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What medications are you looking at?

We are studying four drugs. These drugs are the four most commonly used by women with epilepsy who are pregnant. They are carbamazepine (Tegretol or Carbatrol), phenytoin (Dilantin or Phenytek), valproate (Depakote or Depakene), and lamotrigine (Lamictal). There are generic versions of several of these, in addition to the brand names here. Phenytoin is the oldest of the four—it's been around for over 70 years. Carbamazepine also has been around for quite a while, and it's the one most commonly prescribed for pregnant women with epilepsy. Of the new drugs, lamotrigine is the one that's used most often by pregnant women.

We have a few reports of pregnancies with other new antiepileptic drugs, but the number is not as high as for the other four drugs so we haven't added those. If we try to look at every drug and there aren't many people taking some of them, we won't have much information when we get done. When the sample size is so small, we can't make good conclusions. We'd like to expand the study in the future and put in additional new drugs, but right now other new drugs are not being used at the same rates. They may be used a lot, but not so much in women who are pregnant.

Pregnancy Tips & Guides

Pregnancy is said to occur due to the fertilization of the egg by a sperm which grows in size a woman’s uterus which is called the womb. It takes 270 days for the womb to develop into a baby but the gynecologist will consider the date from the last menstrual period or 300 days (40 weeks).
Abnormalities of pregnancy :* Excessive vomiting – The usual morning sickness will not get worse and this may result in a situation called hyperemesis gravidarum.* Bleeding in early pregnancy – This is not a normal phenomenon and a lot of care and caution must be ensured as it may prove to be fatal for the life of the woman. Its causes are abnormalities of the cervix, abortion, ectopic gestation, vesicular mole.* Albuminuria – The presence of albumin in urine is a known complication of pregnancy. The cause may be cystitis or infection in urinary tract. Cystitis is said to be an infection in the bladder. A lot of pain is felt in the lower abdomen which causes frequent urination as well as burning. Another infection also has its striking postures which involve in the infection of the kidney and ureter. A lot of pain is felt in the loins with nausea, vomiting as well as fever. This sort of syndrome is known as pylo-nephrites.* Pre-eclampsia – This occurs usually after 30 weeks of pregnancy. Early signs are raised blood pressure, increase of albumin in the urine, visual disturbances, severe frontal headache, and abdominal pain, vomiting and oedema of feet and ankles. This disease is dangerous for the fetus and for the mother.* Eclamsia – This means that the woman has fits similar to those of epilepsy, and coma. The condition may develop suddenly in a severe case of pre-eclampsia. The fits may occur during pregnancy, during labor, or soon after delivery. Eclampsia is a dangerous for both the mother and the baby. This condition should be prevented by means of good pre-natal care.* Ante-partum hemorrhage – This means bleeding during pregnancy after the 28th week. If it is slight, the cause could be some lesion of the cervix.* High risk cases of pregnancy – all cases of abnormality or high risk should be identified as early as possible.* Back ache – Slight backache may be due to poor posture and is more common in multiparous women whose abdominal muscles are weak. It can be prevented or lessened by attention to posture and by exercises.* Fainting – Sudden changes of posture, or standing for a long time, may cause the pregnant woman to faint. If she feels faint when lying on her back, this is due to pressure on the large veins, and she should be turned on her side immediately. Check for anemia, which may be the cause of fainting.
Pregnancy Weeks :* 1 to 4 weeks – menstruation stops, pricking in the breasts, whitish vaginal discharge.* 5 to 8 weeks – frequent urination, breasts grow larger, nipple become darker, and surface veins can be seen, nausea and perhaps vomiting especially in the morning, cervix is soft.* 9 to 12 weeks – breast become darker round the nipple, vagina becomes a bluish color. By 12th week, weight gain is about 1.12 kilograms.* 13 to 16 weeks – tiny lumps appear on the areola of the breasts, the uterus rises out of the pelvis, by 16 weeks you can feel the fundus about half way between the symphisis pubis and umbilicus, the mother may feel the fetus moving.* 17 to 20 weeks – a second dark ring appears round the breasts, a little fluid comes from the nipples, the fundus is nearly up to the umbilicus, fetal movement can be felt and fetal heart sound heard, weight gain is about 250 grams per week.* 21 to 24 weeks – dark patches may appear on the face, the fundus is at or above the umbilicus.* 25 to 28 weeks – the blood pressure is slightly below normal, there may be shortness of breath, and quicker respirations, the fundus is 4 to 5 fingers above the umbilicus, weight gain about 450 grams per week.* 29 to 32 weeks – there may be slight swelling of the angles; the fundus is half way between the umbilicus and xiphisternum (bottom of the breast bone).* 33 to 36 weeks – again there is frequent urination; the fundus is at or almost at the xiphisternum.* 37 to 40 weeks – the uterus drops into the pelvis at about 38 weeks, and the fundus is then at a lower level. Breathing becomes easier, but sitting and walking may be difficult. Vaginal discharge increases. The total weight gain by the 40th week is from 9 to 11 kilogram.

