Download Health Promotions HIV prevention 2001/2002

GRAMPIAN NHS BOARD
THE AIDS (CONTROL) ACT 1987
REPORT 2001/2002
DR HELEN HOWIE
Consultant in Public Health Medicine
Grampian NHS Board
Acknowledgements
Aberdeenshire Council
Mrs A Davidson, Senior Planning Officer (Community Care) Social Work Department
Aberdeen City Council
Mr Ray Inkster, Principal Planning and Development Officer, Social Work
Blood Transfusion Service
Dr Henry Hambley, Clinical Director
Drugs Action, Aberdeen
Ms Luan Bruce Deputy Manager
Grampian Buddy Group
Grampian NHS Board
Ms Fiona Aitken, Bloodborne Virus Training Co-ordinator
Mr Grahame Cronkshaw, Drug Misuse Policy Manager
Mr Alan Leitch, Financial Accountant
Ms Gillian Anderson, Health Promotions, Programme Manager Priority Topics
Grampian University Hospitals Trust
Mr I Bovaird, Community Dental Service
Ms Susan Davidson, Clinical Pharmacist
Dr R Laing, Consultant Physician, The Infection Unit
Dr D J Lloyd, Consultant in Perinatal Medicine
Dr Pamela Molyneaux, Consultant Virologist
Dr Gordon McKenna, Consultant Physician, Genito-urinary medicine
Grampian Primary Care Trust
Mrs Eileen McKenzie, HIV Specialist Nursing Service, Genito-Urinary Medicine
Mr John Cosgrove, Nurse Specialist, Moray Drugs and Alcohol Team
Dr G Flett, Consultant, Family Planning and Reproductive Health Medicine, Square 13
Ms Sue Gordon, Specialist Nurse Substance Misuse Service
Phace Scotland Grampian Gay Men’s Health Project
Mr Mark Thomson – Project Manager
Lesbian, Gay and Bisexual Switchboard
Moray Council
Ms Jean Sinclair, Senior Social Work Practitioner Moray Drug & Alcohol Services
Scottish Prison Service
Ian Smillie, HMP Craiginches
2
Table of Contents
Page
2
Acknowledgements
Introduction
4
Epidemiology
4
Part 1 – Return for Treatment and Care
1.1 Finance
1.1.1 Hospitals
1.1.2 Voluntary and non-statutory
1.2 Accessibility
1.2.1 Open Access Services provided
1.2.2 Hospital episodes for patients with HIV
infection
1.3 Drug Therapy
1.4 Primary Care Involvement
1.5 Co-ordination
1.6 Consumer Involvement
1.7 Training
1.8 Community Care
10
10
11
11
12
13
Part 11 – Prevention and Non-Treatment Returns
2.1 Budget Monitoring
2.2 Agency Monitoring
2.3 Effectiveness Monitoring
14
15
16
Appendix 1 – Statistical returns:
 Statistics on newly reported HIV infected persons 1 April
1999-March 2002
 Statistics on newly reported HIV infected persons cumulative
to March 2002
 Statistics on number of HIV cases not known to be dead
cumulative to March 2002
 Statistics on AIDS cases and deaths March 2002
Appendix 2 – Agency Reports
 Health Promotions HIV Prevention 2001/2002
 Report HIV/Sexual Health Specialists Nurses
 Grampian Buddy Group
 Grampian Body Positive
 Aberdeen and North East Blood Transfusion Service
 Grampian Needle Exchange Service
 HIV/AIDS 2001/2002 Budget
7
7
7
8
9
18
19
20
21
22
22
23
23
24
25
26
Copies of this report can also be found on the Grampian NHS Board website on
www.show.scot.nhs.uk/ghb
3
Introduction
This year’s AIDS Control Act Report covers the period April 2001 to 30 March 2002
and follows the format introduced by the Scottish Executive. I am very grateful to the
individuals and the services listed in the acknowledgements for their contributions to
this report. I would like to record my thanks to Fiona Aitken who compiled this report
and to Diane McGregor for her administrative support.
I would like to thank Dr Aileen Downie, Consultant Physician at GUM, for her
contribution to the management of people with HIV. She retired in mid 2002 and I
welcome her successor Dr Gordon McKenna who brings with him a wealth of
experience in the field of HIV. Dr McKenna will be developing the services for HIV
positive people by providing an additional treatment service.
Epidemiology
World-wide there are an estimated 40 million people living with HIV. HIV/AIDS is the
leading cause of death in sub-Saharan Africa and the fourth biggest killer world-wide.
An estimated 60% of people with HIV live in Commonwealth countries, especially in
Africa and India, and as a result the UK may see more imported cases than other
European counties.
At June 2002 3458 people had been diagnosed with HIV in Scotland. Of these 1,303
were known to have died and 1,132 have been registered with AIDS. There was a slight
increase in number of new cases diagnosed in first six months of 2002 in comparison to
earlier years.
Over the last couple of years Grampian has seen an increase in the incidence of HIV.
Heterosexual transmission is now the most common risk factor, with an increase in the
number of women becoming infected compared to previous years. During the period of
April 2001 to March 2002 there have been 19 new cases diagnosed and this is an
increase from 16 in the previous year, (see Figure 1).
Figure 1
New HIV Infections in Grampian 1993 - 2002
30
Nos of new cases
25
20
15
10
5
0
1993 - 94
1994 - 95
1995 - 96
1996 - 97
1997 - 98
Year
Apr - Mar
4
1998 - 99
1999 - 00
2000 - 01
2001 - 02
Fourteen of these cases were attributed to heterosexual transmission, only two to sexual
intercourse between men, none to injecting drug use, one to blood transfusion abroad,
