News

Namlife Comes Alive

posted: 19/12/2008

Namlife is the new website about living with HIV and it is launched today. NAM (National Aids Manual) are behind it and it is for anyone recently diagnosed, everyone who has lived with HIV for a while, all who know someone who is living with HIV, or the rest of the population who just want to find out more.

Namlife is a space where people can find answers to almost any HIV question and benefit from reading other people's own experiences of living with HIV.

Namlife features sections on

• facts,
• Q&A,
• telling people,
• personal stories,
• dealing with depression
• art,
• treatment key facts and
• quizzes.

You will find both information and personal stories on sex, work, treatment, travel and the law and far more. Take a look at Namlife now

Face of Lighthouse

posted: 18/12/2008

Michael Edwards, who was the "face" of the HIV centre, London Lighthouse, warmly welcoming people at reception, has died. Michael Edwards, aged 63, was for nearly 20 years the smiling, welcoming face of London Lighthouse, the north Kensington centre for people infected with or affected by HIV. Diagnosed with cancer, he was given a year to live, but developed pneumonia and died a few days later.

Born in what was then southern Rhodesia (now Zimbabwe), Michael had Scottish and German Jewish grandfathers and two African grandmothers. He was the youngest of nine children, and his siblings spoilt him rotten. After a brief career as a dancer in Salisbury (now Harare), he came to London when he was 19 to train as a nurse, but health problems ruled out this career and he turned to hairdressing.

Almost 20 years of support

Michael joined London Lighthouse in 1989. We worked together on the residential unit, where people infected with the virus came for respite or palliative care, until he was moved to the main reception desk, a job that suited him well.

He was very often the first person a visitor to Lighthouse, perhaps newly diagnosed, met, and the warmth of his welcome was something they never forgot. He could, when needed, be a tremendous pillar of strength, and he helped many people come to terms with their diagnosis, which in those early days could be a sentence of death.

His cheerful, friendly, charismatic personality touched everyone who came into contact with him. He had a wicked sense of humour, and was the life and soul of many a party. Over the past 20 years, thousands of photographs were taken at Lighthouse, and it would be hard to find one that did not show Michael's grinning face.

As well as working at Lighthouse, he was a part-time barman at Ted's Place, a gay club in Fulham, west London.

Michael always did things in style, and the funeral was as stylish as the man. A glass hearse, pulled by two black horses with pink plumes, carried the coffin, and the party afterwards at Lighthouse went on into the night.

source

Zimbabwe - HIV in Crisis

posted: 18/12/2008

Health workers in Zimbabwe are warning that international alarm over the spreading cholera emergency, which has claimed nearly a thousand lives, is overshadowing the HIV crisis, which is killing as many people every three days.

The rising death toll from cholera, brought on by collapsed sewerage systems infecting drinking water, has become the most visible sign of Zimbabwe's extraordinary implosion and the indifference of its leaders. As the disease spread across the border into South Africa, alarmed foreign governments promised to pour in aid to contain the outbreak. But cholera and the failure of the sewerage system are symptoms of the wider collapse of the state and its devastating consequences.

No medicines and starvation causing hundreds to die each day of HIV

Aid workers speak of a silent catastrophe in which people are dying of HIV by the hundreds every day for want of medicines and sufficient food to fight off the disease, and because a cynical government has blocked foreign aid workers from reaching many of the most vulnerable.

About one in five Zimbabweans are HIV-positive. The UN says HIV kills more than 400 Zimbabweans each day.

"This cholera is just one issue," said Meine Nicolai, director of operations for Médecins Sans Frontières Belgium, which is working in Zimbabwe. It is a disease with a risk of high mortality, so we have to pay special attention to treat the patients with cholera because it can spread very rapidly. But it is just one of the problems and the result of a collapsing system that is claiming many more lives. The situation of the wider population is more worrying in terms of a collapsing healthcare system, very high HIV prevalence and the nutritional situation."

Although HIV has been claiming increasing numbers of lives for years in Zimbabwe, health workers say people have been made more vulnerable to the disease by widespread malnutrition.

