New HIV Mental Health Standards

posted: 08/04/2011

The first standards for mental health services for adults living with HIV are now out for public comments, until the end of May.

The new Standards for psychological support for adults living with HIV  were written by a team of experts, with the help of patients’ representatives and the HIV community sector, including George House Trust, Terrence Higgins Trust and NAT (National AIDS Trust).

The new standards describe the care that adults living with HIV should expect to receive from all the services providing mental health and psychological support, from any time after HIV diagnosis. These are not designed for children and teenagers with HIV, but it is hoped that standards for younger people will soon follow.

Psychological support means ‘any form of support which is aimed at helping people living with HIV to enhance their mental health and their cognitive and emotional wellbeing’. Mental health support comes in lots of different ways and not just from experts.

Many people with receive really valuable support from other people living with HIV – at services such as spaces, groups, weekends, which is known as 'peer support'. Experts like psychologists and other professionals (counsellors, nurses, psychiatrists and others) working in HIV clinics, at doctors surgeries and other clinics, as well as in HIV and other community services, provide more specialist support, treatment and help.

Stepped Care and 9 Standards

The standards follow a four-stage 'Stepped Care' model, to match people's growing psychological support needs, as these get more serious and complex. 

• Standard 1: promotion of mental health and wellbeing
• Standard 2: support at the time of diagnosis
• Standard 3: screening
• Standard 4: competence to provide psychological support
• Standard 5: comprehensive psychological support services
• Standard 6: co-ordination of psychological support
• Standard 7: evidence-based practice
• Standard 8: evaluation and audit
• Standard 9: engagement of people living with HIV
   

Say what you think

Comments on the draft standards are very welcome from anyone with experience (good or bad) of using or providing mental health support for people living with HIV. They’d like people to use their special form for your response. This helps by asking questions, and gives you space for any general comments on the whole standards, and on each of the 9 standards.

The standards should be used by the people deciding what mental health support services for people with HIV are provided in each district and by the people providing those services for checking their services are up to the standards.

The Standards

Please use this consultation response form and send your comments to MedFash by 5.00pm on Tuesday 31st May 2011.

These standards are a joint initiative of the Faculty for HIV & Sexual Health of the Division of Clinical Psychology of the British Psychological Society (BPS), the British HIV Association (BHIVA) and the Medical Foundation for AIDS & Sexual Health (MedFASH).

New Government Mental Health Strategy - No Health Without Mental Health

Five Ways to Well-Being

posted: 07/04/2011

Taking the following five actions in our day-to-day lives boosts our well-being, evidence shows. On the day that the draft standards for better mental health support for people living with HIV are launched, here's some simple steps to feel better and enjoy more of life.

Connect
With the people around you. With family, friends, colleagues and neighbours: at home, work, school or in your local community. Think of these as the cornerstones of your life and invest time in developing them. Building these connections will support and enrich you every day.

Be active
Go for a walk or run. Step outside. Cycle. Play a game. Garden. Dance. Exercising makes you feel good. Most importantly, discover a physical activity you enjoy and that suits your level of mobility and fitness.

Take notice
Be curious. Catch sight of the beautiful. Remark on the unusual. Notice the changing seasons. Savour the moment, whether you are walking to work, eating lunch or talking to friends. Be aware of the world around you and what you are feeling. Reflecting on your experiences will help you appreciate what matters to you.

Keep Learning
Try something new. Rediscover an old interest. Sign up for a course. Take on a different responsibility at work. Fix a bike. Learn to play an instrument or how to cook your favourite food. Set yourself a challenge you will enjoy achieving. Learning new things will make you more confident, as well as being fun.

Give
Do something nice for a friend, or a stranger. Thank someone. Smile. Volunteer your time. Join a community group. Look outwards, as well as inside your head. Seeing yourself, and your happiness, linked to the wider community can be incredibly rewarding and it creates connections with the people around you.

Five Ways to Wellbeing, by the Centre for Wellbeing - slide show

draft Psychological Support Standards for adults living with HIV for comments and consultation 

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

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Charging Migrants for HIV Treatment

posted: 04/04/2011

The government has said it will soon change the rules about charging people from abroad for most treatment at NHS hospitals in England. At the moment the rules do not affect many people in North West England with HIV but that is likely to change. New Rules will probably appear in June.

The government has also announced another, bigger review of NHS charges. This will look at anything and everything and is intended to save the NHS a lot of money.

The next step is the department of health will publish the new rules for NHS hospital and clinic charges and guidance quickly – probably before June.

They have just published their response to a public consultation so now we know something about what the new rules from June will probably say. George House Trust gave evidence and comments to this consultation.

