Welcome to London Services
This website provides information about services available to gay and bisexual men in London that help them to maintain and improve their health. It also provides access to other information resources that may be of use to gay and bisexual men and the professionals who serve them.
The information provided on the London Services website is deisgned to support, not replace the relationship that exists between you and your doctor. This website is run by GMFA and funded by GMFA and the Pan London HIV Prevention Partnership.
News and upcoming events
Small Media - out now!
Semen, Sex & HIV
There's a new edition of 'Semen, Sex & HIV' available now in bars and clubs, and to download from this website. 'Semen, Sex & HIV' is a very handy booklet which explains the role that semen plays in the transmission of HIV, and how to reduce the risks of passing on or picking up HIV during sex.
Mini Good Sexual Health
The updated issue of the pocket 'Good Sexual Health' guide to sexually transmitted infections is now available in bars and clubs and to download from this website. The booklet offers a guide to making an appointment at a sexual health clinic and includes details of clinics in London which run sessions specifically for gay men.
It is divided into sections, focusing on different regions of the male anatomy - the mouth, the glands, the pubes, the penis, the balls and the bum. Each section explains in simple language the symptoms of the most common STIs.
Tested Negative
A new booklet called 'Tested Negative' is now available from GUM clinics to men who receive a negative test result. It is aimed at men who have received an HIV negative test result and is designed to help them keep their HIV negative status. This booklet will be given out to gay and bisexual men in GUM clinics by health advisors. If you tested negative recently and but missed out on your copy of 'Tested Negative' you can download yours from this website.
Other small media resources for gay men.
Upcoming Courses & Workshops for gay men:
Workshops and courses in February and March are:
GMFA Courses
If you want to stop smoking then our seven session Stop Smoking course for gay men can help. Evidence shows that the support you get from a Stop Smoking course, combined with the relief from withdrawal symptoms that Nicotine Replacement Therapy gives you, makes your attempt to quit ten times more likely to succeed than if you use willpower alone 1.
For information about course dates or to book a place, please visit www.gmfa.org.uk/stopsmoking.
PACE Workshops
The Black Connection is a monthly group for black men who have sex with men, to meet, talk & socialise as well as explore themes that will help celebrate the diverse community, relationships and lifestyles of Black men who love men.
There will be opportunities for participants to network and connect with other Black men, exploring the challenges they face and issues affecting their lives.
All Black African, Black British and Black Caribbean men are welcome to attend this popular group.
The third Sunday of the month, 6 till 9pm. Next date: 21st June.
TwentySomething is a monthly drop-in group for gay/bi men in their 20s to talk about sex, relationships and gay life in the 21st century.
The third Monday of the month from 6.15pm till 9.15pm. Next date: Monday 15 June 2009.
Positive Hub is a monthly space for positive men to talk and engage in a new kind of positive community. This is a place for connection, honesty, laughter and exploration. It will not be a place for invited speakers and dead end conversations.
The last Sunday of the month from 6 till 9pm. Next date: 28 June.
Sexual Debut is an 8 week programme which will give you an opportunity to explore with other gay/bi men what coming out really means for you. You will gain skills on how to negotiate in the gay scene and build your confidence around sex & relationships.
Begins Thursday 10 September from 6.30 till 9.30pm for eight weeks and includes Saturday 12 September from 10am to 5pm.
MASTI is an opportunity for Asian Gay/Bi men to talk with other Asian Gay/Bi men about their experiences of sex, relationships and life, with the purpose of gaining insight and understanding, and where desired, support and ideas for making changes in the future. Delivered in Association with The Naz Project.
Begins 6pm Friday 12 June. Continues Saturday 13 and Sunday 14 June.
Out of Control? - is a weekend for gay men who are unhappy about the amount or kind of sex they are having. The weekend will explore ways to gain control and develop a sex life that is right for you.
Begins 6.30pm Friday 26 June. Continues Saturday 27 and Sunday 28 June.
Risky Business is a weekly on-going group where you will be able to share and talk about your experience with other gay/bi men, gain insight and make changes in your life. This group is for you if you find it a challenge to maintain safer sex, if your sex life feels out of control or if you have recently been prescribed PEP or used PEP in the past.
Every Wednesday at 6.30pm from 10th June.
To book a place or for more information call 020 7700 1323.
THT Courses
Keeping it hot!
Sex can mean different things to different guys and it's not always easy to know how to keep it safe and hot. On this free one day workshop you'll learn how, and have a lot of fun doing it... Bring your mates too!
Saturday 13th June 2009
Book a place on 'Keeping it hot!'
Mind Your Backs Guys! All you'll ever need to know about your arse and his
Ever been curious about prostates, the male G-spot, buttock exercising or douching? Whether you want to learn more about how to enjoy anal sex or have questions about the health of your posterior, this group is for you.
Every first and third Thursday of the month from 6pm to 9pm.
Book a place on 'Mind Your Backs Guys!'
Out of it?
Ever wanted to know more about the drugs that you are taking? On this one day workshop you will learn about the drugs that are out there, having sex on drugs and the effects when you mix them up.
Saturday 27 June 2009 from 10am to 5pm
Newly Diagnosed Men's Support Group
A safe environment where newly diagnosed gay men in London can be supported in coming to terms with their diagnosis and discuss relevant issues for example disclosure, relationships and sex and adherence.
Six week course begins Tuesday 9th June from 6.30pm to 9pm.
Next course begins Thursday 16th July from 6.30pm to 9pm
Book a place on 'Newly Diagnosed Men's Support Group'
Negative partners support group
A support group for HIV negative people whose partners are living with HIV. If you live in London you can come and share your experiences, give and receive emotional support, access information, develop friendships and support networks, and campaign about common issues. This group is led by its members - it's up to you to decide the direction and rules.
Thursday 25th June and the last Thursday of every month from 6.30pm to 8.30pm.
Book a place on 'Negative Partners Support Group'
Other courses
The next Recently Diagnosed Course at Positive East in Stepney begins on Saturday 25 July (9.30am – 4.00pm) and then continues on Wednesday evenings (5.30pm – 9.00pm) from 29 July until 16 August.
The course is free and designed mainly for people who have received a diagnosis of HIV at some time within the last twelve months.
In a safe and supportive setting, along with others in a similar situation, the course allows you the opportunity to begin dealing with the impact of your diagnosis, and to learn more about living with HIV. You will find that a wide range of information is provided, and we hope that this, along with the chance to share your experiences with others, will help you explore your feelings about being positive and to take a look at the many issues faced by positive people.
The weekly sessions cover topics such as diet and nutrition, advice and information from an HIV consultant, a discussion about sex and relationships with a psychologist, and a talk with a careers advisor about employment related issues.
A clinical nurse specialist discusses practical issues and concerns about treatment and adherence, while a psychologist helps us to explore the issue of disclosing our status to those who are closest to us.
