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HIV treatment is one of the ‘greatest medical trajectories of all time’ — but still remains one of the most demonised of illnesses

mymedicplus — Wed, 30 Oct 2019 05:44:34 +0000

Source: inews.co.uk

On a recent weekend Ashley Dunn, a 48-year old designer, had unprotected sex with an HIV positive man he met in a bar. The man warned him of his HIV status and Dunn weighed up the risks and decided to sleep with him anyway.

“He said, ‘I’m undetectable which means I can’t pass it on’,” says Dunn. “Then he told me, ‘you’re actually more of a risk to me than I am to you. I know my status and have been checked. You haven’t’.”

Not so many years ago this act could have dealt a sure-fire death sentence to Dunn. It was as recent as the 1980s when HIV swept onto these shores, decimating communities and striking fear into a generation.

Back then we didn’t even know if you could catch HIV by drinking from the same glass – so condomless sex was suicidal. There was no treatment, no cure and no hope.

Gareth Thomas and HIV

Last month former Welsh rugby captain Gareth Thomas announced that he had been living with HIV for years. On the day of his declaration he competed in a 140.6-mile Ironman triathlon, one of the world’s most gruelling races.

Here was a man at absolute peak physical fitness saying to the world he had been living with HIV for years. The impact of this disclosure has been huge.

The BBC screened a documentary about Thomas’s life in the run up to him going public. Interestingly, his actual illness hardly featured. A single pill of antiretroviral therapy (ART) taken daily means his life expectancy is normal.

It also means that his viral load, or level of HIV in his blood, is low enough to be considered undetectable. That means he and his husband Stephen, who is HIV negative, can have unprotected sex without fear of infection.

HIV – from a plague to a manageable disease

Today there are around 101,600 HIV positive people living in the UK. A decade ago these people would have been on a complicated cocktail of up to 20 different drugs a day, dealing with the devastation of the illness alongside a catalogue of unpleasant side effects from the medication.

Now, like Thomas, most take a single pill and have a normal life expectancy – the virus all but invisible. Next year, subject to approval from licensing authorities, this medication should be available in the form of just one single, monthly injection.

“The treatment of HIV has been absolutely one of the most spectacular treatment progressions in medicine,” says Professor Chloe Orkin, consultant in HIV medicine at Barts Health NHS Trust. “To go from a plague to a manageable disease where people can live a normal life expectancy within the space of such a short period of time, is one of the greatest medical trajectories of all time.”

‘I lost so many friends to the infection’

Orkin trained to be a doctor in the largest hospital in the township of Soweto in South Africa in the 1990s. It was a time when about a third of all people on the wards were infected with HIV. Of her own tight-knit group of friends she lost about 10 to Aids.

“My friends were all at variable stages of the infection and there was no treatment,” she says. “It was totally devastating. All my friends died except for one who managed to get on to an early AZT drug trial. He later killed himself because he had survivor’s guilt.”

In 1998 Orkin came to the UK to complete her training. At 29 she took up her post at Barts where she became its youngest ever HIV consultant and created what is now a world-renowned research unit there.

In 2017 Orkin, as chair of the British HIV Association, was one of the very first medical professionals to put her head above the parapet and use the word “zero” risk as opposed to “negligible” risk and unequivocally confirm that it is now completely safe to have unprotected sex if the level of virus in the blood is low enough.

Zero risk of transmission

“Studies from hundreds of thousands of sex acts show that if the virus is undetectable then it cannot be passed on during sex without a condom. We say Undetectable = Untransmittable, or U=U,” says Orkin. “And we don’t say negligible risk. We say zero risk. The language is very important.”

The latest data shows that the UK has smashed all UN targets for HIV. And London, in particular, has become a global beacon for best practice (in 97 per cent of people diagnosed, the virus is now undetectable).

But while most of the gay community is clearly clued up and accessing excellent care, there are some small, but still worrying, indicators. The number of late diagnoses, for example, now stands at 43 per cent. This is due to demographics such as women, heterosexual men and black African males being less likely to believe they are at risk.

