Keep HIV in Focus - Crusaid-THT

posted: 16/06/2010

The chief executive of National AIDS Trust urges a continued focus on HIV welfare, following Crusaid's merger with Terrence Higgins Trust, which was announced on Monday.
Deborah Jack expressed her sadness at seeing Crusaid come to an end after 20 years and voiced her worries for the future, in an interview with the PinkPaper.
 

“My main concern is that we’ve lost a charity solely focused with HIV into an organisation which covers all aspects of sexual health. Crusaid always supported those in the greatest need.

The important thing now is making sure … people [living with HIV] are still given the focus they require. Tensions may arise …. as Crusaid staff are used to working on more specific issues around HIV. I am, however, pleased THT have made a public commitment to continue the hardship fund which provides a valuable lifeline for … people living in poverty with HIV."
 

AIDS Support Grant risks
The merger comes just after Communities Secretary Eric Pickles’ announced that the AIDS Support Grant (ASG) will no longer be ring-fenced. This means that this £25.5 million grant (almost £2 million is for NW England) does not have to be spent on social care for people living with HIV. Deborah Jack believes it is important to hold local authorities to account for how they spend this money, otherwise there could be major repercussions, highlighted in a recent report that NAT produced with Crusaid into the need for the Crusaid HIV hardship fund.
 

“In the report we found that 1 in 6 people being treated for HIV applied for help from Crusaid with an average income of just £42 per week. One of the main problems is that many charities rely on contracts from central or local government and without the [AIDS Support Grant] money it might put lots of the smaller charities supporting people on the ground into financial difficulties. A lot of charities use the money they get from the AIDS Support Grant to provide counselling and peer support for people living with HIV. If this money isn’t being spent [on HIV anymore] then these services will be cut and then people in the greatest need will not have the same emotional support, which may lead to … [people living with HIV] becoming isolated and depressed.”
 

Source PinkPaper

Crusaid Merge with THT

posted: 14/06/2010

Crusaid, Britain's largest HIV fundraising and grant making charity has just announced it has merged with the biggest HIV and sexual health charity, Terrence Higgins Trust. 

The merged organisation is now part of the THT brand and will continue to provide grants for people with HIV in need and it hopes to improve HIV fundraising. The news comes just one week after Crusaid's annual Walk for Life in London raised an estimated £250,000.
 

Jordan Hay, Chief Executive of Crusaid, said: “We initiated this merger to ensure that our hardship fund can continue to make a vital difference to the ever-increasing numbers of people diagnosed with HIV each year in the UK. THT shares our vision and values and we are excited about the opportunities to support people with HIV that this merger presents.”
 

Senior staff members from both organisations will now refresh the anti-poverty strategy to support people with HIV, based on research and experience from both organisations.
 

Sir Nick Partridge, Chief Executive of Terrence Higgins Trust, said: “I’m delighted to confirm that Crusaid and Terrence Higgins Trust have merged. The merger will preserve the Crusaid Hardship Fund in a very challenging economic climate and help ensure that people with HIV have the ongoing support they so vitally need. We are also looking forward to combining our experience and research for a renewed anti-poverty strategy in support of people living with HIV in the UK.”
 

Source 
Crusaid merger statement 
THT’s press releases
 

Test and Treat to End HIV in 40 Years

posted: 22/02/2010

A global public health strategy for testing and treating everyone with HIV is now being considered.
Health officials are considering a radical shift in the strategy against HIV that would see everyone tested for the virus and people with HIV then put on a lifetime course of drugs. The strategy, which would involve testing most of the world's population for HIV, aims to reduce the transmission so much that HIV would die out completely over the next 40 years.
 

Brian Williams, professor of epidemiology at the South African Centre for Epidemiological Modelling and Analysis in Stellenbosch, said that HIV transmission could be stopped within five years with the use of antiretroviral drugs (ARVs). "The epidemic of HIV is really one of the worst plagues of human history," Williams told the American Association for the Advancement of Science meeting in San Diego. "I hope we can get to the starting line in one to two years and get complete coverage of patients in five years. Maybe that's being optimistic, but we're facing Armageddon."
 

