Transcript HIV + Dual Diagnosis - Dual Diagnosis Leeds

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.
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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.
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Source THT / HPA
New HIV and AIDS diagnoses and all-cause
deaths among persons with diagnosed HIV
infection: United Kingdom, 2003 – 2012
Number of HIV and AIDS diagnoses and deaths
9,000
HIV diagnoses
AIDS diagnoses
8,000
Deaths
7,000
6,000
5,000
4,000
3,000
2,000
1,000
0
2003
2
2004
2005
2006
2007
2008
2009
Year of HIV or AIDS diagnosis or death
2010
2011
New HIV diagnoses and number of persons accessing HIV care in the United Kingdom: 2012
2012
New HIV diagnoses by exposure group:
United Kingdom, 2003 - 2012
Sex between men (adjusted)
Heterosexual contact (adjusted)
Injecting drug use (adjusted)
Not reported
6,000
Number of new HIV diagnoses
5,000
Sex between men (observed)
Heterosexual contact (observed)
Other (adjusted)
4,000
3,000
2,000
1,000
2003
2004
2005
2006
2007
2008
2009
2010
2011
Year of first HIV diagnosis in the UK
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New HIV diagnoses and number of persons accessing HIV care in the United Kingdom: 2012
2012
New HIV diagnoses by age of diagnosis:
United Kingdom, 2003-2012
3,500
<15
15-24
25-34
35-49
50+
Number of new HIV diagnoses
3,000
2,500
2,000
1,500
1,000
500
0
2003
4
2004
2005
2006
2007
2008
2009
Year of first HIV diagnosis in the UK
2010
2011
New HIV diagnoses and number of persons accessing HIV care in the United Kingdom: 2012
2012
HIV diagnosed persons seen for HIV care by
PHE centre of residence: United Kingdom,
2003-2012
35,000
Persons seen for HIV care
30,000
25,000
2003
20,000
15,000
10,000
5,000
0
North of England
Midlands and East of England
South of England
Country/PHE Centre
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New HIV diagnoses and number of persons accessing HIV care in the United Kingdom: 2012
2012
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.
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2012 figures – HPA
HIV diagnosed persons seen for HIV care by PHE
centre and exposure group: England, 2012
Percentage accessing HIV care
MSM
IDU
Heterosexual contact
Blood product recipients
Mother-to-child-transmission
100%
80%
60%
40%
20%
0%
North of England
Midlands and East of England
South of England
PHE centre providing HIV care
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New HIV diagnoses and number of persons accessing HIV care in the United Kingdom: 2012
BHA Leeds Skyline
Leeds 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.
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BHA Leeds Skyline
Referral 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
email
- 0113 2449767,
- [email protected]
Website – leedsskyline.org.uk
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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)
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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)
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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.
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BHA Leeds Skyline
Has 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 Leeds
Places 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)
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HIV Testing in Leeds
BHA 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.
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HIV and Dual Diagnosis
Referring 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”.
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From 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.”
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From Pink News
CD4 and Viral load
CD4
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
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CD4 and Viral load
Viral 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.
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HIV and depression
Depression 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
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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.
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PARTNER Study
Positive Speaker
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