A late diagnosis means not only are some people actually very sick when they seek help, but they have more opportunity to unknowingly infect others.

Reaching a younger generation

Jo Josh was a successful crisis management consultant from Surrey when she received the shock of finding out she was HIV positive in 2008. “I am a blonde, middle class woman. I wasn’t in an at-risk group,” she says.

“Sometimes you can feel as if you aren’t part of the conversation. It revolves around white gay men talking about white gay men. But worldwide 53 per cent of HIV cases are actually women.

“One of the reasons women don’t figure more prominently in the dialogue could be because we worry about the impact our diagnosis could have on our children. It’s one thing to talk about your diagnosis if you’re a single man, but quite another if you’ve got kids at school.”

Ashley Dunn also worries that for all the progress we’ve made a rather more lackadaisical attitude may have set in amongst the younger generation of gay men who weren’t around to witness the terrifying, “silence=death” public information films of the late 1980s.

“There’s a term ‘bug chasers’ – these are people who don’t care, who’d have bareback sex [without a condom] without asking any questions,” says Dunn. “If you look on dating apps there are plenty of people who state they want to have sex with HIV positive people only.”

Tired of being scared

Rui Cavolo a 31-year old perfume retailer from Selfridges, has seen this, too. “I know some people who are just so tired of being scared of catching HIV that they kind of hope that they get it because then they can just relax. There’s a bit of nihilist attitude too. Right now it feels that London is rife with HIV.”

Days after Gareth Thomas came out as HIV positive so too did gregarious US hairdresser Jonathan van Ness, one of the presenters of the reality show Queer Eye. It felt like a very different to the message to the one Gareth Thomas sent.

“It would be wrong to say it was HIV glamorisation but he came out to quite a bit of fanfare, saying how proud he felt to be part of the HIV community,” says Cavolo. “I think he intended the message to be, it’s not dirty to have HIV, but it actually felt like he was saying it’s good to have HIV – almost like a celebration.

“Try going to certain parts of the US and say you have HIV. I’m not sure you’d be allowed to cut anyone’s hair.”

A drug for safer sex

Cavolo, who has had various HIV scares and whose sex life ranks him as “high risk”, has been taking medication called PrEP since last year. This stands for Pre-exposure Prophylaxis and is a pill that HIV negative people can take prior to sex to reduce the risk of transmission. Cavolo is taking part in an impact trial of 13,000 people in the UK.

“PrEP gives me a second layer of protection,” he says. “Even though there are drugs to make it undetectable, contracting HIV still changes your life. It’s an incurable disease, I don’t want to catch it. Having unprotected sex filled me with a lot of guilt. PrEP has enabled me relax about fear of infection.”

There has been much controversy about this PrEP trial. While PrEP is available on the NHS in Scotland, trials are still being run in England and Wales. Earlier this month the BBC reported that at least 15 people have actually contracted HIV while waiting to get accepted to receive the drug.

“There has been a lot of criticism because essentially PrEP has already been shown to be effective,” says Orkin. “As well as Scotland it has been implemented in large areas of Paris without any problem. It looks like a delaying tactic in order to save money.”

The most demonised of illnesses

Despite huge leaps in treatment, HIV still remains the most demonised of illnesses. Because it was originally seen as a gay disease and because it is sexually transmitted, it was born in a perfect storm of ignorance and homophobia. One hangover from this is the idea that HIV positive people are dangerous and contagious.

These attitudes became entrenched and people with HIV are discriminated against regularly. In July this year a hospital in Bristol, for example, apologised to an HIV positive patient for cancelling her surgery twice because they believed theatre would need a “deep clean” before they were willing to touch her. And an HIV positive pilot was recently refused clearance to fly when Easyjet cited possible side-effects from his medication as an excuse.

Rosalie Hayes from the National Aids Trust takes on these cases of discrimination frequently. “Unless you are in the army or working in very specific health care roles, there is no reason why your employer would ever need to ask about your HIV status, but many still do,” she says.

