End HIV Dentists Ban

posted: 26/10/2010

A call has gone out to end the Department of Health ban on people with HIV from treating dental patients. The ban continues despite the evidence that there is no risk of transmission.

A spokesperson for Dental Protection, who are indemnity providers, says: ‘It is 20 years since the draconian rules were introduced preventing dentists (and other healthcare professionals) from providing treatment to patients.

‘Initially introduced as a precautionary measure soon after the mysterious case of Dr Acer, a dentist in the USA who was thought to have infected six patients, there has never been any other recorded transmission of the disease in a dental setting.'

Out of date ban forces out of work

Meanwhile many UK dentists – along with dental hygienists and therapists – have lost their livelihood because they have been forced to stop working in their chosen profession.

Dental Protection continues: ‘On being given their own diagnosis they were told to “clear their desk” with immediate effect.'

Europe, Australia, USA – Dentists with HIV: no problem
HIV treatments now effectively control HIV, so that the levels of HIV in the blood are too low even to measure. This, with the high standard of infection control that is demanded of dentists, means that this outdated ban on dentistry for people with HIV has disappeared in much of Europe, Australia and the USA.

International declaration from Beijing
The Beijing Declaration from the 6th World Workshop on Oral Health and Disease in AIDS in April 2009 highlighted the outdated stance currently adopted by the Department of Health.

Department of Health discrimination?
The Department of Health in England’s failure to update its ban and guidance despite the consensus of evidence-based opinion means the Department risks complaints of discrimination.

Standing up for dentists with HIV
In calling for greater fairness and a more consistent application of the evidence, Kevin Lewis, director of Dental Protection, says: ‘Dental Protection has championed the cause of HIV-infected dental health professionals for more than a decade in several parts of the world and will continue to take action against this kind of unfair and discriminatory treatment of its members.

‘The international evidence base is overwhelming and the Beijing Declaration unequivocal in confirming that HIV infected dentists can continue to practise safely with no risk to patients, subject only to some very clear and manageable criteria being met.

‘In every other area of professional activity, dental health professionals are directed to follow the evidence base, but HIV has for too long remained a singular exception – during which time careers have been destroyed, lives have been devastated and patients have been deprived access to safe dentists.'

He continues: ‘The time has come to acknowledge the evidence and stop running scared of ill-informed public perception and media scaremongering. It seems to be forgotten that infected dental health professionals are also patients themselves and they should they be treated no less fairly than other patients. The sound of foot-dragging has been deafening and some immediate action needs to be taken to bring the UK guidance out of the previous century.'
 

Source

Harm of Symptoms Ignored

posted: 08/10/2010

Symptoms are common among people with HIV, and when they are ignored, as they often are by doctors, symptoms worsen people's taking of HIV treatment and lead to more risky sex.
Physical and psychological symptoms are highly common among people with HIV in the UK says a new report in the online issue of Sexually Transmitted Infections.
Physical and mental distress is high especially for people having unprotected sex with a partner of an unknown or different HIV status, and when people are struggling to take HIV treatments properly.
 

Symptoms unnoticed and untreated
From the moment of HIV infection, HIV is associated with a high rates of distressing symptoms. The World Health Organization recommends that controlling pain and symptoms should be an essential part of HIV care.
However, research suggests that doctors often do not detect the symptoms, and that many people with HIV have untreated pain and other symptoms.
 

How common are symptoms and what happens?
Investigators in London and south-east England were concerned that symptoms were being overlooked. They wanted to see how common symptoms were and if having symptoms was linked to differences in HIV treatment-taking, unprotected sex, and telling sex partners about HIV status.
So in 2005-06 778 patients took part in the study looking back at any symptoms over the last seven days.
 

Study participants were asked to provide basic information about themselves (age, gender etc) and to say if they had experienced any of 26 physical or psychological symptoms in the past seven days. The distress caused by symptoms was scored on a scale of 0-4. Those taking HIV treatment were asked to report their level of adherence in the previous week. All were asked if they had had unprotected sex with a partner who was HIV-negative or of unknown status in the previous three months, and if they disclosed their HIV status to partners.
 

Who are they?
Most (66%) of the people in this study were gay or bisexual men and were white (67%). The mean age was 40 years. A little over half (51%) of patients were born in the UK, and 45% had a degree.
Taking treatments – lots to improve
Over two-thirds (67%) of people were taking HIV treatments, and most people are not taking HIV treatments very well. Complete adherence to treatment was reported by 42%; partial adherence by 36%; and poor adherence by 22%. A third of people taking treatment had changed their HIV combination once and 40% reported multiple treatment changes.
 