A clear understanding of the benefits system is provided by a welfare rights advisor, while insight is given into a range of available counselling therapies by a counselling psychologist. The present situation regarding transmission and the law is also explained, including a look at the Crown Prosecution Service and recent court precedents.
In addition, there will be the opportunity to meet and talk with people who have lived with HIV for a number of years, and to hear about the beneficial effects of complementary therapies.
If you feel the course offers what you are looking for, you can complete and return the application form or call Jim Jewers at Positive East in Stepney.
Places are limited and will be offered on a first come first served basis. Subsequent courses will run throughout the year.
For more information about this course, please telephone Jim Jewers at Positive East on 02077912855 or email jim.jewers@positiveeast.org.uk.
Caring With Confidence - is a free programme which helps carers aged 18 and over build on their own strengths, share experiences and gain useful information, ideas and tips about looking after someone to help them decide how to make positive changes to their caring role. People supporting those from LGBT communities regardless of their own sexual orientation are welcome on the courses.
Sessions are being run by the GMI Partnership and London Borough of Hounslow and are being held in locations across London on a weekly basis.
Carers can choose how many of the seven sessions in the programme to get involved with depending on their own caring situation and needs, and all are encouraged to attend the introductory session - Finding Your Way - which helps look at what matters to carers and which of the other six sessions they might want to do:
- Caring and Coping
- Caring and Me
- Caring Day-to-Day
- Caring and Resources
- Caring and Life
- Caring and Communicating
Sessions are led by trained facilitators, many of whom are themselves carers or have experience of working with carers.
Anyone interested in finding out more about Caring with Confidence sessions or to register can contact 020 8583 6677 or visit the website www.caringwithconfidence.net.
Recently Diagnosed Course - held four times a year, this is a structured course open to anyone newly diagnosed in London who would like to be better informed.
To access this course, call Simon Johnson on 020 7812 1777 during office hours from Monday to Friday.
Living with HIV in Tower Hamlets - this course is for you if you want to know more about sex, intimacy and status disclosure, dealing with medication, coping with frustration, fatigue and isolation, and moving forward with your life.
Whether you are recently diagnosed or have been living with HIV/AIDS for some time you will find this course helpful and fun!
For more information on the next available course, please call Simon on 020 8694 9988 ext 208 or email epp@thepositiveplace.org.uk
Support Groups
The Midweek Group
Thanks to sponsorship from The Eddie Surman Trust (020 7738 6893) and the hospitality of South Central pub in Vauxhall, 'The Midweek Group', formerly supported by the UKC, continues to meet, socialise and have speakers on a regular basis (Tuesdays 6 - 9pm). Anyone interested in joining the group can come along on a Tuesday to enquire about membership.
Support groups for gay men from THT
Newly Diagnosed Gay Men's Group which meets twice a month at a Soho location, a support group for gay men diagnosed within the last year in London.
Gay Men's HIV Support Group which meets each Monday evening at a Soho location, for longer term diagnosed gay men in London.
Negative Partners Group which meets the last Thursday of the month at THT on Gray's Inn Road, open to the negative partner in a serodiscordant relationship.
In the autumn THT will be starting a Sex Addiction Support Group facilitated by their new addictions counsellor.
To access any of the above support groups, please call Simon Johnson on 020 7812 1777 during office hours from Monday to Friday.
Helplines
London Lesbian & Gay Switchboard - 020 7837 7324
London Lesbian & Gay Switchboard (LLGS) www.llgs.org.uk provides an information, support and referral service for lesbians, gay men, bisexual and trans people (LGBT) and anyone who needs to consider issues around their sexuality. Our helpline number is 020 7837 7324.
You can call us between 10am and 11pm any day of the week, 365 days a year to talk to a fully trained volunteer who will be helpful, friendly and supportive. Operated entirely by lesbian, gay, bisexual and trans volunteers, we offer support and information to any caller on any subject to do with sexuality.
Sex and sexual health – You can ask us anything you like about sex; wanting it, having it, safer sex, sexual health and where to go if you have an itch or a sore. Perhaps you're worried about HIV and AIDS - we'll tell you what the risks are and what precautions you can take.
Coming out – Call us if you want to talk about your feelings; are frightened, confused, isolated or coming to terms with your sexuality.
Going out – Find out where to go; bars, clubs, saunas, social and sports groups or support groups etc – we have comprehensive London and UK listings.
Oh by the way – we won't tell you what to do, we won't judge you and we won't tell anyone else about your call.
LLGS helpline is open: from 10am to 11pm, seven days a week, 365 days a year.
Helpline number: 020 7837 7324
Text phone number: 020 7689 8501
Information website www.queery.org.uk provides 24 hour access to our database of information and resources for the LGBT community.
We have vacancies for the following VOLUNTEER roles: telephone helpline volunteers (full training given, we particularly need people with day time availability), community fundraisers, media relations managers, event co-ordinators, and administration workers. For more information about all the volunteering opportunities at LLGS, call 020 7837 6768 or visit www.LLGS.org.uk
LLGS was launched in March 1974, so this year we are proud to celebrate 35 years of helping our community.
THT Gay Men's Sexual Health Helpline - 020 7998 4161
This is a new helpline to give, information, advice and support about sexual health to gay men in London, whether they have HIV or not.
Broken Rainbow
The Broken Rainbow LGBT Domestic Violence Helpline has partnered with London Lesbian & Gay Switchboard to provide an improved service to the Lesbian Gay Bisexual and Transgender community specifically. The helpline is staffed by LGBT people and offers a confidential service, across the UK, and supports LGBT individuals, family, and friends experiencing domestic violence. They also take calls from agencies seeking information and advice.
The Broken Rainbow LGBT Domestic Violence Helpline is open on: Mondays and Thursdays from 2pm to 8pm; Wednesdays 10am till 1pm. The Helpline numbers are: 08452 60 44 60 - low cost from landlines and 0300 999 LGBT (5428) - better value from mobiles. (Calls to 03 numbers cost no more than a national rate call to an 01 or 02 number and must count towards any inclusive minutes in the same way as 01 and 02 calls. These rules apply to calls from any type of line including mobile, BT, other fixed line or payphone.)
Further information is also available via their website: www.broken-rainbow.org.uk.
HIV treatment and health information
Terrence Higgins Trust and NAM are working together to provide face to face, printed and on-line treatment and health information for people living with HIV in London.
HIV Health Support Service
The HIV Health Support Service will be useful if you have just been diagnosed with HIV, or if you are thinking of starting treatment, changing treatment or experiencing side effects. Your local health trainer can help you gain more knowledge about anti-HIV drugs and how the virus affects your body. They can also help you make changes so you can lead a healthier life.
The service is available across the capital in clinics, at HIV and other community organisations, and if necessary at home. If you prefer you could meet other people with HIV by attending a group health skills session. To find out more information or to make an appointment with your local health trainer call 020 7737 9740.