Many Zimbabweans, particularly in rural areas, eat one meal every two or three days because of the collapse of agriculture following the redistribution of white-owned farms and drought. Some are living off nothing more than berries and roots. With chronic malnutrition comes weakened immune systems and much greater vulnerability to HIV. Undernourishment also erodes the effectiveness of drugs that keep the disease at bay.

Some health workers say that the working-age population of entire villages has either left for South Africa to look for work or died of HIV.

2 in every 3 deaths are caused by HIV

The World Health Organisation says the disease is responsible for two-thirds of all adult deaths in Zimbabwe. More than 40% of deaths in children under five are HIV-related, six times the average in a region where the disease is rife. Life expectancy is among the lowest in the world. More than a million children have been made orphans as a result of HIV.

The dead are buried in overcrowded cemeteries where the graves are bunched together to make room for the next day's dead. Costly headstones have given way to wooden markers for men and women who have barely made it to adulthood.

Drugs now unavailable

Government distribution programmes for drugs such as the one that prevents HIV-positive women from passing the virus to their babies at birth have largely collapsed. According to the Global Fund for Aids, only about one in five of those who need antiretroviral drugs to keep the disease at bay are receiving them. Those who do are generally reliant on foreign aid organisations.

The cholera crisis is not detached from HIV. Nicolai says those most at risk from dying from the disease are undernourished and HIV-positive.

"A weakened population that is undernourished, a population that has a high HIV prevalence, is even more at risk from cholera. So cholera is important, but it's only one of the problems," she said.
 

Holidays Planning

posted: 17/12/2008

Many people find that the Christmas and New Year holidays provide a welcome and enjoyable mid-winter break. HIV services will close for part or all of the holiday period.
 

HIV Clinics - enough pills?

Although you should check details with your own clinic, it is likely that all specialist HIV treatment centres will close on the afternoon of Wednesday 24th December and will not reopen until Monday 29th December, closing again for the New Year holiday on Wednesday 31st December and reopening on Friday 2nd January.
 

It is therefore important to make sure you have enough medication to last you over the holiday period as obtaining further supplies is likely to be very difficult. Get in touch with your clinic now if you think you need to see your doctor or need more supplies of HIV drugs. If you need medical help when your clinic is closed, you should contact your GP, go to a walk-in centre, or in an emergency go to your local hospital casualty (A&E) department.
 

HIV services - council and community

You are likely to find that all HIV services provided both by local authorities and the voluntary sector will close early on 24th December, and will not reopen until the 29th December at the earliest. In addition, the New Year break will mean early closing on 31st December until the morning of 2nd January.
However, you may find that many services will close on Christmas Eve and remain shut until 2nd January, or possibly the following Monday, 5th January. George House Trust closes between 3pm on Wednesday 24 December, until 9am Friday 2 January.

Even when service providers are open between Christmas and the New Year they may be able to offer little more than a very basic service. If you use HIV services, enquire before the holiday period about their opening times.
 

Money and benefits

It's very easy to spend a lot of money at Christmas, but life goes on after the festive period and a major cause of the January blues is over-spending in December.
Money can be especially important to consider if you are on a low income or live on benefits. Benefit offices will also close for Christmas and the New Year holidays and if you are entitled to benefits over the holiday period these should be paid in advance. It is important to budget your money, as you will not be entitled to any further payments until after the New Year.
 

Heat, light and hot water

If you have a prepayment meter card for gas or electric, make sure you have enough credit on the card before the holiday. Shops which can charge these cards may be closed.

Everyday issues

Hopefully you'll enjoy the holiday period. But many people, regardless of their HIV status, find Christmas a difficult time to cope with. You may find that being HIV-positive either makes these problems worse or creates additional ones. For example, adherence to your HIV treatment might be more difficult, particularly if you find that your normal routine is interrupted or disrupted in some way. In addition, spending time with people who do not know that you have HIV might mean that you are questioned about your pill taking.