Risky sex
A total of 11% of patients reported unprotected sex in the previous three months with a partner who may have been HIV-negative, and 6% had never disclosed to a sex partner
 

Symptoms all over
Symptoms were highly prevalent. The mean number of reported symptoms was 18. The mean symptom physical distress score was 0.81, the mean psychological distress score was 1.34, and the global distress score was 1.16.
Lack of energy was reported by 71% of patients, tiredness by 68%, difficulty sleeping by 62%, poor concentration by 61%, worry by 70%, sadness by 66%, diarrhoea by 54% and sexual problems by 53%.
 

Educated, white – less symptom harm
Having a university degree was associated with less symptom-related physical, emotional and overall distress.
In addition, white patients reported less symptom related distress than those of other ethnicities. The investigators think that this could be because many black African patients in the UK are diagnosed late when they are already ill and experiencing symptoms.
Telling others easier with few symptoms; more symptoms leads to risky sex
Disclosure of HIV was significantly associated with fewer symptoms, and reporting unprotected sex with a partner who may have been HIV-negative was associated with a greater number of psychological symptoms.
“Interestingly”, write the investigators, “currently being on antiretroviral therapy was not significantly associated with any of the symptom measures.”
 

Those on treatment
Then they looked at only the people taking HIV treatment. Poor adherence was significantly associated with psychological and global distress. Switching treatment was associated with both physical and psychological distress caused by symptoms, as well as a greater number of total symptoms.
Being born in the UK and having a degree were both associated with a lower burden of physical symptoms.
“The data…reveal high 7-day prevalence and associated distress of burdensome symptoms”, comment the investigators, who conclude: “It is essential that quality management of HIV disease routinely assess these distressing problems, so that key outcomes of risk behaviour and adherence may be optimally influenced.”
 

Source

Reference
Harding R et al. Symptoms are highly prevalent among HIV outpatients and associated with poor adherence and unprotected sexual intercourse. Sex Transm Infect, online edition, 2010 (click here for access to free abstract and paid-for full text).

Police HIV Investigations

posted: 19/08/2010

The key guides for the police investigation of claims of HIV transmission are now available freely on the web. George House Trust helped NAT's work with the Association of Chief Police Officers on these guides.

The police realised that they were reinventing the wheel every time they began a new investigation and that some investigations could be done very much better.

These new guides mean police should now always investigate allegations of criminal HIV transmission in a way which is:
• consistent with Crown Prosecution Service prosecution policy for HIV prosecutions
• well informed about HIV, from both a clinical and a social point of view
• respects human rights and confidentiality
• timely and does not prolong investigations.
 

It's all on POLKA

The complete Guidance is available to all police officers in England, Wales and Northern Ireland via the Police Online Knowledge Area (POLKA) hosted by the National Police Improvement Agency.

Key papers available to all 

NAT now have on their website the key documents so that people with HIV, and organisations supporting people with HIV, know what the police should be doing and best police practice.

• Police Investigation flowchart: This flowchart sets out the whole investigation process
• HIV Key facts: This tells the police key information on HIV, including basic biological and clinical facts, information on PEP, HIV testing, HIV treatments and discrimination issues
• Accused under 18?: This alerts the police how to take special care where the accused is under 18
• Communication Strategy: This guides police about publicity during and after investigations, confidentiality and media relations
• Evidential Flowchart: This key document sets out the evidential steps that must be covered in any investigation, to help avoid unnecessary intrusion and ensure the appropriate evidence is collected. They can't move on to the next invetigation stage until they have collected the necessary evidence. 
• Initial contact with STI / GUM clinics: This advises police to use STI / GUM clinics to contact any new people of interest to them rather than by the police making contact and shocking unprepared people with the news that they may have HIV
• NAT is preparing a simple Q&A on police investigations for people with HIV, which will soon be available on the same NAT webpage.

Hepatitis investigations too

Similar guidance for investigating possible cases of Hepatitis B and Hepatitis C transmission is also available. Contact NAT for these.

Police HIV investigation guidelines

These guidelines are a response to the Policing Transmission report.

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1 in 6 Gay Men Recently Infected

posted: 26/07/2010

One in six gay men having a HIV positive test in the UK became HIV positive within the past six months. This is the first result from a new system tracking trends in recent HIV infections in the UK.
 

