Over 50s - 1 in 12 new diagnoses

posted: 04/05/2010

One in twelve new HIV diagnoses in the UK are in people over the age of 50. Late diagnosis is common among over 50s but almost half of these people were infected after their 50th birthday.

Between 2000 to 2008, one in twelve new adult HIV diagnoses were in a person over the age of 50. The numbers increased year on year, from 304 in 2000 to 787 in 2008.

Typically - male, gay, white, older
The profile of people diagnosed over 50 is rather different to those diagnosed younger. They are more likely to be male, homosexual and white. Older heterosexual men often got HIV in southeast Asia – usually in Thailand.

Infected after 50 – Prevention’s still needed
By looking at the CD4 count when the people were diagnosed, the researchers were able to estimate how long before diagnosis each person had HIV. Just under half (48%) were infected after the 5oth birthday. HIV prevention cannot ignore older adults.

Late diagnosis is big – some deaths within one year
Nonetheless, late diagnosis is more of a problem in older adults than in younger groups. A total of 48% are diagnosed with a CD4 count below 200 cells/mm3, compared to 33% of people under 50. In gay and bisexual men, double the number of over-50s are diagnosed late compared to younger men (40% and 21% respectively).

Moreover, these late diagnoses make a substantial contribution to short-term mortality. Amongst people diagnosed over the age of 50, 14% of those diagnosed late died within a year, compared to 1% of people not diagnosed late.

Whereas people over the age of 50 represented 11% of the individuals accessing HIV care in 2000, they now make up 17% of those doing so.

More on over 50s in Brighton
The Manchester BHIVA/BASHH conference also heard about the treatment and care needs of older adults. One poster profiled 257 patients aged 50 or over attending HIV services in Brighton. The vast majority were white gay men, their mean age was 58 and they had lived with HIV for an average of 12 years.

85% had at least one other health problem, with 43% having three or more. As a result, in addition to anti-HIV drugs, two-thirds were taking medication for other conditions (12% reported five or more other drugs) and 79% were under the care of other medical specialists (dermatology, ENT, cardiology, gastroenterology, etc,). The authors recommended that HIV clinicians should work in close co-operation with these other specialists.

More tests and reviews

Another conference poster highlighted the importance of carrying out additional tests and assessments, for example for prostate cancer and other malignancies. Moreover regular review of all medication is required to monitor possible drug-drug interactions.

Brighton men speak

Finally, the Brighton researchers also presented findings from 20 in-depth qualitative interviews with people with HIV aged between 52 and 78 (mean age 64). Almost all were white gay men.

Some of the key themes were:

• Health: concerns about the unknown effects of HIV and antiretroviral treatment over time; the number of co-morbidities; a desire to have continuity of medical care and more psychosocial support. “Obviously the antiretrovirals are keeping me alive but there must be some long-term damage,” said one interviewee.
• Survival: stories of outliving peers and of not having prepared for the future because none was expected. “They’re all dead and I’m the only one left alive and I’ve got no pension.”
• Self-esteem and rejection, linked to a youth-orientated gay scene, changes in physical appearance and sexual dysfunction. “Who wants an old faggot like me?” was one comment from the interviews.

Advice and Information 

Coming of Age - a guide to ageing well with HIV - 130 pages, UK, 2010

download is free - it is large (2.8 Mb) pdf file, so please be patient while it downloads  

Ahead of Time: A practical guide to growing older with HIV, Austrailia, 2010

Older Adults with HIV - The ROAH study of 1000 adults over 50 by ACRIA, New York

Sources and references

HIV, Human and Sexual Health Rights

posted: 15/04/2010

A groundbreaking guide Advancing the Sexual and Reproductive Health and Human Rights of People Living with HIV has been produced by UNAIDS. Now, policy makers, programme managers, health professionals, donors and advocates have an important tool to better support the sexual and reproductive health and rights of people living with HIV.
 

Networks of people with HIV worldwide contributed to this guide, which explains what people involved in advocacy, health systems, policy making and law can do to support and advance the sexual and reproductive health of people living with HIV, and why these issues matter.

