Teens' Unplanned Pregnancies

posted: 04/05/2010

Around one in seven adolescent females with HIV became pregnant, according to a recent check at UK HIV clinics. Most of the pregnancies were unplanned and a quarter were ended. Although there were problems with adherence to HIV treatments medication among many of the young women, none of the women transmitted HIV to their baby.

These pregnancies highlight the need for sexual health education for young people who acquired HIV from mother-to-child transmission in the 1980s and 1990s. To help health professionals with this work, the HIV in Young People Network (HYPNET) and the Children’s HIV Association (CHIVA) have just produced a draft guide for managing the sexual and reproductive health of HIV+ adolescents.

19 clinics responded to a survey of all mother-to-baby infected young women aged twelve or over. There were 172 young women, and 27 young women had a total of 36 pregnancies.

Of the 36 pregnancies:

• 75% were unplanned
• 86% involved regular partners
• 39% of partners were not aware of the woman’s HIV status
• 25% of the pregnancies were terminated
• 14% ended in miscarriage
• 50% resulted in a live birth and
• 11% were still pregnant at the time of the report.

Most mothers had detectable HIV

Of the 18 live births, 89% of the mothers were on combination therapy at the time of delivery.
In only 8 (44%) of the live births did the mother have an undetectable viral load of <50 copies/ml before delivery. 80% of mothers had poor adherence to treatment during pregnancy, with two being given Directly Observed Therapy (DOT).

One third of the babies were premature and five required neonatal intensive care. Three had a low birth weight. No congenital anomalies were reported. No cases of HIV transmission were recorded.

Two-thirds of the young mothers were reported as having complex social needs, with one quarter of their babies requiring foster care.

Draft guidelines

The first ever guidance for managing the sexual and reproductive health of HIV-positive adolescents has been produced. The document makes it clear that, even if the issue is not raised by the young person, then paediatricians should take responsibility for covering sexual health education and needs during consultations, with the process starting well before sexual maturity is reached. The guidance states that HIV-positive adolescents require the same sexual health information as their HIV-negative peers, as well as further help on applying it while living with HIV.

Topics which need to be discussed include preventing the transmission of HIV and other sexually transmitted infections; contraception; symptoms and treatment of sexually transmitted infections; vaccinations; HIV disclosure; post-exposure prophylaxis; conception options and fertility issues; pregnancy and avoiding mother-to-child transmission; options if there is an unplanned pregnancy; sexual exploitation and sexual violence; sexual difficulties; psychological support for negotiating safe sex, self-assertion, bullying or other issues.

How to work with young people with HIV

The guidance explores some of the issue involved in delivering sexual health work with this age group. Sexual health services for young people should be confidential (without disclosure to a parent or guardian), provided that the young person is assessed as being ‘Gillick competent’ (has the maturity to make their own decisions and to understand the implications of them). For under 16s, Gillick competence needs to be assessed at each clinical visit as it can change over time.

The guidance notes that adolescents value consultations that are non-judgemental, give them correct information and which maintain confidentiality. Professionals are encouraged to use simple language, check understanding and not overload adolescents with too much information. They should not make assumptions about whether the young person is sexually active or what their sexuality is.

The draft guidance is open for comments and feedback until May 28.

Source with references

New Testing Guidance

posted: 01/10/2009

Concise guidelines just published by the Royal College of Physicians, enable any doctor, nurse, midwife or trained healthcare worker to carry out HIV tests to help drive down late diagnoses of the virus. Treatment for people who are diagnosed a long time after infection doesn't work as well and untreated people are more likely to pass on HIV.

Testing progress to cut deaths

A third of HIV-related deaths could be avoided if testing for HIV was more widespread and more socially acceptable. So the guidance calls for tests to be offered to everyone accessing sexual health services, antenatal and abortion services, as well as drug dependency programmes and healthcare services for those diagnosed with tuberculosis, hepatitis B and C and lymphoma. Tests should also be routinely offered to anyone presenting with other clinical indicators for HIV infection, or with an identified risk factor for HIV whenever they access healthcare services. The introduction of universal testing is intended to de-stigmatise HIV testing.

This Royal College of Physicians guidance summarises the 2008 UK national HIV testing guidelines from the British HIV Association. Those are available here 

Also included in the guidance:

• who can test for HIV
• in what settings a test should be offered
• the key elements to the discussion a clinician should have with a patient before and after testing
• a list of conditions that could indicate that a person could be HIV positive and should therefore be offered a test
• While more testing is crucial for identifying those at risk and preventing the spread of HIV, it is also vital that testing remain confidential and voluntary.

Dr Mary Armitage, Former Clinical Vice President of the RCP and Chair of the Medical Foundation for AIDS and Sexual Health (MedFASH) project advisory group, welcomed the publication:
"There are compelling reasons for making the HIV test a routine investigation in many secondary care settings, as set out in these guidelines."

Dr Mark Pakianathan, British Association for Sexual health and HIV (BASHH), commented:
"A 20 year old diagnosed with HIV today can expect to live an additional 50 years with the treatment now available. We have an urgent responsibility to recommend testing when appropriate to avoid unnecessary death and spread of disease."

For a copy of the guidelines, please email or ring Zoë Horwich, Communications Officer at the Royal College on Physicians on 020 3075 1354.

New HIV Testing Resource coming from MedFash next week
There will be a new HIV testing resource pack for clinicians produced by MedFASH, which will be launched at the British HIV Association Autumn conference 2009, on the 8th October.

Photo credit - Creative Commons licence Justinc

End to HIV Treatment Charges?

posted: 07/05/2009

During the debate on the Health Bill in the House of Lords yesterday, the Government announced its intention to conduct a review of NHS charging for HIV treatment, which affects some migrants.

Deborah Jack, Chief Executive of NAT, comments:

“NAT was instrumental in securing this Government review, which is the first step to making access to HIV treatment in the UK a reality for all. NAT was one of the first organisations to recognise the unfairness in the treatment charges introduced by the Department of Health in 2004, and has worked with parliamentarians to use the Health Bill as an opportunity to review HIV treatment charges. We hope the review of current evidence will show that HIV treatment should be exempt from charges. This would ensure that some of the most vulnerable people in the UK would be able to access the vital care they need, both improving their health and reducing the risk of HIV being passed on.”

George House Trust's response

George House Trust warmly welcomes this announcement of a change of heart by government. In the last ten years the charging rules have been tightened, and the department of health has issued dodgy guidance - and been ticked off for this by the courts.

We need to wait to see the detail but it is excellent news that the government has at last responded positively to end the human rights violations and the harm treatment charging causes individuals and HIV prevention in England.

George House Trust drew attention to the International Covenant on Economic, Social and Cultural Rights which the UK signed over 30 years ago in 1976. Governments since have failed to make this part of our own law. This Coveneant gives everyone in any country the 'right to the highest attainable standard of health' and that means accessible HIV treatment for all in the UK. The current rules deny us this basic right in the Covenant.

The department of health's own guidance advises NHS Trusts to follow a human rights approach in providing healthcare but despite this keeps its charging rules.  Human rights in health - a framework for local action, 2007.
 

The Lords announcement