Securing HIV Community’s Future

posted: 10/02/2011

The future for both people with HIV, community and council HIV services is threatened and unstable now because of the government’s responses to the economic situation. Despite the negative outlook, HIV organisations must focus on making the most of what opportunities there are.
 

A new report, Securing Our Future, makes eight action point recommendations for the HIV community sector, based on the views of people with HIV, findings from an online survey, and the views of HIV organisations.

Securing our Future was the work of three London-based HIV organisations - Naz Project London, Positive East and Positively UK (formerly Positively Women), working together as the Counterpoint Policy Alliance.

8 Community Actions

As a result of all the feedback received from the surveys, focus groups and stakeholders, the Counterpoint Policy Alliance identifies eight key action points or recommendations for the HIV charity sector:

1. Maximise the role of people living with HIV working as peers to address their needs and change perceptions about HIV
2. Ensure the sustainability especially of peer-based personal support services (one-to-one, mentoring and support groups), and mental health counselling for people living with HIV and their families
3. Facilitate a process among people living with HIV to build a shared vision of what the HIV charity sector would look like in 5 years, in 2016 
4. Increase innovative sharing and use of peer volunteers across HIV charities
5. Build a unified and strong advocacy voice across HIV charities
6. Initiate a mentoring programme where larger HIV charities are available to assist smaller ones as / if needed, e.g., to understand the changing economic and social environment, and analytical skills to accurately identify what the implications are for the organisation and how best to respond
7. Encourage more partnerships among HIV charities that share back
   office and service delivery functions
8. Explore merger options among HIV charities that avoid homogenisation, and maintain community relationships as well as the ability to target and tailor for specific needs and sub-populations.

As the report tells us “We are moving into an era of radical revamping of the NHS and how health and social care services are provided.

"It is vital that we maximise opportunities to ensure that the needs, views and experiences of people and communities affected by HIV are at the centre of public policy and development.

"In order to achieve this and take forward the above eight recommendations, there will need to be increasing levels of collaboration across the HIV charity sector.”

Securing our Future

£1bn UK HIV Care Costs

posted: 24/01/2011

The cost of providing HIV treatment in the UK could reach £758 million by 2013. Adding HIV social care costs to this total means the total state spending on HIV care could be over £1 billion a year in 2013.
 

The UK has the fastest growing HIV epidemic in Europe, with rising numbers using NHS HIV services. People are continuing to get HIV, and because modern HIV treatments work so well, few are dying early. Both of these trends increase the total cost of HIV care, every year.
 

Annual costs from 1997

The study looked at how much it cost the NHS to provide treatment and care to people with HIV between 1997 and 2006. They also calculated the costs for future years, to 2013.
 

Using information from 14 clinics, they divided people up, depending on the stage of their HIV illness (no symptoms; with illness symptoms; an AIDS diagnosis), and their HIV treatment. They used routinely collected NHS HIV service use data to work out typical care for the different stages of HIV illness.
 

Triple the people, quadruple the bill
The total using NHS HIV services tripled from near 17,000 in 1997 to just over 52,000 in 2006. At the same time, the cost of treatment and care more than quadrupled from £104 million in 1997 to £483 million in 2006.
 

Social Care
Adding in social and community care costs increases the total health and social care costs from £104 to £164 million in 1997, and from £483 to £683 million in 2006.
 

The proportion of the money spent on treatment rose between 1997 and 2006, but spending on social care fell.

Treatment cost between £18,000 to £41,000 a year
In 2006, medical care and HIV treatments costs just over £18,000 for each person without symptoms, £21,500 for people with HIV symptoms, and over £41,000 for people with AIDS.
 

Estimating future costs
By 2013 the researchers estimate there will be 78,370 people using NHS HIV clinics, with their treatment and care costing between £720 million and £758 million.

Adding in social and community care costs raises the total state spending on HIV treatment and care in the UK to as much as £1,065 million.
 

