Sorry not to respond earlier, I thought this thread was dead in the water!
- What do you think the future is going to be for GUM clinics?
I think more and more asymptomatic and non-complex patients will do testing and treatment online, freeing up GUM for more complex cases, which should save money and provide a quicker service. However opportunities for health promotion and education may be lost.
- Are you getting increasing numbers of over 50s being diagnosed? And are there more long term infected, or more recently infected in this age group?
Yes, definitely. I am not sure I understand your question. I think you are asking whether they are new infections, or just newly diagnosed but longer term infections that are only showing up now due to increased testing. If so, it's a combination of both, but more the former due to divorce rates and subsequent new partners, and this age group didn't have good Sexual Health education, and often neglect to wear condoms because pregnancy is no longer a concern.
- Do you think STI testing should be offered in GP settings everywhere? (considering a lot of people have never been to a clinic and would find it weird to do so). I realize latest guidelines suggest GPs offer this to new patients in high risk areas etc so this is a start.
Yes, but only if all GPs had appropriate training, not only on testing and diagnoses but also on providing non judgemental advice and information, especially to young people. The reality is that some GPs would be amazing- and these ones usually have special contracts to provide SH services- and others would be rubbish and could do more harm than good. A better solution is centralised hubs and well distributed spokes combined with online and community services.
- How many simply disappear on hearing their diagnosis?
Depends on what for. Chlamydia- a fair percentage, though they may just present elsewhere and not tell us. HIV- not so much, they usually keep in touch. We are actually researching this very thing at the moment so I will come back to you!
- Have you had those who commit suicide on hearing their diagnosis?
Never.
- Do you find it frustrating when through partner notification you are given the same name over and over be people recently infected, and yet are powerless to do anything other than request he/she come in to be tested?
I have never had this happen, but in theory, I would.
- Do you find GPs could have more knowledge in HIV and do you find they can be reticent in prescribing meds for other conditions?
Yes some are good and some are not. HIV treatment is currently usually managed by consultants.
Do you think there should be more joined up care between consultants & GPs?.
Yes- this is starting but there is a long way to go. The trick is ensuring consistent quality of care which is more difficult with GPs than with specialist consultants.
Are they generally aware of HIV med interactions and know where to look? How could this be improved?
Sometimes yes and sometimes no. More training is needed.
- Do you and your clinic endorse U=U to all your patients?
Absolutely, we are huge advocates. We don't just run clinics; part of our services include advocacy and prevention and education and this is a huge part of that.
- Do you offer a Peer Mentor service at your clinic? If not, why not? If so, do you and your patients find it useful?
For our HIV positive clients we do. It can be great!
- What do think of dual therapy, and it being prescribed off license? (I realize Juluca –DTG/RPV was recently approved in the States, and DTG/3TC is another looking good) and do you get many who have problems with NRTIs? I know some clinics are reticent in prescribing something not officially approved, others are more open to it.
I don't know enough about this to comment as our clients clinically become part of the HIV specialist team and we only see them for advice, advocacy, support, community, mental health, etc.
- Do you find that the vast majority still do not disclose to anyone except perhaps a partner/closest friend?
Depends on the community. MSM tend to be more open, black African communities tend to be more closed, others fall somewhere in the spectrum. This is anecdotal. Also it depends on which illness you mean, people are a lot more likely to say "I had Chlamydia" than "I am HIV positive" regardless of the demographic.
- Lastly (and this one is for me personally) Do you think it a good idea for HIV+ women in (peri)menopause to take HRT in the "most least invasive" way - ie Mirena coil coupled with 50mg Estradiol patch, even if there are no particular meno symptoms? I know Sofia Forums have been studying meno & HIV in general, but I can't find any other useful data on this. Btw I'm late 50s!
I wish I could give you advice but unfortunately I am not an expert in HIV treatment- I am not a doctor! So sorry- I can't even think of where to direct you!