Two years of trials now
Major trials of this universal test and treat strategy are planned in Africa and the USA and will affect whether this becomes part of global public health policy in the next two years.
More than 30 million people are infected with HIV globally and two million die of the disease each year. But across the globe only 12% of those living with HIV get the treatment they need. The disease is overwhelmingly prevalent in sub-Saharan Africa, which accounts for a quarter of all HIV cases globally. Half of these are in South Africa.
 

Broadly the epidemic calculations are that a person with HIV may pass on HIV to between five to 10 others in their time with HIV. Treating people within a year of becoming infected can reduce transmission tenfold, enough to cause the HIV epidemic to die out.
 

Trials plans
In the trials, people will be offered HIV tests once a year, either as routine when they visit their GP, or through mobile clinics in more remote regions. Those testing positive will be put on a lifetime course of ARVs.
"Over the past 25 years we have saved the lives of probably two to three million people using antiretroviral drugs, but almost nothing we have done has had any impact on transmission of the disease," Williams said. "We have stopped people dying but we haven't stopped the epidemic."
If patients take ARVs when they should, the amount of virus in their bodies should fall so low that it becomes undetectable, and they are then extremely unlikely to pass the virus on.

Five years to see the results but worth the price
"The question is, can we use these drugs not only to keep people alive, but also to stop transmission and I believe that we can. We could effectively stop transmission of HIV in five years." Scientists estimate that the cost of implementing the strategy in South Africa alone will be $3bn-$4bn a year. The world currently spends $30bn (£19.4bn) a year on HIV research and treatment, a figure that some experts believe will double over the next decade.
 

Sub-Saharan Africa has seen a dramatic rise in cases of tuberculosis among HIV patients, who are also susceptible to other infections because their immune systems are weakened.
"If you factor in all of the costs, in my opinion, doing this would be cost saving from day one, because the cost of the drugs would be more than balanced by the cost of treating people for all of these other diseases and then letting them die," Williams said. "We're killing probably half a million young adults every year in the prime of their life just at the point where they should be contributing to society and the cost of that to society is enormous," he added. "The only thing that's more expensive than doing this is not doing this."
 

HIV patients in southern Africa are more likely to take ARVs when they should than people living in developed countries, according to health officials. The finding gives doctors hope that the blanket administering of drugs might suppress the virus enough that it dies out naturally.

George House Trust comment 

This assumes a great deal. We are still a long way from providing treatment to all the millions of people in sub-Saharan Africa who need it. This strategy would require us to deliver HIV treatment for vastly more people, reliably, day after day, for decades.

The computer prediction of the epidemic will be correct as long as every African does get tested for HIV every year, everyone who tests positive then starts taking antiretrovirals immediately and 98 out of 100 do not miss a dose. How would people in the UK respond if outsiders decided all adults in the UK must have a HIV test every year?

We know gay men in rich countries use condoms far less now than before effective treatment became available in the mid 1990s, but somehow it's assumed heterosexuals in Africa won't also use condoms less.  

Source

 

USA HIV Travel Ban Goes

posted: 13/01/2010

On 4 January the USA travel ban on people living with HIV was finally ended. Notoriously the Dutchman Hans Paul Verhoff was refused entry into the U.S. in 1989 to speak at a HIV conference in San Francisco. Many people then boycotted the 6th International Conference on AIDS in San Francisco in 1990.

What began first as an administrative ban then became law in 1987 (through action by the homophobic republican Senator Jesse Helms) and this was reinforced in 1993.
 

The travel ban prevented visits to the USA by people with HIV apart from in exceptional circumstances. Officially people with HIV had to apply for a special permission. It was a difficult and slow process and many were refused. The stigmatising nature of the ban was reinforced because your passport was marked in a way which showed you have HIV.

The ban was widely ignored, but often people with HIV were detected by US immigration staff and then refused entry and deported. Others took risks with their health by interrupting their HIV treatment to enter without HIV being discovered.

Washington 2012 International AIDS Conference confirmed

Now the ban has been lifted the International AIDS Society has confirmed that the 2012 International AIDS Conference will be held in Washington DC. 3 in 100 living in the US capital have HIV, well above the threshold for a severe, generalised epidemic, which is 1%.

UK passport holders with HIV who wish to visit the US can now complete the green 'visa waiver' form that allows routine entry to the USA.

South Korea relaxes rules
The South Korean government has also announced that entry restrictions on people who don’t need a visa to enter were lifted from January 1st.