“The direct cost for treatment and care for PLWHIV [people living with HIV] has risen 4.6 fold between 1997 and 2006,” say the investigators, with costs projected to increase “1.5 fold” between 2007 and 2013.
 

What’s pushing up costs?
People should start HIV treatment by the time their CD4 count has fallen to around 350. But late diagnosis is a major problem in the UK and this means many people start treatment late, which is always much more expensive. There’s now a national target to reduce late diagnosis, and this will increase the number of people on HIV treatment and therefore the total bill. But the researchers believe that this is well worth it.

“Starting PLWHIV on cost-effective regimens earlier, will maintain them in better health, resulting in fewer health or social services and thereby generating fewer treatment and care costs, while enabling them to remain socially and economically active members of society.”
 

Cut the bill – spend to prevent HIV
The continuing rise in HIV treatment and care costs really matters when the NHS and council social care budgets are being cut. The authors say trimming the amount it costs for each person would probably worsen HIV patient care, and save little.
 

Instead they say invest more in prevention, to reduce the number of new people needing HIV treatment every year. “Only comprehensive prevention strategies, responding directly to the epidemic dynamics operating in each country, will be able to reduce HIV incidence,” they argue.
“Policy makers and other relevant stakeholders need to use evidence-informed HIV prevention, treatment and care strategies…which will prolong life, reduce morbidity and ultimately deliver the best for both the individual and public health agendas.”
 

Source, with reference 

Free, complete article online

Professionals for HIV Teens to Adults

posted: 21/01/2011

Professionals in the North of England interested in supporting young people with HIV to make the change from childrens to adult services, are invited to regional meetings.

Growing numbers of HIV teens to adults

Many of the children now growing up with HIV are becoming adults and will need to switch to services for adults. Children's and adults' services staff need to think, plan and work together, for a smooth transition between children’s and adult HIV and other services.

Invitation to regional focus group

The Children and Young People HIV Network has arranged focus groups for professionals in the North of England, (and meetings for other regions) to make a start on developing age transition services locally.

The HIV Network invites all children's and adults' professionals (health sector, social care, and community sector) who are, or will, deliver services to 10 – 24 year old young people living with HIV.

This is part of a three-year project to improve the transition of young people living with HIV from children's to adults' services. The project aims to develop capacity by improving partnership working and enabling quality service development, both clinical and social care.

These focus groups will

• find out any current local arrangements for young people living with HIV making the transition from children's to adults' services
• explore the successes and challenges of transition, in different areas, with different numbers of young people, and identify needs
• provide a networking and discussion opportunity for professionals interested in better transitions.

Transitions won't wait

Despite the current upheavals in health, community and social care, young people’s needs for a better transition will not wait. Each area’s professionals need to become involved.

This networking and sharing opportunity will provide professionals with some useful resources on HIV and transition, lunch, and even travel expenses help for some.
 

Manchester, Sheffield, Newcastle, Birmingham

• For Greater Manchester, Merseyside, Cheshire and Lancashire – Manchester, 15 March, 14.00-16.30
• For North, West & South Yorkshire, East Riding, and Lincolnshire – Sheffield, 10 March, 13.30-16.00
• For Tyne and Wear, Co. Durham, Cumbria and Northumberland – Newcastle, 2 March, 10.00-12.30
• For West Midlands, and Leicestershire, Warwickshire, Worcestershire, Herefordshire, Shropshire, Staffordshire, Derbyshire and Nottinghamshire – Birmingham, 15 March, 12.00-14.30.

Join the group where you would have the most service links. No transition arrangements yet? All the better if you attend.

People working with affected families of HIV-positive adolescents are also welcome, although the focus will be on the transition needs of the HIV+ young people.

Book a place
Please email the Children and Young People HIV Network, telling them which one you would like to attend. All places must be booked in advance so they can book suitable accommodation and cater effectively for all. Live elsewhere? - email the Network for details of meetings in other regions

Halving Undiagnosed HIV

posted: 09/12/2010

The Department of Health has welcomed a community-led policy for HIV testing called Halve It. The Halve It campaign aims to cut the number of people who have HIV but don’t know it, in half, and by 2015.

