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Expanded HIV testing
sexual health commissioners for areas in England with a high HIV prevalence
have introduced some form of expanded HIV testing, but only a small minority is
fully following national guidance. The figures come from an audit of the 40
primary care trusts with an HIV prevalence above 2 per 1000.
Although national HIV testing guidelines recommend the
routine testing of all patients newly registering with a GP, this has been
commissioned by less than one third (31%). Similarly, the recommendation for
routine screening of new medical admissions to hospital has been implemented by
one in seven (14%). A larger number had commissioned some expanded testing in
these settings, but it was not universal.
Half the commissioners (51%) had followed the guidelines to
fund outreach community testing, often carried out by the voluntary sector in
settings such as saunas, health centres and churches.
Only 11% of primary care trusts had expanded testing in all
three settings – general practice, hospital and community outreach.
Commissioners cited a lack of resources and the re-organisation of the NHS as
barriers to introducing expanded testing.
The findings suggest that – apart from in GUM and antenatal
clinics – HIV testing remains largely opportunistic or targeted. A significant
reduction in the late diagnosis of HIV is unlikely to occur unless British HIV
Assocation (BHIVA) and National Institute for Health and Care Excellence (NICE)
guidelines are more closely followed.
large American study has shown that offering risk-reduction counselling to
people taking an HIV test had no impact on sexual behaviour or sexually
transmitted infections (STIs). The research lends support to
recommendations in current
testing guidelines that only a brief discussion is provided before HIV
However, the counselling intervention was not intended to be
a discussion of the pros and cons of testing, leading to the individual giving
informed consent – it was focused on developing a plan to reduce sexual risk
The randomised control trial, conducted in sexual health
clinics, compared the outcomes of providing rapid, point-of-care HIV testing
with either risk-reduction counselling, or with information alone.
Six months later, there were no differences in the rates of
STIs, condom use or partner numbers between the two groups.
counselling was much more expensive to provide. The authors recommend that
resources be focused on increasing the number of people who test, so that
universal testing can be achieved, rather than delivering risk-reduction
Sexually transmitted infections
the number of diagnoses of sexually transmitted infections in the UK is very
high in comparison with many other countries, it is possible that this is
partly because other countries have inadequate sexual health services.
This is the
implication of the latest data to be released by the European
Men who have sex with men Internet Survey (EMIS), which in 2010 combined
the UK’s Gay Men’s Sex
Survey with parallel surveys in 25 European languages.
Across Europe, just under a third of respondents had been
screened for sexually transmitted infections (STIs) in the past year. Men who
had been screened were then asked, in non-medical language, what the screening
Their responses showed that whereas blood tests (for HIV,
syphilis and viral hepatitis) were common across Europe,
far fewer men gave a urine sample, had a rectal swab or were physically
examined. This is likely to leave infections such as chlamydia, gonorrhoea and
warts profoundly under-diagnosed.
Whereas men living in London,
Manchester and Birmingham
commonly reported a full range of diagnostic procedures, these were reported by
very few men living in several other European cities including Berlin, Brussels, Cologne, Barcelona, Zurich, Madrid and Paris. This suggests that
comparisons of STI rates between European countries need to be treated with
second study this month has shown that gay men who do not have anal sex are
still at high risk of syphilis and gonorrhoea.
Hepatitis C reinfection
study from England, Germany and Austria has reported high rates of hepatitis C reinfection
in gay men who have been co-infected with HIV and hepatitis C.
There is an epidemic of sexually transmitted hepatitis C
among gay men living with HIV. Risk
factors for transmission include
ulcerative sexually transmitted infections, unprotected anal sex, use of sex
toys, fisting and drug use. Hepatitis C is a serious liver infection but
successful treatment provides a cure; spontaneous clearance is also a
possibility. Diagnosis within six months of infection (during the acute stage) substantially increases the probability that treatment can clear hepatitis C. The British HIV Association recommends testing for hepatitis C after high-risk exposure but doesn’t make a recommendation on regular testing.
included data on 646 HIV-positive men who were diagnosed with hepatitis C
during acute infection (the first months of infection). Most were successfully
treated, while 12% spontaneously cleared the virus.
