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The Truth About HIV

WATCH: Thursday BBC1 at 9pm

HIV has claimed around 35 million lives worldwide. But now, as Dr Chris van Tulleken reveals, cutting-edge science can keep the virus at bay or even prevent infection altogether. As a new preventative treatment called PrEP is rolled out on the NHS in Scotland, and new trials are announced in England and Wales, HIV is under control, in Britain at least, but only when it can be detected and the treatment with antiretroviral drugs (ARVs) can begin.

Chris meets a woman whose husband died without ever knowing he had the condition, by which time he had infected her too. But Chris also finds out how ‘viral loads’ can now be reduced to allow patients to lead healthy lives – and even prevent them infecting anyone else.

Chris meets HRH Prince Harry for an interview at the Mildmay Hospital, an HIV hospital made famous by Diana, Princess of Wales, where Chris also meets a patient whose undetected HIV led to serious brain damage.

Prince Harry visited LASS in March this year, during his visit he took time to reflect on the changes for people living with HIV and unveiled a plaque marking the start of LASS’s 30th year. He was able to look at the history of LASS and viewed the panels that were launched by Princess Diana when she visited LASS in 1991.

HRH Prince Harry unveils a unveiled a plaque marking the start of LASS’s 30th year. With Evernice Tirivanhu, Jenny Hand & David Rowlands

Partner organisations joined LASS in a training session led by Juliet Kisob and Sadiya Mohamed.  They looked at the role of community HIV testing in encouraging people to know their HIV status and to help reduce late diagnosis.  They were joined by Prince Harry for workshops where they used a case study to look at how critical partnerships are to breaking down stigma and to identify new places for LASS to test in our 30th year. In Leicester 59% of patients are diagnosed late, which is 20% higher than the national average.

In the BBC documentary, airing on Thursday evening,  Dr van Tulleken visits a clinic in KwaZulu-Natal, South Africa, where tens of thousands are still dying with seven out of ten of people infected worldwide living in sub-Saharan Africa,

He meets an schoolgirl living with HIV and realises that local attitudes to testing are still leading to unnecessary deaths. But Chris also meets clinicians taking mass testing out to the villages and meets a man whose life was saved as a result.

Back in the UK, talk of a cure may be premature, but Chris finds out more about the controversy around the rollout of PrEP which, when taken daily, can prevent someone becoming infected in the first place.

Why Take a HIV Test?

Some people think taking a HIV testing is scary, but honestly it shouldn’t be. The condition is entirely manageable.  If you test positive, early detection, monitoring and effective treatment means that your life can largely carry on as before.

Incredible medical progress has been made in the last 20 years and HIV treatment is now very effective. If you are diagnosed with HIV before it has damaged your body and you are put on effective treatment, you can expect to live as long as anyone else.

HIV treatment aims to lower the amount of HIV in the body to undetectable levels. Global research, known as the PARTNER study, has found that HIV cannot be passed on when the virus is undetectable. In other words, if someone is on effective HIV treatment, it is extremely unlikely that he or she will pass on HIV to anyone else.

This is a massive breakthrough. It means that if everyone with HIV were on effective treatment, we could finally stop the spread of HIV. Until then, it is essential to use condoms to protect yourself.

There are many ways you can test for HIV, you can visit LASS for a free, confidential rapid HIV test, you can sample your own blood/saliva and send it to a laboratory for the results which are then sent back to you (free) or you may wish to purchase a test which gives you a diagnosis in the comfort in your own home.  More information on HIV testing at LASS, at home, elsewhere in Leicester/shire and testing locations around the UK are available online here: http://www.lass.org.uk/hiv-testing/

 

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How HIV became a matter of international security

Governments around the world were slow to get to grips with HIV/AIDS. But a big change came when they started understanding it not just as a health issue but as a security threat too. Alexandra Ossola investigates.

Richard Holbrooke sat in a blue striped chair in the meeting room of the United Nations Security Council. It was a rainy, unseasonably warm January day in New York City, just ten days into the new millennium. Many people were still relieved that the Y2K millennium bug hadn’t wreaked havoc on computers, as some experts had feared. And yet, during the council’s seven-hour meeting, it was clear that a bigger, real threat was looming.

Doctors had identified HIV/AIDS more than 15 years before, but only by 2000 was its true global impact beginning to become clear. Holbrooke, the US ambassador to the UN, then sitting as president of the Security Council, had pushed for this meeting because he had seen first-hand how AIDS could devastate communities. In 1992, he had visited Cambodia and saw UN peacekeepers who, at the end of the day, would get drunk and visit brothels. Holbrooke was sure this behaviour was spreading HIV locally, and that the peacekeepers would bring the disease back with them to their home countries.

He had seen the impact even more dramatically in 1999, when he and his wife visited Africa. Children whose parents had died of the disease slept in gutters; even AIDS activists were so stigmatised they arrived to meet him in a curtained van. Conversations with leaders in countries like Namibia and South Africa showed Holbrooke they weren’t doing nearly enough to combat the disease. The trip galvanised him. AIDS was spreading, regardless of borders, in a way that threatened the stability of states. So, if national governments weren’t taking action, perhaps the world could.

