You don't need to be signed in to read BMJ Blogs, but you can register here to receive updates about other BMJ products and services via our site.


The True Cost of HIV Treatment

7 Apr, 15 | by shaworth

Last week saw the first pre-election debate between the leaders of major UK political parties. Seven were invited: Conservative, Labour, Liberal Democrat, Greens, UKIP, Plaid Cymru and the SNP, resulting in a set that looked like a strange, suited parody of a quiz show. No one is sure who really won, and we won’t find out what the nation really thinks until the 7th of May, when the election is due to be held.

Despite having no clear winner, one soundbite emerged from the chaos: Nigel Farage’s assertion that foreigners make up most of the new diagnoses of HIV in the UK, at the cost of £25,000 each per year. For those of us following the pattern of gaffes and trip-ups occurring in the UKIP camp, this statement is one to add to that long list.

The truth is somewhat more complicated. HIV treatment is dependent on stage and resistance patterns, so an average is not really reflective of the true financial burden. Nevertheless, the MEDFASH HIV Standards of Care helpfully costed the average lifetime cost of treatment to be between £135,000 and £181,000, with an average cost of service provision for those on HAART at £15,000. The overall cost of HIV treatment is rising, due to the longer survival times, but the provision of antiretroviral treatment has been shown to be cost effective. Between £4,000 to £13,000 can be saved in indirect costs when HIV progression is halted.

With regard to the HIV diagnoses in the UK, the Department of Health statistics show that in 2013 (which is the latest year data is available) 2292 new diagnoses were British (ie born in the UK) and 2698 new diagnoses were in people born elsewhere, so for once, he’s not wrong by a margin of around 400 people.

Subsequently, a YouGov poll of 1900 people suggested that around half agreed with Farage’s suggestion that immigrants should not have access to treatment on the NHS until they have spent 5 years in the country, and a similar number seemed to express agreement with his views on HIV treatment on the NHS, albeit with a very leading set of questions. The fact that the US has double the prevalence of HIV with a privatised healthcare system; however, would suggest that this is perhaps not the greatest public health plan. There are still a quarter of HIV infected people in the UK unaware of their diagnosis, potentially spreading the virus to others without realising. If this is the situation with free testing and treatment, one wonders what effect of marginalising and stigmatising the diagnosis as a burden on the NHS will have.

Sue Capstick – Queens Nurse.

26 Mar, 15 | by shellraine, e-Media Editor

One of the first sexual health nurses in the country to be given the prestigious title of Queen’s Nurse (QN) by community nursing charity The Queen’s Nursing Institute (QNI) hails from Lancaster.

Sue C

As reported in the Lancaster Guardian, Sue Capstick is service manager for Lancashire Care NHS Foundation Trust’s Contraception and Sexual Health (CaSH) Service. Sue said:

“It was an honour to find out I had been awarded the title of a Queen’s Nurse. “The CaSH service is committed to providing excellent care to the people in Lancashire.“The team work together to continually develop new and innovative ways to ensure people receive the highest quality of care. I am proud to be part of such a dedicated and compassionate team and look forward to continuing to improve the sexual health for people in the future.”

A Queen’s Nurse is someone who is committed to high standards of practice and patient-centred care and Sue’s career demonstrates her dedication to the field of sexual health nursing.

She began her nursing career in 1980 and has worked as a sexual health nurse for over 30 years. In that time she has worked in Africa developing sexual health and HIV programmes as well as being a member of a sexual health nursing advisory panel at the Department of Health, developing the competencies required to work in this specialty.

For the past few years Sue has been leading a piece of work in Blackburn which is focused on providing information to women about the various contraception methods available to make informed choices and as a result avoid unwanted pregnancies. The title is not an award for past service, but indicates a commitment to high standards of patient care, learning and leadership.

Nurses who hold the title benefit from developmental workshops, bursaries, networking opportunities, and a shared professional identity.

Sue is the third member of staff at the Trust to be awarded the title . A ceremony will be held later this year in London for the Queen’s Nurses to be presented with their awards.

Many, many congratulations for a well-deserved award.

I’m Positive: The Game

12 Jan, 15 | by shaworth

I’m Positive: The Game is a text-based adventure game that won the CDC sponsored US Games for Health jam in 2014. Developed by a team of four, with a further medical advisor team, you play as Tim, a young man who receives a life-changing phone call from his ex-girlfriend informing him of her newly diagnosed HIV positive status. The game is available for Windows, Mac OS and Linus. Mobile versions for Android and iPhone are due later in the year. It cannot be played online at present and must be downloaded.