113 men (18%) subsequently acquired hepatitis C again, an average of three
years later. Almost all were men who have sex with men, two-thirds were taking
HIV treatment and their average age was 38.
19 men were reinfected a third time, and three individuals a fourth time.
The results highlight the need for the development of
effective health promotion for men with hepatitis C and HIV co-infection, in
order to reduce the risk of reinfection.
NAM has published four leaflets about hepatitis C for
people living with HIV, including 'How
hepatitis C is passed on during sex', which provides clear
information on sexual transmission for gay men. Find out more about these
leaflets at: www.aidsmap.com/hep-c-basics
Case study: faith work
Faith and religion are key to the lives and identities of many black Africans living in England (in the 2011 census, 70% are Christian and 21% are Muslim). A number of organisations, including HIV Prevention England partners, are working with faith communities on HIV prevention and support for people living with HIV.
Working in Corby, Sunrise Family Support has already established relationships with three churches and hopes to work with more – significant numbers of African people attend seven churches in the town. Making contact with church leaders is not always easy; a gradual approach may be needed to build trust. Discussion of HIV tends to focus on compassion and care for people who have HIV, rather than condoms and sexuality. “I am a Christian and I know the kind of things we don’t want to talk about,” says Enady Muza of Sunrise.
The group has been invited to speak to Sunday congregations, emphasising that HIV is “out there”. In the case of a local Pentecostal church, the first approach was centred on introducing the group and appealing for volunteers. Subsequently, one of the church leaders invited them to attend a meeting for mothers and daughters, where Sunrise members spoke about how older women can help girls to take care of their health and to be empowered in relationships with boyfriends. The importance of knowing your HIV status was discussed and while participants were initially reluctant to take up the group’s offer of rapid HIV testing, that changed when the pastor’s wife stepped forward and was the first person to test. In the end, 35 people were tested.
Other recent news headlines
The first day of the 14th European AIDS Conference, held last month in Brussels, featured a satellite symposium on development of HIV microbicides, broadly defined to include a variety of approaches to pre-exposure prophylaxis (PrEP). The session, sponsored by the CHAARM (Combined Highly Active Antiretroviral Microbicides) Project and the European AIDS Treatment Group (EATG), focused on the status of microbicide research in Europe, which some speakers suggested was not keeping up with research in the US and Africa.
Over Europe as a whole, the proportion of people testing late for HIV decreased between 2002 and 2010, a presentation at the 14th European AIDS Conference showed, and the average CD4 count on diagnosis increased. However, these changes have mainly been seen in gay men; heterosexual people and, especially, older people are still much more likely than average not to be diagnosed until they have a low CD4 count or are even sick with AIDS-related conditions.
HIV, at least in some parts of the world, may be developing a lower replicative capacity as it adapts to variations in the human immune system, studies in southern Africa and elsewhere suggest. Philip Goulder of the University of Oxford told the AIDS Vaccine conference last month that competition between HIV and certain varieties of human HLA (human leukocyte antigen) genes may be contributing to a diminution in HIV virulence, a lower community viral load, and an increased proportion of ‘elite controllers’ in the population.
Editors' picks from other sources
from London Councils press release
A new three-year programme for HIV prevention in London has been backed by leaders of all 33 boroughs.
NAT press release
A coalition of health, migrant, children’s and refugee organisations has come out against Government proposals to limit migrant access to NHS services, some of which are included in the Immigration Bill which has its second reading today.
than half of Scots do not know all the ways HIV is transmitted,
according to a new survey. One in 10 (11%) wrongly believe it can be
passed by kissing.
from BETA blog
How do we talk about "undetectable" viral load? And what does it mean to different people in different contexts? BETA put these questions to Zachary Barnett and Derek Brocklehurst, two gay men with different experiences of “undetectable.”
from The Guardian
documentary How to Survive a Plague shows inspirational footage of
1980s AIDS activism in the US – and the message is still relevant today
from buggery.org (blog)
of discussion over the last couple of days about the recently released
Australian annual surveillance report for HIV, which shows a big jump in
the number of HIV notifications for the last year. But if you consider
that the number of new infections must be a function of the number of
people living with HIV, the picture over the last few years is starkly