But Holbrooke was met with resistance. Congressmen criticised him on television; friends and dignitaries warned him privately not to confuse humanitarian issues with national security. How could a disease be an issue of national security, they argued – no disease ever had been. “I was told by everyone, including my own staff, ‘You can’t do this; it’s not done; it’s not in the UN charter,’” Holbrooke said in a 2006 interview with PBS. “And I said, ‘But AIDS is a security issue, because it’s destroying the security, the stability of countries.’”

Luckily, Holbrooke found the Security Council more amenable as he pushed to discuss HIV/AIDS. Only Russia was opposed, which Holbrooke thought was ironic since the prevalence of HIV/AIDS in Russia and its surrounding countries was rising rapidly.

Eventually, Holbrooke prevailed. Russian representatives agreed to sit in on the meeting, but wouldn’t speak or participate. That suited Holbrooke just fine. And on 10 January 2000, representatives from all 15 countries took their blue seats in the Security Council meeting room to hear 40 speakers discuss the threat and impact of HIV/AIDS.

AIDS became the first epidemic in modern history to morph beyond a topic of public health into an issue of national and even international security. Without collaboration between countries, between scientists and military personnel, between industry and government, the disease would have claimed more than the 35 million lives it has to date.

There are other events that could qualify as turning points in the fight. The 2000 conference held in Durban, South Africa, at which Nelson Mandela delivered a heartfelt appeal to the international community. Or the 2002 G8 summit in Alberta, Canada, at which global leaders rolled out a plan to support Africa, in it mentioning their dedication to eradicate HIV/AIDS. Or 1987, when the US Food and Drug Administration announced AZT as the first approved treatment for HIV, due in large part to lobbying from gay activists. Or 1995, when the agency approvedHAART, the drug cocktail that most people with HIV/AIDS take every day to stop the progression of the disease.

But the Security Council meeting was critical. The meeting on that balmy January day marked the first formal discussion of HIV as an issue in which the government and military must get involved to protect a country and its interests. Seven months later, the Security Council passed a resolution calling for more training in AIDS prevention for UN peacekeeping forces and encouraging member states to work together for better prevention and treatment policies.

The rhetoric of national security has shaped the way activists and officials address epidemic diseases today, solidifying partnerships and funding streams. And though there are clear advantages to this large-scale, top-down approach of military involvement, there is much to learn about the best way to stop a pandemic.

By the early 1980s, diseases that ravaged the human population seemed like they might become a thing of the past. Smallpox had been eradicated worldwide by 1980; vaccination campaigns during the 1960s and 70s meant that diseases like polio, mumps and measles affected far fewer people. “People were talking about conquering infectious disease once and for all,” says Joshua Michaud, the associate director of global health policy at the Kaiser Family Foundation. “Nobel Prize-winning biologists were saying that we could see the end of infectious disease in our lifetime, and there were reasons to believe that.”

But when AIDS was discovered in 1981, that illusion was shattered. “We had a lot of magic bullets, we had technical fixes to everything. Then HIV happened,” Michaud says.

HIV/AIDS made for a scary assailant. It surfaced mostly among gay people in San Francisco and New York, a death sentence that catalysed activism among the gay community. This activism became critical in helping people gain access to experimental treatment. HIV became highly stigmatised, a “moral” disease, a plague of philanderers and drug addicts.

The disease hits hardest among adults of reproductive age who are otherwise healthy. It’s a threat that respects no border, as George Tenet, then director of the CIA, noted in 2003. And though the effects of AIDS can feel overwhelming when concentrated within communities, they are even more disastrous when taken at a macro scale.

“AIDS is a long-wave event,” says Simon Rushton, a lecturer in politics at the University of Sheffield. “It’s cross-generational. The impacts on societies are long-term, and they accumulate over time.”

More people would die from AIDS than from any other disease outbreak in human history, including the global influenza pandemic of 1918–19 and the bubonic plague in the 1300s, wrote Peter W Singer, then a postdoctoral fellow at the Brookings Institution, in a 2002 essay. If the disease continued to spread at the same rate in places like South Africa and Botswana – where 20 per cent and 38.5 per cent of the population respectively was infected in the year 2000 – life expectancies would plummet by more than 20 years and child mortality would triple within a decade, Singer said.

Intelligence experts estimated that AIDS would wipe out a quarter of all adults in Sub-Saharan Africa.

“[They] were making a logical case that this was going to keep getting worse and worse, that it will threaten viability of most infected states,” Rushton says. Researchers were struggling to understand the epidemic. “There was a fear, perhaps a well-grounded fear.”

Effects like that would put the political stability of these countries at risk, argued innumerable reports and assessments.

The disease would wipe out government officials and educated, trained professionals that make up the backbone of a society, leaving elderly people to care for orphaned children, a process the experts called “hollowing out”. Militaries, which have higher infection rates than civilian populations (in theory because as young, virile men move around, they engage in sexually risky behaviours, swapping diseases with locals and bringing them to the next deployment), would crumble. Destabilised states leave room for extremist groups to take hold, powered by armies of child soldiers under the command of some of the surviving adults.