Deciding to get pregnant is possibly one of the most exciting and most monumental decisions a woman can make. Although you may not realize it, it takes a lot more to getting pregnant than you may think. A lot of planning goes into pregnancy such as how should you take care of your body during pregnancy and what can you do to prepare? Have you heard that you should be taking folic acid before pregnancy and special vitamin pills once you become pregnant? Some doctors are now even recommending that you take these good multivitamins before you decide to become pregnant. Do you know that it is best to quite smoking and drinking at least three months before becoming pregnant in order to give your body enough time to cleanse itself of all the toxins? Are you worried that even if you do succeed in getting pregnant you will be lost as to what you should do next?

Don't Be Overwhelmed.

It's all pretty confusing isn't it? Everybody is telling you to do this and do that, but remember not to do this. Getting pregnant doesn't have to be this overwhelming. With just a little bit of reading you can learn all of the vital information about what to do when you are trying to get pregnant. Welcome to our sub section on Getting Pregnant where you can discover everything you need to know about getting pregnant, knowing you're pregnant and how to care for yourself once you finally become pregnant.

Will My Baby Have Diabetes If I Have The Disease?

Babies born to mothers with diabetes do not arrive into this world with the condition. However, if the mother did not control the diabetes before and during her pregnancy, the baby very likely will develop low blood sugar and will have to be monitored very closely after birth to ensure his or her body is making insulin adjustments properly.

One of the frequent effects on babies born to diabetic mothers is their large size at birth. These babies are more likely to become obese and eventually develop Type 2 diabetes later in life. It is imperative they develop excellent lifestyle habits of good diet and exercise to lessen the chance of this occurrence.

What Happens To Baby?

An Overview of Diabetes

Diabetes is a condition in which the body is unable to properly utilize sugars and starches (carbohydrates) that it receives in food by converting them to energy. The pancreas is unable to produce enough insulin to do the job and the result is diabetes. This disease is often found in women of childbearing age and may appear as gestational diabetes in some women. That means that they contract the condition but it is only in their bodies for the duration of the pregnancy. Once the baby is born, often gestational diabetes disappears. Type 1 and Type 2 diabetes require insulin regimens and proper diet and exercise to contro

Diabetes is a condition which is often detected in women during the childbearing years and can have a profound effect upon the health of both the mother and the unborn baby. When diabetes is out-of-control in a pregnant woman there is an increase in the chances for birth defects and other problems for the baby, as well as difficulties and complications for the mother.

Diabetes is a condition in which the body is unable to convert the sugars and starches it takes in as food into energy. The pancreas either produces too little insulin or it is unable to utilize the insulin it does make in order to convert the sugars and starches into energy. The result is the collection of the surplus sugar in the blood and the release of some of the sugar through the urine. The extra sugar in the blood system causes damage to organs such as the heart, eyes and kidneys, if it remains in the body too long.

Are All Forms Of Diabetes The Same?