Publications
NAM and THT’s treatment and health publications are pitched at different levels to suit different people’s needs.
The publications are:
- a summary resource setting out the ten most important things it is good to know about HIV and its treatment;
- ten illustrated fact sheets introducing key concepts in HIV treatment and health;
- a range of entry-level booklets, covering broad topics. These may be particularly helpful if you are newly diagnosed. Click for an example of a booklet called Your Treatment;
- a range of booklets on specific treatment and health topics, providing more detailed information;
- a monthly newsletter: HIV Treatment Update;
- a comprehensive directory of symptoms, illnesses, treatments and side-effects;
- a treatments information website.
All printed resources are available free of charge to anyone living with HIV in London. Simply call 020 7840 0050 or e-mail info@nam.org.uk.
FS magazine
The second spring 2009 issue of FS has been published and is available in bars and clubs across London. You can also download a pdf of issue 111 by clicking on the image on the right. Download pdf's of previous issues of FS from the website.
Issue magazine
The latest edition of 'Issue', the magazine of HIV and sexual health sector development,
has been published. Copies can be obtained by emailing Andie Dyer at
andie.dyer@tht.org.uk.
U+ magazine
Terrence Higgins Trust have launched a new magazine for gay men with HIV. U+ presents
health information in an easy to read magazine format, with a mix of articles, interviews
and quizzes, as well as a problem page.
Each issue focuses on a particular theme. Issue three (out now) is about sex for gay men with HIV – dealing with HIV treatment, who's who at your clinic, other ways to look after your body and mind. Click on the image to download a copy from this website.
If you distribute health promotion resources to gay venues in your area, we would particularly encourage you to help us make U+ available on the commercial gay scene.
To order free copies for your organisation, please contact healthpromotion@tht.org.ukMass Media - what is in the press and how to get more information about it:
GMFA's Know Your HIV Status Campaign:
One third of HIV positive gay men don't know they have HIV. If you know you have HIV, you can make informed decisions about your health, the sex you have and your future.
For more information contact tim.molloy@gmfa.org.uk
THT's new 'Seroconversion' campaign:
June 2009: Terrence Higgins Trust (THT) launched a new campaign to advise men of the symptoms that could mean they have been infected with HIV.
Often symptoms of early HIV infection are disregarded. Even GP's often won't think to suggest an HIV test when patients present with symptoms of early HIV infection.
80% of men who are infected with HIV show symptoms of seroconversion (when the body produces anti-bodies to fight HIV). This campaign aims to inform men that if certain symptoms, which can easily be confused with those of a cold or flu, occur between one and six weeks after possible exposure to HIV, they may have picked up HIV.
To obtain a free HIV test in London, see the page of information about clinics in London and find a clinic whose opening times and location suits you best.
Counselling waiting times & information:
Free Counselling Service from The GMI Partnership
The new GMI Partnership Counselling Service offers talking therapies which are designed to assist men who have sex with men:
- identify their risk factors for unsafe sex
- reflect on the issues and challenges in practising safer sex
- set goals and plan and implement strategies for reducing or eliminating risk.
This service is open to all men who have sex with men, without charge and regardless of HIV status, who have concerns with adopting or maintaining safer sex and HIV risk reduction behaviour. All men entering the Service will be offered a confidential assessment, and through a process of discussion will be able to identify the most appropriate talking therapy for them. These include:
- Cognitive Behavioural Therapy
- Peer mentoring
- Other forms of counselling
For further information or to make an assessment appointment please call 020 8305 5002 or email info@gmipartnership.org.uk.
Healthy Gay Living Counselling @ THT
THT now have a dedicated substance misuse and addictions counsellor within the well-being team offering a One-2-One service to gay and bisexual men. It may well be that you do not want to talk to friends or family about your concerns so if you are worried or anxious about the drugs you take, then this counselling resource may be able to help. So if your relationship with drugs is having a negative impact on other areas of your life, feels out of control or you are using drugs in combination and don't know what the consequences might be, feel free to call us with your concerns. You can arrange an assessment by calling the Wellbeing Service on 020 7812 1777 and speak with either Simon or Jason.
Also appointed is a specialist young person's counsellor working with young men living, working or studying in the borough of Southwark. To access this service you need to be male, aged between 16 and 24 and either gay, bisexual or questioning your sexuality. There is currently no waiting time for this service.
Languages we can provided counselling in are: English, French, German, Portuguese, Spanish, Italian, Yoruba, Luganda, Shona. Counselling is available for couples and individuals at sites across London, with appointments available in the evenings or on Saturdays, as well as during the day.
To book an appointment call Simon Johnson on 020 7812 1777 - Office hours are 9.30am to 5.30pm
Volunteers needed
The Gay Men's Interactions Partnership has exciting new opportunities for volunteer peer mentors, counsellors and health trainers. Click for more information about volunteering with the GMI Partnership to view the full advert, call 020 8583 2404 or email volunteering@gmipartnership.org.uk
Other Resources
Resources from THT
Healthy Respect
The Healthy Respect web pages give advice and information for people who have experienced problems with their healthcare because of their HIV status. Problems with GPs, dentists and other healthcare professionals are highlighted and solutions are offered. For more information, visit www.tht.org.uk/healthyrespect
GPs and Gay Men (CHAPS)
This programme of work has launched with the aim of providing gay and bisexual men with information which will enable them to have a better understanding of how the healthcare system works and why being gay or bisexual is important to their health care.
The programme includes a website for gay men including issues such as how the health
system works, what it can do and how being gay might effect your health and healthcare.
This can be found at
http://gpsandgaymen.chapsonline.org.uk.
The website also contains a health professionals’ section containing extra
resources to ensure their services are meeting the needs of their gay and bisexual
patients.
A booklet accompanying this site, ‘GP treatment for gay and bisexual men’ is also available by emailing healthpromotion@tht.org.uk. You can also order booklets individually by calling THT Direct 0845 12 21 200.
Your next steps
This booklet is for you if you’ve just found out you have HIV. You might also find it helpful if you’ve known for a while, but have not wanted to think about it much until now.
The booklet covers things that we often want to know about at this time.
There’s straightforward information about what HIV is and how we can
look after our health. The booklet talks about having sex when you have HIV,
and whether or not it’s a good idea to share your news with other people.
‘Your next steps’ is available by emailing healthpromotion@tht.org.uk or can be ordered individually by calling THT Direct 0845 12 21 200.
Other Services or events of interest to gay men in London.
Living Well
Living Well is an NHS funded programme and is one of the core healthcare initiatives being offered to people living with HIV across London. Living Well provides a wide range of options that are intended to promote long-term life skills, encourage the development of a supportive social community and empower participants with the ability to self manage their condition and work in partnership with their health care professionals.
