Tackling discrimination
The man was refused an endoscopy (examination of the inside of the body using a camera) by Craigavon Area Hospital.
With the support of the Equality Commission, he prosecuted the NHS Trust under the Disability Discrimination Act (DDA).
This legislation makes it illegal to discriminate against people with HIV in health care as well as in education, employment, housing and the delivery of good and services. This is thought to be the first time the DDA has been used to challenge discrimination against a person with HIV when accessing healthcare.
The Southern Health Trust apologised and paid the man £4000 compensation; it said that the refusal to perform the endoscopy had been “entirely inappropriate”.
Normal infection control procedures mean that there is no risk to healthcare staff or other patients from performing medical procedures on people with HIV.
A good place to find out about challenging discrimination in health care and other areas is NAM’s booklet, HIV and Stigma . There’s information in the booklet about how to make a complaint and organisations that can help you.
Treatment for facial fat loss
HIV treatment can cause a collection of side-effects known as lipodystrophy. This is a disturbance in the way that the body processes and stores fat. It can involve fat gain, often around the stomach, and fat loss from the face, buttocks and limbs.
The causes of lipodystrophy still aren’t fully understood, but there is good evidence to suggest that some older anti-HIV drugs can be a key cause.
Fat loss has been particularly associated with AZT (zidovudine, Retrovir, also in the combination pills Combivir and Trizivir ) and d4T (stavudine, Zerit). For this reason, their use is no longer recommended in the UK if other drugs are available.
Although fat loss doesn’t seem to be medically dangerous, it can be distressing and stigmatising, especially fat loss from the face.
The only effective treatment for fat loss from the face is cosmetic, involving injections with synthetic substances. The most commonly used treatment in the UK is New Fill (polylactic acid). It can safely and effectively restore a normal facial appearance. This treatment is available for free, paid for by the NHS, at many NHS treatment centres.
They followed 145 patients who had the treatment for four years. Serious side-effects were extremely rare. Only one patient developed a local infection where he had the injections and this was successfully treated with antibiotics.
In all 89% of patients said that they were ‘satisfied’ or ‘very satisfied’ with the results of their treatment.
A repeat course of injections was needed in 9% of people, and 17% said that they still had some mild fat loss after the completion of treatment.
HIV treatment and PML
Thanks to HIV treatment, many people with HIV can look forward to a longer and healthier life.
The amount of serious HIV-related illnesses seen in people with HIV fell dramatically once effective HIV treatment was introduced.
Progressive multifocal leukoencephalopathy (PML) is a disease of the central nervous system. It is very rare, but people with very weak immune systems have an increased risk of developing it.
Studies conducted before effective HIV treatment became available showed that less than 1% of people with HIV would develop PML. However, it was often rapidly fatal.
They therefore looked at the records of every HIV-positive patient in Switzerland who developed the disease over a twenty-year period between 1988 and 2007.
Their results showed that the disease was diagnosed in people with very weak immune systems, average CD4 cell count being very low at only 60 cells/mm3.
They found that the introduction of effective HIV treatment in 1996 was associated with a four-fold decrease in the number of new PML cases. They also found that survival after diagnosis with PML increased. However, most people continued to have persistent neurological problems.
HIV treatment and pregnancy
Although HIV can be passed on from a mother to her baby, it is possible for an HIV-positive woman to have an HIV-negative baby.
There’s been a lot of research into the safety of HIV treatment during pregnancy. The results haven’t always agreed. Some studies, particularly those conducted in Europe, have found that combination HIV treatment, particularly if it includes a protease inhibitor, increases the risk of having a premature or low birth weight baby. However, other research, often conducted in the US, found no such risks.
Unless a woman needs to take anti-HIV drugs for her own health, treatment to prevent mother-to-baby transmission of HIV is normally started after the first three months of pregnancy.
Their research included women treated at a hospital in Rio de Janeiro between 1996 and 2006.
The rate of mother-to-baby transmission was very low, and was especially rare in women who were already taking HIV treatment when they became pregnant.
But their research showed that women who were already taking anti-HIV drugs when they became pregnant were more likely to have a premature or low weight baby. High blood pressure and a viral load above 10,000 were also risk factors.
Swine flu and HIV
Swine flu has dominated the news this week. There is concern that it has the potential to become the first flu pandemic since the 1960s.
Although swine flu has caused deaths, most of the reported cases have been mild and have responded to treatment with anti-flu drugs.
The UK’s chief medical officer has said that he is “concerned but not alarmed” by the risk of a swine flu pandemic.
A lot of the reporting of swine flu has been speculative and may at times be alarming.
People with HIV, particularly if they have a weak immune system, are one of the groups with an increased risk of developing complications with winter flu. But it’s important to remember that this doesn’t mean there’s an epidemic of flu-related deaths in people with HIV every winter.
There is no evidence that people with HIV will be affected any differently by swine flu. It makes good sense for everyone to follow general precautions to reduce the risk of flu transmission (published by the NHS).
Should the symptoms of flu develop, typically a high temperature, runny nose, cough, headache, sore throat and aching muscles and joints, then it makes good sense to talk to your GP or HIV doctor, or to call NHS Direct on 0845 46 47.