New HIV infections in the United Kingdom continue to rise. The Health Protection Agency in the UK estimates that around 73,000 people currently have HIV in the , of whom around 21,000 – a third or so, are unaware they are infected.
These are depressing numbers suggesting that in fact the rise of new HIV infections continues in an unrelenting fashion. Gay men remain a disproportionate section of the newly infected people, prompting many to ask what has gone wrong in terms of public health campaigns. There is currently great controversy over the approach taken by the UK Dept of Health and some of the HIV charities.
When I grew up there were quite terrifying campaigns with tomb-stones and sinister ice-bergs warning of the dangers of unprotected sex. These were crticised at the time but they did cause an alteration in sexual behaviour with reduced rates of other STD’s suggesting that people were using condoms and taking notice and effort to protect themselves. The current campaigns are nihilistic and feature what are euphemistically called “harm-reduction” iniatives – such as exhortations to pull an unprotected penis out of a partners anus before ejaculating over his back. This is dangerous, facile, patronising and will lead to a sense of false security. The charities promulgating these dangerous messages should have their funding reviewed and withdrawn. Some have become behemoths more concerned with the survival of their own bloated staffing structures than education and HIV prevention.
The recognition that early diagnosis of HIV is possible using HIV DUO tests, sometimes referred to to as 4th generation tests (HIV DUO tests comprise HIV 1 and 2 antibody tests and also HIV p24 antigen) and that early diagnosis presents a real opportunity both to reduce damage to the newly infected individual and also to markedly reduce the spread of the disease has potential to revolutionise testing methodologies. The National AIDS Trust (NAT) which Freedomhealth supports through donations made via its interactive Sexual Health Forum is a charity which has made a concerted effort to address the early testing dilemma. It has published two useful documents recently.
One is “Primary HIV Infection” issued in July 2008 and the other relates to Home Testing for HIV which will be the subject of a separate article. Primary HIV Infection is an excellent document which neatly and easily summarises the new HIV infection position in the UK. There were three main contributors including Dr Fisher, Dr Valerie Delpech and Dr Pillay. In addition, Gus Cairns is thanked for his support.
The paper makes several key points:- 1) There are in reality two key groups in the UK who are at most risk of HIV infection – either new or old infection. These two groups included men who have sex with other men and Africans in the UK. Whether the males identify as gay or not is not necesary. I have many male patients who are married to females and lead ostensibly heterosexual lives but have regular and often risky sex with other males. 2) New HIV testing Guidelines make it clear that testing early offers opportunities to intervene in the HIV “life-cycle” to limit onward transmission and also to offer effective, safe medical interventions that will preserve the underlying architecture of that persons immune system and preventing supervening HIV/AIDS related illness. 3) 4th generation combined HIV antibody/p24 antigen tests should be offered as the norm. These tests are not new. At Freedomhealth we have offered them for the last ten years at least and have a good feel for their accuracy and usefulness. They are fantastically useful tools in the fight against HIV. 4) Dr Fisher made the point that tehre are certain symptoms that should be reagrded as cardinal or herald symptoms or signs of new onset HIV infection. These are, as referred to above, very severe sore throat, maculopapular rash and also a very high fever.
He also makes the point that there are other symptoms and these can be subtle or unnoticed. The key to testing is if there has been a risky sexual event – or a perceived risky event then that person should take advice urgently irrespective of the symptoms. Very early recognition of a potentially unsafe event allows for early intervention using PESE as referred to in previous articles. However, if there has been a risky sexual event, particularly unprotected anal or vaginal sex and Dr Fisher’s triad of symptoms then an early HIV test at 4 weeks using a 4th generation HIV DUO test will be of great benefit.
NAT was at pains to express the view that “Information on when to test for HIV needs to be revised to remove confusion about a three month window period. People concerned about possible HIV infection should be encouraged to seek clinical advice without delay and informed that HIV tests using latest technologies can detect most HIV infections after 12 days” In summary we know that early testing has the capacity both to preserve the integrity of the new HIV positive patient’s immune system and also to limit onward transmission of infection. Modern treatment modalities are very effective and much safer than having undiagnosed HIV. This did not used to to be the case and many people, gay males especially remember the days when they were encouraged to test but actually little if anything effcetive resulted and sometimes poisonous doses of medications were given in desperation. This is not the case any longer in the modern Western World.
