Category: women’s health

New HIV infection in UK in men who have sex with men exceeds heterosexual transmission after many years

Annual report of HIV infections in the United Kingdom in 2001 published by Health Protection Agency (HPA) show that for the first time in  many years newly diagnosed infections were higher in men who have sex with men (MSM) than transmission through heterosexual intercourse.

By the end of 2011, there were an estimated 96,000 (95% credible interval 90,800 – 102,500) people were living with HIV in the UK. Approximately one quarter (22,600, 24% [19%- 28%]) of these were undiagnosed and unaware of their infection. Fig 1

Fig 1. People infected with HIV at the end of 2011

 

This is an increase from the 91,500 people estimated to have been living with HIV by the end of 2010. The estimated prevalence of HIV in 2011 was 1.5 per 1,000 (1.5-1.6) population of all ages, 2.1 per 1,000 (1.9 – 2.3) men and 1.0 per 1,000 (1.0 – 1.1) women.

The rise in new diagnosis in MSM (Fig 2) is particularly worrying as nearly half the patients (47%) are diagnosed late when their immune system is already compromised increasing the chance of a fatal outcome within one year of diagnosis ten fold. These deaths are totally avoidable with the use of anti-viral therapy early in the infection.

 

Fig 2. New cases of HIV by exposure category

 

STIRF: new projects approved

In this year’s funding round we received six applications. After sending them for external peer review by experts, the Scientific Committee approved two projects for funding in 2013 which was submitted to the Trustees.

Project 1: Chlamydia trachomatisis the most common sexually transmitted infection effecting young people in the UK. It infects one in ten of all women aged 15-25 and can cause serious long term complications such as pelvic inflammatory disease and infertility. According to the Health Protection Agency in 2011 in England and Wales 147,594 infections were diagnosed in 15 to 24 year olds.

Recent evidence for emergence of resistance to the commonly used antibotics used in eradicating chlamydia is very worrying. We are delighted to fund Emma Hathorn as part of a multi-centre study to evaluate the incidence of  chlamydia resistance in people attending a clinic for sexually transmitted infections.

Antimicrobial resistance in Chlamydia trachomatis: is it a reality? STIRF-022

 

Project 2: There is increasing focus on involving patients and what they perceive are their actual needs when delivering clinical services in the NHS. This is particularly important in the fast developing field of HIV where new management strategies and new treatments take place within the background of shrinking funding. These clearly call for new ways of delivering these services more efficiently as well as more effectively. It is with this in mind that STIRF decided to fund the nurse-led project by Lucy Land that is taking steps to objectively define these priorities as seen from the HIV-infected patients perspective.

Development of a weighting scale to evaluate the relative importance of items in a validated HIV patient satisfaction questionnaire. STIRF-020

This study aims to refine a questionnaire they developed and validated with the help of HIV-infected patients to find issues that are more important and therefore need to be prioritised in development of HIV services.

Thanks to all the researchers who submitted and to the reviewers who gave their valuable time for free.

Rising gonorrhoea antimicrobial resistance in Europe

A recent report by the European Centre for Disease Prevention and Control has highlighted the danger that rising antibiotic resistance may mean that soon gonorrhoea may become an untreatable disease in some parts of Europe.

According to the report the most worrying result is the increase in the percentage of isolates with decreased susceptibility to cefixime and the increase in the number of countries where this phenotype was identified between 2009 and 2010. [Fig 1]

 

Fig 1. European Centre for Disease Prevention and Control

Patient characteristics of isolates with decreased susceptibility did not differ greatly when compared to the overall population, except for age: patients with decreased susceptibility to cefixime were more likely to be older.

There is some evidence that the rates of ciprofloxacin and azithromycin resistance have both decreased since 2009. However they remain worringly high across Europe (53% and 7%, respectively).

Similar results for cefixime – which is the first line drug therapy in many centres – have been reported by the European gonococcal antimicrobial surveillance programme (Euro-GASP) – Fig 2

 

Cephalosporine resistance in gonococcal isolates 2009 – Euro-GASP

No increase in sexual behaviour in HPV vaccinated teenage girls in US

Since US public health officials began recommending in 2006 that young women be routinely vaccinated against HPV, many parents have hesitated over fears that doing so might give their children license to have sex. Research published on Monday in the journal Pediatrics and reported in the New York Times of October 15 may help ease those fears.

Using a sample of nearly 1,400 girls, the researchers found no evidence that those who were vaccinated beginning around age 11 went on to engage in more sexual activity than girls who were not vaccinated.

