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AIDS Treatment is Good Value for Money, Says New Study

Orphans at the Mildmay HIV Centre in Kampala, Uganda. A funding drop has raised concern about the long-term future of the global fight against Aids and HIV. Photograph: Jon Hrusa/Pool/Reuters

It is becoming increasingly clear that Aids is going to be a loser in the struggle by wealthy governments to cut back on spending in all areas, including development. The numbers from the UK’s Department for International Development (DfID) published on the Global development website on Wednesday tell the tale.

Of course, that was about bilateral aid and many Aids campaigners will be hoping the UK will make up the shortfall in contributions to the Global Fund to fight Aids, TB and Malaria. And DfID and other governments and funding bodies will rightly point out that people with HIV will benefit from increased spending on other programmes – especially those for maternal and child health.

Nonetheless, there are cold shivers running down the spines of campaigners and treatment providers in poor countries. They don’t want more stories about Aids drugs running out in Uganda and clinics that are having to turn new patients away. Aids drugs are for life, not just for Christmas – to distort the old advertising slogan about responsibility and pet animals. If people who start antiretroviral therapy have to stop, they will probably develop resistance and the drugs will no longer work for them even if they eventually get a new supply.

So a new study from the expert number-crunchers at the Results for Development Institute in Washington DC, Harvard School of Public Health and Imperial College in the UK – with help from the Global Fund – is timely. It makes the economic case for investing in Aids treatment programmes. It’s not just humane to keep people with HIV alive and healthy, says the study – it actually saves money. That may just be the only argument in these straitened times that funders will readily listen to.

The study, published by the free-access journal PloS One, is specifically aimed at helping donors wrestle with their dilemma of how best to spend their waning development budget.

The 2008-10 global recession, flattening aid budgets and fiscal tightening in many Aids-affected countries are threatening the ability of donors and countries to continue scaling up ART. In this context, policymakers deciding whether to commit additional resources to ART programmes will want to consider not only the cost and health impacts of programme continuation, but also the likely economic benefits of doing so.

They went about it by analysing the costs and benefits of continuing to treat the 3.5 million people in 98 countries who will be supported by Global Fund-financed programmes at the end of this year. Against the treatment costs they set the restored productivity of people able to work again, the savings in unneeded orphan programmes and delayed costs of medical treatment for tuberculosis and other infections that afflict those with HIV at the end of life.

Keeping these 3.5 million people alive and well would cost $14.2bn in 2011-12, they reckoned – but the financial savings would amount to between $12bn and $34bn. Robert Hecht, of Results for Development, thinks the savings will outstrip the cost. “It looks very favourable. The way we did it, the calculations are conservative,” he told me. This is the paper’s conclusion:

These results suggest that, in addition to the large health gains generated, the economic benefits of treatment will substantially offset, and likely exceed, program costs within 10 years of investment.

Let’s see whether DfID and other donor governments are convinced.

Original Article by Sarah Boseley at The Guardian

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HIV Could Spread If Birth Control Injections Increase, Warn Scientists

Researchers call for new guidelines for women using family planning services in Aids-hit areas.  Campaigns to increase the number of women opting for long-lasting contraceptive injections in Aids-hit parts of the developing world could be helping to spread the epidemic, scientists are warning.

New research shows that women who use hormonal contraceptives may double their risk of contracting HIV and of passing it to their male partner, throwing up a new dilemma for global development.

The authors of the large-scale study, published in the journal Lancet Infectious Diseases, call for urgent guidance to be drawn up and given to women using family planning services in HIV-endemic areas. The study showed particularly that the risk of HIV transmission was raised by the long-lasting injections that are most widely used and most popular in the sub-Saharan regions worst hit by the Aids epidemic.

The results present a significant problem for global health and development. Unwanted pregnancy is a threat to a woman’s life and can lead to greater poverty and deprivation for her family. The more children she has, the harder it will be to feed and educate them.