one mother to child and one was unknown (Appendix 1). Most of the cases attributed
to heterosexual transmission are thought to have acquired their infection abroad. Figure
2 shows the changing distribution of routes of acquisition.
Figure 2.
Newly Reported HIV infected persons by risk factor (cumulative to
March 2002)
250
Others
200
IDU
Nos of cases
Heterosexual
MSM
150
100
50
0
92/93
93/94
94/95
95/96
96/97
97/98
98/99
99/2000
2000/01
2001/02
Year
At March 2002 the cumulative total of reported HIV cases in Grampian was 199, of
whom 137 were still alive. One new AIDS case was diagnosed and one person has died
from AIDS during the reporting period and there are seven people living with AIDS in
Grampian. Improvements in anti-retroviral treatments have delayed progression from
HIV infection to AIDS and whilst these changes are encouraging they also mean that
more patients will require long term care in the future.
Bloodborne viruses, namely HIV, hepatitis B and hepatitis C, are a local priority in
Grampian because we have high rates of hepatitis B, hepatitis C and small but increasing
numbers of people with HIV. The numbers of cases of hepatitis B and hepatitis A had
not returned to normal levels following the recent outbreaks, which were primarily
amongst injecting drug users, in Aberdeen City. At December 2001 1600 cases of
hepatitis C had been identified in Grampian and 72% were associated with a history of
injecting drug use. This gives Grampian the second highest rate of people diagnosed as
HCV antibody positive in Scotland, second only to Glasgow.
Grampian has not only seen a general increase in the incidence of HIV and other bloodborne viruses but also drug use and sexually transmitted diseases resulting in increasing
demands on service providers. The Bloodborne Pathogens Strategy Implementation
Group continue to oversee ongoing work to raise awareness of bloodborne viruses,
encourage timely diagnosis, reduce the spread of these infections and ensure effective
5
investigation and management of the patients affected. In the last year new
developments to address these include:
 specialist bloodborne virus posts created in the Substance Misuse Service, Maternity
Hospital and Drugs Action
 an increase in number of services providing needle exchange
 plans to develop the C Card condom distribution scheme
 a sexual health needs assessment is being undertaken to inform the development of a
local strategy.
 a multidisciplinary working party is planning the implementation of HIV antenatal
screening to commence 1st Nov 2002.
6
Part 1
1.1
Return for Treatment and Care
FINANCE
1.1.1 Hospitals
Funding for HIV/AIDS treatment and care is now included in the Grampian NHS
Board’s general allocation. Funding is then allocated to GUHT to enable
provision of HIV treatments, care and laboratory services.
1.1.2 Voluntary and non-statutory
Various voluntary and non-statutory services are funded from the HIV
prevention budget (see Prevention and Non-Treatment Returns) including: Body
Positive, Buddy Group, Grampian & Moray Lesbian Gay and Bisexual
Switchboard, Drugs Action, Grampian Gay Men’s Health Project.
1.2
ACCESSIBILITY
Patients access all HIV related care and treatment at Aberdeen Royal Infirmary
either on an inpatient or outpatient basis. Patients may have to travel significant
distances to access services.
Genito-Urinary Medicine (GUM) services are predominantly based within
Aberdeen City. Although GUM rural counselling services are available in
Fraserburgh, Peterhead, Turiff, Huntly and Banff, there are still many areas
where people have to travel long distances to access the service. At present there
are no services in Moray. In addition to outpatient facilities at GUM and the
Infection Unit, specialist nursing staff from GUM review patients at home or by
telephone. Specialist nurses also provide a testing service at the Family Planning
Clinic. There is very good working relationship between Family Planning and
GUM however this could be improved by greater integration of these services.
For example women attending for termination may be in a higher risk group and
the GUM health advisors are available to support patients attending for surgical
terminations but a similar service is not available for those requesting medical
termination.
New services for adults and young drug users were developed in 2000-2001.
Additionally two new needle exchange services provides a service in target
areas. However there continues to be a need to further expand needle exchange
services particularly in Aberdeenshire and some areas in Aberdeen City. In
addition gaps have been identified in the provision of needle exchanges at
weekends and evenings.
Women involved in prostitution and men who have sex with men tend not to
access mainstream/statutory services and therefore they benefit from services
delivered where they work. Various outreach projects are provided by Drugs
Action, Grampian Police and Phace Scotland to address these needs.
7
1.2.1
Open access services provided
Service
GUM
HIV testing
open access
available


