Answers in Untested Mystery

posted: 12/04/2011

HIV experts in England are puzzled why some people using STI clinics refuse HIV tests. We know for sure that some of those refusing HIV tests do have HIV (from using blood from samples given for syphilis tests and after the syphilis test is done and the blood sample is made completely anonymous, it can be tested for HIV).

The 2009 results from doing this show that 2.4% of gay and bisexual men and 0.25% of heterosexuals tested for syphilis came to the sexual health clinic with undiagnosed HIV.

But only 63% of these people agreed to a HIV test at the STI clinic - much lower than the average rate of HIV testing for people using STI clinics.

Why are so many people who have ‘undiagnosed’ HIV, refusing HIV tests?

One quarter must already know they have HIV - they are taking HIV treatment !

Some useful answers to the testing mystery have now emerged. Now we know that around a quarter of people with ‘undiagnosed’ must know they have HIV, because blood tests prove they are taking HIV treatment. These and other results, given at the British HIV Association conference in Bournemouth last week, are the first clear evidence of some answers to the ‘undiagnosed’ mystery.
 

Slightly more heterosexual women and men (32% for both men and women) than gay men (24%) are using a different clinic for STI checks than for their HIV treatment. Experts thought gay men with HIV were more likely to go elsewhere for HIV checks than heterosexuals. Experts don’t always guess right. Some people with HIV have told community organisations and patient advocates that one reason they go elsewhere for testing is to avoid unwanted, intrusive or judgemental discussion of their sexual behaviour by their own HIV clinic.
 

The results means

• 9 in 100 of the gay and bisexual men who said yes to a syphilis test but no to a HIV test have HIV. At least 2 of those 9 are on treatment but didn’t tell the STI clinic they have HIV
• 8 in 1000 of the heterosexual women and men similarly are HIV positive. At least 2 of those 8 are on treatment but did not tell the STI clinic they have HIV.
   

These findings will make little difference to national estimates of how much undiagnosed HIV there is in the country.
 

Why do gay men who don’t yet know they have HIV refuse HIV tests?
Another small study given to last weeks conference looked at why some gay men refuse HIV tests. Researchers gave an anonymous questionnaire to 19 men who didn’t want to be tested, even though they had had anal sex without condoms and have, either never been tested, or had taken anal sex risks since their last HIV test.

The men could tick more than one reason.
 

15 of the 19 men said they believed they were at low risk of HIV infection [2 of the 19 men knew their partner has HIV]

• 14 said they were emotionally unprepared for a positive result
• 4 said they don’t like giving a blood [but nonetheless gave this to have the syphilis test]
• 4 also mentioned prosecutions for HIV transmission
• 4 said they were planning to test 'next month'
• 3 mentioned worries about the confidentiality of the HIV test result.

Testing Advantages well known

Most of the men know the advantages of HIV testing

• 16 said testing could give peace of mind
• 16 said testing allows treatment to start at the best time.

Testing worries rule

But all the gay men listed the disadvantages to them of HIV testing.

• 17 said testing was stressful
• 8 were worried about having to tell a boyfriend if they were positive
• 7 were concerned about the insurance and mortgage implications.

Unready for positive result, testing stress, in denial about risks

So most of these gay men didn’t feel emotionally ready to deal with a positive result, and find HIV testing stressful.

• Most thought their HIV risk was low, despite having taken enough risks to have got HIV and needing to visit an STI clinic.

The study authors suggest investigating ways of overcoming gay men’s resistance to testing at STI clinics.
 

Source 
Reference – the free conference abstracts - read O13 & P152

Scary NY HIV Video

posted: 20/12/2010

New York City's Department of Health is defending a controversial ad that uses rotting brains, decaying bones and bleeding anuses to convince young gay and bi men to use condoms.
 

"I am completely comfortable with what we put out here. I have talked with many young men who are HIV positive," said Dr. Monica Sweeney, assistant commissioner for the city's Bureau of HIV/AIDS Prevention and Control. "This is not fabricated. These are real conditions that affect people even though their viral load might be under control."
 

