Guide to Safer Sex Advice

posted: 01/03/2011

The British HIV Association has produced draft guidance for STI clinics on offering Safer Sex Advice for the UK. They are inviting comments on their draft Guidelines.

The Safer Sex Advice guidelines recommend behaviour change interventions, what safer sex advice to give people at risk of STIs, and advising people living with HIV and people at greater risk of HIV infection.

The guidance is also useful for GPs and HIV care services when offering Safer Sex Advice.
 

Comment on Safer Sex Advice Guidance

Comments deadline is 31 May 2011 - comment through this webpage

Safer Sex Advice Guidance for the UK

Harm of Symptoms Ignored

posted: 08/10/2010

Symptoms are common among people with HIV, and when they are ignored, as they often are by doctors, symptoms worsen people's taking of HIV treatment and lead to more risky sex.
Physical and psychological symptoms are highly common among people with HIV in the UK says a new report in the online issue of Sexually Transmitted Infections.
Physical and mental distress is high especially for people having unprotected sex with a partner of an unknown or different HIV status, and when people are struggling to take HIV treatments properly.
 

Symptoms unnoticed and untreated
From the moment of HIV infection, HIV is associated with a high rates of distressing symptoms. The World Health Organization recommends that controlling pain and symptoms should be an essential part of HIV care.
However, research suggests that doctors often do not detect the symptoms, and that many people with HIV have untreated pain and other symptoms.
 

How common are symptoms and what happens?
Investigators in London and south-east England were concerned that symptoms were being overlooked. They wanted to see how common symptoms were and if having symptoms was linked to differences in HIV treatment-taking, unprotected sex, and telling sex partners about HIV status.
So in 2005-06 778 patients took part in the study looking back at any symptoms over the last seven days.
 

Study participants were asked to provide basic information about themselves (age, gender etc) and to say if they had experienced any of 26 physical or psychological symptoms in the past seven days. The distress caused by symptoms was scored on a scale of 0-4. Those taking HIV treatment were asked to report their level of adherence in the previous week. All were asked if they had had unprotected sex with a partner who was HIV-negative or of unknown status in the previous three months, and if they disclosed their HIV status to partners.
 

Who are they?
Most (66%) of the people in this study were gay or bisexual men and were white (67%). The mean age was 40 years. A little over half (51%) of patients were born in the UK, and 45% had a degree.
Taking treatments – lots to improve
Over two-thirds (67%) of people were taking HIV treatments, and most people are not taking HIV treatments very well. Complete adherence to treatment was reported by 42%; partial adherence by 36%; and poor adherence by 22%. A third of people taking treatment had changed their HIV combination once and 40% reported multiple treatment changes.
 

Risky sex
A total of 11% of patients reported unprotected sex in the previous three months with a partner who may have been HIV-negative, and 6% had never disclosed to a sex partner
 

Symptoms all over
Symptoms were highly prevalent. The mean number of reported symptoms was 18. The mean symptom physical distress score was 0.81, the mean psychological distress score was 1.34, and the global distress score was 1.16.
Lack of energy was reported by 71% of patients, tiredness by 68%, difficulty sleeping by 62%, poor concentration by 61%, worry by 70%, sadness by 66%, diarrhoea by 54% and sexual problems by 53%.
 

Educated, white – less symptom harm
Having a university degree was associated with less symptom-related physical, emotional and overall distress.
In addition, white patients reported less symptom related distress than those of other ethnicities. The investigators think that this could be because many black African patients in the UK are diagnosed late when they are already ill and experiencing symptoms.
Telling others easier with few symptoms; more symptoms leads to risky sex
Disclosure of HIV was significantly associated with fewer symptoms, and reporting unprotected sex with a partner who may have been HIV-negative was associated with a greater number of psychological symptoms.
“Interestingly”, write the investigators, “currently being on antiretroviral therapy was not significantly associated with any of the symptom measures.”
 