12 recommendations

1. HIV testing should never be mandatory and always be based on the ‘three Cs’: confidential, based on informed consent, and conducted with counselling. This applies equally to marginalised groups, including sex workers, injecting drug users, prisoners, migrants, refugees, and members of lesbian, gay, bisexual, and transgender and intersex communities.
2. Systems for HIV prevention, treatment, care, and support must be strengthened to deal with increased demand at the same time that HIV testing is scaled up, to ensure that HIV testing results in referral to HIV prevention, treatment, care and support programmes. In particular, pregnant women should not be tested only to prevent transmission from parent to child; they must also be offered prevention, treatment and care services.
3. National laws should be reformed and enforced to ensure that:
   ¤    Laws explicitly ban discrimination based on sexual orientation, gender identity, and HIV status;    ¤    Anal sex, sex work, same-sex relationships, and transgender relationships are decriminalized;    ¤    Disclosure of HIV status is not required by law if a person is practicing safer sex, their HIV status is oherwise known, or there is a well founded fear of harm by the other person;    ¤    HIV transmission is not considered a crime except for rare cases where there is evidence beyond a reasonable doubt that one person deliberately tried to infect another and indeed did so;    ¤    HIV status alone does not affect a person’s right to marry or found a family, is not grounds for divorce, and is not relevant in child custody decisions;    ¤    Young people have the right to confidentiality and do not need parental permission for age-appropriate information and sexual and reproductive health care, even if they are below the age of majority;    ¤    Women’s property rights are ensured and protected, particularly following divorce, abandonment or a spouse’s death;    ¤    Sexual violence, including incest, forced or early marriage, sexual assault or rape (including in the context of sex work or in marriage) is recognised and prosecuted as a crime;    ¤    Injecting drug users are provided with treatment, including opioid substitution therapy, and harm reduction programmes as an alternative to incarceration; and    ¤    Transgender people are legally recognised and clear procedures are in place for changing name and sex on official documents.
4. All people living with HIV – including members of marginalised groups, such as sex workers, injecting drug users, prisoners, migrants, refugees, and members of lesbian, gay, bisexual, transgender and intersex communities – should have access to a full range of sexual and reproductive health services, including:
   ¤    All available contraceptive options and help with dual protection, without coercion toward any method;   ¤    Counselling and support for positive prevention and voluntary disclosure   ¤     Access to safe abortion (where legal) and post-abortion care;    ¤    Counselling and support for safe ways to become pregnant;    ¤    Counselling and practical support for infant feeding, whether breastfeeding or replacement feeding;    ¤    Diagnosis and treatment of STIs;    ¤    Cancer prevention and care;    ¤    Counselling related to violence;    ¤    Sexual dysfunction treatment; and    ¤    Male circumcision for men living with HIV if, when fully informed, they want the procedure.
5. Health workers should receive training in human rights and universal precautions, as well as specific training in sexual and reproductive health care for people living with HIV, including technical skills and stigma reduction. People living with HIV should participate in these programmes as trainers.
6. Health service providers and advocates should support closer linkages between HIV prevention, care, and treatment; comprehensive sexual and reproductive health services; drug substitution therapy; mental health and psychosocial services; and anti-discrimination and antiviolence initiatives.
7. Advocates should ensure that special centres and programmes are developed to deliver information and services to hard-to-reach populations.
8. Governments, international agencies, and NGOs, in collaboration with organizations of young people living with HIV, should develop specific guidelines for counselling, support and care for people born with HIV as they move into adolescence and adulthood.
9. Governments, international agencies, and NGOs should better research and monitor the sexual and reproductive health of people living with HIV, including data disaggregated by gender, age, marital status, geographic location and sexual orientation. This research should be conducted with the input and supervision of people living with HIV.
10. Governments, international agencies, and NGOs should set and monitor concrete targets for involving people living with HIV in all relevant activities, including positive prevention programmes.
11. Governments, international agencies, and NGOs should support income-generating programmes. This includes directly employing people living with HIV, and paying them for their work.
12. Advocates should ensure that programmes to bolster participation of people living with HIV also help build needed skills. In particular, women and young people should be provided with ‘know your rights / laws’ education and advocacy training.
     

• The UNAIDS Guide Advancing the Sexual and Reproductive Health and Human Rights of People Living with HIV  pdf 2.3Mb

Source 

Asylum - Human Rights Ignored

posted: 09/03/2010

A new report for the Equalities and Human Rights Commission lays bare the UK government’s abuse of the human rights of asylum seekers and refugees living here, including many who are living with HIV. People seeking sanctuary in Britain are denied vital healthcare whether they are in detention centres or living in the community, the Equality and Human Rights Commission has found. Hundreds of rape victims, people living with HIV, and traumatised children are missing out on treatment and basic medical help.
 