This worried American intelligence officials. The US would be called upon to provide costly aid to failing states, according to a declassified CIA report from 1987. The Soviet Union would threaten the US’s strategic positioning in Africa – a key concern during the Cold War – by encouraging rumours that American scientists had created HIV and were spreading it throughout the continent to eliminate black people. The disease also seemed likely to spread to places considered geopolitically more important, such as India and China. The Cold War ended, but, as the epidemic persisted after 9/11, the potential rise of more extremist groups seemed even more threatening. Of course, US officials also feared the disease taking a stronger hold at home, affecting more than those groups relegated to society’s fringes. It could weaken the military and put America’s own stability at risk.

Intelligence agencies had been predicting the destabilising effects of AIDS since the 1980s, yet the world didn’t present a cohesive response until 2000. There’s no single reason why it took so long, but one was that the science on treatment and prevention was still murky, says Mitchell Warren, the executive director of AVAC, a global HIV/AIDS advocacy organisation. By the late 1990s, scientists had shown it was possible to treat and prevent the disease, which was enough to spur activists and political leaders to act. Short of a cure, the only way to stop the epidemic from ballooning was prevention.

§

A 25-year-old woman living in rural Malawi found herself very ill. She had shingles and malaria that wouldn’t go away; her weight had dropped precipitously. Though programmes to diagnose and prevent HIV had been running in the country for several years, this woman had never been tested, and neither had her four-year-old son. “She was living in denial, she didn’t want to discover she was HIV positive,” says David Odali, the director of the Umunthu Foundation, a non-profit that offers HIV testing and treatment and runs education campaigns in Malawi. The woman’s family encouraged her to go to Umunthu’s clinic in the small town of Bangwe, where both she and her son tested positive for HIV and started receiving treatment.

It saved her life; in the years since, the woman has had two more children, both of whom are HIV negative. The mother is able to do some work, more than she could do when she was ill, and the son is thriving in school. “He’s brilliant in school,” Odali adds. “He does come here sometimes on his own to get his treatment,” though his mother only recently helped him to understand why he was taking medicine every day when he didn’t feel sick.

Cases like this one are no longer uncommon. There’s no denying the huge impact that AIDS has had on the world population – in 2015, the World Health Organization (WHO) estimated that about 70 million people have been infected with the virus, and 35 million have died. And yet the effects have not been as dire as once feared; in 2001, experts predicted that 100 million would be dead from the disease by 2005.

Bold, creative individuals – scientists, activists, NGO workers, healthcare professionals – made this happen. But they wouldn’t have been there, their organisations unfunded, the research not conducted, without support from national governments.

The US government, for instance, allocated $6.6 billion to fight HIV/AIDS abroad in 2016 (independent of the $26.4 billion it spends on domestic programmes), making its budget many times larger than those of the UK, which allocated $980 million to fight AIDS in 2015, and Germany, at just over $200 million.

The bulk of the US money comes under the President’s Emergency Plan for AIDS Relief (PEPFAR), and trickles down through different government departments, such as Defense, State, and Health and Human Services, and diffuses into smaller agencies and non-profit organisations, or directly to foreign governments for their own treatment and prevention programmes, says Warren. About a fifth is carved out for the Global Fund. “Both of these organisations were the result of this call in 2000 of a need to change the way the world responded to HIV,” Warren says.

To Warren, it’s clear that the response would not have been as robust if HIV had not been considered a matter of national security. The reframing compelled tight-fisted government officials to make room in the budget. “At the end of the day, the most important people at the country level were not ministers of health. They’re ministers of finance,” Warren says.

The security dimension makes it a bigger political issue than public health, Simon Rushton says. It’s high politics. Peter Piot, who was director of UNAIDS for 13 years, says that this helped establish HIV/AIDS as an exceptional epidemic, requiring an unprecedented level of resources and coordination across sectors.

This produced real results. More than 18 million HIV/AIDS patients worldwide were receiving treatment in 2016, and the number of new cases per year dropped by 40 percent between 1997 and 2015.

It’s impossible to know what would have happened if the national security appeal hadn’t had this effect. As Warren puts it, if something didn’t happen, they’d succeeded. Some feared that the framing would divert funds from other public health issues, such as tuberculosis and malaria. Others said it would further stigmatise people. In Europe and Russia, for instance, people from Africa already faced discrimination in housing and the job market because they were feared to carry disease. The same happened to Haitians in the US.

And though it pulls in more money in the short term, framing one disease as a security issue may absolve countries from engaging with future epidemics that don’t present a security risk, wrote Susan Peterson, a professor of international relations at the College of William and Mary in Williamsburg, Virginia, in 2002.