While family planning is still resisted in parts of the developing world, campaigns to promote injectable contraception have met with some success. Many women have sought out the injections that last for months and that they can sometimes get without their husband’s knowledge if he refuses permission.

But the study of 3,800 couples shows that there is a risk which has previously been suspected but unconfirmed. The risk was present for those who took the pill too, but it was not statistically significant because most women in the study had opted for injections.

“These findings have important implications for family planning and HIV-1 prevention programmes, especially in settings with high HIV-1 prevalence”, said Jared Baeten from the University of Washington, Seattle, one of the study’s authors.

“Recommendations regarding contraceptive use, particularly emphasising the importance of dual protection with condoms and the use of non-hormonal and low-dose hormonal methods for women with or at risk for HIV-1, are urgently needed,” said lead study author Renee Heffron, also from the University of Washington.

More than 140 million women worldwide use some form of hormonal contraception.

The study group comprised 3,790 couples where one partner had HIV (usually the woman) although the other did not. They were drawn from two existing studies of HIV incidence in seven African countries – Botswana, Kenya, Rwanda, South Africa, Tanzania, Uganda and Zimbabwe.

The researchers found that women who did not have HIV were twice as likely to be infected by their partner if they were using hormonal contraception. Those who had HIV themselves were twice as likely to give it to their partner. Tests showed that women with HIV using injectable contraception had raised concentrations of virus inside the cervix. Researchers are unclear why and a larger study specifically designed to look at this issue should be carried out, they say.

Meanwhile women should be told there may be an increased risk of HIV infection if they use hormonal contraception and should be counselled that condoms will give them dual protection.

In a comment published by the journal, Charles Morrison from Clinical Sciences, Durham, USA, said: “Active promotion of DMPA [injectable contraception] in areas with high HIV incidence could be contributing to the HIV epidemic in sub-Saharan Africa, which would be tragic. Conversely, limiting one of the most highly used effective methods of contraception in sub-Saharan Africa would probably contribute to increased maternal mortality and morbidity and more low birth weight babies and orphans—an equally tragic result. The time to provide a more definitive answer to this critical public health question is now; the donor community should support a randomised trial of hormonal contraception and HIV acquisition.”

Original Article by Sarah Boseley, health editor at The Guardian

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Poverty-Stricken Families Join a Lengthening Queue for Food Handouts

Stuck around the walls of the church hall at St Paul’s in the heart of Leicester is a series of green laminated signs. There’s one for the Centre Project and another for The Bridge.  There’s the Welcome Project, the St Paul’s over-60s group and your very own “Leicestershire AIDS Support Services“, more besides. Stacked up tidily in front of each one, awaiting collection, is food. Lots of it.

Boxes of fresh vegetables sit alongside bags of freshly baked bread; jars of seafood pasta sauce, still under plastic wrap, are tucked in alongside sacks of rice. Each one of these heaps, obtained by the Leicester branch of the food waste charity FareShare, is a marker for chronic hunger; a profound hunger that, as the economic forecasts worsen and the Conservative party meets in Manchester this weekend to argue over what can be done about it, is only deepening.

“There’s a big increase in demand,” says John Russell of the Centre Project, a drop-in project in the heart of Leicester supporting people in need. “We used to feed 30 or 40 people a week. Now it’s 70 or 80.”

Housing provision and benefit rules have changed, he says, and that’s creating need.

Keith Harrold of Project 5000 in Loughborough, which runs a hot food service once a week from a local church, agrees. “People are struggling. Supermarket prices are shooting up and they aren’t coping.”

Yvonne Welford, who runs the over-60s group for St Paul’s, is seeing the same picture. “There’s been a major increase in demand, especially in the last six months, and I’m afraid it’s only going to get worse.”

Poverty has al ways been a fact of life, even in good times. But FareShare is now seeing a serious growth in the number of people without the resources to feed themselves properly that is, experts say, without precedent in modern Britain.

