Pyschologists don’t prescribe
In your article on sexual dysfunction (PN 107) under ‘NHS rationing’
you mentioned that “specialists, like psychologists” attached
to HIV clinics can prescribe drugs if the patient can show they are “suffering
severe distress” from sexual dysfunction. You explain that HIV doctors
are barred from giving their patients Viagra on the NHS but can refer patients
to “psychologists like Dr. Catalan”.
The fact, is the vast majority of psychologists in this country do not have
any prescribing powers. We are not medically trained and cannot make prescriptions
for any form of medication, including drugs for impotence. As psychologists
we can help people with sexual difficulties through psychological, rather
than biochemical, means. Psychiatrists, on the other hand, are medically qualified
and can prescribe medication. I believe that if Dr Catalan does prescribe
these, you were correct in calling him a psychiatrist in your first paragraph,
and were not in calling him a psychologist subsequently.
We understand that the distinction between psychologists and psychiatrists
can be confusing, but I feel that in pointing out this important difference
regarding the capacity to prescribe medication we will clarify our role, and
avoid raising expectations. However, as a psychologist working in HIV and
sexual health, it is both refreshing and helpful to find articles on the topic
of sexual problems published in PN, as an invaluable vehicle for discussion
with colleagues and clients. Many thanks
Dr. Alex Accoroni, Chartered Clinical Psychologist, Mortimer Market Centre
We care for the carers
In response to the letter Who Cares for the Carers? (PN October 2004) I would
like to draw readers’ attention to our service. Sanctuary Fulham Broadway
is a new drop-in centre in south west London for people affected by HIV. This
includes people who support and care for people with HIV. Sanctuary is run
from the Methodist Church, next door to Fulham Broadway station and we are
open on Thursdays 2-8pm for anyone to drop-in, have refreshments and a chat.
In addition to a coffee bar, we have counselling facilities, internet access,
information, therapy rooms, and meditation classes. This year we are planning
to host a support group for people caring for loved ones with HIV. This group
will meet from 7.30-8.30pm on Thursday evenings. We would like to hear from
anyone who lives within travelling distance and feels that they would benefit
from such a group.
Nicola Crawley, Sanctuary, London, sanctuaryfb@hotmail.com
Doing the SMART thing
I have just read Danny’s column (PN 108). While I would not criticise
his right to choose not to participate in the SMART study, I do think it’s
important to give a balanced picture. We are very lucky to have antiretrovirals
available to us today. All of these were trialled on people who chose to participate
in clinical research and those who chose not to participate have much to be
grateful for.
People in studies are more closely supervised than other patients and there
is evidence that just participating in research means you do better, possibly
because those participating in studies are more motivated and educated about
their illness.
SMART is looking to answer a very important question: how can we best use
antiretrovirals? No-one yet knows. If it showed us we could take CD4 guided
breaks from therapy and still gain the same benefits of HAART, this would
have a huge impact. Not least, you may be able to minimize your exposure to
potentially toxic agents and the risk of side-effects. By doing so we may
be able to get the lifetime cost of HAART down, thus allowing resource-poor
settings to treat more of those affected by HIV and Aids.
Of course there are risks with all trials that have to be carefully managed,
including the possibility of developing resistance and the risk of more infectivity
if your viral load becomes detectable. But without people prepared to take
these risks, as they have in the past, we will never challenge our cosy assumptions
that we already know best about HIV. This is dangerous. HIV evolves as our
knowledge does, and willing volunteers who participate in well designed, carefully
monitored research are essential for ensuring we are able to keep up or even,
one day, begin to nudge ahead.
Tristan J Barber, Research Fellow, Imperial College of Science, Technology
and Medicine Clinical Trials Centre, London
A ball for all?
My girlfriend and I went to the Red Ribbon Ball last year and I feel I should
point a few things out. After stumping up for the tickets - I know its for
charity but, hey, many of us are struggling as it is - there were the ridiculous
coat-check and bar prices, and I doubt any part of that goes to charity. We
had a great time though - we danced ourselves dizzy. Everyone was very nice,
no pushing or shoving, no swearing, well only from me every time I had to
pay that exorbitant price for a beer.
Then it began. Award after award for just about everyone on the planet. Fair
do’s, I guess, as they probably donate money to HIV charities. Up everyone
jumped, cheering and whistling, shouting and screaming as if they themselves
had won an award. We were surrounded by cheering gay men and a few doting
women. My main concern was the lack of straight people there, the gorgeous
Susan Cole (and bump) a prominent exception. I can’t blame the organisers,
and would be loath to criticise such hard-working people. And I appreciate
that the medication that keeps many ticking over is there only for the suffering
of those in the early days of this virus, most of whom I’m sure were
gay men - many of whom sadly lost their lives.
What I guess I want to say is we, the heterosexuals, are here and here we
have to stay and many, many others will soon be joining us from the heterosexual
communities. So please give us equal billing at future events, as no one wants
to feel ignored. I know it’s down to us straight ones to come out of
the woodwork but they won’t come all the time when they get bottom billing.
Time is running out for many who still skulk unwillingly in the shadows of
HIV awareness.
Goodbye for now and happy clubbing and whatever your sexual orientation, may
your rubbers go with you.
Matt, london
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