Overdoing things

Food and drink are traditionally one of the pleasures of the mid-winter holidays, but it can be easy to overdo things. Christmas and New Year is also a season of parties, and for some people this means taking recreational drugs. If you are planning to take drugs, it makes good sense to think about how to do this as safely as possible.

Mid-winter blues?

Christmas can be a time when people get together. This is often rewarding, but can also have stresses and strains. Some people find Christmas quite a lonely time of year, and emotional distress and depression are experienced by some people. Depression is relatively common among people with HIV and although drinking large amounts of alcohol and taking drugs may seem to offer a short-term escape, they will probably make things worse.
Many people relax their inhibitions during holiday periods and Christmas and the New Year are no exception. It makes good sense to think about your sexual health over this period - the first two weeks in January are often one of the busiest times of the year in sexual health clinics.
 

Support and helplines

Although most face-to-face services will be closed, some HIV specific and other telephone helplines are open over the holiday period. Some are open as normal while others are open reduced hours. Details of some are listed below. Please note that they may have reduced opening times, or be closed completely, over the holiday period.
 

THT Direct          0845 1221 200
THT Direct is a specialist HIV telephone information and advice service provided by the Terrence Higgins Trust. THT Direct is usually open 10am-10pm Monday to Friday and 12-6pm at weekends.
It will be closed on the 25th and 26th December and 1st January but will be open for shorter than normal hours on the other days (10am-4pm on 24th, 29th, 30th and 31st December, 12-4pm on 27th and 28th December).
 

African AIDS Helpline       0800 0967 500
The African AIDS Helpline is a telephone support and information service provided by the Black Health Agency and staffed by African men and women. The service is open 10am-6pm Monday to Friday.
It will be closed on the 25th and 26th of December and the 1st of January, but otherwise is open as normal throughout the holiday period.
 

NHS Direct        0845 4647
A service which provides 24 hour confidential health information. It is open every day of the year.
 

The Samaritans       0845 790 9090
The Samaritans helpline is open 24 hours every day of the year. The Samaritans are available to anybody who is lonely or depressed and feel that they have no one else to turn to for support or anybody who is going through a personal crisis and thinking of taking their life.
 

Sexual Healthline       0800 567 123
This is a 24 hour national phoneline and will be open throughout the holiday period offering confidential advice, information and referrals on all aspects of sexual health and HIV to anyone.
 

acknowledgements to NAM's Weekly Update

Oral Sex, Tiny HIV Risk

posted: 17/12/2008

For about 20 years we have said oral sex is low-risk, not no-risk for HIV transmission. Now researchers have tried to say how low the risk really is. This is not so easy to check as you might think.

The risk of HIV transmission during oral sex is very low, but not zero, conclude researchers from Imperial College and the London School of Hygiene and Tropical Medicine. They tried to find all the studies, but found that the lack of data meant they still can't make a broad estimate for the transmission risk through oral sex.

They started with a systematic review (an analysis of all the medical research that meets their standards). The studies reviewed include data from heterosexual, lesbian and gay couples, covering both fellatio (oral sex on a man) and cunnilingus (oral sex on a woman).

Only 10 studies count

Only ten studies were judged to be good enough to include in the review. All were from Europe or North America, and only three used data from after HIV combination treatments became widespread.

Problems

The researchers point out the many problems with measuring oral sex risks for HIV.

• Very few people only have oral sex.
• If a person has both unprotected oral sex and unprotected anal or vaginal sex, and acquires HIV, their HIV infection is automatically attributed to the more risky anal or vaginal route, not to oral sex.
• Data on individuals’ self-reported sexual behaviour is hard to collect accurately, especially because people tend to give more socially acceptable answers (i.e. pretending to have been "good" and not "admitting" sex without condoms).
• Studies frequently group all oral sex practices together, without separating out the oral sex acts by who was doing what to whom, which person has HIV, if there is ejaculation in the mouth or not, and if so, the spit or swallow choices.
• Studies of serodiscordant couples (where one person is HIV-positive and the other is not) are likely to include people with well-controlled viral load, meaning that they are much less infectious than during primary infection (the first few weeks after HIV infection when people are the most infectious they will ever be). Oral sex transmission is more likely during primary infection. Oral sex transmission of HIV is also more likely when one or both have certain other sexually transmitted infections (STIs), especially those STIs that have sores. 
• Studies which do identify a risk from oral sex are more likely to be published and reported than those which do not, because of the interest and comparative novelty of such a finding.

