Public Health Network Cymru - November 2019 English

Welcome

This month’s ebulletin focuses on World AIDS Day. World AIDS Day takes place on 1 December each year. It’s an opportunity for people worldwide to unite in the fight against HIV, to show support for people living with HIV, and to commemorate those who have died from an AIDS-related illness. Founded in 1988, World AIDS Day was the first ever global health day.

Our Homelessness: Reversing the Trauma event took place on 20 November in Cardiff and was extremely successful. Information from the day can be found on the ‘Past Events’ pages of our website.

More events are being planned for 2020 as voted for by our members so keep an eye out for further information.

We are always looking for information and events which we can include in the e-bulletin as well as on the website so please get in touch with us at publichealth.network@wales.nhs.uk

Contact us You can contact Public Health Network Cymru in a variety of ways Email us publichealth.network@wales.nhs.uk Call us 02920 104450 Write to us Public Health Network Cymru, Public Health Wales, Floor 5, Number 2 Capital Quarter, Tyndall Street, Cardiff, CF10 4BZ Social media twitter @PHNetworkCymru facebook Publichealthnetworkcymru

Contents Spotlight on: Worlds Aids Day PHNC: Podcast PHNC: Press Play The Grapevine PHNC: Headlines PHNC: Calendar PHNC: Topics Next Issue

Spotlight on...

World AIDs Day Over 101,600 people are living with HIV in the UK. Globally, there are an estimated 36.7 million people who have the virus. Despite the virus only being identified in 1984, more than 35 million people have died of HIV or AIDS, making it one of the most destructive pandemics in history.

Today, scientific advances have been made in HIV treatment, there are laws to protect people living with HIV and we understand so much more about the condition. Despite this, each year in the UK over 4,300 people are diagnosed with HIV, people do not know the facts about how to protect themselves and others, and stigma and discrimination remain a reality for many people living with the condition.

World AIDS Day is important because it reminds the public and government that HIV has not gone away – there is still a vital need to raise money, increase awareness, fight prejudice and improve education.

World AIDS Day is an opportunity to show solidarity with the millions of people living with HIV worldwide. Most people do this by wearing an HIV awareness red ribbon on the day. You can order a red ribbon through the National Aids Trust online shop, or pick one up in any MAC Cosmetics store, any branch of RBS or NatWest in England and Wales, selected branches of Morrisons, and selected branches of HSBC UK. World AIDS Day 2019

Rock the Ribbon

NAT’s World AIDS Day campaign to end isolation among those living with HIV World AIDS Day is an opportunity to remember those who have died of AIDS-related illness and stand with those living with HIV today. Every 1 December, people across the world attend events, fundraise, and wear red ribbons to mark the day.

This year, NAT (National AIDS Trust) is calling on people to Rock the Ribbon Together, to show their solidarity with those living with HIV. This is vital, as 1 in 5 people living with HIV in the UK have reported feeling isolated and alone as a result of their status. This is partly the result of stigma which still surrounds HIV. Effective treatment means it is now possible to live a long, healthy life with HIV. This means growing older can increase feelings of isolation. Carl, a 63-year old living with HIV, has highlighted the influence this can have on his experience stating, “the only people I discuss this with are the staff at the HIV clinic. As an older patient the sense of isolation is higher.”

In order to end this, comprehensive peer support services must be available for all people living with HIV who want them. This enables people living with HIV to access support from those with whom they have comparable experiences. Funding for HIV support services have been severely cut in re cent years, resulting in three quarters of people who reported feeling lonely while living with HIV stating they haven’t been able to find appropriate help. Proper funding for peer support services would reduce the overall cost on health and social care services while transforming the experience of those living with HIV. To join the campaign to Rock the Ribbon Together, you can order red ribbons from the World AIDS Day website, or find them in branches of MAC Cosmetics, RBS, NatWest, Ulster Bank, Morrisons and HSBC around the UK. https://nationalaidstrust-my.sharepoint.com/:f:/g/personal/katie_clark_nat_org_uk/Epw_twR8OY5HlPSP_ KBQJYABhhbLDpUdrPI6TS5aIhl6Fg?e=CCsa29

Pre-Exposure Prophylaxis (PrEP) use in Wales Zoe Couzens, Principal in Public Health – Public Health Wales World AIDS Day, December 1, is a time for reflection: on what we have achieved with regard to the national and global response to HIV, and what we still must achieve.

World AIDS Day is a day dedicated to commemorate those who have passed on and to raise awareness about AIDS and the global spread of the HIV virus.

The first World AIDS Day was held in 1988 after health ministers from around the world met in London and agreed to such a day as a way of highlighting the enormity of the AIDS pandemic and nations’ responsibility to ensure universal treatment, care and support for people living with HIV and AIDS. UNAIDS has announced that the theme for World AIDS Day 2019 is ‘Communities make the difference’.

