What Needs HIV Research?

posted: 02/09/2010

A new UK HIV research charity is asking people with HIV what needs researching. The UK Foundation for AIDS Research is a member led charity, supporting research into improving the health and quality of life of people living with HIV.

What they research will be guided by people living with HIV. They will only fund and support robust science-based research, but people living with HIV will take the lead in deciding what gets investigated.

Interested in telling them what you think?

They invite people with HIV to help by completing their online survey

Over 50s HIV Infections Double

posted: 18/08/2010

New HIV infections among people over 50 have doubled in England, Wales and Northern Ireland in the last seven years, and almost half the over 50s were diagnosed late, according to a new study in the latest issue of AIDS.
 

More and more HIV experts are now thinking hard about older people with HIV. Not only are the numbers of older people with HIV rising steeply, older people are also getting HIV, health prospects are worse when you are over 50, and it is clear that there are some different problems in living with HIV when older.
 

This latest study looked at older people with HIV in England, Wales and Northern Ireland between 2000 and 2007. The starting point for ‘older’ is age 50 or over.
 

While the numbers of over 50s with HIV tripled between 2000 and 2007, there was also a sharp rise in the number of older adults getting HIV. Is the tripling of the number of people with HIV over 50 because people are living longer because of HIV treatments, or is it because more people are getting HIV after 50?

To find out the Health Protection Agency decided to analyse the national HIV data for the time between 2000 and 2007.
 

Nearly 1 in 10 new infections among people over 50
They found 8% of all new HIV diagnosis were among people over 50. But the new infection rate among over 50s is still rising and in 2007 it reached 9%. The number of older people who were newly diagnosed more than doubled, from 299 in 2000, to 710 in 2010. Almost three-quarters of these new diagnoses were people aged between 50 and 59.
 

Gay and other men who have sex with men were 40% of all the people diagnosed over 50. A third of the newly diagnosed were heterosexual men, and 25% heterosexual women.
Almost all (94%) the gay men are of white backgrounds. Older heterosexual men and women were rather more likely to be white than heterosexual men and women under 50.
 

8000 and rising
A total of 8255 older adults used HIV clinics between 2000 and 2007. This is 16% of all the people using HIV clinics.
 

Late diagnosis and AIDS
20% of the older adults developed an AIDS defining condition in the years 2000 - 2007. Mostly (91%) an AIDS condition was diagnosed within three months of diagnosis with HIV – this means HIV was diagnosed at a really late stage. This is twice the rate of AIDS diagnoses found among the under 50s.
The Health Protection Agency definition of late HIV diagnosis is when the CD4 count is below 200 at diagnosis. People diagnosed over 50 are significantly more likely to have a CD4 count this low than the under 50s (48% for over 50s, 33% for under 50s).

HIV treatment is now started normally when the CD4 count is around 350, so really many more people were diagnosed late than these HPA figures suggest. By the time the CD4 has fallen to 200 avoidable health harm has already been done.

More deaths, sooner
538 (13%) of the people over 50 died between 2000 and 2007. People diagnosed with a CD4 below 200 were 14 times more likely to die than younger patients with this CD4 count (14% for the over 50s, 1% for the under 50s).
 

Moreover, over 50s who are diagnosed late were approximately two and a half times more likely to die within a year of their diagnosis than under 50s with a CD4 count below 200.
 

The overall mortality rate amongst older patients was 25 per 1000 person-years. In contrast, the mortality rate for younger patients was half that - 12 per 1000 person-years.
 

Half got HIV after 50th birthday
Based on CD4 cell count at the time of diagnosis, they worked out that 48% of the older people with HIV got HIV when they were aged 50 and over. This percentage hasn’t changed between 2000 and 2007.
 

Three-quarters of individuals aged over 50 when they became HIV positive are men, and 54% were gay men.

Source

Reference Smith RD et al. HIV transmission and high rates of late diagnoses among adults aged 50 years and over. AIDS 24: 2109-2115, 2010.
 

AIDS Support Grant Changes

posted: 12/08/2010

The Department of Health wants people’s views about changes it plans in how it works out the amount of AIDS Support Grant (ASG) paid to each council. The deadline for comments is Wednesday 6 October.

