SlideShare uma empresa Scribd logo
1 de 3
Baixar para ler offline
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
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.
I have recently been involved with colleagues from
the trust in the making of a blood born virus (BBV)
training video: http://intranet.slam.nhs.uk/bbv. In it
one of my patients, portrayed by an actor, talks about
his experiences as a young gay man in Jamaica, being
horrendously beaten for a night by a homophobic
mob. When I first met him, he was a refugee,
experiencing overwhelming hallucinations of the
crowd who beat him to kill him. He later became HIV
positive. He has now psychologically much recovered
but, as the actor captures in the video, although he
says HIV is no longer a problem, the look in his eyes
says there is a huge weight for those who are positive.
I watched the video with the patient involved and he
wept, saying: "It brings it all back to me. It is ok now -
but it isn’t".
Approximately 37 million people are living with HIV
globally - only 15 million are receiving treatment
(Kate Thomson. Global Fund). For the others HIV
disease is as it ever was.
At South London and Maudsley we run a number
of services that work with HIV diagnosed patients
including a dedicated mental health and HIV service.
Through our addictions services we provide needle
exchange, advice and information and a specialist
chemsex clinic. Please email hivteam@slam.nhs.uk
for more information.
If you would like to read Tony Maden's original article
visit: www.slam.nhs.uk/media/our-newsletter
and follow the link.
Cover story Members update 22/23
Nearly 50 people attended the seminar
where Professor Simon Wessely gave
an informative and amusing talk
about shellshock, Post traumatic stress
syndrome (PSTS) , and the myths that
surround the conditions.
Shellshock was a diagnosis used for a fairly
short period during the First World War,
although there was a tendency to treat
it as moral cowardice and an attempt by
its victims to get out of fighting. In many
countries it was a capital offence.
Shellshock was characterised by both mental
and physical symptoms such as blindness
(when there was no physical damage to
the eyes). One case became a media
sensation in Australia, where a soldier with
total memory loss remained unidentified for
many years. Post-war, shellshock became a
significant theme in fiction.
The diagnosis of PSTS (post-traumatic
stress syndrome) arose following the
Vietnam war. Most of what is now seen
in the media relating to PSTS is inaccurate
or untrue. Prof Wessely treated us to
a one minute talk in the style of ‘The
Unbelievable Truth’ in which every ‘fact’
except one was untrue (that one being
that we no longer shoot people for
having PSTS).
Prof Wessely then spoke about his - and
others’ - research into PSTS, mostly
relating to the Iraq war. Length of
exposure to combat (as opposed to
support roles) increases the risk of PSTS,
but a much greater risk to health is the
level of alcohol intake.
Military from the USA have much higher
rates of PSTS than those from the British
or Canadian armies, something that he
believes actually relates to differences in
health services. The NHS and the Canadian
health service provide free health care,
but the USA only get free treatment if
they have completed 25 years in the army
or have a service-related illness.
We are planning further talks in the
coming months. The next one will feature
c hief executive Dr Matthew Patrick,
talking about the mortality gap – the
reduced life expectancy that people with
mental health problems suffer. If you
have any suggestions or feedback, please
contact membership@slam.nhs.uk or
phone 020 3228 2441.
Members’
Seminar
Post-traumatic
stress syndrome
Anyone can
become a
member of the
trust, and by
doing so you
will have the
chance to
influence how
we develop our
services. You can
get involved as
much or as little
as you like. You
can sign up at
www.slam.nhs.
uk/membership
Seminars are
another chance
for our members
to benefit from
their membership.
by Carol
Stevenson,
membership
officer
Sfc. Al Chang, 1950
© U.S. Army Korea -
Department of Defense
Above:
© Jonathan
Bassett, Alien
Sex Club art
exhibition
Some men I have seen
have said they have
been relieved to have
been infected so that
they perversely do not
need to worry about
being infected.
The unsafe injection of, particularly, crystal meth seems
to be becoming epidemic. The use of these stimulant
drugs are leading to psychotic episodes and in my clinic
I have people, who have been injecting crystal meth,
who have seemingly developed enduring psychoses
with no other clear risk factors.
Alien Sex Club also approaches another issue, that of
the eroticisation of transmission, the so-called "bug
chaser", men who fantasise or actively seek infection.
Effective treatment has opened up a whole range
of different attitudes to infection. Some men I have
seen have said they have been relieved to have been
infected so that they perversely do not need to worry
about being infected. Others, such as the participants
in the research for DV8's "John", reportedly said they
did not worry about getting infected because it was so
treatable now. But then there is a literature of people
in gay communities rejected for being HIV positive.
The other less talked about epidemic is of Hepatitis
C, and the increasing appearance of highly successful
treatment regimes for Hepatitis C will raise complex
issues. As opposed to life-long HIV medication, these
treatments are for a matter of weeks or months. They
are highly expensive and raise the issue of whether we
are able, as an NHS, to spend hundreds of thousands
of pounds on eradicating someone's hepatitis C, for
them to get re-infected in the context of chemsex and
unprotected penetrative sexual contact.
So, it is a more optimistic world than Tony Maden
described in 1986 but, as I have tried to portray in this
piece, a much more complex picture has emerged.
Safer sex and safer needle use seem to be in the
retreat. HIV testing is being normalised and hopefully
there will be more uptake of testing and treatment
leading to lower community or herd infection rates.
But the epidemic of the new psychoactive substances,
and their influence on the transmission of infections,
seems from the view I have from my HIV / mental
health clinic to be on the ascent. Chemsex may become
both a public and mental health phenomenon we still
have to see through.

