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
Better Sex for Gay Men
If you’re looking for ways to spice up your sex life, or just want to try something different, then 'Better Sex for Gay Men' is for you. We've gathered together some of the best advice from lots of gay men on what can make for great sex. We’ve included plenty of photographs throughout and also lots of tips on how to keep the sex you have safe. It is available in bars and clubs around London and you can download 'Better Sex for Gay Men' from this website.
Upgrade Your Life
'Upgrade Your Life' contains lots of practical advice for looking after your health. If you've thought about making some changes, whether to your diet, the amount you drink, your friendships or relationships, we hope this resource will help. As gay men, sexual health and particularly preventing the transmission of HIV is important to us, so we've included information on how to make looking after yourself and your partners a part of your overall health plan. It is available in bars and clubs around London and you can download Upgrade Your Life from this website.
Let's Talk Sex
'Let’s Talk Sex' is packed with information and advice to keep the sex you have safe and fun - whether it is with casual partners, fuck buddies or a long-term boyfriend. Aimed at both HIV-negative and HIV-positive gay men, it includes information on avoiding risks with casual partners and fuck buddies, coming up with a plan to stay safe in relationships and talking openly about safer sex with your partners. It is available in bars and clubs around London and you can download Let's Talk Sex from this website.
Hot Sex!
Packed full of sizzling hot, graphic images of safer sex, 'Hot Sex' is a booklet about condom use in the style of a hardcore gay porn magazine. With page after page of explicit photos, 'Hot Sex' has lots of useful information on condom use and safer sex, and there's plenty of eye-candy on offer.
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 you can download 'Tested Negative' from this website.
Other small media resources for gay men.
Upcoming Courses & Workshops for gay men:
GMFA Courses
The remaining GMFA courses for 2010 will be scheduled shortly, check back soon...
PACE Workshops
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 from 6.30pm to 9.30pm.
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 20 September 2010.
Friend or Foe is a weekend workshop on self-esteem, exploring how you can relate to yourself in more compassionate, supportive and constructive ways and move away from being critical, nasty or destructive to yourself.
Begins 6.30pm Thursday 9 September. Continues Saturday 11 and Sunday 12 September.
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 6.30pm till 9pm. Next date: 29 September 2010.
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 7 October from 6.30 till 9.30pm for eight Thursdays (plus Saturday 10 May from 10am to 5pm).
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. (Thur/Fri eve, Sat & Sun all day - participants are asked to commit to all three days of the workshops)
Begins 6.30pm Friday 24 September. Continues Saturday 25 and Sunday 26 September.
To book a place or for more information call 020 7700 1323.
THT Courses
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.
Wednesday 22 September from 6pm to 9pm.
Book a place on 'Mind Your Backs Guys!'
Are you losing control?
If your drug taking could be having an overwhelming and damaging impact on your life and we may be able to help. Terrence Higgins Trust runs a free weekly group programme for gay men who feel that they have lost control of their relationship with the drugs that they are taking.
Friday 3rd September from 6.30pm to 9pm for eight weeks.
Book a place on 'Are you losing control?'
Call yourself a sex addict?
If you see yourself as a sex addict or a sexual compulsive and feel that your sexual behaviours are having an overwhelming and negative impact on your life, then we may be able to help. Terrence Higgins Trust is running 8 week group programmes for gay men who feel that their relationship with sex is somehow out of control.
Next course begins Thursday 21st October for eight weeks.
Book a place on 'Call yourself a sex addict?'
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 from 6.30pm to 9pm. Start date to be confirmed.
Book a place on 'Newly Diagnosed Men's Support Group'
Book a place on 'Negative Partners Support Group'
Other courses
Positive East runs a Recently Diagnosed Course in Stepney.
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. Courses 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.
Support Groups
The Midmonth Group (formerly 'The Midweek Group')
Thanks to sponsorship from The Eddie Surman Trust (020 7738 6893) and the hospitality of South Central pub in Vauxhall, 'The Midmonth Group', formerly supported by the UKC as 'The Midweek Group', continues to meet, socialise and have speakers on a regular basis (the 3rd Wednesday of every month). Anyone interested in joining the group can come along 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.