The game aims to mimic the real-life dilemmas and choices faced by Americans who find themselves facing the possibility of an HIV positive diagnosis: can they afford to get tested? What if they do not have insurance? It also allows the opportunity to discuss the misconceptions about HIV address concerns about treatment.

The game’s outcome depends on the choices you make during the game: you can be obnoxious to the ex-girlfriend, and choose to ignore her advice to get tested, which results in you eventually collapsing, contracting pneumonia and dying a year later, or get a test which results in you being given the HIV positive diagnosis. It transpires during the clinic appointment and subsequent interactions with your family that today is your birthday and you have the choice of telling your family during the celebrations about your HIV diagnosis, or not.

Whilst the dialogue of the game can be somewhat awkward, particularly in the clinical part of the game, where it doesn’t reflect how most of us would structure a consultation where we break bad news, and crams a lot of information into a very short consultation, the interactions you have with your ex-girlfriend and family feel similar to that which could happen in reality. This likely reflects the games primary aim as a health education tool, rather than a form of artistic expression, which is unfortunate, as it’s not making full use of the medium.

In style, the game reflects early DOS games, likely playing to the nostalgia of the thirty-something generation, but whether this resonates with younger users remains to be seen as the CDC are not evaluating the success of the game until later this year. It’s possible that those not viewing the game with the tint of nostalgia will find the high contrast, occasionally lurid backgrounds and jarringly cheery electronic background music off-putting, which would be unfortunate. It’s possible to produce low-resolution graphic games which manage to express the artistic and educational aspects of the game successfully, such as Unmanned, a game produced to show the dehumanising monotony of drone warfare, without needing to co-opt retro clichés.

Ultimately, the game is an interesting way of communicating the emotional challenges faced by a positive diagnosis, and explores some of the difficult decisions which need to be made as a result. Whether it proves to be of value will ultimately depend on user feedback, but whilst this may not be perfect, it’s certainly opening up a new angle in health education.

HIV and Sex Work: The Lancet Series

28 Jul, 14 | by shaworth

This week saw the publication of the new Lancet series, an ongoing series of analyses of research in HIV with a focus on identifying those at risk and collating the data on prevention strategies. Previous parts of the series have looked at men who have sex with men (2012), and general prevention strategies (2008); however the latest part of the series is a detailed look at the burden of HIV prevention in sex workers.

The series is a detailed look at the studies detailing the HIV burden in sex workers who are female, male and transgender, and as such, gives a fairly broad look at the subject area. It identifies the barriers that are faced in attempts to reduce HIV incidence in this population, and it’s clear from the review that decriminalisation of sex work in order to reduce human rights violations and protect sex workers is a key part of the HIV prevention strategy. For many years, sex workers have been marginalised in attempts to prevent HIV, but it is obvious from the high disease burden in this group that sex workers need to be brought into the centre of HIV prevention strategies.

A particularly interesting part of the report concerning female sex workers comes from a representative of the Dutch police force, who discusses the change in legislation that has decriminalised sex work for those adults who are working voluntarily in this sector, allowing the police to focus their efforts on investigating human rights violations against sex workers and children who are working illegally. The fact that they are still unable to effectively target sex workers who are working illegally in the country remains a point of concern, but it’s hard to doubt that the decriminalisation does allow them to focus their efforts to protect those who chose to be employed in this way.

What’s also fascinating about the series is the study of male sex workers, and the findings that not all of these men identify as gay, potentially undermining public health strategies targeting this group that effectively make this assumption. The understanding of the driving factors behind the choice of these men who have become sex workers is paramount at identifying successful HIV prevention strategies. There’s also a short appendix of local terminology for male sex workers, which may be useful for those looking to work in sexual health abroad.

The inclusion of transgender individuals in the study makes for harrowing reading. Transwomen (the study does not include transmen) have a disproprotionate risk of HIV infection, 13.5 times the risk for natal women. The lack of research in this area, along with a lack of research into effective strategies to prevent HIV in this population undermines our efforts in this area, which is obviously not an acceptable situation to continue.


ESC – 13thCongress and call for applications for project funding

16 Sep, 13 | by shellraine, e-Media Editor

Mark your calendar:

28 till 31 May 2014
Lisbon, Portugal

First announcement

Check out the first announcement including:

  • programme overview: 8 workshops, 21 congress sessions, 2 debates…
  • abstract submission instructions (deadline 1 December 2013)
  • registration form

Register now

Please find here an overview of the registration fees.
You can now register through the online registration form

General information / Programme overviewCall for abstracts (deadline = 1st December 2013)/ Registration

ESC newsletter

Call for project or course applications

The ESC provides funding to support a project within Europe

The available budget for applications received between 1 August and 31 December 2013 is 30,000 euro. Applications should meet the following minimal conditions:

  • The applicant must be a paid-up ESC member
  • The grant may be used to support an individual, group, institute or organisation with a project related to the aims of the ESC.
  • Examples of projects include: research, audit, review, needs assessment

Deadline for the application period:  31 December 2013

Application Form



July Journal published as Impact Factor soars to 2.1!