‘The stigma was the worst thing’

Certainly in Thomas’s case stigma was by far the worst thing about having the illness. “I was fearful of everything,” he says in the film. “Rejection, people not want to be in the same room as me. I was fearful of waking up every single day to what was going to be in the newspaper. I was living with the deep, deep shame of living with HIV.”

Orkin agrees. “Stigma is still the number one problem,” she concludes. “We have worked out how people can live a physically healthy life with HIV. The challenge now is to reduce the impact mentally. Stigma leads to people not getting diagnosed. If you get diagnosed and start treatment early you live a normal life expectancy. If you get diagnosed late you die.”

Fast facts: people with HIV in 2018

Eastern and southern Africa: 20.6 million
Asia and the Pacific: 5.9 million
Western and central Africa: 5 million
Latin America: 1.9 million
The Caribbean: 340,000
Middle East and North Africa: 240,000
Eastern Europe and central Asia: 1.7 million
Western and central Europe and North America: 2.2 million

The post HIV treatment is one of the ‘greatest medical trajectories of all time’ — but still remains one of the most demonised of illnesses appeared first on MyMedicPlus.

What Getting an STI and HIV Test Is Like

mymedicplus — Fri, 16 Aug 2019 12:03:23 +0000

Source: teenvogue.com

Welcome to AP Bio, Teen Vogue’s guide to what you need to know about sex and your body before you head to college. Whether it’s getting tested, taking care of a yeast infection, or opting out of so-called hookup culture all together, we’ve got you covered.

Walking into Planned Parenthood’s Margaret Sanger Center in New York to get an STI and HIV test, I felt nervous. You’d think I’d know the deal by now — after all, I’ve gotten them before, and I’m someone who regularly advocates on this very website for others to know their status and take preventative measures against STIs and HIV. In my personal life, I’ve encouraged friends to go get tested (no, it won’t hurt!), and balked when previous partners told me it wasn’t part of their regular health routine (why not?). Still, as I stepped into the waiting room to be tested for gonorrhea, chlamydia, and HIV, I was scared — and that was the whole point.

If I get nervous or don’t know what to expect despite my experience and advocacy around STI and HIV testing, someone who has never gone through this process before probably feels those nerves much more intensely. Like I was, you might be wondering what exactly getting an STI and HIV test entails, particularly whether or not it hurts. So, let’s walk through it step by step.

I set up my testing appointment online via Planned Parenthood’s scheduling portal, which isn’t available for every health center but the option is expanding to more places. Of course, there are many place to get an STI test — including your primary care physician or other local health centers — so your experience might be different than mine depending on where you go. But, if you do head to a Planned Parenthood where the online scheduling via DocASAP is available, it’s fairly easy. I chose the health center that was most convenient for me, and filled out a bunch of personal information about me, my health, and my insurance plan. (You can still visit Planned Parenthood if you don’t have insurance! Visit your clinic’s website for more information on how they charge.) There were only two snags in the process. It took so long to register for the scheduling platform that the appointment time I wanted was taken by the time I was done, and I was only given male and female as gender identification options. According to Planned Parenthood, the options are due to the scheduling platform DocASAP (which isn’t specific to Planned Parenthood). Currently, Planned Parenthood said it is working with DocASAP to provide more inclusive language.

Once I was registered and my appointment was set, I waited about a month before it was time to go for my screening (if you have symptoms, you definitely should not wait this long). On the morning of my appointment, I arrived a few minutes early and checked in at the front desk of the clinic. I was asked for information about my insurance, marital status, race, and income level. Then I sat in a pleasant and clean waiting room for what seemed like forever because I had to pee SO BAD.

