Disadvantage Affects HIV Futures

posted: 25/01/2011

Low incomes and social disadvantage strikingly affects the life and health prospects of people newly diagnosed with HIV, according to a multi-national study.

An international team wanted to find out if sex and ethnicity affect the outcomes people can expect from their HIV treatment and care. The study looked at people in Australia, Brazil, Canada and the US, and found that sex and ethnicity make often striking differences in health prospects for women and men, and for ethnic minority people compared with white people.
 

Lesson - deal with disadvantages

The lesson the study teaches us “is that socioeconomic factors are a critical influence in determining the likelihood of engaging patients in care. As a result, these factors cannot be overlooked when developing programs that aim to increase the percentage of HIV-infected patients on therapy with undetectable viremia [Viral Load].”
 

The editorial in the Journal of Infectious Diseases says that social and economic disadvantages “represent complex challenges that are beyond the traditional influence of public health,” but the failure to deal with these, undermines attempts to deal effectively with HIV.
 

UK – we have the tool but refuse to use it
In the UK, the tool in the policy toolbox that could make a real difference, the new legal socio-economic equality duty on public bodies, has been locked away by the new government. The conservative led government has decided not to implement this part of the new Equality Act.

The government has also introduced a programme of major cuts in welfare benefits, and in funding for the NHS, Councils and community sector, which will all deepen the HIV disadvantages among people in the UK that we already see.
 

Do sex and ethnicity make a difference with HIV?
The new study looked at eight years in the life of people who were diagnosed very soon after getting HIV. They found that women do worse than men, and people of ethnic minority backgrounds living in the South of the USA have the most HIV-related illnesses.
 

Even when people take HIV tests and become diagnosed, poverty and social disadvantage remain real barriers to many people attending clinics, taking treatments properly and having a reasonably healthy lifestyle.
 

This was an observational study of over 2250 people who were diagnosed with early-stage HIV between 1997 and 2007, in Australia, Brazil, Canada and the US. The people were followed for up to eight years.
 

Women and men
Only 5% of the people in the study are women and most of the women (55%) were of ethnic minority backgrounds. Women had a significantly lower Viral Load (VL) count to start with than the men, but significantly higher CD4 counts (not surprising, since women tend to have higher CD4 counts than men). Three quarters of the men were white.
 

It seems there were few women in the study because the women were half as likely as men to have symptoms typical of early HIV infection, and so women were much less likely to be diagnosed than men at this early stage of HIV.
 

Treating women and men
Similar proportions of both women and men began HIV treatment, and their CD4 cell counts matched when treatment began.
 

But women and men of ethnic minority backgrounds were less likely to start HIV treatment than white men and women. And anyone living in the southern states of the USA was significantly less likely to start HIV treatment.
 

Six months after treatment started, men and women were as likely to have their viral load fall below 400 and have similar increases in CD4 counts.
 

Untreated women and men
However, the investigators then analysed changes in the viral load and CD4 cell count of the people who did not start HIV treatment for up to three years. “Despite the fact women had higher CD4 cell counts and lower viral loads at study entry, they subsequently experienced significantly more combined HIV-related and AIDS-defining events,” emphasise the investigators.
 

Nothing to do with biology: it’s poverty and social disadvantage
After they did their detailed analysis there found no grounds for believing biology is causing women to develop HIV-related illnesses. Instead these illnesses “are the result of socioeconomic conditions.” These include “access to health care, health behaviors, lifestyle and environmental exposures.”
 

Stark ethnic treatment divide

Stark significant ethnic differences are plainly seen in the numbers of people getting HIV illnesses or an AIDS diagnosis.  Eight years after diagnosis

• almost 8 out of 10 (78%) of ethnic minority people in the Southern states of the USA got either an HIV-related illness or AIDS,
• compared to less than 4 out of 10 (37%) of white people living in the same states, and
• compared with a quarter (24%) of white people living elsewhere, and
• about two out of ten (17%) ethnic minority people living outside the South.

USA HIV strategy has three goals: cutting the number of people who are undiagnosed; getting more people to clinics and on effective treatment; and cutting HIV-related health inequalities.
 

But the editorial points out “the findings from this study threaten the success of each of these pillars.” They therefore call for “a collaborative policy and research effort across all levels of community, government and science.”
 

Source Aidsmap has references and links to two free journal articles

Reasons for Travelling to Clinics

posted: 09/12/2010

Most people with HIV in England live within 5km (3 miles) of a specialist HIV clinic, according to a new study. The average distance people travel to their clinic was 2.5km (just over 1.5 miles). However, fewer than 1 in 10 people with HIV use the clinic that is nearest to their home. Why do people travel to a clinic further away?

