Brian West Scot’s corner
I only go to the clinic every six months nowadays, because I’m
such an HIV dinosaur that I’ve been on (virtually) the same treatment
for six years.
One visit to the nurse followed by another one two weeks later to the doctor.
Bliss; the fewer hospital appointments the better I say. But because of this
I tend to miss out on changes to the GUM clinic in Edinburgh.
At my last appointment to give my bloods, a new nurse said, “We’re
routinely offering syphilis and hepatitis C tests to everyone now. Is that
OK?”
Is that OK! I wanted to jump up and down with joy. There was a time when anyone
with HIV going to a GUM clinic was assumed to be a Trapist Monk.
Of course we didn’t have a sex life, because we had HIV. It was assumed
we were in the business of surviving, not actually enjoying ourselves.
Later on, as we began to live longer, clinics realised that we were actually
bonking and that we should occasionally be asked if we would like tests for
gonorrhoea, syphilis etc. But clinic staff were not very proactive, and we
would always be asked if we felt ‘we have put ourselves at risk’
and if we’d like to test?
It was also down to the individual. If I happened to see a doctor or nurse
comfortable with taking the initiative and talking about sex, there was a
discussion. If not, then it was up to me, and it wasn’t always the first
thing on my mind. I never understood why there was a reluctance to talk about
sex and why everyone attending GUM clinics wasn’t offered opt out testing
for any nasty infectious disease that happened to be doing the rounds at the
time
Things are changing. Over the last few years my doctor has been asking me
about my sex life at every visit. Nurses are now taking the initiative when
I go for my bloods. Even the pharmacist has asked me if I need any condoms
when I go to pick up my drugs.
What matters is that there has clearly been an institutional shift. Any reluctance
on the part of our doctors, nurses, health advisers and pharmacists to discuss
intimate details of our sex lives with us has clearly been addressed by the
entire clinic. It is now policy for the whole unit. That’s great news.
So if we’re getting tested for things that we can pick up, what about
the things we already have, what else should we hope to see in future?
It’s obvious, despite the fact the drugs do work, there are still illnesses
we are prone to. People living with HIV are more likely to develop certain
cancers, not necessarily related to HIV itself. Top of the list for me might
be regular opt-out testing for anal cancer.
I remember many years ago (about the same time the ARV’s came along),
a study was looking at anal cancer, and I used to get a little lab brush shoved
up my arse every year to take a smear test.
I soon got used to it, (the lovely Dr Mark - then a junior doctor - so that
made it alright). This doesn’t happen nowadays. Why not?
I know there was some discussion about how effective so-called AIN screening
was. It also depended upon which kind of genotype of HPV we might have. Do
we know yet whether it’s worth being tested annually? Certainly for
gay men, HPV and anal cancer certainly go hand in hand, so shouldn’t
we have our legs up in the stirrups once a year?
It’s great news our clinics are thinking way past the “HIV + ARVs
= Sorted” approach and looking at the other things we may be affected
by. What we might have to do now is work out exactly what the other things
we should be looking for are.
