Guide to Safer Sex Advice

posted: 01/03/2011

The British HIV Association has produced draft guidance for STI clinics on offering Safer Sex Advice for the UK. They are inviting comments on their draft Guidelines.

The Safer Sex Advice guidelines recommend behaviour change interventions, what safer sex advice to give people at risk of STIs, and advising people living with HIV and people at greater risk of HIV infection.

The guidance is also useful for GPs and HIV care services when offering Safer Sex Advice.
 

Comment on Safer Sex Advice Guidance

Comments deadline is 31 May 2011 - comment through this webpage

Safer Sex Advice Guidance for the UK

More HIV Testing Urged

posted: 08/10/2010

The NHS health advice body NICE has produced its first HIV guidance, about HIV testing. The draft HIV testing guidance recommends that mainstream health services offer much more HIV testing to the two communities most affected by HIV in England, black African people and to men who have sex with men. The guidelines also call for more testing to be offered in places such as bars and saunas, using rapid point-of-care tests.
 

NICE HIV testing: open for comments
The National Institute for Health and Clinical Excellence (NICE) tells the NHS which are the best and most cost-effective treatments and public health interventions. NHS bodies are legally required to fund the medicines and treatments recommended by NICE.
 

Making HIV testing guidelines work
Other organisations have produced HIV testing guidelines before, notably the British HIV Association (BHIVA) and the British Association for Sexual Health and HIV (BASHH). But these were not backed by the UK National Screening Committee, nor by NICE, and many parts of the NHS simply ignored them.

The most recent BHIVA and BASHH testing guidelines recommended that HIV testing should be offered in a wide range of healthcare settings, including GP surgeries and most hospital departments. Little was done about this.
 

NICE will force more testing action
To increase testing, the Department of Health asked NICE to produce public health guidance to increase HIV testing both among men who have sex with men and among black African communities. The new NICE guidance supports most of the BHIVA and BASHH testing recommendations, and goes further with some recommendations.
 

There are two guidelines - one to increase testing in men who ave sex with men, and a the other for increasing testing among black African people.
 

Local strategies needed

For both men who have sex with men and for black Africans in England, NICE recommends preparing local strategies to increase HIV testing, developed in consultation with community organisations and the people affected. These strategies should focus on sections of the community who are less likely to use services. Community engagement and involvement is particularly important for black African communities.
 

Africans - involve people as champions and leaders
NICE recommends that black Africans in England should be recruited and trained to act as ‘health champions’ and ‘role models’. HIV testing work must deal with people’s misunderstandings and ignorance about HIV, testing and treatment, and must promote the benefits of early diagnosis and tackle HIV-related stigma.
 

The guidance for black African communities includes providing HIV testing outside sexual health clinics. This is because the evidence from the literature is that HIV testing in sexual health clinics is seen by some black Africans as stigmatising, complicated and time-consuming, while HIV testing in other healthcare settings was welcomed.
 

NICE recommends that general practitioners should routinely offer an HIV test to black Africans who have not tested before or who have had a new sexual partner since the last negative test. In hospitals and other healthcare settings, an opt-out test should be routinely provided to black Africans who are having blood taken for other reasons.
 

Testing in sex venues to reach gay men
Health promotion interventions promoting testing to men who have sex with men should include venues, such as saunas, clubs and cruising areas, or websites, which facilitate sex between men.
NICE appears more enthusiastic than BHIVA about community testing in sex on the premises venues. In gay venues, NICE says rapid tests (using mouth swabs or finger-prick blood samples) should be provided by trained staff, in a secluded or private area.
 

NICE’s guidance for men who have sex with men encourages testing in primary care (GPs), but not in secondary care (hospitals). The BHIVA guidelines are different, and recommend that all healthcare settings should offer an HIV test to any man who says he has sex with other men.
 

NICE recommends that GP surgeries should recommend all males to have HIV tests where the surgery is in an area with a large gay community or theer is a high rate of HIV.
 

