Our CEO Monty Moncrieff writes about the new UK data on HIV and the future of HIV prevention

Public Health England yesterday published the latest data on HIV in the UK. Once again new diagnoses amongst gay, bisexual and other men who have sex with men are at a record high, with 3,360 new diagnoses in this population. Whilst this number is worryingly high, the good news is that undiagnosed HIV is falling, meaning men are able to access vital anti-retroviral treatments which can reduce the level of the virus in their bodies and almost eliminate the risk of them passing it on. However 6,500 gay and bisexual men are still living with HIV without knowing their status. The report comes on the back of high profile media reporting of Charlie Sheen’s recent disclosure he is living with HIV, which has shone a spotlight on the stigma and myths still persisting around the virus.

The data now indicate one in 20 gay and bisexual men in the UK are living with HIV. In London this rises to one in 11. About 14% of these are those who are unaware they have it. As we head towards National HIV Testing Week which begins on Saturday we encourage people to take a test and reduce the risks to their own health as well as the risk of unknowingly passing HIV on to others. Along with a number of new projects announced yesterday as part of PHE’s HIV Prevention Innovation Fund is the launch of a new national postal service, allowing people to take their own tiny blood sample at home and send it off for testing. A positive result allows you to take action to protect your own health and that of others by beginning medication sooner.

Treatment as Prevention (TasP) marks a brave new world for HIV prevention and achieving an undetectable viral load is a key strategy in stemming future transmission. Despite the fact that around 90% of people diagnosed and on treatment now achieve an undetectable status, and are extremely unlikely to pass on HIV to others, knowledge of this remains poor. A survey for GMFA’s FS magazine found 49% of gay and bi men didn’t know what this meant. A third (31%) also were unaware of PrEP (Pre-Exposure Prophylaxis), a course of medication that can prevent you becoming HIV positive in the first place, which is widely expected to become available to men most at risk on the NHS next year.

Information needs on HIV prevention are changing fast: in a world of new acronyms navigating PEP, PrEP and TasP can be a minefield, both for gay and bisexual men themselves and the healthcare professionals who support them via HIV prevention outreach and care. Whilst our traditional message to always use a condom remains sound, and will offer additional protections against other STIs, the reality is not everyone uses them consistently. We need to be honest with men who sometimes, or always, don’t use them, with nuanced messages and information which reflects the new realities of how they have sex.

Public Health England acknowledges that whilst more men now test and have their HIV status diagnosed the number of new infections also continues to rise at a high level. Their report highlights the need for a multi-faceted approach: “The ongoing high rates of HIV transmission and acquisition among men who have sex with men emphasise the need for high impact, appropriately tailored combination prevention strategies and programmes”.

The report reinforces condom use as an important strategy, and also stresses the need to address the wider determinants of poor sexual health. These are outlined in PHE’s 2014 report Promoting the health and wellbeing of gay, bisexual and other men who have sex with men. They include mental health and the use of drugs and alcohol as factors that can increase risk. Yesterday the Public Health Minister Jane Ellison wrote in Pink News citing the challenge of chemsex, on the back of a new PHE briefing for substance misuse and sexual health services, which cites our own guidance to improve outcomes for LGBT drug and alcohol users.

Mental health and substance misuse are factors we are only too aware of at London Friend, and issues we seek to address through our Antidote and counselling services both of which have seen a huge rise in men engaged in chemsex. We’ve also begun SWAP, a new intensive therapeutic programme run over four consecutive weekends addressing chemsex in the context of self-esteem, relationships, identity and wider well-being.

Feedback from these services is extremely positive with the vast majority of men reporting abstinence or control over their drug use as a result of accessing support. But such services are almost becoming a luxury against falling HIV prevention budgets and slashed to public health funding like the £200million cuts announced earlier this summer. Our  therapeutic services for HIV prevention took a 55% hit this year when the national HIV Prevention England programme shrunk, funding us only to provide brief advice and information. We await to see how much of the public health budget remains after next week’s Government Spending Review in unveiled. For the moment we’re lucky that most of our work is funded through charitable trusts rather than through public health monies.