Today, scientific advances have been made in HIV treatment and we understand so much more about the condition. HIV testing is essential for expanding treatment and ensuring that all people living with HIV can lead healthy and productive lives. It is also crucial to achieving the UNAIDS 90–90–90 targets and empowering people to make choices about HIV prevention so they can protect themselves and their loved ones.

In the last two years in Wales we have had the additional opportunity to prevent HIV infection by using Pre-Exposure Prophylaxis (PrEP). This is a strategy in which HIV-negative people use HIV antiretrovirals (ARVs), drugs usually used to treat HIV infection, to reduce their risk of becoming infected with HIV. PrEP should not be considered in isolation but be seen as part of a comprehensive package of HIV prevention that includes PrEP along with PEP (Post-Exposure Prophylaxis) and TasP (Treatment as Prevention).

Between 1st July 2017 and 30th June 2019, 1158 people started PrEP in Wales. 653 people were relatively new to the service (not more than 2 months), of which 449 were completely new to the service which means that they had not previously taken the opportunity to be tested for HIV. At least 13 individuals were newly diagnosed with HIV when they were first seen, at the baseline test.

These people are now on treatment so they will maintain their health and be no risk to their future partners.

Those starting on PrEP so far have been aged between 16 and 77 years, with a median age of 32 years. There have been no diagnoses of HIV in people once they have started taking PrEP. For further details please contact Zoe Couzens: zoe.couzens@wales.nhs.uk

Measuring, Understanding, and Optimising HIV pre-exposure prophylaxis (PrEP) in Wales Dr David Gillespie, Deputy Director of Infection, Inflammation and Immunity Trials - Cardiff University Adam Williams, Cardiff University Human immunodeficiency virus (HIV) is a virus that weakens and damages the human immune system, resulting in those infected being unable to fight infections naturally. In Wales, over 100 people are diagnosed every year, with a 10% increase every year. Pre-exposure prophylaxis, or PrEP, is the use of antiretroviral medication in individuals living without HIV but who are considered to be at risk of acquiring it in the future. Clinical trials and other evidence demonstrates that when PrEP is taken as prescribed, it is virtually 100% effective in preventing HIV. Wales has recently introduced PrEP through integrated sexual health clinics, where it is prescribed to those considered to be at increased risk of acquisition. The risk criteria for PrEP largely focusses on individuals who engage in repeated condomless intercourse and/or are known to clinics due to past diagnoses of sexually transmitted infections (STIs).

There are currently two research projects focussing on PrEP being conducted by researchers in Cardiff University.

The first is a Health and Care Research Wales funded Fellowship called the DO-PrEP study led by Dr David Gillespie (https://www.cardiff.ac.uk/people/view/362454-gillespie-david, @DaveGUK87).

Measuring “adherence” to PrEP (i.e. the extent to which the medication is taken as prescribed) is challenging, as it requires an understanding of a person’s day-to-day pill taking as well as their risk exposure to HIV. Both of these things can fluctuate over time, and hence to understand adherence to PrEP, there is a need for a detailed study into both medication use and risk exposure over time.

During the DO-PrEP study (https://www.cardiff.ac.uk/centre-for-trials-research/research/studies-and-trials/ view/do-prep, @prep_do), 60 PrEP users recruited from sexual health clinics across Wales will be studied for up to nine-months. Their PrEP use will be studied by replacing their bottle caps with a smart cap which records the date and time of each dosing event, and their sexual behaviour by completing an online weekly sex quiz (which will document the type of sex they have had the previous week). Coupled with questionnaires regarding health beliefs, information from sexual health clinic notes, and one-to-one interviews with a subset, this research will lead to insights around PrEP use, sexual behaviour, how these evolve over time, and whether changes in patterns are predicted by particular behaviours or events. This work will lead to the development of support tools to help individuals who are taking PrEP. The second project is a KESS2 funded PhD studentship led by Adam Williams (@AdamDaleNewman1).

The key risk criteria for providing PrEP has led to theoretical concerns that the introduction of PrEP could result in an increase in STIs through a reduction in condom use. As STIs are typically treated with antimicrobials, there are concerns that this could contribute to the growing concerns regarding antimicrobial resistance (defined by the WHO as “the ability of a to stop an antimicrobial from working against it.”) AMR is a global public health threat that is estimated to cause 10 million deaths by 2050, and governments worldwide are working to tackle the issue.

There is currently no robust evidence to either refute or support the above claim. While there is some evidence that STIs are increasing amongst high risk populations, this can also be explained by the increased amount of testing that PrEP users undergo while receiving PrEP, this is known as surveillance bias. Selection bias also poses an issue in research as those who are provided PrEP are individuals who admit to infrequent condom use before use. Therefore, their rates of condomless sex and rates of infection may not be increasing as much as staying regular.

