This week is National HIV Testing Week, leading up to World Aids Day 2013 on 1 December. The question is, how many of you were aware of this - and what can we do to enhance that awareness?
For too long, educational messages about HIV/AIDS, and about the way it is transmitted and prevented, have not been heard. This task is only becoming more difficult in a financial climate in which health promotion budgets are shrinking, and the cost of advertising becomes ever more expensive.
Those of you who are old enough - that is, over the age of thirty-five - will remember the tombstone campaign in 1985. This was a campaign which literally scared the sexually active population into wearing condoms. It had a big effect on stemming the HIV epidemic, and the huge predicted increases did not occur in the UK. How do we know this? Because we saw dramatic reductions in other STIs, notably syphilis - rates of which dropped dramatically - following this campaign.
That was the last major campaign, however, and really there has been nothing since. What that means is that people think HIV has gone away, or is something that only happens in other countries. This is far from the truth: today, there are over 20,000 people living with HIV in the UK who are completely unaware they have the virus. This means they are unknowingly allowing the virus to damage their immune system to a degree which can ultimately lead to death. At the same time, they are also potentially passing the virus on to all those with whom they have sex.
This has to change, in no small part because things have changed: we now have effective treatment for HIV, something which was not the case in 1985. It's trying to get this important message out to the general public that is now essential. Despite the fact that the AIDS campaigns of the early 1980s were successful in preventing an explosion of the epidemic, they also left a degree of stigma which has encouraged many to believe that HIV and AIDS are something dirty which shouldn't necessarily be talked about - and perhaps only affects individuals with some moral fault.
Let me reiterate: the reason that HIV has primarily affected homosexual men in the UK and the USA is that the virus was introduced into this population, and this population tends generally not to sleep with women. This is in complete contrast to sub-Saharan Africa, where HIV is a predominantly heterosexual disease and more women are infected than men. Similarly, when the epidemic started amongst intravenous drug users in Spain and Italy, the infection continued to spread amongst the heterosexual population.
But this fundamental misconception that HIV only affects gay men still persists, and still feeds the stigma that surrounds HIV. This stigma doesn't just exist within the general population, but within specific groups which have been affected by HIV, such as the black African population. In my clinic I see many an African patient who would not dare to reveal their HIV status for fear of castigation, and of rejection from their family and community. This is not helped if preachers continue to propagate the myth that HIV is really only associated with gay people and those with loose morals.
So we have to educate the public about the ways in which HIV is transmitted, and do so in such a way that we can tackle the stigma that is associated with HIV. We need to educate the public that if people are diagnosed early they can be put on life-saving treatment which can give them a normal life expectancy. Furthermore, they need to know that going on antiretroviral treatment can reduce their infectiousness by over 95%, as evidenced by a recent randomised trial.
This is more crucial because there is another side to this coin. People who are unaware of their infection are still dying of HIV and AIDS-related conditions. The medical profession is not testing as they should when patients present with indicator symptoms associated with HIV. Moreover, the general public do not perceive themselves at risk because they do not identify with those groups in which HIV infection rates are seen to be high. It's worth noting, then, that 25% of all HIV diagnoses come from populations which are not classified as a classic 'at risk' group. Testing is for everyone.
How can we educate the public on a mass level in 2013? Both in my own practice and at Saving Lives, we have been working for the last five years trying to engage sportspeople and professional footballers to become involved in campaigning for the normalisation of HIV tests. Only now is this beginning to bear fruit - but what potential it has.
The message is simple: HIV testing saves lives, full stop. The medium is a group of individuals to whom people who would otherwise switch off will instead listen. It doesn't matter what you have done in the past, you must get yourself tested. In that way, you'll stay healthy and you can begin to look after you sexual health if you have not done so previously.
I would like at this time, then, to thank publicly the players and ambassadors such as Curtis Davies, Darren Bent, Jack Butland, Nathan Redmond, Karen Carney, Natasha Dowie, Sally Walton, Hannah England, Matt Murray, Carl Froch and many other sporting stars who have helped try and normalise HIV and HIV testing. You may not be aware of it, guys, but when we look at the numbers of people that our messages reach when you tweet and retweet educational messages, the impact you are having is huge. Thank you.
Tweeting, of course, is free. But advertising still has its place. If anyone would like to take advantage of some of our powerful HIV awareness tools, then - to produce anything from humble clinic posters to posters for the sides of buses in your city, as is happening in Birmingham this month - then please contact us.
We've done a lot of hard work - and put in the significant investment - to get these ambassadors onboard. All we now ask is that partners find the money locally or nationally to deploy these materials. It's a cost-sharing, culture-changing model which we hope will empower us all to save lives this National HIV Testing Week.