Service Provider



GUM Clinic, Aberdeen (GUHT/GPCT)
GUM rural service (5 areas)
Square 13 Centre for Reproductive Health (GPCT) by
GUM
GUM Clinic (in addition to routine testing accelerated
testing is provided 2 days a week)
GUM Rural Service
GUM provide testing services in hospital/prison
GUM provide testing in Turning Point and Substance
Misuse – Community
GPCT/GP services
Substance Misuse in Pregnancy clinic - GUHT
GUM Clinic
GUM rural service
Square 13 Centre for Reproductive Health
Drugs Action / Drugs Action Outreach
Substance Misuse Service
Turning Point
Substance Misuse – Community
Drugs Workers Aberdeen Prison
Grampian Lesbian, Gay and Bisexual Switchboard
Drugs Action
Drugs Action Aberdeen Outreach Services
11 Community Pharmacies
GPCT Substance Misuse Service
Moray & Fraserburgh




Counselling

Needle
Exchange
















Although some of services above are available on a ‘walk-in’ basis the majority
require appointments. ‘Open access’ does not imply 24-hour access and some
services have endeavoured to alter opening times to accommodate service users
but there continue to be gaps in the flexibility of times offered.
HIV patients managed by the Infection Unit can self refer for assessment,
treatment and management. Services such as substance misuse, dietetics,
occupational therapy, HIV pharmacist and social work, all important in the care
of people with HIV, are available on referral from General Practitioners, medical
staff and some nursing staff at the Infection Unit or the GUM Clinic. Although
patients’ dental care should be managed by their own dentists, if HIV associated
conditions exist patients can be referred to the Community Special Needs Dental
Service.
The number of clients seeking HIV antibody test counselling sessions from
GUM has increased by 155 this year resulting in 2,249 sessions taking place.
During all pre and post test counselling sessions the health advisors take the
opportunity to discuss safer sex, safer drug use, prevention of transmission of
8
HIV, hepatitis B and C and other relevant infections. Condoms and literature on
health promotion are freely available to clients.
HIV antibody tests are carried out in the Department of Medical Microbiology,
Aberdeen Royal Infirmary. Repeat reactive samples are sent to the HIV
Reference Laboratory, Gartnaval Hospital, Glasgow for confirmation. The total
number of people tested for HIV antibody in Grampian during 2001-2002 has
increased this year to 2,225 people tested.
The following table shows the
source of these tests.
Source
Number of people tested
Primary Care
GUM Clinic
Hospitals
Prisons
Other
Total
751
882
519
51
22
2,225
Other services which have the availability of open access






