Coronavirus tests becoming normal could help people see HIV testing in a new light

By Julia Gregory, local democracy reporter

“It’s coming up to 25 years now since I was diagnosed with HIV,” said Mortimer Market patient Ian Green.

He was just 31 when he was diagnosed and given the shattering news that he had just eight years to live.

“It was shocking, like having the rug pulled from under your feet. At the time the side effects of the medication were absolutely horrendous.”

“Medical advances have changed significantly since then and since the early days of the epidemic in the mid 1980s. I have a normal life expectancy.”

“It’s a condition that’s eminently treatable.”

And he wants to keep the pressure on the Government’s commitment endorsing the global aim to end HIV transmission by 2030.

“I do not want to see any 31-year-old being diagnosed in 2030,” he said.

But whilst Mr Green is the chief executive of the Terrence Higgins Trust, a HIV and sexual health charity, he has first-hand experience of the stigma which people suffer.

He pointed to issues in healthcare settings where he’s been sent for a blood test and spotted that the notes were marked high risk, when there was “no need”.

“It’s about making sure that healthcare professionals have an up-to-date understanding of HIV in 2021, not 1991,” said Mr Green.

And the former chief executive of YMCA England and ex mayor of Ealing said it was crucial as stigma “creates a sense of shame”.

“That has been with me through my journey with HIV. I thought I was this vector of disease.

“After a while it becomes exhausting challenging other people’s stereotypes.”

He recalled getting diagnosed when he was 31 and the GP who ensured a friend was in the waiting room when he got the result.

Afterwards he had several weeks counselling and went to stay with friends.

“In a funny way I was relieved because I was dodging the HIV bullet in the 1980s. I was 18 in the 1980s.

“I was exploring my sexuality and there was all this fear about this strange virus.

“We did not know how HIV was contracted. There was a cycle in my mid 20s when four of my friends died from Aids related illnesses.

“When I was diagnosed it was a shock.”

He added: “I was extraordinarily lucky to be diagnosed when I was to have that treatment available to me right from the beginning.”

And now aged 55  he just takes three tablets a day with no side effects and is testament that people can live with HIV.

Dr Laura Waters at the clinic he attends stressed: “The message is people with HIV have a normal life expectancy, zero risk of transmission

“And men with HIV typically live slightly longer anyway than men without because typically men in their 30s or 40s aren’t going to see a doctor to get advice about  blood pressure and cholesterol and all those other things.”

The recent Channel 4  hit drama It’s A Sin hit a chord.

The drama charted the fear in the early days of Aids and HIV.

Mr Green said: “There were times when I laughed so much my sides hurt. It was full of drama that resonated and there were times when I sobbed my heart out.”

He identified a scene when the character Ritchie was checking himself in the mirror for Kaposi’s sarcoma, a cancer associated with HIV.

“I was gripped with fear that it was a sarcoma and it was the trauma of losing people. I was seeing people who were vibrant, fit and healthy, clearly becoming very unwell and very often you did not see them anymore. Often people were not invited to funerals.”

He said the drama by Russell T Davies has helped people “rengage the public around the narrative around HIV that’s been lost. HIV has changed significantly. A third of people with HIV are women,” he said.

“It’s about having adult conversations.”

And he hopes that as Covid testing is becoming normal people will see HIV testing in the same way.

Having witnessed the start of one pandemic as a patient he’s now having mainly telephone conversations with his doctors at the Mortimer Market clinic in Bloomsbury  as we cope with the current crisis.

Run by Central North West London NHS Trust it cares for 5,000 patients across the UK, with a third from North Central London, Camden and Islington.

Staff are now asking every patient if they have been affected by domestic abuse.

Although it’s not an issue which has affected Ian or his husband he welcomed the move.

“It’s such an important question, it’s something that’s important for everybody and it’s patient centred care.”

He added: “There are many people in the last 12 months who are struggling – not being able to leave home, people being on top of each other all the time.”

And he explained that it’s important for healthcare professionals to raise the issue.

“It’s the opportunity to have a safe space” so people can raise the issue.

And like many other charities, the national helpline at the Terrence Higgins Trust has seen a “significant increase” in calls as people feel isolated.

Nadia Ahmed, consultant HIV and sexual health physician at Mortimer Market said the pandemic has highlighted the issue.

“It’s been a drive to increase screening about domestic abuse.

“It’s about asking people if they feel frightened or  threatened or safe at home, we all ask in different ways but ask  on a regular basis.

She stressed the unique opportunity to talk to patients, especially at a time when they don’t have access to posters and leaflets at the clinic so readily.

“We look after our patients for many years. Some people have looked after patients for 20 years.”

And the number of patients who disclosed domestic abuse has gone up twofold since before the first lockdown – as staff have increasingly asked the question.

Domestic abuse can cover anything from controlling behaviour, sexual and emotional abuse and questions about people’s whereabouts to physical harm.

“It can start with minor things – somebody controlling or asking where you are going, what time you will be back,” said Dr Ahmed.

But it can grow into “accusing somebody of something they have not done”.

“It’s done in a very subtle way and escalates.

“People typically have to be asked twice before they disclose

“It’s been more with men and men who have sex with men. Basically domestic abuse can happen to anyone by anyone.”

And staff can refer them to refuges, or counselling, depending on what is appropriate.

Her colleague consultant HIV physician Dr Laura Waters, who chairs the British HIV Association said: “The challenge is determining the frequency. Patients respond really well – there are many who  thank us for asking.”

She said amongst heterosexual  patients the numbers of reports of abuse were more evenly split between men and women.

The issues triggering domestic violence amongst heterosexual HIV patients, include stresses around cramped housing, lack finances and family living away.

Whilst with men issues can involve problematic drug use, including the use of chemsex drugs, along with all the other stresses.