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
The London Lesbian & Gay Switchboard provides an information, support and referral service for the LGBT community and anyone who needs to consider issues around their sexuality.
Call Switchboard on 020 7837 7324. The line is open between 10am and 11pm any day of the week, 365 days a year.
LLGS is operated by fully trained volunteers who will be helpful, friendly and supportive to any caller on any subject to do with sexuality.
- Sex and sexual health - You can ask 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; if you are frightened, confused, isolated or coming to terms with your sexuality, LLGS volunteers can provide calm words when you need them most.
- Going out - Find out where to go: bars, clubs, saunas, social and sports groups or support groups etc - we have comprehensive London listings as well as most of the regional options.
LLGS volunteers are all gay, bisexual, lesbian or trans. We won't tell you what to do, won't judge you and won't tell anyone else about your call.
Information website www.queery.org.uk provides 24 hour access to our database of information and resources for the LGBT community.
Switchboard has 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 Direct - 0845 122 1200
THT Direct: 0845 12 21 200
Monday to Friday 10am – 10pm
Saturday & Sunday 12noon – 6pm
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.
For more information about HIV treatment, visit: www.gmfa.org.uk/positive and www.aidsmap.com.
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 latest issue of FS has been published and is available in bars and clubs across London. You can download a pdf of this issue by clicking on the image on the right. Download pdf's of previous issues of FS from the website.
Issue magazine
Copies of 'Issue', the magazine of HIV and sexual health sector development, can be obtained by emailing Andie Dyer at andie.dyer@tht.org.uk.
U+ magazine
U+ is a magazine for men living with HIV. It provides 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 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.
To order free copies of U+ for your organisation, please contact healthpromotion@tht.org.uk
Mass Media - what is in the press and how to get more information about it:
THT's new 'Relationships' campaign:
Spring 2010: Terrence Higgins Trust (THT) launched a new campaign to advise you, if you're in a relationship, to test before you stop using condoms, and to keep using condoms if you're still having sex outside your relationship.
For more information about the campaign, visit: www.gmfa.org.uk/londonservices/adcampaigns/latest
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 7160 0941 or email info@gmipartnership.org.uk.
PACE Counselling
Couples Counselling for People impacted by the Recession
PACE is London's leading charity promoting the mental health and emotional wellbeing of the lesbian, gay, bisexual and transgender community.
PACE is able to offer no cost or very low cost couples counselling to people who have become unemployed or who have been impacted by the recession.
Call Flavio on 020 7715 0370 for more information.
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.
Positive East also offers a rapid HIV testing clinic on Tuesdays between 6pm and 9pm. The service is free and confidential and no appointment is necessary but please ensure you arrive 30 minutes before the end of the session. For more details visit www.itsbettertoknow.org.uk or call 020 7791 2855.
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 KINGDOM : New HIV Cases 'Preventable'
In 2009, the HIV prevalence rate in England's North West was 80 diagnosed cases per 100,000 population, according to a new report by the Health Protection Agency North West and the Center for Public Health. Many of the 498 new diagnoses across Greater Manchester in 2009 "were acquired in the UK and would have been preventable," said Dr. Penny Cook, lead author of the report.
High-prevalence areas, nationally defined as more than 200 cases per 100,000 population, include the Manchester local authority (365.6), Salford (229.6), and Blackpool (203.6).
The number of patients seeking HIV treatment and care in the region rose 8 percent from 2008, to 6,238 individuals, the report said. The major modes of infection among new patients were heterosexual sex (48 percent) and sex between men (41 percent). That pattern was mirrored in the Greater Manchester area, with 250 cases tied to heterosexual sex, 202 to sex between men, 10 to mother-to-child transmission, six to injection drug use, and 29 undetermined.
"We must ensure that in this difficult economic time resources continue to be invested in prevention, since targeted health promotion campaigns save the NHS [National Health Service] a substantial amount of money in the long run by preventing infections," said Cook.