A Grampian AIDS Line provides information and support to the public
Drugs Action provides a telephone helpline, information and advice on drug
related concerns
Grampian Lesbian Gay and Bisexual Switchboard. This year has seen the closure
of Moray Lesbian Gay and Bisexual Switchboard
Phace Scotland – Grampian Gay Men’s Health Project
Drugs Action and Grampian Police provide outreach work for sex industry
workers.
Hepatitis B and A immunisation provided by GP’s and GUM nurses based at
Drugs Action.
1.2.2
Hospital episodes for patients with HIV infection
Provider
No of in-patient
episodes
52
Infection Unit, GUHT
No. of day-patient
episodes
Average (mean) length of in-patient stay for patients with HIV disease
Provider
GUHT
Total Bed Days
Total No of
HIV/AIDS patients
Average length
Of stay
259
24
10.8
All in patient episodes are at the Infection Unit in GUHT. Due to advances in
drug therapies the number of inpatient episodes for management of HIV infection
has declined in the last few years.
9
1.3
DRUG THERAPY
Until March 2002 all anti-retrovirals were prescribed by the Infection Unit,
however this service is now also offered by GUM.
Drugs
Hospitals
Ganciclovir (oral)
Combination
Therapies
Dual
Triple
Quadruple
Cost
£6,432
£36,000
£326,280
£62,040
No. of patients
1
3
55
4
N.B. a new drug introduced this year Keltra has been counted as one single drug
Percentage of patients in each of the listed disease stages receiving
combination therapy
Stage of Disease
Number of
patients
Number Receiving
Combination Therapy
Percentage Receiving
Combination Therapy
E1 (Asymptomatic)
24
8
33%
E2 (Symptomatic)
34
29
90%
E3 (AIDS)
25
25
100%
Although patients are offered treatment there are many different reasons why
some patients may not have commenced combination therapy e.g. due to
personal preference or side effects.
Patients receiving viral load testing
The cost of unfunded assays for HIV viral load testing to the Department of
Medical Microbiology was £17,564
1.4
PRIMARY CARE INVOLVEMENT
Proportion of HIV/AIDS patients in shared care with GPs
In this context ‘shared care’ is defined as GPs awareness of patients’ diagnosis
and involvement in discussion or treatment. There is probably little ‘shared
care’ in the sense of the General Practitioner playing a role in the specialist
management of HIV related disease and making decisions about therapy. All
patients managed by the Infection Unit are known to their GP’s. GP’s have
endeavoured to provide vital support for patients whilst maintaining anonymity
and confidentiality which are of major concern for individuals living in rural
communities. There has been some concern noted that some Dental Practitioners
are not happy to see HIV patients and consequently inappropriately refer patients
to Maxillofacial Surgery Department and/or community dental service.
10
1.5
CO-ORDINATION
The Bloodborne Pathogens Strategy Implementation group was established in
2001 to implement the strategy and improve co-ordination and collaboration of
agencies involved. This multi-agency group consists of representatives from
health care, local authorities, voluntary agencies, prison, drugs services and sexual
health services. In addition there are various subgroups, which feed into the main
group these include: Needle Exchange, Joint Community Care Planning Group
for people with HIV/AIDS, Bloodborne Virus Public Awareness and World AIDS
Week Planning Group.
Five Drugs Alcohol and HIV Forums operate within Grampian. All of these
enable staff to share information, promote best practice and contribute to the
development of services. Community Care Plans for the three local authorities
have been produced which include HIV related issues.
There is a wealth of multi-agency working initiatives ongoing in Grampian:
 Integrated Drug Services, are being further developed in line with the
Scottish Executive Joint Future Programme
 Buddy Group and Body Positive benefit from the co-ordination and support
provided by the nurses at GUM.
 Grampian Police, Drugs Action and Phace Scotland provide joint outreach
work targeting sex industry workers and men who have sex with men.
 Midwifery staff, Social Work, Substance Misuse and Drugs Action provide
specialist clinics for pregnant women with substance misuse problems.
Various statutory and voluntary services are involved in the fourth stage of the
Aberdeen/Gomel Teenage pregnancy Twinning Initiative where young mothers
are visiting Aberdeen.
1.6
CONSUMER INVOLVEMENT
Service users including people with HIV are actively encouraged to attend both
Drug Alcohol and HIV Forums and Community Care Planning Group for People
with HIV. However due to lack of membership, within the Body Positive group,
they are unable to provide representation. Phace Scotland will be undertaking a
needs assessment for HIV positive people in 2002-2003.
Aberdeen City Drugs Alcohol Forum has appointed a member of staff to assess
user views of current services. Interviews with service users are currently taking
place.
Drugs Action is continuously assessing their clients’ views and suggestions. A
recent audit was conducted to assess the accessibility of needle exchange
services. Results of the audit are currently been reviewed.
Following consultation with relevant at risk groups and positive people a variety
of campaign materials have been produced to increase awareness, promote
prevention and provide information for those infected and affected by
bloodborne viruses. As a result of an audit to GP surgery’s GUM rural
11
counselling service is endeavouring to increase awareness of the service by
