Tag Archives: England

HIV testing rates surge among gay men in England, following nationwide drive

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The numbers of gay and bisexual men in England coming forward for HIV testing has surged, following a nationwide drive to encourage those in high-risk groups to test for the virus and reduce the proportion of infections that remain undiagnosed.

Data collected by Public Health England (PHE) showed a marked increase in HIV testing rates among men who have sex with men during the period from 2011 – 2012, the period when Terrence Higgins Trust and HIV Prevention England launched National HIV Testing Week. The week was launched in November 2012 to encourage HIV testing among high-risk groups, in the largest partnership to date between NHS sexual health clinics, community based HIV testing services, and national and local HIV prevention organisations. This year, the third National HIV Testing Week will run from 22nd – 30th November.

Between 2011 and 2012, the number of gay and bisexual men who had an HIV test in NHS clinics in England rose by 13% (64,270 – 72,710). In London, the increase was sharper still, with a rise of 19% (28,640 – 33,980). During the same period, the proportion of gay and bisexual men with HIV who remained undiagnosed fell from 20% to 18%.

Cary James, Head of Health Improvement at Terrence Higgins Trust, said: “We have been thrilled by the success of National HIV Testing Week, and particularly the speed and enthusiasm with which people all over the country have picked up the event and run with it.

“The national figures on HIV give us confidence that our ongoing drive to get more gay men testing more regularly is having an impact. Testing rates are up, diagnoses are up, and the level of undiagnosed HIV is coming down. We need to keep this momentum going, so we will be throwing everything we have behind National HIV Testing Week 2014. We want to get the message out there that together, we can stop HIV.”

In the UK, gay men and African communities are the groups most at risk of HIV. Currently, around one in five people with HIV remains undiagnosed and therefore more likely to pass the virus on than someone who has tested and is on treatment. HIV Prevention England’s It Starts With Me campaign focuses on curbing new infections by increasing testing rates and reducing the level of undiagnosed HIV within high-risk groups.

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

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Listening event for Leicester Hospitals

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Have you, or a friend or family member been a patient at any of Leicester’s Hospitals recently? If so, Leicester Hospitals extend an invitation to an important listening event hosted by their new Chief Nurse Rachel Overfield.

Rachel is new to Leicester and would like to hear directly from you what it is like being a patient in Leicester Hospitals.

Whatever your experience, if you have 15 minutes to spare please drop in any time at the Leicester Guildhall between 2pm – 7pm on Thursday, December 5th. (For venue information, directions and a map, please click here).  Coffee and mince pies will be available all day,  (and they’ve also been promised an open fire)!

During the afternoon, Rachel and her senior colleagues from the hospital will be available to hear from patients and families about their personal experiences of Leicester Royal, Leicester General and Glenfield Hospital’s services. There is no need to book a place, simply drop in whenever you are free.

Why not join them for a coffee and mince pie while you are out Christmas shopping. You might even want to take in the Richard III exhibition while you are at the Guildhall!

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Audit shows many high HIV prevalence areas in England are failing to expand HIV testing

HIV TESTING

Most sexual health commissioners for areas in England with a high HIV prevalence have introduced some form of expanded HIV testing, a study published in the online edition of HIV Medicine shows. However, only a small minority were following national guidance, with just a third having commissioned testing for new registrants in general practice and 14% commissioning testing for people admitted to hospital.

“The results of this audit confirm that routine HIV testing in these settings has been commissioned in only a minority of high-prevalence areas”, comment the authors. “Prioritizing the introduction of routine testing in these settings will be necessary to fully implement national testing guidelines.”

Late diagnosis of HIV is a major concern in the UK. Approximately half of people newly diagnosed with HIV have a CD4 cell count below the threshold for the initiation of antiretroviral therapy (350 cells/mm3) recommended by the British HIV Association (BHIVA) and between a fifth and a quarter of all HIV infections are undiagnosed. Improving HIV diagnosis rates is key to strategies to reduce rates of HIV-related illness and also the continued spread of the virus.

National HIV testing guidelines were issued in 2008 and were endorsed in 2011 by the National Institute for Health and Care Excellence (NICE). These recommend that HIV testing should be expanded beyond traditional settings (sexual health clinics and antenatal services) in areas with a high HIV prevalence – an infection rate of above 2 per 1000. In these circumstances, the guidelines recommend the universal testing of all patients newly registering with a GP, the screening of all new medical admissions to hospital and targeted outreach programmes.

Investigators wanted to assess the level of adherence to these guidelines and to see if there were any obstacles to the expansion of testing.

Between May and June 2012, the investigators contacted sexual health commissioners in the 40 English primary care trusts (PCTs) with a HIV prevalence above 2 per 1000. There was an 88% response rate (35 of 40).

All the respondents were aware of the testing guidelines and the majority (80%; 23 of 35) has introduced some form of expanded testing.

In most cases, this was testing in the community (51%; 18 of 35), followed by testing in general practice (49%; 17 of 35) and testing in hospitals (37%; 13 of 35). However, only four PCTs (11%) had commissioned expanded testing services in all three settings.