"As the NHS is transformed, prevention of sexually transmitted infections must be seen as a priority; otherwise, we risk not just higher levels of HIV but more chlamydia in young people and infections like syphilis," Cook said.
The full report is available online: http://www.cph.org.uk/showPublication.aspx?pubid=658
One in ten people in UK with gonorrhoea have a strain with reduced susceptibility to treatment
Depending of the definition of ‘resistance’ used, between 1% and 10% of people with gonorrhoea in the UK have a strain which is resistant to the antibiotic that is most frequently used to treat the infection. Releasing the data today, the Health Protection Agency drew attention to the risk of treatments becoming ineffective but did state that actual cases of treatment failure remain rare.
The public health body also released figures showing that just under half a million new diagnoses of sexually transmitted infections were made in 2009, continuing the upward trend seen over the last decade. The largest number of diagnoses are in young people under the age of 25.
Drug-resistant gonorrhoea
Recommended antibiotic treatments for gonorrhoea have changed frequently, as bacterial strains have developed resistance to existing treatments. In the late 1990s, resistance to drugs in the quinolone class (e.g. ciprofloxacin) led to the drugs being abandoned as first-choice treatment, to be replaced by drugs in the cephalosporin class (e.g. cefixime, ceftriaxone).
But while ciprofloxacin is no longer widely used in the UK, a third of new gonorrhoea infections are of strains that are resistant to it. Similarly a fifth have a strain that is resistant to penicillin and two-thirds have a strain resistant to tetracycline. With so many treatment options already exhausted, it would be of concern if currently used treatments become ineffective in the next few years.
The Health Protection Agency’s Gonococcal Resistance to Antimicrobials Surveillance Programme (GRASP) has monitored the issue since the year 2000. The programme conducts antimicrobial susceptibility testing on isolates of N. gonorrhoeae collected at 26 sexual health clinics in England and Wales. In 2009, 1395 samples were tested.
Reflecting the wider epidemiology of gonorrhoea, a large number of samples came from men who have sex with men (38%), and a third of this group also had HIV. Among women (28%) and heterosexual men (34%), significant proportions came from young people under 25 and from people of black Caribbean ethnicity.
Cefixime is the most commonly used antibiotic to treat gonorrhoea. There is some uncertainty about which cut-off point to use to define decreased susceptibility, or resistance, to the antibiotic. The HPA provide data for two different cut-off points: the most widely accepted definition (a Minimal Inhibitory Concentration of greater than 0.25mg/L) and an alternative, lower one (a Minimal Inhibitory Concentration of greater than 0.125mg/L).
Using the standard definition, 1.2% of cases in 2009 were resistant. However, using the lower cut-off point 10.6% of cases were resistant, a jump from 0.1% in 2005 and 2.8% in 2008.
These strains were found in people from all demographic groups, but were more predominant in gay and bisexual men. These men tended to be white and to report at least two UK sexual partners in the three months before diagnosis.
Although gonorrhoea treatment guidelines recommend that that local patterns of drug sensitivity should be considered when providing treatment, the Health Protection Agency (HPA) report does not contain data on regional variations.
Less than 1% of strains were resistant to the second most commonly used treatment, ceftriaxone. However strains which were resistant to one drug were very frequently resistant to a number of other drugs.
The HPA is investigating combination therapies to treat the bacteria and is encouraging pharmaceutical companies to develop new drugs.
The HPA recommends that clinicians should be vigilant to the possibility of treatment failures among their patients. Moreover, they should consider performing tests of cure, particularly if symptoms persist or following a throat infection.
Professor Cathy Ison of the HPA commented: “At the moment the drugs we use in the UK are still effective for treating gonorrhoea. But our lab tests show that the bacteria are becoming less sensitive to these drugs and the worry is that with we could see gonorrhoea become a very difficult infection to treat within the next five years, as elsewhere in the world.”
She added that this could mean that changing sexual behaviour would become the only way to control the infection.
THE NETHERLANDS: Hepatitis C Virus Infections Among HIV- Infected Men Who Have Sex with Men: An Expanding Epidemic
Since 2000, outbreaks of sexually transmitted hepatitis C virus have been reported among HIV-positive men who have sex with men (MSM). In the current study, the authors conclude that the prevalence of HCV in this population is "high and increasing."
