GP Guide - Migrants' Health

posted: 26/01/2011

The Migrant Health Guide is a free new online “one stop information shop” for GPs and practice nurses who are working with migrants.

It comes from the Health Protection Agency who have produced it because migrants health needs are often more complex than for other people. HIV is included.

The online guide gives doctors and nurses easy access to the facts, so they can improve their patients’ care and quality of life.
 

Although most migrants to the UK are healthy, TB and HIV and other conditions are more common.

The guide supports diagnosing and managing a range of typical migrant health conditions. Early diagnosis and prompt treatment of HIV and other conditions is important for the health of the individual and to reduce onward transmission.
 

Produced by experts working with primary care practitioners, it comes with the blessings of the Royal College of General Practitioners and the Royal College of Nursing.

Key Recommendations

• Know your local migrant population and their rights to care
• Teach patients how the NHS works
• Assess new patients using the checklist and their country page
• Vaccinate and immunise as normal
• Watch and test for infectious diseases and conditions typical of their country
• Check and advise on any plans to visit friends and relatives abroad.

The Migrant Health Guide has

• detailed information for each country
• tools for assessing migrant patients – new patients, patients with symptoms, identifying more vulnerable patients
• how to talking about the NHS with migrants – explaining it, migrants rights to treatment, languages and interpreters, cultural awareness
• sections about migrant health conditions (including HIV), infectious diseases, vaccinations

Migrant Health Guide

HIV in Primary Care : The best HIV guide for GPs and primary care is (free download) HIV for non-specialists, by MedFash.

Side Effects - a Better Quality of Life

posted: 22/12/2010

i-Base, the HIV treatment information organisation, have produced a new issue of their guide to HIV treatment, side effects and complications.

The guide should help you get better medical care and improved health. It should help you feel more in control of your treatment, and, most importantly, to get a better quality of life.
It has been written by people who are HIV-positive, who have used many of these treatments and had many of the side effects.
 

“Everyone worries about side effects before they start a new treatment.
I have changed treatment four times since 1996. This has always been related to side effects or because new research has shown I can change the dose.
Every time, my quality of life improved more than I expected, even switching from twice-daily to once-daily.
It always takes me a while to change, even when I know that other drugs could be better.
As the benefits from treatment are hopefully going to keep me alive for many years, I want to make sure I am on a combination that is effective, easy to take and tolerable–and that gives me the best quality-of-life.”

Read the guide online

Order a free printed copy

Download the pdf version 1.2 Mb
 

The guide has information on how to talk to your doctor about side effects. There are sections on each of the major side effects and medical and alternative treatments are included.
 

What's new?

This is the fifth edition of the guide HIV and your quality of life:  a guide to side effects and other complications, issued this December.
 

• It has been updated to include side effects of the latest drugs.
• There is less information on side effects of drugs that are now rarely used in the printed book, but all the details are still online. T-20, lactic acidosis, indinavir, d4T and abacavir hypersensitivity reactions are online, not in print.
• More information on long-term complications. These make a big difference to the best quality of life. For example, there are sections on bone and heart problems.
• There’s a new section on HIV and ageing, because this an essential part of living well with HIV.
• The guide includes comprehensive references in the online version. There are hyperlinks to over 250 documents. These include: the product information for each drug; UK, European and US treatment and management guidelines; and related studies that focus on safety and tolerability of drugs. Whenever possible we selected references that provide free full text access online.

Feedback and comments

i-Base welcome feedback and comments and you can tell them what you think in their online survey.
 

No Fear in HIV Prevention

posted: 09/11/2010

Using fear as a tool for HIV prevention, like in the 1980s British AIDS tombstone and icebergs campaigns, causes more harm than good, according to a recent review of the evidence.

The idea behind the AIDS tombstones and icebergs was that making people fear death would encourage self preservation by using condoms. Similar fear approaches to HIV prevention were used in the United States, and in Australia (with images of the Grim Reaper).

Following the success of HIV treatments, fear arousing campaigns have picked out some unwanted treatment side effects (for example, facial wasting and diarrhoea).

Attention Grabbing, but does fear work?
Campaigns arousing fear are good at grabbing public attention by using graphic imagery, simplistic language and shocking statements. Fear campaigns are often very memorable.

Recently the use of fear has increased in other health promotion campaigns highlighting the harm from smoking, excess alcohol use, and drug use. The public has great faith in the use of fear to change behaviour.

Frustration
The media, including the gay press, have been calling for more emphasis on harm from sexual risks. The public and campaigners are frustrated at high rates of HIV and STI infection in the UK and the lack of progress in reducing these. That is often behind the calls for what seems to be an ‘obvious solution’.