20 Jun, 13 | by shellraine, e-Media Editor

The July edition of the Journal is now available online and includes:

Venous thromboembolism and COCs: an ongoing saga

This ongoing controversy recently resulted in the decision of the French authorities to withdraw the combined oral contraceptive (COC) containing ethinylestradiol (EE) and cyproterone acetate (i.e. Diane 35®) from the market. This consensus statement from 26 international experts in contraception concludes that “Both epidemiological data and clinical trials must be taken into account when best practice is defined. Regulatory restrictions of previously registered methods should only be made after careful assessment of all the available evidence”. See page 156

Serum CA125 for ovarian cancer screening

This timely commentary raises questions about the widespread use of screening women with non-specific symptoms by measuring serum CA125 levels, following the publication of the NICE guideline on ovarian cancer in 2012. The authors acknowledge that there are barriers that prevent women with symptoms associated with ovarian cancer from presenting to their general practitioner. However, the authors also point out that this will lead to increased use of CA125 in general practice and raise concerns about how women with raised CA125 in the absence of evidence of any disease should be managed. See page 160

Ovarian cancer symptom awareness and help-seeking behaviour

Ovarian cancer symptom awareness is low in the UK, and varies widely between symptoms. In this study, Low et al. identify variables that may be implicated in a longer time to help-seeking for possible ovarian cancer symptoms, and highlights the need for more in-depth research into the factors related to time to help-seeking in real-world situations. See page 163

Fertility preservation decisions faced by women with breast cancer

This article presents a contemporary summary of fertility preservation techniques available to women of reproductive age with breast cancer. It offers unique insights into the difficult treatment decisions coupled with the difficult fertility preservation treatment decisions that these women face. The article highlights a number of themes that influence the decision-making process for these women. Egg and embryo banking appear to be the fertility preservation treatment of choice. Finally, this work may assist health care commissioners when deciding funding priorities within a health economy such as the NHS in the UK. See page 172

Correlates of unprotected sex in drug-injecting women

This study demonstrates that despite the high risk for HIV acquisition or transmission and unintended pregnancy, condom use among women who inject illicit drugs or who have sexual partners who inject drugs in St Petersburg in Russia is low. Programmes to investigate and improve contraceptive use, including condoms, among this vulnerable group of women are needed and might benefit from addressing alcohol misuse. See page 179

Contraception in a university environment

This is a very simple real-life observational study of a cohort of young, nulliparous women in a university-based general practice choosing and continuing with long-acting reversible contraceptive methods (LARCs) as their first line method of contraception. This article urges the health professional reader to consider offering this ‘fit and forget’ method of contraceptive to our younger population as a matter of routine. See page 186

Impact of UKMEC on CHC prescribing

Briggs et al. have assessed the effect of the UKMEC on prescribing of combined hormonal contraceptives (CHCs). Sadly, although there has been a small decrease in the proportion of higher-risk women being prescribed CHCs, their results suggest that in 2010 7.3% of CHC users had UKMEC Category 3 or 4 risk factors, particularly BMI ≥35 kg/m2. The authors point out that it is likely many of these women were being placed at an unnecessarily high risk of cardiovascular events, given the availability of lower-risk alternatives. See page 190

Financial cost to patients of a suspected ectopic pregnancy

In this article, Unger and colleagues in Edinburgh report on their assessment of an area of patient experience that is not often considered when assessing medical interventions. The financial impact on patients’ lives of the need to seek medical attention can be considerable and may become more significant as economic hardship increases. This article describes a well-conducted questionnaire study on the costs that patients themselves incurred in attending their general practitioners and a hospital clinic with a suspected ectopic pregnancy. The authors argue that such costs need to be factored into decisions regarding the cost-effectiveness of medical procedures. See page 197

Emergency contraception algorithm based on risk assessment

Introduction of a standardised protocol for the provision of emergency contraception (EC) has significantly increased the proportion of women offered an intrauterine device (IUD) as postcoital contraception, particularly in women at high risk of conception. Introduction of ulipristal acetate as an alternative method of EC has resulted in a reduction in the uptake of the emergency IUD. McKay and Gilbert state that this is cause for concern, and further investigation into the reasons behind this decrease in IUD uptake is needed. See page 201