Mais conteúdo relacionado

Mais procurados

State Press - Dangerous liaisons
State Press - Dangerous liaisonsState Press - Dangerous liaisons
State Press - Dangerous liaisonsJeffrey Hampl
 
IOSR Journal of Pharmacy (IOSRPHR), www.iosrphr.org, call for paper, research...
IOSR Journal of Pharmacy (IOSRPHR), www.iosrphr.org, call for paper, research...IOSR Journal of Pharmacy (IOSRPHR), www.iosrphr.org, call for paper, research...
IOSR Journal of Pharmacy (IOSRPHR), www.iosrphr.org, call for paper, research...iosrphr_editor
 
Cdc hiv-genepislideseries-2013
Cdc hiv-genepislideseries-2013Cdc hiv-genepislideseries-2013
Cdc hiv-genepislideseries-2013Richin Koshy
 
Sean Davison - Euthanasia: The right to die with dignity
Sean Davison - Euthanasia: The right to die with dignitySean Davison - Euthanasia: The right to die with dignity
Sean Davison - Euthanasia: The right to die with dignityRunwaySale
 
Aids knowing no boundaries in 3 rd world countries
Aids knowing no boundaries in 3 rd world countriesAids knowing no boundaries in 3 rd world countries
Aids knowing no boundaries in 3 rd world countriestuikings
 
Plos Medicine 2016 (Ebola)
Plos Medicine 2016 (Ebola)Plos Medicine 2016 (Ebola)
Plos Medicine 2016 (Ebola)Christopher Dye
 
Major Health Issues in India: HIV/AIDS & CANCER IN INDIA...
Major Health Issues in India: HIV/AIDS & CANCER IN INDIA...Major Health Issues in India: HIV/AIDS & CANCER IN INDIA...
Major Health Issues in India: HIV/AIDS & CANCER IN INDIA...Ravi Spikey
 

Mais procurados (8)

State Press - Dangerous liaisons
State Press - Dangerous liaisonsState Press - Dangerous liaisons
State Press - Dangerous liaisons
 
IOSR Journal of Pharmacy (IOSRPHR), www.iosrphr.org, call for paper, research...
IOSR Journal of Pharmacy (IOSRPHR), www.iosrphr.org, call for paper, research...IOSR Journal of Pharmacy (IOSRPHR), www.iosrphr.org, call for paper, research...
IOSR Journal of Pharmacy (IOSRPHR), www.iosrphr.org, call for paper, research...
 
