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

Police, Prosecutors, Press Bungle HIV Crime

posted: 01/09/2010

Despite new police HIV crime investigation guidelines, HIV prosecution guidelines and new press HIV reporting guidelines, it appears that all were ignored and left on office shelves in the latest prosecution for reckless HIV transmission.
 

A man accused of passing on HIV to a woman of 19 was jailed for a year, and given a five year sexual offences prevention order yesterday.

Nicholas Richards, who is 31, and lived in Sittingbourne, Kent, admitted Grievous Bodily Harm (GBH) for the HIV offence of reckless HIV transmission at a previous hearing at Maidstone Crown Court.
 

Richards was also given a five-year sexual offences prevention order, which stops him from having unprotected sex or not telling his partners about his HIV.
 

He was jailed yesterday for a year on that charge and was sentenced to a further year for an unrelated GBH charge, for attacking a man in Medway, Kent.  

The court heard Richards exposed the 19-year-old woman to HIV in June 2008. The young woman, who cannot be identified for legal reasons, found out she had HIV during routine blood tests when she became pregnant. Her baby does not have HIV, say the police.
 

Police comments
After the hearing, Det. Ch. Insp. Simon Wilson said the crimes committed by Richards were "abhorrent and callous" and had far-reaching consequences. He said: "Not only did he knowingly infect a young girl with HIV - a disease she will have to live with for the rest of her life, but he also selfishly put her child at risk too. Thankfully, the sheer bravery the victim showed in coming forward immediately and giving evidence in court helped us secure a conviction against him and I would pay tribute to her courage." He urged anyone else who had "fallen prey" to Richards to contact the police.
 

George House Trust comment

 
More Police, Crown Prosecution Service and Press failings

Because HIV crimes are complex to investigate and prove beyond reasonable doubt, and because of the harm HIV stigma and discrimination cause, police and prosecutors have strict guidance and policies to follow in HIV cases. This case seems to prove that these were ignored. The investigation and prosecution system cannot be relied on to work properly in all HIV cases.

Police

It appears that the Police ignored their own HIV investigation guidelines. They have clearly ignored their own Communication Strategy guidance, because Det. Ch. Insp. Simon Wilson should never have made his inaccurate and sensationalising comments and blatantly fished for other people to come forward who may have ‘fallen prey’ (his words) to the man.
 

Crown Prosecution Service

The Crown Prosecution Service appear to have yet again ignored their own HIV prosecution policy and guidance. Prosecutor Roy Brown seems to have been the man responsible. Guilty pleas should not be accepted without rigorous efforts to obtain transmission evidence.There is no evidence from the media reports that phylogenetic analysis was carried out as the prosecution guidelines require. So we can't be sure the man found guilty did pass HIV to the young woman.

Press

It was only the middle of August, just a few weeks ago, that the managing editor of The Sun told us about his paper’s commitment to responsible reporting of HIV at the launch of NAT’s new press guidelines. Graham Dudman, Managing Editor at The Sun, we were told, ensures his staff use the guidelines. He says: “At The Sun we pride ourselves on getting the facts right and staying up to date. This can be a challenge in sensitive areas like HIV. NAT's guidelines for journalists are very useful, really simple to work with and lay out all the facts reporters need.”
 

He seems to have forgotten the press guidelines for HIV very, very quickly. The Sun’s headline for this HIV news story: ‘HIV fiend jailed for infecting girlfriend’
 

News reports

BBC

Independent

Daily Mail

The Sun

21st Century Press Guidelines

posted: 13/08/2010

The media reporting of HIV is often wrong and negative. New detailed Guidelines for Reporting HIV are out today to help editors and journalists write well about HIV in the UK.

The guidelines dispel common myths about HIV, provide up-to-date information and tell journalists where to go for more information.

The new guidelines, from NAT (National AIDS Trust), are backed by the National Union of Journalists, the Press Complaints Commission, and the Society of Editors.
 

Accurate, up to date, respectful

HIV has changed a lot in recent years. Testing and treatment, quality of life and life expectancy are radically better. The guidelines help journalists report about HIV in the 21st century. For example, it is no longer correct to suggest that HIV is a death sentence, that HIV automatically leads to AIDS, or that you must wait three or six months for a test, all of which have been said in recent news reports.
 

Deborah Jack, Chief Executive of NAT, says “The public get a lot of their knowledge about HIV from the press, so it is important journalists get it right. Accurate reporting benefits public health, dispels myths, undermines prejudice and increases understanding. We hope these guidelines will help journalists update their knowledge about HIV in the 21st century.”
 

News Mistakes

NAT monitors the press for inaccurate coverage about HIV. Some of the most common mistakes journalists make include suggesting there is a risk of HIV infection from discarded needles, biting, or spitting, reports often treat HIV and AIDS as if they are the same thing, and suggest HIV is deadly.
 