Options provided are:
Positive Self Management Programme (PSMP)
One of the first steps for those who join Living Well is the Positive Self-Management Programme; better known as the PSMP. The PSMP is run by trained facilitators, some of whom are living with HIV themselves, and consists of seven weekly sessions of two and a half hours each and an optional residential weekend. Some of the areas covered include:
- Goal setting
- Action planning
- Problem solving
- Coping Skills
- Support and information
- Planning for the future
The PSMP is delivered in a supportive group environment. Through discussion and sharing of information participants are encouraged to attain new skills and direction to help them make better informed decision about managing their condition.
The PSMP allows participants to meet other people facing similar concerns and challenges, helping them to overcome isolation and build a supportive social network.
Non-residential Weekend
Participants who have completed the PSMP are invited to attend an optional residential weekend. This is an opportunity to engage in workshops that will encourage a deeper experience and exploration of some of the issues and topics raised throughout the seven week programme
Facilitator Training
Training is offered to participants who have completed the PSMP and wish to become tutors, delivering the PSMP to their peers. Training is delivered under assessed conditions under license of Stanford University.
Life-Coaching
Twelve one-to-one sessions are offered with a qualified coaching psychologist. Coaching is suitable for clients who are keen to work strategically towards achieving future goals.
Counselling
Hour long sessions with a Living Well counsellor. These sessions are suitable for clients who are dealing with emotional issues which are usually related to their HIV status.
Positive East
The Gay Men's Team at Positive East offers a comprehensive range of services for gay men and men who have sex with men who are positive, negative or untested, who live or work in East London. For details visit www.gaymenswellbeing.com, email us at gaymen@positiveeast.org.uk or telephone Positive East on 020 7791 2855.
Himat, a group for South Asian gay, bisexual and men who have sex with men exploring issues of sexuality, culture, religion and race. For many South Asian gay men in London, facing up to being different can be full of unique problems. Being a minority within a minority can create a strong sense of isolation from other gay men. For details on Himat visit www.gaymenswellbeing.com or call on 020 7791 2855.
Positive Life is an activities group for HIV positive gay and bisexual men. The groups main aims are to offer a non-scene space for gay and bisexual men to meet and discuss topics of interest; to make friends with other positive gay men; be able to share experiences and where they can give and/or receive support, as well as an opportunity to learn new skills. For details on Positive Life go to www.gaymenswellbeing.com email positivelife@positiveeast.co.uk or call on 020 7791 2855
Signpost, a confidential telephone helpline for men who have sex with men provides basic information and guidance on sexual health, HIV/STI's as well as accessing services and groups across east London. Signpost operates every Tuesday and Thursday from 6.30 to 8.30pm on 020 7790 5795. For details on Signpost visit www.gaymenswellbeing.com
Advice services for Homeless LGBT people across London are saved and will expand
Stonewall Housing provides supported housing, advice and advocacy for the lesbian, gay, bisexual and transgender communities in London.
They research and lobby at a strategic level on the housing issues affecting our communities.
They are the only specialist housing support provider in England wholly dedicated to serving the LGBT communities.
At the heart of their work is the aim to help LGBT people find a home they feel safe and secure in.
Anyone who is homeless or has a housing problem and needs advice can call the advice line: 020 7359 5767 or visit www.stonewallhousing.org.
Interesting articles and news from around the world:
UNITED STATES: Scientists Now Trying to Outflank HIV
In a new approach, researchers are sidestepping the body's immune system to fight HIV by inserting a gene into muscle tissue to create protective antibodies. Already successful in mice, the technique has now worked in monkeys, which scientists turned to because of the similarity of simian immunodeficiency virus (SIV) to HIV.
"We used a leapfrog strategy, bypassing the natural immune system response that was the target of all previous HIV and SIV vaccine candidates," said study leader Dr. Philip R. Johnson of the Children's Hospital of Philadelphia. Over a decade, Johnson, Reed Clark of Nationwide Children's Hospital in Columbus, Ohio, and colleagues developed immunoadhesins - antibody-like proteins designed to attach to SIV and block it from infecting cells. The research was supported by the National Institute of Allergy and Infectious Diseases.
The team injected monkeys' muscles with modified adenovirus that carried immunoadhesin DNA, and then the muscles began producing the antibodies. One month later, nine vaccinated monkeys and six unvaccinated control monkeys were intravenously challenged with SIV. None of the vaccinated monkeys developed AIDS, though three showed signs of infection. A year later, they still had concentrations of the vaccine-generated antibodies in their blood. All six unvaccinated monkeys acquired infections, and four died.
Building upon this progress, Johnson is working with the International AIDS Vaccine Initiative toward human trials of a new HIV vaccine candidate.
The full study, "Vector-Mediated Gene Transfer Engenders Long- Lived Neutralizing Activity and Protection Against SIV Infection in Monkeys," was published online ahead of print in Nature Medicine (05.17.2009:doi:10.1038/nm.1967).
UK's failure to tackle undiagnosed HIV infections is 'appalling' says The Lancet
The large number of undiagnosed HIV infections in the UK is “appalling”, a former government official is quoted as saying in an editorial published in the May 30th edition of The Lancet.
“There is no credible strategy to diagnose and care for those living with, but unaware of HIV in Britain today”, writes the author of the editorial.
There are 77,000 people living with HIV in the UK. However, it is estimated that 21,000 of these individuals are unaware of their HIV infection.
Many of these undiagnosed individuals will only have their HIV detected when they are already seriously ill with an AIDS-defining illness. Late diagnosis of HIV is the underlying cause of the majority of HIV deaths still seen in the UK. With earlier diagnosis these individuals would have been able to take appropriate treatment for HIV and other infections meaning that these deaths are entirely avoidable.
Furthermore, there is accumulating evidence that the undiagnosed individuals are the principal source of new HIV infections in the UK. A presentation by Dr Valerie Delpech at a recent NAM symposium on the potential of HIV treatment to help control the spread of HIV emphasised the importance of undiagnosed HIV to the continued epidemiology of HIV. One of the event's take home messages was that reducing the number of undiagnosed HIV infections is essential to the control of the epidemic.
“It should be a matter of deep concern to the UK’s Department of Health that so many individuals are entirely unaware of their positive HIV status”, states the editorial. Recommendations from the Health Protection Agency that individuals with any risk or possible symptoms of HIV infection should be offered an HIV test “have largely been ignored”, write the author.
“No one is listening” to urgent pleas for action to reduce the high number of undiagnosed infections, continues the editorial. At a recent seminar on late diagnosis of HIV, a senior HIV consultant described the rejection by a specialist GP journal of a study showing that symptoms of primary HIV infection were often missed in general practice and the potentially serious consequences of this. Nor are hospitals paying adequate attention “to their public health responsibilities, of which HIV diagnosis is an important part.” Furthermore, primary care trusts have exhibited little interest in “this serious public health challenge.”