'Offensive and dishonest', or 'Prevention shock value'

The ad has split people – many are offended by its scare tactics and call the campaign dishonest – but others think the video's shock value could prevent the spread of HIV.
 

"I reject portraying my life -- 15 years and counting with HIV -- as a hellish nightmare," said Jim Pickett, advocacy director at the AIDS Foundation of Chicago. "Has it been tough? Yes ... living with HIV is challenging, but it is not one big long scream of agony for most of us. But nuance isn't eye catching or sexy, is it?"
 

The controversial NY City Department of Health video ‘It’s Never Just HIV’

Scaring people about HIV does NOT work
There is no evidence that scaring people works for HIV – and much evidence to show it does far more harm than good – the recent UK review of all the evidence, the Role of Fear in HIV Prevention, shows the use of fear fails.
 

Does using fear of HIV work?
Would using more fear in HIV prevention work? ‘The role of fear in HIV prevention’ is written as a guide for gay men’s HIV prevention workers, but many other people, including people with HIV, are very interested in this and have strong views about it. It is an interesting and informative read, on four illustrated pages.
 

It looks at the scientific evidence for whether fear works or not, considers the ideas behind it, and looks into the unforeseen consequences and risks of using fear in HIV campaigns.
 

Fear is for the Fearless
The evidence shows that fear only works with people who are not already frightened by HIV. But 98% of gay men say (in Gay Men’s Sex Survey, 2008) they agree or agree strongly that “HIV is still a very serious medical condition.” So almost every single gay and bi man is already fearful of HIV. Perversely, adding to that fear can make things worse for the men at more risk of HIV.
 

As Adam Bourne says:

“It will remain a constant challenge for those promoting sexual health and well-being to attract the attention of their target audience among the many other advertisements that compete for their attention.
“The temptation is to produce shocking or explicit imagery, which may stand a better chance of being noticed or being remembered.
“However, it is doubtful whether it will actually be successful at influencing behavioural choices.
“Most gay men and other men who have sex with men are already motivated to avoid HIV, but some still lack the knowledge or the power to do so.”
________________________________________
“Inducing fear is not an effective way to promote previous HIV relevant learning or condom use either immediately following the intervention, or later on.
However, HIV counselling and testing can provide an outlet for previous HIV-related anxiety and, subsequently, gains in both knowledge and behaviour change immediately and longitudinally.”  Earl & Albarracin, 2007

The role of fear in HIV prevention, Adam Bourne, 2010, Sigma Research Briefing no.1 for the CHAPS gay and bi men’s HIV prevention partnership

Source

More information and comment from The Body (leading USA HIV website)

The NY City Department of Health video ‘It’s Never Just HIV’

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

THT Hardship Fund Open

posted: 13/10/2010

The Terrence Higgins Trust (THT) Hardship Fund has now opened. People with HIV who need fnancial support can now apply for up to £100. In mid June Crusaid's Hardship Fund merged with Terrence Higgins Trust and the hardship fund closed temporarily. 

The replacement Hardship Fund service from Terrence Higgiins Trust will be fully working from April 2011. In the meantime George House Trust, which is the only approved referring agency in North West England, can apply to the THT hardship fund for grants of up to a maximum of £100 per person. People can't apply direct - they either need to apply through us, or use the Terrence Higgins Direct phone service: THT Direct on 0845 1221 200

If you live in NW England please speak to one of our service advisers for more details - 0161 274 4499. We can help in various ways, including through our own welfare fund, and with benefits and money advice.

Sir Nick Partridge, chief executive of THT, said:

“For years the Hardship Fund has been an important resource, making a real difference to the lives of people with HIV, and THT is fully committed to preserving its legacy. We are working hard to get the national fund fully operational by next spring, and in the meantime we hope our interim fund will continue to help those who need it most.”
 

A report released this week by THT and the National AIDS Trust said that one in six people diagnosed with HIV make use of the fund, and that the majority of beneficiaries are living in “extreme” poverty, on just 20 per cent of the average weekly income. Read more about this 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