from Gary Cooper
Gary Cooper, a former NHS finance manager living with HIV,
berates myopic health ministers for restricting HIV screening for high risk
groups
I am baffled how the developed world can so easily mobilise
resources to prevent another 9/11 and yet, by comparison, their collective
response to a preventable illness like HIV is so low key. This is all the
more odd when you consider the total dead from the Twin Towers is less than
the number of Aids-related deaths every single day.
As a non-African straight man living with HIV, I could be considered as no
longer having a vested interest in protecting the ‘untested-presumed-negative’
world’s sexual health, especially given the undiminished stigma and
bigotry towards people with HIV.
However, as an employee with inside knowledge of NHS budget setting, I am
deeply concerned. Our government and others worldwide are becoming complacent.
The ‘HIV negative’ world is pursuing sex-driven consumer capitalism
as though it were the new religion. People with HIV are cast in the role of
medieval ‘sin-eaters’, beggars paid to be scape-goats for the
wrong-doing of the fresh corpse of humanity - to protect it from divine retribution.
Recently I read that UK public health minister Caroline Flint wants the NHS
to focus screening and prevention efforts on high risk groups only. While
this clearly saves the government money, they fail to see that general HIV
and sexual health screening for represent arguably the best long-term return
on NHS investment.
A pound spent on posters in GP surgeries could save not only lives but tens
of thousands in meds and treatment over a patient’s lifetime. I still
have a normal life expectancy as I, like many newly diagnosed, am responding
well to HAART.
My experiences are anecdotal but if extrapolated across the UK are absolutely
horrifying. In 2004 my clinic was seeing around 2,000 PLWHAs, now it’s
almost 3,000. Sadly, my consultant is so much in demand I cannot always see
him. Consultant hours have been reduced to counter year-end overspends and
gaps are filled by non-HIV specialist locums drafted in from general GUM clinics
in the leafy suburbs.
The most common cause of infection these days is through heterosexual sex.
I have never taken IV drugs or had anal intercourse, yet there are plenty
of other people just like me, attending our completely unfunded, self-run
support group in London, Str8talk.
The fact our group is not funded severely compromises our ability to deliver
and expand. I often wonder what most other poz straights, diagnosed and undiagnosed,
are doing out there. I speculate on how much ‘future business’
they are unknowingly drumming up for us. We can’t offer a cure but can
at least promote prevention. They could rebuild their shattered social lives
and maybe even find a partner.
We are seldom consulted and are treated like an embarrassment. Yet we could
perform an important role in changing sexual behaviour and patterns among
heterosexuals in the UK. We are an indictment of a 25-year-old public health
policy that only focuses on high risk groups. I fear many so-called ‘low-risk’
people like me are slipping through the net because we are rarely encouraged
to screen or protect ourselves from HIV.
Like most people I never donated blood, like most people I never felt the
need to get a full STI screen at a clap clinic. And I never had my bloods
done for pregnancy for obvious gender reasons.
No, I just fell ill one day out of the blue. What is perhaps more frightening
was the attitude of the doctors, apart from my GP, in discouraging me from
getting tested. It took over two years for me to have the HIV diagnosis confirmed.
In that time I was free to sleep with whoever I wanted. Not that I did.
The Government’s new sexual health campaign also sends out confusing
messages. The TV ads are aimed at 16-24 year olds on the pull and warn about
gonorrhea, chlamydia and syphilis. But where is HIV? Why is the NHS being
so coy and Victorian and why do they regard HIV as such a dirty word?
And it’s not just TV that recoils from mentioning HIV. In a recent Guardian
Weekend medical advice page, a woman described her partner’s symptoms
in a way that seemed to mimic classic HIV sero-conversion, including night
sweats and fatigue. In her response the advisor avoided mentioning HIV at
all. Perhaps they didn’t want to put their Crouch End readers off their
Saturday breakfasts?
At least the far more pragmatic Americans are changing their tune. They are
extending screening to those assessed as being at ‘average risk’,
not just high risk. American HIV experts say only two per cent of new cases
of transmission involve people who already know their HIV status. Some 6.9
per cent of those untested but HIV positive are believed to have unwittingly
passed on the virus. This group is almost three and a half times more likely
to infect the ‘general population’ because they are the general
population.
I may be due to start a new finance role soon and there is a chance I will
be expected to play hatchet man by having to advise all departments to hit
new savings targets, when over-performance on some contracts is inevitable.
I may well be forced to be an NHS accomplice to reducing services. This seems
madness in the face our growing UK epidemic.
Surely the time has come when sexual health services should no longer be treated
just like any other directorate and screening is promoted to all groups in
society.
