56 Dean Street has been at the forefront of reducing HIV infections amongst gay men for almost 10 years since opening in Soho in March 2009. The clinic’s medical staff have been leading in areas like PrEP, chemsex advice and support, working with the trans community and crucially diagnosing large numbers of gay and bisexual men with HIV and rapidly getting them on to treatment – and so making them uninfectious to others. We spent a morning at 56 Dean Street to see the team in action and talked to the Lead Clinician Dr Alan McOwan.
Dr Alan, you first brought the gay community’s attention to the idea of zero HIV infections two years ago with your Plan ZERO campaign. Do you think we can get to zero new infections amongst gay and bisexual men and what are the hurdles?
Absolutely. There are so many ways to attack HIV. We just need people to choose one of them, but there are still some barriers. Free PrEP is available through the IMPACT trial, but there simply aren’t enough spaces for those who need it. Dean Street has used up all its places. It’s heartbreaking meeting men in clinic who caught HIV while they were struggling to get PrEP. It’s scandalous that gay men get NHS funded PrEP in Scotland and Wales but not in England.
Secondly, to beat HIV, people at risk need to test regularly. Sexual health services are funded by your local council. As you’ve seen on the news, many of them have terrible financial pressures. This means they are forced to make some difficult decisions. However, I truly believe we can do this, but we all need to act. This World AIDS Day please give me 30 seconds of your time. Visit dean.st/zero and we’ll beat HIV together.
Why do you think 56 Dean Street is so popular with gay men?
Everyone is welcome at Dean Street, but the service was specifically designed to meet the needs of the LGBT community. There were studies showing high levels of undiagnosed HIV in Soho and we were determined to change things. We’re really proud that half of all gay men attending a sexual health clinic in London choose us. We want to reflect the diversity of London. We understand that all gay men aren’t the same.
Dean Street was inspired by a San Francisco LGBT community centre that had a small STI screening service. We decided to turn that idea on its head. That’s why we offer a community space for groups to meet in our building and our Wellbeing Programme runs events in local venues. It makes us part of the community we serve.
We’ve also got some lovely staff. When I’m interviewing, I try to decide whether I would like to see them as a patient myself. Lots of people tell us that they applied to work at Dean Street because they had a good experience at the clinic. That’s one of the nicest compliments we could wish for.
Why are HIV diagnoses falling faster at 56 Dean Street than the rest of London?
In the last two years the number of London’s gay men diagnosed with HIV has fallen by 44%. That’s brilliant news. There are so many people and organisations that have worked really hard to achieve it. World AIDS Day is the perfect time for everyone to celebrate their hard work.
Dean Street has seen a drop of 80%. Why the difference? Well I think there are probably a few reasons. Beating HIV has always been our number one priority. Everyone in the team is focused on it. We’re determined to win. Every time there’s a new way to attack HIV we introduce it as quickly as we can. We’re not afraid to push the boundaries and do things differently. Sometimes that’s been controversial. We had to really fight to get things approved. Now lots of those things are mainstream. It’s funny how things change.
So how are things different?
Well a good example is how we’ve changed the ways people can test for HIV. When we introduced the first HIV test with a 60 second result, lots of people initially thought it was completely outrageous. Some actually said it was a good idea to make people wait a week!
Then all hell broke loose in 2011 when Jeremy Joseph suggested we test hundreds of people in G-A-Y Bar on World AIDS Day. It was a great way to spread the message about the benefits of HIV testing. However, at the time, the idea was felt to be so shocking that it was featured on every national news bulletin. The following year HIV Testing Week was launched in the UK. Now it runs across the whole of Europe.
Home HIV testing was another real challenge. We were the first to offer an NHS online testing service. We faced a lot of criticism and it was incredibly hard to get off the ground. Now it’s widely available. Public Health England funds a national home HIV testing service (test.hiv). I think it’s really important that everyone has the choice of where they can test.
Dean Street Express was designed to make it simpler for men at risk of HIV to get regular check ups. It offers the world’s fastest results service. After it opened there was a significant increase in higher risk men testing. Public Health England links it opening with the fall in HIV transmission that started before PrEP became widely available. Now we’ve redesigned Express so it also supports people on PrEP. We’re continually reinventing ourselves.
We’re determined to beat HIV. I think it’s really important to keep innovating. Every time we’ve offered a new way to test, a different group of people decide to test for the first time.
