“Robert,” 29, (not his real name), has been HIV positive since 2007. A casual partner sexually assaulted him when he was passed out after a heavy drugs session. Only his closest friends and immediate family are aware of his status. He puts this down to the assumptions that people make about those who are positive. “It’s not the fact that it’s an unattractive quality [to be HIV positive], it’s that people think you had a choice. You hear a lot about bareback parties and people who think that those who have a lot of condom-less casual sex ‘deserve’ to get HIV. I don’t judge anybody but I don’t want to be put in that category. I’m not ashamed of being HIV positive, but it does affect how people perceive you if they don’t know you.”

Robert has told around ten partners about his status when they’ve asked about barebacking. “I don’t have unprotected sex unless we are both aware of our status,” he says. Even so, he says it’s still common for HIV positive guys to be afraid to disclose their status to others in the same position: “I’ve even met positive guys who I’ve been honest with, but they have lied about being positive because they don’t want to say they are.”

It’s upsetting to think that we are forcing so many thousands of gay men into a situation where they feel alienated by their own community. It takes a strong person to rise up against a tide of possible condemnation and be among the first to speak up.

Luke lost friends after going public about his diagnosis. People stopped answering his calls. He believes it was because they were afraid to be associated with somebody that was openly HIV positive. Similarly, when he confided in a friend about his status, she was more concerned that she’d shared his wine glass than how Luke was feeling. (Incidentally, if you labor under similar misconceptions, HIV cannot and ​will not be spread by sharing glasses.)

Sadly, despite it now being considered to be a very manageable long-term health condition, HIV is still widely misunderstood. “You can sit on a park bench and talk for two hours with someone about your diabetes,” Luke says. “But you can’t do that with HIV because you’ll often get a look of fear and shock.”

Niyi eventually reached a point when he had enough of feeling ashamed. “I woke up one day and was like, life isn’t always going to be easy. Self-pity isn’t fierce and it isn’t fun. Doing things and being around people that encouraged me to feel good about myself was such a big help.”

There is one hurdle that remains for him, though, and that’s relationships. He’s been single for seven years. “The thought of being rejected by a guy because of it terrifies me. I feel that it will always hold me back until I am able to get past that final fear.”

James has been luckier in love. He met his boyfriend 18 months ago and they married last August.

Niyi, Luke and James are heroes!  They have decided that it’s time to challenge the stigma that looms around HIV for no other reason than people are not talking about an issue that affects us all. The education system is broken, so they’ve taken it upon themselves to speak out about it. They have taken a situation that could have stripped them completely, that could, if they let it, absolutely define them, but instead have turned it into something powerful.

As his fears subsided, Luke was inspired by another HIV activist and started blogging about his experience. “It got a lot of attention. I wanted to help people understand and it was a feeling of empowerment. The good reactions that followed confirmed it was the right thing to do,” he says. He now also writes monthly about the subject for Gay Times.

Niyi agrees. “There are so many people suffering unnecessarily because they feel that being HIV nullifies everything good about who they are, but it really doesn’t. Everybody deserves to wake up feeling like they are of value and if all I have to do is talk about my situation in order for people to see that, then that’s what I will do. People need to know that someone’s HIV status is not an indication of what kind of person they are.”

Story via Vice

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Shooting Challenge: Week 4 Winner & Week 5: “HIV Testing Week”

Contrast, by Jenny Hand

 

Congratulations this week goes to Jenny Hand who’s photo this week received the most votes.  As World AIDS Day is approaching, Jenny said she wanted to include the symbol of the day and decided to contrast it against the white of a sperm keyring she has.  Well done Jenny!  Her image will be added to the winners of this and the next 3 Shooting Challenges where an overall winner will be decided and a prize given.

Poisoned Apple, by Zoe Van-De-Velde

Poisoned Apple, by Zoe Van-De-Velde

Our other entrant this week is from Zoe Van-De-Velde, featuring a biblical theme with Eve biting into the forbidden fruit and a green ribbon representing the snake.

 

 

 

 

 

 

WEEK 5: HIV Testing Week!

Our theme this week is slightly different, in that we’re not specifying a particular photographic technique to use.  If you’ve been following our shooting challenge you’ll see we haven’t had many entries and that’s ok, it is of course for fun and we feel that some people may be put off by adhering to a photo technique.  So this week, to encourage more entrants, you can use whatever technique you like!  HOWEVER, in keeping with our ever present HIV and Sexual Health theme, we would like you to photograph “HIV Testing”

Nat Tst Wk 2014 GREENIt’s currently HIV Testing Week and LASS are planning a number of events in Leicester to mark it’s third anniversary.

