Sexual health in lockdown: experiences from 56 Dean Street

Guest blog by Dr Diarmuid Nugent, Consultant Physician, 56 Dean Street

It has been over six weeks since the UK went into lockdown to tackle the COVID-19 pandemic and the fabric of our everyday life changed beyond recognition almost overnight.

Like many other sectors, we in sexual health have had to adapt rapidly to the ‘new normal’. From the outset of the pandemic there has been no question that provision of sexual health and HIV services is vital and must continue, both for the health and well-being of those who need them, and to avoid undue pressure on other medical services like A&E and GP surgeries. Our challenge at 56 Dean Street has been to do all we can to maintain the excellent standards in the care that we provide while keeping our patients safe and, where possible, at home.

A new way of working

For our sexual health services, we asked our patients to phone ahead first before attending in person. We find that a remote consultation with an experienced sexual health clinician means that many concerns can be managed with advice, support, sending out medication or prescriptions by post where needed and referring for self-testing for STIs.

We’re lucky in that there is already established service for home STI testing in London, managed by Sexual Health London (SHL). Typically this has been for people with no symptoms, but with the right support some individuals with low-risk symptoms can be directed to home testing alongside the expert advice and treatment they receive from us.

Those with urgent symptoms who need to be assessed or to receive treatment in person still come in but with fewer patients needing to attend, we have the space to maintain effective social distancing measures.

Patients living with HIV

For our patients living with HIV, many have understandably been really anxious about what the COVID pandemic means for them. The advice from the British HIV Association (BHIVA) has been very clear and reassuring that there is no evidence that those living with well controlled HIV are at any greater risk of either getting COVID-19 or becoming unwell if they do become infected.

That said, those with a low CD4 count, who are not on treatment or have recently had an infection associated with HIV will be at greater risk of infections in general and so may be at increased risk. We’re providing extra support to these people; however this is a small proportion of our patients and a minority of people living with HIV in the UK.

For the majority, the priority has been to maintain an uninterrupted supply of antiretroviral medication. To do that we reached out to all our patients who were due to come in, and then set up a telephone service where patients can contact us when approaching their last month of medication. If the most recent blood tests were stable and there are no urgent health concerns we prescribe and supply six months of antiretroviral medication without the need for additional blood tests or a face-to-face review. But for the few that do need to see us, the fact that most patients have been reviewed virtually means we have the capacity to see those who do need to come in quickly and safely.

PrEP and lockdown

At Dean Street we estimate that we support over 10,000 PrEP users either through the IMPACT study, purchased directly through our PrEPshop and self-sourced on-line. For many people on PrEP, lockdown means they are not sexually active and therefore not at risk of HIV.

Through our social media channels we promoted video advice about how PrEP can be started and stopped safely but we have continued to provide PrEP to those who remain at risk with telephone support, home HIV testing and posting out medication when it’s still needed.

Trends in STI transmission and behaviour

As a busy clinical service we tend to see trends in STI transmission and behavior quite quickly here at Dean Street. What was clear in the first week or two of lockdown was that our rates of STI diagnoses had dropped dramatically – we went from 350 cases of gonorrhoea each week to around 50.

When it’s in the penis, gonorrhoea has a short time lag before symptoms show so most cases urethral gonorrhoea will have been picked up quite recently. So when gonorrhoea cases fall, that may indicate that people have been having less sex recently. Of course, it may also be that people are testing less during lockdown, in particular as gonorrhoea in the throat and rectum often shows no symptoms, so it might be that it’s there but we are just not finding it.

However our presentations for PEP, emergency medication after a potential exposure to HIV after condomless sex, have also dropped dramatically, from around 50 cases per week to less than 10. We think PEP is a clear indicator of sexual behavior, and as most of our PEP and gonorrhoea presentations are in gay and bi men, we think this means that gay and bi men are having much less sex during lockdown.

It might seem like a simple observation, but we felt it presented us with a fantastic opportunity. When people have acquired HIV very recently, within the last four weeks, it may be too early to show up on even the best tests and so if someone with recent HIV tests negative they can continue to pass on the infection unknowingly. Also, those who have acquired HIV recently will often be highly infectious to their sexual partners, again without realising.

Under normal circumstances, this kind of HIV transmission is very difficult to eliminate. But our lockdown data suggests that the number of people with recent HIV is greatly reduced at the moment, so there’s much less chance of missing an infection on the tests and fewer people who are highly infectious.