Researchers wanted to see how far people live from a HIV clinic, and understand why some people travel further than they have to for HIV care.
 

Choice and advice on chosing clinics

People have the right to choose which HIV clinic to use and the British HIV Association recommends people who require routine, uncomplicated care to use their local clinic, and that people with more complex needs should use a more specialised clinic.

Not much has been studied about travelling to HIV clinics in the UK, nor about the social, demographic or clinical characteristics associated with people's choices about travelling to a HIV clinic.

Over 46,000 people studied
To get a clearer understanding of clinic travel, researchers looked at data on 46,550 HIV-positive adults who received HIV care in England in 2007. They pinpointed the closest HIV clinic for each person. All clinics within 5km of a someone’s home are considered ‘local’.

They looked at the wealth in each person’s borough of residence, and the person’s ethnicity, HIV risk category, length of HIV diagnosis, and HIV treatment status.

What they found – urban and often poor

Most (66%) of the people were men and 50% were white. The great majority (95%) live in an urban area, and 42% live in an economically deprived area. Almost three-quarters (73%) were on HIV treatments.

The median distance travelled to their clinic was 2.5km; but this ranged from less than 1km to 80km (50 miles). People in London travelled less than everyone else (2km vs. 3.7km).

Clinic access is good: 81% live within 5km of a specialist HIV clinic, and 93% live within 10km.
In London people had an average choice of three clinics within 5km, but those living outside the capital average just one local clinic.

The average distance travelled by patients to their clinic was a little under 5km. Overall, 73% use a local clinic. However, only 9% used the clinic closest to where they lived.

Reasons for travelling further
Haemophilia - People who were infected with HIV by blood products (mainly haemophiliacs infected during an old UK blood scandal) were most likely to travel further (51%). “These patients may need to attend specialist services that are not provided locally,” comment the authors.

Urban – People living in urban areas were significantly more likely to attend a non-local clinic than those who live in rural areas (44% vs. 22%) – people in major towns and cities are more likely to have a local choice. People living in rural areas and smaller towns have less or no choice nearby. Travelling to the next clinic is also less practical.

Ethnicity - Black African and black Caribbean people were statistically rather less likely to travel beyond their local service than white people.

Length of diagnosis - How long people have been diagnosed also affected travelling distance. People who had been diagnosed for at least a year were 50% more likely to use a clinic over 5km away service than those diagnosed within the last year (27% vs. 20). The investigators suggest “this may be because patients may not become aware of the choices available to them until they have adjusted to their HIV diagnosis.”

Poverty - Wealth also significantly affects the choice of clinic. People who lived in the better areas were twice as likely as those living in the poorest districts to travel further for treatment (42% vs. 21%). The investigators suggest that “financial difficulty” may prevent some people from travelling to clinics further away. Another recent study showed that almost a third of people with HIV in the UK did not have enough money to meet their needs and that 10% had difficulty meeting travel costs.

Help with paying to travel

If you have a low income or are on benefits, you may have a right to help with the costs of travelling to your clinic. Here's information on help with hospital travel costs.

“Barriers to service choice are likely to related to poverty and unfamiliarity with the options for HIV care,” conclude the authors, “consequently, provision of local services remains vital.”

Source including reference details

 

More Disability Tests for Benefits

posted: 08/12/2010

All 3 million people with disabilities and long term conditions such as HIV, including pensioners and children, who are getting Disability Living Allowance will soon be forced to have medical tests.

Ministers announced yesterday plans to end the automatic right to disability living allowance, worth up to £70 a week for care and up to £50 a week for travel needs. This benefit will soon be called the 'personal independence payment'.

Waiting and testing

Claimants will have to wait for a year for the new "personal independence payment" and then face a series of medical and other tests focusing on "an individual's ability to carry out a range of key activities necessary to everyday life".
 

Medical tests already under fire

The existing system of medical tests that are used to judge people claiming sickness and disability benefits (Incapacity Benefit and Employment Support Allowance) is already under review after mounting evidence that people with serious illnesses like HIV are being judged fit to work, when they are not. The tests for the replacement 'personal independence payment' will be based on these.

Many claim that the disadvantages of the medical tests will outweigh any benefits. The medical tests system is often very wrong and very inefficient. 40% of people who appleal the decision win their appeals.

"We have fundamental concerns that the cost of the administration will mean there is no saving here. Claiming these benefits mean at the moment filling out a very long form. I don't think the answer is a whole new process of interviews, which many disabled people may find intimidating," said Guy Parckar of the Leonard Cheshire disability charity.
 

Do what we say

Welfare support will also be conditional on disabled people acting on government instructions to "better manage or improve their situation if appropriate".
 

Behind the changes - cuts of £1 billion from Disability Living Allowance

Charities said they were "deeply concerned" about the proposals – the government plans to save £1bn from DLA in the June budget.
 

