Project title: Exploring perspectives on provision and accessibility of Pre-exposure prophylaxis (PrEP) in North England and the West Midlands.
Principal Investigator Professor Marie Claire Van Hout
Team: Professor Vivian Hope; Mr Jim McVeigh: Mrs Jennifer Germain
Site: Public Health Institute, Liverpool John Moores University, Liverpool
The United Kingdom (UK) has a concentrated HIV epidemic, with an estimated 101,200 people living with HIV in 2015. A decrease in diagnoses among men who have sex with men (MSM), the group most affected by HIV transmission, has recently been observed, and is probably due to increased frequency of testing (3 monthly) among those at greatest risk and rapid treatment for those testing positive.
Pre-exposure prophylaxis (PrEP) is an evidence based biomedical HIV prevention strategy which involves HIV negative individuals taking antiretroviral drugs to reduce probability of infection if exposed. The UK PROUD study found PrEP reduced HIV infection risk by 86% among MSM. PrEP is available on the NHS in Wales and Scotland. In October 2017, the IMPACT trial commenced in England, with PrEP being rolled out to 10,000 eligible people.
The project will explore and describe MSM and health professional perspectives on PrEP using qualitative interviews in three Northern cities (Liverpool, Manchester, Sheffield) and one city in the West Midlands (Birmingham) where PrEP is available through the IMPACT trial. Interviews with a purposive sample of participants (8-12 MSM and 4-8 health professionals per city) will focus on: PrEP awareness and sources of information including eligibility, compliance, drug interaction and online sourcing; impact of PrEP on HIV testing patterns, hepatitis C, sexual risk and other sexually transmitted infections; and on issues related to accessing PrEP and optimal service provision
The project is timely given the current IMPACT trial in England, with results informing policy, practice and professional training.
Applications are invited from researchers in various fields related to sexual health, HIV and other sexually transmitted viruses.
Sexually Transmitted Infections Research Foundation (STIRF) was set up to pump prime research projects relating to the epidemiology, pathophysiology, management, and health care delivery of sexually transmitted infections and HIV in the East and West Midland, the North East and North West Regions.
The primary aim is to provide initial funding to allow promising projects from young researchers to obtain preliminary results as a prelude to acquire further funds from larger funding bodies.
We invite applications from researchers in the above regions on projects relating to sexually transmitted diseases and HIV. All projects will be initially screened by the Scientific Committee of STIRF and those considered suitable will be sent for peer review by experts in the field.
The following fields of research will be considered in relation to STIs and HIV
- Epidemiology of HIV and other sexually transmitted diseases
- Research on HPV and other sexually transmissible malignancies
- Health care delivery including views of clients
- Issues relating to deprived or marginalised communities.
- Pathophysiology of diseases and syndromes
- Inter-relationship between diseases
- Treatment modalities
- Complications of treatment and co-morbidities
Applications should not exceed £50,000 in the first year. Depending on satisfactory reports a further £25,000 may be available for the second year. Joint funding with other grant giving bodies will be considered.
For further information and guidance on how to apply visit
How to apply for grants
Deadline for applications is 30th June 2016
Applications using the appropriate form downloaded from the STIRF web site should be sent by email to:
Dr Mohsen Shahmanesh,(Hon Secretary STIRF)
Daily HIV medicine taken by men who have sex with men (MSM) reduces risk of HIV infection by 86% as was reported by Molina J-M, and colleagues in the ANRS Ipergay trial at the Conference on Retroviruses and Opportunistic Infections held in Seattle, USA in 2015 (23LB.).
Molina et al reported the final results of a three year study which randomised MSM who were negative for HIV to either take daily HIV prophylaxis with two anti-retroviral drugs in a single tablet immediately or deferred for 1 year.
The study showed that those taking the drugs on a daily basis have a 86% reduction in the risk of being infected by HIV than MSM not taking the drug (p=0.0001). The trial was stopped in October of 2014 and all participants in the deferred group were offered pre-exposure prophylaxis (PrEP)
As a Lancet editorial commented:
The science is now clear: oral pre-exposure prophylaxis (PrEP) with a coformulation of tenofovir disoproxil fumarate and emtricitabine (Truvada) significantly reduces the risk of HIV infection among individuals at high risk of HIV infection.
The news that PrEP has shown consistent efficacy among those who take it as prescribed should be a cause for celebration, and galvanise action to ensure access to PrEP for those who could benefit the most. But almost 3 years since the US Food and Drug Administration approved tenofovir–emtricitabine for PrEP little is being done on implementation.
With more than 2 million new HIV infections every year worldwide, it is time for that to change.
A workshop on philosophical aspects of sexual health is being held at
Seminar Room 3.28, New Business School, Manchester Metropolitan University Manchester, United Kingdom
The workshop is run by Dr Phil Hutchinson and was part funded by a research grant from Sexually Transmitted Infections Research Foundation (STIRF). Project STIRF-026
Workshop 1: The Problem of Selection Bias in Biomedical & Public Health Research. Wednesday September 16
Workshop 2: Shame, Stigma and HIV. Thursday September 17
Venue: Seminar Room 3.28, New Business School, Manchester Metropolitan University, Manchester, UK
Mandatory registration: contact: firstname.lastname@example.org
Further information can be obtained from Phil Hutchinson email@example.com
A new project funded by STIRF (STIRF-027) has just been completed.
Background: In the United Kingdom there is an established and growing refugee population from Somalia. Despite this Somalis have remained absent from much of the official statistics largely because ‘Somali’ is rarely recognised as a distinct ethnic category. Little is known about the sexual health needs of this particular community but in terms of their broader health issues, Somalis are known to have a high level of need but low uptake of health care services (Carswell et al.2011).