Public Health England’s advice on HIV prevention states:

• Early diagnosis of HIV infection enables better treatment outcomes and reduces the risk transmitting the infection to others. Have an HIV test if you think you may have been at risk.
• Always use a condom correctly and consistently, and until all partners have had a sexual health screen.
• Reduce the number of sexual partners and avoid overlapping sexual relationships.
• Men who have sex with men are advised to have an HIV and STI screen at least annually, and every three months if having unprotected sex with new or casual partners.
• Unprotected sex with partners believed to be of the same HIV status (serosorting) is unsafe. For the HIV positive person, there is a high risk of acquiring other STIs and hepatitis. For the HIV negative person, there is a high risk of acquiring HIV infection (6,500 of MSM remain unaware of their HIV infection) as well as of acquiring STIs and hepatitis.

With new bio-medical options and a better understanding of the wider health and wellbeing needs of gay and bisexual men we are at a pivotal point for HIV prevention. At London Friend we would love to see a national strategy with a vision to end new HIV infections within a decade; to reduce the stigma of HIV; to equip our health and care sectors to support HIV prevention; and with programmes that offer men clear information about their sexual health and improving their confidence to choose safe, fun and satisfying sex.

Monty

London Friend welcomes the JCVI recommendation to extend HPV vaccinations to men who have sex with men, but calls on the Government to vaccinate all boys

Yesterday the Government’s advisory group the Joint Committee on Vaccination and Immunisation (JCVI) published its advice on extending the HPV vaccine to men who have sex with men (MSM). It recommends that men up to 45 should be able to receive the vaccine through a programme delivered in GUM clinics. Currently the vaccination is delivered only to girls, with the implication that most men will be indirectly protected through sexual contact with vaccinated women.

London Friend is a member of HPV Action, a coalition of 43 patient and professional organisations that advocates gender-neutral HPV vaccination. We believe the vaccinations for MSM are a step forward but that this change in policy does not go nearly far enough. What is urgently needed is a decision to vaccinate all adolescent boys. With every year that passes, 400,000 more boys are left unprotected against HPV-related diseases. This is unacceptable.

Human papilloma virus (HPV) is a very common sexually transmitted infection that can cause a range of cancers (cervical, vaginal, vulval, penile, anal, and oral) as well as genital warts. HPV Action estimates that, each year, HPV causes over 2,000 cases of cancer and 48,000 cases of genital warts in men; in women, it causes almost 5,000 cases of cancer and over 39,000 cases of genital warts. The incidence of anal cancer is highest in MSM and particularly in HIV-positive men.

Vaccinating just girls and MSM is not sufficient for these reasons:

1. Just vaccinating girls and MSM leaves men who have sex with women (MSW) at risk from infection by women who have not been vaccinated in the UK or other countries.
2. Vaccinating MSM who attend sexual health clinics is not the best way to protect the MSM population as a whole. This is because many MSM do not attend sexual health clinics and the average age of first attendance is 28. Despite advice that MSM should have an HIV and STI screen at least annually, and every three months if having unprotected sex with new or casual partners, an estimated 16% of MSM who are living with HIV remain undiagnosed.
3. Immunity against HPV is greatest if the vaccine is administered before age 16.

The most effective way to protect MSM – and MSW – is therefore to protect all boys through a vaccination programme for all boys and girls aged 12/13.

Today the Terrence Higgins Trust’s Director Executive Director of External Affairs, Dr Sean Griffin, has said “The Government already spends £60 million per year on treating genital warts which if left untreated can cause head and neck, penile and anal cancers. It is estimated that it would cost just £22 million per year to make the HPV vaccine available to all school-aged boys.”

London Friend continues to support HPV Action in its call to extend vaccinations to all boys. You can find out more about the campaign at hpvaction.org

Our CEO Monty Moncrieff discusses a new report in the British Medical Journal, and outlines Antidote’s response to chemsex.

Our work on chemsex is widely discussed in the media today following publication of a new article in the British Medical Journal. The report – co-authored by our Antidote Training and Outreach Manager Jamie Willis, along with colleagues at our partnership service The Mortimer Market Centre, discusses the public health concerns of chemsex. The article is reported in, amongst others, The Guardian, The Independent, The Telegraph and The Daily Mail.