The security framing may also shift the focus of the HIV/AIDS spending itself. When PEPFAR launched in 2003 with a budget of $15 million, its efforts initially focused on 15 countries. These were not the top 15 countries affected by AIDS at the time. “People have looked at that initial list,” says Rushton, “and it looks like it’s at least partly motivated by security concerns.” He notes that Vietnam, one of the 15 countries on the original list, had only 220,000 cases of HIV/AIDS in 2004 – a mere fraction of the number of people infected in Malawi (940,000), which did not receive initial attention from PEPFAR, and far less than Russia (more than 320,000), which similarly received no support.

And though countries like South Africa were at the centre of the AIDS epidemic and deserved the funding and attention they received, critics have suggested that global powers, including the US, might have been more invested in their political stability.

David Odali still struggles to get enough funding for Umunthu’s ambitious programmes, although a six-year partnership with the NGO AVERT has enabled them to reach out to more patients. Though he and his collaborators have had many successes, there were still 33,000 new cases of HIV in 2015 in Malawi. “As we are talking, someone out there is contracting the virus, through unprotected sex, through rape, through caring for a patient,” he says. “The infection is still there with us.”

§

When West Point was first dredged from the sea, in the 1940s, it was probably a beautiful place. This neighbourhood at the most northwestern point of Monrovia, Liberia, is a peninsula, cut off from the rest of the city by two rivers to the north and east, and with the Atlantic Ocean to the west. Its beaches are a sandy yellow, and a few palm trees dot the shore. But today, that beauty is only visible in fleeting moments, like afternoon light through slanted blinds. West Point is a slum, home to 75,000 people who live in densely packed houses cobbled together from roofing tin. Its beautiful beaches are coated with a layer of garbage. Many former child soldiers, disabled by war, live here; drug use is common. There is a market on the one main road that connects the neighbourhood with the rest of the city, on which patrons can buy shark freshly caught by the fishermen who shove off the beaches in long, narrow boats.

Since there’s only the one road, it wasn’t hard for the Liberian army to quarantine the neighbourhood one cool night in the heat of the Ebola crisis in August 2014. The week before, health officials quietly converted a school building into an Ebola holding centre; when the locals found out, some looted the facility, carrying off items that had likely been contaminated. So when the Liberian president issued a curfew on 20 August, West Point was also put under quarantine. Residents awoke that Wednesday morning to find their commutes thwarted by barbed wire; fishermen were stopped from pushing off in their boats.

The locals rioted. They rattled barricades and threw rocks at soldiers, who responded by opening fire. Food and water were hard to find, medical care was even rarer. After 10 days, the president lifted the quarantine. A 15-year-old boy died of complications from bullet injuries in his legs. “You fight Ebola with arms?” a 34-year-old resident yelled at the soldiers, according to the New York Times. No one in West Point was diagnosed with Ebola.

In the wisdom and comfort of hindsight, experts can assess the world’s response to emerging pandemics. The 2009 H1N1 (swine flu) outbreak was well-contained, partly because of good communication and partly due to simple luck: the disease wasn’t as deadly as feared. The Middle Eastern respiratory virus (MERS), which hit South Korea in 2015, didn’t spread because it didn’t evolve and was quickly contained.

But to many experts, the world’s response to Ebola was wanting. Public health officials admit that action wasn’t fast enough, that misinformation spread quickly among a largely illiterate population, that foreign policy makers lacked a cultural understanding, which allowed the disease to spread, and that governments in the most affected countries used too much force. As a result, more than 11,000 people died of the disease in West Africa.

And yet the death toll would have certainly been higher if not for the lessons learned from HIV.

The engineers of the world’s HIV response in the early 2000s knew that they were laying the groundwork to combat future epidemics. Richard Holbrooke, who died in 2010, said in his 2006 PBS interview: “There’s a possibility that we’re entering into an age where new diseases are beginning to break out… If that’s true – and a lot of friends of mine in the field think it is true – the first lesson is you’ve got to move really fast. The second lesson is you have to get away from mythology, stigmatisation and all these other things that created such a slow, slow reaction to AIDS.”

Because of HIV and those discussions that began in 2000, governments and international organisations have logistical protocols to address new epidemics. Emerging diseases are now discussed at the Security Council, as AIDS was. Should a new one arise, officials in the US government, along with international organisations such as the UN and the WHO, have designated procedures for assessing the threat and working with experts on the best way to respond. Time, they have learned, is of the essence – the slow growth of HIV diagnosis programmes meant that many people spent a long time unknowingly infected – during which time they infected others; physician and radio show host Stanley Monteith wrote in 1997 that the AIDS epidemic would have been preventable had health organisations acted earlier.

Now experts know that early response is key. By April 2003, six months after the severe acute respiratory syndrome (SARS) epidemic started, the US had 289 suspected cases, But the disease didn’t spread because of good planning and communication between local and federal health workers, public health officials told the New York Times. And the impetus for that was laid in the framing of the disease as a threat to national security.

In the process of meeting the need for HIV testing and treatment in remote areas, many African countries developed sophisticated systems to monitor emerging diseases. Ebola would have been a disaster if it had spread throughout Nigeria, the most populous country in Africa and a hub for international travel. But it didn’t, Warren says, because of systems put in place to combat HIV which were then used to fight Ebola. “The surveillance system and treatments of those Nigerians with Ebola was so rapid that the disease didn’t spread,” Warren says. “If you look at why, it’s because the health system had been developed and strengthened from the HIV response.”