Here is where I made my first mistake: I thought my STI screening would include a urine test, so I drank a ton of water and rolled up to the clinic with a very full bladder. First I sat smugly, thinking this wouldn’t be one of the many times a doctor has asked me to pee in a cup and I couldn’t even squeeze out a drop. But as the minutes ticked by, my smugness wore off. The clinic was running a little behind that morning, so I sat in the waiting room for quite a while, squirming. When I was finally called in to the testing room, though, I realized my pent-up pee was for not — urine testing was not in my future.

Once in the testing room, I chatted with a very kind nurse, who, unlike the scheduling platform, asked very inclusive questions about what pronouns I use, what genders my sexual partners are and were, and what kind of STI prevention methods I use. Then she performed the HIV test, which included a very quick finger prick, some coercing of blood out of my finger, and a rapid diagnostic test that gives you the result of the test in minutes. I won’t lie — this process isn’t totally painless, but it’s not exactly painful. The finger prick hurts about as much as a quick pinch (but honestly kind of less). The worst part of this process was the nurse collecting the blood from my finger, for which she had to kind of squeeze my finger tip for a few minutes until she had enough. It didn’t hurt, but it wasn’t a super comfortable process.

According to the Centers for Disease Control and Prevention (CDC), HIV testing can be done on either blood, oral fluid, or urine — though blood and oral fluid are most common. The blood can be collected via finger prick, like mine was, or drawn from the vein. Oral fluid can be collected by swabbing the inside of your mouth. So depending on which test your doctor opts for, the pain or discomfort level can vary from not at all to a solid pinch. Some tests deliver rapid results, meaning you’ll know the results of the test before you leave the doctor’s office. Others require testing in a lab. It’s also important to remember that no test can tell whether you have contracted HIV directly after exposure. Depending on what kind of test you get, it won’t be detectable until between 10 and 90 days after exposure according to the CDC. If you suspect you’ve been exposed to HIV, you can ask your doctor about taking post-exposure prophylaxis — a drug that can help prevent infection when you’ve been exposed to HIV — within 72 hours after the potential exposure. If you believe you’re at high risk of HIV exposure, you can ask your doctor about taking pre-exposure prophylaxis (PrEP), which can reduce your risk of infection should you be exposed to HIV in the future.

After the finger prick, the nurse sent me and my newly bandaged finger to the bathroom with a plastic bag containing a swab and a vile that would be used for the chlamydia and gonorrhea tests. She instructed me to insert the swab into my vagina, swirl it around a bit, and then put the swab in the vial (which contained some type of liquid) and place it all back in the bag to return to her. This process didn’t hurt a bit — in fact, I loved this step in the testing because it meant that I was in a bathroom and could finally pee. It was honestly a sweet relief.

According to the American College of Obstetricians and Gynecologists, testing for both chlamydia and gonorrhea can be done on people with vaginas by “a swab from the vagina, mouth, throat, rectum, or the area around the cervix.” A self swab is available if you’re testing the vagina or rectum. A urine test (I wasn’t totally off base!) can also be used for people of any sex.

The final step in the testing process was a visit with a doctor, who asked if I had any symptoms, or any reason to believe I had been exposed to an STI. She sent me on my way after a very brief chat, and told me that I could access my results online in a few days. Should any of the tests come back positive, she informed me that the clinic would call to let me know. No call, she said, meant negative tests.

Because the clinic was busy on the day I went, the process did take about an hour and a half, but it was mostly waiting time. The actual tests were quick, easy, and mostly painless. Of course, everyone’s pain tolerance is different, and you might not get the same tests that I did, meaning your experience may be different. I was also only screened for a specific set of infections, which are deemed appropriate for women in my age range. Depending on your sex, sexual orientation, and number of partners, these recommendations could be different.

No matter what kind of testing you get, though, the truth is that it’s worth it. Whether it’s the quick pinch of a needle or the feeling of holding your pee for a much longer time than you ever needed to, the slight discomfort is quickly forgotten once the tests are over. Knowing your status and being proactive about your health protects you — and there’s nothing more valuable than that.

The post What Getting an STI and HIV Test Is Like appeared first on MyMedicPlus.