1. THE AFRICAN EYE TRUSTHIV/AIDS in 2007: A Complex Picture Adapted from the HPA 2006 report BBV 2007/MJ/BM

2. Epidemiological trends • 2006 A Complex Picture: describes a worrying situation with undiminished and high levels of transmission of HIV. • By the end of 2005, an estimated 63 500 living with HIV in the UK. • 32% were unaware of their infection. • During 2005, 7 450 new HIV diagnosis in the UK (7 283 in 2003). • Majority of cases (4 100) were diagnosed in heterosexual men and women. (women > men) • MSM cases were 2 356 (largest number for past 25years) • 111 infected infants born in 2005 (total 1765 reported in the UK) BBV 2007/MJ/BM

3. HIV in injecting drug users • HIV in IDUs have remained low • Constant annual average of 136 between 2003-5 • In 2005, 156 diagnosis (75% men and 25% women) • 1005 accessing HIV care in 2005 • Over a quarter have had AIDS • 30% not receiving ART: 68% were on 3 or more drugs • 21% had CD4 counts below 200 (compared to12% of other routes) BBV 2007/MJ/BM

4. Changing needs • ART has had a dramatic impact on HIV-positive individuals/families. • The lives of asylum seekers/refugees/migrants are often characterised by poverty and social exclusion. • HIV-related Brain Impairment (rehabilitation very costly) • Cohort of young adults/adolescents with HIV (transition into adult services) • Late diagnosis amongst HIV-infected adults BBV 2007/MJ/BM

5. Late Diagnosis in HIV-infected Adults (2005) Individuals with CD4 counts below 200 • 34% were diagnosed late • 11% had AIDS at the time • Lowest amongst MSM (22% late and 7% AIDS) • Increased through IDUs (28% and 11%) • Heterosexual Men (47% and 19%) • Heterosexual Women (37% and 10%) BBV 2007/MJ/BM

6. AIDS in 2005 • Pneumocystis Pneumonia (207 adults) • Pulmonary TB • Extra pulmonary TB • Kaposi’s Sarcoma • Cerebral Toxoplasmosis and PML (in Brent) BBV 2007/MJ/BM

7. Psychological needs Shift from acute mental health problems associated with dying to chronic problems associated with living. Examples? The prosecution of HIV Transmission. Social exclusion HIV not seen as a plague but HIV related stigma continues. Non-disclosure and lack of support Welfare rights issues Discrimination at work Poverty: a salient feature Core Psychosocial needs BBV 2007/MJ/BM

8. Criminal Prosecution of HIV Transmission • 6 prosecutions for transmitting HIV by Jan 2006. • Under the provisions of Section 20 of the Offences Against the Person Act 1861 (OAPA). • Section 20 criminalises the “reckless” infliction of grievous bodily harm. • May also consider charging people under section 18 of the OAPA relating to “intentionally” inflicting GBH. • Intentional transmission is much more difficult to prove. BBV 2007/MJ/BM

9. C P of HIV T • In terms of the law it now appears that if someone is HIV-positive and: • Does not disclose that they are HIV positive to their partner, • Does not use condoms consistently, • HIV is transmitted, and • The partner decides to make a complaint to the police, then a prosecution for reckless transmission could be brought. • Not testing is not a defence (CPS to clarify this issue). • Useful links: www.tht.org.uk/prosecutions BBV 2007/MJ/BM

10. Cultural perspectives • Ability to give optimum care depends on an understanding of where the patient’s “journey” begins; traditions and beliefs. • The acceptance of conventional treatment or reliance on alternative and complementary therapies. • Major factor in “Adherence” to ART • Secondary prevention: Vital role for Voluntary organisation. • HIV testing in the community (VCT): CHAT in 2007 • Peer Support • Religious communities: sources of support or barrier? BBV 2007/MJ/BM

11. Predictors of Adherence • Client’s belief that they can fit the treatment in their lifestyle. • Understanding the treatment regimen and side-effects. • Short and long-term side effects. • Reduced pill counts. • Length of time on therapy. • Client-provider relationships and the system of care • Positive Self-management Programme. • The best time to start therapy is when the client is ready! BBV 2007/MJ/BM

12. Clinical Considerations • HIV-related symptoms or opportunistic infections (comprehensive assessment) • CD4 counts, Viral Load. • Resistance tests recommended b4 therapy (new guideline from BHIVA) • Prior experience of treatment. • New classes of ART (nucleoside, non-nucleoside, protease inhibitors, fusion inhibitors and experimental integrase inhibitors): 19 distinct anti-HIV drugs • Identifying a regimen FOR the client. BBV 2007/MJ/BM

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