advertising.
1.7
TRAINING
A recent audit was conducted to review training on bloodborne viruses
throughout Grampian, including who provides training and groups requiring
training to identify any gaps. It has been acknowledged by many sectors that the
request for training is not as great as it should be, due to staff’s lack of awareness
of the relevance of training. There continue to be many gaps in the provision of
training in the voluntary and statutory sector and plans to address these are
underway.
During 2001-2002 there were a variety of training sessions covering various
aspects of bloodborne viruses including HIV throughout Grampian.
Many
specialists in the field regularly carry out training e.g. nurses, doctors, health
promotion specialists, Phace Scotland and drug workers. Training is aimed at a
variety of different groups e.g. Local Authorities, health care staff, voluntary
staff, prison staff, workplace staff.
Some organisations provide awareness raising sessions on sexual health and
drugs e.g. school, community groups, prison and voluntary organisations.
Regular ongoing training provided:
 BBV Clinical Training Co-ordinator provides a series of training sessions
throughout the year to relevant staff including health care workers, other
voluntary and statutory sector staff.
 Health Promotions run multi-agency staff training on drugs and sexual
health
 Health Promotions provide training for workplaces
 GUM specialist staff involved in regular HIV sexual health training
 Specialists provide training within the universities and colleges
 NHS Grampian Public Health Team provides infection control training
 Infection Control Nurses and Occupational Health staff frequently provide
training to health care staff
 STRADA have commenced training in the North East on drugs alcohol and
BBVs
Amongst the difficulties is the availability of training for specialists working in
the fields of bloodborne viruses, drugs and sexual health. There is a lack of
funding available for attendance at training out-with Grampian and difficulties
are experienced by both the statutory and voluntary sectors in the release of staff
to attend training events.
12
1.8
COMMUNITY CARE
Although both NHS Grampian and the social work department have a role in
providing care, specific HIV 24-hour care in the community relies heavily on
informal carers. A 24-hour home care service to support individuals in the
community that includes those with HIV is available however is rarely requested
for this client group.
Communication between acute and community services is improving with the
availability of HIV Specialist Nurses being available at the Infection Unit at
particular times in the week allowing HIV positive individuals the opportunity to
see their multidisciplinary team at one appointment.
The Local Authorities have a Carers Strategy where carers are entitled to an
assessment of their own needs. Aberdeenshire Council has a palliative care
strategy developed in partnership with health care staff.
There are no specific inpatient respite facilities available for individuals infected
with HIV, thus patients are nursed in their terminal stages in the Infection Unit
which is not felt to be appropriate. Individuals needs are assessed and prioritised
on an individual basis.
13
Part 11 – PREVENTION AND NON-TREATMENT RETURNS
2.1
BUDGET MONITORING
Year
2001/2002
2000/2001
1999/2000
1998/1999
Total prevention Allocation
772,476
520,476
385,751
271,000
Total Prevention
Spend
612,476 *
£520,476
£385,751
£271,000
Under-spend of £160,000 carried forward to 2002/2003 to fund predetermined commitments
arising from local and national strategy.
The AIDS Control Act Report 1997/1998 omitted spend of funds allocated to Substance Misuse
BREAKDOWN OF TOTAL EXPENDITURE BY TARGET GROUP
Target Population
Gay & Bisexual men1
People with links to high prevalence
countries (at present sub-Saharan Africa) 2
Women partners of men in the above
groups
People with AIDS and HIV3
Injecting Drug Users4
Other:
 Sex industry workers
 Young people sexual health needs
assessment
 BBV prevention Public Awareness
Campaign
 Health promotion activities including:
health education, resources, training
for professionals, condoms, direct
services to young people in formal and
informal education settings.
 Specialist posts in sexual health, drugs
and bloodborne viruses
TOTAL
1.
2.
3.
4.
Total Expenditure
£77,426
£22,000
As above
£12,120
£251,873
£15,000
£22,000
£30,851
£181,206
612,476
Aberdeen & Moray Lesbian, Gay & Bisexual Switchboards, Grampian Gay Men’s
Project
Workplace education – Travel Health
Buddy Group, Body Positive, HIV secondary prevention
Needle exchange Services and Drugs Action
14
2.2
AGENCY MONITORING
Amounts and percentages of expenditure from the ring-fenced prevention
budget spent
Sector
Amount
Percentage
Statutory Health Total
 Health Promotion, family planning, sexual
health, primary care, community care, education
 Substance misuse*
 GUM
 Other statutory health
Voluntary/Non-statutory
Local Authorities
Prisons
Other
Total prevention spread
*where paid from HIV prevention allocation
15
£256,057
42%
£130,873
Nil
Nil
£225,546
Nil
Nil
21%
Nil
Nil
37%
Nil
Nil
£612,476
100%
2.3
EFFECTIVENESS MONITORING
Steps taken to ensure that the commissioning of HIV prevention work is evidence-based
in relation to risk groups targeted; effectiveness of interventions used and monitoring of
work being undertaken
Target Groups
Evidence based commissioning
Men who have sex
with Men
Sex Industry
Workers
Intravenous Drug
Users (IDU)