Those on treatment
Then they looked at only the people taking HIV treatment. Poor adherence was significantly associated with psychological and global distress. Switching treatment was associated with both physical and psychological distress caused by symptoms, as well as a greater number of total symptoms.
Being born in the UK and having a degree were both associated with a lower burden of physical symptoms.
“The data…reveal high 7-day prevalence and associated distress of burdensome symptoms”, comment the investigators, who conclude: “It is essential that quality management of HIV disease routinely assess these distressing problems, so that key outcomes of risk behaviour and adherence may be optimally influenced.”
 

Source

Reference
Harding R et al. Symptoms are highly prevalent among HIV outpatients and associated with poor adherence and unprotected sexual intercourse. Sex Transm Infect, online edition, 2010 (click here for access to free abstract and paid-for full text).

Better Psychological Support Needed

posted: 15/09/2010

People living with HIV are not having their psychological needs met properly, says a new report by NAT (National AIDS Trust).

The report Psychological support for people living with HIV  shows that not getting adequate psychological support can have a severe impact on people's health and well-being. Anxiety, depression and other emotional and mental health problems are all far more common among people with HIV than is usual for people.

NAT says more must be done to give proper support – at present these needs are often overlooked, because the focus is mainly on signs of physical health, like CD4 counts and Viral Load.

People with HIV at George House Trust helped 

People with HIV met at George House Trust to help NAT understand mental and emotional support health needs better, and to talk about the experience of using services.

At George House Trust we gathered black African men and women. Positively Women (now Positively-UK) gathered women, and GMFA gathered a group of gay men. Altogether 32 people talked about emotional and mental health needs and services for people with HIV with workers from NAT. 

Experiences of the immigration system and the impact of these on emotional and mental health were a big issue in Manchester. Women at Positively Women talked a lot about peer support from other women with HIV, and the gay and bi men at GMFA talked about their experience of using mental health services. 
 

There were four main issues leading to the need for support :

• managing HIV - coping with diagnosis, telling others, and coping with the physical effects of HIV and treatment; how poor emotional and mental health affects taking treatments properly; services for older people with mental health problems such as HIV-related dementia
• psycholigical impact of having HIV - anxiety, depression, suicidal thoughts, stigma, low self-esteem, coping by drinking heavily
• managing relationships - telling people, help during a relationship crisis, help with forming relationships, being isolated, bereavement, negotiating safer sex
• the needs of migrants especially asylum seekers - the harm lengthy uncertainty over immigration status causes.

What forms of emotional and mental health support are there?

• HIV support organisations - peer support and meeting with others like yourself is highly valued, where it is available
• HIV clinicians - HIV clinicians rarely ask how people are coping emotionally
• NHS psychological support services - some good experiences but a great deal of frustration about long waiting times, severe cases only being helped, everything has to be strictly HIV-related when many serious issues are indirectly connected
• Counsellors - can be very helpful, but some bad experiences; waiting times and travel costs were problems
• Informal support - from partners, friends, family, community - for gay men this was their main source of support; for women and Africans this can be good or a problem
• Other support - Social Services seen as only for the dying, support from churches can be good or harmful, the internet's potential 

Deborah Jack, Chief Executive of NAT, says:

“People can often find it difficult to come to terms with an HIV diagnosis and deal with the ongoing implications. Psychological support can be as important for the health and well-being of someone living with HIV as going to the doctor or taking treatment. This form of support can be the crucial difference between finding every day a struggle, and feeling able to cope with and enjoy daily life."

"Providing such psychological support is more cost-effective in the long-run as it means that people living with HIV can manage their condition, take treatment properly and stay healthy. It is essential that, at this time of cuts, decisions are not made which may save money in the short-term but will increase the burden on the NHS in the long-run.”

Key findings from the report include:

• Evidence of higher rates of psychological need amongst people living with HIV, compared with the general population
• HIV and mental health problems are both highly stigmatised, and this often makes people even more unwilling to say they are having mental health difficulties
• The psychological needs of people living with HIV are not being met fairly across the whole NHS
• Investing in psychological support for people with HIV has significant benefits in the long-run for individual and public health.

Mark (not his real name), who is living with HIV, spoke about the impact of having a mental health problem:

“They reduce our immunity… If you are carrying so many things in your head there is no way you’re going to cope with your medication. So it comes back to HIV.”

