Covid-19 Crisis Hopes to End UK Transmission of HIV | Society


“In the war against any infectious virus,” says Dr. Alan McOwan, “you are trying to win various battles. You have to keep shaking it from all possible directions. “

This is true for coronavirus, he says, as well as other viral conditions. An HIV specialist at the sexual health clinic at 56 Dean Street in London, McOwan finds similarities between Covid-19 and HIV. Both are viruses without an effective vaccine, you can be infectious without knowing it, and both rely primarily on close human contact to spread.

McOwan and his colleagues are not only interested in comparing the two viruses, but also in examining their interaction. Because while the spread of all infectious diseases, including Covid, is slowed by physical remoteness, sexual health specialists believe that the unique set of circumstances that the foreclosure has created offers an unprecedented opportunity in the fight of decades against HIV.

Since the time before the lockdown, clinicians at 56 Dean Street have been closely monitoring their new gonorrhea cases and prescriptions written for post-exposure prophylaxis (PEP), a treatment which, if taken within 72 hours of exposure to HIV can stop the virus from taking hold. On both fronts, they registered sharp declines.

“We chose these two markers because they are things people would tend not to delay,” said McOwan. “If you have gonorrhea in your penis, you feel like you are peeing on razor blades and you can have a discharge within four to seven days. To be effective, PEP must be taken quickly. “

Their results confirmed what health professionals in the country predicted: by following physical distance measures, the public has less “risky” unprotected sex with new partners. This alone has helped slow the rate of HIV transmission, but a long period of sexual inactivity in Britain has other advantages in trying to slow new HIV cases.

People are more contagious in the early stages of contracting HIV and are therefore more likely to transmit it. Typically, the viral load of untreated HIV-positive people is in the tens of thousands, while the figure for a McOwan patient who had recently contacted HIV was 520 billion. “Since very few people have caught HIV recently,” says McOwan. “There are far fewer of these highly contagious people around.”

Having already lasted for seven weeks, the lockout also alleviates one of the biggest challenges that sexual health clinicians typically face: it can take up to a month after potential HIV exposure for current tests to return a final result. “If no one has had sex that puts them at risk of contracting HIV for at least four weeks,” said McOwan, “there will be no one in this blind spot who might otherwise be missing.”

During regular treatment, HIV-positive people have an undetectable viral load and therefore cannot transmit the infection. New HIV infections had already declined nationwide, in part because the NHS is improving public access to pre-exposure prophylaxis (PrEP), a drug taken by HIV-negative people before and after sex, which reduces the risk of contracting HIV. In 2012, there were around 2,800 new HIV diagnoses among men who have sex with men in the UK. By 2018, that number had dropped to 800, a drop of 71%.

“If we can now find the remaining HIV-positive people through screening and put them on treatment,” says McOwan, “We could remove any infectious person from the population with lasting effects.” We will no longer get this two month window without sex. “

Similar successes could also be seen in other locked countries where testing and treatment are widely available. The New Zealand AIDS Foundation has already contacted Dean Street for permission to replicate his campaign. It’s an opportunity, says McOwan, that he and his colleagues are determined to “shoot for.”

Along with the Terrence Higgins Trust and other industry organizations, the Dean Street team works to encourage anyone who may have been exposed to HIV since their last check to be tested before the end of the test. isolation. Their publications on social networks explaining how this period could “break the chain” were the most shared.

But this effort can only succeed if patients can access HIV testing before resuming normal sexual activity. Sexual health services are ordered by local authorities rather than by the NHS England at the national level, which means that access to different testing methods depends on where the patient lives. Online mailing tests are not always routinely available in all areas, and the coronavirus has seen many face-to-face sexual health services closed while resources are being redeployed.

Results of a survey by the British Association for Sexual Health and HIV, published in early April, revealed that a quarter of responding physicians could not provide patients with access to online HIV testing. More than half reported having less than 20% of their standard capacity to provide face-to-face HIV services.

“Where available online, postal testing has increased,” said Dr. Michael Brady, sexual health and HIV consultant at King’s College Hospital, and medical director of the Terrence Higgins Trust. “In London, and in many other parts of the country, we have great online testing services with capacity, but it’s not consistent. There will be places that do not offer online tests or have a limited number of tests available, and there will be a problem if, in these places, face-to-face services are not yet open. “

While some clinics remain closed, many NHS trusts have adapted their HIV tests to introduce online services and have informed front-line health workers, but some have not. When the Guardian contacted a clinic at the NHS in Northumbria to ask if routine HIV testing was available, he was told that this would not currently be possible in person or online. A spokesperson for the trust later added that they offered an HIV test and corrected the fact that incorrect information was being provided.

A clinician at trusted Sherwood Forest hospitals in Nottinghamshire also said the tests were not available, although a spokesperson later confirmed that the tests were being done online.

The advice from the experts is clear: the lockdown gave us a unique chance to reduce new HIV transmissions; if you are in a risk group and you may have been exposed to the virus since your last test, order a test and do it now.

As it stands, however, not everyone can. And even when testing capacity is available, some clinics apparently don’t know it.

“The message about this unique opportunity is futile,” says Brady, “unless we make sure the postal tests are there for those who need them.” If everyone is able to use their locked out time to test for HIV and find out their status, we could make significant progress in stopping the spread of HIV in the UK. “


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