Time to Test

We created our #TimeToTest campaign based on the above trends. If as many gay and bi men can test as possible now, before the end of lockdown, we have a real chance to break the chain of new HIV infections that result from undiagnosed or recent infections. We could also make a similar impact on other STIs like gonorrhoea and syphilis.

Our Test Now Stop HIV site aims to encourage people to take a test and to access home testing kits. As local authorities across the UK differ in how they offer HIV and STI testing for their residents, we have also tried to bring this information into one place to make it easier for people to find out how they can access HIV testing not matter where they live.

While the COVID-19 pandemic has been devastating for so many, we feel that a drop in new HIV infections could be one unexpected silver lining on a very dark cloud. We may not get a similar opportunity again which is why we’re encouraging everyone to take a test.

Using online video conferencing platforms safely and securely

As we navigate new ways to deliver care and support through online services, it’s important to ensure the safety and security of people accessing these services, especially where their personal information is concerned.

The following information provides some guidance for people working in HIV and sexual health organisations who are currently delivering services through popular webinar, virtual meeting and video conferencing platforms.

Platforms and applications

Zoom has become the video conferencing platform of choice for most organisations and the majority of information herein will refer to this application. However, there are alternatives available:

Suitable for work with service users

  • Google Duo provides video conferencing for up to 12 people and is available via web and mobile devices. Video and audio calls are end-to-end encrypted.
  • Webex is a popular video conferencing and webinar platform already used by many businesses. Video calling supports end-to-end encryption.
  • GoToMeeting provides a similar service and includes end-to-end encryption as standard. There are no free plans.

Suitable for work with teams and colleagues

  • Microsoft Teams is a ‘full-package’ collaborating tool which is one of the most comprehensive options available; with good security features and streamlined synchronisation with other Microsoft Office applications. However, it can be complicated and clunky compared to Zoom, which is simple and straightforward to use, or other options.
  • Skype, Slack (paid plan only) and Facebook Messenger provide means to communicate by video but without full end-to-end encryption.

Using Zoom safely and securely

There has been noticeable media attention relating to ‘zoombombs’ in which uninvited trolls enter meetings and disrupt them by talking over meeting hosts or sharing undesirable content via video or screen share options.

There are some simple steps to avoid this practice:

  • Do not share Zoom meeting numbers publically, send the joining information in private emails to registered attendees.
  • Create a new meeting ID for each event or meeting rather than using your own personal meeting ID.
  • Create a password for your meeting, and never share this publicly.
  • Enable a waiting room (see advanced options), this will allow you to block anyone from joining who you were not expecting.
  • As a meeting host you can decide whether you want to give all meeting attendees the option of sharing their screens.
  • Once all of your attendees have arrived you can lock meetings to prevent anyone else from joining.

Recording meetings

Hosts can record audio and video from meetings and capture the chat function via meeting reports, including private 1-2-1 conversations between attendees.

  • Hosts should advise people in advance if they intend to record and share webinars and other educational meetings.
  • Avoid discussing confidential matters with other attendees if you do not want the information shared with the meeting organiser.

Zoom provides a comprehensive guide to security of their platform including information on:

  • Protecting your meetings
  • Protecting your data
  • Protecting your privacy

If you are concerned about the security and privacy in relation to providing services where personal information may be shared (for example online counselling), read more about Zoom’s security features and specific information regarding encryption for meetings.

Coronavirus (COVID-19) guidelines and resources for HIV and sexual health sector

Coronavirus (COVID-19) has created the biggest public health challenge in living memory. As the NHS continues to respond to the pandemic, the HIV and sexual health sector has adapted quickly to continue to support the populations it serves.

Our health systems and services delivered by the Voluntary, Community and Social Enterprise (VCSE) sector are finding new ways to deliver care and support by telephone, online and via their communication channels.

The following information provides sector guidelines for people working in HIV and sexual health, including resources for communities in response to the challenges coronavirus have presented.

Guidelines for health and sector professionals

British HIV Association (BHIVA)

British Association for Sexual Health and HIV (BASHH)

Faculty of Sexual and Reproductive Healthcare (FRSH)

FRSH, BASHH and BHIVA

The Association of Directors of Public Health (ADPH)

Community resources and information

Terrence Higgins Trust

NAT (National AIDS Trust)

NAM

i-base

Joint Council for the Welfare of Immigrants (JCWI), Migrants Organise, and Medact

Correlation Network, Europe

International

World Health Organisation (WHO)

UNAIDS

As new information arises we will update accordingly.

Manchester launches new HIV campaign

HIV: Let's sort this together.