Grampian Gay Men’s Project continues to address the findings
of the Sexual Health Needs Assessment undertaken in 2001

Services to sex industry workers are provided on an outreach
basis providing access to needle exchange, condoms and
information/advice. The findings of a needs assessment
undertaken drives the development of this service.

Following an audit to assess IDU’s knowledge, access to
injecting equipment and perceived risk of sharing injecting
equipment, a group has been established and is currently
addressing services, injecting equipment availability and
providing information to IDUs.
NHS Grampian and SCIEH conducted a case control study to
investigate the outbreak of hepatitis A in IDUs in Grampian.
Hepatitis A immunisation and health promotion education
continues following this.
Drugs Action is currently involved in local and national
research projects on IDU’s
A&E have completed an audit including information on IDUs,
and plan to review the provision of health promotion activities.



General Public


Young People
The BBV public awareness campaign continuously evaluates
information developed on prevention of BBV.
Youth and adult lifestyle surveys are currently been
conducted.

A young people’s sexual health needs assessment was
undertaken in 2001/2002 to identify physical and
psychological barriers to accessing sexual health services. The
findings have been used to inform the planning and delivery of
sexual health and HIV prevention activities including policy
development, training of professionals and increasing access
to sexual health services and free condoms.

In response to the high rate of teenage pregnancies in Moray a
pilot project has been established in the Health Promotions,
Health Information Centre. The service provides young people
with information on lifestyle issues, including sexual health,
provision of contraception, pregnancy testing and chlamydia
testing.
16
Professionals with
a health
promotion remit

The plan to increase BBV education to professionals is in
progress following an audit of identifying need and evaluation
of existing training.
Effectiveness of
interventions