The three most common types of diabetes are Type 1, Type 2, and gestational diabetes. A person with Type 1 diabetes suffers with a pancreas that makes so little insulin that the body is unable to use blood sugar for energy. This type of diabetes requires daily insulin shots to control. Type 2 diabetes is either the low production of insulin or the inability of the body to use the insulin it does make to convert blood sugar to energy. This type of diabetes is controlled through proper diet and regular exercise. Some people with this type of diabetes take pills or injections. A pregnant woman who has never had diabetes may contract it while she is pregnant and this is called gestational diabetes. Proper diet, exercise and sometimes injections are used to control this type of diabetes which often disappears after the birth of the baby.

Identifying and testing children living with HIV

Providing treatment for children with HIV/AIDS essentially involves three stages: finding a child, testing a child and treating a child. Most children living with HIV become infected through mother-to-child transmission, and these children need to be tested as soon as possible after birth to find out if they are HIV positive. If a child living with HIV is only clinically identified once they are ill, it may be too late for antiretroviral treatment to be effective.

In developed countries, children can be tested soon after birth (sometimes within 48 hours) using polymerase chain reaction (PCR) tests and other specialist techniques. Where this technology is available, the longest a mother will have to wait for an accurate result is usually around six weeks.

In resource-poor countries, where PCR testing is generally unaffordable or unavailable, a mother may have to wait up to 18 months after giving birth before antibody tests (which are used in adults, and are more commonly available) can be used to accurately diagnose her child. During this time the antenatal clinic, where the mother was probably diagnosed, is likely to lose contact with her.

In some resource-poor countries, ‘dried blood spot’ testing has been introduced in recent years. This is where a small sample of blood is taken from a child, dropped onto paper, and sent to a laboratory where it can be tested. Since these samples do not need to be refrigerated and are easy to transport, they can potentially be sent miles away to places where PCR is available. This means that even children living in resource-poor areas can be tested relatively quickly. However, dried blood spot testing can be expensive and it can take a long time for test results to return. There's also evidence that when the drug nevirapine is used to prevent mother-to-child transmission of HIV, dried blood spot testing doesn't always detect HIV in the first few days of the child's life.

Anthony

I am a 42 year old Italian guy from Staten Island NY. I have been living with this disease for 10 years going on 11. I was diagnosed in 1996 and from 1996-2000 I was in so much denial I ran the streets as I had before smoking crack and just wanting to get high and higher, because I thought if I was going to die , I was going to die happy and high.

So I thought. After 4 years I saw I was still here and healthy , so to speak. I decided to get help for my addiction and get educated about HIV/AIDS. I am happy and yes even proud to say that I have been clean from the drug of my choice for 6 going on 7 years and have been an HIV/AIDS Outreach Worker, Educator and Test Counselor for the same number of years and still am. I have also been a member of many groups within the government of New York: HIV/AIDS Planning Council, Advisory Group to the Planning Council, HIV/AIDS Advocate, Human and Civil Rights Advocate. I have found my passion and knowing now that it is not a death sentence, just a change of life, I can go out and spread the word that, "WE CAN LIVE" and live a very happy, productive life.

I have been addicted to crack for 12 years and lost everything: my job, my partner after 8 years, my home but mostly myself. I am back now with alot of thanks to many, but mostly to myself because it was me who willing and chose to get the truth and I did. I will persevere in this fight to educate and fight for the rights of HIV/AIDS people and all people who are treated unjustly........ I have never been more content and happy than now.

Anthony J Raiola

Russell

Hi my name is Russell a white 20 year old male. What am about to write is a true story about me finding out that I have HIV (Some events have been left out and some names changed), and the truth of what am going though now and back when I found out…

So lets travel back a two weeks ago, I woke up like every other day, the date Sunday the 31st of Aug 2008, it’s the day that will go down in history for being the start of the worst week in my life, but at the same time a new scary beginning. A beginning that I had of read about when I was 16 years old, A STI that around 1100 people in Western Australia live with every day, that we know of. This is how I became that 1101 person.