Clinical Benefits

There are clinical reasons why psychological support is beneficial. Research shows the big impact that mental health can have on physical health and how someone copes with having HIV. For example, depression has an effect on how well someone takes HIV treatment properly which is essential. Psychological well-being also influences people’s behaviour, and depressed, anxious and upset people are more likely to have unsafe sex, drink too much and use drugs.
NAT argues that investing in better psychological support for people living with HIV saves money in the long run, not only because people will be healthy for longer, but also because people are then less likely to miss medication or have unsafe sex, and this reduces the risk onward HIV transmission to other people.
 

Psychological Care Standards for HIV
One of the recommendations of the report is that the British Psychological Society and others interested publish standards for psychological support services for people with HIV. The British Psychological Society has formed a working group to prepare these standards, and NAT is a member of this group. For more information about these standards or to order hardcopies of the report contact policyandcampaigns@nat.org.uk.

A copy of the report is going to each HIV clinic in the UK, funded by the drug company Abbott.

“Mental health has become a major focus for Abbott's HIV community engagement. Despite the advances in and access to treatments, many people living with HIV tell us that the psychological burden of the disease significantly compromises their quality of life. NAT's report will help inform all stakeholders about the need to consider the psychological impact of living with HIV on the quality of life and, consequently, health care provisions,” said an Abbott spokesperson.

The report is available here

and to download direct from NAT, with more information on HIV and psychological issues 
 

Check Your Drinking in NW

posted: 23/09/2008

How do you know if you could be drinking more than is good for you? If you’re worried about your own drinking, take the  DrinkCheck Quiz. It’ll help you assess the effects of your drinking. And if it suggests you are drinking too much, there's advice on how to drink less. DrinkCheck

This site - Know your Units - explains the mystery of those alcohol units

The 9 Types of Heavy Drinker

The Department of Health identifies the nine personality types of heavy drinkers at risk of liver damage and other alcohol-related illnesses that are costing the NHS in England about £2.7bn a year.

Its researchers investigated the social and psychological characteristics of problem drinkers in an attempt to devise more effective public health campaigns to encourage safer use of alcohol.

They found that people who regularly drink at least twice the recommended limit, ie 35 units a week for women and 50 for men, ranged from depressives drinking at home alone over extended periods to macho exhibitionists who spend almost every evening in the pub.

The department said it was using social marketing techniques to tailor its propaganda to suit all the target personalities.

A spokesman said: "This will be a tough one to crack. Research found many positive associations with alcohol among the general public - even more so among those drinking at higher-risk levels. For these people alcohol is embedded in their identity and lifestyle: so much so that challenging this behaviour results in high levels of defensiveness, rejection or even outright denial."

The nine alcohol-fuelled personality types are:

De-stress drinkers use alcohol to regain control of life and calm down. They include middle-class women and men.

Conformist drinkers are driven by the need to belong and seek a structure to their lives. They are typically men aged 45 to 59 in clerical or manual jobs.

Boredom drinkers consume alcohol to pass the time, seeking stimulation to relieve the monotony of life. Alcohol helps them to feel comforted and secure.

Depressed drinkers may be of any age, gender or socioeconomic group. They crave comfort, safety and security.

Re-bonding drinkers are driven by a need to keep in touch with people who are close to them.

Community drinkers are motivated by the need to belong. They are usually lower middle class men and women who drink in large friendship groups.

Hedonistic drinkers crave stimulation and want to abandon control. They are often divorced people with grown-up children, who want to stand out from the crowd.

Macho drinkers spend most of their spare time in pubs. They are mostly men of all ages who want to stand out from the crowd.

Border dependents regard the pub as a home from home. They visit it during the day and the evening, on weekdays and at weekends, drinking fast and often.

The department launchs a trial information campaign in north-west England to persuade problem drinkers to cut down. It will include self-help packs, available online and in printed form, telling drinkers how to calculate the medical risks associated with different levels of alcohol intake. The DrinkCheck web tool is available at DrinkCheck

Dawn Primarolo, the public health minister, said: "The pilot will help up to 4,000 drinkers cut down in the first year alone."
 

source