The Lancet editorial recommends that all patients registered with GPs and admitted to hospital who are aged between 15 and 59 should be offered an HIV test. It notes that routine antenatal HIV testing in the UK has a very high acceptance rate.
Failure to develop a strategy to deal with the high level of undiagnosed HIV infections in the UK “is an extraordinary failure of public health ”, concludes the editorial, adding “this failure needs an urgent response.”
Article reference:
"The UK’s appalling failure to tackle HIV." The Lancet 373: 1820, 2009.
AFP: Call to brand HIV positive Swazi buttocks fuels debate
JOHANNESBURG , May 26, 2009 (AFP) - Swazi residents were asked Tuesday to debate a politician's call for HIV positive citizens to be branded on the buttocks, which has sparked an uproar in the small mountain kingdom.
The Times of Swaziland asked for feedback on best ways to combat HIV and rights to freedom of speech after Timothy Myeni told fellow politicians that all Swazis should be tested for HIV and their backsides marked if infected.
"I have a solution to this virus. The solution will come from a law that will make it compulsory to test for HIV. Once you test positive, you should be branded on the buttocks," the member of parliament said last week.
"Before having sex with anyone, people will then check the buttocks of their partners before proceeding with their mission," the newspaper reported him saying.
Landlocked Swaziland is one of the world's poorest nations with the highest HIV prevalence in the world under the rule of Africa's last absolute monarch King Mswati III.
Miyeni , who leads a popular gospel group, has stuck to his call for compulsory HIV testing but apologised for the buttocks branding suggestion.
"I am very sorry for saying HIV positive people should be branded, I did not know it would turn out like this. I have seen that the suggestion was very offensive and many think I was discriminating, so I withdraw my statement," he said last week.
Reader responses will be published in the Times of Swaziland next Tuesday, the newspaper said in its online edition.
UK HIV charities produce guide to criminal HIV transmission
A guide explaining prosecutions for HIV transmission has been produced by UK HIV charities, THT and NAT.
Since 2003, a number of people with HIV have been imprisoned for “reckless” HIV transmission and many more cases have been investigated by the police without reaching court.
The new guide ( which can be downloaded here) explains that these prosecutions have been brought using the 1861 Offences Against the Persons Act and that the individuals have been convicted of grievous bodily harm.
For a person to be guilty of reckless HIV transmission, it is necessary for five criteria to apply at the time the alleged offence was committed:
- The person must know they have HIV.
- They must understand how HIV is transmitted.
- They did not tell their sexual partner that they had HIV.
- They did not use a condom.
- HIV was transmitted to their sexual partner.
There is information in the guide about the circumstances in which an offence has not been committed. For example, a person cannot be prosecuted for reckless HIV transmission if they had unprotected sex that did not result in HIV be transmitted.
Scientific evidence has been used to “prove” that a person transmitted HIV to another individual. The new guide explains that this involves complex tests known as phylogentic analysis. Although this can show if the virus in two individuals is similar, it cannot prove that a person transmitted HIV to another.
It is vital that individuals accused of reckless HIV transmission obtain expert legal advice as soon as possible. There is information in the guide about how to obtain this.
Finding out that you have HIV can be a shocking experience and difficult to come to terms with. Anger and blame are common experiences. However, feeling about living with HIV an change over time, and the guide notes that tens of thousands of people with HIV are living normal, productive lives. It therefore urges people not to rush into an allegation of reckless transmission. It also notes that the sexual history of a person making a complaint will be thoroughly investigated ,in effect “put on trial” and previous sexual partners will need to be contacted and tested to rule out the possibility that they were the source of the HIV infection.
THT Direct provides a good source of information and support about the criminal law and HIV transmission. They can be contacted 0845 1221200.
You can also read about HIV and the law here.
Even a very low viral load may cause hardening of the arteries in patients with HIV
HIV-positive individuals have an increased risk of hardening of the arteries, or atherosclerosis, even when taking into account the possible effects of HIV treatment, continued HIV replication, and immune suppression, US investigators report in the June 1st edition of "AIDS". They believe that chronic inflammation, caused by even very low levels of HIV replication, may be the cause.
Cardiovascular disease is an increasingly important cause of illness and death in people with HIV. There are a number of possible explanations for this. These include the side-effects of some anti-HIV drugs; and the inflammation that can accompany HIV replication and a weak immune system.
Chronic inflammation and immune activation have both been identified as risk factors for atherosclerosis (hardening of the arteries). Investigators wished to test the importance of HIV treatment, HIV replication, immune suppression, and chronic inflammation to hardening of the arteries in HIV-positive individuals.
To ensure that their cross-sectional research could examine each of these factors, their study population comprised a diverse sample of HIV-positive patients. This included 'elite' controllers (33 individuals), patients who maintained an undetectable viral load without the need for HIV treatment; untreated patients with a detectable viral load (96 individuals); and patients taking antiretroviral therapy some of whom had an undetectable viral load (180 patients), with others having a detectable viral load (92 individuals).
The researchers compared carotid intima-media thickness, an important measure of atherosclerosis, in the HIV-positive patients with 93 HIV-negative controls. They then undertook further analysis restricted to the patients with HIV to assess the importance of HIV-related factors to hardening of the arteries.
As expected, HIV-positive patients had significantly higher carotid intima-media thickness than the HIV-negative controls (median 0.91 vs 0.72 mm, p < 0.001). This remained the case when the investigators controlled for potentially confounding risk factors such as cigarette smoking, blood lipids, and high blood pressure (p < 0.001).
Furthermore, the researchers found that carotid intima-media thickness was higher in HIV 'elite' controllers than HIV-negative controls (median 0.92 vs 0.72 mm. p < 0.001). This difference was still significant when the investigators restricted their analysis to controllers with a CD4 cell count above 500 cells/mm 3 (p = 0.001). Further analysis that took into account independent risk factors for hardening of the arteries still showed that 'elite' controllers had significantly higher carotid intima-media thickness than HIV-negative controls (p = 0.031).
The investigators then compared carotid intima-media thickness between “elite” controllers and HIV-positive patients not taking antiretroviral drugs who had a detectable viral load. This comparison showed that controllers had slightly higher carotid intima-media thickness (0.91 vs 0.83 mm). The investigators write that this suggests “that high levels of HIV replication and/or immunodeficiency…are not a prerequisite for the development of atherosclerosis in the setting of untreated HIV infection.”
There was no evidence of a difference in carotid intima-media thickness between controllers and patients taking HIV treatment, irrespective of whether they had an undetectable viral load. Nor was CD4 cell count shown to be significant in any of the investigators’ analysis.
