North West ‘Treatment as Prevention’ seminar

posted: 18/05/2012

George House Trust will be holding a day seminar on ‘Treatment as Prevention’ to be held at George House Trust in Manchester on Friday June 22nd from 10 am to 3pm (with registration open from 9.30am). Lunch will be provided.

The concept of ‘treatment as prevention’ is one which is currently the focus of much discussion amongst HIV organisations and people living with HIV.

The seminar will provide an opportunity for representatives from HIV organisations across the North and North West to discuss some of the aspects of the ‘treatment as prevention’ concept and the implications for people living with HIV.

It will provide a space for discussion about how - and if - the ‘treatment as prevention’ concept might change the way in which organisations work with, advise, and support people living with HIV.

We are delighted to announce that Gus Cairns, HIV activist and editor of NAM’s ‘HIV Treatment Update’ will be joining us to give a keynote address and lead some of the discussions.

We are inviting people to reserve a place on this seminar by emailing colin@ght.org.uk - please provide the names and job titles of people from your organisation who would like to attend.
Places will be strictly limited and so you are advised to reserve your place as soon as possible.

There will a nominal registration fee of £5 per person attending – however, we will only request this payment from you, and provide you with details of how to pay – once your place or places are confirmed.

We look forward to welcoming you to what we are sure will be an interesting and stimulating day.

Treatment Protects Partners

posted: 13/05/2011

There’s been a lot of publicity in the last day or so about HIV treatment helping stop the spread of HIV. 96% of HIV transmissions among couples are blocked by early treatment of the partner with HIV, was the headline result from a multinational study.

The results were so striking that the study was stopped three years early and everyone with HIV who was not already on HIV treatment was immediately offered HIV treatment.

The results show that treating people living with HIV is at least as good as using condoms to prevent HIV transmission.
 

Universal access to treatment goal
This treatment for prevention success offers an extra reason for pushing the world to achieve the internationally agreed World Health Organisation goal of universal access to HIV treatment, prevention and care. The goal was to reach universal access by 2010, but better late than never. Millennium Development Goal 6 includes halting and beginning to reverse the spread of HIV/AIDS by 2015.
 

Gay men too?
The study included hardly any gay couples (only 3% were gay), so the results don’t prove a 96% reduction in transmission in gay couples. Other evidence already strongly suggests gay men living with HIV on successful treatment are also much less likely to transmit HIV, but probably not by the same amount. (Anal sex is riskier than vaginal sex for passing on HIV, gay men tend to have more partners than heterosexual couples, and other sexually transmitted infections also raise the risks).
 

What they found
The study began in 2005 of 1763 couples where one partner has HIV and the other did not (97% were heterosexual couples). They wanted to find out whether HIV treatment prevented the uninfected partner from getting HIV. It was an international study at 13 sites in Botswana, Brazil, India, Kenya, Malawi, S Africa, Thailand, USA (only one couple were from the USA), and Zimbabwe.
 

They split the couples in half randomly and half the partners with HIV immediately started HIV treatment (with CD4 counts higher than normal for starting treatment at between 350 and 550). The other half of positive partners only started treatment when their CD4 count fell to 250 or less, or they developed an AIDS defining illness.
 

• 39 (2.2%) of the negative partners out of 1763 got HIV
• Up to 11 of the 39 got HIV from someone else, not their partner in the study
• 28 (1.5%) got HIV from their partner in the study, and all but one of those were infected by positive partners who were in the delayed treatment half of the study.

That result was so stark they stopped the study and offered immediate treatment to everyone with HIV not already on treatment because the prevention effect of early treatment was so clear. Early treatment also prevented partners from getting tuberculosis (TB) with only 3 of the people treated early getting TB, compared with 17 of those treated after their CD4 count fell below 250. There were slightly more deaths among the deferred treatment group, but the difference was not statistically significant.
 

You can read the report from the US National Institute of Allergy and Infectious Diseases here  and their Q&A page about the study here
 

Aidsmap’s report

New HIV Treatments Directory

posted: 11/05/2011

The latest version of NAM’s excellent HIV Treatments Directory is now available – either free online or as a paid for book, at just under £65.
This tells you all you (and the HIV clinic) ever need to know about HIV treatment.

Simpler Treatments Information

For many people with HIV this is far more than you need and there are simpler leaflets for day to day use.

