56 Dean Street clinic’s Dr Alan McOwan explains how last year London saw a drop in new HIV infections and what needs to be done next to continue this significant success.
Last year something amazing happened. New cases of HIV in London’s gay men dropped by over 40%. What makes this so incredible is that for the last 20 years, the trend has been going in the opposite direction. So what’s changed? Have we found new ways to protect ourselves from HIV? If so, how can we use these weapons more effectively? Can we make 2017 even better?
One thing we do know is that the drop isn’t because gay men have stopped having sex. Rates of other sexually transmitted infections are rising. The number of rectal (arse) infections tells us it is not due to increased condom use either. Condoms are great. Most of us use them whenever we have anal sex. Things would be dramatically worse if we didn’t. But if it’s not all about condoms, what has changed?
In the last few years, researchers have discovered new ways to fight HIV. San Francisco learnt the lessons early. Their ‘Getting to Zero’ plan has led to massive falls in HIV across the city. We believe that it’s London’s turn, and that’s why the team at Dean Street has shamelessly copied every trick that San Francisco has used.
The first new fact is that modern treatment makes people with HIV non-infectious to others. They can’t pass their HIV on, once the treatment has suppressed the virus to ‘undetectable’ levels in their body. That’s why it’s recommended that HIV positive people start meds as soon as they feel ready to. Since Dean Street introduced this option, over three quarters of people start HIV treatment at their first doctor’s appointment.
The second advance was that we now know that HIV is most infectious in it’s earliest stages. Levels of the virus in the body are sky high during this time. It’s estimated that half all UK HIV is caught from someone who was recently infected themself. People often feel unwell a few weeks after they catch HIV. That’s why it’s so important to get tested immediately if you feel like you have flu and have recently had unprotected anal sex. Immediate treatment will make you feel better and as well as stopping HIV getting passed on. That’s why Dean Street has really concentrated on catching infections early. The clinic diagnoses half of London’s HIV in gay men, and 50% are picked up in the early stages. We’ve followed San Francisco’s lead and offer people the chance to start treatment within 48hrs of diagnosis.
Starting treatment at this early stage doesn’t just make people non-infectious. It also prevents the HIV from finding places to hide in your body. This hidden ‘reservoir’ of HIV is the reason why the infection is so hard to cure. Doctor’s believe that people who start immediate treatment are most likely to benefit if a cure for HIV is discovered.
Thirdly, we know that other infections make it easier for HV to get passed on. Having Gonorrhoea or Chlamydia doubles the chance. The risk with syphilis is even higher. That’s why we introduced our Infinity machine at Dean Street Express. People now get their STI test results in hours rather than a week later. That means people get treated faster and infections don’t get passed on.
But the fourth and biggest game changer has to be PrEP (It’s stands for Pre Exposure Prophylaxis). This involves taking a pill which protects you from catching HIV. It contains 2 medicines (tenofovir and emtricitabine). The commonest brand name is Truvada. In studies, no one who took the tablet correctly caught the infection. I would strongly recommend that you consider PrEP if you regularly have anal sex without a condom. Maybe you’re not keen on tablets? Don’t forget, you’ll only need to take PrEP while you’re at risk. However, if you don’t protect yourself, you could end up on HIV meds for the rest of your life.
At the moment PrEP is not available on the NHS. There are plans for a pilot roll out later in the year, but the limited funding means that it will probably only be available to the people at very highest risk. However, it’s perfectly legal to buy PrEP online for your personal use without a prescription. The www.iwantprepnow.co.uk website is a great place to get more information about reliable sources of the medicine. Alternatively watch the videos on the ‘Dean Street Official’ YouTube channel. These online sellers usually sell a different brand of PrEP such as Tenvir-EM. It costs about £45 per month. These pills contain exactly the same medicines as Truvada. It’s just like buying Ibuprofen rather than Nurofen. Dean Street worked with www.iwantprepnow.co.uk and tested the blood of people using these sites and we’ve shown that they contain the active drugs.
There are some really important things you need to do before starting PrEP. Firstly you need to be 100% sure you don’t have HIV. Second, you need a kidney blood test. Your GUM clinic or GP can sort this out. Third you need to decide which way to take it. Most people choose to take it regularly every day, but the intermittent method is great if you can predict when you are going to be at risk in advance. If you’re not sure you may find the YouTube videos helpful. Lastly you should get a check up every 3 months. Most London GUM clinics can support you.
Of course, we mustn’t forget condoms. They may have been around a long time but they still work. They also reduce your risk of catching other infections such as hepatitis. If you have a condom slip up, don’t forget that there is also an emergency back up. You have up to 72 hours after the risk to start PEP (The sooner the better). This involves taking a triple HIV combination for 28 days. You can get it from any GUM clinic or Emergency department. If you’re not sure whether you need PEP try our simple online calculator (www.dean.st/p-e-p)
This drop in HIV is absolutely fantastic news. We should all celebrate. However, HIV hasn’t gone away. Dean Street still diagnosed 393 gay men last year. What’s changed is that we’ve got these new weapons to beat it. We can follow San Francisco’s lead. Check out the flowchart below and decide on your strategy. Together we have the power to free our community from HIV.