All of the organisations in Leicester that are supplied by FareShare describe themselves as being dependent on the charity, which obtains food from manufacturers and supermarkets that might otherwise end up rotting in landfill sites, and supplies it to groups helping those in need.

Founded in 2004, the charity works from 17 sites in the UK and shifts 3,600 tonnes of food a year, worth more than £8m. In the past 12 months the number of people it feeds has risen from 29,000 to 35,500. The number of organisations signed up to receive food has risen from 600 to 700. And 42% of those organisations are recording increases of up to 50% in demand for their services.

John Willetts, a former NHS trust chief executive and now the volunteer project director for FareShare in Leicester, said: “It’s a constant ramping up in demand all the time. The volume of food we’re distributing has risen from 41 tonnes a year three years ago to 98 tonnes now, and that’s to the same number of organisations.”

He takes me to meet Diana Cank of the community action social project (Casp) in the deprived Northfields district of the city. Much of the food FareShare distributes goes to drop-in centres and homelessness hostels that cook meals on site, but Casp distributes food bags directly to those in need.

“The demand has always been there,” says Cank, a sturdy, cheerful woman who has worked in community care for 25 years. “But that demand has escalated. At the beginning of this year I suddenly realised there were just more people coming. To be honest, I think most people would be shocked by the growing need for basic food.”

Three grandmothers from the estate admit that times are indeed tough. “We’d be lost without the food from here,” says Joan. “It’s the fresh fruit and vegetables that are so good,” says Julie. “The benefits are just not enough to get us through.” Each of them is the matriarch of a family blighted by unemployment and need. “The food from FareShare helps us to make things go further.”

The Joseph’s Storehouse project in Loughborough, run out of a pub that’s been converted into a homelessness hostel, has also seen more and more people coming to its doors for food parcels. “We’ve gone from about a dozen a week to over 100,” says project manager Judith Spence. The main change, she says, is the type of people coming. It used mostly to be single men; now she is seeing many more families.

Bruce Bateson, who acts as carer for his wife and for his young child, knows the pressures families are under. “We’re all unemployed in our household and simply didn’t have enough to feed ourselves,” he says, as though it is a blunt fact of life. So how important is the food? “What I can get here saves me £15 or £20 a week, and that enables me to get other bills paid.”

I ask Spence if there’s been a very recent increase in demand. At first she says no, but then she begins flicking through the list of registered users. Every user of the service has to show they are on benefits to register. Once every three months, she says, she goes through the list and takes off those who haven’t come to them for food in the previous three months.

She squints at the list. “I take it back. In the past three months I haven’t taken anybody off the list, but another 200 have come on. The number of users has doubled.”

The FareShare headquarters is on a light industrial estate in Bermondsey, south London. Here, major food manufacturers and supermarkets deliver their leftovers to an airy warehouse filled with industrial-scale fridges.

Some of it is the result of poor forecasting of demand, resulting in oversupply. Some of it is too close to the use-by date to go on sale, or has a misprint on the labelling or damage to the packaging. The warehouse is stacked with pallets of instant gravy granules and jars of pickled cucumbers. The fridges are filled with boxes of apples and tomatoes, with fresh milk, and a curious amount of jarlsberg cheese.

Because they are there to make use of what the food industry does not want, they can be a repository for anything from the most banal to foie gras parfait and rib-eye steaks.

Lindsay Boswell, the charity’s chief executive, makes no secret of the fact that the original motive was making better use of the environment. “We started out purely interested in liberating waste,” he says. “We are an environmental charity that gets bloody angry about food being wasted.”

Hence much of the early effort lay in getting the supermarkets to admit they were wasting food, and to make use of the surplus rather than use landfill sites to get rid of it.