Areas with especially high prevalence were more likely to have commissioned services. All but one of the PCTs with a prevalence above 5 per 1000 (92%, 11 of 12) had commissioned some form of expanded testing. More worryingly, a third of PCTs with background prevalence between 2-3 per 1000 had commissioned any form of expanded testing and only 33% had introduced testing at GPs, with just one commissioning testing in hospitals.

When the investigators examined adherence to the specific recommendations of the guidelines, they found that only 31% of PCTs (11 of 35) had commissioned routine testing of new registrants at GPs. Moreover, only a small minority (10 to 20%) of GP practices in these areas participated in expanded testing. In a fifth of PCTs, testing was limited to high-risk groups. PCTs in London, compared to PCTs elsewhere in England, were somewhat more likely to have commissioned the routine testing of new GP registrants (38 vs 18%). HIV testing was incorporated into general sexual health screening at GPs in 17% of PCTs (6 of 35).

An even lower proportion of PCTs had commissioned the routine testing of new admissions to hospital (14%; 5 of 35).

Over half of PCTs (51%) had commissioned community testing via outreach programmes carried out by charities and the voluntary sector. This testing targeted high-risk or marginalised populations including men who have sex with men (six PCTs), African people (four), sex workers (two), people who inject drugs (one) and the homeless (one). Settings for community testing included saunas, polyclinics, pharmacies, prisons, churches and health centres.

Almost all PCTs (94%; 33 of 35) cited lack of resources as a barrier to introducing expanded testing, with two-thirds (23 of 35) also stating that the re-organisation of the NHS was an obstacle. Approximately 75% of commissioners (26 of 35) expected the rate of HIV testing carried out in their area to increase over the next year. None expected a decrease.

“Modelling of the UK HIV epidemic has shown that higher rates of testing combined with timely initiation of antiretroviral therapy can result in reduced HIV incidence”, write the authors. They note that most respondents had introduced some form of expanded testing, “however, only a minority covered the two medical settings mentioned in national testing guidelines…new registrants in general practice…and general medical admissions.” The authors conclude that recent organisational changes in the NHS make it important to monitor “changes in the commissioning of testing over time”.

HIV TESTING WEEK

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Did you know it’s National HIV Testing week from 25th? – If you’ve never had a HIV Test and had sex at least once, without a condom, then YOU need a test!

Check out the details of HIV Testing week and remember, you can pop in to LASS for a free and confidential rapid HIV test.  It only takes a few minutes to get the result.  Call us on 0116 2559995 if you’re interested.

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Black History Month 2013 – Interview with LASS’s very own, Rachael Ng’andwe

Rachael-Award

Rachael N’Gandwe receiving her NIACE Certificate

As part of NIACE’s blog series to mark Black History Month, Rachael Ng’andwe – a 2013 Adult Learners’ Week award winner – is sharing her story. Rachael is a Women’s Project Coordinator atLeicestershire AIDS Support Services, working with HIV positive women to educate and empower them through training and other opportunities.

Tell me a bit about yourself and early years.

I was born in Lusaka, Zambia. I grew up there and attended primary school through to college, where I studied Travel and Tourism. I qualified as a travel consultant, which is what I did for a living in Zambia before I came to the UK. Since coming to England in 1997 I haven’t been back.  It’s been difficult being away- part of it has been immigration and it was not possible until a couple of years ago.

What are you doing now?

I’m a single mum to an 8 year old beautiful daughter. Her dad passed away in 2009 and I have been on my own raising her as a single parent, which takes up a lot of my time as I‘m very hands on. I’m also currently enrolled in a Level 2 Diploma in Health and Social Care Course – which started September 2013.

What inspired you to get involved in learning and education?

Originally, I gave my time up for volunteering as I wasn’t allowed to work due to my immigration status. Through that, I got involved in the training opportunities available for volunteers.

My love for working with people still carried on and having left my job where I did IT with the travel consultancy job, but I didn’t get a chance to practice since I moved here. I knew I needed to do something, so with the help of the Lass the voluntary organisation I was attached with I took the ICT Level 2 and passed.

I then took every opportunity that came along, instead of being idle at home. I just got lost in studying while volunteering and this gave me a break from other personal problems.

I was also involved in family learning classes at my daughter’s school. I did maths Level 1 and went on to do Level 2 with Leicester College. I knew that I needed to improve my maths to be able to help my daughter with her homework.

Were you faced with any barriers and if so, how did you overcome them?

I had barriers getting into mainstream education because I didn’t have the right immigration status.  Although being a voluntary sector, Leicestershire AIDS Support Services (LASS) provided me with the opportunity to learn and created a platform for me to use my learning. Even after obtaining my leave to remain in the United Kingdom, getting into university has not been easy because of the conditions on my status. I like many others whom I have come across, still struggle to meet up with financial demands to get into higher education. Passion is there but the reality always knocks us down and leaves us with the option to only do short college courses.

What was particularly helpful in supporting you to progress and achieve?