Here I am getting up out of bed and getting ready for my day the sun was shining the cats where trying to get outside like they do every morning, the time was around 9am. Today was abit different and for me it felt different maybe cos I knew i was about to get tested for HIV, and all the other STI’s who knew all I knew is I had this wierd feeling that something was not right. My closes mate at the time Smith said “I am sure it will be ok.” Just the day before. Smith and I where great close friends some thought that we where an item but we weren’t. Smith and I went back just a few months but for some reason unknown to us we felt like we knew each other for a life time.

I headed out to go to RPH (Royal Perth Hospital) arund 10am I had my appointment at 11am, To get to the city I have to catch the 421 bus and the Striling Train into the city, all the way I was thinking to myself that all I have to do is turn away and go back home and no one would be the wiser. However I had to do it. I had not had a blood test for close to a year and something in me said that I needed to find out if I had anything. All the way sitting on the bus and train I was trying to take my mind off the feeling that I am about to have a test that could change my life. To take my mind off it I started listening to my iPod and one song kept playing and playing. For some reason all I wanted to do was listen to this one song that reminded me of living in foster care and growing up in over 30 different foster homes, going to 20 plus schools, being belted, raped and neally killed. The song Secrets by Anastacia hearing the kids at the start and end of the song made me feel safe while the words stuck out in my mind like my life in a song. Never being able to be a child always having to think fast on my feet, not worrying what some one would say or do to me as long as they did not do it to my sisters or older brother.

Before long I am there waiting in the waiting room to see the Doctor, he was the doctor that three days from now would ring me up and tell me to come in. He asked me when was the last time I had a HIV test I said around a year or maybe more. He looked at his records and it showed that I have not been tested since late 2006, He said that they will do a full STI test which ment anal, mouth, and cock swaps to test for any other STI’s and a blood test to see if I had HIV.

I went from the doctors office into the nurses room standing beside me a young 20 something year old lady who was about to take my blood, I said to her “I might scream, I hate needles.” She replied “Oh there is nothing to be worried about, ill be soft.” Yeah I heard that from many people in the past from other Doctors to the first guy I had sex with.

Before long it was all over and was told that I should be notifided by Wednesday. The day continues on, heading home all I can think about is that what if the test comes back POZ what will I do then, What will my life be like? Will I crash, will I be able to carry on? Oh and the big question was will I still have the strength to keep working on my own business, or will I give up and get a 9 to 5 job?

Tuesday was not that easy I stayed in bed slept for most of the day, I rang Smith at around 10am and just talked he kept saying it will be ok. Being the friend that he is. But deep down I knew something was going to come up and eat me alive.

Wednesday morning comes, I get a phone call around 9am from the Doctor asking me “Hi Russell I need to see you. Can you come in as soon as possible thanks.” I left for RPH straight way did not know what I was going to be told. At first I was thinking HIV then maybe some other STI I was so confussed I just did not know what to do. I got there around 10:30am and went straight in, it was like they where waiting for me ready to take my soul and toss it out the 4th story. I went into his office and I sat down, then I hear “Russell am sorry to say but the test for HIV is positive.” I frooze for a few seconds and just looked amazed. What felt like a life time of silance was around 30 seconds. I said “I was thinking it might come back that way.” I cant believe that I said that really the first words out of my mouth was I thought it might come back that way. What a dick nob.

We talked for about 30min about the T count and how they have to do more testing. That day was going to be a hard one, for what I thought was going to be a 20 min visit soon turned out to being a full day there from 10:30am till 5pm when I was able to get up and go home. It was like a bad dream getting tossed from department to department, getting 9 tubes of blood out and being told that it is a very very rare thing for them to be wrong about this. Still they tested it and the wait was on till Friday when I would finialy find out if I was the next person in WA for that matter in the World to have HIV.

While waiting for the test I had to get back to work working on organzising the Mr. G competitions (This name has been changed in this story to protect the competition.) I had to organize the Melbourne, and Sydney rounds that where coming up search for the hottest male in Australia. The Melbourne rounds that are coming up in a few weeks was my most concerend about event. I took my worry about my health and placed my worry on my business. I need this to be the hottest competition in Australia, I want to show people that not all guys are alike. We're not the way the media likes to show us.