I’ll never forget that first G-A-Y Bar World AIDS Day event. I met a 75 year old man who’d always been too scared to test for HIV. After 30 years, G-A-Y Bar was the place he felt able to do it. Things like that make me love my job.
Regular testing, immediate treatment
Hassan Mohammed, 56 Dean Street’s HIV pharmacist, with some of the HIV drugs he administers
“It’s always been our priority to diagnose HIV before there’s a chance for the virus to get passed on. HIV is at its most infectious in the first few months, as the levels of virus are really high. However, once people are on effective HIV treatment they cannot transmit it to others. The chain of infection is broken. It’s one of the most effective ways we have to prevent HIV transmission. Early treatment is also better for people’s long-term health.
That’s why most people want to start their HIV meds right away. We were the first service in the UK to offer everyone treatment within 48 hours of their HIV diagnosis. Now early treatment is recommended across the country.
If you catch HIV it’s important to find out as soon as possible. So get an HIV test right away if you develop flu like symptoms and have had condomless anal sex in the previous 6 weeks.”
The PRIME membership programme
“A few years ago we worked out that there were some early warning signs that mean people are at ‘super risk’ of catching HIV in the next 12 months. Examples included catching syphilis or getting rectal gonorrhoea (up your arse). We decided to do something about it and that’s why we developed our PRIME membership programme which offers online tailored support. Over 7500 men have been signed up. The fantastic news is that PRIME men are 20 times less likely to catch HIV than before.
The success is why we launched Plan ZERO. We now want to get the message to everyone. It uses the same options as PRIME. We’re asking all gay men to try the interactive tool at dean.st/zero. It takes less than 30 seconds to get your personalised plan. If you prefer you can do it in Spanish, Italian or Portuguese. If we all follow Plan ZERO, we can make HIV history.”
When chemsex drugs stop being fun
Clinic Manager Leigh Chislett explaining 56 Dean Street’s Chemsex support services in a counselling session
“The last few years have seen an increase in the use of party drugs such as G, Mephedrone and Crystal Meth. For some people it can become a problem which affects other parts of their lives. Some can find themselves taking risks during sex that they hadn’t planned.
That’s why we pioneered chemsex support services at the clinic. There are times you can walk in for a one to one chat. Or if you don’t feel ready to speak to someone, you can try our interactive online support to explore your options at dean.st/chemsex-tool”
Six thousand men on PrEP and counting
Jon Clark is the Charge Nurse at 56 Dean Street and one of the team you may meet when you go on PrEP.
“If you take PrEP correctly it works. Simple as that. If you’re not using condoms consistently for anal sex, we strongly recommend you consider it. It will protect you from HIV. Though it’s important to remember that unlike condoms, PrEP doesn’t protect you against other STIs.
We think it’s such a game changer, that anyone taking or considering PrEP can walk into Dean Street Express without an appointment. We’ll sort out your pre start check up and 3 monthly monitoring. We want to make it as simple as possible. You can get PrEP through the PrEP IMPACT trial (prepimpacttrial.org.uk). Dean Street can sell it to you through our unique ‘PrEP Shop’ service (dean.st/prepshop). Or you can buy it online from iwantprepnow.co.uk. Wherever you get PrEP from, make sure you follow our 5 point check list (at the end of this article) before you start.”
Searching for the next weapon
Dr Jey Zdravkov is one of the 56 Dean Street medical team who meet regularly to discuss everyone who’s just tested positive and try to work out any patterns to reduce future infections.
“As the number of diagnoses falls it gets harder to reduce it further. So once a month the team meet and discuss everyone who’s just tested positive. We’re trying to work out what we need to do next. If we spot a pattern we try and contact people with those characteristics to offer them extra support. We’ve also noticed many of the people who we test positive have never been to a clinic before. That’s why we run our community outreach programme, launched our interactive Plan ZERO tool (dean.st/zero) and developed the ‘Grass is Grindr’ serial on the ‘Dean Street Official’ YouTube channel. We need to reach people before they come for their first check up.”
Serving the T of LGBT
Dr Tara Suchak is a Consultant at 56 Dean Street and runs the CliniQ service for Trans people.
“Trans people tell us they often get a raw deal in the health service. That’s why we worked with CliniQ to launch the UK’s first and only weekly sexual health service for Trans people. It runs every Wednesday evening from 4.30pm-7pm. It felt a really important thing to do. We wanted to create a safe place where people could be themselves. We’re delighted that we’ve helped more Trans people on to PrEP than anyone else.”