compiled by Martin Flynn
News
SECURITY (AND INSECURITY)
Walking
home in the wee small hours after a particularly boozy Easter, yours
truly was knocked over, held down and mugged by a gang of teenagers.
Nothing unusual in that you might think, but for someone who is six feet four
and over 80 kilos and who has travelled around the world in bemused safety,
it was a shock to the system, not least because when I was bigger and butcher
I used to work in the security business.
When I reported the crime my local police were helpful and supportive and
have even caught a couple of the miscreants when they tried to use my cards.
The bank and the phone people were also helpful and, unsurprisingly, the only
people who treated me like a leper and a criminal was the insurance company.
In the weeks after the mugging I began to feel paranoid around groups of teenage
boys and angry that it could happen to me.
My local gay and lesbian liaison police officer, PC Andy Hewlett (PC Poz,
PN59) explained we often think this sort of crime only occurs to others and
the last thing we expect is to be a ‘victim’ ourselves.
As the mugging rate doubles each year, he gave us his top advice for staying
safe:
• plan your journey to avoid poorly lit, deserted or dangerous areas,
especially after dark
• keep to well-lit main roads where possible, avoiding alleyways, woody
or bushy areas
• don’t wear excessive bling, headphones or carry too much cash
• let someone know where you are going and when you’ll return
• avoid walking alone at night, especially if you’re trashed
• Most attacks come from behind or out of your line of vision so stay
alert and be aware of what’s going on around you.
• Don’t fight back if you’re outnumbered or are facing a
knife or, God forbid, a gun; hand over the loot and get away safely.
If you are mugged don’t blame yourself; it can happen to anyone, but
make sure you report it to the police, who can be wonderful.
Personal security support and advice:
• www.report-it.org.uk
(hate crimes)
• Crimestoppers 0800 555 111
• www.met.police.uk/crimeprevention
• wwwvictimsupport.org.uk
• www.samaritans.org.uk
• http://petitions.pm.gov.uk/Crime-Pod/
• www.gmfa.org.uk
(self defence)
DIRTY SECRET HABITS
By
the beginning of July, smoking in public places will be banned across Britain,
when England steps into line with its UK neighbours.
As the NHS promises to increase funding for local stop smoking services, the
Department of Health is predicting 600,000 fewer smokers after the ban. Already
this March’s No Smoking Day has persuaded a million more smokers to
quit.
New research is revealing that not only do a substantial number of people
secretly smoke but many are prepared to actually lie to friends and family
about their covert habit.
A study in last month’s Lancet shows smoking activates the genes that
breaks down collagen in the skin, leading scientists to confirm that a smoker’s
skin ages faster.
So there’s another good reason to quit, apart from the improvement in
breathing, heart, lungs, blood pressure, appetite, ability to ward off infections,
mouth hygiene...
YOU CAN ONLY FLY
SO HIGH...
At
last month’s British HIV Association (BHIVA) conference in Edinburgh,
the city’s renowned HIV specialist Dr Ray Brettle pointed out the dangers
of interactions between some HIV meds and recreational drugs.
Nearly 15 per cent of deaths among people with HIV on antiretroviral therapies
in this country are liver related (see page 50).
People on a boosted protease inhibitor regime containing ritonavir (Norvir),
are particularly advised to be careful if they take recreational drugs.
Levels of ecstasy and the already dangerous GHB are boosted by between six
and ten times in the blood of people on ritonavir.
Ritonavir makes your body produce less of an enzyme (3A4) that breaks down
some drugs, including some recreational ones. With less enzyme to break them
down drug levels can get dangerously high. Nevirapine has the opposite effect
and decreases the levels of some drugs.
Dr Brettle explained that the HIV drugs are not believed to affect cocaine
levels but can boost diazepam (Valium) levels and lower methadone or heroin
levels. There have been a couple of deaths in recent years from such dangerous
drug interactions.
“Avoid ritonavir for drug users ,” Dr Brettle told the BHIVA meeting,
“particularly if they are also taking stimulants.”
Feature NIGHT
SWEATS
Soggy bedclothes can leave you feeling tired and run down, writes Laurence
Gibson
None
of us enjoy sweating at the best of times, least of all during the middle
of the night. But unfortunately night sweats are a common phenomenon among
HIV positive people.
They may either be mild and infrequent or become quite severe. The worst case
could see you requiring a change of sheets regularly during the night.
Why do people sweat?
Sweating is normally a means of controlling your body temperature. Sweat forms
on the skin surface and takes the heat with it as evaporates. Hence in hot
weather or when your muscles warm up because of exercise more sweat is produced.
Sweating is also increased by nervousness and nausea, and decreased by the
cold. However night sweating is not caused by any of these external forces.
Normal body temperature is 37°C. It is thought that when your body gets
an infection like flu it sometimes responds by making your body temperature
higher; this makes you a less hospitable environment for the invader and hopefully
gets rid of it quicker.
Why do we get them?
Unfortunately night sweats are a common problem with HIV. If they are intermittent
and/or localised then HIV infection is usually responsible.
Many will notice having night sweats shortly after contracting the virus,
this is called a sero-conversion illness. At this stage the sweats should
only last a week or so before passing.
As HIV progresses and damages the immune system, night sweats are commonplace.
If you have a very low CD4 (below 150) then the likelihood of frequent sweating
increases, especially during the night.
If you are HIV positive and on HAART, taking an interruption from your medicines
may cause you to have night sweats for the first couple of weeks of your break.
