HIV Training and Resources

posted: 02/03/2011

The Sheffield Centre for HIV & Sexual Health has a solid reputation for its training courses and resources. Their 2011 training and resources brochure is now available.
 

We’re highlighting here a few useful courses and resources – HIV prevention for men who have sex with men, HIV Reality Check (about HIV stigma), Partner Notification Skills for Beginners, and a leaflet written by Sheffield women living with HIV.

• HIV Prevention with Men Who Have Sex With Men (MSM)
  1 day course £125 13th July 2011; 11th July 2012

This one-day training course explores the reasons for HIV prevention work with men who have sex with men (MSM), one of the communities most affected by HIV in the UK.
It outlines ways to plan interventions that are targeted and appropriate.
 

In order to plan effective interventions you need to understand the context in which MSM live their lives. This course examines key issues, including the impact of internalised homophobia on self esteem and risk-taking behaviour, and how existing services may be inappropriate and inaccessible due to hetero-sexism and a lack of awareness.
 

The course also highlights the needs of specific MSM communities / population groups that may be more vulnerable to HIV infection e.g. young men, black and minority ethnic community men, men engaging in risk-taking behaviours with multiple sexual partners, and men with lower educational qualifications.
 

The course closes by exploring the opportunities and challenges involved in different methods of working with MSM, including:
• Outreach in a range of settings (e.g. Public Sex Environments, Online, Pubs, Clubs, and Saunas)
• Work in community settings (e.g. drop-ins)
• Community development
• Group work (e.g. training and workshops)
• Production of targeted campaigns / resources
The course is for anyone planning, commissioning or delivery of HIV prevention / sexual health promotion with MSM in both the statutory and voluntary sectors.

• HIV Reality Check
  

1 day course; £125, 10th October 2011

Developments in treatments mean that more and more people with HIV are living longer and
healthier lives. But the prejudice and stigma experienced by people living with HIV can still be a barrier to them accessing the support services and treatment they need.
 

Currently, about a third of people with HIV are unaware that they have the infection, with stigma playing a major part in preventing people from testing for HIV.
 

This one-day training course encourages service providers to:
• Check their current levels of knowledge and understanding on HIV and transmission
• Explore the varying impacts of HIV related stigma on different communities
• Discuss the issue of prosecution for HIV transmission, and anxieties around disclosure of HIV status
• Action plan based on recommendations produced in consultation with people living with HIV
 

The course is suitable for professionals looking to develop their basic knowledge and awareness of HIV related stigma. The training is suitable for professionals from services including Primary Care, Social Care, Health and Education.

• HIV Reality Check Manual

£40, available in April 2011
A training manual with accompanying CD, for health and social care professionals on raising awareness and addressing the issues of HIV related stigma and discrimination in service provision.
The manual includes:
• Research and consultation findings on people living with HIV’s experiences of stigma and discrimination
• A range of training sessions with step by step exercises for delivering training to other professionals
• Guidance for the planning and delivery of training for people living with HIV, on developing the skills to manage stigma and discrimination and for positive living.
 

• Partner Notification Skills for Beginners

2 day course; £250; 7th - 8th March 2011; 5th - 6th March 2012
 

This two day course has been designed to assist practitioners who are new to the role of tracing and notifying sexual partners of those found to have sexually transmitted infections, including HIV, to:
• Understand the rationale and evidence base for partner notification
• Understand national guidelines, policies and protocols related to partner notification
• Understand the legal and ethical framework for partner notification
• Explore different partner notification strategies
• Develop the skills to negotiate partner notification with patients, and trace partners directly if required
• Assess outcomes and audit partner notification
 

• Positive Women Thoughts and Feelings
  

£15 for 25 copies

A booklet of writing and illustrations by a group of HIV positive women from Sheffield about their experiences of living with HIV - a useful resource in raising issues around HIV and AIDS.

Sheffield's training and resources - details and booking form

Guide to Safer Sex Advice

posted: 01/03/2011

The British HIV Association has produced draft guidance for STI clinics on offering Safer Sex Advice for the UK. They are inviting comments on their draft Guidelines.

