One of the more dismaying aspects of the HIV pandemic has been the fact that very many of the people who are infected are unaware of their HIV status and have not been tested.

Public Health doctors and people involved in the HIV diagnostic and treatment fields have been looking for innovative ways to increase the HIV tetsing yield.

Several issues have conspired to prevent full take up of HIV testing and these include fear, difficulty obtaining testing, desire to remain anonymous and simply finding time to get tested in the first place.

At Freedomhealth we're always looking at new ways of improving our service and allowing access to as many people as possible.

We've just launched a service in the UK and Western Europe where people wanting modern fourth generation HIV DUO tests can use a TEXT request system.

It works by texting FHPATH4 to the following numbers:-

88020 if you live in the UK

+447950080232 if you live in Western Europe

Once you have sent the TEXT TO 88020 you will receive an automated message asking for you to confirm the request and also asking for your name and delivery address. There is no payment at this stage.

The kit will be despatched to you the same day, arriving at a UK address the next day. You then have to ask a local GP clinic, NHS pathology department or a local private hospital to take the small blood sample for you. They will usually charge a modest fee for this.

The charge for the HIV DUO test is £30 and is payable by cheque or card on returning the sample to the laboratory.

The result will be texted to you by return. If it a positive test, one of our doctors will call you and guide you on next steps and if necessary facilitate entry into an HIV clinic for further investigation and if necessary, treatments.

Other tests are available and can be seen here on the relevant website page:-
http://www.freedomhealth.co.uk/sexual-health/std-sti-chlamydia-testing-service-by-text-and-post/191/

The UN AIDS programme estimates that in excess of 5.7 million people are living with HIV in South Africa with around 3.2 million being women and 280,000 children up to the age of 14 years.

The prevalence of HIV in the general population in South Africa is over 18% compared with less than 0.2% in the UK.

There is a significant difference in HIV prevalence in South Africa between different provinces with KwaZulu-Natal having a rate of above 40% to approximately 15% in the Western Cape (Cape Town).

At Freedomhealth we have seen a large number of men who have returned recently from South Africa who have had unprotected sex with female commercial sex workers. This presents a significant hazard to the men themselves and their female partners they might return to. Significant numbers of these males have required either early intervention here in the UK with Post Exposure Prophylaxis (PEP) for HIV or have needed continuation of PEP already commenced in South Africa.

UNAIDS/WHO data (which is subject to time lag in terms of collection and reporting) suggests that in the major urban areas of South Africa the prevalence of HIV infections in female sex workers is in excess of 50%.

The generally stated and averaged risk of heterosexual transfer of HIV during heterosexual vaginal sex is approximately 0.1% or 1 in 1000 to 1 in 1200 "chance". However, this is an average and will vary quite markedly depending on both the "source" ie the infected patient's status and also the health of the non-infected participant. The figure is also taken from data obtained from industrialised Western countries irrespective of use of antiretrovirals.

We know that the rate of bacterial STD's in South Africa especially in the sex worker communities is very high indeed. We know also that other sexually transmitted diseases will facilitate the transfer of HIV. Sexual violence, poverty, underlying nutritional and health status and simultaneous presence of other, especially genitally ulcerating STD's will increase the chances of HIV transfer. Ulcerating genital disease caused by STD's such as herpes, syphilis, gonorrhoea, chancroid will increase the chances of transfer by up to approximately 6 times.

HIV transfer rates are up to 10 times higher in the early and late phase of HIV disease when the HIV viral load - the amount of virus in the blood stream and thus probably in genital secretions is markedly increased. In the quiet, asymptomatic phase a few months after infection, viral load will fall and so will potential infectivity.

Consequently, men having unprotected vaginal or anal sex with female sex workers in South Africa especially in some of the very high prevalence urban areas will expose themselves to an escalating lottery of risk depending on the circumstances of the women with whom they have sex. Uncontrolled HIV with high viral load, together with acquisition of STD's resulting in genital ulceration will expose them to an extremely high risk of contracting HIV. Unfortunately with upwards of 50,000 UK supporters in South Africa for the World Cup it is a certainty that some will return with a new HIV infection.

Condoms remain a thoroughly effective way of preventing HIV transfer and indeed are the only way to prevent transfer. The problem is not intact condom failure but failure to wear them in the first place and occasionally rupture or tear of the condom itself.

Men exposed to unprotected sex whilst in South Africa should seek medical attention whilst they are present there or return home for consideration of Post Exposure Prophylaxis and also screening for STD's and STI's prior to resuming sex with their regular partners.

Many of the questions we answer on this Forum and also the Freedomhealth Sexual Health Forum relate to anxiety about HIV and also possible early HIV symptoms.