Instead of working out the ASG amounts each year, The Department of Health wants to decide and tell councils now what they will get in the following four years. However they don’t guarantee anything about the future of ASG, because of the Autumn Spending Review, which will be announced in late October.
 

Two Options

They suggest two options. The first, which they prefer, is based on the current formula which would be frozen. This would mean using the most recent HIV data (on the numbers of people with HIV and of children with HIV in each district) to decide the grant for each year of the Spending Review. The second option uses another formula - the younger adults social care relative needs formula. This produces very strange results.

Impact in NW England

We have produced a table showing the amounts of ASG paid to NW councils this year and last year, and the amounts using the two formulas, that would be paid for the next four years. 

The consultation proposals and response form are here
 

The deadline for replies is Wednesday 6 October.
 

The Future of Immigration Legal Help

posted: 05/08/2010

Face the Facts on Radio 4 explores the tough problems effective community immigration and asylum advice organisations are facing from the government. Free immigration and asylum legal help is under threat from government policy and practice. The programme includes Greater Manchester Immigration Aid Unit who do so much to help many people living with HIV.

Immigration advice in crisis

An asylum seeker takes his own life after his lawyers go into administration; a man and his family are thrown into detention because they've unwittingly been given false papers by an unscrupulous immigration adviser; a woman who's fled torture but hasn't been able to see her children for years because of bungling lawyers.

Their experiences cost them money and heartache. But poor legal advice can cost all of us in the long run if wrongly advised clients end up appealing their decision, or people, who've been told incorrectly that they can stay, then have to be removed from the country at the taxpayers' expense.
 

Government cuts and changes imperil lives

Changes to the way legal aid is paid have made the system "unsustainable". Asylum lawyers can now wait years for legal aid payments to be settled.

John Waite talks to some of the hundreds of committed advisers who have been forced out of their jobs because they either can't make it pay - or can't do the job properly any more. And he asks the Legal Services Commission to justify a false economy and a failure of justice.

Listen Again

This Face the Facts programe (half an hour long) was broadcast this lunchtime (Thu 5 August) but it is repeated on Sunday 8 Aug at 9pm in the evening on BBC Radio 4

You can also Listen Now online

This article in the Guardian discusses the need for better decisions by the UK Borders Agency on asylum claims because poor intial decisions add to legal aid bills for appeals.

HIV Microbicide Success

posted: 20/07/2010

A vaginal microbicide gel containing the anti-HIV drug tenofovir (Viread) reduces the risk to women of HIV infection by 39%, results of a study show. This is the most hopeful news in the years long search for something that women can use to protect themselves from HIV risk. There was a recent flurry of hope about another microbicide which showed some signs of working but further study showed it wasn't good enough.

Women who used this new gel more reliably, during four out of the last five times they had had sex saw their risk of HIV infection reduced by 54%. The microbicide also had another useful sexual health benefit, halving the risk of infection with genital herpes.
 

Other reports about this microbicide explain that women must apply the gel 12 hours before sex and once again as soon afterwards as possible.

There is more work to be done before this microbicide can supplied publicly, but this was a top-notch scientific study, a randomised, placebo-controlled trial – called CAPRISA 004 – in South Africa. 889 HIV-negative women were randomly divided into two groups, one was given the tenofovir-containing gel and the other group was also given gel that looked exactly like the first but without any tenofovir in it. No-one (neither women nor the clinic staff) knew who was getting what. Both groups of women got advice about safer sex and free condoms. The women were monitored for two and a half years.
 

Results from the study will be officially presented to the AIDS 2010 conference in Vienna today, but they have already generated a lot of excitement.
“This is an important day,” said Yasmin Halima, director of the Global Campaign for Microbicides. “We now have evidence that a vaginal gel can help prevent HIV. This is good news for women, good news for the field and a good day for science.”
 

Next Steps

To stimulate and prioritise rapid action, WHO and UNAIDS announced that they will convene an expert consultation in August with women’s health and HIV prevention advocates, scientists, microbicide research teams and product developers, and public health experts to discuss the next steps with the product.

A webcast of this session and interviews are available on the Kaiser Family Foundation website

More information from NAM/aidsmap.com

Image - Prof. Quarraisha Abdool Karim, Associate Scientific Director of CAPRISA, explains how to use an applicator with gel       from blogs.timeslive.co.za