Overcoming stigma in HIV prevention

Though antiretroviral therapy (ART) is successful in the treatment and prevention of HIV, the numbers of people living with the disease are increasing and work remains to be done in educating the community to remove the stigma around taking it and encourage uptake.

A total of 100,000 people are living with HIV in the UK, with a quarter of these undiagnosed. This situation is not limited to London, as latest research suggests that a fifth of people with HIV in the West Midlands remain undiagnosed, for example. This is deeply concerning as statistics suggest that there are more people living with HIV than ever before in the region.

Moving forward, routine testing is becoming more regular in different resource settings, including GP practices, A&E and prisons. Sexual health screening continues to grow in traditional settings, but is also available in bars, clubs and sex environments.

"This is an opportunity to engage, inform and educate this sometimes hard-to-reach population"

This is an opportunity to engage, inform and educate this sometimes hard-to-reach population, but it will also help to break down the stigma of testing within the community. One key message is: 'get tested, know your status'.

Recently, there has been a much greater emphasis on preventing HIV and treating people who have HIV with antiretroviral therapy (ART), which involves taking a combination of HIV medicines. While this has health benefits for the individual, it is also reduces onward transmission of the virus. This is known as treatment as prevention (TasP). Many experts and advocates believe that the provision of this medication may be one of the most important elements of any strategy to end the HIV epidemic.

Men in steady, same-sex relationships, where both partners are HIV negative, will often forgo condoms out of a desire to preserve intimacy, even if they also have sex outside the relationship. But the risk of HIV transmission still is high. In a recent study of gay and bisexual men, respondents reported at least one instance of anal sex, without a condom, in the last 30 days and researchers found that the same desire for intimacy is also a strong predictor of whether men would be willing to take antiretroviral medications to prevent HIV, a practice known as pre-exposure prophylaxis (PrEP).

Prevention

In early 2014, a report published by the World Health Organization made 'strong recommendations' that all men who have sex with men should seriously consider taking antiretroviral medicine as an additional method of preventing the HIV infection from spreading, even if they haven't got the virus themselves. This could have a significant impact on stopping the spread of HIV, and it could prevent a million new infections in the next 10 years.

Many people wonder whether men will make PrEP part of their daily lives and what will keep them motivated to adhere to it strictly, which is required if the medication is to have its protective effect. It has been on the market for a decade but it has appeared in prescribing guidelines only recently.

In addition, some people using PrEP may worry that not everybody in the community understands its preventative remit, so there is stigma attached to taking it. We have a responsibility to make sure that the community is briefed, enabling people to make informed decisions.

I feel that PrEP is a good prevention method for individuals for a period in their life and should not be seen as a long-term solution to their sexual behaviour. It also has the potential to be cost effective, preventing people from becoming infected with HIV and being on treatment for their whole lives.

Hope from SIV vaccine

Meanwhile, a vaccine which works in an unusual way has managed to completely block infection with SIV in monkeys, the monkey equivalent of HIV. This gives new hope for the development of a vaccine which could prevent HIV infection in humans. This research is also encouraging in terms of a vaccine for people who already have HIV, which would work by suppressing the replication of HIV as, when the vaccine was given to monkeys previously infected with SIV, their viral load was rapidly suppressed.

"Even the French and Chinese scientists who developed it were surprised by the positive results of their unconventional methods"

The vaccine works in a very different way to other HIV vaccines. Even the French and Chinese scientists who developed it were surprised by the positive results of their unconventional methods, stating that it could herald a new approach for developing an HIV vaccine in humans.

As a first step, two safety trials are planned in humans. In one, HIV-negative volunteers, at low risk of HIV, will be given the vaccine to see if it stimulates the same immune and virus suppressant responses. In the other, HIV-positive volunteers on fully suppressive HIV treatment will be given the vaccine and then taken off treatment six months later if test tube results suggest the vaccine has produced such responses.

HIV experts and advocates in the UK are actively working together to encourage participants from different networks and walks of life to find out about volunteering for these clinical trials. I feel it is critical that the HIV community plays a role in this process and speaks with one voice.

Ageing population

Research for a HIV vaccine is important, but there are also challenges to face over treatment for the growing number of older people living with HIV in the UK. It is estimated that by 2015, half of those living with HIV will be aged 50-plus. This will require new approaches to the way HIV care and treatment are designed, managed and delivered. The goal, I believe, should be to ensure that appropriate care and support should be offered to everyone with HIV, enabling them to live long and fulfilled lives.

Improving the quality of primary care for people with HIV, and establishing better interaction between HIV specialists and other community clinicians, is essential. This will provide good quality, patient-centred care, particularly as it is critical to the sharing of knowledge and expertise when managing complex long-term conditions due to ageing with HIV.

About the author:

David Rowlands is the director of Design-Redefined.co.uk, a healthcare communication agency working in the public, private and charity sectors. Its key objective is to design, develop and deliver community projects to enable people living with, or affected by, HIV and/or Hepatitis C (HCV) to become better engaged with their treatment and care. Working over a number of media platforms, it is able to establish a link to these sometimes hard-to-reach communities.

Contact David on: david@design-redefined.co.uk or DR_tweetUK

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