Institutional failures

The report, from the University of Kent, warns "There is evidence of an institutional failure to address health concerns about asylum seekers in detention. More specifically there are concerns about children's health, mental health, treatment for those with HIV and access to female GPs, especially for women who have suffered rape and sexual violence."
 

Asylum and medical charity workers said the findings confirmed the experience of hundreds of refugees. A spokeswoman for Medical Justice said: "Sadly and unsurprisingly, findings of these failures accord with what our volunteer doctors have been seeing on the hundreds of occasions they have visited immigration detainees and seen their medical notes."
 

Time for action

This EHRC report sets out problems of poor treatment of refugees and asylum seekers in the UK. There are some serious failings. We’ll be checking to see what action the Commission now takes to end the government’s mistreatment and denial of people’s human rights.

HIV, health and social care
Inadequate HIV healthcare is one of the points highlighted in the healthcare section of the report. There are specific concerns around vulnerable groups. For women asylum seekers and refugees there is evidence of poor antenatal care and pregnancy outcomes. There is little evidence of the commissioning of services for disabled asylum seekers (such as everyone with HIV) and no clear guidance exists on local authority responsibilities towards asylum seekers with care needs. Mental health problems including post-traumatic stress disorder, depression and anxiety are prevalent among asylum seekers and refugees, and the provision of mental health services for survivors of torture and organised violence is widely regarded as inadequate.
 

The vulnerability and ill health of asylum-seeking and refugee children is an area of particular concern, as are the health needs of older refugees. There are also concerns around the provision of healthcare to asylum seekers in detention with communicable diseases and with HIV/AIDS.
 

Poverty, destitution and access to accommodation and financial support
Asylum seekers are vulnerable to poverty and destitution (defined as not having adequate accommodation or support for themselves and their dependants for the next 14 days) as a result of a number of factors. These include: the circumstances in which they and their dependants arrive in the UK (often without money or accommodation), the complexity of the rules for entitlement to financial and other support for asylum seekers and those refused asylum, the occurrence of administrative and casework errors, and the fact that the vast majority of asylum seekers do not have permission to work.

Evidence indicates that refused asylum seekers are the most disadvantaged group and evidence of destitution appears to run counter to Section 11 of Chapter 42 of the Human Rights Act 1988 and Council Directive 2003/9/EC.
 

Care needs gaps
Asylum seekers with care needs are particularly vulnerable to poverty and to falling through the gaps between Home Office and social services support. Other vulnerable groups include single women and those with children.
 

There are concerns about the specific requirements that asylum seekers must meet when lodging a claim in order to be eligible for support. The incompatibility of the Section 55 and 9 provisions with Articles 3 and 8 of the European Convention on Human Rights (ECHR) remains a key concern, as do the conditions that asylum seekers must comply with in order to receive Section 4 support. Complex issues surround the provision of support for unaccompanied asylum-seeking children, and there are doubts as to whether the UK’s responsibilities under domestic legislation and international human rights principles are being fulfilled.
 

Key issues for action now by the Equalities and Human Rights Commission
There is an ongoing tension between policies relating to immigration control and those concerned with welfare. This lies at the heart of many of the concerns regarding the equality and human rights of asylum seekers and refugees.

• Processes for removal involving detention and deportation have been the subject of sustained criticism on human rights grounds.
• Living conditions and support received by asylum seekers and refugees in the UK also cause concern. There are general inefficiencies within the system: many people do not know or understand the process, and receive different and conflicting advice from different agencies. On accommodation and support, the impact of the Section 55 and Section 9 provisions has been of considerable concern and, despite various clarifications and revisions by the government, may continue to have an adverse impact on asylum seekers. The quality of housing remains problematic and in some instances appears to conflict with the respect for family and home required by Article 8 of the ECHR.
• There is evidence of problems of access to healthcare. There is a serious lack of clarity with respect to the healthcare entitlements of asylum seekers and this feeds into confusion at ground level.
• Policies and practices within the asylum system covering the seven equality areas, as well as the treatment of vulnerable groups, also cause concern. The provisions put in place by UKBA in order to meet its legal requirements to take gender, race and disability into account have been criticised, and there is clearly a need for more rigorous and widespread equality impact assessments of the various aspects of the asylum system. Furthermore, less consideration is given to those equality areas not subject to the current equality duties. Ideally, the introduction of a new single equality duty covering all seven strands should help to initiate consideration of the issues affecting gay, lesbian, bisexual and trans asylum seekers, as well as those of different ages and with different religion or beliefs.