The majority of our work in our Antidote drug and alcohol service now centres around chemsex, a trend we began to notice a few years ago. Antidote clients reported a stark change in the drugs they were using, and the situations they were using in. Strong stimulants like crystal meth and mephedrone are extending chemsex sessions, with practices such as ‘slamming’ (injecting) and condomless sex raising public health concerns.

Of equal significance is the impact of chemsex on mental health, with those most adversely affected also likely to report low self-esteem and a lack of belonging, struggling to find their place in the gay community and on an unforgiving commercial club scene selling the dream of sexual escapism and a glamourous perfect-bodied fantasy lifestyle.

Antidote’s response to chemsex has been to incorporate interventions around sexual behaviour into substance misuse treatment, to look at all the issues holistically. Our staff and volunteers provide an LGBT environment where our service users feel safe to discuss all aspects of their sexual and substance behaviour without judgement, and are encouraged to take steps to improve their health and wellbeing by stopping or learning how to better control their drug and alcohol use.

We’ve worked hard to highlight the issues, writing articles and training healthcare staff working in drug services and sexual health clinics - almost 700 people attended training with us last year. We’ve taken drug services into sexual health settings, pioneering specialist clinics like Code at 56 Dean Street and Monday mornings at The Mortimer Market Centre. We’ve inputted to new clinical guidance for professionals new to the changing drugs with our partners at the CNWL Club Drug Clinic, and have published a report, Out Of Your Mind, which can help commissioners and providers of drug treatment services improve their work with LGBT people and chemsex.

As London sexual health clinics embark on a new transformation project it’s the perfect opportunity to consider the integration of sexual health and substance misuse support, ending the current postcode lottery of local drug services for local people with varying knowledge of chemsex trends and centres that are unwelcoming to gay and bisexual men. GUM is the new frontline for chemsex and in it we have opportunities to reach people before their chems become a problem, with harm reduction support to help people take back more control over their health.

Monty

Twitter: @montymoncrieff

Antidote offers free drug and alcohol support for LGBT people, specialising in chemsex. For information on our services, including our partnership sexual health clinics, visit www.londonfriend.org.uk/2012/antidote

Yesterday saw some disturbing news as a man was charged with the murder of four men. It’s alleged he contacted the men via gay websites and that their deaths were caused by ‘poisoning’ with the drug GHB. As yet we don’t know any further details about the case, but the story does raise issues of personal safety whilst using online dating sites and apps, as well as with the drug itself, which is commonly used during chemsex.

Following the case we have published personal safety advice for people using online sites and apps to meet dates or sexual partners. You can access this here.

The case also raises issues with G, also known as GHB or GBL, a drug used by hundreds of men we support each year through our Antidote service. Our G Aware pages have more specific advice about the drug, including harm reduction advice. It’s important when using G to be aware of the dose; a small amount too much can cause users to pass out, leaving you vulnerable to assault, and larger doses can be fatal. Make sure you know how much you’re taking, and be aware that drinks may be spiked.

Some basic advice with G includes making sure you know how much you’re taking, and not ‘topping up’ too soon, in case you overdose. Look out for your drink in clubs, and if someone offers you drinks in their home ask them to open the bottle or can in front of you so you can be sure nothing else is added.

G can also be dependence forming if used on a regular basis. It’s easy to stave off a comedown by taking just a little bit more to ‘take the edge off’ but this can be a significant factor in creating the physical dependence that will make your body need more of the drug. If you think you might be dependent contact Antidote or your local drug service before stopping as going ‘cold turkey’ can be extremely dangerous. Support from a drug service can help you bring your use under control with a planned reduction or detox if required.

Our Antidote service offers chemsex advice with support to reduce drug or alcohol use or to stop completely.

www.londonfriend.org.uk/2012/antidote

www.g-aware.com

London Friend has worked with Public Health England and other members of the National LGB & T Partnership to produce a new briefing which aims to reduce alcohol related harms for LGBT people.