Regular and continuous evaluation is carried out
Monitoring of
work undertaken

Regular auditing of activity reporting is standard across all
funded groups including drug misuse services, needle
exchange and health promotion
Have there been any notable problems or successes in this area?
Grampian Gay Men’s HIV Prevention Project, continues to develop. The
appointment of voluntary workers has facilitated further work to the target group.
The success of the ‘Get Rubbered’ postal condom distribution scheme has
resulted in the continuation of this service.
The HIV specialist nurses, Buddy Group, Body Positive and Health Promotions
and other services all play a valuable role in providing a service for those
infected, affected and at risk of HIV infection and a more detailed report is
provided in Appendix 2.
17
APPENDIX 1
AIDS (CONTROL) ACT 1987: STATISTICS ON NEWLY REPORTED HIV INFECTED
PERSONS
Health Board:
Grampian
1 April 2001 to 31 March 2002 (as at 31 March 2002)
Signed
Name:
Tel No:
How person probably acquired the virus
Male
Female
Total
Sexual intercourse between men
2
0
2
Sexual intercourse between men and
women
8
6
14
Injecting drug use (IDU)
0
0
0
IDU and sexual intercourse between men
0
0
0
Blood factor (eg haemophiliac)
0
0
0
Blood/Tissue transfer (e.g. transfusion)
1
0
1
Mother to child infected
0
1
1
Other/undetermined
1
0
1
TOTAL
12
7
19
Notes:
1
2
Cases are allocated to a particular health board based on the patient’s Health Board of Residence. If this is not
known, they are allocated based on Health Board of Specimen origin.
This table, supplied by The Scottish Centre for Infection and Environmental Health (SCIEH) – Tel 0141 300 1100 – is
for the 2000/2001 reports by Health Boards under the AIDS (Control) Act 1987.
18
AIDS (CONTROL) ACT 1987: STATISTICS ON NEWLY REPORTED HIV INFECTED
PERSONS
Health Board:
Grampian
Cumulative to 31 March 2002
Signed
Name:
Tel No:
How person probably acquired the virus
Male
Female
Total
Sexual intercourse between men
70
0
70
Sexual intercourse between men and
women
43
34
77
Injecting drug use (IDU)
22
6
28
IDU and sexual intercourse between men
2
0
2
Blood factor (e.g. haemophiliac)
6
0
6
Blood/Tissue transfer (e.g. transfusion)
2
3
5
Mother to child infected
2
1
3
Other/undetermined
6
2
8
153
46
199
TOTAL
Notes:
3
4
Cases are allocated to a particular health board based on the patient’s Health Board of Residence. If this is not
known, they are allocated based on Health Board of Specimen origin.
This table, supplied by The Scottish Centre for Infection and Environmental Health (SCIEH) – Tel 0141 300 1100 – is
for the 2000/2001 reports by Health Boards under the AIDS (Control) Act 1987.
19
AIDS (CONTROL) ACT 1987: STATISTICS ON NEWLY REPORTED HIV INFECTED
PERSONS
Health Board:
Grampian
Number of cases NOT KNOWN TO BE DEAD; Cumulative to 31 March 2002
Signed
Name:
Tel No:
How person probably acquired the virus
Male
Female
Total
Sexual intercourse between men
41
0
41
Sexual intercourse between men and
women
37
28
65
Injecting drug use (IDU)
13
4
17
IDU and sexual intercourse between men
1
0
1
Blood factor (eg haemophiliac)
2
0
2
Blood/Tissue transfer (eg transfusion)
2
2
4
Mother to child infected
0
1
1
Other/undetermined
5
1
6
101
26
137
TOTAL
Notes:
5
6
Cases are allocated to a particular health board based on the patient’s Health Board of Residence. If this is not
known, they are allocated based on Health Board of Specimen origin.
This table, supplied by The Scottish Centre for Infection and Environmental Health (SCIEH) – Tel 0141 300 1100 – is
for the 2000/2001 reports by Health Boards under the AIDS (Control) Act 1987.
20
AIDS (CONTROL) ACT 1987: STATISTICS ON REPORTED AIDS CASES AND
DEATHS
Health Board:
Grampian
Year ending 31 March 2001
Signed
Name
Tel No
Period
1 April 2001
to 31 March 2002
Cumulative to
31 March 2002
People with AIDS –
First reported from
this Health Board
- reported to, and
accepted by SCIEH in
period
Numbers of above
known to have died in
period
- cumulative number
reported to, and
accepted by SCIEH in
period
Numbers of above
known by 31 March
2002 to have died
Known to be resident
of this Health Board
1
1
0
0
39
39
31
33
Notes:
1.
2.
This form should be completed as part of the reports made by Health Boards under the AIDS (Control) Act 1987
The form should be completed from information provided by SCIEH
21
Appendix 2
Health Promotions HIV prevention 2001/2002
Health Promotions continues to be the leading source of health information in
Grampian. During 2001/2002 a total of 187,207 drug and sexual health leaflets were
distributed to professionals via the resource scheme.
Health Promotions operates a condom distribution scheme which can be accessed by
professionals working within the community, in 2001/02 87,000 condoms were
distributed. Health Promotions continues to run the Safer Sex Website
www.safersex.org.uk.
The provision of training to professionals continues to be a priority, with 288
professionals attending drug and sexual health training during 2001/2002. The following
courses were offered:
 Drugs Education and Awareness (course accredited by Robert Gordon University)
 HIV Prevention/Sexual Health Awareness
 Personal relationships and sexuality foundation course for staff working with people
with learning disabilities.
 Sexuality, youth and community work.
Health Promotions provides interactive workshops in relation to drugs and sexual health
to secondary school children across Grampian. Demand for direct input to schools and
community settings increased steadily during 2001/2, resulting in the provision of 211
sessions to young people in a range of formal and informal educational settings.
Health Promotions is the managing organisation for Scotland’s Health at Work Award
Scheme (SHAW). With the aim of increasing the number of Scottish workplaces with a
drug policy a partnership was established with Scotland Against Drugs (SAD) in 1998
and this partnership continues successfully. In order to establish the success of the
activities carried out through the SAD/SHAW partnership, retrospective evaluation is
currently being undertaken. During 2001/2002 Grampian based companies have
received assistance in developing workplace drug policies. In many cases this has been
supported through the provision of training sessions for managers and awareness raising
sessions for employees.
Report from the HIV/ Sexual Health Specialist nurses
