Watch Out for Drug Interactions

posted: 29/04/2010

Over 1 in 4 people taking HIV treatments face drug-interactions when they take non-HIV treatments  or recreational drugs as well. Most HIV doctors don’t spot this even if you have side effects from the mixing of the HIV and non-HIV treatments or other drugs. The big concern is that the other treatments will mean the HIV drugs don’t work properly. Drug interactions can mean that you will have too little of the HIV drugs in your blood for the drugs to work properly, or far too much.

Researchers from Liverpool University Hospital recorded clinically significant drug interactions in 27% of patients, and over a third of the interactions went unnoticed by doctors.

Best ask and check

Your doctor and HIV pharmacist should check for interactions whenever you are prescribed a new drug. It’s therefore very important that you make sure your HIV doctor and GP doctor know all the drugs you are taking, including those prescribed by other doctors, and any you buy yourself, legal or not. If you are collecting or buying drugs at a pharmacy / chemist, ask the pharmacist if they will interact with your HIV treatments. You can ask to speak to the pharmacist privately.

Although we know that significant drug interactions are common amongst people taking HIV treatment, no previous study has looked into whether HIV doctors spot this when it happens.

What they checked and found

159 people taking HIV treatments in summer 2008 at Liverpool were asked what other medicines and drugs they used – including any prescribed by a healthcare professional, bought over the counter, and recreational drugs.
 

The HIV doctor then identified all potentially significant drug interactions, and said if they had changed the HIV drug doses, or used therapeutic drug monitoring (therapeutic drug monitoring measures how much of the HIV drugs are in your blood – like the bowls of porridge in the story of Goldilocks and the Three Bears – is there too much, too little, or just the right amount?).

2 out of 3 people in this study had an undetectable viral load.

Around 1 in 4 people on HIV treatment, 43 people, had potentially significant drug interactions (27%).

Protease inhibitors are main risk

Men, white people, and those taking a protease inhibitor had the greatest risk of drug interactions.

Interactions with protease inhibitors are highly significant. (Being a man also appears significant but they warn that this is unlikely to be true. They say it lacks “biological plausibility.” This means they can’t think how this could happen scientifically and also point out that other research has never found this. Things can sometimes be statistically significant, but statistics can sometimes deceive – perhaps 5 times out of every 100, statistics may mislead.

Too little HIV drugs for 1 in 7
The drug interactions could reduce the working amount of the HIV drugs in the blood for 1 in 7 (15%) of people.

Many other drugs interact
A broad range of interactions were observed, including those with other antiretroviral drugs,antidepressants, antibiotics, statins and recreational drugs.

2 in 3 drug interactions are missed by doctors

Only 36% of interactions were correctly indentified by the treating physicians.

Therapeutic drug monitoring (checking your blood has the right amount of the drugs ) was used to manage 26% of the people with interactions. These people were much more likely to have the doses of their medication increased or decreased, than people not checked in this way.

They advise : “We recommend that all physicians are vigilant to the risks of clinically significant drug interactions, use available drug information resources, and that the pharmacy department aid in identification of clinically significant drug interactions and regularly audit prescribing practice.”

Liverpool has the national centre for HIV drug interactions with a useful online chart. 

Source with reference 

HIV Stigma and Harassment Action

posted: 24/03/2010

Ending HIV stigma and harassment has edged a little closer. An official inquiry is about to begin into progress by public authorities on eliminating disability harassment – and this includes HIV stigma. The Inquiry is called because of recent cases of severe disability harassment neglected by public authorities. Councils and the NHS, among other public bodies, are simply not doing what the law tells them to - eliminate disability harassment.

Last week George House Trust met with the Equalities and Human Rights Commission in Manchester at a consultation into exactly what the disability harassment inquiry should look into.
 

• We made it plain that the official Inquiry must include HIV and not just people with learning difficulties or mental health problems.
• We said that people with invisible but highly stigmatised conditions like HIV face considerable disability harassment and stigma, and many barriers to complaining.
• We said that public bodies, with rare exceptions, ignore their duty to eliminate HIV disability harassment and stigma.