Alcohol is the third biggest risk factor for ill health in the UK (after smoking and raised blood pressure). Research by the LGBT Foundation and Stonewall has found LGB people drink more than the population as a whole, and more often. The Trans Mental Health Study found 47% of trans people drank at high and potentially problematic levels.

Alcohol IBAs (Identification and Brief Advice interventions) are a key part of the Government’s strategy to reduce alcohol related harms, and have been extensively evaluated as effective in doing so. This briefing discusses IBAs in relation to LGB & T people, highlighting how they can be made available to more LGB & T people.

Healthcare staff already delivering alcohol IBAs can ensure their approach is culturally sensitive and LGB & T-inclusive. LGB & T organisations may be ideally placed to deliver IBAs in their existing screening and assessments processes, and alcohol commissioners can consider how the needs of LGB & T people are considered when planning and commissioning delivery of alcohol IBAs locally.

You can download the resource from the National LGB & T Partnership’s website. Please also complete the short survey linked on that page to provide feedback on the resource.

In 2015 the stigma around HIV has failed to be controlled anywhere near as well as the virus itself.

My heart sank when I heard the news of yesterday’s leak of HIV patient data from 56 Dean Street. It’s a devastating blow for all concerned. For the individuals whose names are on the list, who might may fear being identified; for our own clients who work in partnership with us and the clinic; and for the staff at 56 Dean Street who have worked so hard to make the service welcoming and accessible to LGBT patients.

The error is one we all live at risk of. So many of us must have clicked the wrong button, or selected the wrong name when sending digital communications. Mostly it’s with less consequence – embarrassment at having copied in the wrong colleague, or once in my case texting a friend about how a date had gone but sending it instead to the date himself. Cringe worthy at the time, but a cringe soon passes. The consequences of this could live much longer.

Of course, any breach of procedure needs serious investigation, and this will reach further into the NHS as a whole than just this clinic. As this goes on it feels a timely point to look at what the impact on affected patients might be, and here there are some far more significant issues at play than whether a policy or process has been breached. The fear that some affected patients will inevitably feel is driven by one ugly factor: in 2015 the stigma around HIV has failed to be controlled anywhere near as well as the virus itself.

I don’t want for a moment to diminish the very real emotions that anyone named may feel; the issues of disclosure should be a personal choice, and many fear this choice may have been taken away. But what’s driving the decision to remain private about being HIV positive is that disclosure still results in rejection, in prejudice, and in discrimination. HIV positive people can be made to feel ashamed, but the really shameful thing is that the understanding of what living with HIV is like lags in the stereotypes and myths of four decades ago. 

Living with HIV today in Britain –when diagnosed early and properly treated – is no longer a life-limiting condition. Life expectancy for an HIV positive person is virtually the same as for one who’s negative. People on treatment enjoy a suppressed viral load, making HIV undetectable in their bodies, and making them the least likely to pass it on. People who test, receive a positive diagnosis and commence treatment are taking responsibility for their health, and the health of others. New advances such as PrEP offer exciting opportunities to HIV negative people to remain so, and hope to those of us working in public health that we have new tools to eliminate the spread of HIV.

1 in 6 people think you can get HIV from kissing

But stigma still blocks the way of our progress. Old habits die hard, and research published by the National AIDS Trust last year showed public awareness of HIV to be shockingly lacking. Only 45% of people correctly identified all routes through which HIV is transmitted, with about one in five not knowing HIV can be passed on through sex without a condom. One in six still think it can be passed on by kissing. One in ten think people diagnosed with HIV will be dead within three years with a further quarter not sure whether this statement is true or not. Some of the awareness had worsened over time when the data was compared. We ought really to be seeing this improve.

Given such misinformation it’s scant wonder many people decide against testing. Almost one in five men who have sex with men in the UK who are HIV positive don’t know their status. It makes them the most likely to pass on HIV without even knowing. Stigma is preventing people from accessing treatment that can improve their own health and reduce the risk to others. We can’t let stigma continue, but when we see politicians like Nigel Farage and journalists like Sky News’ Kay Burley rehashing inaccurate information and deploying divisive, inflammatory language we set the fight to combat stigma back a few more steps.

