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

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

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

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

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

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

Core Psychosocial needs 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 BBV 2007/MJ/BM

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

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

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

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

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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