The setting for the research was a large STD clinic in Amsterdam, where the authors studied the prevalence and determinants of HCV among MSM.
In 2007 and 2008, an anonymous, bi-annual cross-sectional survey was administered to 3,125 patients, of whom 689 were MSM. Participants were interviewed and screened for HIV and HCV antibodies, and all anti-HCV-positive and HIV-positive persons were tested for HCV RNA. Phylogenetic analysis was used to compare HCV strains of the STD clinic patients with those isolated from MSM with acute HCV in 2000-2007. Logistic regression was used to analyze determinants of HCV infection.
HCV infection was diagnosed in two of 532 HIV-negative MSM (0.4 percent) and 28 of 157 HIV-positive MSM (17.8 percent). Among HIV-positive MSM, HCV prevalence increased from 14.6 percent to 20.9 percent during the study period. Acute HCV infection was noted among seven of 28 co-infected MSM (25 percent). Of the 28 co-infected men, only five reported any history of injection drug use (IDU).
HIV infection, IDU, fisting, and use of gamma hydroxyl butyrate (GHB) were found to be significantly associated with HCV infection. A high degree of MSM-specific clustering was found through phylogenetic testing.
"Though not statistically significant, this trend, and the relatively large population of acute infections suggest ongoing transmission of HCV in HIV-positive MSM," the authors concluded. "Regardless of IDU, rough sexual techniques and use of recreational drugs were associated with HCV infection; phylogenetic analysis supported sexual transmission. Targeted prevention, like raising awareness and routine testing, is needed to stop the further spread among HIV-infected MSM, and to prevent possible spillover to HIV-negative MSM."
Three Distinct Routes Detailed for How HIV Arises in Male Genital Tract
New research uncovers three methods of HIV development in the male genital tract that can make the virus look different from blood-borne populations
More than three-quarters of new HIV infections worldwide are acquired through sexual contact, nearly all of which involve at least one male. As researchers have been uncovering a growing number of differences between the semen-based virus and blood-borne populations—and the number of people with the virus continues to rise rapidly—the race to piece together a better understanding of the virus's makeup and behavior in the male genital tract has grown ever more urgent.
Upon infection, the virus in the blood and semen are often nearly identical, but over time, previous studies have shown, the different populations become varied, making it "clear that the virus in the blood does not always represent the virus at the site of the transmission," Jeffrey Anderson and Li- Hua Ping, both of the Center for AIDS Research at the University of North Carolina, noted in an e-mail to Scientific American.
A new series of studies reveals three distinct ways in which virus populations in the male genital tract can arise, paving the way for more refined research into virus dynamics at this crucial transmission site. The work is described in a new paper published online August 19 in PLoS Pathogens.
"These studies are rather illuminating because they provide new insights into the population of HIV virons that spreads horizontally from men," Warner Greene, director of the Gladstone Institute of Virology and Immunology at the University of California, San Francisco (UCSF), who was not involved in the new work, noted in an e-mail.
To assess these various HIV populations, the researchers, led by Anderson and Ping, sampled blood and semen from 16 men with chronic HIV-1 infections (four of whom had U.S.-based subtype B and 12 of whom had subtype C and were from Malawi). These were compared against 18 HIV- and sexually transmitted infection–negative men. The research team used single-gene amplification to study the gene responsible for HIV's major surface protein, env.
The virus is constantly changing throughout the body—in both blood and genital sites—due to both host immune-system pressures and virus copy errors. But the researchers found distinct differences in the semen-based HIV.
"In some men, the virus population was very similar to that in the blood, suggesting that the virus was being imported from the blood to the genital tract," Anderson and Ping explained. But many men had virus populations in their genital tract that looked quite different from those in their blood.
"We found two mechanisms that significantly altered the virus population in the semen," the lead researchers noted, which suggests that the "virus can grow in the seminal tract in two different ways."
