Are we still dying of ignorance?
Conservative MP Mike Freer writes about his adjournment debate in parliament on 'Innovations in HIV prevention'
Thirty years ago we became aware of AIDs. The 1980s saw a groundbreaking public information campaign about AIDs, leaflets to every households, television and radio all made us aware of the illness and the risks. The term 'safe sex' and the knowledge of the need to use condoms became established and behaviours changed. Yet today infection rates mean 6000 people a year are diagnosed (down from 7700 a year in 2004) but amongst MSM (men who have sex with men) the rates are increasing (2450 in 2004 to 3250 in 2013).
Whilst we have made progress in combatting stigma and in challenging that it is problem just effecting the gay community (in fact 55% of people living with HIV in the UK acquired the infection through heterosexual transmission). We need to combat the rising levels of infections. In the UK it is estimate that 108,000 people are living with HIV, but that 25% are unaware and are at risk of passing on the infection. It is true that new anti-retroviral drug treatments (ARVs) have transformed the lives of those who are HIV+. The ARVs help most people live near normal lives but it is still a life changing diagnosis. ARVs have to be taken every day for the rest of the person's life. Relationships can be harder or maintain or establish as partners reject them.
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Despite discrimination laws, few employees volunteer their HIV status, not just for the fear of overt discrimination but the subtle passing over for promotions and then there is the fear of shunning or harassment by co-workers. Despite all of the work done over the years, some people still believe HIV can be transmitted through saliva/sharing cups etc. So the human cost of depression and isolation remains. Then there is the cost of treatments. The lifetime cost of treatments for a person with HIV is between £250,000 and £330,000. So there are both human and financial reasons to understand what is driving infection rates up and then taking action.
There are underlying groups where HIV infection rates remains high. Men who have sex with men (MSM) and black African men remain cohorts showing an increase in infection rates. Aversion to condoms, continued stigma and unwillingness to be open about male to male sexual partners, drug use (ChemSex) and a lack of knowledge are just some.
The obvious starting point is to educate when people are becoming sexually aware. Sex education in schools is always controversial but we have to accept that teenagers will have access on-line pornography. We have to accept that many teenagers will become sexually active and yet Sex and Relationship Education remains poor. The National Aids Trust recently published a report that showed that in SRE there is little teaching about same sex awareness or HIV transmission. Homophobic bullying contributed to teenagers feeling uncomfortable about seeking advice. SRE is inconsistent and too often ignore LGBT issues. It's time to make it compulsory and inclusive.
Outside of schools people we are accessing sex differently, so we need to educate and inform differently. The increasing use of 'dating apps' means that increasing numbers are finding sexual partners through their phones. Are we using that technology effectively to ensure appropriate sexual health messages are there too? We have to work harder to reach black African males and sexual health clinics need more support in educating patients who may not disclose themselves as MSM but are presenting for other help. Drug use needs to be recognised and treatment integrated into sexual health clinics, not referred on to drug treatment centres. We have to accept people will make poor choices and have unprotected sex. Initial studies show that post exposure prophylaxis (PeP) and pre-exposure prophylaxis (treatments immediately after suspected exposure to HIV or as a preventative measure) seem to work and the evaluation of a widespread programme needs to be accelerated.
Importantly we need to increase testing and make it easier. Increased routine testing in clinics and home testing kits should be explored. Early diagnosis and early treatment dramatically improves the lives of the individual and reduces transmission.
Often we shy away from talking about sex and certainly we are uncomfortable learning about sexual practices that are outside our own experiences. Yet if we are to tackle the issues, we have to deal with the problems as they exist. We have to deal with the world as it is, not as we might like it to be.
That's why we have to redouble our efforts to educate and innovate.