Despite FareShare’s efforts, it estimates that it only handles 1% of the three million tonnes of food that goes to waste every year. Now, though, the work of the charity has moved on. “We’re clear that alleviation of poverty has become the side that leads. I think most people in this country would assume that generally people can feed themselves. But they can’t.” If all FareShare was concerned with was waste, he says, it could just give food away to commuters. “But that’s not what we’re about. Demand for our food is going up faster than we can source it.”

Its findings are backed by the experiences of the Trussell Trust, a Salisbury-based charity that runs around 100 food banks all over the country, providing emergency supplies to people referred by frontline social services and care agencies. In the past year, it has seen a 50% increase in the number of people the food banks are feeding, from 41,000 a year to 61,500. Part of that, the trust says, is simply due to the expansion of the charity’s work.

“But there is also a definite increase in need,” says Jeremy Ravn, the charity’s food bank network director. “We’re seeing a larger number of younger people who are unable to find work. But there’s also an increase in those who were, for want of a better term, normal working people. Those who have lost jobs or who were running their own businesses and still need to feed their families.”

The problem, he says, is a failure by the welfare state to react quickly enough to need. “There can be a terrible lag between an application for benefits being accepted and the money coming on stream.”

Martin Caraher, professor of food policy at City University London, says recent research confirms what both the Trussell Trust and FareShare are seeing. “There are around 13 million people in Britain living in poverty, which is defined as earnings of 60% of the national average. Of those, four million are suffering nutritionally related consequences. And the big new group who are really suffering are working families.”

FareShare is dependent on volunteers, to help get deliveries in, catalogue them, and then make up the packages for distribution. Each delivery day, community food members are phoned up, told what’s on offer and asked what they would like. Organisations pay a small weekly fee for the service, which is a tiny portion of the cost of the food they receive.

For a day I join the volunteers in London. Out in the van we travel from homeless hostel to drop-in centre to homeless hostel and across to the Refugee Council. At each place the story is the same. More and more people are coming to them for the hot meal service. There are more and more people who need to be fed.

“We couldn’t live without the FareShare deliveries,” says Grant, a resident at an Emmaus community, a halfway house for homeless people coming off the streets. Grant used to be a chef and now helps to cook the meals for his fellow residents. “It makes a serious difference,” he says.

Cecilia Mpamugo, chef at the Refugee Council’s drop-in centre in Brixton, south London, cooks food for at least 100 people a day, many of whom have no other way to get a hot meal. “It’s shameful that the food would otherwise go to waste. And the quality is very, very good.”

So is FareShare part of the solution to Britain’s growing food poverty crisis? Lindsay Boswell thinks not. “We’re in the business of addressing the symptoms without addressing the disease. We are simply part of the alarm system.”

And the warning bells are ringing very loudly indeed. Food poverty is on the rise. The question remains: as politicians and lobbyists wine and dine each other around Manchester this weekend, is anyone listening?

Original Article by at The Guardian

LASS regularly welcomes an NHS Dietician to deliver sessions here at LASS. These sessions include one to one appointments, group discussions and activities where service users have been involved in making healthy smoothies and fruit kebabs!

We have had to make changes to the Foodbank scheme last year due to restraints in funding. Whilst the amount in vouchers has been reduced we are now able to offer a food hamper on collection dates thanks to the food provided by FareShare Leicester. Service users are able to choose from a selection of produce which includes fresh food. Over the last year 74 people have benefited from regular Foodbank payments. Feedback for this change in service has been very positive

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HIV tests to be offered in high-prevalence areas

Hundreds of thousands of people living in areas with high HIV infection rates face pressure to be tested for the virus under new plans designed to curtail its spread.

NHS staff will be told to “offer and recommend” tests to all those who use A&E services and register as new patients with GP practices in high prevalence areas in England. This move effectively forces patients to opt out of the testing.

In areas where more than two in 1,000 adults have been diagnosed with HIV, anyone who has a blood test for any reason should be offered a test for the virus too, according to guidance issued by the National Institute for Health and Clinical Excellence (Nice).

