Stigma is a Side-Effect of HIV Prevention Medicine

David Rowlands

100,000 people are living with HIV within the UK, and one-quarter of these are undiagnosed. This is not only within the capital; latest research suggests that one-fifth of people with HIV in the West Midlands remain undiagnosed. This is deeply concerning as statistics suggest there are more people living with HIV than ever before in the region.

Moving forward, routine testing is becoming more regular within different resource settings, including GP practices, A&E and, prisons. Sexual health screening continues to grow within traditional settings, but also within bars, clubs, and sex environments. This is an opportunity to engage, inform, and educate this sometimes hard-to-reach population, but it will also aid to breakdown the stigma of testing within the community. One key message is: ‘get tested, know your status.’

Recently, there has been a much greater emphasis on preventing HIV and treating people who have HIV with antiretroviral therapy (ART), which involves taking a combination of HIV medicines. While this has health benefits to the individual, it is also reduces onwards transmission of the virus. This is known as ‘treatment as prevention’ (TasP), with many experts and advocates believing that the provision of this medication may be one of the most important elements of any strategy to end the HIV epidemic.

Men in steady same-sex relationships, where both partners are HIV negative, will often forgo condoms out of a desire to preserve intimacy even if they also have sex outside the relationship. But the risk of HIV transmission still is high. In a recent study of gay and bisexual men, respondents reported at least one instance of anal sex without a condom in the last 30 days, and researchers found that the same desire for intimacy is also a strong predictor of whether men would be willing to take antiretroviral medications to prevent HIV, a practice known as ‘pre-exposure prophylaxis’ or PrEP.

In early 2014, a report published by the World Health Organization made “strong recommendations” that all men who have sex with men should seriously consider taking antiretroviral medicine as an additional method of preventing the HIV infection from spreading, even if they do not have the virus themselves. This could have a significant impact on stopping the spread of HIV, and it could prevent a million new infections in the next 10 years.

Many people wonder whether men will make PrEP part of their daily lives and what will keep them motivated to adhere to it strictly, which is required if the medication is to have its protective effect. This medication has been on the market for a decade but only recently has it appeared in prescribing guidelines. We must also consider that some people using PrEP may worry that not everybody in the community is up to speed with the knowledge, and that there is stigma attached to taking this drug. I believe that we have a responsibility to make sure that the community are informed and we can enable people to make informed decisions.

I feel that PrEP is a good prevention method for individuals for a period in their life and should not be a long-term solution to their sexual behaviour. It also has the potential to be cost-effective, preventing people from becoming infected with HIV, and being on treatment for the duration of their lifetime.

Moving forward, an encouraging vaccine which works in an unusual way has managed to completely block infection with SIV, the monkey equivalent of HIV, in monkeys. This finding gives new hope for the development of a vaccine which could prevent HIV infection in humans. This research is also encouraging in terms of a vaccine for people who have already acquired HIV; in other words, a therapeutic vaccine to suppress the replication of HIV. When the vaccine was given to monkeys who were previously infected with SIV, their viral load was rapidly suppressed.

The vaccine works in a very different way to other HIV vaccines, which have previously been tested. The French and Chinese scientists who developed it were themselves surprised by the positive results of their unconventional approach, stating that the results suggest a new approach for developing an HIV vaccine in humans.

As a first step to finding out, two safety trials are planned in humans. In one, HIV-negative volunteers, at low risk of HIV, will be given the vaccine to see if it stimulates the same immune and virus suppressant responses. In the other, HIV-positive volunteers on fully suppressive HIV treatment will be given the vaccine and then taken off treatment 6 months later if test tube results suggest the vaccine has produced such responses.

HIV experts and advocates are actively working together within the UK to encourage participants from different networks and walks of life to find out about volunteering for these clinical trials. I feel it is critical that the HIV community play a role in this process and have a uniformed voice which is heard.

Research for a HIV vaccine is important, but for the first time we have a significant cohort of  those living with HIV aged over 50 in the UK. It is estimated that by 2015, half of people living with HIV In UK will be aged 50 plus. This will present with new challenges to the way HIV care and treatment are designed, managed, and delivered. The goal, I believe, should be to ensure that appropriate care and support should be offered to everyone with HIV, enabling them to live a long and fulfilled life.

Improving the quality of  primary care for people with HIV, and establishing better interaction between HIV specialists and other community clinicians, is essential.  This will provide good quality patient-centred care, particularly as it is critical to the sharing of knowledge and expertise when managing complex long-term conditions due to ageing and being older with HIV.

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