Researchers are also in a better position to meet the challenge of a new infectious disease. Epidemiologists developed new techniques, such as contact tracing, in which scientists work backwards from a newly diagnosed patient to determine where else the disease might spread. Teams of scientists brought together to discover treatments for HIV have used their expertise to treat other rapidly mutating diseases – a team of HIV researchers at Walter Reed Army Institute of Research, based in Maryland but with facilities in Africa and South-east Asia, created one of the most promising vaccines to fight Zika virus. And when it comes to disease research within communities, scientists have found that they get much more cooperation if they work with local governments and community advisory boards before starting a project.

Charged by the national security argument, militaries – especially the US military – have become the quickest and most efficient force for quelling emerging infectious diseases. “The only institution that was felt could address Ebola at the scale at which it was needed was the US military,” Joshua Michaud says – the army had the communication, infrastructure and transportation to get the job done.

But that can come with a cost. The need to act quickly can sometimes elevate issues past the normal democratic checks and balances, so they are subject to less scrutiny. When security is at risk, it gives militaries licence to infringe on civil liberties. That’s what happened to West Point during the Ebola outbreak. It happened elsewhere, too – in the US, many questioned the quarantine practices of the Centers for Disease Control and Prevention. One woman, a nurse quarantined for two days after she returned from treating Ebola patients in Sierra Leone, tried to sue the governor of New Jersey for unlawful detainment (a judge dismissed the lawsuit in September 2016).

“One downside is that the security discourse can be misappropriated by those in power and used improperly to justify punitive policies and laws, which are only likely to fuel stigma, fear and spread of disease further,” Peter Piot says. “The military has a role to play, we just have to think in a considered, nuanced manner about how they can best support civilian-led efforts to contain pandemics.”

Each new pandemic will be different – where it starts, how contagious it is, how it’s transmitted. But as government agencies push to act quickly, more officials are realising that the first actions taken to fight a disease can determine whether the efforts are successful. If misinformation spreads early on, it can lead infected people to be stigmatised, which may inhibit them from receiving the best possible care. Warren recalls photos from the early days of the fight against Ebola in which healthcare workers were reluctant to touch patients.

“For a lot of us working with HIV, some of those pictures were harsh reminders for what it meant to be patient-centred in our care,” Warren says. “The stigma and culture around disease, around clinical research, is really intense. We need to be sensitive to that.” Public health workers had collaborated with community leaders before, but they had never tried to create these partnerships on such a massive scale until the HIV response. Ceremonies surrounding stages of life, such as birth and reaching sexual maturity, create different ways for disease to spread. Only with sensitivity to local cultural practices – what purpose they serve, and how they can be modified while still keeping the main point of the ritual intact – could doctors and researchers stop the spread of disease. Officials were faced with a similar challenge during the Ebola epidemic, when they discovered that traditional burial practices, such as the communal washing and cleaning of the dead body, were spreading the infection.

§

Public health emergencies come and go, but HIV appears to be here to stay, at least for the next few decades. Some fear that, as health workers settle in for a long fight, governments will no longer prioritise HIV as they did a decade ago, limiting the funding to support their efforts. Progress in reducing the number of new infections has slowed. “AIDS is slipping down the policy agenda because we’re also now in the long slog phase,” Simon Rushton says. “We know it’s not something that will be solved in the next five to 10 years – it demands a continued commitment for another 20 to 30 years at least. That’s a much less sexy policy sell. Policy makers like problems they can solve during their term.”

With the election of Donald Trump as President of the United States, the country’s role in the continued fight against HIV/AIDS is further called into question. During much of Trump’s campaign, no one was certain where the candidate stood. There were reasons to feel optimistic about the country’s continued support. In a 2008 speech, Vice President Mike Pence, then serving in the House of Representatives, had said that the US had a “moral obligation to lead the world in confronting the pandemic of HIV/AIDS”, bolstering his stance with a security argument.

But early signs from the new administration have not been heartening. In his first week in office, Trump signed an executive order that withholds funding from organisations that perform abortions or provide information about them. In the past, similar but less expansive policies have resulted in the closure of many rural clinics, often the only place where locals could receive drugs to treat HIV and AIDS. Now many organisations fear the effect will be even more dramatic.

In some ways it’s harder than ever to imagine a world in which infectious diseases no longer exist, the idealistic bubble burst by HIV. And yet in other ways, the world is better poised than ever before to make that fantasy into reality. That single January 2000 meeting set the stage for leaders within countries to have their own discussions about how to respond to the epidemic, about how to spend money to counter it within their own borders and beyond.

As the then US Vice President Al Gore said at the meeting, AIDS “is a security crisis because it threatens not just individual citizens, but the very institutions that define and defend the character of a society”.

“It was one of the most exciting days we had in the UN,” Richard Holbrooke told PBS, “and I think history shows that it helped redefine the issue.”