Carl Burnell, of the gay men’s health charity GMFA, questions whether this will is work, because of the many other demands on GP surgery capacity. “The strategy assumes that other services are running like clockwork and have capacity to offer HIV testing,” he said.
 

Clear path from testing to services
All testing services need clear pathways for people to obtain any necessary confirmation of the HIV test result, HIV treatment services and HIV support groups. People who test negative may need help through counselling and safer sex interventions.
 

The draft guidance comes before results are published on several Department of Health funded pilot projects evaluating new testing strategies.
 

NICE’s guidance is open for feedback and comments until late November. The final NICE HIV testing guidance will appear in March 2011.

HIV testing guidelines for MSM 

HIV testing guidleines for black Africans in England
 

Source

Over 50s - 1 in 12 new diagnoses

posted: 04/05/2010

One in twelve new HIV diagnoses in the UK are in people over the age of 50. Late diagnosis is common among over 50s but almost half of these people were infected after their 50th birthday.

Between 2000 to 2008, one in twelve new adult HIV diagnoses were in a person over the age of 50. The numbers increased year on year, from 304 in 2000 to 787 in 2008.

Typically - male, gay, white, older
The profile of people diagnosed over 50 is rather different to those diagnosed younger. They are more likely to be male, homosexual and white. Older heterosexual men often got HIV in southeast Asia – usually in Thailand.

Infected after 50 – Prevention’s still needed
By looking at the CD4 count when the people were diagnosed, the researchers were able to estimate how long before diagnosis each person had HIV. Just under half (48%) were infected after the 5oth birthday. HIV prevention cannot ignore older adults.

Late diagnosis is big – some deaths within one year
Nonetheless, late diagnosis is more of a problem in older adults than in younger groups. A total of 48% are diagnosed with a CD4 count below 200 cells/mm3, compared to 33% of people under 50. In gay and bisexual men, double the number of over-50s are diagnosed late compared to younger men (40% and 21% respectively).

Moreover, these late diagnoses make a substantial contribution to short-term mortality. Amongst people diagnosed over the age of 50, 14% of those diagnosed late died within a year, compared to 1% of people not diagnosed late.

Whereas people over the age of 50 represented 11% of the individuals accessing HIV care in 2000, they now make up 17% of those doing so.

More on over 50s in Brighton
The Manchester BHIVA/BASHH conference also heard about the treatment and care needs of older adults. One poster profiled 257 patients aged 50 or over attending HIV services in Brighton. The vast majority were white gay men, their mean age was 58 and they had lived with HIV for an average of 12 years.

85% had at least one other health problem, with 43% having three or more. As a result, in addition to anti-HIV drugs, two-thirds were taking medication for other conditions (12% reported five or more other drugs) and 79% were under the care of other medical specialists (dermatology, ENT, cardiology, gastroenterology, etc,). The authors recommended that HIV clinicians should work in close co-operation with these other specialists.

More tests and reviews

Another conference poster highlighted the importance of carrying out additional tests and assessments, for example for prostate cancer and other malignancies. Moreover regular review of all medication is required to monitor possible drug-drug interactions.

Brighton men speak

Finally, the Brighton researchers also presented findings from 20 in-depth qualitative interviews with people with HIV aged between 52 and 78 (mean age 64). Almost all were white gay men.

Some of the key themes were:

• Health: concerns about the unknown effects of HIV and antiretroviral treatment over time; the number of co-morbidities; a desire to have continuity of medical care and more psychosocial support. “Obviously the antiretrovirals are keeping me alive but there must be some long-term damage,” said one interviewee.
• Survival: stories of outliving peers and of not having prepared for the future because none was expected. “They’re all dead and I’m the only one left alive and I’ve got no pension.”
• Self-esteem and rejection, linked to a youth-orientated gay scene, changes in physical appearance and sexual dysfunction. “Who wants an old faggot like me?” was one comment from the interviews.