International HIV travel summary
A list of countries and their entry policies for people with HIV can be in NamLife here.

Stigma and Supporting Disclosure

posted: 16/11/2009

How much do our friends and family influence our lives? Living with HIV, we rely on our social network for advice, emotional support, and information. But to get this HIV support, we have to disclose our HIV-positive status. Disclosing status almost always has some risk. We might be rejected, or experience their discomfort about HIV.
 

Practice makes telling easier
The advantages of telling others about being HIV positive status are well known, and one advantage is the "practice effect." The more we successfully tell others, the easier it becomes. Even if it didn’t go well, we still learn from the experience and will be more prepared next time. Positive experiences in telling others encourage us to do it again.
 

But negative experiences like rejection, and sometimes even physical abuse, may reinforce the social stigma we feel. What we feel and think about HIV stigma is based on what we know about the reality of HIV stigma and discrimination, the actual or potential social disenfranchisement, limitation of opportunity, and negative change in social identity.
 

Internalising stigma and the telling moment
Perceived stigma may lead to various outcomes, including negative changes in self-concept and emotional reactions toward those who may invoke the stigma. HIV-positive people tend to tell significant other people about HIV once they think the rewards of telling will outweigh the possible costs and risks.

Disclosing benefits
Telling others can lead to receiving more and better emotional, physical, and social support. The emotional benefits include

• social support,
• relief that comes from sharing a burdensome secret, and
• the reward of educating others about HIV.

Reasons for secrecy
Reasons for not telling people are

• fear of rejection,
• fear of stigma,
• privacy,
• self-blame, and
• risking the opportunity of sex.

We want to avoid serious negative consequences, so we avoid taking the risk of telling.

How do HIV stigma and social support influence telling partners?
This study gave people different situations and they were asked to say how willing they would be to tell the partner then about HIV. The study tried to discover what encourages HIV disclosure to sex partners, and what discourages disclosure, from the perspectives of HIV-positive gay men.

The study was of gay men using a Chicago, USA, HIV support organisation. The men were between the ages of 18 and 63, gay, 90% white, and 60% were diagnosed over 4 years. 80% of the men were on treatment.

"I've told all but family, who have issues."
The men had a wide range of views on stigma. Feeling socially supported didn’t seem to make this sample of men more ready to tell others. As earlier studies have shown, other things that predict telling sex partners include

• type of sexual relationship and
• adult romantic attachment style.

Social support might not have made the difference in telling for these men because it is possible the partners were part of the men’s existing HIV+ support networks. Many gay men with HIV have many positive men in their friendship networks.

The more socially supported and networked the men are, the less stigma hurts and harms them. Social support allows people to cope better with HIV stigma. Boosting social support therefore could be a way to improve how well people cope with HIV stigma.

This particular study of well-networked positive gay men did not find evidence that better social support encourages telling sex partners. Telling sex partners you have HIV is important because it alerts partners to the risks but telling partners does not automatically lead to changes in sexual risk taking. Some men confident about safer sex might ‘do’ the safer sex to avoid disclosure. Not telling, but using safer sex, seems to be doing enough morally.

Social support supports safer sex

The study did find social support helped men to have safer sex. Having safer sex and not telling suggests past experiences of sexual rejection after disclosure, and not being willing to risk such sexual rejection.

Social support from other HIV-positive gay men encourages men to initiate safer-sex, but didn’t, in this study, increase disclosing to sexual partners. The researcher speculates that most of the gay men probably knew each other already (including their shared HIV status) through using the same HIV support organisation for over four years. Probably for most of the positive gay men, there was simply nothing to say about both men having HIV.

Perhaps social support made no difference to telling sex partners partly because positive gay men often deliberately seek out other positive gay men as sex partners. Perhaps simply coming to a HIV+ social support group improves men’s communication skills and confidence about managing safer sex, with or without disclosure.

Feeling better after a good tell
Disclosing HIV may help improve psychological well-being if the response is good and positive. The value of a HIV support group comes from sharing information, and physical and emotional experiences and learning. For example, HIV-positive gay men can provide others with emotional support and reassurance that one is loved and valued despite HIV-positive status. HIV-positive gay friends can also provide empathy, familiarity and trust.

Telling other positive people does not, however, always help people tell people who, we assume, doesn’t have HIV.

Source

Help with telling people including a video from Terrence Higgins Trust