In the first scenario, the virus can multiply rapidly, creating a population that "is relatively homogeneous" over the course of days or weeks. In the other process, the virus replicates in immune T cells in the genital tract over months or years, "creating a separate population of virus that is both complex and distinct from the virus in the blood," Anderson and Ping explained.
The three origins of semen-based HIV populations were not present in all men. Nadia Roan, a research scientist who works with Greene at UCSF and was also not involved in the new work, noted that "it would be very interesting to further decipher what conditions favor one mechanism over the other."
To further assess the differences in these various populations within individuals, Anderson, Ping and their team found that chemical messengers called cytokines and chemokines "can be concentrated in semen by several orders of magnitude" over those in the blood. That shift can lead to "an environment that is conducive to T-cell replication that results in amplification of subsets of viral populations and creation of genetically distinct, compartmentalized viral populations," they explained.
These chemical communicators can also make for increased inflammation, Roan noted, adding that "the inflammatory effects of semen in the context of HIV infection is an interesting area of investigation that we are also pursuing."
Previous research had found that a protein found in the male genital tract (prostatic acid phosphatase) can boost HIV's infectiousness by 50 to 100,000 times.
"We do not yet know how these differences change the biology of the virus or if these changes are important for the transmission process," Anderson and Ping noted. And as they took samples from the volunteers only once, the analysis does not compare these changes over time (but rather uses the differences in the genetic profiles to trace virus development backward).
At the very least, the researchers noted in their paper, the additional evidence of various origins and populations of HIV in semen could mean that determining the source of a sexually transmitted infection based on blood testing alone would provide "suboptimal" results.
More research remains to be done to determine how these various virus populations might play a role in sexually based infections. But, Anderson and Ping noted, " if we can find that these differences in the virus populations are important in transmission…then we can begin to apply this knowledge to vaccine and prevention strategies."
Maraviroc potentially of benefit for many patients with late HIV diagnosis
Almost two-thirds of patients whose infection with HIV was diagnosed late had virus that uses the CCR5 co-receptor, and could therefore potentially benefit from taking a treatment regimen that includes maraviroc ( Celsentri), Austrian investigators report in the 24 th August edition of AIDS.
Maraviroc was recently approved for use in first-line HIV treatment, although it is most widely used in extensively treated patients. However, the investigators believe that the drug could be especially beneficial for patients who are diagnosed late. Some research suggests that the drug can boost CD4 cell count, even when viral load is not suppressed.
HIV uses one of two co-receptors to attach to human cells: CCR5 or CXCR4. Additionally, patients may sometimes have what is called mixed or dual tropism virus, and this occurs when both co-receptors are present.
The presence of CXCR4 and dual/mixed tropism-using virus is associated with late-stage HIV disease and a low CD4 cell count.
Little is known about the re-receptor types that are present in patients whose HIV infection is diagnosed late (a CD4 cell count below 200 cells/mm 3).
Therefore Austrian investigators analysed the co-receptors of 50 patients with late HIV diagnosis between 2004 and 2007. To see if any factors were associated with the presence of particular co-receptors, information was also gathered on the patients’ baseline CD4 cell count and viral, as well as their demographic details.
A total of 31 patients (62%) had HIV that used the CCR5 co-receptor.
Baseline CD4 cell counts were higher amongst patients in whom the CCR5 co-receptor was used (61 vs 32 cells/mm 3), but this difference was not statistically significant. Nor was there any difference between the two groups of patients with respect to their baseline viral load.
Individuals who had been infected with HIV via injecting drug use were more likely to have virus that used the CXCR4 co-receptor or that was dual/mixed tropisms than those who were infected with HIV through sex (p = 0.02). The investigators note that earlier research has shown that CXCR4 and dual/mixed tropism virus is efficiently transmitted through injecting drug use.
Finally, the investigators restricted their analysis to patients with a CD4 cell count of 50 cells/mm 3 or below at the time of their diagnosis, and compared the severity of HIV disease between those with the CCR5-using virus and those with the CXCR4 co-receptor or dual/mixed tropism virus.
Of the eleven CCR5 patients, ten had an AIDS-defining illnesses. However, only 50% of those with virus that used other co-receptors had progressed to AIDS, one patient having no symptoms of HIV disease at all.