No need for water torture

Cameron and colleagues set out to answer a simple question, namely does a full bladder assist insertion of intrauterine contraception? In the world of assisted conception a full bladder had been shown to aid intrauterine catheter insertion for embryo transfer, but could this knowledge be transferred usefully to the world of contraception? This simple question was answered in a simple and elegant way with a properly constructed and conducted randomised trial, which showed that we needn’t ask our clients requesting IUD/IUS insertion to arrive bursting – a fact for which both they and clinic staff will be duly grateful. See page 207

New monophasic natural estradiol COC

Lee Shulman reviews a new monophasic natural estradiol COC, Zoely®. This COC benefits from the progestogen nomegestrol acetate (NOMAC), which appears to result in good cycle control, with a 24/4 regimen. Since it is monophasic, it also has potential for extended cycle use. The great hope is that natural estradiol COCs will have a lower risk of venous thromboembolism (VTE) than EE-containing pills, but it should be stressed that there is currently no actual evidence for this. Studies are ongoing, but at present these COCs should be treated just like any other from the point of view of VTE. See page 211

Brook/FPA UK Sexual Health Awards 2013

The Journal’s Consumer Correspondent writes about the recently awarded Brook/FPA UK Sexual Health Awards, and opines that awards of this type are a good thing for the SRH profession generally and so rightly should be regarded as a highlight of the sexual health year. See page 219


An obituary for Dr Alison Bigrigg by Dr Audrey Brown; an organisational factfile on Tommys; a conference report from the FSRH Annual Scientific Meeting at University of Warwick;

And last, but by no means least, the Journal Impact Factor has risen, once again, to 2.1. Many congratulations to Anne Szarewski and her team.


GUNA Summer Meeting

17 Jun, 13 | by shellraine, e-Media Editor



GUNA Summer Clinical Meeting – Shaping Best Practice


GUNA is holding its summer meeting on 28th June at Jury’s Inn Hotel, Islington.

The GUNA summer clinical meeting for 2013 is being held on Friday 28th June and focuses on ‘Shaping Best Practice.’ Bringing together some of the UK’s most renowned sexual health practitioners, policy makers and service providers, the meeting will explore the latest themes and current topics, providing a clinical update and new perspective for delegates working in the area of sexual health, HIV and contraception. The programme includes:

‘New’ NHS in England – overview of the landscape’ – Leela Barham, Policy Advisor, RCN

Antibiotic resistance in Neiseeria gonorrhoea – Michelle Cole, Healthcare Scientist, Health Protection Agency

Men might be from mars … but are they also the elephant in the room: considering outcomes of poor male engagement with sexual health – Dr David Evans, Senior Lecturer Greenwich University

Sexual health improvement framework, comments and other News

22 Mar, 13 | by shellraine, e-Media Editor

A Framework for Sexual Health Improvement in England’ sets out the government’s ambitions for improving sexual health.

Designed to be used by local organisations when they are looking at how best to provide sexual health services in their area. This includes the need for:

  • a fall in the number of unwanted pregnancies
  •  greater efforts to prevent STIs and HIV
  •  an increase in the number of people in high-risk groups being tested for HIV
  • building an honest and open culture where everyone is able to make informed and responsible choices about relationships and sex
  • making sure that all people have rapid and easy access to appropriate sexual health services
  • offering counselling to all women who request an abortion so they can discuss the options and choices available with a trained counsellor

Responses to ‘Framework for Sexual Health Improvement’.

 The Sex Education Forum, based at leading children’s charity The National Children’s Bureau, welcomed the publication of the government’s strategy for improving sexual health and its focus on preventative measures, such as good quality sex and relationships education (SRE). However, more needs to be done to ensure all schools step up to the mark, in providing the information, support and advice that children want and need.

FPA welcomes the Government’s long-overdue publication of its Framework for Sexual Health Improvement in England document, which finally provides guidance to local government to help ensure that the nation’s sexual health improves.

Although we support the Government’s formal endorsement of the need to improve areas of sexual health like sexually transmitted infection (STI) and teenage pregnancy rates, we are acutely aware that there is absolutely no guarantee that local councils will actually act on this guidance.

We know from our Unprotected Nation report, released in January, that if the situation worsens, and local government chooses not to invest in sexual health services, the additional cost to the economy is likely to be over £135 billion over the next few years.