“We’re hopeful that once physicians see this, it will give them evidence that they can give to parents,” said Robert A. Bednarczyk, the lead author of the report and a clinical investigator with the Kaiser Permanente Center for Health Research Southeast, in Atlanta. “Hopefully when parents see this, it’ll be reassuring to them and we can start to overcome this barrier.”

HPV, the most common sexually transmitted virus in the United States, can cause cancers of the cervix, anus and parts of the throat. Federal health officials began recommending in 2006 that girls be vaccinated as early as age 11 and last year made a similar recommendation for preadolescent boys. The idea is to immunize boys and girls before they become sexually active to maximize the vaccine’s protective effects.

Data from the CDC showed that in 2011 nearly a third of children 14 to 19 years old are already infected with HPV. But despite the federal recommendations, vaccination rates around the country remain low, in part because of concerns about side effects as well as fears the vaccine could make adolescents less wary of casual sex. A study by Basu et al from Yale on parental attitudes toward the vaccine found that concern about promiscuity was the single biggest factor in the decision not to vaccinate.

Sex workers collective show long-term health gains of self-empowerment

A parallel AIDS conference in Kolkota, India gave the rights an update on the success of the VAMP sex-workers colective – now in its 15th year reports, reports Andera Cornwall the Guardian.

They have shown an impressive ability to minimise risk of HIV and other sexually transmitted infections in sex workers.

Founded in 1997, Vamp now has more than 5,000 members. Weekly meetings bring the collective together to tackle a wide range of issues faced by members. Health work and advocacy for sex rights’ human rights are interwoven with Vamp’s everyday work in the densely populated alleyways in the red-light districts of Sangli and other towns in the region.

Vamp’s mission is to change society. Rather than treating sex workers as victims to be rescued or rehabilitated, it demonstrates the power of collective action as a force for women’s empowerment, mobilising sex workers to improve their working conditions, and claim rights and recognition. And they’re yielding results.

The report showed how self-empowerment and education can achieve high rates of safe sex in women at high risk of sexually transmitted infections and HIV. It is yet another reminder to that the most effective way to protect this vulnerable population is to help then self-organise and self-protect rather than to criminalise prostitution.

The latter, as many studies have shown, merely drives women into the hands of criminal gangs, or leads to risk-taking sexual practices and high rates of self-harm.

Dramatic drop in health spending according to OECD

Growth in health spending slowed or fell in real terms in 2010 in almost all OECD countries, reversing a long-term trend of rapid increases, according to OECD Health Data 2012.

In real terms average health spending has declined by over 6% compared to the start of the millenium.

Overall health spending grew by nearly 5% per year in real terms in OECD countries over the period 2000-2009, but this was followed by zero growth in 2010. Preliminary figures for a limited number of countries suggest little or no growth in 2011. The halt in total health spending in 2010 was driven by a fall of 0.5% in public spending for health, following an increase of over 5% per year in 2008 and 2009.

While government health spending tended to be maintained at the start of the economic crisis, cuts in spending really began to take effect in 2010. This was particularly the case in the European countries hardest hit by the recession.

UK gonorrhoea rates increase by 25%

Although overall rates of sexually transmitted infections rose by 2%, there has been an increase of 25% in new infections by gonorrhoea reported to the UK Health Protection Agency (HPA) – the second increase in two years running. Gonorrhoea rates increased from 16,835 to 20,965.

Other significant increases in sexually transmitted infections were in infectious syphilis (10%; 2,650 to 2,915) and genital herpes (5%; 29,794 to 31,154).

In contrast there was only a 1% rise in genital warts, perhaps reflecting the effectiveness of the vaccination programme. Diagnoses of genital warts cases in women aged 15-19 actually fell by 14% (11,251 to 9,700).

The greatest increase in sexually transmitted infections was in men who have sex with men and in heterosexual men and women aged 15-24. The high rates of infection reported in girls aged 15-19 is particularly worrying.

According to Professor Cathy Ison, director of sexually transmitted bacterial reference laboratory, the appearance of resistant strains for which no single antibiotic is effective is particularly worrying. This opens the prospect of having to use combination therapy in the future.

Research on effective behavioural change therefore remains a top priority.

Invitation to apply for research funds

We have entered a new round of invitation to apply for research funds. We are particularly interested in providing initial funding in projects that may allow young researchers to obtain preliminary results as a prelude to acquire further funds from larger funding bodies.

We invite applications from researchers in the East and West Midland, the North East and North West 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. We encourage applications for

The following fields of research will be considerd in relation to STIs and HIV

  • Epidemiology of HIV and other sexually transmitted diseases
  • 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.

Further information and guidance on how to apply can be found on

How to Apply for Research funds