The Health Protection Agency devised a formula (an algorithm) and method for tracking recent HIV infections. Knowing how many people were recently infected is helpful for working out what is actually happening in the UK HIV epidemic.

The number of recent infections matters because people who are recently infected are far more infectious than at any other time.
 

Tracking recent infections
The new formula and tracking method, called either the Recent Infection Testing Algorithm (RITA) or Serological Testing Algorithm for Recent HIV Seroconversion (STARHS), measures the amounts of certain antibody markers. These amounts change depending on how long ago the HIV infection took place. Amounts below a certain level mean the infection was recent (approximately within the last six months).
 

The RITA / STARHS method is not exact enough to tell an individual when they became HIV positive, because we all vary in how our immune system responds to HIV, but the method is good enough to give rough timings, which is all we need to track what is happening with the epidemic.
The work on this tracking system began in 2008, when the Health Protection Agency rolled-out STARHS as part of the routine public health monitoring of all newly diagnosed HIV infections in the country.
 

Results
The data presented the International AIDS 2010 conference in Vienna that has just ended, came from samples of 2099 people, who broadly represent, demographically and geographically, people newly diagnosed in the UK. The samples were collected between February 2009 and May 2010.
 

Gay and bi men results

Amongst gay and bisexual men, 16.1% of diagnoses were judged to be recent – within the past six months – one in six. There wasn’t any difference between gay and bi men of different ages.
 

Heterosexual results

Among heterosexuals, 6.2% men and 6.8% women were recently infected. This is just one in sixteen heterosexuals being infected within six months of their positive test.
 

There appears to be a trend for recent infections to be more commonly identified in younger heterosexual women (probably due to antenatal testing), but the age variations were not statistically significant. Curiously, in women aged 50 or over, there was a relatively high proportion of recent infections, but this is based on a small number of cases and could be due to chance. But it fits with another recent report from the HPA at the Vienna International AIDS Conference - many long-term heterosexual relationships break up when people are in their 50s, and women, no longer needing contraception, may neglect to consider the need for safer sex - condoms - to protect against STIs such as HIV.

Recently infected heterosexuals were largely people born in the UK. Heterosexual people born in Africa tend to have infection diagnosed later, the majority becoming HIV positive before migration to the UK.
 

Source

Reference: Lattimore S et al. Surveillance of recently acquired HIV infections among newly diagnosed individuals in the UK. Eighteenth International AIDS Conference, Vienna, abstract FRAX01001, 2010.
 

HIV and the Criminal Law

posted: 22/07/2010

A new book, HIV and the Criminal Law, has just appeared online from NAM/aidsmap. It will also be published on paper in the autumn.

HIV & the Criminal Law is about criminalisation of HIV transmission and exposure and the effects this has on individuals and society. It is written for people living with HIV, advisers, policy and lawmakers, people in the criminal justice system, and journalists.

George House Trust's policy expert Chris Morley helped with the production of the book by commenting and making suggestions on some of the chapters.

Here's the book's contents which available to read in full here

• Preface By The Hon. Michael Kirby AC CMG and Edwin Cameron, Justice of the Constitutional Court of South Africa
• Introduction - How this resource addresses the criminalisation of HIV exposure and transmission
• Fundamentals - An overview of the global HIV pandemic, and the role of human rights and the law in the international response to HIV
• Laws - A history of the criminalisation of HIV exposure and transmission, and a brief explanation of the kinds of laws used to do this
• Harm - Considers the actual and perceived impact of HIV on wellbeing, how these inform legislation and the legal construction of HIV-related harm
• Responsibility - Looks at two areas of responsiblity for HIV prevention: responsibility for HIV-related sexual risk-taking and responsibility to disclose a known HIV-positive status to a sexual partner
• Risk - An examination of prosecuted behaviours, using scientific evidence to determine actual risk, and how this evidence has been applied in jurisdictions worldwide
• Proof - Foreseeability, intent, causality and consent are key elements in establishing criminal culpability. The challenges and practice in proving these in HIV exposure and transmission cases
• Impact - An assessment of the impact of criminalisation and HIV – on individuals, communities, countries and the course of the global HIV epidemic
• Details: international resource and individual country data - a summary of laws, prosecutions and responses to criminalisation of HIV exposure or transmission internationally, and key sources of more information.

Ordering paper copies of the book

If you want to buy a paper copy when this appears in the autumn please email NAM