The management at LASS, in particular the CEO Jenny Hand and my line manager Juliet kisob. They have been there with me pushing me to achieve. They saw the potential which I did not see in myself to go for bigger things –they were my backbone and all that I had. I have close friends who have supported me in my journey to achieve better for me and my daughter.

What impact has winning an Adult Learners’ Week this year had on you?

It’s had a huge impact on me, especially with the women I work with. They see me in that position from the picture on my desk and they ask me questions like “How do I get onto a course? How can I get such an opportunity?” I see a change in them and they want to do better for themselves.

My daughter is also very proud of me. She asked me, “Mummy did you graduate?”

With significant strides in race equality over the last 30 years, what do you think the barriers for BAME learners are today?

It depends on where you go, but language is still a barrier when it comes to learning. If you don’t have English how will you understand the person who is teaching you? Without 1:1 support learning is very hard for people whose first language is not English.

It’s the same for children – language is a problem and they need extra support to achieve in class.

Refugees and asylum seekers also face barriers as there is stigma attached to them. I experience this myself – people look down on you because you apply to stay in the country on these grounds. They don’t see your potential – they only see the status so you always have to challenge and speak out or get taken for granted.

I also feel that the welfare cuts have hit people in a big way – women didn’t need to work in the same way before, but the cuts will mean everyone has to work and no more stay-at-home mums.

For some it will be very hard especially if they have not worked before. Where do they start and who is there to support them? Until there are some changes in the way the system works, this will remain a problem in our society.

I still believe the Equality Act has created more opportunities for BAME background. People just need to be empowered to challenge inequality when things are not right.

We know that there are significant differences between particular groups and sub-groups of minority ethnic learners. What can practitioners and providers do to support them?

Black learners sometimes have to do extra to get the same credit as other learners. The expectation from black learners is higher because their proficiency levels are not recognised – this is a barrier because they have to achieve exceptionally high grades in order to compete on the same market level. There will always be a gap in achievement between ethnic groups until they change the criteria in which enrolment and provision of educational materials is awarded to individuals regardless of ethnic back ground.

What would you like to see changing over the next 30 years for BAME learners and what role do you want to play in that?

Provision of a wide range of courses for different skills to match the employment requirements should be offered to BAME on quota basis. We should learn from what skills people are bringing into the country and increase the variety. I also think people should be afforded a future based on their capability – not on their status. Too many highly qualified people come to this country and end up stacking boxes in factories.

Organisations such as accounting firms that offer different routes into tertiary education such as articles should open this route to all individuals especially the BAME communities. Apprentiship courses should be offered to BAME communities at level 5 and 6 for those exiting secondary school educations.

How do you see your role as a BAME learner and the impact this may have on BAME learners, aspiring leaders and the wider community?

First and foremost – for single mums; be a role model giving hope to achieve anything you want to achieve. I want to be an advocate for under achievers by signposting them to relevant agencies and inspiring them to have a sense of self belief. My role as a BAME learner should inspire aspiring leaders and the wider community to engage in learning regardless of age, gender and ethnicity.

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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

HAVE YOU EVER HAD A HIV TEST?

If you’re interested in having a HIV test, we offer a completely free and confidential rapid HIV test and you’ll get the results within 60 seconds from a simple finger prick test. We use the Insti HIV test produced by BioLytical laboratories. The test is 99.96% accurate from 90 days post contact for detecting HIV 1 and 2 antibodies. We also have a mobile testing van which is often out in communities providing mobile rapid HIV tests. Appointments are not always necessary, if you would like a test, please contact us on 0116 2559995

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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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From today, HIV treatment is free for all who need it!

Lord Fowler

In March of this year we shared the the news that Asylum Seekers and other non-British citizens were to be given free HIV treatment after the government indicated it was willing to accept an amendment from Lord Fowler to the health bill.

That removal of charges for undocumented migrants and non-UK citizens accessing HIV treatment and care in England comes into effect today. From now on, HIV treatment will be provided free of charge to all who need it, regardless of citizenship or immigration status.

The move was first announced in February and the relevant legislation passed in June. Health ministers have justified the change on the grounds of public health, pointing to the impact that HIV treatment has on onward transmission.

Although it was initially proposed that free HIV treatment should only be available to people who have been living in the UK for more than six months, this requirement has not been retained in the legislation.

While treatment in HIV clinics will always be free of charge, migrants living with HIV who need hospital treatment for another health condition, such as diabetes, heart disease or cancer, or who require antenatal care, may still be subject to charging regulations.

Moreover, the rules have only changed in England. In Scotland and Wales, although charges for HIV treatment have not been levied or actively pursued in recent years, the legislation still states that HIV treatment may be chargeable. In Northern Ireland, the legislation still states that HIV treatment may be chargeable, and these regulations have sometimes been rigorously enforced.

The National AIDS Trust (NAT) has called for a formal change in the law in Scotland, Wales and Northern Ireland, to ensure that free universal access to HIV treatment is guaranteed across the UK.

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