The Safer Sex Advice guidelines recommend behaviour change interventions, what safer sex advice to give people at risk of STIs, and advising people living with HIV and people at greater risk of HIV infection.

The guidance is also useful for GPs and HIV care services when offering Safer Sex Advice.
 

Comment on Safer Sex Advice Guidance

Comments deadline is 31 May 2011 - comment through this webpage

Safer Sex Advice Guidance for the UK

Microbicides and Prevention

posted: 01/03/2011

There’s been much more progress in developing gels that help prevent HIV infection. The first trial of rectal use of a tenofovir microbicidal gel has produced useful results and boosted hopes.

Last year we heard of the first successful trial of a vaginal HIV prevention gel. Using this gel in the rectum for HIV prevention caused some side effects and may not be safe, the 18th Conference on Retroviruses and Opportunistic Infections (CROI) in Boston, USA, has just heard. However the problems found are already being solved and new microbicides are under exploration.
 

80% preventive but few liked it
Although the gel was 80% effective in inhibiting HIV from infecting rectal cells, it caused stomach side effects as cramps and discomfort among some, and was unpopular, with only 25% of users liking it.
 

Next: 2nd attempt at anal gel
They are now working out a new version designed just for rectal use, and they are seeing if tenofovir can be given as a HIV prevention douche or enema.
 

Complex rectal microbicide study

• The study was complex and needed a lot of commitment from the 18 people who took part – all HIV-negative, 14 men and four women. First they had a single dose of oral tenofovir and then waited two weeks. During this time they had five rectal examinations and biopsies.
   
• Then they were either given one dose of either the CAPRISA tenofovir gel, or a placebo (fake) gel and again waited two weeks and had five more biopsies taken.
   
• Then, at last they were offered either the tenofovir or placebo (fake) gel once a day for seven days and had some final biopsies done.

Altogether 2000 biopsies were taken (they were very dedicated patients in this trial - on average each person had 111 biopsies!)
 

Why were there so many biopsies?
Somehow we need to test the gel against HIV in real life. The biopsies allowed the microbicide-treated cells to be kept alive in the laboratory to see how they respond to large doses of HIV. This is the closest we can get to doing the normal drug safety and safe doses tests.
 

Blood and rectal response
The researchers compared how much tenofovir was in the blood and rectal tissues after taking the pills and using the gel. Take the tablet and there was 30 times more tenofovir in the blood than after using the rectal gel, while using the gel meant there was 100 times more tenofovir in rectal tissues after just one rectal dose and after using it for 7 days it was 500 times higher. After seven days of rectal use HIV had 80% less viral infectivity.
 

Works, but side effects and unloved
So the gel shows signs of working well, but there were significant side effects and, perhaps most importantly, it was disliked by most.
 

Two volunteers reported grade three adverse events, meaning diarrhoea, cramps and discomfort. These were bad enough for the two to stop before completing the seven-day course. There were also some signs of cell damage being caused.
 

Only 25% of users said they liked the tenofovir gel, although 75% of people said they would be prepared to use it again if it proved protective against HIV.
 

Enemas and new versions, new microbicides
The tenofovir gel is now being reworked to be less toxic to cells.
The first trials of an enema delivering the anti-HIV drug involved nine gay men trying two different enema formulations and distilled water as the base for the enemas. Men preferred the enema which was designed to be in balance with the body (so it doesn’t draw out moisture from the tissues), and they found it went much further up the colon so would protect more, and found it was also the least toxic to cells.
 

Other experimental microbicides
Results for other experimental microbicides were also presented at the conference, including hi-tech ones containing broadly neutralising antibodies, which would act like a short-lived ‘mucosal vaccine’.
So there is more work to be done but microbicides are looking much more hopeful now than even 2 or 3 years ago.
 

Source with abstracts and references

Talking and Telling about HIV

posted: 28/02/2011

There’s a lot of fuss made about how important it is for gay and bi men diagnosed with HIV to tell their sexual partners about HIV, before any sex takes place – which is known as ‘disclosure’.

Telling people whether or not you have an STI / HIV is your choice.