Extended Essay IB
Extended Essay IBExtended Essay IB
Extended Essay IB
 
Cdc hiv-genepislideseries-2013
Cdc hiv-genepislideseries-2013Cdc hiv-genepislideseries-2013
Cdc hiv-genepislideseries-2013
 
Sean Davison - Euthanasia: The right to die with dignity
Sean Davison - Euthanasia: The right to die with dignitySean Davison - Euthanasia: The right to die with dignity
Sean Davison - Euthanasia: The right to die with dignity
 
Aids knowing no boundaries in 3 rd world countries
Aids knowing no boundaries in 3 rd world countriesAids knowing no boundaries in 3 rd world countries
Aids knowing no boundaries in 3 rd world countries
 
Plos Medicine 2016 (Ebola)
Plos Medicine 2016 (Ebola)Plos Medicine 2016 (Ebola)
Plos Medicine 2016 (Ebola)
 
Major Health Issues in India: HIV/AIDS & CANCER IN INDIA...
Major Health Issues in India: HIV/AIDS & CANCER IN INDIA...Major Health Issues in India: HIV/AIDS & CANCER IN INDIA...
Major Health Issues in India: HIV/AIDS & CANCER IN INDIA...
 

Destaque

Successful club presidents 30082013
Successful club presidents 30082013Successful club presidents 30082013
Successful club presidents 30082013m nagaRAJU
 
Infant Sleep Safety: Understanding Risks and Exploring Safety Measures
Infant Sleep Safety: Understanding Risks and Exploring Safety MeasuresInfant Sleep Safety: Understanding Risks and Exploring Safety Measures
Infant Sleep Safety: Understanding Risks and Exploring Safety MeasuresAngel Eyes
 
Which brands are winning the social video shootout during Euro 2016
Which brands are winning the social video shootout during Euro 2016Which brands are winning the social video shootout during Euro 2016
Which brands are winning the social video shootout during Euro 2016GM BBI research & liaison
 
Artisan Cabinets LinkedIn p6
Artisan Cabinets LinkedIn p6Artisan Cabinets LinkedIn p6
Artisan Cabinets LinkedIn p6Michael Taibi
 
How to Create a Top Performing B&B Website
How to Create a Top Performing B&B WebsiteHow to Create a Top Performing B&B Website
How to Create a Top Performing B&B WebsiteLeonardo
 
Chronic Pain: Dangers and Opportunities
Chronic Pain: Dangers and OpportunitiesChronic Pain: Dangers and Opportunities
Chronic Pain: Dangers and OpportunitiesNathan Cone
 
Periodismo digital en educación
Periodismo digital en educaciónPeriodismo digital en educación
Periodismo digital en educaciónevaristogonzal2
 
Essay on Culture Understanding
Essay on Culture Understanding Essay on Culture Understanding
Essay on Culture Understanding Fatima Mairaj
 
Redes sociales y ciberacoso - UAB - 16 diciembre 2016
Redes sociales y ciberacoso - UAB - 16 diciembre 2016Redes sociales y ciberacoso - UAB - 16 diciembre 2016
Redes sociales y ciberacoso - UAB - 16 diciembre 2016evaristogonzal2
 
TANET - Bai giang ve luat ke toan va cac van ban huong dan thuc hien luat ke ...
TANET - Bai giang ve luat ke toan va cac van ban huong dan thuc hien luat ke ...TANET - Bai giang ve luat ke toan va cac van ban huong dan thuc hien luat ke ...
TANET - Bai giang ve luat ke toan va cac van ban huong dan thuc hien luat ke ...Pham Ngoc Quang
 

Destaque (12)

Successful club presidents 30082013
Successful club presidents 30082013Successful club presidents 30082013
Successful club presidents 30082013
 
Infant Sleep Safety: Understanding Risks and Exploring Safety Measures
Infant Sleep Safety: Understanding Risks and Exploring Safety MeasuresInfant Sleep Safety: Understanding Risks and Exploring Safety Measures
Infant Sleep Safety: Understanding Risks and Exploring Safety Measures
 