If you have only recently started to sweat at night then it is first important
to ensure there is no other underlying cause.
Other causes
Any secondary infection may cause you to sweat at night. Tuberculosis, for
example, will cause drenching night sweats and would also be accompanied by
a phlegmy cough, fatigue and weight loss.
Another underlying cause could be congestive heart failure, which would cause
sweating both during the day and night (other symptoms are high blood pressure,
palpitations, fatigue and breathlessness).
Or perhaps you just have a good old-fashioned bout of the flu or a common
cold.
If you are a woman just entering the menopause or suffering from PMS then
you may also be prone to night sweats.
What can we do?
• Take paracetomol or aspirin before you go to bed as this helps control
body temperature
• Keep cool before bedtime and do not wear too many bedclothes
• Put a waterproof cover under your bed sheets to protect the mattress
• It’s easier to control your temperature with blankets and sheets
than a douvet
• If the weather permits, sleep with a window open
• Take a cool bath if you are sweating too much during the night
• Avoid spicy foods or hot drinks before you go to sleep
• Herbalists recommend sage tincture but not if you’re taking
PIs
Food for thought
CARNITINE
If a supplement can reverse neuropathy then why doesn’t
my doctor give it to me?
Several
years ago a substance called acetyl-l-carnitine or ALCAR hit the
headlines with claims it extended life, helped weight loss and revitalised
the elderly. Its effects on neuropathy, CD4 counts and fat levels in HIV positive
people showed initially promising results but interest now seems to have waned.
What is it?
ALCAR is a form of l-carnitine, a substance your body needs to help turn certain
fats into energy your body can use. We absorb it from food and our bodies
also make it, so deficiency in otherwise healthy people is unusual. It is
found mainly in red meat and dairy but even vegans don’t suffer from
a shortage as the body seems to alter the rate at which it is absorbed and
made, depending on availability.
What does it do?
Over time HIV gradually depletes the number of CD4 cells in your body, leaving
it more susceptible to attack. It does this by directly infecting them to
use them as nurseries for creating new HIV. But it also seems having HIV makes
uninfected CD4 cells die prematurely, leading to further depletion.
This early ‘programmed cell-death’ (apoptosis) is not fully understood,
but limited studies suggest carnitine seems to slow this process down leading
to higher CD4 counts.
Certain HIV drugs, especially AZT and the ‘d’ drugs (ddl, ddC
and d4T), damage our body’s energy units (mitochondria). This in turn
leads to the death of nerve cells in feet and hands causing the painful stinging
sensation many of us experience, or peripheral neuropathy. Because carnitine
brings fuel to these energy units it can, in theory, help the body rebuild
damaged nerves and ease the pain. Several trials seem to confirm this, but
they haven’t been sufficiently scientifically rigorous to prove this
beyond doubt.
There is also limited evidence that carnitine can have a beneficial effect
if our lipid levels are unbalanced by medication and so may lessen the effects
of lipodistrophy.
Sounds
good
The reason we’re not all given a life-time supply at diagnosis is the
evidence, while compelling, is not conclusive. The HIV/GU directorate at the
Kobler centre, where some early trials into carnitine took place, stopped
giving it to patients in 2004 because of lack of evidence and a then restricted
supply.
How much do I need?
As with other things about this newly explored compound, the amount we should
take is also a bone of contention. Our bodies happily manufacture the amount
healthy people need. But if HIV and meds cause a fall in available levels
then supplements are the only way to counter this. The dosage used most frequently
in the studies was 3,000mg per day which would prove very expensive.
Our expert* says
Carnitine is one of those nutrients that could potentially help with a lot
of things if only we understood it better... and had more clinical trials
to prove its use. Our bodies are efficient at making carnitine and it is found
in red meat and dairy products, so generally, you won’t become deficient
even if it is lacking in your diet. Tell your doctor if you decide to take
carnitine as a supplement. They should monitor your thyroid hormones as some
studies show taking carnitine at doses of 2g or 4g per day lowered their levels.
* Karen Klassen is lead HIV dietitian at St Mary’s Hospital, London
SURVIVAL TIPS
David
Dawson
DX1994: Forgive yourself
My advice to someone recently diagnosed is forgive yourself. Most people with
HIV blame themselves for becoming positive and I was no exception.
After my diagnosis I spent a lot of time blaming myself, which led to even
more self-destructive behaviour. But as I began to think about the reasons
I began to see that, although we like to think we’re in control of everything
that happens to us, it isn’t always that simple.
As a gay man I was brought up thinking I was less important than other people
because that is the message society gives children growing up gay. I didn’t
learn to value myself so I didn’t protect myself.
I could only blame myself; I knew about HIV but put myself at risk because
I was so out of control. But I was a different person then, more naïve
and needy.
Everyone needs to take responsibility for their own actions – that’s
healthy. But once you’ve accepted that, I think it is important that
you don’t let blame engulf you.
I realised I could feel bad about myself, which would undoubtedly lead to
a miserable life and an early death, or I could decide to forgive myself and
try and do something productive with it. Give something back to the world
before you leave it – you’ll be dead a long time.
It’s not easy to forgive yourself when we’re told by so many different
voices that we are bad. But remember you are only human. Remember everyone
has sex. Most people catch an STI at some point and a small percent will get
HIV. The only difference is they are luckier than you, not better.
It’s a cliché but you can either live in the past or learn from
it and move on.