National HIV Testing Week was established by HIV Prevention England in 2012, in a bid to reduce high levels of undiagnosed and late-diagnosed HIV among gay and bisexual men and Africans in England. In 2013, there were an estimated 1250 people living with HIV in Leicester & Leicestershire, one in five of whom remain undiagnosed and therefore more likely to pass the virus on unwittingly.

You do not need to be a photographer to join into this competition (and if your a student of the art, we’d love to see your ideas and pictures)!  Almost everyone has a camera on their phone, everyone is capable of taking photographs – we’d like to tap into this, get creative with the gear you already have, it’s not about the tech, it’s about YOU!

THE BRIEF:

Simply photograph anything you feel is related to a HIV Test.  You could be literal, conceptual, funny, clever, thought provoking, depressive, emotive, sexy, it’s all about what you can come up with, and who knows, you could win!

THE EXAMPLE

 

by Tom Robson

“I’m Testing” by Tom Robson & Chaz Ram

Clearly, you can see this shot didn’t take a lot of time, there are creases in the background, the colour is very slightly off and not all of the scene is in focus.  Yet you can still see elements of clinical procedure here, perhaps the aftermath of a test, (or failed test as there is no blood in the test tube)*

There’s no technique this week and this example demonstrates you can create a photograph using objects around you.  Sure, at LASS we have the advantage of latex gloves, a test tube, rack and a plaster and we’re sure you’ll be able to find items around the home or provide a much better image than this one so why not give it a try?  Tom & Chaz decided upon and shot this image within 2 minutes to demonstrate it doesn’t take a lot of time to get your picture, once you have your idea.

*(LASS Rapid HIV Tests do not need test tube amounts of blood, it’s a simple finger prick)

THE RULES:

  • Follow the brief
  • Send your best photos by 6PM on Sunday 30th November 2014 with “Shooting Challenge” in the subject to photography@lass.org.uk and we’ll announce the winner on World AIDS Day, (1st December 2014) as we set the theme for next week’s shooting challenge.
  • Submissions must be your own work.
  • Photos must be taken after the challenge was published; so no existing shots please.
  • Explain briefly in your submission email the equipment, settings, technique used and the story behind the image/images.
  • We will of course credit you so if you have a website or twitter handle, let us know! – If you’re happy for us to use the images elsewhere on our site – do let us know!
  • Save your image as a JPG, and use the following naming convention FirstnameLastnameEasy.jpg
  • Anyone can enter, regardless of camera gear, or location!
  • The most important rule — HAVE FUN!
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LASS marks National HIV Testing Week in Leicester with a range of HIV Testing opportunities

Nat Tst Wk 2014 GREEN

LASS is planning a number of events in Leicester to mark the third annual National HIV Testing Week (22nd – 30th November).

National HIV Testing Week was established by HIV Prevention England in 2012, in a bid to reduce high levels of undiagnosed and late-diagnosed HIV among gay and bisexual men and Africans in England. In 2013, there were an estimated 1250 people living with HIV in Leicester & Leicestershire, one in five of whom remain undiagnosed and therefore more likely to pass the virus on unwittingly.

LASS and its regional partners in the HPE contract are extending the number and range of testing opportunities for people during National HIV Testing Week. Celia Fisher of LASS says: “Our aim is to increase the uptake of HIV testing within the different African communities in Leicester, as well as other communities. Our experience shows that by making HIV testing more accessible in different social & community venues it has become more acceptable and we always have a queue.”

LASS will be offering Rapid HIV Testing at LASS on Saturday 22nd & Saturday 29th November from 9.30 – 12:  the ideal opportunity for people who do not have time during the week. We are also offering Couples testing on both days – so you can get tested together and share your results.

We will be offering HIV Testing at Club Oxygen on Wharf Street on Saturday 29th November from 5 – 8pm.

Weekday testing is available every day at LASS from 9.30 – 4.30 – so you can drop in anytime if that suits you.

National HIV Testing Week is supported by major public health bodies, including Public Health England, the British HIV Association (BHIVA), and the British Association of Sexual Health and HIV (BASHH).

To get involved in this year’s National HIV Testing Week, visit http://www.StartsWithMe.org.uk. For further information on National HIV Testing Week events in Leicester please contact Celia Fisher (celia@lass.org.uk).

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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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