What percentage of STI infections are among young people between 16 and 24? 8 years represents approximately 10% of our lives, so maybe you think a figure round about a tenth is most likely, or maybe you’re thinking something double that, say 20%, would be more accurate as it reflects the increased sexual activity young perople have (or, at least are seen to have). Well, actually you’d be way out if you thought either of these. The actual number of new STIs in that 8 year age group is over 50%, much more than many of us might expect. Of particular concern is the increasing number of young people with Chlamydia, which has increased dramatically over the last decade . In total in the UK there are an estimated 186,000 new cases in 2011, 117,000 of those in the 16-24 age group. Young people are substantially more likely to get an STI than any other age group and so it is clear that there is a need for prevention work targeted at this age group.
Stats such as those above suggest that many young people are not aware of the prevalence of STIs and how they can protect themselves against STIs. For this reason one of our partner agencies, The Metro Centre, has started the ‘Getit’ campaign which targets young people specifically through outreach work in youth clubs, schools, sports sites and other locations popular with the 16-24 age group. The campaign is helping to ensure young people in Wandsworth have the necessary knowledge and skills to practise safe sexual behaviour and reduce STI transmission and have access to free condoms. Similarly, West London Gay Men’s Project recognise the importance of working with young people to reduce STI infections, perhaps best highlighted in their innovative online outreach support programme. Young LGBT people use the internet more than their older peers, especially for hooking up, and so the importance of such projects cannot be overstated. In the US the GYT campaign, promoted on MTV through the IYSL (It’s your sex life) is a good example of HIV and STI prevention work targeted specifically at young people. The tag line of the campaign is ‘Know yourself, know your status, get yourself tested’ and it works to increased knowledge and testing of HIV and STIs amongst young people through using material such as TV adverts and posters, such as the one below:
Why is the increasing number of STIs amongst young people such a concern? Well, why some STIs may be harmless and many are easily treatable, some are not. Some STIs, for example, are becoming increasingly resistant to current treatment. Gonorrhoea is becoming particularly difficult to treat with current antibiotics and treatment options for the future are uncertain. Also some STIs have undesirable side effects such as infertility or even potentially life-threatening ectopic pregnancies, which young people are often not aware of. Another, not especially well known, side effect of having an STI is the increased risk of contracting HIV. In fact, the risk is estimated to be between two and five times greater! For this reason STI management is an essential part of HIV prevention, including projects working with young people. While GMI’s key focus is on HIV prevention, each of our strands concentrates on STI management too – for example increasing awareness and promoting STI avoidance and testing. For example, the GMI mentoring programme, which is most popular among young gay men in their 20s and 30s, works with mentors specifically trained around STIs and uses modules focused on STI knowledge, testing and understanding as well as HIV. This holistic approach to HIV prevention is mirrored in our counselling and health trainer programmes. What is clear from the stats around STIs in the 16-24 age group is the effectiveness of current integrated HIV and STI prevention projects and the need for more similar work if the disproportionately high number of new cases in this category are to be reduced. This approach is vital to improve the sexual wellbeing of young people in the UK and elsewhere.
If you would like information on where to get a free sexual health check up in London please check GMFA’s website here
GMI Partnership provide free, non-judgementral seuxal health services to gay and bisexual men in London. For more information please see our website or contact firstname.lastname@example.org . The views are those of the author and do not necesasarily represent GMI.
At the end of January the topic of the GMI blog was whether a cure was in sight for HIV. As I wrote then this is an area that is changing constantly as more research is conducted, drug trials are completed and our understanding of HIV is pushed forward. A few days ago a story was published of a baby from Mississippi who was seemingly cured of HIV. This week the blog explores this case and asks what it could mean for the hope of finding a cure for HIV on a larger scale.
– The baby’s mother was HIV positive and this passed to the baby during pregnancy.
– Doctors decided to start the baby on anti-retroviral treatment less than 30 hours after it was born, much sooner than in most similar cases. Normally treatment is started after 6 weeks, once results from blood tests confirm the baby is HIV positive (see link).
– The baby’s viral count declined until HIV could no longer be detected after 29 days. The child now has no sign of infection, over 2 years after beginning treatment (see Huffington Post article).
– Treatment was stopped 1 year ago and there are no indications of infection.
– Researchers have been talking about a ‘functional cure’, rather than a technical cure for HIV. The virus has not been completely eradicated, rather it exists in such a low amount that the body is able to control it (4 copies of HIV DNA per million of white blood cells – see NHS article).
What are the hopes that this represents a cure for others?
The enthusiastic nature with which many doctors have commented on the case seems to imply that this case brings us closer than ever to finding a cure for HIV. Dr Rowena Johnston, of the Foundation for Aids Research, was extremely upbeat about the results of the approach used. In a BBC article on the case she commented ‘I actually do believe this is very exciting. This certainly is the first documented case that we can truly believe from all the testing that has been done. Many doctors in six different laboratories all applied different, very sophisticated tests trying to find HIV in this infant and nobody was able to find any’ . But what hope does this mean to others who are HIV positive or to those that are at risk of becoming positive?
Well, there are 33 million people worldwide with HIV and this is only the second reported cure (see the Berlin case for the other). In that respect the results of this case definitely appears to be groundbreaking. However, the NHS warns of reports of an HIV cure as premature. While it is possible the child could grow up with continued extremely low levels of the virus they could start to rise and antiretrovirals may be needed again in the future to control the virus. One thing appears certain – this approach must be replicated with other newborns to determine whether there is hope of using it in other cases. In terms of the transferability of this specific approach to HIV prevention it is important to recognise that in the vast majority of wealthy countries HIV positive mothers take antiretrovirals during pregnany, which significantly reduce HIV transmission, and prenatal testing is common to assess whether this is necessary. In the UK this prevents mother to child transmission in approximately 98% of cases. However, this approach definitely appears to be useful in the developing world where this approach is not as common and where mothers might discover they are HIV positive in labour, as was the case in this example.
Truvada, recently approved in the US for those at high risk of becoming HIV positive
What this case does show, quite clearly, is the potential value of using antiretrovirals (treatment) as a form of prevention. This, more general approach, is definitely something which is being trialled outside mother to child transmission cases, like the one above. For example after trials in the US, the government has recently approved truvada, as a form of pre-exposure prophlyaxis (Find out more about PrEP here) for high risk groups, such as men who are HIV negative and having unprotected anal sex. The idea with such treatment as prevention approaches is for medication to be taken by HIV negative people before they become infected with the virus. Nevertheless, using antiretrovirals to prevent HIV infection is an area that is seen by many in sexual health as controversial. Some worry that it takes the focus away from behavioural changes that can be taken to prevent HIV transmission, such as wearing condoms, which may be cheaper and have less health consequences. For example, there are concerns that taking truvada (used for PrEP) could result in drug resistance and make treatment of HIV infection much more problematic if the individual becomes HIV positive in the future, as highlighted by the ‘No Magic Pills’ website. While it is hard to deny that treatment as prevention offers great hope for finding a cure for HIV, it is a contentious issue and the possibility that it will become a widely used form of prevention still appears a long way off.
What do you think about treatment as prevention? Does treatment as prevention represent a viable approach? How close do you think we are to finding a cure for HIV?
GMI Partnership provide free HIV prevention services for men who have sex with men in London. For more information please contact email@example.com
The views in the article above are those of the author and do not necessarily represent GMI Partnership.