EHRC report (pdf) - Refugees and asylum seekers : a review from an equality and human rights perspective

Source 
Equality and Human Rights Commission

UN to Uganda - Scrap Anti-Gay Laws

posted: 18/01/2010

The UN's top human rights official has called on Uganda to drop its proposed anti-homosexuality law that would impose the death penalty on gay and lesbian people with HIV, among others. Navi Pillay, the UN's high commissioner for human rights, joined a growing chorus condemning the bill as discriminatory and called for homosexuality to be decriminalised in the country.
 

"The bill proposes draconian punishments for people alleged to be lesbian, gay, bisexual or transgendered – namely life imprisonment, or in some cases, the death penalty," she said. "To criminalise people on the basis of colour or gender is now unthinkable in most countries. The same should apply to an individual's sexual orientation."
 

Bill fails human rights standards
Pillay called on the Ugandan ¬government to put the draft bill on hold because it breaches international human rights standards. ¬Pillay said Uganda had a generally "good track record" of co-operating with human rights mechanisms but the bill "threatens to seriously damage the country's reputation in the international arena".
The UN said Uganda's parliament may discuss the bill as early as this week. It has provoked criticism from western governments and gay rights groups and protests in London, New York and Washington.
 

President worries about threat to international aid

President Museveni has recently begun distancing himself from the bill. In his first public comments on the issue, he told a meeting of his ruling party that their handling of the bill "must take into account our foreign policy interests".
He said: "When I was at the Commonwealth conference, what was [the Canadian prime minister, Stephen Harper] talking about? The gays. UK prime minister Gordon Brown ... what was he talking about? The gays."
Nsaba Buturo, the ethics and integrity minister, has said a revised law would now probably limit the maximum penalty for gay people with HIV to life in prison rather than execution.
 

Existing anti-gay law has 14 year jail penalty
Homosexual acts are already punishable by up to 14 years in jail in Uganda. The private member's bill, tabled last year, would raise that penalty to life in prison. And it proposes the death penalty for a new offence of "aggravated homosexuality" – defined as when one of the participants is a minor, or HIV-positive, or a "serial offender".
 

Sneaks and harassers charter
It could also lead to a prison sentence of up to three years for anyone failing to report within 24 hours the identities of any lesbian, gay, bisexual or transgendered person.
A local independent newspaper, the Daily Monitor, quoted parliament's speaker as saying the legislative body would debate the bill despite President Museveni's call for more talks. Edward Ssekandi said: "There is no way we can be intimidated by remarks from the president to stop this bill."
 

Source
 

NF HIV Hate in Village

posted: 10/12/2009

Stickers have been popping up around Canal Street, the heart of Manchester’s gay village saying ‘'National Front. Homosexuality Equals AIDS. The Queer Plague.’

They have been defaced or torn down by locals whenever they are spotted and Greater Manchester Police were called in after several complaints on Monday December 7th.

Taking DIY Action

Josh says “As a positive gay man walking through our community on Canal Street last weekend, I was appalled to find a sticker placed there by the National Front attacking us as a community. The ignorance and prejudice held by the National Front is just shocking, if it wasn't so ludicrous. Looking at the sticker you can clearly see skulls in the red and one of the letters in a shape of a coffin. Why should I, let alone anyone else in our gay community, or even Manchester have to deal with such stigma, discrimination or hatred in 2009? This offensive and disturbing sticker was thankfully defaced by myself and my good friends.”

Kath Morgan, Awareness Raising and Events Coordinator at George House Trust commented
“This kind of ignorant and abusive attitude takes us back to the late 70’s and early 80’s when the gay community came together with other marginalised groups to fight the spectre of fascists trying to impose their evil views.
The gay community was not cowed then and HIV positive people will not be cowed or frightened now by this crass attempt to demonise HIV positive people.
We must be ever vigilant for those who would seek to malign and divide our community and we must also remember that HIV positive people are very much part of our diverse gay community and that we are stronger by far when we support each other and stick together in the face of such bigotry.”

Recruiting

The sticker gives a phone number. This simply takes you to an answer-phone message about NF membership.

The NF website says homosexual or lesbian relationships are not valid alternatives to heterosexual marriage. They would repeal laws ‘permitting homosexuality and its promotion’. The National Front says if elected it would make homosexuality once again illegal: “Gay bars will be closed, soaps will have their gay story lines removed and public displays of homosexuality, lesbianism and transgenderism will also be made illegal.”