Patients taking antiretroviral therapy had higher carotid intima-media thickness than those not taking anti-HIV drugs (0.94 vs 0.85 mm, p = 0.006). Increased duration of treatment with anti-HIV drugs, therapy that included a protease inhibitor, and use of a nucleoside reverse transcriptase inhibitors were all significantly associated with increased carotid intima-media thickness (all p < 0.001).
The investigators also found that levels of C-reactive protein, a measure of inflammation, were higher in HIV-positive patients than controls (p = 0.03). There was no difference in C-reactive protein levels between controllers and other groups of HIV-positive patients.
“Compared to uninfected controls, carotid intima-media thickness was higher among all groups of HIV patients, irrespective of antiretroviral treatment or the level of viremia”, write the investigators. They add “these data argue for a possible role of persistent HIV-associated inflammation as a potential cause for accelerated atherosclerosis in HIV disease".
Even a very low level of HIV replication that is below the limit of detection may be contributing to inflammation and hardening of the arteries. The investigators therefore conclude “in the future, achieving and maintaining even lower viral loads than current therapies permit in individuals with HIV will need to be investigated both in terms of HIV disease and cardiovascular risk.”
Article reference:
Hsue PY et al. "Role of viral replication, antiretroviral therapy, and immunodeficiency in HIV-associated atherosclerosis" AIDS 23: 1059-67, 2009.HIV drugs 'could stop virus spread'
The main focus for HIV prevention work is still encouraging people to use condoms.
But in this week's Scrubbing Up health column, HIV expert Michael Carter says increasing the numbers taking medication would reduce infections to the same degree.
Over the last 15 years, HIV treatment has transformed the outlook of people with the virus.
Modern HIV treatment is now so good many with the virus will be able to live a normal lifespan.
But HIV treatment also has another desirable outcome - the people who take it are less infectious.
Indeed, the impact of HIV treatment on infectiousness is so great that it might have the potential to stop the epidemic in its tracks if everyone took an HIV test each year and everyone diagnosed with HIV received treatment.
'Zero risk'
The currently available treatment cannot cure a person of HIV.
Instead, taking a combination of three different drugs every day can reduce levels of HIV in the blood to undetectable levels.
Because there is hardly any HIV around, the immune system can stay strong and fight infections.
Treatment not only works against virus in the blood, it also lowers the amount of virus in genital fluids, and this has a huge impact on an individual's infectiousness.
“ Taking long-term HIV treatment to help control the epidemic is realistic ”
Indeed, some doctors believe that in certain circumstances people taking HIV treatment pose a zero risk of infection to their sex partners.
In January 2008 some senior HIV doctors in Switzerland issued a statement that said that people who've been taking HIV treatment for at least six months, who take their treatment properly, and who don't have any sexually transmitted infections, are never infectious to their monogamous heterosexual partner.
Evidence supporting what's become known as the Swiss Statement comes from studies that showed that there were no HIV transmissions in heterosexual couples when the amount of virus in the blood fell below a certain level.
No replacement
There is a general consensus that anti-HIV drugs can dramatically reduce the risk of HIV transmission.
Just how dramatic the impact of treatment on infectiousness actually is has been hotly debated.
It's been pointed out that there are apparent cases of HIV transmission when a person is taking HIV treatment, despite having undetectable levels of the virus.
However, these are few and far between (although that's likely to be little comfort for the individuals involved).
Overall, HIV treatment resulting in undetectable levels of the virus in the blood is thought to reduce the risk of HIV transmission to the same extent as correct and consistent condom use.
That doesn't mean that it is a replacement for condoms or other methods of HIV prevention.
Condoms remain central to the control of the epidemic, not least because sexually transmitted infections can increase the amount of HIV in genital fluids, meaning a person is more infectious.
There is real hope that HIV treatment can make a difference to the spread of the epidemic.
Increasing the number of people on treatment is being advocated as an HIV prevention method in the Canadian province of British Columbia.
Getting more people to test for HIV and start treatment at the right time could have a big impact on the number of new infections in the UK, which are among the highest in Europe.
Modern HIV treatment is powerful, can consist of just one pill once-daily, and often causes only mild side-effects.
Taking long-term HIV treatment to help control the epidemic is therefore realistic.
HIV nevertheless remains an extremely serious, life-affecting and potentially life-limiting infection.
Recognising the potential of HIV treatment to prevent infections could slow, even halt the epidemic, and spare people the physical and mental suffering that the infection all too often entails.
It's worth giving it a try.
VIEWPOINT - Michael Carter, Editor for NAM, theHIV/Aids information charity
Immune suppression has important role in development of non-AIDS cancers
Immune suppression plays an important part in the development of non-AIDS-defining cancers in people with HIV, Australian investigators argue in a letter published in the June 1 st edition of AIDS. The investigators were prompted to write to the journal after the publication of a US study earlier this year that found that neither CD4 cell count nor use of antiretroviral therapy were risk factors for such cancers.
The authors note that this study, which involved 4500 individuals diagnosed with HIV between 1984 and 2006, did not include an analysis of the impact of the cumulative duration of immune suppression on cancer risk.
Furthermore, they refer to the findings of other research that shows a clear link between the risk of non-AIDS-defining cancers and immune suppression.
The D:A:D study examined risk factors for death due to cancer in 23,500 patients taking antiretroviral therapy. Among the risk factors for death from a non-AIDS-defining cancer were latest CD4 cell count. Univariate analysis of the results of this study also showed that the cumulative duration of immune suppression, defined as time spent with a CD4 cell count below 200 cells/mm 3 was also significant.
Research conducted by investigators at the Chelsea and Westminster Hospital in London also showed that a lowest ever CD4 cell count below 200 cells/mm 3 and use of antiretroviral therapy were risk factors for the development of a non-AIDS-defining cancer. This research involved over 11,000 patients who attended the hospital between 1983 and 2007.
“We believe that the findings from these studies suggest that HIV-related immunosuppression does play an important role in the risk of specific cancers in the HAART era”, comment the authors. They also note “the remarkable similarity in the range of cancers occurring at excess rates in solid organ transplant recipients and people with HIV infection strongly supports an effect of long-term immunosuppression on cancer incidence.”
Accordingly, the authors recommend that future large cohort studies should examine “the independent effects of ageing, the time-dependent severity of immunosuppression, and the cumulative duration of immunosuppression on cancer risk.” They also recommend that the role of these factors in the development of individual cancers, or groups of cancers, such as those caused by the same virus, should be examined.
They believe that such analyses “will assist in the development of strategies to minimize or prevent the occurrence of cancer in patients with long-term immune deficiency.”
Article reference:
Vajdic CM et al. A role of ageing in HIV infection in HIV-related cancer risk. AIDS 23: 1183-84, 2009.
Don't take Gingko with efavirenz
The herbal remedy Ginkgo should not be taken with the anti-HIV drug efavirenz, Dutch investigators warn in the June 1 st edition of AIDS. They report the case of an individual whose viral load became detectable with the development of drug resistance because Ginkgo interacted with efavirenz.
