Heterosexual men: the HIV minority

Transcription

1 Heterosexual men: the HIV minority Richard Riley Social Worker Clinical Specialist, HIV John Hunter Hospital 15 March 2013

2 Outline of session 1. Aims of this session 2. HIV infection rates 3. Transmission, prevention and treatment 4. HIV and the law 5. Small group discussion and feedback: What are the issues for heterosexual men? 6. Strategies to engage heterosexual men local example 7. Having children 8. Breaking news

3 HIV in Australia* 31,379 HIV infected since ,542 living with HIV, ,104 new cases of HIV, 2011 NSW stable around 370/year Qld, WA, Vic recent increases Australian HIV Surveillance Report, Jan 2012 The Kirby Institute

4 Who is being infected with HIV? MSM 75% of new diagnoses (86% newly acquired) Was 95% in mid 1980s Heterosexual 21% (10%) - prior increases, currently stable Was 3% in mid 1980s IVDU 4% (4%) Remains quite stable and low 47.6 % (34 0f 72) of newly diagnosed seen by I&ID social work Jan 2003 to July 2009 were heterosexual transmission

5 HIV is not transmitted by: Sharing cooking and eating utensils Touching, hugging, massaging or kissing someone Sharing bathroom or toilet facilities Insects or animals Food or water Faeces Nasal fluid Saliva unless mixed with blood Sweat Tears Urine Vomit

6 Transmission HIV is in people s blood, semen, vaginal fluid and breast milk. Since 1985 all blood products are screened for HIV and other blood borne diseases. The most common methods of HIV transmission are through: Unprotected anal, vaginal sex with someone who is infected with HIV. Oral sex is low risk of transmission. Sharing needles or syringes with someone who is infected with HIV. From mothers to their babies before the baby is born, during birth or through breastfeeding.

7 Prevention Use condoms and lube Use clean injecting equipment and do not share Ante natal testing Have regular STI and HIV checks depending on the number and frequency of partners Know your partner s HIV status Use PEP if you think you have been exposed to HIV

8 Treatment Antiretroviral therapy counteracts the ways HIV works to limit its replication and spread by minimizing the Viral Load. Allows the immune system to have the strength via stable or increasing CD4 count to protect the body and brain from infections that might opportunistically arise. Life expectancy is an average of 35 yrs from diagnosis, and increasing. There is no cure nor vaccine» Show chart

9 HIV and the law Confidential information (whether tested or the result) can only be disclosed if: The person with HIV/AIDS consents Duty of care A court orders the disclosure Services do not have the right to disclose a persons HIV status to other agencies. NSW Public Health Act: person with HIV is required to disclose their status to their sexual partners. Information on a worker s HIV status belongs to the worker concerned. Commonwealth law of discrimination on grounds of disability includes infectious disease

10 30 years on heterosexual transmission Is this the Grim Reaper revisited?

11 Small group discussion What do you think some of the issues might be for heterosexual men diagnosed with HIV?

12 Feedback from small groups What do you think some of the issues might be for heterosexual men diagnosed with HIV?

13 Heterosexual plwh Culturally and linguistically diverse Late diagnosis with acute hospitalization common Older age (anecdotally increase in younger, and with babies) No community of support do not know anyone else that is HIV positive reluctant to disclose less access to informative or affirmative media more isolated Persson et al, Straightpoz study, Vol 2 NCHSR 2009

14 In patient late diagnoses Late diagnosis is when someone is found to be HIV positive at a level that would normally require treatment immediately Some diagnosed when HIV had progressed so far that cognition, mobility impaired and infections present. Commonly in hospital for two months Recently some with in patient diagnosis never leave hospital Mix of gay, straight, bi, men and women, ages

15 Local experience of heterosexual plwh Many undisclosed except to doctor Heterosexual plwh often looking for contact with other plwh 6 18 months after diagnosis. Existing NGO services not attracting heterosexual plwh Reluctant to approach mainstream services around HIV issues.

16 The Waiting Room Politics of inclusion gay friendly services developed to make a vulnerable (but dominant) population welcome and safe using culture, language and particular ways of relating Some other groups, especially heterosexual men, can feel like cultural outsiders and as though the service is not intended for them

17 Strategies for engaging heterosexual men Previous attempts Promotion What has worked

18 Previous attempts to engage heterosexuals Social work contact on individual basis Few heterosexual men and virtually no women access the local HIV NGO, Karumah. Annual events by Karumah and Poz Hets over four years with attendance varying between one and five. Monthly women s group started in 2011 by female SW at Karumah - attendance two to four each time. Attendance at Poz Het retreats encouraged with HIV SW co - facilitating annually since 2010 Women s group requested broader group in late 2011 due to low numbers.

19 Promotion Flyers E mail Telephone Post Other agencies Promotion Reminder telephone and e mail, especially for people who have not been before Safety who else is there; meeting them; transport home?

20 Participant characteristics 24 years to 66 years 7 women, 6 men (and 2w, 3m indicating they want to come along) 2 Aboriginal, 3 CALD, 6 working, 5 OA and DSP pensioners, 1intellectually impaired and under Guardianship Most have had acute hospital admissions due to late diagnosis 4 had not met another HIV positive person before the group 2 had disclosed HIV to wives and then never talked of it again All on medication although adherence is an issue with three.

21 What works? Gathering data - data mining and I&ID database Applying social justice principles Repeated individual contact and a slow build Normalisation Partnerships Mixing education with social support

22 Having children Now low risk for a HIV positive woman if: ante natal testing Mother s HIV viral load is reduced by treatment Infusion of HIV drugs at birth and 1 month ART for baby Caesarian at 38wks reduces transmission risk to 1% Vaginal delivery now has 2% risk No breastfeeding

23 Recent changes HIV and pregnancy Increases in pregnancies to HIV positive women Longer life expectancy with medications Men and women more optimistic about forming relationships Less transmission risk with father s and mother s suppressed viral load Positive men can access sperm washing mostly private sector Increased local presentations Collaboration between HIV unit and Paediatrics Sharing knowledge Developing roles Continuity of care Ante natal testing education to reaffirm HNE LHD policy

24 HIV and Pregnancy - information Dr Michelle Giles m.giles@alfred.org.au ID Physician with Discordant Couples Program at Royal Women s Hospital, Victoria Positive Life fact sheets: #6 - positive pregnancy #18 - disclosing to your child Treat Yourself Right information for Women with HIV and AIDS 3rd ed. 2008

25 Late diagnosis research Arose from reappearance of HIV inpatient deaths and disability. Existing research tells us who but not why. If we know why, we could prevent as many late diagnoses Focus regionally by recruiting survivors of late diagnoses over last 5 years and comparing with early diagnoses. HIV SW, CNC, Population Health as partners Literature survey completed Questionnaire finalised Methodology: decided and written Ethics proposal being prepared

26 Breaking news wake up hidden virus (Lewin, Melbourne). self destruct by killing the cell it inhabits, once woken up Gene therapy (Harrich, QLD). modified protein potentially stops HIV replicating.