This article first appeared on Mosaic and is republished here under a Creative Commons licence.

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Hospitals & GP practices fail to test for HIV

HIV test

Some hospitals and GP practices in England and Scotland are failing to carry out recommended HIV checks, a BBC investigation has found.

(Story via The BBC)

Experts suggest patients in areas with high rates of HIV ought to be offered a test when they register with a GP or are admitted to hospital.  But research carried out for BBC Radio 4’s You and Yours programme suggests many NHS providers are not doing this.  Health officials said the prevention of HIV infection remained a priority.

The National Institute for Health and Care Excellence (NICE) is currently reviewing its guidance on HIV testing and is due to release its findings in December. Its existing guidance – last updated in 2011 – says GPs and hospitals in high-risk areas should “consider” testing new patients.

Test and treat

In 2013, the British HIV Association circulated UK-wide guidance that said in high-prevalence areas (where there are two or more people in every 1,000 diagnosed with the virus) all men and women should be offered an HIV test on registration with their GP or when they are admitted to a medical unit in hospital.

This was issued in partnership with organisations including The British Association of Sexual Health and HIV,

Official figures show:

  • Out of 152 local authorities responsible for public health in England, 54 are classed as high-prevalence areas
  • In Scotland, two out of 14 NHS boards count as high-prevalence areas
  • There are none in Wales or Northern Ireland

An investigation by BBC Radio 4’s You and Yours programme found that 82% of hospitals in high-prevalence areas in England were not offering HIV tests in accordance with the guidelines and 70% of local authorities in high prevalence areas in England do not fund all GP surgeries to test patients.

Neither of the two NHS boards in Scotland routinely offers the checks.

In England, local authorities are responsible for funding population based HIV testing in this way.  HIV experts say this could be causing avoidable deaths.  People who are not yet diagnosed risk passing HIV to partners if they are unaware of their status and they will not be receiving HIV drugs to manage their condition.

Dr Chloe Orkin, from the British HIV Association, said: “Testing for HIV is very cost-effective.  Deaths due to late diagnosis are completely preventable through excellent treatments.”

More than 100,000 people live with HIV in the UK, according to figures from Public Health England.  Of these, an estimated 17% are undiagnosed and unaware of their infection.

Barriers to testing

Chairman of the Local Government Association’s Community Wellbeing Board, councillor Izzi Seccombe, said councils were commissioning HIV testing in a variety of settings, not just in GP surgeries or hospitals.

“In some areas, it may be more appropriate to reach out to people by providing tests in the community or at sexual health clinics,” she said.

But she was concerned that cuts to public health funding might affect such services.

The British Association of Sexual Health and HIV (BASHH) urged local authorities to work with local providers to meet best practice guidelines around routine HIV testing outside sexual health services.

A Department of Health representative for England said: “Over the next five years, we will invest more than £16bn in local government public health services.

“While councils have had to make savings, they have also shown that good results can be achieved at the same time, and are best placed to understand where money is best spent”.

Scotland’s Public Health Minister, Aileen Campbell, said:”Prevention of HIV infection remains a priority for the Scottish government, and we continue to provide funding for boards for prevention work.

“The BHIVA guidelines are good practice, and we would expect boards to take them into account while developing their local strategies.”

Have you ever had a HIV Test? – Read here why it’s a good idea and where you can get tested for HIV.

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Why we shouldn’t be scared of ‘The Test’

LONDON, ENGLAND - JULY 14:  Prince Harry has blood taken by Specialist Psychotherapist Robert Palmer as he takes an HIV test during a visit to Burrell Street Sexual Health Clinic on July 14, 2016 in London, England. Prince Harry was visiting the clinic, run by Guy's and St Thomas NHS Foundation to promote the importance of getting tested for HIV and other STDs.  (Photo by Chris Jackson/Getty Images)

Prince Harry takes a HIV test during a visit to Burrell Street Sexual Health Clinic.  Prince Harry was visiting the clinic to promote the importance of getting tested for HIV.  (Photo by Chris Jackson/Getty Images).  Click here to read about Harry’s fight against HIV and his mother, Princess Diana’s Visit to LASS in November 1991. 

Some people think taking a HIV test is scary, but honestly it shouldn’t be. The condition is entirely manageable.  If you test positive, early detection, monitoring and effective treatment means that your life can largely carry on as before.

Incredible medical progress has been made in the last 20 years and HIV treatment is now very effective. If you are diagnosed with HIV before it has damaged your body and you are put on effective treatment, you can expect to live as long as anyone else.

HIV treatment aims to lower the amount of HIV in the body to undetectable levels. Global research, known as the PARTNER study, has found that HIV cannot be passed on when the virus is undetectable. In other words, if someone is on effective HIV treatment, it is extremely unlikely that he or she will pass on HIV to anyone else.

This is a massive breakthrough. It means that if everyone with HIV were on effective treatment, we could finally stop the spread of HIV. Until then, it is essential to use condoms to protect yourself.