So I kept going working as hard as I have every worked in my life. I called my mate Smith and told him that I was HIV poz and he just froozed hung up the phone and did not return any of my calls, sadly to this day I have no idea what he is doing or if he is ok.

Friday come so fast went in to the doctors and the Dcotor called me in, sat me down and said “Yeah the test come back poz.” I left there feeling down, sad and all alone, who do I tell, who can I tell, who can I trust?

Sitting down writing this is the hardest thing I have had to do today. Realizing that I have HIV well that has not hit me just yet. I told a true friend of mine just two days ago he went to have sex and unlike normal where he would just have bareback sex, he told me he put on that condom and is now going to get himself and his partner tested. He went on to say He would not be able to be me, in the way that I am staying strong and following my future, there is NO WAY that am going to let this little bug kill me. I want to help inform people young and old that its better to have safe sex and get tested every 3 months, other wise they risk ending up like me HIV POZ!!!

Isha

During my pregnancy I found out I was HIV+ and it was a day just before Christmas. I went to my doctor for a check up knowing that I had done an HIV test. I didnt expect the results that day but even though the doctor told me he had my results I was not bothered at all because in my mind I was sure I was negative. The doctor went to take my results as my fiance and I were sitting down waiting. He came back and I could see my fiance panicking as he is the one more emotional than I. the doctor set down as he opened my file and read the results to us. You are HIV+, he said. I didnt say anything in shock as my mind just stopped working at all. My God, I said. My doctor continued to speak and giving us advice and telling my fiance to go test as well. He told me about my CD4 count and viral load of which I didnt even hear what he was saying at the time.

My doctor gave a prescription of is called TRIOMUNE 30, it was a very good medicine he said as it was just introduced and was a combination of the HIV meds. As I said it was just a day before Christmas and you can just imagine the mood everyone is in. I was going driving home that day as I like spending my holidays with my family. I am a kind of person that when I find out about something disturbing I switch off and not even feel hurt over it but when it hits me it really does. I got home and we were all happy to be together as we are a only girls at home (5 girls) and my mother is a single parent which I met only in 2004 Dec, 22 yrs at the time. When I first saw my mother she was really struggling and poor with 3kids as my old sister and I were brought up by my dad. Saying anything to my mother would destroy her as she has a soft heart and all of them basically at home are very fragile compared to me.

I didnt want to spoil the holidays for them really and I was the bread winner at home and still am as I said when I found my mom she was really struggling. The night before Christmas I watched all of them busy up and down preparing for Christmas. Cooking, baking and all that and remember that I was still pregnant at the time therefore they just told me to sit there and relax because we were up and down after my doctors appointment buying everything needed. I remember sitting in the lounge alone whist they were playing gospel music so loud. At home we are all Christians and God comes first. As they were busy in the kitchen I just sat there and listened to the music playing, oh God tears started falling from my eyes as I really thought of this deeply this time, what it meant for my unborn baby, what it meant for my future. I cried, really cried because since I had been told the news I had not responded anyhow. Unfortunately my mom saw me and she asked what is wrong now baby. I couldnt say anything but cry. My sisters came as well and my big sister who understood me better than all of them came as well. She said to them no ma dont worry I know she is only crying because she is in worship because of the songs that they were playing. I couldnt stop crying really and my mom started crying as well, it started to be a very sad moment for us now. Just imagine if they cry only because they saw me cry how much more if they had known what was going within me.

I started taking meds to prevent my baby from getting infected and now she is a beautiful 3mnths old and I am so crazy about her. Eventually my fiance went for a test this year as well and he was HIV+ as I knew already because I knew he gave me that disease as I was a very careful in my past relationships. The good thing is that both our CD4 counts are still fine. Mine is 451 and his 351 but my worry is that I was recently tested for TB and it was positive and now I am on treatment and my fiance is. They gave pills for my baby as well to prevent me from giving it to her. My big worry is that I am a smoker and its very hard for me to stop as I am used into and I tried stopping but I always fail. My fiance smokes as well and this is not good for both of us mostly I with TB I know. My life is just a mess at he moment and with every puff I take I think of my baby and I value her and I grew without my mother and I worry that by smoking I am taking the opportunity of leaving a longer life with my kid. She is my princess and I do everything for her hence I got to stop smoking.

