What gay men need to know

Swine flu (H1N1) can affect anyone. Swine flu is highly contagious. In most cases the virus has proved relatively mild and the numbers of people reporting infection in the UK has been falling since the late Autumn. As a result the decision was taken to close the National Swine Flu helpline service in February. However, around the world over 10,000 people and the Department of Health still recommends that people in high risk groups get vaccinated. (NHS Swine Flu update 4/2/10)

There is no evidence that people with HIV are more likely to catch swine flu. However, according to the NHS, it may be more likely to result in medical complications for people with damaged immune systems.2

According to Eurosurveillance, as reported by NAM, obesity and diabetes were the most common underlying health conditions, present in 27% of reported deaths up to 16 July 2009.3 This was followed by respiratory disease (17%), heart disease (17%), and unspecified other infectious diseases in (9%).

Immunodepression was recorded in 8% of patients, including cases of cancer, transplantation, and auto-immune disease. HIV was not mentioned by the authors as being a specific risk factor for an increased risk of death.

There were concerns that there may be a considerable increase in the number of swine flu cases this winter, however this has not been the case to date. Throughout December the number of new cases of swine flu fell, week on week. It is too early to say whether it will continue this way and the NHS continues to advise that people take precautions to prevent infection. By mid December there had been 298 deaths in the UK: 203 in England, 55 in Scotland, 26 in Wales, and 14 in Northern Ireland.4

Click to go to:

If you have not been diagnosed HIV positive
If you have been diagnosed HIV positive
How to avoid infection with swine flu
If you are concerned you have swine flu
If you have been infected with swine flu

If you have not been diagnosed HIV positive:

Some men have HIV without knowing it. According to the HPA, there are an estimated 32,000 gay men with HIV in the UK5, with over a quarter of them unaware of their infection.

People who have been infected with HIV but have not been diagnosed may have a damaged immune system. According to the HPA, about 1 in 7 gay men who test HIV positive in London are diagnosed after the point at which treatment is recommended to begin. This can result in a low CD4 count, which may put you more at risk of complications arising from swine flu.

If you have never been tested for HIV, or if you have taken any sexual risks (such as fucking without condoms) since your last HIV negative test result, now is a good time to test. To find your nearest clinic, visit our clinics page.

If you are then diagnosed HIV positive, HIV treatment can boost your immune system so that you will be less vulnerable to complications arising from swine flu. Also, you will be eligible for early vaccination against swine flu.

If you have been diagnosed HIV positive:

People with diagnosed HIV will be eligible to receive vaccinations against swine flu from their GP. This vaccination programme starts in October 2009 and the earliest doses of the vaccine would be given to at-risk groups, starting with people aged between six months and 65 years in the clinically at-risk groups for seasonal flu. The Department of Health has confirmed that individuals with HIV will be one of the priority groups for swine flu vaccination in the United Kingdom.6

However, there are currently no plans for HIV clinics to provide swine flu vaccinations. Therefore, you will need to let your GP know that you are HIV positive to receive the vaccine under this scheme. There are organisations that can support you if you are disclosing your HIV status to a GP. If you would like advice on this, call THT Direct on 0845 12 21 200.

If you have not already done so, it is recommended that you register with a GP. To find your nearest GP, visit the NHS services directory page.

The swine flu vaccine is voluntary. However, the government strongly encourages everyone in an at-risk group to have it.7 Ultimately, it is down to the individual to decide whether they have a vaccine or not.

If you are on treatment for HIV, your clinic may advise you to stock up on medication in case their service is disrupted. It is best to check this with your clinic to be sure.

Contingency plans have been put in place to issue HIV drugs for longer periods in case appointments need to be postponed or drugs cannot be home-delivered in time. It is always a good idea to keep at least one month’s supply of HIV drugs at home.

If you have a low CD4 count of below 200 you should seek medical advice urgently if you believe you may have contracted swine flu.

How to avoid infection with swine flu:

According to the NHS website, early tests of a swine flu vaccine in Australia suggest that a single dose of the vaccine may be enough to produce an immune response, and that the vaccine appears to be safe in the short term with mostly mild to moderate side effects.8

The vaccine is different to antivirals such as Tamiflu, which aim to reduce the symptoms of swine flu.