Aims: Through the use of focus groups and individual interviews this study sought to explore the sexual health needs of the local Somali community by ascertaining from their perspective, what they know about sexual health services, the challenges that may prevent them taking up these services and how services could be adapted to best meet their needs.
Results: The study showed little knowledge of services, especially about sexual health, how to accessing services, issues relating to shame, stigma and taboo, the influence of gender, religious and cultural norms, the perceptions of young people, the language barrier lack of cultural awareness and sensitivity demonstrated by healthcare professionals.
- Urgent attention be given to raising awareness, amongst the Somali community, about local sexual health services and how they can be accessed.
- Information about sexual health services be made available in a format that is accessible to the Somali refugee community, for example, via a CD, DVD or USB stick.
- That public health professionals and health care practitioners make clear the concept of preventative screening, making explicit the value of screening and early diagnosis for infectious diseases including TB and HIV/AIDS.
- Health practitioners and public health professionals exercise extreme sensitivity when discussing issues related to sexual health and well-being. Every effort must be made to gain the trust of the individual so that they are able to discuss their fears or concerns.
- Public health professionals and health care practitioners receive appropriate training and education so that they are equipped with the necessary cultural understanding and skills when working with the Somali community.
- That a proactive approach be taken to helping Somali refugees to attend a programme of induction that includes language classes.
- That a register of trained interpreters, who understand medical terminology and who are trained to work with those who may have experienced rape and torture should be available for public health professionals and health practitioners. Telephone interpretation should also be made available during consultations.
The results of the study have been presented in international meetings and published in reputable international journals.
A large international study (INSIGHT START) published in the New England Journal of Medicine has found that starting antiretroviral therapy immediately after human immunodeficiency virus (HIV) diagnosis rather than waiting until a patient’s CD4+ count has declined is of considerable benefit.
The results of the study were also released at the International AIDS Society conference in Vancouver, Canada, on 20 July.
Currently most authorities strongly recommend starting anti-HIV once CD4+ count drops to below 350 cells per cubic millimetre. Until the INSIGHT START study there was no randomized trials showing the benefits and risks of initiating antiretroviral therapy in patients with asymptomatic HIV infection who have a CD4+ count of more than 350 .
START study conducted in 35 countries randomly assigned 4,685 HIV positive patients to either receive immediate antiretroviral therapy (median CD4+ of 650) or wait until their counts fell to below 350.
After a mean follow up of 3 years the study found that 42 patients in the immediate-initiation group died, as compared with 96 patients in the deferred-initiation group (95% confidence interval, 0.30 to 0.62; P<0.001). Reduction in deaths were largely from tuberculosis, Kaposi’s sarcoma, and malignant lymphomas – conditions that can occur in HIV-infected individuals with only moderately damaged immune systems.
Currently the WHO requires all patients with HIV to be treated CD4+ of 500 or less. WHO may need to extend that to treating anyone at diagnosis. This would not only benefit the individual but by reducing viral shedding in body secretions reduce transmission and hence have a public health benefit. Moreover some of the costs of starting early would be offset by not needing to perform repeated CD4+ counts.
This is part of a series of articles on HIV and sex workers published by The Lancet and freely available.
In this article Michelle Decker et al reviewed evidence from more than 800 studies and reported on the burden and HIV implications of human rights violations against sex workers.
Abuses of human rights are perpetrated by both state and non-state actors. Such violations directly and indirectly increase HIV susceptibility, and undermine effective HIV-prevention and intervention efforts.
Violations include homicide; physical and sexual violence, from law enforcement, clients, and intimate partners; unlawful arrest and detention; discrimination in accessing health services; and forced HIV testing.
Abuses occur across all policy regimes, although most profoundly where sex work is criminalised through punitive law.
The authors conclude that protection of sex workers is essential to respect, protect, and meet their human rights, and to improve their health and wellbeing.
Research findings affirm the value of rights-based HIV responses for sex workers, and underscore the obligation of states to uphold the rights of this marginalised population.
The 2013 round of applications for funding has resulted in approval for the following pilot project:
Designing a Research project for understanding the role of stigma and shame in STI and HIV testing
The project will be headed by Phil Hutchinson, Ph.D. (Man.), M.A. (Man.), B.A. (London), Senior Lecturer in Philosophy, Manchester Metropolitan University.
The aim of the preliminary project is to find the methodology to test the hypothesis: is shame one of the reasons for failing to attend for STI and HIV testing. The project will be completed within six months involving setting up workshops with groups involved with both patient groups and those sexual health care.
The March issue of the journal STI included an article by Sonia Fernandez-Balbuena and colleagues in Madrid which demonstrated that offering HIV testing on the street may allow a significant number of hard-to reach populations to offer themselves for HIV testing.
Of 7552 persons in various Spanish cities who were asked to full a brief questionnaire and offered HIV testing 3517 participants (47%) were first-time testers. These included 24% of men who have sex with men , 56% of exclusively heterosexual men and 60% of women. 22 undiagnosed HIV infections were detected with a global prevalence of 0.6% and 3.1% in MSM.
The authors concluded that their community programme attracted a substantial number of persons previously untested and particularly hard to reach, such as those with low education and MSM who were least involved in the gay community.
In their view a decisive in decisive factor for almost two of every three persons who had never been tested. was the visibility of the programme.
A useful tool for practice nurses who want to take sexual history. Click on link below
Sexual history taking for nurses