Besides all this I know God is my strength I am not only strong because I can do it but because God gives me strength and He sustains me. He is looking after my baby and he is a God of possibilities and He surpasses all circumstance.

To you all out there please take care of yourselves and know that Greater is God than any disease out there, be strong all the time and know that even the person next door might be living with HIV but you dont know as she doesnt know about you, therefore dont feel sorry for yourself. Live your life and be strong. Be healthy.

Drug users and sex work

Although injecting drug users constitute a risk group in themselves, there is also an overlap between drug addiction and those involved in sex work. Individuals who fall into both categories are therefore particularly vulnerable to HIV and are perhaps doubly stigmatised. The link between substance abuse and sex work is hard to pinpoint though there are a variety of factors that are common to both including homelessness, unstable family lives, socio-economic deprivation, disrupted schooling, local authority care and co

One study of UK cities found 63% of people who sold sex outdoors did so mainly to pay for drugs. Heroin was the most commonly used drug, with 78% having used it, and just under half the sample had injected drugs in the previous month.³⁰ UNAIDS believes that the spread of HIV in several North African and Middle Eastern countries is being facilitated by a combination of injecting drug use and sex work with one third of IDUs having paid for or sold sex. In Syria 53% of drug users have sold sex, with 40% of these saying they had never used condoms.³¹ One study of Sichuan province, China, reported similar rates, around 56%, of female IDUs who sell sex.³²

IDUs who are sex workers put themselves at risk and also facilitate the transmission of HIV between population groups. Looking at the spread of HIV among the two risk groups in Jakarta, Indonesia, the Commission on AIDS in Asia found that infection levels began to increase within commercial sex networks only after the epidemic among injecting drug users had reached significant levels.³³Sexual risk behaviour related to drug use should not just be considered within the bounds of sex work. While the impact of drugs on sexual behaviour may vary by drug, length of use, sexual identity, and other factors, there are a number of effects related to drug use that could influence unsafe sexual behaviour. HIV transmission may be facilitated among drug users and their sexual partners if the user is sexually stimulated or disinhibited by drugs.

nfidence and esteem issues

Injecting drugs and marginalisation

People who inject drugs are perhaps the most marginalised group at risk of HIV infection. According to nongovernmental sources reporting to UNAIDS, only 16% of countries have laws or regulations protecting drug users from discrimination, compared with 21% and 26% of countries providing protection for sex workers and men who have sex with men, respectively

Injecting drugs for purposes not prescribed by a doctor is illegal worldwide, and the criminalisation of drug use and possession can hinder attempts to engage IDUs with available HIV services. There have been documented incidences of Ukrainian police arresting and beating IDUs near needle exchanges for possessing used and sterile syringes.²⁰ Police in Thailand have reportedly acted similarly despite possession of syringes being legal in the country.²¹ It is estimated that 40% of countries have laws that interfere with their ability to reach injecting drug users.²²

IDUs who find themselves on the wrong side of the law and in confrontation with the police may be mistrustful of the authorities in general and hesitate to seek treatment or take advantage of prevention initiatives in the first place. Following a major drug operation by Vancouver police in the Downtown Eastside district, in which there were reported cases of unnecessary force and illegal search and seizure, the number of sterile syringes provided nightly by a local needle exchange program dropped by a third.

Why are drugs injected?

There are several possible reasons as to why drugs are injected rather than taken in other forms. The UNDP HIV and Development Programme suggests these include the availability of drugs that can be injected, linked to production locations and trafficking routes; that it is a cheaper and more rapidly acting method; the sharing of knowledge about such techniques that comes from migrating drug users; and so none of the drug becomes lost in smoke, especially when drug control efforts reduce its availability.⁷

The UNDP estimates that the most common change in drug consumption patterns is the move from the smoking of opium to the injecting of heroin and other drugs as a result of law enforcement.⁸ Populations in developing nations have become more exposed to new methods of drug taking, including injecting, as refinement of drugs into injectable forms has been forced from more developed nations and closer to production areas.