The Department of Health said: “We really welcome the Halve It campaign. Encouraging HIV testing is everyone’s business – the NHS, charities and groups, individuals, the media and industry.”

Best test early

If diagnosed early, HIV can be successfully treated and people with HIV live to near-normal life expectancies. Late diagnosis, by contrast, is associated with a greater risk of hospitalisation and AIDS-related illness, reduced life expectancy and increased cost to the NHS. It is also associated with increased onwards transmission, and continued sexual risk taking while people are unaware of their HIV-positive status.

Halve It is a new coalition of national experts determined to tackle the continued public health challenges posed by HIV. This campaign is being supported by BHIVA (British HIV Association).

They have produced a position paper Early Testing Saves Lives

Simon Kirby, the Conservative MP in Brighton Kemptown, is the vice-chair of the All-Parliamentary Group for HIV/AIDS. He said he was “delighted” that the government supports the campaign. Calling the target “ambitious and admirable”, he said: “I am delighted that the government will support the coalition of experts involved in the Halve It Campaign in achieving their goal.”

Caroline Lucas, the Green MP for Brighton Pavilion, added: “What we really need is a much stronger commitment from the government to properly address the issue – and, importantly, some assurances that greater resources will be made available for those working in HIV detection”.

Action not words
The chief executive of the National AIDS Trust, Deborah Jack, said the government needed to do more action than simply making welcoming noises. “The Halve It campaign requires leadership and support from the top – and it would be good to know what plans the government has to reduce significantly the rates of late HIV diagnosis in the UK,” she said.

NW England has the worst rate of late diagnosis in England.

Call for national screening
The Halve It campaign calls on the government to set up a national screening programme, and to make HIV testing more accessible.

Baroness Gould talked about this at the autumn party conferences. She pointed out this was the first time that there had been a really active campaign around undiagnosed HIV and highlighted the case for including sexual health and HIV in the upcoming new Public Health White Paper. "We need to analyse why people don't get tested", she said.

Dr. Ed Wilkins (consultant at the regional specialist HIV centre, North Manchester General Hospital) said the problem was that too many patients appear with symptoms of long HIV infection, with serious complications brought about by a damaged immune system. Early testing for HIV has to be a public health priority.

Doctors miss chances
"75% of people who have been diagnosed late, originally visited a GP with ill health and the virus wasn't picked up so there is clearly a need to educate health professionals about early diagnosis too." said Dr. Wilkins.

Men with the wrong ideas
Sir Nick Partridge (Terrence Higgins Trust chief executive) highlighted that HIV testing is quick, easy and it can save lives and far too many people do not realise this. Sir Nick drew attention to the fact that men, whether they are gay or heterosexual and whatever their ethnicity including African, still have out of date ideas about HIV and what treatment and testing is like.

He pointed out that 1 in 7 gay men on the gay scene in London are HIV positive (it is around 1 in 10 in Manchester and Blackpool) and that 1 in 5 gay men with HIV do not know this. Many men have never taken a HIV test.

We need more community based, easily accessible rapid testing clinics to target high risk groups of undiagnosed people, such as African men and men who have sex with men.
David Cairns Labour MP for Inver Clyde said that "MP's on the all party Parliamentary Group on HIV are 100% behind the new 'Halve It' campaign. Stigma is still an enormous challenge to overcome."

Get Tested
The Lesbian & Gay Foundation's Rapid HIV Testing clinic for gay and bi men runs every Thursday at LGF, 5 Richmond Street, Manchester, M1 3HF.
The clinic takes place every Thursday at The LGF from 4-6pm and you can just drop-in, as no appointment is necessary.
 