The researchers conclude, “treatment with CCR5 antagonists in ART [antiretroviral therapy]-naive patients, even if newly diagnosed at a late stage of HIV infection, should be of value and needs further evaluation”.
New diagnoses among over 50s double in England, Wales and Northern Ireland
Almost half of older patients with HIV are diagnosed late, according to a study published in the August 24 th edition of AIDS.
The study was conducted using data gathered in England, Wales and Northern Ireland between 2000 and 2007. The investigators defined older as aged 50 or above. The number of adults in this age bracket living with HIV in these countries tripled in this time period, and new diagnoses doubled. Moreover, almost half of older adults who were newly diagnosed with HIV acquired their infection when they were aged over 50.
“Adults aged 50 years and over account for a significant number of persons living with HIV in developed countries and it is important that global and national surveillance outputs include older age groups,” write the investigators.
A separate study published in HIV Medicine demonstrated that the proportion of new HIV diagnoses involving older adults in Europe differed according to geographical region. The paper also outlined the burdens that living with HIV in older age can entail.
HIV in older adults in England, Wales and Northern Ireland
Between 1997 and 2007 there was a three-fold increase in the number of people living with HIV in the UK. During this period there was also a sharp rise in the number of older adults living with the infection.
However, it is unclear whether this increase is because patients with HIV are living longer because of antiretroviral therapy, or due to an increase in new HIV diagnoses in this age group.
In order to gain a better understanding of this issue, researchers from the Health Protection Agency analysed surveillance data gathered between 2000 and 2007.
This showed that adults aged 50 and over accounted for 8% of all new HIV diagnosis between 2000 and 2007.
However, this increased from 8% of new diagnoses in 2000 to 9% in 2007. In addition, the absolute number of older patients newly diagnosed with HIV more than doubled from 299 in 2000 to 710 in 2010. The median age at the time of diagnosis was 55. Almost three-quarters of new diagnoses in this older age group involved individuals aged between 50 and 59.
Gay and other men who have sex with men accounted for 40% of diagnoses in the over 50s. A third of new diagnoses were in heterosexual men, and 25% involved heterosexual women.
Almost all (94%) of older gay men were of white ethnicity. Compared to younger heterosexual men diagnosed with HIV, older patients were more likely to be of white ethnicity (25 vs 14%) and to report their probable region of infection as Asia (18 vs 6%). Older women diagnosed with HIV were also more likely than the under 50s to be of white ethnicity (21 vs 9%).
A total of 8255 older adults accessed HIV care between 2000 and 2007. These individuals represented 16% of all HIV-positive patients seen in this period.
Between 2000 and 2007, AIDS was diagnosed in 20% of older adults. Most (91%) of these diagnoses were made within three months of diagnosis with HIV. During this same time period, only 10% of younger patients with diagnosed with HIV, but like the older patients, 90% of these diagnoses were made soon after the initial HIV diagnosis.
The investigators defined late HIV diagnosis as a CD4 cell count of below 200 cells/mm 3 at the time of diagnosis. Older patients were more likely than younger patients to have a CD4 cell count below this level at the time of their diagnosis (48 vs 33%, p < 0.001).
A total of 538 (13%) older patients died between 2000 and 2007. Older patients diagnosed with a CD4 cell count below 200 cells/mm 3 were 14 times more likely to die than younger patients who had a CD4 cell count below this threshold at the time of their diagnosis (14 vs 1%, p < 0.001).
Moreover, older patients diagnosed late were approximately two and a half times more likely to die within a year of diagnosis than younger patients who were diagnosed with a CD4 cell count below 200 cells/mm 3.
The overall mortality rate amongst older patients was 25 per 1000 person-years. In contrast, the mortality rate for younger patients was 12 per 1000 person-years.
Based on CD4 cell count at the time of diagnosis, the investigators calculated that 48% of older patients were infected with HIV when they were aged 50 and over. The proportion of patients infected with HIV in older age remained stable over the period of the study.