Which brands are winning the social video shootout during Euro 2016
Which brands are winning the social video shootout during Euro 2016Which brands are winning the social video shootout during Euro 2016
Which brands are winning the social video shootout during Euro 2016
 
Artisan Cabinets LinkedIn p6
Artisan Cabinets LinkedIn p6Artisan Cabinets LinkedIn p6
Artisan Cabinets LinkedIn p6
 
How to Create a Top Performing B&B Website
How to Create a Top Performing B&B WebsiteHow to Create a Top Performing B&B Website
How to Create a Top Performing B&B Website
 
Chronic Pain: Dangers and Opportunities
Chronic Pain: Dangers and OpportunitiesChronic Pain: Dangers and Opportunities
Chronic Pain: Dangers and Opportunities
 
Periodismo digital en educación
Periodismo digital en educaciónPeriodismo digital en educación
Periodismo digital en educación
 
Essay on Culture Understanding
Essay on Culture Understanding Essay on Culture Understanding
Essay on Culture Understanding
 
App...rendere collaborando
App...rendere collaborandoApp...rendere collaborando
App...rendere collaborando
 
Redes sociales y ciberacoso - UAB - 16 diciembre 2016
Redes sociales y ciberacoso - UAB - 16 diciembre 2016Redes sociales y ciberacoso - UAB - 16 diciembre 2016
Redes sociales y ciberacoso - UAB - 16 diciembre 2016
 
Rest And Sleep
Rest And SleepRest And Sleep
Rest And Sleep
 
TANET - Bai giang ve luat ke toan va cac van ban huong dan thuc hien luat ke ...
TANET - Bai giang ve luat ke toan va cac van ban huong dan thuc hien luat ke ...TANET - Bai giang ve luat ke toan va cac van ban huong dan thuc hien luat ke ...
TANET - Bai giang ve luat ke toan va cac van ban huong dan thuc hien luat ke ...
 

Semelhante a HIV DOF Dec15

Human Immunodeficiency Virus ( Hiv )
Human Immunodeficiency Virus ( Hiv )Human Immunodeficiency Virus ( Hiv )
Human Immunodeficiency Virus ( Hiv )Amanda Reed
 
Sexually Transmitted Infections
Sexually Transmitted InfectionsSexually Transmitted Infections
Sexually Transmitted InfectionsLorie Harris
 
Ghost Map Epidemiology
Ghost Map EpidemiologyGhost Map Epidemiology
Ghost Map EpidemiologyKatrina Green
 
The Early Days Of The Aids Epidemic Essay
The Early Days Of The Aids Epidemic EssayThe Early Days Of The Aids Epidemic Essay
The Early Days Of The Aids Epidemic EssayStephanie Roberts
 
history of HIV
history of HIVhistory of HIV
history of HIVMIN ZAW
 
Hiv And The Hiv Epidemic
Hiv And The Hiv EpidemicHiv And The Hiv Epidemic
Hiv And The Hiv EpidemicAdriana Wilson
 
Barry Adam, "The biomedical and the social in HIV prevention"
Barry Adam, "The biomedical and the social in HIV prevention"Barry Adam, "The biomedical and the social in HIV prevention"
Barry Adam, "The biomedical and the social in HIV prevention"CBRC
 
Benefits Of Using Needle Exchange Programs
Benefits Of Using Needle Exchange ProgramsBenefits Of Using Needle Exchange Programs
Benefits Of Using Needle Exchange ProgramsLisa Stephens
 
Human Rights And Students Essay
Human Rights And Students EssayHuman Rights And Students Essay
Human Rights And Students EssayLisa Williams
 
Co relation of csf and neurological findings in hiv positive patients
Co relation of csf and neurological findings in hiv positive patientsCo relation of csf and neurological findings in hiv positive patients
Co relation of csf and neurological findings in hiv positive patientsRahul Nirmale
 

Semelhante a HIV DOF Dec15 (20)