The testing will cost nearly £16m a year and affect 37 primary care trusts, 26 of which are in London. Those outside the capital include Blackpool, Brighton and Hove, Birmingham, Leicester, Manchester and Milton Keynes.

The policy, say its supporters, should lessen the stigma sometimes affecting gay men and black Africans, who make up significant proportions of those with the condition. Instead, HIV testing will become a more routine part of NHS healthcare.

Ben Tunstall, of the Terrence Higgins Trust, said the guidance was a vital step forward. “We urge anyone having sex with different partners to make regular HIV testing a priority. These guidelines need to be put into practice to combat onward transmission of HIV and reduce the unacceptably high levels of undiagnosed HIV that we’re still seeing in the UK.”

Keith Radcliffe, president of the British Association for Sexual Health and HIV, said: “The later people are diagnosed with HIV the more difficult and expensive it is to treat them, the poorer their outcome may be and the more likely they are to have transmitted the infection.”

Mike Kelly, director of the centre for public health excellence at Nice, said: “For many people of black African heritage there is a fear that being diagnosed HIV positive will result in social exclusion, or racism and prejudice from both inside and outside their community. As such there is often a reluctance to be tested, which can significantly delay diagnosis.”

Nice is acting on recommendations from health professionals, including the Health Protection Agency (HPA), to take a tougher line on testing.

The move also endorses the policy of the British HIV Association of offering tests to patients attending genito-urinary and sexual health clinics, antenatal and abortion services, or drug dependency programmes, and those treating people with TB, hepatitis or lymphoma.

The guidance was published alongside HPA figures suggesting that 46% of 6,750 estimated new HIV diagnoses in the UK last year were linked to sex between men, half were thought to be through heterosexual contact, with the rest attributed to causes such as infected needles, contaminated blood products and mother-to-child transmission.Of the new diagnoses, 3,780 people are thought to have acquired HIV in the UK rather than abroad, a figure that has doubled in the last decade. It includes 2,530 men who had had sex with men, and 1,150 people who were probably infected through heterosexual contact.

Source: http://www.guardian.co.uk/society/2011/mar/23/hiv-tests-offered-worst-hit-areas

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Appointments are not always necessary, if you would like a test, please contact us on 0116 2559995

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Jonathan Grimshaw: ‘I tested HIV positive in 1984’

Jonathan Grimshaw was one of the first men to be infected by HIV in Britain. Here, he talks about survival and the illness that has become his life’s work

Jonathan Grimshaw at home in East Sussex. Photograph: Sonja Horsman for the Observer

By the beginning of 1987, Jonathan Grimshaw had established himself as the UK’s most visible HIV-positive man. He looked striking: he was 32, bald and he often wore a bow-tie. He spoke eloquently about a terrible disease, something he’d been diagnosed with soon after the tests became available in February 1984. With no specific treatments, his prognosis was not good, but he believed his best chances of survival lay within the realms of activism, honesty and education. So he wasn’t at all surprised one day to be seated on a sofa for an explicit live television programme with Claire Rayner.

It was National Aids Week, the first of its kind, and all the channels had given up airtime to support the government’s unprecedented public health campaign. Everywhere one looked, there was a nervous health minister explaining that we were all at risk and how best to protect ourselves. In the ad breaks, there were images of icebergs and tombstones and the voice of John Hurt imploring us not to die of ignorance. And as the country sat down to dinner, it was greeted with the sight of an agony aunt with a condom in one hand and something else in the other.

“She had been sent a very peculiarly shaped wooden phallus by a fan,” Grimshaw recalls, “and she was trying to get this condom on to this very fat phallus. First take, she couldn’t get it on. KY all over the place. She had this blouse which she was getting black marks on because of the KY. Second take, she couldn’t get it on. Third take, she finally forced the condom down on this wooden monstrosity.”

