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

Texts Doubles HIV Testing

posted: 08/04/2011

Twice as many gay men tested for HIV again, when they were sent text (SMS) reminders, than men who were not texted a reminder to come back for another HIV / STI test.
Gay men in Australia are advised to have an HIV test once a year – like gay men in the UK. And men with riskier sex lives are advised to test every 3 or 6 months.

Increasing the proportion of men who know their HIV status through testing regularly helps cut the number of new infections. The problem in Australia (and it is not much different in the UK) is that only a quarter of gay men taking more sex risks do take more than one HIV test a year.
 

So a clinic in central Sydney tried sending text (SMS) reminders to see if this helped get the men in for testing more often. 714 HIV-negative gay men who had an HIV test and sexual health screen between January and August 2009 were sent a text to remind them to come for another HIV/STI check, every four months.
 

They compared these 714 HIV negative men with two other groups. 1084 other men who had had a HIV test got no text reminders. Another comparison was made with 1753 men who tested at the Sydney clinic in 2008 before they tried sending anyone text reminders.
 

Re-testing doubled returning for testing
The answer was texting more than doubled the rate of returns for testing within the year - 64% of the men who had a text reminder came back, compared with 30% of those who didn’t and 31% of those from before texting started to be tried.
 

Really it was 4 times better 
After taking into account some differences in the study groups, the clinic found the text reminders meant there was in fact a four-fold increase in the chances of re-testing (using an odds ratio statistical analysis).
 

Texts are an easy win for clinics

They comment that text reminders are an easy win for the clinic because they “allowed large numbers of messages to be sent simultaneously and automatically, reminders were direct, immediate and cheap to send and demanded minimal labour.” If morwe clinics used text reminders this has “great potential to reduce HIV/STI infection rates” among gay and bi men.
 

Frequent testing means people who do get HIV will have better health

Another study, this one from the Netherlands, shows that frequent testing (at least once a year) means people who do get HIV have better prospects for good health and life with HIV. “Our findings illustrate the benefit of repeated testing for HIV,” write the investigators, “it shortens the time between infection and diagnosis and improves the likelihood of timely treatment, with the prevention of clinical progression to AIDS and death.”
 

The Dutch researchers also believe that “increasing testing to annually may greatly impact on transmission rates at a population level.” They quote a modelling study that suggests transmission rates in the Netherlands could fall by 40% over ten years “if the average time between infection and diagnosis was reduced to 1 year.”
 

Source for Austrailian texting with reference

Source for Dutch annual testing, better health if you do get HIV with reference

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.”

Guides for More HIV Testing

posted: 04/04/2011

The number of people who got infected with HIV within the UK in the last 10 years has almost doubled. New infections that happened in the UK (rather than abroad) rose from 1,950 in 2001 to 3,780 in 2010.

In response the National Institute for Clinical Excellence (NICE, the body that tells the NHS what healthcare works and is good value for money) has issued new guidance for the testing of the two groups most at risk of getting HIV in the UK, gay/bi men and African people.

HIV testing helps people keep good health

Testing and treating people with HIV helps the person with HIV stay healthy and to live a near-normal life, helps avoid passing on HIV to others, and can save the NHS a lot of money.
 

The NICE guidance aims to increase the numbers taking HIV tests to reduce the number of people who do not know they have HIV and so help prevent HIV being passed on by Africans living in the UK and gay men.

Gay and bisexual men remain the group most at risk of becoming infected with HIV in the UK with 70 per cent more men being diagnosed with HIV in the past 10 years (from 1,810 in 2001 to 3,080 in 2010).
 

‘NAT welcomes the new NICE guidance on increasing testing among African communities and gay men. Not only is the number of people being diagnosed with HIV still too high, late diagnosis is an extremely important problem as it means a person is likely to have had HIV for a number of years – with a high risk of transmission to sexual partners – and it can also reduce the effectiveness of treatment,” commented Deborah Jack, Chief Executive of NAT (National AIDS Trust).

‘It is crucial that HIV testing becomes ‘normalised’ in our society, not just among gay men and African communities, but also amongst health professionals. Many people with HIV attend NHS services for years without being offered an HIV test and this neglect needs to be addressed and stopped.’

'The importance of HIV testing should now be reflected in Government plans as they reorganise the NHS and public health. In particular, it is essential that HIV late diagnosis remain a key outcome indicator to assess progress in public health at the local level. It is also vital that the extensive reorganisation of the NHS does not undermine recent momentum in HIV testing.’
 

‘Public Health England must ensure that the vision for HIV testing amongst gay men and African communities set out in the NICE Guidance is consistently implemented across the whole of the NHS and public health system.’
 

NICE HIV testing guidance for gay/bi men

NICE testing guidance for Africans living in the UK

Source – HPA press release

Image

Football, HIV and Saving Lives

posted: 16/03/2011

When Birmingham City play Arsenal in the Carling Cup Final this weekend, they are launching a HIV awareness campaign for soccer fans.
 

Birmingham City and England goalie Ben Foster with midfielders Alexander Hleb and Craig Gardner are supporting Football Saving Lives, a national health promotion project.
 

Get Tested, then Stay Negative or Get Treated
“Saving lives is, of course, a lot harder than saving goals,” says Ben Foster, “but I’m a proud to be an ambassador for this campaign, precisely because it makes things so simple: get tested, get treated.

It’s as easy as that. It is definitely in your best interest to get HIV tested if you get the opportunity: if you’re negative, then you can stay that way, and if you turn out positive there are now life saving treatments available ”.
 

22,000 people do not know they have HIV
Football Saving Lives is part of a Birmingham NHS HIV campaign. Dr Steve Taylor says “One in four of those who have HIV are unaware they’re infected. That means that they cannot access the life-saving treatment we can now offer, and in addition they may well be unknowingly infecting others. We need to tackle this problem and diagnose the 22,000 people in the UK who have HIV but are totally unaware.”
 

Football Saving Lives raises public HIV awareness and corrects the wrong ideas people may have about HIV and HIV testing. Being rhis reluctance to take HIV tests, or thinking you are not at risk, remain key reasons why so many are untested and often end up in hospital because of the damage HIV infection causes over time.
 

People still die of HIV even though excellent treatment gives people reasonable health and life propects as long as people are tested and diagnosed early.
Soccer fans may not give much thought to HIV so the players and campaigns hopes to make fans think and act.
 

HIV hasn’t gone away
“I grew up in Birmingham,” says Blues midfielder Gardner, “and I remember the HIV prevention campaigns at school. But I haven’t heard anybody talk about HIV for years – I thought it had just gone away. But to think that there are some 22,000 people out there who have no idea they are infected is a really scary statistic. I’m supporting this campaign because I believe that education and raising awareness are the best ways of helping young people look after their sexual health and start to reduce the spread of HIV.”
 

Testing and timely HIV treatment allows people to live a near normal life. Treatment also helps cut the spread of HIV because people on successful HIV treatment with undetectable viral loads are far less likely to pass on HIV.
 

Almost all pregant women get tested - why not soccer fans?

Ninety-five per cent of pregnant women already receive an HIV test as standard, and if the mother has HIV treatment of the mother and baby means babies now rarely get HIV.
 

“Football Saving Lives is about getting these really important public health messages regarding sexual health and HIV testing out to the public,” summarises Alexander Hleb, on loan to Birmingham City from Barcelona.
 

Football Saving Lives, includes player profiles

Source