Does using fear of HIV work?
Would using more fear in HIV prevention work? The role of fear in HIV prevention is written as a guide for gay men’s HIV prevention workers, but many other people, including people with HIV, are very interested in this and have strong views about it. It is an interesting and informative read in four illustrated pages.

It looks at the scientific evidence for whether fear works or not, considers the ideas behind it, and looks into the unforeseen consequences and risks of using fear in HIV campaigns.

Fear is for the Fearless
Fear only works with people who are not frightened by HIV. But 98% of gay men say (in Gay Men’s Sex Survey, 2008) they agree or agree strongly that “HIV is still a very serious medical condition.” So almost every single gay and bi man is already fearful of HIV. Perversely, adding to that fear can make things worse for the men at more risk of HIV.

As Adam Bourne says: “It will remain a constant challenge for those promoting sexual health and well-being to attract the attention of their target audience among the many other advertisements that compete for their attention.

“The temptation is to produce shocking or explicit imagery, which may stand a better chance of being noticed or being remembered.

“However, it is doubtful whether it will actually be successful at influencing behavioural choices.

“Most gay men and other men who have sex with men are already motivated to avoid HIV, but some still lack the knowledge or the power to do so.”

“Inducing fear is not an effective way to promote previous HIV relevant learning or condom use either immediately following the intervention, or later on.

However, HIV counselling and testing can provide an outlet for previous HIV-related anxiety and, subsequently, gains in both knowledge and behaviour change immediately and longitudinally.”

Earl & Albarracin, 2007

Read The role of fear in HIV prevention, Adam Bourne, 2010, Sigma Research Briefing no.1 for the CHAPS gay and bi men’s HIV prevention partnership 
 

More HIV Testing Urged

posted: 08/10/2010

The NHS health advice body NICE has produced its first HIV guidance, about HIV testing. The draft HIV testing guidance recommends that mainstream health services offer much more HIV testing to the two communities most affected by HIV in England, black African people and to men who have sex with men. The guidelines also call for more testing to be offered in places such as bars and saunas, using rapid point-of-care tests.
 

NICE HIV testing: open for comments
The National Institute for Health and Clinical Excellence (NICE) tells the NHS which are the best and most cost-effective treatments and public health interventions. NHS bodies are legally required to fund the medicines and treatments recommended by NICE.
 

Making HIV testing guidelines work
Other organisations have produced HIV testing guidelines before, notably the British HIV Association (BHIVA) and the British Association for Sexual Health and HIV (BASHH). But these were not backed by the UK National Screening Committee, nor by NICE, and many parts of the NHS simply ignored them.

The most recent BHIVA and BASHH testing guidelines recommended that HIV testing should be offered in a wide range of healthcare settings, including GP surgeries and most hospital departments. Little was done about this.
 

NICE will force more testing action
To increase testing, the Department of Health asked NICE to produce public health guidance to increase HIV testing both among men who have sex with men and among black African communities. The new NICE guidance supports most of the BHIVA and BASHH testing recommendations, and goes further with some recommendations.
 

There are two guidelines - one to increase testing in men who ave sex with men, and a the other for increasing testing among black African people.
 

Local strategies needed

For both men who have sex with men and for black Africans in England, NICE recommends preparing local strategies to increase HIV testing, developed in consultation with community organisations and the people affected. These strategies should focus on sections of the community who are less likely to use services. Community engagement and involvement is particularly important for black African communities.
 

Africans - involve people as champions and leaders
NICE recommends that black Africans in England should be recruited and trained to act as ‘health champions’ and ‘role models’. HIV testing work must deal with people’s misunderstandings and ignorance about HIV, testing and treatment, and must promote the benefits of early diagnosis and tackle HIV-related stigma.
 

The guidance for black African communities includes providing HIV testing outside sexual health clinics. This is because the evidence from the literature is that HIV testing in sexual health clinics is seen by some black Africans as stigmatising, complicated and time-consuming, while HIV testing in other healthcare settings was welcomed.
 

NICE recommends that general practitioners should routinely offer an HIV test to black Africans who have not tested before or who have had a new sexual partner since the last negative test. In hospitals and other healthcare settings, an opt-out test should be routinely provided to black Africans who are having blood taken for other reasons.
 

Testing in sex venues to reach gay men
Health promotion interventions promoting testing to men who have sex with men should include venues, such as saunas, clubs and cruising areas, or websites, which facilitate sex between men.
NICE appears more enthusiastic than BHIVA about community testing in sex on the premises venues. In gay venues, NICE says rapid tests (using mouth swabs or finger-prick blood samples) should be provided by trained staff, in a secluded or private area.
 

