Category: Sexual health services

New project approved for 2018: Provision and Accessibility of Pre-exposure Prophylaxis (PrEP) in North England and the West Midlands.

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.

Sexually transmitted infections: challenges ahead

A commissioned article in Lancet Infectious Diseases on July 9, 2017 highlights some of the major issues and challenges facing us in the growing global epidemic of sexually transmitted infections (STI). Authors Prof Mabhus Unemo et al summarise the key issues as follows:

WHO estimated that nearly 1 million people become infected every day with any of four curable sexually transmitted infections (STIs): chlamydia, gonorrhoea, syphilis, and trichomoniasis. Despite their high global incidence, STIs remain a neglected area of research.

In this Commission, we have prioritised five areas that represent particular challenges in STI treatment and control.

Chlamydia remains the most commonly diagnosed bacterial STI in high-income countries despite widespread testing recommendations, sensitive and specific non-invasive testing techniques, and cheap effective therapy. We discuss the challenges for chlamydia control and evidence to support a shift from the current focus on infection-based screening to improved management of diagnosed cases and of chlamydial morbidity, such as pelvic inflammatory disease.

The emergence and spread of antimicrobial resistance in Neisseria gonorrhoeae is globally recognised. We review current and potential future control and treatment strategies, with a focus on novel antimicrobials.

Bacterial vaginosis is the most common vaginal disorder in women, but current treatments are associated with frequent recurrence. Recurrence after treatment might relate to evidence that suggests sexual transmission is integral to the pathogenesis of bacterial vaginosis, which has substantial implications for the development of effective management approaches.

STIs disproportionately affect low-income and middle-income countries. We review strategies for case management, focusing on point-of-care tests that hold considerable potential for improving STI control.

Lastly, STIs in men who have sex with men have increased since the late 1990s. We discuss the contribution of new biomedical HIV prevention strategies and risk compensation.

Overall, this Commission aims to enhance the understanding of some of the key challenges facing the field of STIs, and outlines new approaches to improve the clinical management of STIs and public health.

Read full article on Lancet Infectious Diseases

Cuts to sexual health services are putting patients at risk

Cuts to sexual health services in parts of England are placing the care of patients at risk, a new report has warned according to a report published in the BMJ.

The research by the healthcare think tank the King’s Fund concluded that budget cuts of more than 20% to genitourinary medicine (GUM) services in some parts of the country had led to service closures and staffing cuts that have harmed patient care. Experts said that the findings were particularly worrying given that numbers of diagnoses of sexually transmitted infections such as syphilis and gonorrhoea were rising.

Current pressures on services were also having a negative effect on staff morale and leading some staff to consider alternative careers, the report warned.

The researchers analysed data and interviewed frontline staff to examine the effect of funding pressure on patient care across four service areas: GUM, district nursing, elective hip replacements, and neonatal care.

Their findings indicated that sexual health and district nursing had been hardest hit which undermined the vision set out in NHS England’s Five Year Forward View to strengthen prevention and community based services.

The authors said that sexual health services such as GUM had become more prone to budgetary cuts since moving from the NHS to local government, because of local authorities’ legal obligation to balance their books.

Centenary of nationwide free access to sexual health clinics in England and Wales

STI began in 1925 as the British Journal of Venereal Disease, and you can read early editions on the sti.bmj.com website. The very first issue covers skin complaints often mistaken for syphilis, the use of bismuth and malaria inoculation to treat syphilis, and the establishment of a network of clinics following a Royal Commission.1 It also discusses diathermy in the treatment of gonorrhoea!

A hundred years ago, we had no effective treatment for gonorrhoea, and it is sobering to realise we may soon be in the same position. The GRASP surveillance system which tracks antimicrobial resistance in England and Wales shows indications that we are not far from ceftriaxone treatment failures in a report by Town et al.2 In an age of nucleic acid based diagnostics, we need alternatives to culture for detecting resistance. A fascinating report by Graham et al reports that whole genome sequencing can be achieved with urine specimens, including the detection of markers associated with resistance.3 On a related note, this month’s editorial by Nigel Garrett reflects on the perhaps brief life of syndromic management.4
Read full article

 

PrEP introduction for adolescent girls and young women

Pre-exposure prophylaxis PrEP use in the sexually active females prevents HIV acquisition.

The International AIDS Conference in Durban, South Africa, in July 2016, has renewed interest and momentum around HIV prevention. High and sustained HIV incidence rates—about 2 million people acquiring HIV every year for the past 5 years—highlight the need for new prevention technologies for populations at substantial risk of HIV.1 As many as 7000 new infections a week are occurring in the most vulnerable adolescent girls and young women in eastern and southern Africa.1 75% of young people in sub-Saharan Africa living with HIV are adolescent girls and young women age 15–24 years; AIDS is the leading cause of death for girls age 10–19 years in Africa.1 To date, prevention efforts have not had sufficient effect on risk of HIV in adolescent girls and young women.

Oral pre-exposure prophylaxis (PrEP)—the use of antiretroviral medications by HIV-negative people to avoid getting HIV—is a new biomedical intervention that has the potential to substantially reduce HIV acquisition in the people at greatest risk. Recent evidence suggests that PrEP was effective among several populations in reducing the risk of HIV infection by 70%.2 Less is known about the effectiveness of PrEP for young women,2 but the intervention could greatly increase the ability of adolescent girls and young women to protect themselves from HIV if they are able to access and use it effectively.

Read whole article

Invitation to apply for research Funds – 2016 Round

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)

Stirfweb@gmail.com

Access to Sexual Health Services for the Somali Community in Birmingham UK

The UK, hosts a large number of refugees from Somalia.

Somalis are absent from much of the official statistics largely because ‘Somali’ is rarely recognised as a distinct ethnic category. Therefore, when decisions are being made in relation to addressing the needs of recently arrived refugees the needs of those who originate from Somalia may be neglected.

Somalis are known to have a high level of need but low uptake of health care services. This included sexual health.

Earlier STIRF funded a project which looked at issues and problems relating to access for sexual health services. The project is now completed and is presented in a meeting held on:

Date: April 27
Venue: Birmingham City University
Time: 16.00 – 18.00

Meeting on Sexual Health needs of Somali Community

Sexually abused children should be offered HPV vaccination

Should children exposed to sexual abuse be offered human papillomavirus (HPV) vaccination alongside screening for sexually transmitted infections? A recent article in the Lancet argues for a yes answer.

The WHO defines childhood sexual abuse  as the involvement in sexual activity of a child under the age of 18 years who did not give informed consent or is not developmentally prepared.

The global prevalence of childhood sexual abuse is estimated to be 8–31% for girls and 3–17% for boys. The true figures are probably nearer the upper figure.

According to a review, parents were the perpetrators of about 45% of cases of childhood sexual abuse in the USA, and other relatives were responsible for a further 19%.  Others included figures of authority such as priests and teachers. Survivors of such abuse are often hesitant to report such incidents because of shame and fear of retribution. Thus, the incidence and prevalence of childhood sexual abuse is almost certainly underestimated. Read more

Daily pri-exposure prophylaxis (PrEP) prevents HIV infection in high risk gay men

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.

Invitation to workshop: role of stigma and shame in the access to sexual health clinics

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: marie.chollier@stu.mmu.ac.uk

Further information can be obtained from Phil Hutchinson p.hutchinson@mmu.ac.uk