Three-quarters of individuals aged over 50 at the time of their infection were men, and 54% were gay men.
HIV amongst older adults in Europe
In separate research, investigators used World Health Organization data to estimate the proportion of new HIV diagnoses involving older patients in western, central and eastern Europe.
Their analysis showed that in 2007 a total of 13% of new diagnoses in western Europe involved patients aged 50 and above. The figures for central and eastern Europe were 10% and 3% respectively.
The researchers also outlined some of the issues that an HIV diagnosis involves for older patients. These included:
- Stigma related to both HIV and older age.
- The diseases of ageing and their synergy with HIV.
- Lack of targeted prevention resources.
References
Smith RD et al. HIV transmission and high rates of late diagnoses among adults aged 50 years and over. AIDS 24: 2109-2115, 2010.
Lazarus JV et al. HIV and people over 50 years old in Europe. HIV Medicine 11: 479-81, 2010.
UNITED KINGDOM : Free Drugs May Help More Get Chlamydia Treatment
Many partners of chlamydia patients will seek out antibiotics for the infection if provided a voucher, according to a recent study. The results suggest a way to expand treatment for the STD among people who want to avoid clinics and may not otherwise get treated, said the study authors.
Over 18 months, doctors in Lothian, Scotland, distributed 577 vouchers for a free course of antibiotics for their chlamydia patients to pass along to their partners. While some US states allow physicians to distribute antibiotics to patients for partners, the practice is not allowed in the United Kingdom.
The vouchers could be redeemed at one of 90 area pharmacies for a course of azithromycin, a prescription that would otherwise cost about $20.
Forty percent of the vouchers were redeemed, most within a few days, while only 4 percent of the partners presented at a clinic for treatment.
Health care professionals have voiced concerns about distributing antibiotics by proxy. The practice incurs the risk of creating antibiotic resistance and does not adequately inform the partner of possible drug side effects, critics say.
However, resistance is not a pressing concern in chlamydia treatment and "the effect on overall antibiotic use would be small," said Peter Carr, manager of the STD and HIV section of the Minnesota Department of Health. "It would be a really tiny portion of the total antibiotics prescribed," he said.
In these circumstances, the ethical mandate to expand treatment outweighs the concern about providing patient information, said Dr. Mark Levine, the former chair of the American Medical Association's Council on Ethical and Judicial Affairs. "There are ethical trade-offs in what we do," said Levine, who was not involved in the study.
The full report, "Expedited Partner Therapy for Chlamydia trachomatis at the Community Pharmacy," was published in BJOG: An International Journal of Obstetrics and Gynecology (2010 ;117(9):1074-1079).
Gay Men Condemn Blood Ban as Biased
For most people, donating blood is as simple as rolling up a sleeve. But not for gay men. Since 1983, the Food and Drug Administration has barred them from donating.
The F.D.A. has re-examined the ban over the years, but maintains that the restriction is necessary to keep the blood supply safe and untainted by H.I.V., the virus that causes AIDS. Critics say the ban is scientifically and medically unjustified and that it unfairly singles out gay men.
Earlier this year, Senator John Kerry, Democrat of Massachusetts, and 17 other senators sent a letter to the agency opposing the ban. The agency announced it would revisit the issue, but in June a government advisory board voted to uphold the restriction, disappointing not only gays but also the nation's leading blood banks, which have spoken out against the rule.
Some saw a silver lining in the acknowledgment by the panel, known as the Advisory Committee on Blood Safety and Availability, that the current policy is "suboptimal." The committee recommended that more research be done on alternative policies before the ban is lifted.
"We certainly see this as a discriminatory issue," said Nathan Schaefer, director of public policy for the Gay Men's Health Crisis, an AIDS service organization in New York City. "But while the committee's decision wasn't ideal, we have them on the record saying that they can do better."
While the F.D.A. is not bound to follow the advisory committee's decision, the agency generally follows its recommendations, said Shelly Burgess, a spokeswoman for the F.D.A. The final decision to lift the ban will be made by the leadership of the Department of Health and Human Services. She could not give a timeline for when that decision will be made.