Removing stigma - preventing HIV

The key to HIV prevention is removing this stigma, and making HIV just another long-term medical condition; we must remove the stigma of testing; we must remove the stigma of a positive diagnosis; we must remove the stigma of living with HIV; and we must remove the stigma that prevents people disclosing their status. These are the actions that will ultimately reduce the fear felt by those whose status may have been accidentally disclosed yesterday. To do this will require a shift in public awareness, a shift that will be harder to achieve with continued disinvestment in HIV prevention, which has been slashed over a decade, and harder to achieve with more public health cuts looming ahead.

In the short term we need to look after those affected by yesterday’s data breach and rebuild trust with patients and service users. This is something all of us working in the HIV sector need to support. The 56 Dean Street clinic remains a leader in its field. For us at London Friend it’s been a joy to work with them developing such innovative services as Code and cliniQ, and see barriers tumble thanks to the will of staff and management to make ideas happen. It’s no coincidence they have the trust and confidence of thousands of patients each month because they’ve worked hard to reduce the stigma of attending a sexual health clinic and to make service users welcome. It would be a crying shame to see this lost at the push of a mistaken button.

Monty

56 Dean Street, and its parent NHS Trust, have taken swift action to try to limit the impact and set up support for those affected. It is right that a breach or procedure such as this is properly investigated by the relevant authorities. As a partner agency we will maintain contact with the clinic as their investigations continue and take any actions needed to ensure this doesn’t happen again. A helpline has been set up by the clinic for any patients worried about their own data and privacy. People can contact them on 020 3315 9555 or 020 3315 9594.

Co-Exist - living with HIV & Hepatitis C

London Friend would like to invite gay and bisexual men living with both HIV and Hepatitis C to a discussion around the future provision of a Peer Support Group. This initial session will help assess need and inform the content and design of this new group.

This session will be held on Tuesday 8^th September 6.30 – 8.00pm at London Friend, 86 Caledonian Road, N1 9DN.

The group aims to:

• Provide support and understanding.
• Offer a safe place and a comfortable environment.
• Create support systems and perhaps create new friendships.
• Share experiences and learn how to live well with co-infection.
• Build coping mechanisms to deal with difficult feelings.
• Breakdown the sense of isolation felt from living with co-infection.

The group will be facilitated by Joel, who for the last 16 years has worked in health and social care. Joel is also a qualified counsellor & writer for Baseline Magazine. Recently, Joel has successfully completed Hep C treatment, he has lived with HIV for 11 years, and so has a personal and professional understanding of what it means to live with co-infection.

This is open on a first come first serve basis to the first 15 people that book their place. For more information and to book your place please contact Joel: joel@londonfriend.org.uk 

We're thrilled to announce that UK Black Pride is supporting London Friend's work through a generous donation. UK Black Pride promotes unity and co-operation among all Black people of African, Asian, Caribbean, Middle Eastern and Latin American descent, as well as their friends and families, who identify as Lesbian, Gay, Bisexual or Transgender. London Friend has been named as their charity partner for their 10th annual Pride event this year.

Announcing the Board’s commitment to make a donation after the tenth anniversary festival, Pav Akhtar, Director for UK Black Pride, said:

“A significant number of UK Black Pride members have had cause to use many of the counselling and support services provided by London Friend. From issues such as same-sex relationships, sexual and gender identity, to promoting personal growth and self-confidence, we are proud that London Friend has stood by the Black LGBT to offer culturally sensitive and confidential support.

It stands to reason then, at this time when so many public health services are being starved of funding by central and local government, that the LGBT community must rally behind to support the delivery of vital lifelines, such as London Friend, to ensure that LGBT people are continue to be afforded some of the social and welfare protections needed at this time.”

Welcoming the commitment of support, Chief Executive of London Friend, Monty Moncrieff, said:

“We’re really pleased that UK Black Pride has, once again, elected to recognise our charity’s work for the support we offer to Black LGBT communities.