In Pakistan, for example, the last 10 to 15 years has seen a shift from the inhalation and smoking of heroin, to the injecting of heroin and synthetic drugs. Injectors of heroin are an ever growing proportion of total heroin users rising from less than 2 percent in 1993 to 15 percent in 2000 to more than a quarter in 2007. This is largely attributed to aggessive drug control measures that have reduced supply, boosted the cost, and made injecting a more economically viable method of consumption.⁹

One HIV-positive IDU in Pakistan described the scarcity and growing cost of heroin as the primary reason for switching from inhaling to injecting:

Why do people take drugs?

People take drugs, both legal and illegal, for a variety of reasons that will differ from person to person and from drug to drug. Individuals may enjoy the sense of detachment or euphoria that drugs create, their relaxing or energy-inducing properties, the heightened alertness or sensitivity they produce, and their medicinal qualities. Peer pressure or habit may be other reasons, and if they are chemically dependent, addicts will feel they cannot operate without them. These reasons will depend on an individual’s own background and socio-economic circumstances.

Drugs can be taken in a variety of ways including drinking, smoking, snorting and rubbing, but it is the injection of drugs that creates the biggest risk of HIV transmission.

HIV testing in the UK

According to British guidelines, HIV testing should be offered at GUM clinics as part of routine STD screening, regardless of symptoms of disease or risk factors of infection. The guidelines state that everybody taking an HIV test should have a pre-test discussion, and be offered counselling if requested, or if there is a high risk of a positive result.²⁸

The number of people being tested for HIV and other STDs at GUM clinics (where the majority of people are tested for HIV) has risen in recent years. Almost half of sexual health screens in 2003 included an HIV test; this proportion increased to two-thirds for England, Wales and Northern Ireland in 2006. Overall, around 800,000 had an HIV test in a GUM clinic in England, Wales and Northern Ireland in 2007

A major worry is that many people infected with HIV aren’t accessing testing services soon enough. It’s estimated that nearly one third of HIV-positive adults in the UK are diagnosed late, and for heterosexual men this figure rises to 42%.³⁰ It can be difficult to treat someone with HIV if they are diagnosed late, and in some cases late diagnosis leads to death. According to the British HIV Association (BHIVA), at least a quarter of deaths reported in HIV-positive people in the UK between 2004 and 2005 may have been avoided if HIV had been diagnosed at an earlier stage³¹. BHIVA, along with other experts, say that non-HIV clinicians such as General Practitioners (GPs) need to be made more aware of the importance of early diagnosis. They have also called for HIV testing to be made a routine part of more generic healthcare services that aren’t specialised towards HIV or sexual health³². Introducing an opt-out testing policy (whereby everybody attending a GUM clinic is given an HIV test unless they specifically ask not to be tested) may be another way to reduce the number of people diagnosed late. Of previously undiagnosed HIV-infected heterosexual men and women attending GUM clinics in 2006, one quarter left the clinic unaware of their HIV infection in 2006³³.

HIV/AIDS prevention in the UK

HIV prevention in the UK currently includes measures to educate people about HIV/AIDS and how it is passed on so that they can take measures to protect themselves (by using condoms for example); encourage harm reduction measures for drug users (such as needle exchange programmes); and promote HIV testing.

It is widely felt by those working in HIV/AIDS organizations and the healthcare sector that HIV prevention in the UK needs to be stepped up and improved as the number of new infections continues to rise as the level of knowledge of the virus falls.