"There's no evidence of widespread fraud and no evidence to back up claims that the benefit acts as a barrier to work," said Richard Watts, of the Essex Coalition of Disabled People.
 

Department of Work and Pensions announcement 

Consultation proposals

Consultation on the proposed changes - response deadline 14 February 2011

Source

Rise in Extreme HIV Poverty

posted: 19/10/2010

A new UK report shows one in six people with HIV are living in poverty. The new report on Poverty and HIV by NAT (National AIDS Trust) and Terrence Higgins Trust (THT) reveals at least one in six people diagnosed with HIV in the UK experienced severe poverty between 2006 and 2009. Furthermore, the level of poverty experienced by people living with HIV has dramatically increased over recent years. In the current climate – and without determined Government action – the poverty crisis for many people living with HIV will get even worse.

The HIV welfare charity Crusaid ran a welfare fund until it merged with THT earlier this year. This report looks back at the recent evidence of HIV poverty from all the applications for help made to Crusaid in the last three years.

Income falls two thirds in 10 years to £42 a week
People paid grants from the Crusaid Hardship Fund, now run by THT, had an average weekly income of just £42 per week – two thirds less income than the average person who claimed 10 years ago (£93). In addition, many have no income at all. Most applicants are now living in extreme poverty, living on only 20 per cent of the average income for a single person.

Nick Partridge, Chief Executive of THT commented:
“The level of poverty people with HIV are experiencing across the UK has dramatically increased over recent years. Where the Hardship Fund used to buy people a fridge, or pay for respite care, now it mainly goes on basic survival – food, clothes, a bed.”

Causes of HIV poverty

The report analyses the underlying reasons why people with HIV face poverty. Over a quarter (29 per cent) of applications to the Hardship Fund gave the immigration system as the main reason for poverty. In October 2009, the Government support for single asylum seekers was reduced from £64.30 to £35.13 a week - just £5 a day. A further 17 per cent of people said that problems relating to the benefits system were the main cause of hardship. These problems included awaiting a benefit decision, changes to the benefit system, or delays in receiving benefits they were entitled to.

Deborah Jack, Chief Executive of NAT (National AIDS Trust), commented:
“Charities are picking up the pieces of a poverty crisis in the UK, but there is only so much the sector’s limited funds can do. The Government needs to address the underlying causes of this hardship, some of which it has been responsible for creating. Granting asylum seekers the right to work after six months and ensuring people are not left in poverty while waiting for their benefits to be processed are two crucial steps that would release many people with HIV out of the poverty trap.

20 ideas for change
The report makes twenty recommendations that would address the root causes of poverty amongst people living with HIV.

Benefit delays make homeless
James, 35 years old and HIV positive, is homeless and sometimes sleeps on floors at friend’s houses and occasionally in shop doorways. He came to the UK as an asylum seeker and was granted leave to remain here. He was then no longer eligible for housing with his asylum support, so he applied for housing benefit but he did not receive any payments. An investigation revealed that backlogs in dealing with benefits claims meant that by the time James’ claim was processed he was homeless and therefore did not qualify for the benefit. James was one of 7,900 people with HIV in the UK who relied on a grant from the Crusaid Hardship Fund in the last three years to pay for basic needs.

George House Trust
In 2009-10 George House Trust assisted 712 people with 3160 grants through both Crusaid and our own HIV welfare fund. George House Trust paid out £112,000 in grants to people with HIV in NW England in that year.

Poverty and HIV - download here

HIV Hardship Fund ‘Soon’

posted: 05/07/2010

Following Crusaid’s merger last month with Terrence Higgins Trust (THT), THT have vowed to re-open the Crusaid HIV hardship fund "as soon as possible." The hardship fund provides vital financial assistance to people living with HIV.

After addressing thousands of people at Pride London's Trafalgar Square stage, Lisa Power - Corporate Head of Policy at THT - told PinkPaper "The most important thing I have to say today is that we are going to re-open the hardship fund as soon as we can, within the next few months. After that, we're going to make sure it has a long-term future. And that it helps people to help themselves.”

"We've just done a big research project with the Joseph Rowntree Foundation which shows that older gay men with HIV are in far more poverty than their peers, so we know that there's a real issue out there. As people survive longer with HIV, it's not just about the pills keeping you well, but also the quality of your life".

When asked about the criticisms surrounding THT's recent merger with Crusaid, Lisa Power rebutted complaints that they are monopolising the HIV and STI community health sector. "We merge with people who approach us, which is what Crusaid did. The issue is about making sure services survive. We represent economies of scale. We represent a whole load of stuff that is available, which smaller organisations can't do alone."
 

Source