Responding to the publication of A Framework for Sexual Health Improvement in England Simon Blake OBE, Brook’s Chief Executive, said:

“We are pleased that the Framework for Sexual health has been published just in time for the move to local authorities and that there are clear aspirations for the improvement of young people’s sexual health, in particular that all young people have access to confidential services and support.

“We are also pleased to see the ambition that all children and young people should receive good quality Sex and Relationships Education (SRE) at school which we know is vital in preventing abuse and exploitation and promoting positive relationships. However, this ambition will never be realised whilst the Department for Education fails to ensure that every school is required to deliver a comprehensive programme of SRE.

“As we move towards 1st April we look forward to working local authorities to realise these ambitions and improve young people’s lives.”

FAMILY PLANNING 2020 names Director of the global partnership

The Family Planning 2020 (FP2020) Reference Group announced that long time global advocate for family planning and reproductive health Valerie DeFillipo has been named Director of the global partnership. FP2020 builds on the partnerships launched at the London Summit on Family Planning. It will sustain the momentum from London and ensure all partners are working together to achieve and support the goals and commitments announced at the Summit.


World AIDS Day 2012 – News

30 Nov, 12 | by shellraine, e-Media Editor

“Getting to Zero: Zero new HIV infections. Zero deaths from AIDS-related illness. Zero discrimination” is the theme of World AIDS Day 2012 on 1 December. Life-saving antiretrovirals have reduced new HIV infections and deaths. The 2015 target of 15 million HIV-infected people on antiretroviral medicines worldwide looks more achievable now than ever before.


World AIDS Day – BMJ special promotion 

The BMJ Group is putting together a special promotional webpage for World AIDS Day on 1st December that will offer a week’s free access to all relevant content published by our full range of journals. Please click here for access

New resources for young people living with HIV 

To mark World AIDS day on the 1st of December, the Children and Young People HIV Network, based at leading children’s charity the National Children’s Bureau, is sending a message of support to young people with HIV by launching a range of materials to support them in managing life with the condition.

The ‘Your Life’ leaflets and the ‘Studying with HIV’ guidance and LifeLinks resources are all available from

More than Half of those with HIV in the UK are Overweight:  The Surprising Issues Facing Those Living with HIV

The British Dietetic Association (BDA) will once again be supporting World Aids Day on 1st December. Early data from the BDA’s DHIVA specialist group audit suggests that more than half of people living with HIV in the UK are overweight or obese, with only about one-in-nine being underweight.

In fact by far the most common issues facing HIV dietitians in the outpatient clinic these days are dyslipidaemia, hypertension, diabetes and osteoporosis, with over 75% of HIV patients Vitamin D deficient. Dealing with these issues is not as straightforward as it might seem, with HIV-specific barriers to lifestyle change emerging.

Members report common themes from their patients, including a fear that deliberate weight loss might lead to others guessing their HIV status (“why are you getting thin – you don’t have AIDS do you?”), and a feeling that being overweight is safer (“I remember how ill and thin I was before starting ARVs and I don’t want to go back there again”). from Alastair Duncan, Chairman of the BDA’s DHIVA (Dietitians in HIV/Aids) specialist group.


UNITAID welcomed the good news this World AIDS Day that the number of children newly infected with HIV continues to decline but urges the international community to step up efforts for those children already living with the disease. more from the website

    2012 UNAIDS World AIDS Day Report



MedFASH celebrates 25 yrs

15 Nov, 12 | by shellraine, e-Media Editor

The Medical Foundation for HIV and Sexual Health is 25 yrs old (rebranded as MEDFASH). Established in 1987 by the BMA, as an independent foundation, with the aim of improving knowledge and understanding of HIV among health professionals it has grown and spread to encompass all aspects of sexual health.

As part of this celebration the foundation has a new website and has launched its Sexual Health & HIV Policy eBulletin.  MEDFASH Chief Executive, Ruth Lowbury, introduces the eBulletin: it is designed with local sexual health and HIV commissioners and providers in mind. It will give a concise and regular round-up of emerging policy developments, relevant evidence updates and available tools and resources across the field of sexual and reproductive health and HIV. It will also consider the impact the change agenda is having on this area of healthcare through a series of eFeature articles and interviews with those working at both national and local levels. This is particularly useful now at a time when service delivery is changing and many of us will be involved with new (and possibly challenging) ways of working and new communication channels.

Amonst other things the first issue includes: transfer of sexual heath services to local authorities; local transition arrangements; re-tendering of GUM services; Healthwatch England (the new consumer champion for health and care in England); HIV treatment for overseas visitors.

Latest from JFPRHC

Latest from JFPRHC