Over the next year the Equality and Human Rights Commission will investigate and we have offered to help gather HIV evidence. We are working with NAT to make this a nationwide effort.
 

What will happen?
The Commission has considerable powers to force public bodies to act if they are not doing their job. We have a right to expect things to improve and the least we expect is public campaigns to make HIV stigma and harassment socially unacceptable everywhere, a bit like the Kick Racism out of Football campaign.
 

The powers the EHRC has to force public bodies to eliminate HIV stigma and harassment means HIV stigma and harassment could really start to fade away. We think the Commission should start using its powers - this is one of the best hopes we have for ending HIV stigma and harassment.
 

We’ll keep you updated on the Inquiry and how you can give evidence confidentially.
Disability Harassment Inquiry
 

Women for Positive Action

posted: 04/03/2010

To mark International Women's Day (Monday March 8th) Women for Positive Action are launching a series of tools to raise awareness of the challenges facing women living with HIV/AIDS today. Women for Positive Action (WFPA) is led by a broad coalition of healthcare professionals, women living with HIV and community representatives from Europe, Canada and Latin America. The free educational web slide kits are to support health care professionals and women living with HIV across the globe, and are in English and Spanish.
 

The educational slide kits are available free here

The slide kits are

• HIV, conception, pregnancy and contraception,
• Emotional wellbeing of women living with HIV,
• Women and clinical trials in HIV,
• Women and HIV testing, and
• Supporting the patient–healthcare professional relationship.

"Women living with HIV face many challenges … including depression, guilt, isolation, discrimination and body image concerns" said Sharon Walmsley, Director of HIV Clinical Research, University of Toronto, Canada. "The new WFPA resources will encourage education and stimulate communication between women with HIV and those who care for them". The educational resources include information on current best practices and research, in addition to informative case studies.

WFPA brings together a unique combination of those involved in the care of women living with HIV with the first-hand perspectives of those living with HIV themselves. The group aims to empower, educate and support the needs of women living with HIV, their healthcare professionals and community advocates involved in their care.
 

International Women’s Day
The theme for International Women's Day this year is 'Equal rights, equal opportunities: Progress for all', and provides the ideal opportunity to consider the unique impact of HIV on women. Understanding the effect of HIV is a key step in improving the lives of women and working towards bridging gender inequalities in HIV. Around 16 million women are living with HIV. Young women, in sub-Saharan Africa, aged 15-24 are three to four times more likely to become infected than young men (UNAIDS, 2009).
 

The educational slide kits are available free here

Women for Positive Action
 

Health Must Deal With HIV Stigma

posted: 16/11/2009

Healthcare providers can and must respond to HIV-associated stigma and discrimination, according to a review in the 'Journal of the International AIDS Society'.

“Stigma reduction in health facilities … has important implications for improving patient-provider interactions, improving quality of care, and creating a safe and supportive space for clients that can help them deal with, and in some cases challenge stigma from family and community members”, write the authors.

HIV and stigma

HIV is both preventable and treatable. However people with and at risk of HIV often experience stigma and discrimination. This can mean that they are put off from using HIV prevention, care and treatment services. Stigma is responsible for many people dropping out of HIV clinics, as we have reported.

Heathcare leads to most stigma complaints

Healthcare is the source of most complaints from people living with HIV in the UK - the NHS is the world’s largest employer. HIV stigma is rare in HIV clinics, but most often found among some dentists, GPs, and hospital departments unfamiliar with HIV. Stigma and discrimination in healthcare is, say the authors, “pernicious” and “its physical and mental health consequences to patients can be damaging.”

Little attention has been paid to HIV-related stigma and discrimination in health care, especially in resource-limited settings.

They suggest there are three reasons:

• Lack of awareness about the effects it has
• Lack of capacity to respond
• Thinking wrongly that its too common to be eliminated.