The NHS website also reports on the findings of a US study, which suggests that a programme to vaccinate everyone before the start of an autumn spread of the virus or a phased vaccination at the onset of an autumn surge are likely to be effective as long as 70% of the population is vaccinated.9 This suggests that if a relatively high vaccination coverage in the UK population can be achieved this could reduce the impact of swine flu.

You can reduce - but not get rid of - the risk of catching or spreading swine flu by:10

Always covering your nose and mouth with a tissue when coughing or sneezing.
Disposing of dirty tissues promptly and carefully.
Maintaining good basic hygiene, for example washing your hands often with soap and warm water to reduce the spread of the virus from your hands to face, or to other people.
Cleaning hard surfaces, such as door handles, often and thoroughly using a normal cleaning product.

The Health Protection Agency (HPA) recommends that healthcare workers wear a facemask if they come into close contact with a person with symptoms (within one metre), to reduce their risk of catching the virus from patients.

However, the HPA does not recommend that healthy people wear facemasks in their everyday life.12

If you are concerned you have swine flu:

If you have flu symptoms and are concerned you may have swine flu, the advice from the NHS is to stay at home and contact your GP who will be able to assess you and authorise antivirals if you need them. Your GP will also be able to advise you on vaccination.

If you are HIV positive and your CD4 count is under 200, it is important that you seek advice if you have symptoms of swine flu, particularly if your symptoms are severe. According to the NHS, patients with swine flu typically have a fever or a high temperature (over 38°C / 100.4°F) and two or more of the following symptoms:13

unusual tiredness,
headache,
runny nose,
sore throat,
shortness of breath or cough,
loss of appetite,
aching muscles,
diarrhoea or vomiting

If you have been infected with swine flu:

Some people believe that the government should only give antivirals to those who are most at risk of developing serious complications from swine flu. In other words, if people are otherwise healthy, the virus should be treated with paracetamol and bed rest until the person is better, as you would with seasonal flu.

However, the government's Scientific Advisory Group on Emergencies (SAGE) believes that there is still some doubt about the risks of the virus. For example, there are reports of some cases in Argentina where young, healthy adults have become extremely ill from swine flu.14

While there is still this doubt, the government has decided to offer the antiviral medicines Tamiflu or Relenza to everyone who is confirmed with swine flu. If you have a compromised immune system, as a result of HIV infection, or another serious underlying medical condition, such as diabetes, chronic heart, lung, kidney or neurological disease or have received drug treatment for asthma, you will need to start taking antivirals as soon as it is confirmed that you have the illness.

Tamiflu is not expected to alter the effect of any other medicines, such as HIV treatment. If you are taking other medicines and have any questions or concerns, you should speak to your GP or pharmacist. Tamiflu can be taken with paracetamol, ibuprofen or acetylsalicylic acid (Aspirin).

As a precaution, the MHRA has set up a web portal for people to report any side-effects from antivirals prescribed for swine flu.

Doctors may advise some high-risk patients to take antivirals before they have symptoms, if someone close to them has swine flu.

If you have swine flu, avoid unnecessary contact with family and friends while you are infectious, which is usually until five days after your symptoms appear. Once your symptoms have gone, you are no longer infectious.15

Keep one metre or more away from people’s faces to avoid droplets from your throat affecting others. Where possible, you can avoid exposing your partner to infection by sleeping in the spare room.

If you are unable to look after yourself at home, ask a friend or relative to collect medicines and groceries for you, order any repeat prescriptions, help with basic household tasks, such as cooking, and generally care for you.

If your friend or relative keeps their distance from you wherever possible and you both have good hygiene (sneezing into a tissue and washing your hands thoroughly), there is a good chance that they will not catch the infection.

If you feel up to it, you may want to get some fresh air. Do not go on public transport, stay in crowded places or visit your GP or hospital when you have swine flu symptoms, as you may infect other people with the virus.

If you suddenly get much worse, seek medical advice immediately.

For more information, contact the National Pandemic Flu Service at www.pandemicflu.direct.gov.uk or on 0800 1 513 100, or visit www.nhs.uk.

This web page is jointly written and produced with the NHS and was accurate as of 17 February 2010. We will be updating this page when more information becomes available so check back regularly to keep informed.