One of the main problems in relying on HIV symtoms themselves is that they are notoriously vague and almost all the symptoms may in fact be symptoms of a different disease. The best method always of diagnosing HIV is to have a modern HIV test. Diagnosis may be difficult and uncomfortable but in Western Industrialised countires knowing your HIV status - positive or negative is ALWAYS a good thing. Knowing you are HIV positive and engaging in medical care will preserve your life to a normal lifespan.

It sounds obvious, but in order to acquire HIV there has to be a significant exposure. A significant sexual exposure means unprotected vaginal and or anal (or both)  penetrative sex with a person who already has HIV infection.

Dr Martin Fisher of Brighton and Sussex University Hospitals in the UK has looked specifically at HIV sero-conversion illness and has found that it occurs much more commonly than is currently thought.

We knew already that early HIV disease provides a short interval at an early stage in the illness to identify new infections. By identifying new HIV infections early we can do two important things.

Firstly we can dramatically alter the health of the person we have just diagnosed. This is because we are in an informed position where we can prevent that person entering a long period of several years chronic undiagnosed infection which ultimately ends in a crisis catastrophic illness where the diagnosis is made. This long period of slowly deteriorating health can be halted by just knowing a persons HIV status. The crisis point where a previously undiagnosed HIV positive patient becomes critically ill will frequently end their life.

Secondly, we can dramatically alter the onward transfer rate of HIV to other people. Dr Fisher, in his contribution to the UK's National Aids Trust Policy Report "Primary HIV Infection", cites some research published by Marks in the Journal of AIDS 2005 where a 50% reduction in risky behaviour was seen in people who were aware of their HIV diagnosis. There was an even greater reduction in risky behaviour when the HIV positive person was aware that their sexual partner was HIV negative.

The possibilities presented by the second of these points are enormous in terms of reducing spread. Imagine if we could successfully reduce transfer rates by greater than 50% without doing anything special ? We can. We just need more people to be aware of their status.

So what are typical HIV Symptoms?

Dr Fishers team looked at 108 people with HIV and found that 70 per cent of them had three classic symptoms - the HIV "Triad". These are:-

Severe sore throat

High Temperature

A body rash

These three classic symptoms and signs in an adult should suggest a possible HIV infection and should generate a suggestion that that person should have an HIV test.

There are many other symptoms and signs such as severe muscle aches, headaches, night sweats, lymph node enlargement, and joint pains.

All of these are valid but the key three features are as given above - 1) very high temperature 2) very sore throat 3) body rash. These three classical symptoms should point to the need for an HIV test, preferably one or a mix of a 4th generation HIV DUO test and/or an HIV PCR test. Both of these will allow us to make an early diagnosis with the option then of stopping a severe seroconversion illness early and preventing early immune damage and also allowing the newly infected HIV positive patient to limit the accidental further spread of HIV.

Being diagnosed with oral gonorrhoea comes as a surprise to many people who think that sexually transmitted infections or diseases are limited to genital to gential contact.

In fact, gonorrhoeal infection of the throat is common and often does not produce any symptoms at all. It is estimated that 9 out of 10 cases have no symptoms. Diagnosis until recently has been rather difficult due to the poor pick up rate of traditional swabs and the fragility of the gonorrhoea bacteria. Recent PCR testing has increased diagnostic pickups very considerably.

A recent paper in the International Journal of STD and Aids 2010: 21; 138-140 by Manavi and co workers looked at the rate of co-infection with other STD's, susceptibility of the gonorrhoea detected to antibiotics and the treatment outcome.

The authors make the interesting observation that in conjunction with gonorrhoeal infection of the throat there was a high rate of chlamyidal, HIV, hepatitis B and gonorrhoeal infections of the anus and or genitals in the study group.

They found that the rate of antibiotic resistant gonorrhoea infections was high with as many as 27% of gonorrheao infections in the UK in 2007 being resistant to ciprofloxacin whereas none of the patients studied was resistant to the antibiotic cefixime. It should be noted that in the UK the antibiotic ceftriaxone by injection is the preferred treatment for oral gonorrhoea although the use of an injection may be offputting for some patients.

The majority of the patients in the study were taken from a busy urban genitourinary medicine clinic in the UK. Most were of white ethnicity, were males who had sex with other males, were aged less than 4 years and had other infections.

What this means in practical terms is that it is well worth performing full STD screens, screening for all the above, when patients appear for testing. In addition of course, taking the opportunity to immunise as many people as possible against Hepatitis A and B would be of great benefit.

Using modern screening methods such as DNA PCR swabs is likely to increase the diagnosis.