We think it is smarter if every  person in the UK were to talk about HIV and discuss their and partners’ HIV and STI status and risks before sex. But telling others about having HIV is always a choice.

One-sided talking

One major problem is that undiagnosed people, including gay and bi men, rarely ever talk about their own HIV status, but instead expect diagnosed people to always reveal their HIV status.

Some undiagnosed men then decide not to have sex, or decide on less risky sex after the partner says they have HIV.

Conference debates

George House Trust has critically examined the evidence for and against relying on being told HIV status as a way of avoiding getting HIV. Chris Morley, George House Trust's HIV policy expert, issued a challenge to gay men's HIV prevention workers when he gave a detailed presentation at the CHAPS conference last week for England's sexual health and HIV prevention organisations.

The challenge is to tell undiagnosed men that relying on being told by people with HIV is a seriously flawed way to try to avoid HIV. The HIV risk run by men expecting disclosure is simply too high. The challenge was also to help undiagnosed men be more respectful to anyone who does disclose having HIV. Some disclosing men with HIV are then shamed, abused, rejected, or worse.

Talking about HIV happens very unevenly and the expectations of disclosure put an unbalanced burden on people with HIV.

Dysfunctional Disclosure

The far bigger problem however, is that relying on being told, and being told accurately, is a highly risky way to manage anyone's HIV risks.

Only men diagnosed with HIV have HIV status information that is at all reliable.

Depending on men to tell you they have HIV puts you at a big HIV risk. Disclosure doesn't work at all well as a way of staying HIV negative. 

• 1 in 3 gay and bi men have never had a HIV tested - so untested, can't tell anyone anything useful about their own HIV status
• Men who have been tested usually only have information that is past its sell-by date
• Many men have had condomless anal sex since they had their last negative HIV test. An MOT certificate saying your car was roadworthy is no guarantee of future safety after you have had a crash. In the same way, a negative HIV test result becomes worthless once you have had unprotected sex.
• The only dependable information is from men who have been diagnosed with HIV to tell you this; but not all diagnosed men disclose in all situations; for example disclosure by diagnosed HIV+ men is less common in gay saunas and clubs.

George House Trust is also making a second presentation, about cuts in legal advice and representation for people with HIV. 

HIV Legal Advice Services
Among the hundreds of cuts, one cut would remove most legal aid for advice and representation at courts and tribunals. £450 million is to be slashed from budgets for advice, such as provided by Citizens Advice, Manchester Advice, Law Centres and other organisations, for immigration and asylum, welfare benefits, housing, employment and most discrimination cases.
 

This will affect millions of people a year, and you can tell things will become really bad, because even the Judges’ Council has gone public with its objections.

HIV Talking and Telling - George House Trust discussion for CHAPS-14 conference, Manchester  

HIV Advice Services - George House Trust discussion for CHAPS-14 Conference, Manchester

CHAPS-14 Conference, Manchester, March 9-11th

Image - Let's Talk HIV - Swedish language HIV site
 

Gay, Positive, Herpes and LGV

posted: 25/02/2011

Gay men living with HIV who have herpes may find symptoms flare up worse and last longer. Preventive treatment can help prevent herpes flare ups.

Herpes also makes it much easier to pass on HIV (and other STIs) because it raises your viral load, and the blisters contain HIV and provide a way in and out for HIV.
 

Herpes leaflet for gay men

As well as that herpes leafte for gay men, there’s also a new detailed briefing about herpes for sexual health and HIV professionals from Sigma Research, produced for CHAPS, England's gay men's HIV prevention and sexuial health partnership.

LGV
LGV (lymphogranuloma venereum) is a much more uncommon sexually transmitted infection and, like herpes, it's one that gay men living with HIV are more likely to get. It’s caused by varieties of chlamydia bacteria.

LGV caused ulcers, like herpes and syphilis do, and these surface wounds are always a route in and out for HIV.

Having LGV also increases your HIV viral load and that makes passing on HIV more likely.

LGV leaflet for gay men

THT have more information about herpes, LGV and other STIs, on their new website for people living with HIV, My HIV