The ban has been defended by groups representing hemophiliacs, who say that scientific evidence for establishing more lenient donation guidelines is lacking.
"We appreciate the altruism of those wishing to donate," Mark Skinner, president of the World Federation of Hemophilia, said in an e-mail message. "We recognize that donor deferral policies are discriminatory by their very nature."
"Currently we don't have the answers to change the system," he added, "but through research we may be able to answer the critical questions in a way that would allow adapting the system."
The F.D.A. initially banned gay men from giving blood when the risk of AIDS from transfusions was recognized. At the time, it was considered the best way to keep the blood supply safe. The restriction applies to any man who acknowledges having had sex with another man since 1977.
Gay rights groups, blood banks, and many doctors and scientists consider the ban inconsistent with the restrictions placed on other high-risk groups and antiquated in light of the advances that have been made in testing donated blood.
Donated blood is routinely screened for H.I.V. and other infectious agents. The F.D.A. employs multiple safeguards, including donor evaluations and computerized blood testing, to ensure that infected blood is not distributed.
Since the 1980s, when the ban was enacted, the tests have become much more sensitive and accurate. The F.D.A. did not take this into account when it reviewed the restriction in past years, said Bebe Anderson, H.I.V. Project Director for Lambda Legal, a national gay rights group that has opposed the ban.
"We think this policy is harmful and makes no sense," she said. "Turning away perfectly good donors gives an incorrect and harmful message about transmission risk. This is screening donors based on sexual orientation, not on risk. It also stigmatizes people who wish to donate."
Brad Basso, a project manager for a nonprofit organization in St. Paul, first tried to donate blood in college but was turned away because he is gay. Now, he finds himself trying to explain to co-workers why he can't donate blood when blood drives are held at work.
"I work in the nonprofit sector, and it's important for me to give back. But when you can't participate in a workplace event, it makes you feel bad," said Mr. Basso, 31. "I have to go into a teachable moment and explain that my government thinks my blood is tainted."
Many who are critical of the policy agree, and for years they have asked the F.D.A. instead to require that gay men refrain from giving blood for 12 months after having sex with another man. They say that would bring the restriction into line with those in place for other donors who have engaged in potentially risky behavior.
Earlier this year, Gay Men's Health Crisis issued a comprehensive report on the ban, saying that the policy should be changed to permit low-risk gay men -- such as those in a monogamous relationship -- to donate blood without a deferral period, while deferring higher-risk gay men for a period of time.
In their letter to the F.D.A., Mr. Kerry and his Senate colleagues wrote that the ban perpetuated an unscientific double standard and noted that it did not distinguish between safe and unprotected sexual activity by gay men.
Dr. Steven Kleinman, senior medical adviser to the American Association of Blood Banks, an international association that opposes the ban, says the controversy springs partly from the fact that homosexuality is a socially charged issue. "You wonder, if this wasn't about gay men, would the rules be applied in the same way?" he said.
The F.D.A. has said that its policy toward gay men is not discriminatory but rather based on statistics. Men who have had sex with other men since 1977 have an H.I.V. infection rate 60 times higher than that of the general population, and 800 times higher than first-time blood donors. Even the most sensitive tests may not be able to pick up a new H.I.V. infection within a one- to two-month window. That's why most blood collection agencies are suggesting a one-year deferral period for gay men who have engaged in sex with another man. (All blood collection agencies must work under F.D.A. guidelines.)
Dr. Kleinman said that since much of the testing performed these days was computerized, errors were rare. And while changing the deferral period for gay men could increase the risk of H.I.V.-infected blood, the risk is commensurate with that posed by other donor groups with 12-month deferrals.
Researchers at the University of California, Los Angeles found that if the ban were lifted in favor of a 12-month deferral, an additional 219,000 pints of blood would be donated each year. While that would not significantly increase the available blood supply, many experts say the ban should be lifted on the grounds of fairness and scientific consistency.
"No one has a right to give blood," Dr. Kleinman said. "But we have to ask the questions: Are there ethical fairness issues involved? Is this seen as a stigma within the gay community? And will lifting the ban be an important symbolic change?"
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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