Estimates of the per-partner transmission risk - zero to 20%!
Five of the studies provided estimates of the risk of multiple oral sex acts during the life of a sero-discordant relationship.Three of these studies gave that estimate as zero – no transmissions were reported.

The fourth study provided a figure of 1% for receptive fellatio.

The fifth study, from Sweden, provided a much higher estimate of 20%. However the sample was very small (ten couples reporting oral sex as their only risk factor), and the review authors comment that the high estimate may be due to under-reporting of higher risk activity, or simply due to chance. Moreover, this is the only reviewed study which identified any HIV transmission among heterosexuals that could be attributed to oral sex.

Estimates of the per-partner incidence, per 100 person years
Three of the studies also reported estimates which calculated the transmission risk of multiple oral sex acts, but with the duration of the relationship stated. In each case, the estimate was zero.

Estimates of the per-study-participant transmission risk
Three further studies followed HIV-negative people who reported unprotected oral sex as their sole risk factor. However the authors note that these studies have additional methodological limitations: the number of sexual partners and their HIV status is not known. This implies that the findings cannot be transferred to other populations where numbers of partners and HIV prevalence are different.

Two American studies gave estimates of 0% and 0.4% respectively, and the more recent Canadian Omega cohort provided a figure of 0.5%. Each study was conducted with gay and bisexual men.

Estimates of the per-act transmission risk
Three studies attempted to calculate the risk of HIV transmission during a single act of oral sex.

Two studies both provided zero estimates – no transmissions were reported.

The third study is Vittinghoff’s often cited paper which used data from American gay or bisexual men who reported multiple risk behaviours. Mathematical models were employed to estimate the risk of different sexual acts, and unprotected receptive oral sex with ejaculation was calculated to have a 0.04% risk of HIV transmission. However the review authors note that this estimate is based on sex with both infected and uninfected men – if the researchers had been able to exclude sex with HIV negative partners, the figure would have been higher.

Conclusions
The authors note the paucity of data to inform this review. Reliable estimates would be important for prevention workers and clinicians advising people on the relative risks. Moreover, because of the low risk of transmission, "large and expensive studies" would be required to provide more precise estimates.

They also comment: "The fact that infected study participants with solely this exposure have remained difficult to identify may suggest that indeed the contribution of orogenital intercourse to HIV incidence remains low."

Nonetheless they do recommend that "individuals should protect themselves using condoms or dental dams to minimise this small risk."

George House Trust comment - STIs and gum disease raise risks

After 20 years we are no nearer answering the oral rex risk question with scientific accuracy. The balance of the evidence is clear - the risk is minimal.

But from other research we know that the risk of HIV (and STI) transmission during oral sex is far higher when people have other STIs (herpes, syphilis, gonorrhoea included) either in their mouth or genitals. It is also higher when people have gum disease and other mouth and throat infections. Both STIs and gum disease increase the risk of transmission during oral sex because they can provide an open pathway into the bloodstream for the HIV virus.

We can reasonably expect that oral sex risks are highest in these situations, especially when people are in the much more infectious primary stage of infection (within the first two months of themselves becoming infected). For people at other times, and especially for those people on treatment with undetectable viral loads, the transmission risk would seem to be very close to zero.

In terms of prevention priorities, fretting about the tiny oral sex risks is a diversion from the things that would really make a difference to the annual numbers becoming infected, including consistent condom use in anal and vaginal sex, reducing the numbers of people with undiagnosed HIV as far as possible, and actions which prevent transmissions during the most infectious first few weeks.

Source and Reference