HIV in the U.K.

HIV is associated with serious morbidity, high costs of treatment and care, significant mortality and high number of potential years of life lost. Thousands of individuals are diagnosed with HIV each year. The infection is still frequently regarded as stigmatising and has a prolonged ‘silent’ period during which it often remains undiagnosed.

Anti-retroviral therapy has resulted in substantial reductions in AIDS incidence and deaths in the UK. People diagnosed promptly with HIV can expect near normal life expectancy. Challenges remain, with high rates of late HIV diagnoses and an ageing population.

1 Source HPA website

HIV in the U.K.

The latest set of data (2012) shows that 51% of new diagnosis were among Men who have Sex with Men (3,250 new diagnosis)

In 2012 there were a total 77,614 people accessing care for HIV in the U.K.

2 Source THT / HPA

2 New HIV diagnoses and number of persons accessing HIV care in the United Kingdom: 2012

New HIV and AIDS diagnoses and all-cause deaths among persons with diagnosed HIV

infection: United Kingdom, 2003 – 2012

0

1,000

2,000

3,000

4,000

5,000

6,000

7,000

8,000

9,000

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

Nu

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HIV

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Year of HIV or AIDS diagnosis or death

HIV diagnoses

AIDS diagnoses

Deaths

3 New HIV diagnoses and number of persons accessing HIV care in the United Kingdom: 2012

New HIV diagnoses by exposure group: United Kingdom, 2003 - 2012

-

1,000

2,000

3,000

4,000

5,000

6,000

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

Nu

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Year of first HIV diagnosis in the UK

Sex between men (adjusted) Sex between men (observed)Heterosexual contact (adjusted) Heterosexual contact (observed)Injecting drug use (adjusted) Other (adjusted)Not reported

4 New HIV diagnoses and number of persons accessing HIV care in the United Kingdom: 2012

0

500

1,000

1,500

2,000

2,500

3,000

3,500

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

Nu

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IV d

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s

Year of first HIV diagnosis in the UK

<15 15-24 25-34 35-49 50+

New HIV diagnoses by age of diagnosis: United Kingdom, 2003-2012

12 New HIV diagnoses and number of persons accessing HIV care in the United Kingdom: 2012

HIV diagnosed persons seen for HIV care by PHE centre of residence: United Kingdom,

2003-2012

0

5,000

10,000

15,000

20,000

25,000

30,000

35,000

Pe

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IV c

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Country/PHE Centre

2003 2012

North of England Midlands and East of England South of England

HIV in Leeds

In Leeds there are 1,048 people accessing care for HIV infection.

Skyline has 275 clients.

2 full time support workers,

3 part time support workers.

72012 figures – HPA

0%

20%

40%

60%

80%

100%

Pe

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ac

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ing

HIV

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PHE centre providing HIV care

MSM IDU Heterosexual contact Blood product recipients Mother-to-child-transmission

13 New HIV diagnoses and number of persons accessing HIV care in the United Kingdom: 2012

HIV diagnosed persons seen for HIV care by PHE centre and exposure group: England, 2012

North of England Midlands and East of England South of England

BHA Leeds SkylineLeeds Skyline was set up in 2007 by Black Health Agency (Now BHA For

Equality since 2010) from Manchester.

Leeds Skyline took over HIV support from Terence Higgins Trust and Barnado’s

Leeds Skyline became BHA Leeds Skyline in 2010.

BHA Leeds Skyline sees anyone infected or affected by HIV with a Leeds postcode.

BHA Leeds Skyline has contract for HIV prevention in the African community.

9

BHA Leeds SkylineReferral process

By self or any health professional or agency worker.

Initial assessment to happen in three days,

Comprehensive assessment to happen within seven days of referral.

Referral by phone - 0113 2449767,

email - leedsskyline@thebha.org.uk

Website – leedsskyline.org.uk

10

BHA Leeds Skyline - services

1-2-1 Support work.

Support Groups

PACT (Positive And Coping Together – Gay and Bi-sexual men)

Women’s Group

Valour (For women with school age children)

Drop in

Joe’s Café

Complementary Therapies (Reflexology and light massage with oils)

11

BHA Leeds Skyline - Services

Access to crisis funds,

Terence Higgins Hardship Fund.

BHA Leeds Skyline Crisis Fund.

Food Bank

Donated food. (Chicken)

Purchased food. (Staples such as pasta, rice, fish, soup etc)

12

BHA Leeds Skyline – Living well

Workshops provided,

One off sessions -

BEST (Better Equipped To Start Treatment)

HIV And Your Body (Liver, Heart, Bones, Cancer, Ageing)

Positive Self Management Program

A 6 week course affiliated to Stamford Universities Expert Patient Program. BHA Leeds Skyline is linked with living Well in London and the manual was re written last year.

