Monthly Archives: May 2018

When I admitted I was HIV positive, my fellow academics excluded me

When I was diagnosed with HIV, I had no idea that new drugs had transformed the virus from something life-threatening to little more than an inconvenience. Today, a daily pill gives me an average life expectancy and makes it impossible to pass the virus on. But there’s one last major health barrier: the social stigma, and the mental health issues it causes. Worryingly, this is so prevalent that it can even come from those who claim to be experts on the topic. In my case, this happened when I disclosed my status to academic mentors.

Three days after my diagnosis, a professor specialising in sexual health contacted me online to share her views about HIV-positive people. She said the virus affected only reckless people, who couldn’t be trusted to take their meds.

I replied that her comments were judgmental and ignorant, contributing to an outdated attitude that forces many people to hide their status. She replied: “It’s not irrational to protect yourself. They should be honest, unless they are unethical”, adding that HIV was a “killer” with “a higher probability of death” than other sexually transmitted infections. I had looked up to this professor, and her comments hurt.

Framing HIV-positive people as “reckless” and HIV-negative people as “rational” is a binary logic that has roots in the political climate of the 1980s. HIV was seen as the responsibility of individuals, rather than of the state to provide adequate healthcare. The inaction of Conservative leaders at the time inspired queer protest movements. Similar tensions have re-emerged recently over whether the NHS should fund PrEP, a tablet (identical to mine) that prevents HIV infection. The tabloids call it a “promiscuity pill”.

Although my PhD supervisor was initially sympathetic about the diagnosis, once I fell out with the professor he began to treat me differently. Until then, we had maintained a close personal and professional relationship, communicating regularly through social media. Our relationship changed quickly from friendly to formal. Where once we had exchanged hundreds of WhatsApp messages, these dwindled to a couple a month. Eventually, all communication was through university emails, focused on work.

Until you experience it, indirect discrimination can be difficult to see, let alone prove. I decided to drop my supervisor, given the emotional pain I experienced when he ignored my messages. But other PhD students in the professor’s sphere of influence also stopped talking to me.

By falling out of favour with the clique’s matriarch, I was ostracised by the whole gang of scholars, perhaps for the good of their own career prospects or publication metrics. Mine, by contrast, have suffered. While my previous publications have been cited by this group dozens of times, my most recent journal article has not been cited once, despite its relevance to their body of research.

My story is not the only example of so-called experts holding discriminatory views. For example, one black woman living with HIV described in a blogpost “an HIV researcher who became disgusted after she revealed her status to him”.

We must remember that HIV is an intersectional issue, disproportionately affecting not just middle-class white gay men, but people of colour, trans women and sex workers. While it’s by no means widespread and may often be subconscious, discrimination and disgust towards those of us living with HIV matters. It will be a barrier to wider participation in the academy for as long as its hypocrisy goes unchallenged.

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Doctors urged to consider psychological as well as medical factors in HIV treatment

Doctors need to consider the social and psychological, as well as the medical, aspects of HIV diagnosis and care, advised Professor Rusi Jaspal in his keynote speech at the UK’s largest HIV conference.

The fourth joint conference organised by the British HIV Association and the British Association for Sexual Health and HIV, brought together around 400 clinicians from across the country to discuss the latest advances in treatment, care and initiatives to engage hard-to-reach communities. You can watch his lecture here.

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Prof Jaspal, Chair in Psychology and Sexual Health, explained how tenets of Identity Process Theory can help clinicians understand the factors that can lead people to engage in high-risk behaviours – and provided evidence-based recommendations on how clinicians can intervene to help reduce the risk of HIV infection, particularly among men who have sex with men (MSM).

In response to social and psychological trauma, such as homophobia or childhood abuse, some MSM may adopt unhealthy coping strategies. Some may not engage with treatment or care because they do not see themselves as in need of help or because do not want to see themselves as being “high risk”. By understanding more about how patients view themselves, their social networks and their psychological wellbeing, Prof Jaspal argued, clinicians may be better positioned to identify potential risk factors and improve patient outcomes.

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He said: “By discussing with patients the broader context of their lives, clinicians may be able to identify potential risk factors for HIV infection or for poor engagement with HIV care

“Crucially, doctors should be aware of the complexity of patients’ lives and identities – what may seem a good clinical solution to a particular medical problem can pose significant risks for psychological wellbeing, so this needs to be managed carefully. Understanding this can improve the effectiveness of the clinical solution.

“At a time when cuts are being introduced due to austerity, it is essential that policy-makers and commissioners do not overlook the importance of psychosocial support in sexual health. By investing in psychosocial support services, we have the potential to improve sexual health outcomes, and to prevent HIV, in patients.”

Rusi-book-cover560x876Prof Jaspal’s lecture introduced Identity Process Theory, which presents a model of how people attempt to cope with the adverse psychological events that can occur in their lives, so that clinicians might be able to predict coping patterns and encourage more effective and healthy coping strategies in patients.

The keynote discussed the temptation of engaging in ‘escapist’ behaviours like drug use in sexualised settings (or ‘chemsex’) in order to cope with psychological adversity. HIV is preventable with the use of condoms and/ or pre-exposure prophylaxis (PrEP). HIV infection is effectively treatable with the use of antiretroviral therapy.

Prof Jaspal’s book ‘Enhancing Sexual Health, Self-Identity and Wellbeing among Men Who Have Sex With Men: A Guide for Practitioners’, which presents practical recommendations for sexual health practitioners, is out on 21 June 2018.
Men who have sex with men (MSM) are the group most affected by HIV in the UK. Around 47,000 MSM were living with HIV in the UK in 2015 – approximately 46% of the HIV patient population in the Uk.