Graham Dudman, Managing Editor at The Sun, ensures his staff use the guidelines. He says:
“At The Sun we pride ourselves on getting the facts right and staying up to date. This can be a challenge in sensitive areas like HIV. NAT's guidelines for journalists are very useful, really simple to work with and lay out all the facts reporters need.”

George House Trust hopes The Sun reports HIV responsibly in future – in June its front page was a scare-mongering report suggesting British troops could get HIV from old needles or razor blades in Afghanistan. It published this on the front page, despite including a comment from NAT denying the claim that troops could be infected in this way. There was no HIV risk to troops but The Sun still printed the story, and on the front page. This was then repeated elsewhere, including on BBC radio.

Stephen Abell, Director of the Press Complaints Commission said "While public and media understanding of HIV and AIDS has improved, it remains vital that the press takes particular care when reporting on these issues - both by being accurate and by respecting the privacy of those who live with either condition. The PCC has a clear role to play in resolving complaints, upholding and improving standards, and providing a public service to those who have concerns about the press."

Download the Guidelines for Reporting HIV 
 

USA - Treatment as Prevention

posted: 10/12/2009

The USA has joined the list of countries producing national statements about how effective HIV treatment can make passing on HIV during sex very unlikely. 

The USA statement uses much the same evidence as the earlier Swiss, French and German statements on HIV treatment as prevention that we have reported. However, it is a lot more cautious, urging continued consistent condom use.

"In summary, for couples in which one member is HIV-infected, treatment of the infected partner with effective ART and suppression of viral load to undetectable levels should greatly reduce the risk of transmission to the uninfected partner. However, this risk is not eliminated and it may not be maximally reduced at all times due to some of the factors discussed above. Moreover, the likelihood of transmission may be expected to increase with repeated exposures over time."

"In a model which estimated transmission risk in the setting of suppressed viral load (<50 copies/mL) without intercurrent STIs, the number of expected transmission events occurring within a population of 10,000 serodiscordant couples over 10 years was estimated to be 215 for female-to-male transmission, 425 for male-to-female transmission, and 3,524 for male-to male transmissions [31]."

"In a meta-analysis of data from 11 cohorts including 5,021 heterosexual couples observed no transmissions among persons receiving ART with a viral load of <400 copies/mL; however, analysis of the data was compatible with the possibility of one event per 70 person-years [32]. For this reason, it is important that individual couples recognize the risk, and use additional preventive methods (e.g., condoms) in order to further minimize the chance of transmission."

So they advise condoms for heterosexual couples to prevent a 1 in 70 person years possibility of transmission.

This statement and advice comes from the US Centers for Disease Control.

Effective HIV treatment where the viral load is undetectable reduces the risk of HIV transmission but some slight risk remains. The risk is higher for gay men than most heterosexual people, and sexually transmitted infections especially raise the risk of transmission.

US Centers for Disease Control statement Effect of Antiretroviral Therapy on Risk of Sexual Transmission of HIV Infection and Superinfection [read on webpage] OR download it as a pdf

French statement

German statement

Swiss statement

Children’s HIV Mental Support

posted: 27/11/2009

Ways to meet children’s mental health support needs before, during, and after a parent (or other close relative) dies with HIV, are given in a new international review from aidsmap / NAM.

It's written for resource-limited settings, but the how-to advice is excellent for children here and everywhere. Most useful in the UK are sections on ‘addressing grief and bereavement,’ checking for childhood mental health problems, and basic and more advanced ways to support children affected by HIV-related deaths.

A useful overview to helping children cope with death and grief the review recommends is the recently published guide Children’s Palliative Care in Africa, (download the whole book free - the only price to pay is taking part in a quick survey). 

One chapter in this book provides advice about

• making memory boxes (to collect items that remind them of the person who has died and times they shared)
• making a family record to help a child or young person gain a sense of where they and the person who has died fits into the family. This is particularly important when a child is to be removed from their old home, or separated from siblings or cousins, and hence when there is a danger of losing a sense of his or her ‘roots’
• telling the story by helping the child write or tell (with an adult writing) their story so that they remember clearly what happened — which can provide carers an ideal opportunity to pick up misconceptions and misunderstandings
• handprints: a print of their hand and their parents and other loved one’s touching
• writing a “children’s will”: children are sure to have some items that they treasure and they might have a clear idea of what they wish to happen to these
• permanency planning so that children have a clear idea about what will happen to them (if they are bereaved)
• a “bereavement tree” (a practical tool that sensitises people to the feelings and behaviours of individuals and expectations of society, to create awareness about bereavement in order to encourage community support to all bereaved people — there is an appendix with this tool in the book.

The book also highlights the importance of spiritual development (as well as play), and describes a number of beliefs and practices surrounding death in Africa.

Another fine resource

Some other useful resources can be found in the April 2009 issue of Together Now, the newsletter of the International HIV/AIDS Alliance in India, including using art therapy for children and child-centred counselling. The article also usefully describes different mental health screening tools for children.
 

Children’s Palliative Care in Africa

download the whole book free here

The international review After my parents died: The effect of HIV on the mental health of children: a clinical review