13

BHA Leeds SkylineHas a Cognitive Behavioural Therapist who is also a Clinical Nurse Specialist in

HIV and Mental Health working 2 days a week.

Clients can have 12 sessions with CBT Therapist (usually 1 or 2 week waiting list).

Referral through Support Worker.

CBT is now recognised as HIV prevention.

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HIV Testing in LeedsPlaces to get an HIV test in Leeds

MESMAC offices – Tuesday and Thursday 6 – 8pm

Steam Complex Wed 12 – 2pm

Centre For Sexual Health @ L.G.I. Monday to Friday walk in and by appointment.

G.P. – Appointment needed. (Goes on medical record)

15

HIV Testing in LeedsBHA Leeds Skyline – Monday to Friday 9am – 5pm

PAFRAS (St. Aiden’s Church) Thursday 12 -2pm.

If reactive result – Support worker to accompany client to L.G.I. GUM

(If late in the day, meet client to take to GUM 9am next morning)

Confirmation blood test (by vein) done by GUM

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HIV and pregnancy.Pregnant women are given medication in the last trimester. This is the only time

that medications are stopped.

If woman has undetectable viral load she can have a vaginal delivery.

If the woman has a viral load she must have a c-section.

Breastfeeding is not allowed as vertical transmission can happen.

Vertical transmission occurs in less than 1%

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HIV and Dual Diagnosis

HIV and other BBV (Such as Hep C)

Seen by consultant at LGI GUM or St. James ward J20.

18

HIV and Dual DiagnosisReferring to the CODE statistics showing an increase in clients using

GHB/GLB, crystal meth and mephedrone, the Chemsex Study noted that “changes in clinical presentations could reflect changes in drug use among gay men broadly, but could also be the result of improved visibility and awareness of these services and improved referral pathways between professional services that work to meet the health needs of gay men.”

The increased demand at 56 Dean Street could be because its services have been given greater prominence. When asked why certain men used drugs for sex, Mr Stuart said there were many different reasons. “I know people that do drugs because when they are lying in bed they don’t feel horny. Why not? Well, sometimes growing up gay makes you feel different and you become hyper-vigilant about being judged and rejected”.

19From Pink News

Mr Stuart added: “And drugs make it all go away. It’s also that drugs feel really good, sex does go on for a long time, for some people they don’t want to think about HIV they feel diseased when they are in bed, which is a horrible thing to say, but they don’t feel diseased when they are high and horny. There are a lot of HIV positive guys who will only sleep with other HIV positive guys to avoid disclosing it. And the drugs are a place to hide and play where those conversations don’t happen.”

20 From Pink News

CD4 and Viral loadCD4

Measurements of CD4 (in cubic mm of blood) cells enable clinicians to monitor virus progression.

1500 – 500 – Normal range

500 - Start of medications in USA and France

350 – Start of medications in U.K.

200 or below – Serious risk of catching something that will kill you in the short term

21

CD4 and Viral loadViral Load

Used by clinicians to monitor medication efficacy.

Count of millions not unusual during initial infection and with late diagnosis.

Viral load (copies of virus per cubic mm of blood) should be undetectable after 3 months of medication.

22

HIV and depressionDepression in PLWHIV: Wide variety of estimates from 0% to

80%, most estimate 20–30%

Problems with measuring instruments and cut‐off points

UK study: 26.6% had ‘moderate or severe (6.6%)’ depression,

cf. 7% in general population

US study: 22% ‘major depression’, 48% some depression or

anxiety

23 HIVANDYOURBODY.com

Poor adherence = a risk behaviour

• Unlikely to be sole explanation for the relationship between depression

and mortality, as depression can increase many risk behaviours

• In a UK study of HIV+ patients with depressive symptoms1:

– 24% missed no doses in past two weeks

– 34% missed 1–2 doses

– 42% missed >2 doses

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• Viral load:

– For those without depression, 7.5% had detectable HIV virus, while in those who had

depression, the figure was 16.3%1

• In a US meta‐analysis2 of 95 studies (n=36,000) depression (assessed

various ways) was associated with 20% poorer adherence overall

• Treated depression is associated with significantly better than average

adherence in several studies3

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PARTNER study

Analysis of data from 2 years of study show that there was no single case of HIV transmission between heterosexual and gay couples when the HIV+ person’s viral load was fully supressed.

Transmission can take place when a person has a suppressed viral load if they have other S.T.I’s, as HIV sheds from reservoir in the gut.

26 PARTNER Study

Positive Speaker

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