Efavirenz (Sustiva, also in the combination pill Atripla) is one of the mainstays of first-line HIV treatment. It has a powerful anti-HIV effect, is easy to take, has a long half-life, and generally only causes mild side-effects.
The body metabolises efavirenz using the P450 pathway in the liver. Other medicines, herbal remedies and recreational drugs are also processed using this mechanism, meaning that they can interact with efavirenz.
Such an interaction occurred in a 47-year-old HIV-positive patient in Amsterdam, leading to the virological failure of his HIV treatment.
The patient was fully adherent to his antiretroviral therapy and reported never missing a dose. His treatment consisted of efavirenz combined with FTC (emtricitabine) and tenofovir (Viread). The patient started therapy with this combination in 2005.
In late 2007, he experienced virological failure with the K103N and M184V resistance mutations emerging.
To try and identify the cause of this treatment failure, his doctors questioned him about the use of other medications and drugs. It became clear that the only product the individual had been taking was Ginkgo biloba.
Using stored samples from the two years of efavirenz treatment, the investigators checked concentrations of the drug in the patient’s blood.
Concentrations of efavirenz in his blood declined from a peak of 1.26mg/l (well within the drug’s therapeutic range) in late 2006 when the patient’s viral load was undetectable, to a non-therapeutic 0.48mg/l in February 2008. By this time the patient’s viral load was 1780 copies/ml.
Gingko is a widely-used herbal remedy that is thought to have beneficial effects on concentration, memory, dementia and depression. Of note, efavirenz can cause side-effects such as poor concentration and depression. Gingko's chemical composition means that, like efavirenz, it is metabolised using the P450 pathway. It is already known that Gingko interacts with other drugs processed by the body in this way, such as warfarin, aspirin and ibuprofen.
“We conclude”, write the investigators, “that an intake of Gingko can decrease human plasma efavirenz levels, may result in virological failure and should be discouraged.”
Article reference:
Wiegman D-J et al. Interaction of Gingko biloba with efavirenz. AIDS 23: 1184-85, 2009.
AFP: Cream with green tea extract hinders HIV transmission: study
WASHINGTON, May 19, 2009 (AFP) - A chemical found in green tea helps inhibit sexual transmission of the virus which causes AIDS, said a study Tuesday that recommends using the compound in vaginal creams to supplement antiretrovirals.
Medical experts at Germany's University of Heidelberg said the compound could be a low-cost arrow in the quiver of medical weapons to fight the spread of HIV in research-poor countries.
The researchers said they determined that the green tea polyphenol, or vegetable tannin, called epigallocatechin-3-gallate (EGCG) is capable of neutralizing a protein in sperm which serves as a vector for viral transmission during sex.
EGCG degrades what is known as a semen-derived enhancer of virus infection, or SEVI, described in the study as "an important infectivity factor of HIV."
Writing in the online edition of the Proceedings of the National Academy of Sciences, the researchers said they "recently identified a peptide fraction in human semen that consistently enhanced HIV-1 infection."
SEVIs capture viral elements and attach them to the surface of target cells, enhancing cell fusion and decreasing a cell's ability to repel viral threats.
EGCG "targets SEVI for degradation" and "abrogates semen-mediated enhancement of HIV-1 infection in the absence of cellular toxicity," said the researchers, some of whom work at the university's Heinrich- Pette-Institute for Experimental Virology and Immunology.
Because of its effects on semen-based HIV transmission threats, the study's authors said "EGCG appears to be a promising supplement to antiretroviral microbicides to reduce sexual transmission of HIV-1."
With the vast majority of the world's 33 million people with HIV infected through heterosexual sex, and as 96 percent of new infections occur in poor and developing nations, researchers said the use of green tea EGCG in topical creams would "provide a simple and affordable prevention method" to guard against HIV transmission.
Green tea, which originated in China and is widely consumed in Asia, the Middle East and growing numbers of western countries, is already popular for its antioxidant qualities.
AUSTRALIA : What Men Who Have Sex with Men Think About the Human Papillomavirus Vaccine
The current study "aimed to ascertain the attitudes of men who have sex with men (MSM) to the human papillomavirus (HPV) vaccine and to determine the age at which MSM would be willing to ask for the HPV vaccine in relation to their age of sexual debut."
The study questionnaire was completed by 200 of 205 MSM attending the Melbourne Sexual Health Center between December 2007 and January 2008 (98 percent acceptance rate). The median age of participants was 27.
Only 30 percent of respondents indicated they were aware that a vaccine was available offering protection against certain types of HPV. When told of the increased risk of anal cancer among MSM, 47 percent of participants indicated they would be willing to pay $450 (US $333) for the vaccine course. Asked whether they would be willing to disclose as MSM to health care providers in order to access the vaccine without cost, 93 percent said they would, but not until a median age of 20: two years after the median age of sexual debut (18), and after a median of 15 sex partners.
"If the HPV vaccine is targeted to MSM, the challenge will be for MSM to be vaccinated before they acquire HPV infection," the authors concluded.
Sexual problems common in HIV-positive gay men
Just under half of gay men with HIV have multiple sexual problems, Australian investigators report in the May edition of the Journal of Sexual Medicine. HIV-positive gay men were significantly more likely to report sexual difficulties than HIV-negative gay men, with the causes differing according to the men’s HIV status.
Sexual expression can affect physical, mental and social wellbeing. There is, however, little information about sexual dysfunction in gay men. The few studies that have been conducted in this population suggest that sexual problems in gay men can have a number of causes. These include social factors, such as age and employment status; physical health factors, related to HIV infection and other chronic illnesses; psychological issues, for example depression and internalised homophobia; and behavioural factors, including recreational drug and alcohol use.
Furthermore, studies to date have only focused on two measures of sexual dysfunction: erectile problems and problems with ejaculation. Nor has earlier research explicitly examined the association between poor sexual function in HIV-positive gay men and mental health. What’s more, the existing research has not examined if the sexual problems experienced by HIV-positive gay men are different to those encountered by HIV-negative gay men.
Investigators from Australia therefore conducted a study involving 542 gay men who were recruited from general practices that have a large number of HIV-positive patients. A total of 217 men (40%) included in the study were HIV-positive.
The men were asked if they had experienced any of seven sexual problems lasting for at least four weeks in the previous twelve months.
HIV-positive men were more likely than HIV-negative men to have experienced each of these measures of sexual dysfunction: erectile problems (52% vs 39%); difficulty ejaculating (31% vs 22%); premature ejaculation (21% vs 17%); loss of libido (60% vs 40%); lack of pleasure from sex (32% vs 26%); anxiety over sexual performance (47% vs 42%); and pain during sex (8% vs 7%).