NICE’s guidance for men who have sex with men encourages testing in primary care (GPs), but not in secondary care (hospitals). The BHIVA guidelines are different, and recommend that all healthcare settings should offer an HIV test to any man who says he has sex with other men.
 

NICE recommends that GP surgeries should recommend all males to have HIV tests where the surgery is in an area with a large gay community or theer is a high rate of HIV.
 

Carl Burnell, of the gay men’s health charity GMFA, questions whether this will is work, because of the many other demands on GP surgery capacity. “The strategy assumes that other services are running like clockwork and have capacity to offer HIV testing,” he said.
 

Clear path from testing to services
All testing services need clear pathways for people to obtain any necessary confirmation of the HIV test result, HIV treatment services and HIV support groups. People who test negative may need help through counselling and safer sex interventions.
 

The draft guidance comes before results are published on several Department of Health funded pilot projects evaluating new testing strategies.
 

NICE’s guidance is open for feedback and comments until late November. The final NICE HIV testing guidance will appear in March 2011.

HIV testing guidelines for MSM 

HIV testing guidleines for black Africans in England
 

Source

Police, Prosecutors, Press Bungle HIV Crime

posted: 01/09/2010

Despite new police HIV crime investigation guidelines, HIV prosecution guidelines and new press HIV reporting guidelines, it appears that all were ignored and left on office shelves in the latest prosecution for reckless HIV transmission.
 

A man accused of passing on HIV to a woman of 19 was jailed for a year, and given a five year sexual offences prevention order yesterday.

Nicholas Richards, who is 31, and lived in Sittingbourne, Kent, admitted Grievous Bodily Harm (GBH) for the HIV offence of reckless HIV transmission at a previous hearing at Maidstone Crown Court.
 

Richards was also given a five-year sexual offences prevention order, which stops him from having unprotected sex or not telling his partners about his HIV.
 

He was jailed yesterday for a year on that charge and was sentenced to a further year for an unrelated GBH charge, for attacking a man in Medway, Kent.  

The court heard Richards exposed the 19-year-old woman to HIV in June 2008. The young woman, who cannot be identified for legal reasons, found out she had HIV during routine blood tests when she became pregnant. Her baby does not have HIV, say the police.
 

Police comments
After the hearing, Det. Ch. Insp. Simon Wilson said the crimes committed by Richards were "abhorrent and callous" and had far-reaching consequences. He said: "Not only did he knowingly infect a young girl with HIV - a disease she will have to live with for the rest of her life, but he also selfishly put her child at risk too. Thankfully, the sheer bravery the victim showed in coming forward immediately and giving evidence in court helped us secure a conviction against him and I would pay tribute to her courage." He urged anyone else who had "fallen prey" to Richards to contact the police.
 

George House Trust comment

 
More Police, Crown Prosecution Service and Press failings

Because HIV crimes are complex to investigate and prove beyond reasonable doubt, and because of the harm HIV stigma and discrimination cause, police and prosecutors have strict guidance and policies to follow in HIV cases. This case seems to prove that these were ignored. The investigation and prosecution system cannot be relied on to work properly in all HIV cases.

Police

It appears that the Police ignored their own HIV investigation guidelines. They have clearly ignored their own Communication Strategy guidance, because Det. Ch. Insp. Simon Wilson should never have made his inaccurate and sensationalising comments and blatantly fished for other people to come forward who may have ‘fallen prey’ (his words) to the man.
 

Crown Prosecution Service

The Crown Prosecution Service appear to have yet again ignored their own HIV prosecution policy and guidance. Prosecutor Roy Brown seems to have been the man responsible. Guilty pleas should not be accepted without rigorous efforts to obtain transmission evidence.There is no evidence from the media reports that phylogenetic analysis was carried out as the prosecution guidelines require. So we can't be sure the man found guilty did pass HIV to the young woman.

Press

It was only the middle of August, just a few weeks ago, that the managing editor of The Sun told us about his paper’s commitment to responsible reporting of HIV at the launch of NAT’s new press guidelines. Graham Dudman, Managing Editor at The Sun, we were told, ensures his staff use the guidelines. He says: “At The Sun we pride ourselves on getting the facts right and staying up to date. This can be a challenge in sensitive areas like HIV. NAT's guidelines for journalists are very useful, really simple to work with and lay out all the facts reporters need.”
 

He seems to have forgotten the press guidelines for HIV very, very quickly. The Sun’s headline for this HIV news story: ‘HIV fiend jailed for infecting girlfriend’
 

News reports

BBC

Independent

Daily Mail

The Sun