Messaging Gay Men About STIs

posted: 07/04/2011

Manchester gay and bi men using the Royal Infirmary's Hathersage Clinic (along with men using STI clinics in Sheffield, Brighton and at four London STI clinics) now have a new way to warn partners they may have been in contact with a sexually transmitted infection.

The Sexual Health Messaging Service has just begun, launched by GMFA, the gay men’s health charity, and is linked in with the popular gay profile sites Fitlads, Gaydar, Manhunt and Recon, and the cruising app Bender.

Men need to Opt-in for notifications  if they get an invitation, for it to work.

It's funded by the Elton John AIDS Foundation and aims to help cut the number of men with undiagnosed STIs, including HIV. Men who are diagnosed with an STI can tell previous sexual partners by using an online system (anonymously if prefered), so the partners can go and get tested and, if necessary, treated.
 

99% want to know about any STIs

Over a quarter of gay men with HIV do not know they have HIV. GMFA’s study shows that the vast majority of gay men (99.3%) want to be told if any sexual partner gets an STI and 97.5% want to be told if this is HIV.
 

Matthew Hodson of GMFA, commented: “Many STIs don’t show any symptoms, so lots of men may be infected and not know it. While it’s best to tell men you’ve had sex with if you find out you’ve picked up an STI, making that awkward phone call or sending an email can be difficult. As a result, some men choose not to tell, even though they know they should. We’ve made the process as easy as possible by doing most of the work for you – all you need is a contact for your partners and we’ll take care of the rest.”
 

An easy (even anonymous) way to tell

Existing ways of telling partners often require anyone who is diagnosed with an STI to contact their partners direct, sometimes using a pink slip issued by the clinic. GMFA’s research shows these systems often don’t work.

For all kinds of reasons some men can't or won't notify sexual partners. Of the men who do tell partners about having an STI or HIV, only 65% told all their partners. Here's some of the difficulties and reasons for this

• not having partners’ contact details (sometimes only a first name, or only a profile name)
• embarrassment
• not wanting the partner to know about their having an STI or HIV 
• not wanting to see the guy again.

Now men using the Hathersage in Manchester, men in Brighton, Sheffield and parts of London can use GMFA’s new Sexual Health Messaging Service. It  will then be spread across the rest of London later this year and then the rest of the country next year. 

The GMFA service means clinics give men a unique reference number so they can log in to the online system and send notifications using a number of contact methods, including

• website profile name
• cruising app profile name
• mobile 
• email.

The message is automatically written and contains links to where their partners can go for testing. While men are encouraged to say who they are, it can be kept anonymous.

The service started its six-month pilot on Monday. The clinics taking part are

• In Manchester, the Hathersage Centre (Upper Brook Street / Hathersage Road corner) 
• In Sheffield, the Royal Hallamshire Hospital
• Brighton, Claude Nicol Centre at Royal Sussex County Hospital
• 56 Dean Street, Soho, London,
• Homerton University Hospital, London
• The Lloyd Clinic at Guy’s Hospital, London
• St Bartholemew’s Hospital, London 

Men can use the service to send messages to partners met through the four participating gay dating websites (Fitlads, Gaydar, Manhunt and Recon) and the cruising app, Bender.

Opt-in to take part 

Profile site members need to opt-in to receive notifications if and when they are sent an invite.
 

Matthew of GMFA tells us: “This is a major project and marks a huge shift in the way men can notify their partners about STIs they’ve picked up. By making the process easy, we hope to make more men aware of any STIs they may have and ultimately reduce the number of STI infections in the community.”

HIV Healthcare Training Online

posted: 03/03/2011

HIV and STI doctors and other healthcare staff have an engaging and extensive online learning programme called eHIV-STI. This e-training has been put together by the British Association for Sexual Health and HIV and the Federation of the Royal Colleges of Physicians. Keeping HIV clinic staff well trained is an important part of good HIV care.
 

This eHIV-STI training provides the knowledge healthcare professionals need for treating and supporting people with sexually transmitted infections, including HIV, and related conditions. It’s designed to be used alongside clinic training.
 

3 knowledge levels

They provide training to three levels of knowledge, from introductory, to more advanced and finally specialist knowledge, so people can learn in stages.
 

The 60 sessions of e-learning with video clips and case studies cover most of what HIV and STI clinic staff need to know. The training is open for doctors and NHS healthcare staff in England who register with the site.
 

HIV & STI e-Learning for Healthcare

GP Guide - Migrants' Health

posted: 26/01/2011

The Migrant Health Guide is a free new online “one stop information shop” for GPs and practice nurses who are working with migrants.

It comes from the Health Protection Agency who have produced it because migrants health needs are often more complex than for other people. HIV is included.

The online guide gives doctors and nurses easy access to the facts, so they can improve their patients’ care and quality of life.
 

Although most migrants to the UK are healthy, TB and HIV and other conditions are more common.

The guide supports diagnosing and managing a range of typical migrant health conditions. Early diagnosis and prompt treatment of HIV and other conditions is important for the health of the individual and to reduce onward transmission.
 

Produced by experts working with primary care practitioners, it comes with the blessings of the Royal College of General Practitioners and the Royal College of Nursing.

Key Recommendations

• Know your local migrant population and their rights to care
• Teach patients how the NHS works
• Assess new patients using the checklist and their country page
• Vaccinate and immunise as normal
• Watch and test for infectious diseases and conditions typical of their country
• Check and advise on any plans to visit friends and relatives abroad.

The Migrant Health Guide has

• detailed information for each country
• tools for assessing migrant patients – new patients, patients with symptoms, identifying more vulnerable patients
• how to talking about the NHS with migrants – explaining it, migrants rights to treatment, languages and interpreters, cultural awareness
• sections about migrant health conditions (including HIV), infectious diseases, vaccinations

Migrant Health Guide

HIV in Primary Care : The best HIV guide for GPs and primary care is (free download) HIV for non-specialists, by MedFash.