If what you want is easy answers we suggest you find what you need in

• The Basics leaflets

And for a bit more detail try the

• The Booklets

And for even more information try the

• Treatments Topics pages

Treatments Directory

The Treatments Directory itself has almost 600 pages of detailed information on

• Introduction to HIV and AIDS
• The immune system and HIV
• Monitoring the immune system
• Genetics and HIV treatment
• Ways of attacking HIV
• Starting HIV treatment
• Changing HIV treatment
• Drug resistance
• Side-effects
• Adherence
• Drug interactions and pharmacokinetics
• Women's health issues
• Prevention of mother-to-child transmission
• HIV treatment in children
• Treatment guidelines
• A to Z of antiretroviral drugs
• A to Z of investigational drugs – new drugs in the pipeline
• A to Z of other drugs
• A to Z of illnesses
• A to Z of symptoms
• A to Z of tests

Treatments Directory 2011
 

HIV Patients made Prisoners

posted: 03/05/2011

NHS consultants say that security measures imposed by the UK Border Agency have turned Hillingdon hospital’s HIV clinic into a prison.
Hillingdon hospital in west London, is the nearest to Heathrow airport, and some of the people with HIV that it treats are detained at nearby immigration removal centres, who are brought to the hospital for treatment.
 

Patient cuffed to guard

The problems began when an immigration guard who had handcuffed a patient to him refused to remove the handcuffs so the man could be treated in privacy. When the guard refused to uncuff the man the doctors refused to treat him and made a formal incident report to the hospital’s medical director. That’s a serious formal complaint, and it concerns inhuman and degrading treatment.
 

Clinic windows barred - a prison for all
Officials from the UK Border Agency then fitted restraints on the windows at the hospital's sexual health clinic to ensure that detainees could not escape.
HIV specialist Ben Holden, a consultant at the hospital, said: "The unit is now a prison for us all. Our windows only open two inches but UKBA have installed chunky locks on them. We were told they would bring removable window restraints but these are permanent.
 

No attempts to escape
"No detainee has ever absconded or attempted to abscond. As doctors we believe that to keep immigration detainees restrained or locked in is discriminatory. I don't want to be part of a process that treats people in a less than human way."
Doctors are angry that immigration detainees who have committed no crime, approximately half of whom are later released, are treated in this way.
 

Deported without needed HIV drugs
An audit conducted at Hillingdon hospital also revealed that none of the detainees removed from the UK were dispatched from the UK with a full three month supply of anti-retroviral drugs (in accordance with British HIV Association / National Aids Trust guidelines). They left without an adequate tide-them-over drug supply because in many cases doctors at the hospital are not told by UKBA before people are removed from the UK. UKBA frequently cancel clinic appointments and some HIV-positive patients were removed before they were even seen at the hospital.
 

British HIV Association 'disappointed'

Professor Jane Anderson, chair of the British HIV Association, said: "BHIVA and the National Aids Trust have developed advice on appropriate HIV treatment and care for people in the immigration removal system, and we are disappointed to hear that this advice is not always being followed. We want to see the highest standards of care for everyone with HIV in the UK. Any factors that make the provision of high quality clinical care difficult give us cause for concern."
 

Emma Ginn, co-ordinator of the charity Medical Justice – which recently published Detained and Denied, a report cataloguing examples of poor medical treatment of HIV-positive detainees in the UK – said: "Along with the potentially lethal medical abuse they suffer in detention centres, detainees are suffering sub-human conditions in hospital."
 

Window bars excused
The UK Border Agency said: "We have agreed the installation of window locks for detainee treatment with Hillingdon hospital and are working with them to address the concerns now raised. Detainees are only handcuffed when absolutely necessary and they are not handcuffed during treatment.”
"The welfare of detainees is important but this must always be balanced with the security of the detainees and the public. Detainees have round-the-clock access to healthcare services to discuss their medication needs."
 

Hospital’s story
A spokesman for the Hillingdon hospitals NHS foundation trust said: "The UK Border Agency has told us that they do not believe our open ward environment is suitable for the treatment of individuals who may be failed asylum seekers and under restraint. However, a large proportion of the patients who are brought to our sexual health department by the agency are later discharged into the community and are not subject to the criminal law.
"We have agreed a temporary measure with the Border Agency to put discreet bars on windows in the unit, but we are continuing to negotiate an agreement with the agency that will offer a solution that allows us to treat all our patients with respect."
 

George House Trust would point out that Hillingdon hospital has allowed the UKBA to fit restriction devices onto its hospital clinic windows. It was under no legal obligation to treat all its sexual health clinic patients and staff in this way. And handcuffing patients is very rarely justifiable and hospitals must always consider alternatives or risk legal action under the Human Rights Act.

The NHS Constitution seems to have been ignored by the hospital - it says 

"You should always be treated with dignity and respect, in accordance with your human rights. This means, for example, that your right to privacy should be respected."

Complaining is far more difficult for people using Foundation Trusts like Hillingdon Hospital – there is no independent body to represent patients and help with complaints, Hillingdon’s website won’t even let you download its complaints leaflet and you will wait many months for the Ombudsman to deal with any complaint.
 

NHS complaints advice 
 

Source

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