You can find details of the nearest HIV test centres in NW England here

Early Testing Saves Lives - the Halve It  campiagn position paper

More HIV Testing Urged

posted: 08/10/2010

The NHS health advice body NICE has produced its first HIV guidance, about HIV testing. The draft HIV testing guidance recommends that mainstream health services offer much more HIV testing to the two communities most affected by HIV in England, black African people and to men who have sex with men. The guidelines also call for more testing to be offered in places such as bars and saunas, using rapid point-of-care tests.
 

NICE HIV testing: open for comments
The National Institute for Health and Clinical Excellence (NICE) tells the NHS which are the best and most cost-effective treatments and public health interventions. NHS bodies are legally required to fund the medicines and treatments recommended by NICE.
 

Making HIV testing guidelines work
Other organisations have produced HIV testing guidelines before, notably the British HIV Association (BHIVA) and the British Association for Sexual Health and HIV (BASHH). But these were not backed by the UK National Screening Committee, nor by NICE, and many parts of the NHS simply ignored them.

The most recent BHIVA and BASHH testing guidelines recommended that HIV testing should be offered in a wide range of healthcare settings, including GP surgeries and most hospital departments. Little was done about this.
 

NICE will force more testing action
To increase testing, the Department of Health asked NICE to produce public health guidance to increase HIV testing both among men who have sex with men and among black African communities. The new NICE guidance supports most of the BHIVA and BASHH testing recommendations, and goes further with some recommendations.
 

There are two guidelines - one to increase testing in men who ave sex with men, and a the other for increasing testing among black African people.
 

Local strategies needed

For both men who have sex with men and for black Africans in England, NICE recommends preparing local strategies to increase HIV testing, developed in consultation with community organisations and the people affected. These strategies should focus on sections of the community who are less likely to use services. Community engagement and involvement is particularly important for black African communities.
 

Africans - involve people as champions and leaders
NICE recommends that black Africans in England should be recruited and trained to act as ‘health champions’ and ‘role models’. HIV testing work must deal with people’s misunderstandings and ignorance about HIV, testing and treatment, and must promote the benefits of early diagnosis and tackle HIV-related stigma.
 

The guidance for black African communities includes providing HIV testing outside sexual health clinics. This is because the evidence from the literature is that HIV testing in sexual health clinics is seen by some black Africans as stigmatising, complicated and time-consuming, while HIV testing in other healthcare settings was welcomed.
 

NICE recommends that general practitioners should routinely offer an HIV test to black Africans who have not tested before or who have had a new sexual partner since the last negative test. In hospitals and other healthcare settings, an opt-out test should be routinely provided to black Africans who are having blood taken for other reasons.
 

Testing in sex venues to reach gay men
Health promotion interventions promoting testing to men who have sex with men should include venues, such as saunas, clubs and cruising areas, or websites, which facilitate sex between men.
NICE appears more enthusiastic than BHIVA about community testing in sex on the premises venues. In gay venues, NICE says rapid tests (using mouth swabs or finger-prick blood samples) should be provided by trained staff, in a secluded or private area.
 

NICE’s guidance for men who have sex with men encourages testing in primary care (GPs), but not in secondary care (hospitals). The BHIVA guidelines are different, and recommend that all healthcare settings should offer an HIV test to any man who says he has sex with other men.
 

NICE recommends that GP surgeries should recommend all males to have HIV tests where the surgery is in an area with a large gay community or theer is a high rate of HIV.
 

Carl Burnell, of the gay men’s health charity GMFA, questions whether this will is work, because of the many other demands on GP surgery capacity. “The strategy assumes that other services are running like clockwork and have capacity to offer HIV testing,” he said.
 

Clear path from testing to services
All testing services need clear pathways for people to obtain any necessary confirmation of the HIV test result, HIV treatment services and HIV support groups. People who test negative may need help through counselling and safer sex interventions.
 

The draft guidance comes before results are published on several Department of Health funded pilot projects evaluating new testing strategies.
 

NICE’s guidance is open for feedback and comments until late November. The final NICE HIV testing guidance will appear in March 2011.

HIV testing guidelines for MSM 

HIV testing guidleines for black Africans in England
 

Source