Co relation of csf and neurological findings in hiv positive patients
HIV DOF Dec15
1. World Mental Health
Day and Black History
Month
Life on AL1 older
adults ward
Bethlem apple harvest
and the power of nature
+
SLaMnews
News from South Londonand Maudsley
NHS Foundation Trust for staff and members
Winter 2015/16
HIV,
mental
health
and
stigma
2. Stigma is what prevents people being tested for this
now treatable condition. The fear of rejection and
the baggage of the old days when AIDS equalled
death and AIDS labelled you as socially undesirable -
along with the cultural fantasy that HIV was able to
make moral decisions about who it infected, based
on their life choices. Through the work of the Global
Fund for the Eradication of AIDS and Malaria, based
in Geneva, and currently led by Microsoft's Bill Gates,
these medications are increasingly available globally.
Guy Burch's recent exhibition "Head Spaces" at
the Menier Gallery addressed memories of the
decimation of London's gay communities in the
1980s, and the issues for those who survived long
enough to get cART. Many people from those days
have lost so many people in their lives and, having
assumed they would die young, are now entering
middle age.
But new problems arise that still seem to be
relatively unknown among health professionals. I
found John Walters’ installation, "Alien Sex Club"
(www.aliensexclub.com), which was at the University
of Westminster and is opening again in Liverpool
this winter - as did DV8's phenomenal dance theatre
work by Lloyd Newson, "John" (www.DV8.co.uk)
both about HIV today, both addressing what to
me, as a psychiatrist practising in HIV psychiatry, is
the contemporary discourse. Forget the skull and
crossbones and the falling gravestones, and enter
a world where gay communities are living with the
plethora of antiretroviral medications and some
sections of the gay communities, as well as other
communities, are being deeply affected by a tidal
wave of "chemsex”.
For those who are unfamiliar with the term, chemsex
refers to the use of probably 120 new psychoactive
substances (often augmented with Viagra), which
are compulsive to take, increasing sexual arousal
and repressing shame, leading to the enactment of
pornography. Also in a world of geo-social apps (for
example, Grindr or Scruff) it can lead to drug-fuelled
sessions that can go on for hours or days, in which
safer sex is unlikely to be maintained.
Cover story 20/21
The message is to get
everyone tested for
HIV, which is now SLaM
policy and is extending
across the NHS.
What HIV means
for mental
health today
In 1986 Professor Tony Maden wrote a feature
in the Maudsley and Bethlem Gazette on AIDS
and its implications on public health policy. At
the time the UK was experiencing an epidemic
following on from the initial outbreak in the
early 1980s in the US.
In the same year the UK Government launched
the world’s first major government-sponsored
national campaign with the slogan “AIDS:
Don’t die of Ignorance”.
Tuesday 1 December is World Aid’s Day, the
day aims to raise support and awareness for
people living with HIV.
What a difference over 30 years makes since the first
cases of HIV disease were recognised in Los Angeles
in 1981.
If I were to design a poster now, it would be “HIV
Stigma Kills; get tested for HIV” because HIV
infection is treatable with long-term medication, and
seemingly has no impact on people's life expectancy.
There is even some evidence suggesting those
who do not smoke, who are HIV positive and on
treatment have extended life expectancy, probably
due to close medical supervision.
We know more about the treatment revolution
which began in 1996 with the appearance of
combination antiretroviral treatment (cART). In
the early years, it transformed the prognosis for
those living with infection; although with the
early medications the side effect burden was high.
We now know that people on treatment are not
infectious as long as they have a reliably undetected
viral load, meaning that physical care or the
most intimate sexual contacts are without risk of
transmission.
In my weekly HIV/mental health clinic with CASCAID,
I urge the men I see to use condoms more to protect
themselves from, for example, hepatitis C and
treatment-resistant gonorrhoea than to protect
against the possibility of infecting others with HIV.
We also now know that giving these medications in
the 72 hours after possible exposure to HIV (post-
exposure prophylaxis = PEP) vastly reduces the risk of
transmission, and now there is evidence that using
medication for HIV negative sexually active men
who have sex with men reduces infection risk (pre-
exposure prophylaxis = PREP).
Consultant psychiatrist and HIV specialist Dr
David O’Flynn from our CASCAID HIV service
looks back on the 30+ years since the first
cases of HIV were detected and what the virus
means for our population today.
The message is to get everyone tested for HIV, which
is now SLaM policy and is extending across the NHS.
For example, Chelsea and Westminster Hospital
have a long and well established programme of
offering blood-borne virus (BBV) testing to all who
present for care. Under the current philosophy of
"normalisation", HIV and other BBV testing should
just be seen as a routine test.
Adding the bells and whistles of consent forms and
health advisers just increases reluctance. We know
from antenatal clinics that women have been strong
uptakers of testing. It seems when testing is made
easily accessible at any point of access to health care,
people will go for it.
Lambeth and Southwark have the highest rates
of HIV prevalence in Europe (13 to 15 per 1000
residents). Broadly speaking, half are people of
Black African origin, and half are men who have sex
with men. In the experience of CASCAID, we have a
number of people of African descent who present
late with advanced HIV disease. Some present with
psychosis or HIV-related neuro-cognitive disorder
to our inpatient wards, a tragedy considering the
cerebral damage is irreversible and treatment is so
freely available locally.