The Department of Health's plans for the June rules are 

• They won’t change which treatments will be charged for yet – but may do so later.
• The rules will be changed to make it clear that refused asylum seekers who get Section 4 and Section 95 payments do not pay for NHS treatment
• Unaccompanied children will no longer have to pay, but children with parents here can be charged
• They will make clear in the new rules that anyone who has begun HIV treatment that is free of charge (e.g. because they have an asylum claim which has not been finally decided) will continue to receive free HIV treatment
• They will keep putting up posters about charging for treatment in hospitals and clinics, even though they know this frightens some people that need treatment away and can lead to discrimination by hospitals
• They will change the guidance that tells doctors to think about the cost of treatment, because this encourages discrimination
• They will start a new system of telling the UK Borders Agency about the people who owe the NHS money. This will mean people will be refused permission to stay longer, applications for citizenship may be refused and people will be refused a visa to return to the UK if they leave
• They will consider introducing a rule that will force visitors from overseas to have health insurance
• They will look at charging people for primary care (treatment by family doctors)

Free HIV treatment for all?
The Government still has not decided whether to make HIV treatment free for everyone who needs this on public health grounds, like for all other sexually transmitted infections. They say they are still considering this and will report “in due course”.

Next, an even tougher review
They have also announced another major review which is designed to save the NHS a lot of money. This will look at

• Changing the residence rules, including the definition of ordinary residence
• Changing some or all of all the types of treatment and types of people who do not have to pay for NHS treatment
• Making people pay for primary care (that is treatment by family doctors and dentists)
• Changing which bit of the NHS has to pay when people cannot pay
• Making the procedures for checking who should pay tougher before treatment begins
  Making the procedures for collecting charges tougher
• Using new ways to collect charges 
• Requiring migrants to have health insurance 
• They will consider anything and everything else.

They try to soften this tough new cost-saving review by saying “the NHS is, and must remain, ultimately a humanitarian organisation. In undertaking the review, we will be mindful of the NHS’s core values, in particular its obligations to provide urgent treatment to any person irrespective of their status or ability to pay, to protect the vulnerable and respect our obligations on healthcare provision under international treaties . There is no intention to consider policies that would deny access to any group, only whether an individual should be charged. It will consider the full benefits and costs of introducing new charges including risks of deterred or delayed treatment and any other societal costs. In addition, we will ensure that public health considerations are fully factored into proposed rules and processes (ensuring in particular that access policies do not compromise the identification and control of infectious diseases).”

A comprehensive package of confirmed proposals will be put to full public consultation on completion of the review work, in 2012. We may consult separately at an earlier stage on some options, such as primary care charging.
 

You can read the details of the government's proposals for the June regulations and this new review here. The new review details begin on page 24. 

Proposals and Review report

Fresh Gay Men’s HIV Prevention

posted: 16/03/2011

HIV prevention work for gay and bi men in England has been freshened up in the latest edition of Making it Count. Making it Count is the HIV prevention framework used in England by gay men’s and other HIV prevention organisations.
 

Making it Count first appeared in 1998 and the new edition describes how to do HIV prevention and education with gay and bisexual men. It’s been totally rewritten and is available here. It's produced by the CHAPS gay men's HIV prevention and sexual health partnership.

George House Trust is not part of CHAPS but we play a lively and active role. At the CHAPS conference last week we made two conference presentations based on our experience of the sexual health and HIV support needs of HIV+ gay and bi men.

George House Trust also made detailed comments and suggestions for improving the latest Making It Count.

Risky Choices

The new edition of Making It Count considers the various choices facing men who have sex with men that make a difference to HIV transmission, and puts more emphasis on what motivates and drives men in making these critical decisions on sexual risks.

Making It Count brings education and empowerment together in HIV prevention, in a way that values and respects gay and bi men, including men with HIV. It includes using social norms to influence men’s sexual behaviour.

Best Sex with Least Harm
Making It Count aims to promote the best sex with the least harm among gay men and bisexual men.

Making It Count Briefing Sheets

Making It Count Briefing Sheets are also available. These are handy summaries of the evidence on important HIV prevention and sexual health issues.

Making It Count Briefing Sheets already available are 

• Using fear in HIV prevention
• Herpes
• LGV
• Gonorrhoea, chlamydia and non-gonococcal urethritis (NGU)
• Hepatitis C
• Social marketing.

Future Briefings will soon be added for

• Poppers
• Microbicides
• PEP
• Undiagnosed HIV infection.

Making It Count Briefing Sheets

Making It Count from Sigma Research