Claire Rayner, alas, is no longer with us. And nor are almost all of Jonathan Grimshaw’s friends from that time. But at the age of 56, Grimshaw is still in fairly good health, one of this country’s longest-surviving, HIV-positive men. After a period of retirement, he is once again engaged with HIV work and, as we approach the 30th anniversary of the first Aids case in the UK, he finds himself reflecting with a mixture of sadness and wonderment.

“It’s so horrific looking back. I don’t look back very often. It’s hard to conceive that it was actually all happening – you’d get phonecalls to say, ‘So and so is ill’, and it wasn’t that they were ill – they were dying. And you would see them dying. Over the course of a couple of years, you would see them wasting away, you’d go to see them in hospital and you’d go to their funerals. And it was one after another. I don’t know how we did it. Most of the people I knew, most of my friends, died. I was talking to another friend of mine recently who’s also got HIV, and who’s also one of us long-term survivors, and he said that although we’re well and there are treatments, there isn’t a single day that goes by without you having been affected by it.” Grimshaw laughs, as he often does, as a release. He adds: “That’s all I can say about it really.”

But of course there is more. Grimshaw lives with his long-term partner in an elegant, 18th-century, beamed house in Tunbridge Wells. He says that he first became fully aware of HIV the same way many of us did – by watching a 1983 BBC Horizon programme about the epidemic in New York. He had lived in New York a few years before and not long after his return to London he began to see stories about a mystery illness in the newspaper Capital Gay. “But I didn’t know anyone personally affected by it. It seemed to be in America, remote, and it didn’t seem like anything that was going to affect me very much.”

It became more personal in 1983. “An ex-partner of mine called me up and told me that somebody who we’d both slept with at some time in the past had got this new disease. And the doctor who was treating him had suggested that all of his sexual partners should attend the clinic just to be monitored. At that time, the cause wasn’t known, but it was thought there was a sexual transmission element.”

He attended the St Stephen’s clinic, which became part of the Chelsea and Westminster Hospital. He seemed to be fine, but was asked to come back every three months.

“So I kept going back. Then on one visit later they said they had tested my blood for this new virus which was thought to be the cause of Aids and the test had come back positive. I think I was one of the first people to be tested in the country. You just think, ‘Oh Jesus, I’m going to die. I’ve got this disease, and if I have intimate sex with somebody I can kill them.’ You can’t really take in much more than that. The doctor was saying, ‘Will you be able to cope?’ and I was saying, ‘Of course I’ll be able to cope’, and then I left the clinic reeling.

“I didn’t have a partner at the time. I told my parents and I said I wanted to go home for a few days to see them and talk about things. I was in a pretty bad way emotionally. But they didn’t want me to go home. I had a younger brother who I think at the time was 13 and they just didn’t know if there might be some kind of risk to him from my going home. It was terrible. On one hand, I could understand what they were saying and even sympathise with it. On the other, I was dreadfully upset. It really felt like a rejection. I told a very helpful nurse at the clinic what had happened and he said, ‘Do you want me to talk to them?’

“My parents lived in the north-east, so they came down, and this nurse took them through the risks and how it could be transmitted and not transmitted, and for them being able to hear this with a medical hat on reassured them. So after that I was able to go home.”

Grimshaw learned that the Terrence Higgins Trust was about to set up a support group for people who were infected but evidently healthy. “I made sure I was in it – I really was not coping at all well. Drinking quite a lot and completely not knowing what I was going to do.”

There was no treatment against the virus, and no known prognosis, but there was much prejudice. “Because there wasn’t a scientific explanation,” Grimshaw recalls, “all those very ancient theories about what causes disease came up – the idea that disease is some kind of punishment. Those are very difficult things to dislodge.”

The first support group was only intended to last for six weeks, but Grimshaw recognised a need to extend this and co-founded the organisation Body Positive in 1985. This provided a telephone helpline, counselling and hospital visits and spread out from London to 43 local groups.

