Many people living with HIV are now enjoying full lives but early diagnosis and treatment are key, a local consultant has said.
Ahead of World Aids Day on December 1st, the ‘Journal’ this week spoke to Melissa Perry, Consultant in Genito-Urinary/HIV Medicine at Altnagelvin Hospital in Derry about the importance of routine and regular testing for sexually transmitted infections, and breaking down the myths and stigma associated with getting checked out.
For the past year, Dr. Perry has been working at the Genito-Urinary Medicine (GUM) Clinic at Altnagelvin, which is the main service within the Western Trust, although there are other clinics and ongoing outreach work.
Banbridge native Dr Perry trained in general medical training, and then went on to do a year’s research on HIV in London, and has combined this with specialising in sexual health medicine. She has also worked as a doctor in Africa.
At present the number of people being diagnosed with HIV in Northern Ireland is rising, and speaking about HIV awareness locally, Melissa said: “There’s still an awful lot of work that needs to be done but I think it’s improving.
“There’s two elements to the message we want to get across- it’s OK to have a test (a lot of people think that it might affect insurance policies even if the test is negative but it doesn’t) and the other thing is the stigma attached if your HIV test is positive.
“A lot of people think that HIV is a death sentence. It’s not true. It’s a treatable chronic illness. Most people have really good prognosis now, but the key to that is testing early and accessing treatment early.
“There’s lot of different options- most people on treatment will have no side effects although currently treatment remains life-long. When I see people here it is often people diagnosed very late and that is one of the keys. It is still treatable but if you are diagnosed late the likelihood of having other infections that make you sick are much higher.”
Melissa said that the stigma of coming to a GUM Clinic does still exist.
“Some of it might be people’s perceptions of what their risk is. We advise people your risk depends on the risk of the people you are having sex with but you don’t always know that so we advise you should just regularly test.
“People who come to a GUM Clinic shouldn’t just be people who are worried that it is going to be positive or people who are symptomatic. Everybody who is sexually active should have regular check-ups. It’s just an element of your health you would check up.
“There is still room for improvement around how people view coming to a GUM Clinic. I think there are still some misconceptions about what happens when people come to a Gum Clinic.”
She said this included men frequently thinking they are going to have some kind of umbrella device used on them. “Even if they are symptomatic, you will have a swab but it’s not an umbrella- it’s quick and reasonably painless.”
With HIV, one of the main advances is that when people are on treatment and the virus is suppressed, the risk of transmission is now known to be negligible, if any at all, even through unprotected sex.
“That’s a massive issue- people thinking this is the end of my sex life,” Melissa claimed.
She adds that if a pregnant woman is HIV positive and doesn’t know, then the risk of transmission to the child is 60%. “Every mother here is tested through ante-natal. If they are treated and the virus is suppressed then transmission is less than 1%.”
The GU clinic can also provide PEP (post exposure prophylaxis), a course of medication that can be taken for 28 days to try to reduce the transmission of HIV if you have had a known risk of exposure within the previous 72hours. There is also PREP (pre-exposure prophylaxis) that is taken prior to having sex and has proved extremely effective in clinical trials. This is not yet available on the NHS but the GU clinic are very happy to give advice and further information regarding PREP.
While people can attend their GP to be tested for HIV, going to a GUM Clinic has the added benefit of being offered a full sexual health test for other conditions such as syphilis, chlamydia and gonorrhoea, and if you are deemed at risk, vaccinations will be offered to prevent hepatitis.
Speaking about the most common conditions treated locally, Melissa said: “We still see lots of genital herpes, genital warts, and chlamydia. They are the most common but we do see plenty of other infections, gonorrhoea and syphilis. They are an issue in Northern Ireland because they are on the rise. These are things that have been around for a long time. We are having problems treating gonorrhoea because of resistance to antibiotics. If you don’t test and you don’t know you have it, this can have some long term problems with them.”
It is recommended that people who are sexually active and heterosexual should test once a year, or every time they have a change in sexual partner. For a man who is having sex with a men every three months.
As well as sexual health check-ups and treatment, the local GUM clinic also treats people with other genital skin problems, advice regarding safe sex and contraception.
“When you see someone in the waiting room it just means that they could be here for the same problem, or a skin problem or they are just looking after their sexual health. It doesn’t mean you have an infection,” Melissa said.
For those being screened, results are usually returned within a week to two weeks via text message or a discreet phone call. Melissa said that the whole service is discreet, confidential and non-judgmental.
On a personal level, Melissa said that people are often surprised at her choice of profession. “People think it’s strange because, ‘oh you look at genitals’, but then I might think it’s weird surgeons look inside people all day. It’s all very much about an individual thing. It is a job, you don’t remember things, you don’t remember people’s individual sexual history when you meet them in the street. It’s nice to meet different people; it’s nice to help people, even to give information, sometimes you can just really improve people’s understanding.”
She added that talking and educating openly about sex and sexual health remained an issue. “We have quite a conservative society here so openly talking about sex and things that are considered private are much harder for people to do. The more rural you go the more that is still there.
“Safe sex is obviously important and we can provide an element of that within our clinic but actually the best time to teach children about this is before they are sexually active so they have an understanding; an awareness of how to use condoms so they don’t find themselves in a situation where they don’t know how to stay safe. It’s about equipping people for a safe sex life.
“We educate our children in every other way. Everything we do is to give them education to make quality choices in life; informed choices. The majority of people are going to become sexually active at some stage so it’s just another role we should play to help equip them to make those choices safely.”
And as part of this the Trust is currently looking at ways of reaching people through different means, including social media, to provide accurate information, rather than people being left to Google STIs, dispel myths and offer testing in innovative ways.
“We’re not lecturing people about what they should do, everything is about personal choice. It’s about, ‘let’s equip you, so if you are going to do it, this is how we recommend you do it safely; whatever choices you make, these are the consequences and this is what you should do if you have concerns need advice’.”
For Altnagelvin GUM Clinic times: www.westerntrust.hscni.net/services/2013.htm.