I clearly remember one day in Summer 1980 after morning surgery discussing with my GP partner at the time an article he had read in the New England Journal of Medicine. It was a discrete article postulating that a rare cancer called Kaposi Sarcoma was more common amongst sexually active homosexuals. The reason we were discussing this was because a patient, who was homosexual had returned from the USA and had heard a rumour that there was an increased risk of his developing cancer. My partner was was wondering if he should share what he read with the patient or not. We decided that as the article was so small on balance it was probably not appropriate. In 1994 it was found to be caused by a virus and confirmed as an AIDS-defining illness.
HIV/AIDS was formally identified in the 1981.
I came to London in 1982 and I was working as an Examining Medical Physician which involved home visits to disabled people to assess for Attendance Allowance and Mobility Allowance (benefits which preceded Disability Living Allowance). One day I visited a man in Chiswick and after waiting at the door for a while whilst he struggled to get to the door he greeted by saying “I hope you are not going to be like the last doctor and take flight without completing the examination”
He then told me the tale of how an elderly doctor had visited and began the examination assuming the man had Parkinson’s Disease. The man interjected by telling the doctor that actually he was suffering from AIDS and the doctor promptly got up from his chair and hastily left the house. That was how people reacted at that time and believe or not 30 years some people still react in this way!
However, I shall always be grateful to this man as he gave me my first tutorial on this condition and the dreadful side effects of the anti-viral treatment at that time,as it was a
‘new’ disease the majority of doctors had very limited knowledge. He knew that his life would soon be coming to an end.
It is comparatively recently that as doctors we have felt confident to suggest blood testing in the surgery. One such patient we carried out the test and it came back positive and it was necessary to break the news to him. Although, devastated he told us how much better it was to be given the news by the doctors he had known for some years rather than by an unfamiliar doctor and sent Dr Livingstone and myself some flowers. However. sadly this delightful young man died suddenly before we had chance to thank him. Again a reminder of this devastating disease and the stigma that still remains.
Many of the facts and details can be obtained on the following website http://www.nhs.uk/Conditions/HIV/Pages/Causes.aspx
but I feel it is important to outline these by reprinting them in this blog to inform and in respect to those patients I have met over the years and particularly those who have been my main source of education.
HIV stands for the Human Immunodeficiency Virus. It is a virus which attacks the body’s immune system — the body’s defence against diseases.
Highlights of facts about HIV in the UK:
- Over 90% of people with HIV were infected through sexual contact
- You can now get tested for HIV using a saliva sample
- HIV is not passed on through spitting, biting or sharing utensils
- Only 1% of babies born to HIV positive mothers have HIV
- You can get the results of an HIV test in just 15-20 minutes
- There is no vaccine and no cure for HIV
How common is HIV?
At the end of 2011, there were an estimated 96,000 people in the UK living with HIV. The majority were infected through sex (40,100 gay and bisexual men and 51,500 heterosexuals).
Around 1 in 4 people with HIV (currently approximately 25,000) do not know they are infected.
Around 1 in every 650 people in the UK has HIV but the two groups with highest rates of HIV are gay and bisexual men and African men and women, where the rates are 1 in 20 and 1 in 25 respectively.
The World Health Organization estimates that around 34 million people in the world are living with HIV.
The virus is particularly widespread in sub-Saharan African countries, such as South Africa, Zimbabwe and Mozambique.
How is HIV spread?
HIV cannot be transmitted
HIV is found in the body fluids of an infected person, which includes semen, vaginal and anal fluids, blood and breast milk. It is a fragile virus and does not live very long outside the body.
HIV cannot be transmitted through sweat or urine.
The most common way of getting HIV in the UK is by anal or vaginal sex without a condom. According to statistics from the Health Protection Agency, 95% of those diagnosed with HIV in the UK in 2011 acquired HIV as a result of sexual contact.
Other ways of getting HIV include:
- using a contaminated needle, syringe or other injecting equipment
- tranmission from mother to baby during pregnancy, birth or breastfeeding
- through oral sex or sharing sex toys (although the risk is significantly lower than for anal and vaginal sex) sweat or urine.
- The most common way of getting HIV in the UK is by anal or vaginal sex without a condom. According to statistics from the Health Protection Agency, 95% of those diagnosed with HIV in the UK in 2011 acquired HIV as a result of sexual contact.
The main ways the virus enters the bloodstream are:
by injecting into the bloodstream (with a contaminated needle or injecting equipment)
- through the thin lining on or inside the anus and genitals
- through the thin lining of the mouth and eyes
- via cuts and sores in the skin
HIV is NOT passed on through:
- being bitten
- contact with unbroken, healthy skin
- being sneezed on
- sharing baths, towels or cutlery
- using the same toilets and swimming pools
- mouth-to-mouth resuscitation
- contact with animals or insects such as mosquitoes
There are now more people than ever living with HIV in the UK — around 100,000 — with a quarter of those people are unaware they have the virus.
Where to get tested?
There are various places to go for an HIV blood test, such as:
sexual health clinics, also called genitourinary medicine (GUM) clinics
clinics run by charities such as the Terrence Higgins Trust
some GP surgeries
some contraception and young people’s clinics
local drugs agencies
at an antenatal clinic, if you are pregnant
a private clinic, where you will have to pay
Home testing kits are also available, which allow you to take a saliva sample or blood spot and send them off to a laboratory for testing. These are available online and from some pharmacies, but you will generally have to pay for them.
From early 2014, it will also be possible to buy self-testing kits that will allow you to test yourself and find out the results immediately. It is important to check that any test you buy has a CE quality assurance mark and is licensed for sale in the UK, as poor quality HIV self-tests are currently available from overseas.
It is your choice where you would be most comfortable having the test.
Your nearest location can be found on the NHS choices website
Symptoms of HIV
Most people who are infected with HIV experience a short, flu-like illness that occurs two to six weeks after infection. After this, HIV often causes no symptoms for several years.
The flu-like illness that often occurs a few weeks after HIV infection is also known as seroconversion illness. It’s estimated that up to 80% of people who are infected with HIV experience this illness.
The most common symptoms are:
fever (raised temperature)
Other symptoms can include:
swollen glands (nodes)
The symptoms, which can last up to four weeks, are a sign that your immune system is putting up a fight against the virus.
These symptoms can all be caused by conditions other than HIV, and do not mean you have the virus.
However, if you have several of these symptoms, and you think you have been at risk of HIV infection, you should get an HIV test.
After the initial symptoms disappear, HIV will often not cause any further symptoms for many years. During this time, known as asymptomatic HIV infection, the virus continues to spread and damage your immune system. This process can take about 10 years, during which you will feel and appear well.
It is important to remember that not everyone with HIV experiences early symptoms, so you should still take an HIV test if you have put yourself as risk, even if you experience no symptoms.
2 There is no job which someone can’t do specifically because they have HIV
3 Treatment can mean that people living with HIV are no longer infectious
4 Men and women living with HIV can become parents of an HIV free baby
5 BUT people living with HIV still face stigma and discrimination