Human Immunodeficiency Virus ( Hiv )
Human Immunodeficiency Virus ( Hiv )Human Immunodeficiency Virus ( Hiv )
Human Immunodeficiency Virus ( Hiv )
 
Epidemiology Paper On Hiv
Epidemiology Paper On HivEpidemiology Paper On Hiv
Epidemiology Paper On Hiv
 
Sexually Transmitted Infections
Sexually Transmitted InfectionsSexually Transmitted Infections
Sexually Transmitted Infections
 
Aids Essay
Aids EssayAids Essay
Aids Essay
 
Mary Fisher- A Whisper Of Aids Essay
Mary Fisher- A Whisper Of Aids EssayMary Fisher- A Whisper Of Aids Essay
Mary Fisher- A Whisper Of Aids Essay
 
Essay On Hiv Aids
Essay On Hiv AidsEssay On Hiv Aids
Essay On Hiv Aids
 
Assignment 5 new
Assignment 5 newAssignment 5 new
Assignment 5 new
 
Aids Awareness
Aids AwarenessAids Awareness
Aids Awareness
 
Ghost Map Epidemiology
Ghost Map EpidemiologyGhost Map Epidemiology
Ghost Map Epidemiology
 
The Early Days Of The Aids Epidemic Essay
The Early Days Of The Aids Epidemic EssayThe Early Days Of The Aids Epidemic Essay
The Early Days Of The Aids Epidemic Essay
 
history of HIV
history of HIVhistory of HIV
history of HIV
 
Hiv And The Hiv Epidemic
Hiv And The Hiv EpidemicHiv And The Hiv Epidemic
Hiv And The Hiv Epidemic
 
HIV Research Paper
HIV Research PaperHIV Research Paper
HIV Research Paper
 
Ghap hiv aids_handbook
Ghap hiv aids_handbookGhap hiv aids_handbook
Ghap hiv aids_handbook
 
Barry Adam, "The biomedical and the social in HIV prevention"
Barry Adam, "The biomedical and the social in HIV prevention"Barry Adam, "The biomedical and the social in HIV prevention"
Barry Adam, "The biomedical and the social in HIV prevention"
 
HIV And AIDS
HIV And AIDSHIV And AIDS
HIV And AIDS
 
Benefits Of Using Needle Exchange Programs
Benefits Of Using Needle Exchange ProgramsBenefits Of Using Needle Exchange Programs
Benefits Of Using Needle Exchange Programs
 
Epidemiology HIV Paper
Epidemiology HIV PaperEpidemiology HIV Paper
Epidemiology HIV Paper
 
Human Rights And Students Essay
Human Rights And Students EssayHuman Rights And Students Essay
Human Rights And Students Essay
 