The PaSH Partnership (BHA for Equality, George House Trust, and LGBT Foundation) have launched a new campaign which aims to end new cases of HIV in Greater Manchester.

Launched at the HIV Commission Hearing Session on 13 February 2020, the HIV: Let’s sort this together campaign is part of the first phase towards Greater Manchester’s ambition of ending all new cases of HIV within a generation by reducing transmissions, late HIV diagnoses, and eventually new diagnoses of HIV. This is an important part of the Greater Manchester Population Health Plan for residents to have the best start in life, and to live and age well.

The campaign

The campaign motivates residents of Greater Manchester to take charge of their sexual health and plan a safer, more enjoyable sex life in a number of ways:

  • TEST: Encourage residents to test regularly for HIV by providing information on how and where to test.
  • MANAGE: Advise those who test positive for HIV how to manage their HIV treatment and receive the support they need to reach undetectable and, therefore, untransmittable viral levels (U=U).
  • PREVENT: Inform and encourage methods such as PEP, PrEP, and condoms and lube.

The campaign is promoted via:

  • social media and digital advertising
  • radio and out-of-home advertising
  • the Sort HIV website
  • merchandise for community events
  • PR

Get involved

Community leaders, faith leaders, GPs, sexual health clinics and other stakeholders are invited to take part by:

  • Using promotional materials such as print-ready posters and flyers, waiting room screens and digital assets, including email footers, website banners and desktop wallpaper – access via Dropbox.
  • Sharing the campaign on your social media channels and through internal communications.
  • Telling service users and community members about SortHIV.org.uk, where they can access information about HIV and prevention as well as links to order home testing kits.
  • Using the hashtag #SortHIV to talk about the campaign on social media.

HPE Conference 2020

HPE organises a conference to bring together professionals working in HIV prevention and sexual health in England, as well as other key figures and influencers in the field of HIV. The 2020 conference took place on Tuesday 18 February in central London.

Download the programme [PDF]

Coming soon: conference presentations

Morning conference sessions

Opening plenary

  • Welcome: Adam Winter, Public Health England.
  • Keynote Speech: Bruce Richman, Prevention Access Campaign.
  • The HIV Commission: Dame Inga Beale, HIV Commission.
  • Progress towards getting to zero transmissions, zero deaths and zero stigma due to HIV in the UK: Dr Valerie Delpech, Public Health England.
  • Chair: Ian Green, Terrence Higgins Trust.

HIV testing: Breaking barriers, driving access

  • Changing trends of HIV risks among MSM in London: Dee Wang, Spectra and The GMI partnership
  • Reducing barriers to HIV self-testing among black Africans: George Halfin, Terrence Higgins Trust
  • Incentivised HIV testing at food banks: Anne Glew, The Brunswick Centre
  • A reflection of seven years of HIV testing during National HIV Testing Week in Croydon: Denise Dixon (On behalf of Fred Semugera) Croydon Council

Afternoon conference sessions

Ensuring PrEP access and uptake in key populations

  • Attitudes and factors determining PrEP uptake in London: Dee Wang, Spectra and The GMI partnership
    MobPresh: women, PrEP and sexual health: Amelia Thorp, Yorkshire MESMAC
  • Are MSM using PrEP safely? Results from an online questionnaire: Greg Owen, I Want PrEP Now
  • PrEP and Prejudice: PrEP initiative for BA communities: Juddy Otti, Africa Advocacy Foundation
  • Reflections from a woman PrEP user: Haru Majengwa

STIs and sexual health: what’s working to reach highly affected groups

  • STI diagnoses among asymptomatic MSM in community testing services: Alissa Ferry, Positive East and the GMI partnership
  • Increasing STI e-testing uptake among black queer men: Phil Samba, PrEPster
  • Different community models to reach key populations in the North of England: Wellington Moyo and Pat McCusker, Yorkshire MESMAC
  • Age is no Protection: sexual health promotion in the over 50s: Steve Maddern, Wiltshire Council and Age UK
  • Improving Trans and Non Binary sexual health: third sector partnership with GUM services: Patrick Hands and Dr Madeleine Crow, Yorkshire MESMAC and Leeds Sexual Health

Closing plenary

  • The HIV Prevention Programme 2016-2019: Chamut Kifetew, Terrence Higgins Trust
  • Overview of future HIV technologies: Simon Collins, i-Base
  • No one left behind, panel discussion: Dr Vanessa Apea, Luis Guerra, Ian Howley, Lizzie Jordan, Harvey Kennedy and Michelle Ross