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Caught on Camera: How HIV Infects Cells

Live Imaging of HIV-1 Transfer across T Cell Virological Synapse to Epithelial cells that Promotes Stromal Macrophage Infection

Real et al. established by live imaging the dynamics of virological synapses formed between HIV-1-infected T cells and the epithelium at the surface of a human reconstructed mucosa. HIV-1 virions formed at the viral synapse cross the epithelium and reach the mucosal stroma, where the virus establishes a latent infection in macrophages.

During sexual intercourse, HIV-1 crosses epithelial barriers composing the genital mucosa, a poorly understood feature that requires an HIV-1-infected cell vectoring efficient mucosal HIV-1 entry. Therefore, urethral mucosa comprising a polarized epithelium and a stroma composed of fibroblasts and macrophages were reconstructed in vitro. Using this system, we demonstrate by live imaging that efficient HIV-1 transmission to stromal macrophages depends on cell-mediated transfer of the virus through virological synapses formed between HIV-1-infected CD4+ T cells and the epithelial cell mucosal surface.

We visualized HIV-1 translocation through mucosal epithelial cells via transcytosis in regions where virological synapses occurred. In turn, interleukin-13 is secreted and HIV-1 targets macrophages, which develop a latent state of infection reversed by lipopolysaccharide (LPS) activation. The live observation of virological synapse formation reported herein is key in the design of vaccines and antiretroviral therapies aimed at blocking HIV-1 access to cellular reservoirs in genital mucosa.

Read more on the research here: https://www.cell.com/cell-reports/pdfExtended/S2211-1247(18)30570-9

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Ramadan, Fasting and HIV

Crescent Moon

Image Credit: Tom Robson

Ramadan is the name of one of the 12 lunar months of the Islamic calendar.  For 29/30 days of Ramadan, Muslims fast from sunrise until sunset.  Many HIV-positive wish to join their community in observing this important month, can they?

During Ramadan, (due to start on Tuesday) Muslims practice the maximum self-control by denying their bodies every earthly pleasure during the daylight.  This means that eating food and drinking (including water).

After sunset, a fasting individual may eat and drink.  Many attend Mosques at night to pray and socialise.  Ramadan ends when the next crescent moon is born and celebrated with Eid ul-Fitr [breaking fast feast].

Fasting is a healthy practice for people with good health; the Quran exempted some categories from fasting – the sick, pregnant, breastfeeding mothers and travellers — and the wisdom behind this waiver is to spare hardship or damage. However, in spite of the Quranic waiver to those who are sick, many Muslims insist on fasting even if they have a minor health condition, justified the rewarding experience and of course to be part of the community.  Of course if you decide not to fast, the Quran says that you are obliged to feed someone who is less fortunate than you.

The question is, can someone or should someone who is HIV positive fast for Ramadan?

The best person to help you decide is your HIV doctor.  To help you and your doctor make the decision, you need to take under consideration some general factors, such as: when you were diagnosed, your overall health, your viral load and T-cell count.  Those in the early period of treatment should not fast, because the body is still trying to adjust to HIV and the treatment which you are having.

If you have been on treatment for some time, and your T-cell numbers are good, with undetectable viral load, and an overall good health then you might consider discussing your wish to observe Ramadan with your doctor.  Explain to her/him that you cannot let any substance go down your mouth to your stomach from sunrise to sunset.

Ask your doctor if your medication regimen could be adjusted with no risk, so you can take it before the sunrise and/or after the sunset.  If you are on a one pill regimen it might be easier for you to fast than if you are on a multiple pill one.

Once you get the green light from your doctor, you still need to take extra steps when fasting Ramadan.

For example, try to prepare good supplements to use on a daily basis during the month if you haven’t been doing so; in Ramadan eating less meals a day could seriously decrease your intake of important minerals and vitamins. Drink plenty of water during the night and avoid salty meals that could make you thirsty. Avoid unnecessary exposure to sun or heat to avoid dehydration. Do not overload your body with work and rest well while fasting.

Medical experts appeal to those who fast and ask them to stay from fizzy or carbonated drinks like cola, lemonade & other flavours even at Lftar (fast-breaking time).  A long day of fasting causes dehydration of the kidneys.  Having cold and fizzy drinks can suddenly cause the kidneys to fail.  Instead, use fresh water and fresh juices.

Ramadan is a good opportunity to quit bad habits; remember that smoking is not allowed while fasting, so if you do smoke maybe this is a good time to quit.

Fasting can also have great health benefits if done the proper way.  According to Mayo Clinic, “Regular fasting can decrease your low-density lipoprotein, or ‘bad,’ cholesterol. It’s also thought that fasting may improve the way your body metabolizes sugar. This can reduce your risk of gaining weight and developing diabetes, which are both risk factors for heart disease.”

Remember: the Quran forbids Muslims to commit acts that could even remotely jeopardise your health.  If your doctor advised against fasting, or if you have any concern that fasting might hurt your health, then don’t fast and invest the month in doing all the other good deeds that you can do; you can delay your lunch meal to be able to join your community in the daily fast-breaking ceremony.

We wish you a joyful and happy Ramadan filled with blessings and generosity.  We hope this Ramadan will enable you explore the great benefits of spirituality while fighting against HIV/AIDS or any other hardship.

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Art Therapy Workshop

You are invited to an Art Therapy Workshop with a focus on mental health & wellbeing on Thursday, 10th May – 11am till 1pm

Light refreshments provided – All are welcome, no previous art experience necessary.

For more information, please see our Facebook Event, or contact contact Rachael (rachael@lass.org.uk) or call us on 0116 2559995

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