Better Primary Care for HIV

posted: 11/02/2011

How should HIV clinics and GPs work together caring for people living with HIV, when HIV clinics look after the HIV, and the GP is responsible for general healthcare? Lots of people with HIV, GPs and HIV doctors find this split rather clumsy. Two central London NHS Trusts asked Positively UK to investigate what people want and how we can make things work better.

Their report gives Manchester as one example of how to offer better primary care for people with HIV.
 

Manchester Primary Care Trust did this by introducing compulsory HIV awareness training for GPs and offering guidelines about disclosure and confidentiality. It made this a compulsory part of every GPs contract.

Another way of improving GP care for people with HIV is being used in Brighton. There they didn’t try compulsion, but invited GPs there to sign up to offer a Local Enhanced Service (the doctors are paid extra for this) where there is HIV training, see a minimum number of HIV+ patients, and carry out some extra health tests and checks.

This Positively UK study surveyed people with HIV, primary care staff and HIV clinics about what would help patients make the change from using the HIV clinic for everything, to using a GP for day to day, non-HIV healthcare. The report includes these 15 recommendations.

15 suggestions for action and improvement

• Increase people with HIV’s use of primary care by providing services in new ways 
• Provide short training sessions for all general practices to raise awareness of HIV, patients’ concerns and to boost practice confidence
• Introduce enhanced GP services for HIV using a 2-day training course and annual update training
• All staff (including receptionists) of practices that offer an enhanced service for HIV must attend HIV awareness training
• Develop quality standards on the basic information GPs should gather on patients’ HIV health and medications; increase standard length of appointments for patients living with HIV; agree protocols for protecting patient confidentiality
• Incorporate these quality standards into the existing GP Quality Outcomes Framework, to help implementation and monitoring of progress
• Provide enhanced HIV services to patients outside the practice catchment area where people with HIV have no local practice offering an enhanced HIV service
• Encourage practices already offering an enhanced local STI service or HIV testing to extend this by offering an enhanced HIV service
• PCTs consider providing primary healthcare for people with HIV in any ‘one-stop shops’ that are developed
• Base a GP at HIV clinics to offer short-term primary care as a step to using a local GP for primary care
• Consider how to manage the transfer to primary care of people using clinics in another PCT district
• Provide a ‘hotline’ at HIV clinics for GPs with concerns about HIV patient care
• Use the CQUN standards as a basis for routine sharing of information between HIV clinics and General Practice
• Following past recommendations appoint a nurse specialist and community lead as ‘champions’ to promote good practice and care shared between General Practice and HIV Clinics
• Provide information for people with HIV about finding a GP, patient rights and telling the doctor.

Primary Care Access: GPs responding better to the needs of people living with HIV – executive summary and recommendations
 

Primary Care Access full report and recommendations 
 

free to download HIV in Primary Care book from MedFash

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

George House Trust's AGM and Annual Report

posted: 30/09/2010

George House Trust held a well attended Annual General Meeting on 23rd September 2010. Members elected our new Board of Trustees: Steven Ainscow, Kate Alcock, David Borrow, Paul Fairweather, Tony Harrison, Damian Kelly, Adela Mugabo, Stewart Murau, Joe Philips, Leo Platt, David Teasdale and Jim Vann.

The meeting also approved amendments to George House Trust's Aims and Objectives set out in our Memorandum & Articles of Association. Our revised Aims and Objectives are:

•  to support people living with and affected by HIV in the North West of England through the  delivery of responsive and relevant services
• to deliver interventions to help prevent the transmission of HIV
• to campaign and educate to bring an end to HIV related stigma and discrimination

George House Trust's 2009-2010 Annual Report is now available. Last year, we delivered over 15,964 services, excluding email and postal services, to over 2000 people living with or affected by HIV. You can read highlights from the year by downloading our Annual Report here.

HIV Prejudice Evidence

posted: 13/09/2010

More detailed information about HIV stigma, prejudice and discrimination against people living with HIV in the UK is now becoming available. 857 people with HIV took part in the UK part of an international survey the The People Living with HIV Stigma Index.

The first UK results were reported in Give Stigma the Index Finger.
All the HIV prejudice, stigma and discrimination evidence is grouped into main themes 

• health settings
• exclusion
• disclosure decisions
• diagnosis experiences
• disclosure experiences
• self-stigma
• rights and laws
• effecting change.

Now the UK workers on the Index want to help people understand and use the wealth of detail that was collected about HIV prejudice and discrimination. All the data (anonymised of course) is in a computer database and they have done some more detailed analysis, and produced a computer tool to crunch the numbers, find relevant comments and produce fully detailed evidence. The idea is to use these to inform and train organisations to help end HIV prejudice and discrimination.

There’s now a presentation report called questionnaire, pointers and qualitative exploration that explains this. ‘Pointers’ is the name of their tool for detailed computer analysis. Starting on page 29 there are four presentations, to illustrate how people can make use of all the data in the UK index.

The index covers discrimination in

• family planning and pregnancy
• housing and UK residency
• employment
• family and friends
• mental health
• dental health
• faith and religions
• doctors in general practice.

Questionnaires, Pointers and Qualitative Exploration presentation with examples

HIV in NW Rises Above 6000

posted: 17/08/2010

The latest annual report on HIV in NW England shows us that there are 8% more people with HIV using HIV clinics in 2009 than the year before: for the first time there are now over 6,000 people using NW England's HIV clinics. in 2009 there were 6,238 people using clinics compared with 5,767 in 2008. Modern HIV treatments are working well for most people.
 

Infections in the UK - gay and bi men

Almost three quarters of all the new people who get HIV in the NW are gay or bisexual men. However gGay and bi men are only 43% of all the new HIV cases in the NW in 2009.

This is because many people in NW England got HIV abroad - forty-one percent of the new cases were people who were infected outside the UK. Four out of five of the new cases infected abroad are heterosexual women and men, and most had no idea they even had HIV when they left their home countries.

Some countries, especially in sub-Saharan Africa, have very much higher rates of HIV compared with the UK.
 

Five times more using HIV clinics than a dozen years ago

Now the total number of people using HIV clinics in the NW of England (6,238) is five times bigger than a dozen or so years ago. This is because there are around 800 to 900 new cases each year, and modern HIV treatments work so that very few people die with HIV now. The death rate from HIV is below half of one per cent now, while before modern HIV treatments really started working, the death rate was 9%, back in 1996.

Around the region

Greater Manchester has the largest number of people with HIV by a long way, ahead of Merseyside and Cheshire, and Cumbria and Lancashire. Greater Manchester has 3,754 people using HIV clinics – here HIV affects around 137 per 100,000 people. In 2009 there were 498 new cases in Greater Manchester. Most people with HIV in Greater Manchester live in Manchester and Salford.
Cumbria has the fewest people with HIV in the NW (131; HIV affects around 25 per 100,000 people), and there were 16 new cases in Cumbria last year.

Dr Penny Cook, the author of the HIV & AIDS in the North West of England 2009 report said:
“The number of people in treatment for HIV in the North West has now reached over 6,000. Many of the new infections were acquired in the UK and would have been entirely preventable. We must ensure that in this difficult economic time resources continue to be invested in prevention, since targeted health promotion campaigns save the NHS a substantial amount of money on treatment in the long run.”

Professor Mark A. Bellis, Director of the Centre for Public Health commented:
“As the NHS is transformed, prevention of sexually transmitted infections must be seen as a priority.”

Source - Press Release

2009 Report - HIV & AIDS in the North West of England 2009

All years - HIV in NW reports and data 1996 -2009