On December 1st every year we show our support for World AIDS Day. An opportunity for worldwide unity in the fight against HIV. It allows each of us and our organisations to show support for those living with HIV and commemorate those who have died from an AIDS-related illness. Globally, there are an estimated 36.7 million people who have HIV and more than 35 million people have died of HIV/AIDS, making it one of the most destructive pandemics in history.
Major advances: PEP and PrEP
Today, major advances have been made in HIV treatment along with effective prevention measures beyond simply using condoms. We now have access to both PEP (post exposure prophylaxis) and PrEP (pre-exposure prophylaxis) which prevent the virus taking hold when exposed. As researchers, we understand so much more about the developments in HIV. Yet this has not translated to the public. People do not know the facts about how to protect themselves and others. With stigma and discrimination remaining a reality for many people living with HIV. Each year in Wales over 100 people are diagnosed with HIV, a number far higher than it should be.
Research in Wales
Thanks to the interest of the Centre’s Director, Prof Kerry Hood, we have developed a program of research centred on HIV prevention. In partnership with Public Health Wales, two areas were identified which required researching for Wales. First was the concern around adherence to PrEP, the second was the impact on other sexually transmitted infections if there was a reduction in condom usage.
In relation to adherence, Dr David Gillespie is currently undergoing a research fellowship (funded by Health and Care Research Wales) investigating how individuals accessing PrEP in Wales are using it, how their use corresponds to their sexual behaviour (as this is the primary route of HIV transmission), and whether there are any processes that influence sub-optimal use of PrEP. He recently completed an intensive longitudinal study, using electronic medicine caps to measure PrEP use and weekly electronic surveys to measure sexual behaviour.
Along with a qualitative study where participants were interviewed about their experiences of using PrEP. He hopes to use data from these studies, as well as a comprehensive review of relevant literature around adherence to PrEP and other similar preventative medicines, to develop a prototype intervention to improve how PrEP is used. Throughout his fellowship, Dave works closely with four sexual health clinics in Wales (based in Aneurin Bevan UHB, Cardiff and Vale UHB, Betsi Cadwaladr UHB, and Swansea Bay UHB), a group of mentors with a wide range of expertise, and a stakeholder group comprising experts in PrEP use, PrEP prescribing, sexual health advocacy, and policy.
To address the potential negative behavioural impacts of PrEP, Kerry and Dave developed a PhD studentship (funded by the Knowledge Exchange Skills Scholarship), to which I was the successful applicant. My research aims to understand the relationship between PrEP, sexually transmitted infections and antibiotic resistance in Wales. To explore this relationship I will analyse Public Health Wales’ sexual health and antibiotic resistance data from pre and post PrEP’s introduction to identify any potential changes. Currently I am conducting interviews to explore the knowledge and concerns of gay and bisexual men about PrEP and its relation to sexually transmitted infections and antibiotic resistance.
In response to the Coronavirus pandemic as work was I developed a rapid electronic survey study which examined sexual activity during the UK’s lockdown period. This data provided a snapshot of behaviour during this time which will be used to explain some of the findings from the interviews and analysis fo Public Health Wales data. I intend to triangulate the findings from the quantitative and qualitative work and develop a causal model of the relationship between the variables.
Fast Track Cities
From mine and Dave’s work the Centre’s research on HIV prevention has expanded and we have recently paired with the organisation Fast Track Cities (FTC) alongside Public Health Wales to help them achieve the UNAIDS 90/90/90 targets: 90% of all people living with HIV diagnosed, 90% of all people diagnosed with HIV being on treatment, 90% of all people on treatment having undetectable, untransmissible viral load.
Kerry acts as a stakeholder within the FTC group and works with the team to identify the particular issues and needs faced by Cardiff. Due to the Covid-19 pandemic, it resulted in FTC being unable to perform their community consultation and so an alternative was required. I, Kerry and Dave aided in delivering a project which explored how the public viewed the sexual health services in Cardiff and the Vale. Other projects have also developed including an intercalated project for one of Cardiff’s medical students which will examine HIV related stigma. Molly Timlin will conduct a systematic review of interventions that target HIV self-stigma and from the findings explore how these interventions could be applied in Wales.
From this you can see the Centre for Trials Research has numerous projects currently examining the prevention of HIV. We are working hard to improve knowledge and help bring an end to HIV transmission in Wales. World AIDS Day highlights the importance of our work , and it reminds the public and government that HIV has not gone away – there is still a vital need to raise money, increase awareness and fight prejudice.
– Adam Williams