It was around this time that Grimshaw became the acceptable public face of HIV. “I suppose I felt at that point that people had to take me as I am. It became obvious to me that the way the stigma was partly going to have to be dealt with was that the public needed to see people – as I thought, fairly normal people – on television talking about it, about how if affected them as a human being. I also felt I had nothing to lose – I was probably going to die. There were a few periods when I was on television a lot and I remember I would be careful not to stand at the edge of the tube platform. There were stories about people with Aids being attacked and things could be quite violent.”

Grimshaw looked after himself as best he could. He joined a gym; he ate well. And then there was his work, the sense of fighting the virus by doing something. “Psychologically, that was hugely important to me. I remember a few people who got very involved in the activism used to say, ‘This is the best thing that has happened to me – I’m doing something with my life now that’s really important and worthwhile, and if HIV hadn’t happened I would never have done anything like this.'” (Before his new mission, Grimshaw worked as a television production manager; his last project before diagnosis was a six-part series for Channel 4 called Survive.)

Grimshaw’s work expanded from Body Positive to include consultative and educational roles at many Aids organisations. He also sat on the first committee responsible for planning the Conservative government’s public health campaigns, advising ministers on the most effective language to persuade gay men to protect themselves. He remembers fearing a backlash “if suddenly the public was being told what gay men did in bed”.

His counselling work culminated in the establishment in 1989 of the Landmark, a day centre in south London. It was opened by Princess Diana; a year later, Grimshaw was awarded an MBE, the first such honour for someone in the HIV sector. Looking back, he flippantly suggests he may have had “a kind of Aids activist compulsion disorder”. Regarding his public visibility he says: “I may have been a bit overexposed. I was told at one point that people were calling helplines asking if HIV made you lose your hair.” In fact, his baldness is due to alopecia (“like Matt Lucas”).

During this period, his blood was monitored every three months. For more than a decade, his T-helper cells, the standard gauge of a responsive immune system, remained high. Grimshaw was fortunate to be a slow progressor.

Fifteen years ago, things slowly changed. His T-cell count began to decline and he found he was continually exhausted. He retired from the Landmark in the mid-90s (the centre now caters for people with learning disabilities), and moved to Brighton, where he bought himself a flat and tried not to be too pessimistic. “If you looked at the downward slope on the graph it wouldn’t be too many years before it hit bottom and I’d be done for. The advice at the time was, ‘Cash in your pension, have a good time with the years that you’ve got left.’ So that’s what I did. I thought that was it.”

But then the drugs took effect. The new treatments, known as protease inhibitors, worked particularly well when taken in a carefully balanced combination, and Grimshaw has had to modify his particular cocktail a few times to combat resistance. Although bouts of breathlessness require him consciously to conserve his energy, he remains largely well. He is a little hard of hearing, but he attributes this to standing too close to nightclub loudspeakers.

Five years ago, he decided to stop the Aids work completely. But last year he came across a study by the Terrence Higgins Trust into the lives of people over 50 with HIV. “There were echoes of how things used to be and it got me very annoyed again. It’s been found that people with HIV are experiencing diseases of ageing, like heart disease or liver disease or kidney disease 10 to 15 years earlier than the general population. A lot of them are quite likely to be poor, because they’ve cashed in their pensions, they haven’t worked for a long time. And there are still problems even in the NHS of people experiencing stigma and discrimination.” Grimshaw volunteered again to work on strategy.

As of June 2010, there have been 26,262 diagnoses of Aids in the UK and there are about 90,000 people living with HIV. I ask Grimshaw how many people from the original Body Positive support group were still around.

“I think they’re all dead. Four definitely are and the fifth I lost touch with. I think I would have heard if he was still alive.”

I wonder whether he ever asks himself: “Why me?”

“Not really. I don’t think my survival is a result of anything I’ve done or not done. I think it’s just a particular make-up of my immune system. I am extraordinarily lucky.”

Source: http://www.guardian.co.uk/society/2011/feb/06/jonathan-grimshaw-hiv-aids-survival

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