HIV update - 15th October 2014

Stigma not decreasing in African countries

Two new studies show that HIV-related stigma is not going away in African countries.

Stigma involves negative attitudes to HIV and people living with HIV. One dictionary defines stigma as “the shame or disgrace attached to something regarded as socially unacceptable.” Stigma can make it hard for people to disclose their HIV status to others. While stigmatising attitudes are often expressed by people who don’t have HIV, it can also affect the feelings that people living with HIV have about themselves – some people have felt guilty or ashamed because of having HIV. Researchers sometimes call this “internalised-stigma” or “self-stigma”.

Many people hope that as HIV treatment becomes more widely available, people’s fear of HIV might decrease. But a study from rural Uganda, conducted between 2006 and 2012, is not encouraging on this point. Annual surveys with people living with HIV showed that concerns about disclosing HIV status and measures of internalised stigma had increased during this time. And surveys done with the general population showed that an increasing number of people said they would expect people living with HIV to experience stigma when disclosing their HIV status.

The second study was conducted with nearly 40,000 schoolchildren, aged 12 to 14 years, in nine southern African countries in 2007. In four countries, one-in-five children said that they would “avoid or shun” a friend who revealed that they had HIV. In three countries, over a third of students believed that children living with HIV should not be allowed to continue to attend school.

Children from poorer families and children living in rural areas were more likely to have stigmatising attitudes.

Children with accurate knowledge about HIV transmission, good reading ability and better school exam scores had less discriminatory attitudes. Also, the two countries with the fewest children expressing stigmatising attitudes (Malawi and Swaziland) have mounted strong public awareness campaigns. All this shows that attitudes towards people living with HIV can be improved with education, especially when it is provided at a young enough age.

For more information, you may find our booklet 'HIV, stigma & discrimination' helpful. The booklet explains what stigma and discrimination are, makes some suggestions for how to deal with these problems and gives information about your legal rights in the UK. Visit www.aidsmap.com/booklets

Testing for hepatitis C

In the last edition of HIV update, we reported on a study showing that antibody tests for hepatitis C have a long window period and may not be able to detect infections caught in the previous three or four months. The Dutch researchers who conducted that study recommended that when people could have recently acquired hepatitis C, a different type of test (a test for hepatitis C RNA, i.e. viral load) should be used.

Now clinicians from Brighton, United Kingdom have suggested that a third type of test – for core antigen – should be used. They say it is as accurate as the RNA test, but much cheaper and less time consuming.

As part of routine care, people living with HIV had liver function assessments every few months. When results indicated problems with the liver, three further tests for viral infection were conducted. The hepatitis C antibody tests missed several cases of recent infection, which were all picked up by both the RNA test and the core-antigen test.

If you are being tested for hepatitis C and there is a possibility that you could have recently been exposed to the virus (for example, during unprotected sex), it’s important that one of the more accurate tests is used. Hepatitis C treatment works best when it is started early, soon after infection.

PrEP will need to be targeted

An analysis from New York City suggests that offering Truvada to HIV-negative people as pre-exposure prophylaxis (PrEP) could be cost-effective. But the drug should only be provided to those most in need (i.e. gay men who have multiple sexual partners). The cost of providing PrEP to everyone in the general population would be astronomical and it would not even be cost-effective for people who inject drugs or “high-risk heterosexuals”. 

Also, adherence needs to be maintained at a high level and drug costs need to fall considerably – which may happen in 2017 or 2018, when tenofovir (one of the drugs included in Truvada) comes off patent.

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