AIDS & HIV in the UK - the current situation

Although AIDS gets less attention from the media in the UK than it did during the early history of the UK AIDS epidemic, it’s far from a problem of the past. In fact, the epidemic has expanded, with the annual rate of new HIV diagnoses more than doubling between 1999 and 2003, and peaking in 2007.²

HIV prevalence in the UK is relatively low and currently stands at 0.2% of the population³. Statistics show that at the end of 2007 there were an estimated 77,400 people living with HIV in the UK, of whom approximately 20,700 were unaware of their infection. An estimated 7,734 people were newly diagnosed with HIV in the UK in 2007.⁴

Relatively low numbers of people in the UK have died from AIDS in recent years thanks to the availability of HAART (Highly Active Antiretroviral Therapy), which dramatically increases the life expectancy of people living with HIV. In 2007, around 540 HIV-infected persons died, compared to 1,726 in 1995, when antiretroviral treatment for HIV/AIDS was not available. The majority of AIDS related deaths occurred because people were diagnosed late and therefore did not start treatment early enough. In 2007, an estimated 31% of newly diagnosed, HIV-infected adults were diagnosed late.⁵

Although HIV is often perceived to be a ‘gay’ problem, infections acquired through heterosexual sex account for the largest number of HIV diagnoses in the UK. The majority of people who acquired HIV heterosexually were infected overseas but only became aware of their status after being tested in the UK. In terms of HIV infections actually occurring within the UK, gay men (and other men who have sex with men) accounted for two thirds of new cases.⁶

Despite the rising numbers of new HIV infections in the UK, public knowledge of HIV and AIDS appears to have declined. While 91% of people in the UK knew that HIV was transmitted through unprotected heterosexual sex in 2000, by 2007 this figure had fallen to 79%⁷.

Many UK HIV/AIDS organisations are calling for improved sexual health services. The Terrence Higgins Trust, for example, released a 2007 report stating that sexual health services in England remain woefully under prioritised and under funded. It claims that despite the government’s promise of an extra £300 million for sexual health services across the United Kingdom to modernise clinics and reduce waiting times, many GUM (Genitourinary Medicine) clinics remain cramped, out-of-date and understaffed

An overview of AIDS in the Caribbean

Due largely to their close geographic locations, the Caribbean is usually grouped with Latin America in discussions about HIV and AIDS, but the epidemics in these regions are very different. Even within the Caribbean, each country faces a unique situation. The diversity of the region – which is apparent in terms of politics, languages spoken, geographic location and wealth – is reflected in the significantly different ways that countries are affected.

At one extreme, the Bahamas has the highest HIV prevalence in the entire western hemisphere (3%); at the other, Cuba has one of the lowest (0.1%). Haiti (2.2%), Trinidad and Tobago (1.5%) and Jamaica (1.6%) are all heavily affected, while Puerto Rico is the only Caribbean country apart from Cuba where it is thought that less than 1% of the population is living with HIV. ² Other factors, such as AIDS mortality rates and transmission patterns, also vary across countries and areas. ³ See our Caribbean statistics page for more data.

Recent developments have given cause for optimism, with an overall stabilisation in the region. A small number of countries in the Caribbean have even shown signs of a decline in prevalence. In the Dominican Republic prevalence fell from 1% in 2002 to 0.8% in 2007. HIV infection levels have also decreased in Haiti, which has been partly attributed to an increase in condom use and changes in sexual behaviour. ⁴ However, HIV surveillance in the Caribbean is generally considered inadequate, so these reported trends are only vague indicators. Both HIV prevalence and AIDS cases are thought to be widely underestimated in the region. ⁵

Reflecting global patterns, heterosexual sex is now the main route of transmission throughout the region, and it has been established that women and young people are particularly vulnerable. ⁶ Little is known about the role that sex between men plays in the region’s epidemics – it has been estimated that men who have sex with men account for 12% of infections, but it is thought that the actual proportion is higher than this, since the rampant homophobia that exists throughout the region has led to denial and under-reporting.⁷

Despite differences between countries, the spread of HIV in the Caribbean has taken place against a common background of poverty, gender inequalities and a high degree of HIV-related stigma. Migration between islands and countries is common, contributing to the spread of HIV and blurring the boundaries between different national epidemics. ⁸ Additionally, poor availability of HIV and AIDS data makes it difficult to gain a clear picture of each country’s situation.