They therefore explain why it is important to deal with stigma in healthcare settings. They give examples of how people in resource-limited settings have dealt with stigma and discrimination.

A definition of stigma
UNAIDS defines HIV-related stigma and discrimination thus:

“a process of devaluation of people either living with or associated with HIV and AIDS…Discrimination follows stigma and is the unfair and unjust treatment of an individual based on his or her real or perceived HIV status.”

What does stigma and discrimination look like?
Studies in Tanzania, Ethiopia, and India have shown that stigma and discrimination towards people with HIV appears in a number of ways, including:
 

• Neglect
• Differential treatment
• Denial of treatment
• Testing and disclosure without consent
• Avoidance
• Unwarranted infection control procedures
• Making moral judgments.

This can have “potentially devastating consequences on care-seeking behaviour”, say the investigators, meaning that “stigma represents a major cost for both individuals and public health".

People may as a result avoid prevention, testing, care and treatment services – people become 'lost to clinics' and care. We have reported that this is exactly what is happening in NW England and elsewhere, and that stigma is a major cause.

Fear of stigma can mean that healthcare workers who are HIV-positive or at risk of HIV become especially reluctant to use HIV services because they fear the reaction of colleagues.

Tackling stigma and discrimination
Studies from around the world have revealed three ways in which stigma and discrimination can be immediately challenged:

• Raise awareness of what stigma looks like and its consequences
• Provide information about HIV transmission, addressing unwarranted fears about the risk of infection with HIV after casual contact
• Emphasise that something can be done about stigma.

“What is needed…is the political will and resources to support and scale up stigma reduction activities throughout healthcare settings globally,” conclude the investigators. They add, “given the detrimental effect of stigma on both individual health and wellbeing and public health outcomes, it is clear that healthcare managers cannot afford inaction any longer.”

Source 
 

The full article is free online under a Creative Commons licence here - Nyblade L et al. Combating HIV stigma in health care settings: what works? Journal of the International AIDS Society 12: 15, 2009.
 

Pride 2009 - Thanks

posted: 02/09/2009

As we recover from a hectic Manchester Pride weekend, we say a warm and huge thank you to everyone who supported George House Trust over the Pride weekend.

The big, heartfelt thank you goes to:

• The 80 supporters who joined our Pride Parade entry, who chanted and shouted slogans to STOP STIGMA and until their throats were hoarse, klaxoned, whistled and made sure people knew exactly who we were and what we wanted, in the streets of central Manchester
• Our wristband exchange volunteers and staff who supplied the queues of ticket holders with wristbands, welcoming people to the event with friendly banter and cheery smiles
• Our weekend's Lifestyle Expo stall volunteers and staff, who provided advice to hundreds of people, and promoted our STOP STIGMA campaign. All were fantastic ambassadors for George House Trust and our GO TAKE ACTION message.
• All our candle sellers and volunteers who helped at the HIV candlelit vigil on Monday night, despite getting soaked for hours in the Manchester downpours, including the lovely volunteers from the Lesbian and Gay Foundation
• The staff and speakers who helped to organise and perform at the HIV candlelit vigil, providing moving personal testimonies, and a clear message that together we can and need to STOP HIV STIGMA
• The staff and volunteers at Manchester Pride who supported our work before and during the weekend
• Everyone who supported our STOP HIV STIGMA – GO TAKE ACTION campaign at any point over the weekend, by wearing a sticker, putting money in tins, buckets or envelopes, cheering our parade entry, signing up to a pledge, or reading our posters and thinking afresh.

What an amazing group of people! We couldn’t participate in Manchester Pride without everyones' generous and committed enthusiasm and support.

In particular, we’ve been really pleased with how much our Pride campaign has inspired people, and the thousands of actions that people have made commitments to, so we can work together to STOP HIV STIGMA.

See some of the many pledges people made to STOP HIV STIGMA NOW in our Flickr set