Indian social activists and children release a World AIDS Day awareness sign tied with ballons in Kolkata on December 1, 2015. According to the UN AIDS programme, India had the third-largest number of people living with HIV in the world at the end of 2013 and it accounts for more than half of all AIDS-related deaths in the Asia-Pacific region. In 2012, 140,000 people died in India because of AIDS. The Indian government has been providing free antiretroviral drugs for HIV treatment since 2004, but only 50 percent of those eligible for the treatment were getting it in 2012, according to a report by the World Health Organisation. AFP PHOTO/Dibyangshu SARKAR / AFP / DIBYANGSHU SARKAR (Photo credit should read DIBYANGSHU SARKAR/AFP/Getty Images)

    These days it’s the over-50s who risk ‘dying of ignorance’ about HIV

    1 December 2016

    Much has changed since the scare-mongering 1980s, when that Aids-engraved tombstone whipped Britain into a national frenzy. Today, on the 28th World Aids Day, the future is less bleak: HIV is treatable and no longer a death sentence for those who know they have it. Yet targeted campaigning by Public Health England (PHE) — predominantly towards homosexual men and black Africans — remains very much the same as during the run of Saatchi & Saatchi’s notorious 1987 ‘Don’t Die of Ignorance’ crusade.

    This week, the World Health Organisation (WHO) revealed that 64 per cent of HIV-positive people are not among these high-risk groups. ‘This proves how vastly misguided and outdated PHE’s targeted approach to educating and free testing is,’ says Brigette Bard, CEO of BioSURE, the UK’s only manufacturer of HIV self-testing kits. ‘As a white heterosexual female I cannot get a funded home postal test (from PHE) as I’m not deemed to be of risk,’ she adds, explaining that this medical exclusion drills into the female psyche that HIV is not applicable to them. ‘It’s to the detriment of everyone outside of the so-called ‘key populations’ where transmission rates are on the rise.’

    In the UK, the prevalence of HIV is growing in heterosexual men and women due to low levels of awareness and stigma around testing. More than car accidents, malaria or gender-based violence, the biggest killer of women aged 15 to 49 on earth is HIV. Look beyond the 50 mark and post-menopausal women represent the fastest rising group of HIV diagnoses in the UK, as declared by PHE. This sector has seen an increase of 16 per cent in the last year and 13.5 per cent averaged over the past three – about 300 new diagnoses each year.

    ‘There’s a growing number of older women who come out of long-term monogamous relationships and venture back on the dating scene,’ Bard explains of the trend. ‘They aren’t using barrier contraception because they’re no longer concerned about pregnancy.’ Medical experts suggest that age-related thinning and dryness of genital tissue may raise their risk for HIV infection.

    If older women choose to visit sexual health clinics, HIV is not always screened for. The only time females are routinely screened for HIV in the UK is if they access maternity services. Additionally, the majority (over 55 per cent) of older women are diagnosed late, meaning they have had the virus for a while, resulting in poorer health outcomes and shorter life expectancies.

    They are also more likely to have unwittingly passed it on. ‘These women often sleep with men over 50 who are even less likely to be targeted or screened and have no awareness,’ Bard adds. ‘Older males are generally reluctant to visit their doctor if they’re not symptomatic — a stiff upper-lip mentality.’ And the early stages of HIV don’t show any symptoms.

    If older women (and men) are encouraged to use HIV self-tests, whereby a drop of blood results in an immediate reading, Bard believes this would significantly reduce transmission rates. ‘Like a pregnancy test, it is a convenient, discrete and anonymous way to get a result and, if necessary, to take action.’

    This week, the WHO announced its support for wide-scale use of HIV self-testing, which currently remains limited despite over 14 million people worldwide who have contracted HIV being unaware of their status. In the UK, one in four people who have the infection don’t know it. Only 23 countries worldwide have national policies that support this method.

    In the UK, the legislation against HIV self-testing was only recently revoked in 2014 but in Germany, for example, it is still illegal. ‘In many countries there’s a fear that self-testing will prevent governments from capturing results or that infected people won’t go on to seek care,’ Bard, who advises WHO, explains. ‘That’s ridiculous — most people have an innate drive to survive.’

    A policy shift and awareness campaign to promote testing across the board for anyone who has taken a risk seems to be the answer. Targeting ‘key populations’ continues to ‘promote stereotypes that lull other people into a false sense of security’, something which needs to be ‘urgently addressed by PHE’, says Bard. (Dr Valerie Delpech, head of HIV surveillance at PHE, said the agency was ‘working with local authorities to fund the HIV home-sampling test kit’.) If this isn’t addressed, Bard says, ‘thousands of people will “die of ignorance” again’ — this time not because they have contracted HIV but because they weren’t diagnosed in time.