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, and so the fear of a silent killer left a scar on our cultural memory which has never really healed, and even in 2016, the mere mention of HIV and AIDS still has a way of stopping conversations.

Thankfully, things have changed since then and treatment for HIV is better now than it has ever been. People who have the condition are now finding that their lives have not changed completely, and they are still able to live as long and do all the same things they could before. It’s true that they now have a few additional concerns to think about but with the help of medication, HIV is now manageable.

HIV is no longer the death sentence it used to be and people are able to live, healthy and happy lives like they did before. However, this is thanks to the amazing progress we have made in treating the condition and we can only begin to do that when we make the decision to get tested and keep on top of our health. Late HIV diagnosis in Leicester is 13.8% higher than the average for England.  It’s a scary prospect to some and no one takes that for granted, but by taking the chance to be tested, you could be buying yourself years of life.

GET A HIV TEST AT LASS

Our Rapid HIV testing service is available Monday-Friday between 9am – 4pm.  You do not need an appointment.

The test is performed at our office on Regent Road, Leicester by qualified and experienced HIV testers.  The process usually takes around 20 minutes.  If you’re unsure, or would like to speak to someone about HIV Testing, please call us on 0116 2559995 or pop in and see us.

The test is free to ‘at risk groups’ and always confidential.  If you’re not at risk, we can refer you to an alternative service who will be able to provide you with a free HIV test.  You can still test with us for £20 or you may prefer a free Home Sampling kit or buy a Home Testing kit from BioSure for £29.95.

Other places which can test for HIV

SHACC (Sexual Health and Contraceptive Clinic) in Leicester.  They offer information, advice and screening for Sexually Transmitted Infections (STIs) as well as HIV in GP settings.  For more information or to book an appointment Phone 0800 75 66 277 or visit shacc.co.uk

St Peters GU Medicine Clinic provide Free, confidential services including STI testing including HIV tests along with A full range of contraception including Post Exposure HIV Prophylaxis – PEP/PEPSE Tel: 0300 124 0102 or 0800 318 908 or visit them online at leicestersexualhealth.nhs.uk

Trade Sexual Health offers a rapid HIV testing service for LGB&T individuals.  Contact them on 0116 2541747 or visittradesexualhealth.com for more information.

There are lots of places where you can get a HIV test if you’re unable to use services in Leicester or Leicestershire.  Visit NAM, they have an online portal which can help you find a service in your area.

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HIV effort let down by test shortages, says WHO

The Most Revd Ephraim S Fajutagana, Supreme Bishop of the Philippine Independent Church, undergoes an HIV test as part of the National Council of Churches in the Philippines public campaign to remove the stigma associated with HIV/Aids.

The Most Revd Ephraim S Fajutagana, Supreme Bishop of the Philippine Independent Church, undergoes an HIV test as part of the National Council of Churches in the Philippines public campaign to remove the stigma associated with HIV/Aids.

A shortage of HIV testing could undermine global efforts to diagnose and treat people with the infection, warn experts from the World Health Organization.  They looked at responses to annual surveys that the WHO had sent to 127 countries between 2012 and 2014 asking about capacity and usage of blood tests that check HIV status and health.

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They found worrying gaps in provision. They warn that United Nation targets for HIV could be missed as a result.

The targets say that by 2020, 90% of all people living with HIV should know their HIV status, 90% of those diagnosed should receive antiretroviral therapy and 90% of these treated patients should have “durable viral suppression” (a measure of effective treatment).

Laboratory testing is vital to meet and monitor these aims.

But Vincent Habiyambere and his colleagues say in the journal PLoS Medicine that some low and middle-income countries, including African countries where the HIV burden is high, are not yet geared up for the challenge.

The surveys were sent to:

  • all 47 countries in the WHO African Region
  • 33 countries in the WHO Region of the Americas
  • all 21 countries in the WHO Eastern Mediterranean Region
  • eight high-burden HIV countries in the WHO European Region
  • all 11 countries in the WHO South-East Asia Region
  • seven high-burden HIV countries in the WHO Western Pacific Region

Over the three survey years, 55 (43%) countries responded to all three surveys, 35 (28%) to two surveys, 25 (20%) to one survey, and nine (7%) responded to none of the three surveys.

Testing provision did improve over the years, but shortfalls remained in some parts of the world.

Worrying gaps

Reasons for the gaps in provision included lack of reagents, equipment not being installed or maintained properly and inadequate or absent staff training. In some laboratories, machines were not serviced regularly. In others, machines broke down and were not covered by contracts to be serviced or fixed.

Dr Habiyambere and his team say: “A national laboratory strategic plan to strengthen services must be developed, implemented, and monitored by governments and their national and international partners.

“The focus of the international community, to ensure optimal use of laboratory technologies, should be on those countries where interventions for scaling up access to HIV diagnostic technologies are most needed.”

They acknowledge that they did not look at private sector testing and that some countries might rely more heavily on this than others.

In an accompanying editorial, HIV experts Peter Kilmarx and Raiva Simbi say the findings show some programmes may have been “overly focused” on buying equipment without planning for how it would be used and maintained.