“All of London Friend’s services are delivered by a team of over 100 highly trained LGB&T volunteers who are supported by a small staff team. The work of London Friend depends entirely on the generosity and goodwill of our donors, volunteers and supporters without whom we could not provide the services or support we currently offer.”

Attend UK Black Pride

To attend the tenth UK Black Pride festival, which is an integral part London LGBT Community Pride’s Pride in the Park celebration on Sunday 28 June in London Vauxhall’s Pleasure Gardens, simply come along from 12 noon until 9pm. The free event will feature a main stage where UK Black Pride will blend live music, politics and poetry to deliver an entertaining, family-friendly, and inclusive festival of community pride. With a disco stage, comedians, sports activities, education and welfare stalls, alongside world food and drink (or bring your own picnic), it’s guaranteed that there’ll be something for all tastes at the event.

www.ukblackpride.org.uk

Toni Hogg, manager of London Friend's drug & alcohol service Antidote, is recognised in the inaugural Attitude Magazine Pride Awards

Our Antidote drug and alcohol service manager Toni Hogg has won an Attitude Magazine Pride Award! The Awards are new this year – which sees the 21^st Anniversary of Attitude – and honour what the magazine calls 12 “extraordinary ordinary” people who they feel embody the spirit of lesbian, gay, bisexual and transgender pride. The Awards will be presented on the eve of the London LGBT Pride march at the Grosvenor House Hotel in Park Lane.

Toni has been recognised alongside other LGBT activists and campaigners for her 15 years with Antidote, which has seen her rise from being a weekly volunteer to service manager, as the work she oversees has become increasingly needed in a changing scene of newer drugs and online hook-up apps making chemsex parties easy to arrange. Toni has led Antidote’s response to meeting these new challenges which has forced the service to expand its own awareness of the risks of newer substances, and develop new ways of supporting service users.

Speaking to Attitude Toni described the changes, seen most prominently among gay and bisexual men. “People were coming in saying they were using crystal meth and G. There wasn’t a lot of knowledge in generic service about those drugs”. Originally located within a mainstream drug treatment agency before moving to LGBT charity London Friend in 2011, Antidote realised it was attracting a very different clientele to those using drugs like heroin or crack cocaine which the parent service was more used to seeing. Antidote’s clients were more likely to be professionals who had no previous history of drug or alcohol problems.

“They have very good careers but have either tried chemsex as a one off and got hooked or found that it was a way of facilitating meeting men easily for sex” Toni explains; “The drugs involved are quite compulsive and psychologically addictive. If you combine the drugs with sex it’s quite an explosive situation”.

Antidote was the first service to identify chemsex trends in the UK, having seen drugs like crystal meth and mephedrone explode onto the scene and prompt more and more people to seek support when things began to get out of hand. Sexual health services have also begun to report increasing occurrences of chemsex, and have begun to employ their own drugs workers after Antidote piloted a pioneering new approach to bring chemsex support into gay men’s clinics with partners 56 Dean Street.

Toni’s award champions the work she has done to help hundreds of LGBT people address their drug and alcohol use, something she admits personal experience of, which led her into the job she does today. Running away from home at 15 she recalls “I got heavily into drugs and was very suicidal. When I trained as a counsellor I knew I wanted to work within the LGBT community from the start.”

One of Antidote’s strengths is understanding why LGBT people seek out specialist support. “It can be really difficult for people to talk at generic services” says Toni. “They worry about homophobia. It’s more comfortable for people to know they are going to be seen by other LGBT people who aren’t going to be judgemental about what they’ve been doing in their private lives.”

Toni credits Antidote’s success to its dedicated team of volunteers, without whom she says the service would collapse. Most of all, though, she is driven by Antidote’s service users. “I love coming to work every single day. I love my clients. I feel truly blessed to be in this position and I really enjoy working with our client group. They are a great bunch of guys.”

Antidote is the UK’s only LGBT-specific drug & alcohol service, based at London Friend, the UK’s oldest LGBT health & wellbeing charity.

www.londonfriend.org.uk/2012/antidote

Photo credits: Ellis Parrinder for Attitude Magazine