Co relation of csf and neurological findings in hiv positive patients
Co relation of csf and neurological findings in hiv positive patientsCo relation of csf and neurological findings in hiv positive patients
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.
  • 3. I have recently been involved with colleagues from the trust in the making of a blood born virus (BBV) training video: http://intranet.slam.nhs.uk/bbv. In it one of my patients, portrayed by an actor, talks about his experiences as a young gay man in Jamaica, being horrendously beaten for a night by a homophobic mob. When I first met him, he was a refugee, experiencing overwhelming hallucinations of the crowd who beat him to kill him. He later became HIV positive. He has now psychologically much recovered but, as the actor captures in the video, although he says HIV is no longer a problem, the look in his eyes says there is a huge weight for those who are positive. I watched the video with the patient involved and he wept, saying: "It brings it all back to me. It is ok now - but it isn’t". Approximately 37 million people are living with HIV globally - only 15 million are receiving treatment (Kate Thomson. Global Fund). For the others HIV disease is as it ever was. At South London and Maudsley we run a number of services that work with HIV diagnosed patients including a dedicated mental health and HIV service. Through our addictions services we provide needle exchange, advice and information and a specialist chemsex clinic. Please email hivteam@slam.nhs.uk for more information. If you would like to read Tony Maden's original article visit: www.slam.nhs.uk/media/our-newsletter and follow the link. Cover story Members update 22/23 Nearly 50 people attended the seminar where Professor Simon Wessely gave an informative and amusing talk about shellshock, Post traumatic stress syndrome (PSTS) , and the myths that surround the conditions. Shellshock was a diagnosis used for a fairly short period during the First World War, although there was a tendency to treat it as moral cowardice and an attempt by its victims to get out of fighting. In many countries it was a capital offence. Shellshock was characterised by both mental and physical symptoms such as blindness (when there was no physical damage to the eyes). One case became a media sensation in Australia, where a soldier with total memory loss remained unidentified for many years. Post-war, shellshock became a significant theme in fiction. The diagnosis of PSTS (post-traumatic stress syndrome) arose following the Vietnam war. Most of what is now seen in the media relating to PSTS is inaccurate or untrue. Prof Wessely treated us to a one minute talk in the style of ‘The Unbelievable Truth’ in which every ‘fact’ except one was untrue (that one being that we no longer shoot people for having PSTS). Prof Wessely then spoke about his - and others’ - research into PSTS, mostly relating to the Iraq war. Length of exposure to combat (as opposed to support roles) increases the risk of PSTS, but a much greater risk to health is the level of alcohol intake. Military from the USA have much higher rates of PSTS than those from the British or Canadian armies, something that he believes actually relates to differences in health services. The NHS and the Canadian health service provide free health care, but the USA only get free treatment if they have completed 25 years in the army or have a service-related illness. We are planning further talks in the coming months. The next one will feature c hief executive Dr Matthew Patrick, talking about the mortality gap – the reduced life expectancy that people with mental health problems suffer. If you have any suggestions or feedback, please contact membership@slam.nhs.uk or phone 020 3228 2441. Members’ Seminar Post-traumatic stress syndrome Anyone can become a member of the trust, and by doing so you will have the chance to influence how we develop our services. You can get involved as much or as little as you like. You can sign up at www.slam.nhs. uk/membership Seminars are another chance for our members to benefit from their membership. by Carol Stevenson, membership officer Sfc. Al Chang, 1950 © U.S. Army Korea - Department of Defense Above: © Jonathan Bassett, Alien Sex Club art exhibition Some men I have seen have said they have been relieved to have been infected so that they perversely do not need to worry about being infected. The unsafe injection of, particularly, crystal meth seems to be becoming epidemic. The use of these stimulant drugs are leading to psychotic episodes and in my clinic I have people, who have been injecting crystal meth, who have seemingly developed enduring psychoses with no other clear risk factors. Alien Sex Club also approaches another issue, that of the eroticisation of transmission, the so-called "bug chaser", men who fantasise or actively seek infection. Effective treatment has opened up a whole range of different attitudes to infection. Some men I have seen have said they have been relieved to have been infected so that they perversely do not need to worry about being infected. Others, such as the participants in the research for DV8's "John", reportedly said they did not worry about getting infected because it was so treatable now. But then there is a literature of people in gay communities rejected for being HIV positive. The other less talked about epidemic is of Hepatitis C, and the increasing appearance of highly successful treatment regimes for Hepatitis C will raise complex issues. As opposed to life-long HIV medication, these treatments are for a matter of weeks or months. They are highly expensive and raise the issue of whether we are able, as an NHS, to spend hundreds of thousands of pounds on eradicating someone's hepatitis C, for them to get re-infected in the context of chemsex and unprotected penetrative sexual contact. So, it is a more optimistic world than Tony Maden described in 1986 but, as I have tried to portray in this piece, a much more complex picture has emerged. Safer sex and safer needle use seem to be in the retreat. HIV testing is being normalised and hopefully there will be more uptake of testing and treatment leading to lower community or herd infection rates. But the epidemic of the new psychoactive substances, and their influence on the transmission of infections, seems from the view I have from my HIV / mental health clinic to be on the ascent. Chemsex may become both a public and mental health phenomenon we still have to see through.