In Zimbabwe, for example, only 5.6% of HIV patients on drug treatment in 2015 received regular blood checks to monitor their viral load – far fewer than the goal of 21%.  This was largely down to problems with resource mobilisation and specimen transport as well as equipment procurement, they say.

“Strong leadership, resources, planning, and management are needed to scale up laboratory services,” they conclude.

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Annual General Meeting 2015

AGM-2014

LASS Annual General Meeting

Thursday 8th October 2015

  • Doors open 6pm
  • Refreshments at 6:30pm
  • Meeting 7pm – 8:30pm

At Warning Zone: 30 Frog Island, off North Bridge Place, Leicester, LE3 5AG (Location and how to get to Warning Zone).

Everyone is welcome to our AGM; you can bring your family & friends

To reserve your space at the AGM, please enter your name and email address below and we’ll confirm your place.  We look forward to seeing you there!

Halve-It-Logo

Guest speaker

Tom Addison of Halve It

Halve It is a coalition of national experts determined to tackle the continued public health challenges posed by HIV. Their goals are to: Halve the proportion of people diagnosed late with HIV and to halve the proportion of people living with undiagnosed HIV.

The Halve It campaign calls upon all levels of government and their agencies to ensure that HIV is a public health priority both locally and nationally, they are asking the government to:

  • Fully implement National Institute for Health and Care Excellence (NICE) public health guidance on HIV testing.
  • Support the delivery of the Public Health Outcomes Framework (PHOF) by ensuring that local health organisations are equipped to realise the benefits of early detection of HIV.
  • Offer incentives to test for HIV in a variety of healthcare settings, for example through the Quality and Outcomes Framework (QOF) and Commissioning for Quality and Innovation (CQUIN) frameworks.
  • Ensure that people diagnosed with HIV have access to any retroviral therapies (ARTs) to prevent onward transmission in line with the joint recommendations of the Expert Advisory Group on AIDS (EAGA) and the British HIV Association (BHIVA).
  • Ensure quality-assured (ie CE marked) self-testing kits for HIV when available, are integrated into local HIV testing strategies along with home sampling kits.

To find out more about the campaign download their position paper here

For more information on our AGM please contact: Reception@lass.org.uk, or call us on: 0116 255 9995

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Shooting Challenge: Week 5 Winner & Week 6: “Unsafe Sex”

KeeberEstelleHIVTesting

HIV Testing by Estelle Keeber

Congratulations to Estelle Keeber, who created a collage of emotions.  Estelle has said there are various emotions when confronted with HIV testing and there is a mix of people to show that HIV and HIV testing can affect everyone.  She also said this is light hearted, hence the exaggerated expressions but the message is clear.  That it is ok to feel however you want about HIV testing, that everyone is different.  You can see Estelle’s work and that of all our Shooting Challenge entrants (up to last week) at the Positive Art exhibition on Charles Street, Leicester.  (Details here)

Other entrants this week are Celia Fisher, Gavin Whyman and Zoe Van-De-Velde, (images below).  Thank you all for your pictures this week and we can’t wait to see what you come up with next week!

FisherCeliaItStartedWithMe

It Started With Me by Celia Fisher

FisherCeliaPowersOfPersuasion.jpg

Powers Of Persuasion by Celia Fisher

OLYMPUS DIGITAL CAMERA

Know your Viruses by Gavin Whyman

 

VandeVeldeZoeWitchTest

Witch Trial by Zoe Van-De-Velde

 WEEK 6: UNSAFE SEX!

As with last week, there’s no photographic technique this week but we do want you the conform to theme.  We’ve spoken about stigma, big phama, chastity, infections, HIV testing & Safe Sex.  This week, we’d like to know how you would photograph Unsafe Sex.  (Now, bear in mind we’re a family blog, so nothing which can be considered pornographic thank you)!

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:

Photograph what you consider unsafe sex to be.  This could be a broken condom, (no condoms)? — drugs, one night stands, alcohol, etc.. get creative and show us how you can represent what unsafe sex can be!  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

RobsonTomUnsafe

Ready & Waiting by Tom Robson

In the photograph above, you see clear signs of substance abuse together with an on-line dating app.  What’s just happened? – The individual is face down, is he conscious? Did he manage to get a fix? Did he manage to find someone before he passed out?  What did he say to them if he did? How will he be looked after?  Can he be assured he’s about to have safe sex? These are just the starting questions from this photograph.  Is there anything in this scene which is safe? – Has he called for an ambulance? What is about to happen?

This shot was quickly set up and posed for, yet it’s connotations are that of unsafe sex. – What will your gaze tell you?

THE RULES:

  • Follow the brief
  • Send your best photos by 6PM on Sunday 7th December 2014 with “Shooting Challenge” in the subject to photography@lass.org.uk and we’ll announce the winner on Monday, 8th December 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 FirstnameLastnameUnsafe.jpg
  • Anyone can enter, regardless of camera gear, or location!
  • The most important rule — HAVE FUN!
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