Treating HIV-2 Guidelines

posted: 04/11/2010

There are two main types of HIV, and HIV-2 is found mainly in West Africa and less so in parts of India, with very few migrants in the UK having this HIV type; most people in the UK have HIV-1.

The first treatment guidelines for HIV-2 have now been agreed by BHIVA (British HIV Association).
 

Under 150 people are diagnosed with HIV-2 in the UK and under 50 people have both HIV-1 and HIV-2, so these guidelines try to make sure the considerable differences between the two HIV types and the best treatments for HIV-2 are well understood.
Although HIV -1 and HIV-2 are closely related, there are some big differences in testing, monitoring viral load, in treatment.
 

Less transmission and health harm
HIV-2 is harder to pass on, because it is 5 – 10 times less infectious in heterosexual sex than HIV-1 is. Women are also less likely to pass on HIV to a baby: this is 20-30 times less likely with HIV-2. The assumption is that HIV-2 can also be passed on through sex between men and injecting drug use, like HIV-1.
 

HIV-2 is also less harmful than HIV-1. Death rates are far lower, people show no HIV symptoms for far longer (10 - 20 years without symptoms is not unknown) and some people may never develop AIDS. But HIV-2 also varies and some people will become ill as fast as they would have with HIV-1.
 

Testing
Standard HIV tests find people with HIV-2 but because dealing with HIV-2 is different to HIV-1, people with HIV-2 need to spotted during testing. Not all UK labs can test for HIV-2 but testing for HIV-2 needs to be done for people to be given proper treatment and care. There are special tests to identify people with HIV-2.
 

Measuring the viral load of people with HIV-2 is a problem. Different tests give different results. HIV-2 viral load is harder to find because it is about 30 times lower than with HIV-1: viral load is much more likely to be undetectable. There are no commercial HIV-2 viral load tests for sale.

Viral load is not detectable in half the people with a CD4 count of 300. The higher the CD4 count, the less likely it is that any HIV-2 viral load will be found. The CD4 counts and viral loads of people with HIV-2 have to be interpreted quite differently to people with HIV-1. There are four specialist labs in the country that can do this.
 

Treatment
Where HIV-2 viral load is undetectable the CD4 count may be the only guide to when to begin treatment. CD4 counts can remain stable for years. But CD4 can also fall as fast as with HIV-1, when a HIV-2 viral load is high. CD4 counts tend not to bounce back upwards as much after treatment as with HIV-1.
 

The BHIVA Guidelines for HIV-2 advise clinicians to refer all HIV-2 patients to someone expert in treating HIV-2. Most HIV doctors in the UK don’t have the necessary experience, and interpreting test results is a problem.
 

BHIVA’s treatment guidelines for HIV-2 describe how it responds to the various types of HIV drug. They suggest preferred first and second line treatment combinations for HIV-2 and the use of two NRTIs and one or more PIs. Second and third line options are limited. A good number of HIV drugs are not effective with HIV-2 and these must be avoided. Where people have both HIV-1 and HIV-2, treatment choices are limited and should be considered carefully.
 

When to treat
They suggest starting treatment before the CD4 count falls to between 350-500, and treating people whenever the VL is above 1000.
 

Source HIV Medicine (2010) 11, 611-619: the November issue and soon online

Public Health Watch

posted: 29/10/2010

Updating of public health rules means public authorities in England and Wales have powers they can use against individuals with HIV to protect the public health from 'infection or contamination'. Magistrates can make compulsory public health orders (known as Part 2A orders) on people. Similar powers were used in Manchester against a man with HIV in 1985.

Late in 1985, just after Manchester AIDS-Line (later George House Trust) was set up with the help of a small grant from Manchester City Council, the same council used its public health powers backed by a magistrate. It compulsorily detained a man with HIV at Monsall Hospital. Major protests followed and, after a court case, he was freed to leave hospital a few days later.

This was the first and only time public health powers have been used against someone with HIV in this country. You can read more about this here.

New Health Protection Regulations

These old public health powers have now been updated in new Health Protection Regulations. Helpful guidance has been produced by the Department of Health on how to use (and not use) these powers.

This makes clear that in almost all cases using these powers to manage the risk of HIV or STI transmission would be inappropriate and should only be considered, if at all, in the most exceptional of circumstances.

HIV community and clinical organisations like BHIVA and BASHH oppose the use of these powers against people with HIV. They would cause more harm than good, damaging trust in STI and HIV clinic confidentiality, increasing HIV hate and discrimination, and would only ever be a short-term fix for someone with a life-long health condition.

More information

More information on the new public health powers and HIV can be found at the NAT website.
 

The official guidance makes clear that Part 2A orders 'are not a tool for managing long-term problems' and that the orders:

• are not meant in any way to change the current system and culture of confidentiality within sexual health services
• are not to be a routine part of managing those with HIV who present with evidence of ongoing unsafe sex (for example by presenting with repeated STI infection)
• are not generally appropriate for contact tracing
• could have harmful consequences for wider trust in sexual health services
• and that in the very exceptional circumstances where a Part 2A order might be considered, advice should be sought from the treating clinician and clinic director as to the possible consequences of such an order, and confidentiality must be respected at all times.

Even with this guidance, these powers could be misapplied to people with HIV or another sexually transmitted infection.

We, and NAT, are keen to hear about any attempts to coerce someone with HIV, through the use or threatened use of these powers. We do not expect the powers to be used, because the old powers were only used once against someone with HIV, 25 years ago, and have not been used again since. But it could happen. 

Department of Health: Health Protection legislation guidance 2010, laws and regulations