Advice and Information 

Coming of Age - a guide to ageing well with HIV - 130 pages, UK, 2010

download is free - it is large (2.8 Mb) pdf file, so please be patient while it downloads  

Ahead of Time: A practical guide to growing older with HIV, Austrailia, 2010

Older Adults with HIV - The ROAH study of 1000 adults over 50 by ACRIA, New York

Sources and references

Late HIV Diagnosis Warning

posted: 23/04/2010

Far too many people in the UK with HIV are being diagnosed late, when they may have had the virus for as long as 10 years and are likely to have passed the infection to other people, sexual health experts warned. In Manchester, the British HIV Association (BHIVA) and British Association for Sexual Health and HIV (BASHH) conference is under way.
 

Urgent action is needed to make routine testing the norm in areas where HIV prevalence is high – and this includes Manchester, Salford and Blackpool in NW England. HIV rates in the UK are steadily rising, and delays in diagnosing infection increase deaths and onward transmission.

NW is late diagnosis hotspot

NW England has the worst rate of late diagnosis of all regions in England. Manchester last year had the largest number diagnosed late, 54 out of 142 people: 38% diagnosed late. But this is next door to Manchester's twin city Salford, where just 23.9% were late (11 out of 46). The national average rate for late diagnosis is a high 32%.

"It is in the interest of everyone for local health authorities and healthcare professionals to take a real stance on this issue," said Dr Keith Radcliffe, president of the British Association for Sexual Health and HIV.
 

1 in 3 diagnosed late
The conference heard that more than a third of HIV infections were still being diagnosed late. If infection is missed at an early stage there may be no symptoms for 10 years, until the patient falls seriously ill with a potentially fatal AIDS-related condition.
 

There is a window of opportunity to diagnose HIV early, during what is known as sero-conversion, when the body produces antibodies to the virus. It is also the time when people with HIV are the most infectious. The person is likely to have a flu-like illness including a rash and a sore throat.
 

Missed chances
But Dr Mark Pakianathan, a London-based HIV consultant, said GPs and A&E staff may not realise it could be HIV – or may not want to suggest a test.
 

Sometimes doctors are reluctant to raise the possibility because of their own assumptions about the person’s lifestyle. "They think it can't be HIV – it must be something else," said Pakianathan. The doctor may assume it is glandular fever or even swine flu. "An opportunity could be lost for 10 years," he added.
 

Later clues
There can be an intermediate phase, when patients may be diagnosed with illnesses such as fungal nail infection, related to the erosion of their immune system by the virus. But often patients are not diagnosed until they develop an AIDS-related illness such as a lymphoma or bacterial meningitis, which can be life threatening.
 

More than 7,000 new HIV diagnoses are made every year in England, Wales and Northern Ireland. At the end of 2008 there were an estimated 83,000 people infected, according to the Health Protection Agency.
 

Testing is a lottery
Studies presented at the conference showed what Radcliffe called the "lottery" in HIV testing. An investigation of HIV testing patterns in a large inner city hospital with high local prevalence found that 41% of HIV-positive patients had been in contact with a health professional, with a HIV-related symptom, in the last two years but had not been offered a HIV test.
 

A second study, lasting six months, of acute general medical admissions, found that only one third of undiagnosed HIV-positive patients were correctly advised to have a HIV test by clinicians. The two-thirds who were missed would have been identified if HIV testing was made routine for all general hospital admissions.
 

Testing urged because of treatment successes
Pakianathan said some clinicians seemed not to have caught up with the massive change in the prospects for people with HIV that has come about in the last decade with the availability of drugs that can keep people not only alive but well and active for the foreseeable future. He had visited GP surgeries in London to talk to them about de-stigmatising HIV testing.
 

"I still get [doctors and nurses] saying: 'When I offered a test, the patient got up and left the room'. It is about how  you offer the test as well," he said.
 

Professor Ian Gilmore, president of the Royal College of Physicians, said: "Someone in their early 20s promptly diagnosed with HIV can today, with the current treatments available, look forward to a relatively normal life, whereas delayed diagnosis and treatment increase the rate of illness, premature death and the unknowing spread of the disease. Changing patterns of HIV transmission further underscore the need to raise awareness among physicians and make the test a standard first-line investigation in many secondary care settings."
 

BHIVA HIV Testing Guidelines

Source