Not only were HIV-positive men significantly more likely than HIV-negative men to report a single sexual problem (81% vs 67%, p < 0.001), they were also more likely to have experienced multiple problems (48% vs 35%, p = 0.002).
Next the investigators examined the causes of multiple sexual problems for HIV-positive and HIV-negative men.
For both HIV-positive and HIV-negative men, major depression was significantly associated with sexual problems (HIV-positive men, p < 0.05; HIV-negative men, p < 0.001).
However, other factors differed according to the men’s HIV status. For HIV-positive men, treatment with antidepressants (p < 0.05), poor coping strategies (p < 0.003) and unprotected anal intercourse with a casual partner in the previous six months (p < 0.001) were all significant. For HIV-negative men the significant factors were poor general health (p < 0.05), and lack of social support (p < 0.01).
“Rates of self-reported sexual problems are high among gay men in Australia”, write the investigators. They add, “Gay men with HIV are more likely to experience sexual problems than those without HIV. With the exception of major depression, factors associated with multiple sexual problems differ between the two groups.”
The investigators draw attention to their finding that sexual dysfunction in HIV-positive men is associated with unprotected anal sex with casual partners. They conclude this “needs to be a priority issue for future HIV prevention education.”
Article reference:
Mao L et al. Self-reported sexual difficulties and their association with depression and other factors among gay men attending high HIV-caseload general practices in Australia. J Sex Med 6: 1378-85, 2009.Ontario researchers look at gonorrhea in the throat
Infection with bacteria called N. gonorrhoeae is a problem among sexually active people, including men who have sex with men (MSM). Moreover, because gonorrhea can cause inflammation in the wet tissues of the genitals, rectum and throat, this inflammation can weaken these tissues and increase the risk of transmitting and getting HIV.
Into the throat
Researchers in the U.S. have found that gonorrhea-causing bacteria can infect the penis during insertive oral sex. Also, other U.S. researchers have found that gonorrhea of the throat (pharyngeal gonorrhea) can occur because of receptive oral sex.
To study pharyngeal gonorrhea, researchers collaborated at these Canadian institutions:
- Ontario Agency for Health Protection and Promotion: http://www.oahpp.ca/
- Public Health Agency of Canada: http://www.phac-aspc.gc.ca/index-eng.php
- McMaster University : http://www.mcmaster.ca/
- Hassle Free Clinic: http://www.hasslefreeclinic.org/
The team reviewed medical and laboratory records of men who attended the Hassle Free Clinic— Toronto’s premier clinic for STI (sexually transmitted infection) diagnosis and treatment—for the management of gonorrhea. The results suggest that gonorrhea is a relatively common STI and that studies assessing effective treatment of throat gonorrhea are needed.
Study details
Researchers reviewed the clinic’s medical records between 1995 and 2008. During this time, clinic staff took swabs from the throat, rectum and urethra of men who entered the study so they could be tested for gonorrhea and Chlamydia. In this report we will focus on gonorrhea.
Results - testing
In total, 178 cases of gonorrhea in the throat were detected. However, not all of these people returned to the clinic for further aspects of the study. Other key findings were as follows:
- 40% of 176 men with pharyngeal gonorrhea who underwent gonorrhea testing of their urinary tract (or urine samples) had gonorrhea-causing germs detected in the urinary tract.
- 40% of 89 men who had pharyngeal gonorrhea who also underwent rectal screening for this infection had detectable gonorrhea in their rectum.
These findings suggest that a substantial proportion of men with gonorrhea in their throat can also have this problem in their genitals or rectum.
Results - treatment
More than 99% of people who had pharyngeal gonorrhea received antibiotics, usually cefixime ( Suprax). Researchers encouraged participants to return to the clinic to undergo further testing to confirm that treatment worked—their gonorrhea was cured. However, only 122 out of 176 people returned for repeated testing. Among these 122 people, 9% (or 11 people) continued to test positive for gonorrhea of the throat, despite having received a course of antibiotics.
Nine of these 11 men returned for further study. Ten of the men were initially treated with cefixime and the 11th with ofloxacin ( Floxcin). The N. gonorrhoeae that could be grown or cultured from these people was still susceptible to cefixime despite its apparent treatment failure. In the case of the 11th man, he had been infected with a strain of ciprofloxacin-resistant gonorrhea.
The nine men were retreated with either cefixime or ofloxacin. Eight were cured. The 9th man received another dose of cefixime and was subsequently cured.
Key findings
Over the course of this study, N. gonorrhoeae was regularly found from throat swabs of men attending a major STI clinic. Moreover, throat infections would have been missed if urine samples or urethral swabs had been relied upon as the sole sample for analysis.
In about 9% of cases of pharyngeal gonorrhea, repeated bouts of antibiotics were necessary to achieve a cure. Clinic records indicate that the men who needed repeated treatment were abstaining from sex, suggesting that these cases represented apparent failure of treatment and not re-infection from the same partner.
Because of these cases of apparent treatment failure, the study team calls for the development and testing of specific antibiotic treatment regimens for pharyngeal gonorrhea.
Article references:
1. Handsfield HH and Sparling PF. Neisseria gonorrhoeae. In: Mandell, Douglas and Bennett. Principles and Practice of Infectious Diseases. 6th ed. Philadelphia: Elsevier, 2005. P. 2514-2529.
2. PHAC. Gonococcal infections. Canadian Guidelines on Sexually Transmitted Infections. 2008. Available at: http://www.phac-aspc.gc.ca/std-mts/sti_2006/sti_intro2006-eng.php. [Accessed March 31, 2009].
3. Jakopanec I, Borgen K, Aavitsland P. The epidemiology of gonorrhoea in Norway, 1993-2007: past victories, future challenges. BMC Infect Dis. 2009 Mar 19 ;9:33.
4. Ota KV, Jamieson F, Fisman DN, et al. Prevalence of and risk factors for quinolone-resistant Neisseria gonorrhoeae infection in Ontario. CMAJ. 2009 Feb 3;180(3):287-90 .
5. Ota KV, Fisman DN, Tamari IE, et al. Incidence and treatment outcomes of pharyngeal Neisseria gonorrhoeae and Chlamydia trachomatis infections in men who have sex with men: a 13-year retrospective cohort study. Clin Infect Dis. 2009 May 1 ;48(9):1237-43.
Disclaimer: Please don’t assume that GMFA or the Pan London HIV Prevention Partnership endorse or oppose the points of view of the authors. Please read these articles critically. Sometimes articles may contain mis-statements, we believe they are important to include because of the information they contain or the arguments they put forward. If you have a story or article on STI or HIV prevention which you would like to be distributed please forward it to londonservices@gmfa.org.uk.
Disclaimer: All of the above information is included in good faith, and is current at the time of publication.
Page references:
1 The Smoking Cessation Research And Training Programme. Peter Hajek, Robert West, Gay Sutherland.
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