The work of the HIV/Sexual Health specialist nurses encompasses work within the
GUM Clinic and specialist counselling and liaison work within the community. The
current staffing is one full time specialist nurse (team leader), two full time and one part
time specialist nurses. There are also four community nurses who are specially trained
and supported by the specialist nurses who offer an HIV/sexual health service in
Turriff, Banff, Fraserburgh, Peterhead and Huntly areas.
Throughout the year the team of specialist nurses has continued to provide a flexible
counselling, nursing and advisory service. This includes pre and post test HIV
counselling; support and nursing care to HIV positive people and their carers; liaison
between primary and secondary care; co-ordination and supervision of Body Positive
and Grampian Buddy Group; training and updating health care staff, community groups,
prisons and students. Other areas of work includes co-ordination of the HIV rural
22
counselling service, pre and post test counselling for hepatitis B and C. Contact tracing
for patients diagnosed with sexually transmitted infections is a major part of the work
undertaken. In addition the nurses attend various groups and committees to address BBV
and sexual health issues across Grampian.
The team is experiencing an increasing demand for their services. During 2001-2002 the
number of patients seen has increased by 1,258 from the previous year with a total of
3,940 patients seen, in addition 2,495 telephone contacts were made.
A major contributory factor to the increase in demand is counselling, health education
and contact tracing for sexual transmitted infections.
Patients referred to health advisors for contact tracing this year is:
Number of contacts sought by the health advisors
Number of contacts found by the health advisors
741
956
565
In addition there has been an increase in demand for HCV testing and between January
2001 and December 2001 225 patients were tested.
Grampian Buddy Group
Grampian Buddy Group are trained volunteers who befriend and support people who are
living with HIV/AIDS. They are seen as an additional support service and not put in
place instead of a professional health service worker. Individuals who are in a Buddying
relationship meet as required by the service user and the Buddy group meets monthly.
Volunteers who are not in a Buddying relationship have a vital role in supporting those
who are. Presently 6 people are in a buddying relationship.
This year nine volunteers have been recruited, giving a total of twenty buddies. There
have been training weekends held over the last year with a residential training weekend
planned for later in the year. New Volunteer guidelines have been distributed to every
member, together with Code of Practice booklets. Two members of the group attended
the Mastery weekend, which was held at Body Positive in Glasgow.
The Buddy Group launched its own web site in time for World AIDS day which has
attracted a lot of interest world-wide.
Grampian Body Positive
Grampian Body Positive is a self-help group open to anyone in Grampian infected with
HIV. Its aim is to provide a safe environment for people to share experiences, combat
isolation and stigma.
Individuals infected with HIV remain reluctant to attend meetings, although they still
make use of the organisation’s resource material related to HIV. A few people living
with HIV have used some of the resources to visit and liaise with other HIV
organisations in the UK.
The HIV/Sexual health specialist nurses provide support for Grampian Body Positive
but they feel that this role has developed inappropriately causing conflict in their roles.
The Aberdeen and North LHCC HIV/Sexual health group is currently addressing this
matter.
23
Aberdeen and North East Blood Transfusion Service
Grampian HIV Positive patient CD4 count information 2001-002
Number of CD4 counts performed on HIV positive patients: - 279
Number of HIV positive patients ‘active’ at 31st March 2002: – 83
Grampian HIV positive patients CD4 counts at 31st March 2002
CD4 count
Number
Risk Group
>500
25
6 IVDU, 6HX, 10HET,
1AFR, 2U/K
400 – 500
9
1 IVDU 3HX, 3 HET,
1 U/K
300 – 400
20
2 IVDU, 7HX, 8 HET,
3 U/K
200 – 300
12
1 IVDU, 7HX, 6 HET, 2
U/K
100 – 200
7
1 IVDU, 6HET, 3HX,
2 U/K
<100
5
1 HET 3HX 1U/K
IVDU=intravenous drug user HX=homosexual, HET=heterosexual, AFR=African, U/K =Unknown
24
Needle Exchange Services in Grampian 2001/2002
1999/2000
2000/2001
2001/2002
6
9
2
7
9
2
7
9
2
120,000
150,000
20,000
75%
150,000
150,000
25,0000
75%
212,500
160,000
25,000
75%
65,000 GHB
20,000 ACC*
85,000
105,000
28,000
Community Pharmacists
Grampian
65,000 GHB
52,000
Primary Care Trust
-
45,000 GPCT
Number of Needle exchange sites in
Grampian
- Drugs Action
- Community Pharmacists
- Grampian Primary Care Trust
Number of needles supplied
-
Drugs Action
Community Pharmacists
Grampian Primary Care Trust
Fraserburgh/Elgin
Exchange Rate
Costs
Drugs Action
*ACC
52,000
45,000
45,000
-Aberdeen City Council
25
HIV/AIDS 2001/02 Budget
Expenditure
2001/02
£
1
HIV/AIDS Health Promotion & Prevention
Health Promotion - General/Training & Condoms
HIV/AIDS Clinical Training Co-ordinator
Aberdeen Gay Switchboard
Body Positive
Buddy Group
116,897
32,921
9,426
2,020
10,100
1999/2000 Developments
HIV Clinical Training (HQ)
Moray Gay Lesbian Switchboard
HIV Secondary Prevention
Needle Exchange - Aberdeenshire
10,760
3,000
0
20,500
2000/01 Developments
Needle Exchange - Aberdeen
Sex Industry Workers
Public Awareness
Gay Men's Project
Condoms
Young People
45,000
15,000
30,851
65,000
6,000
22,000
389,475
11 HIV/Drugs Related
Training - Health Promotion
Drugs Action - Needle Exchange Service
Needle and Syringe Exchange Services in A'shire
Injecting Equipment - Reported to GHB
Health Promotions Adviser
10,621
40,000
25,000
33,529
22,007
131,157
Non Recurring
2000/01 Carry Forward - Confirmed (Non Recurring)
Kemnay Needle Exchange
2001/02 New Monies
Hepatitis B Immunisation
Needle Exchange - Staffing
Maternity Services BBP post
Specialist Blood Borne Pathogen Post (DA)
1,628
25,000
20,000
10,000
Contribution to GPS budget - Methadone shortfall
91,844
TOTAL BUDGET
612,476
Funding Carried Forward to 2002/03
160,000*
772,476
* This was carried forward to meet the following agreed commitments:
Antenatal HIV Screening, Specialist BBV posts, C Card scheme, Needs
Assessment for Vulnerable Young People and HIV positive people, pilot of a
rural needle exchange and condoms.
26