The aim of this project will be to understand the relationship between pre-exposure prophylaxis, sexually transmitted infections, and antimicrobial resistance in Wales. Acknowledging the sources of bias within data and attempting to understand the true picture using a mixed methods approach. This project intends to develop knowledge and understanding around the impact of PrEP and enhance its use. Hopefully, awareness around the dangers of antimicrobial resistance will be enhanced and allow for people to engage in safer sexual activity.

Sharing is Caring? Why Patients Disclosing Chronic Conditions Matters Adam Jones, Senior Policy Officer, Public Health Wales When diagnosed, chronic conditions, such as HIV or viral Hepatitis, will require ongoing monitoring and routine treatment. A patient will receive monitoring and treatment for their condition from a specialist. However, it is recognised that these service users are also prone to other general infections and health issues e.g. influenza, pneumonia, cardiovascular disease. Indeed, service users with a chronic condition are more likely to experience other health complications because of their pre-existing chronic condition.

If other clinicians are not aware of the pre-existing condition, there is a risk that that clinician may prescribe medication, which, unbeknown to them, could interact with the medication the patient is taking for their chronic condition. If the clinician knows that the patient also has a chronic condition, they will be able to seek alternative treatment options.

This is not a hypothetical scenario. There have been real-world examples, here in Wales, where a patient has been at risk of unintended harm simply because their pre-existing chronic condition had not been disclosed outside of their specialist care provider. The primary aim in all healthcare interventions is to ‘first, do no harm’ – in order to achieve this we need to change practice regarding sharing health information.

In November 2016, Welsh Government requested Public Health Wales to commence a review of sexual health services in Wales. Amongst the tasks identified in the Sexual Health Review was a need to consider the sharing of patient information in line with the National Health Service (Venereal Diseases) Regulations 1974. The need to undertake this task arose from concerns raised to Welsh Government about the care of service users diagnosed with chronic conditions whereby service providers are uninformed about the service users’ underlying condition(s).

To address this, a Task and Finish Group was established to consider the evidence using specific examples where patient care had been impacted by the lack of information sharing. A final report [in English only] looked at perspectives on balancing confidentiality with patient care, and considered ways forward in a series of three options. This work was presented to Welsh Government in September 2017.

The three options presented to Welsh Government in the report were: 1.

2.

3.

Maintaining status-quo Amending/Repealing existing regulations and replace with new/updated regulations Issuing new guidance to clarify expectations

Of these, all stakeholders agreed that maintaining status quo is not a viable option. Too many service users have had their healthcare impacted by a clinician being uninformed about the service users’ pre-existing chronic conditions.

So, what happens next?

In lieu of possible legislative change in the future, as an interim measure, Public Health Wales and the Welsh Government’s Sexual Health Programme Board will recommend an enhanced discussion between diagnosing clinicians and patients, emphasising the importance of the patient disclosing their condition to other medical professionals, particularly those with prescribing responsibilities. All clinicians should ensure that the patient: • •

Understands the risks of the interactions between the medication that they are receiving for their chronic condition and other medication(s); Understands why sharing details of their condition and treatment with other clinicians matters.

To keep things simple, the main message in all cases should be: ‘Every time someone prescribes medication for you, or if you buy medication over the counter, be sure to let them know about your existing condition.’

Should the Welsh Government Sexual Health Programme Board accept the recommendation, it is anticipated that further information will be circulated to relevant health professionals in due course as a Welsh Health Circular.

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Latest Podcast

Welcome to our new PHNC Podcast Page of the Ebulletin. Here you can listen to the the previously released Podcasts.

The Latest Podcast in the series is on Learning Disabilities.

If you are interested in recording a podcast with us in the future, please contact us via email: publichealth.network@wales.nhs.uk

Click to view the Sound and Vision Pages

Learning Disabilities: Multi-Sport Arts and Health: Roadshow Health Impact Assessment: WHIASU Heart Health: BHF Nutrition: Early Years with Andrea Basu International Health: Migrant Health Community Care: OP who are Neurodiverse Dementia: World Toilet Day Sustainability: Sue Toner and Bronia Bendall Love Activity, Hate Excercise Sexual Health Alcohol: Drinkwise Age Well Sun Safety: Skin Cancer Gambling: The living room

Latest Video

Welcome to Press Play, here you can get the latest PHNC videos from youtube!

Every month we will add new videos as they get uploaded. We have a number of events planned over the next few months so keep your eyes peeled for the latest streams on our twitter feed or come back and visit Press Play after the event!

Our latest video is from our Learning and Development Seminar that was held in carmarthen earlier this year.

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LD Seminar: Simon Rose and Karen Warner LD Seminar: Sam Dredge LD Seminar: Ruth Northway LD Seminar: Karen Everleigh and Hazel Powell Public Health Network Cymru in Numbers Shaping our Future: Cat Tully Shaping our Future: Sophie Howe Shaping our Future: Highlights Early Years Nutrition: Highlights Early Years Nutrition: Andrea Basu Early Years Nutrition: Judith John Old and Alone: Not just an isolated Incident Ageing Well in Wales: Steve Huxton A prescription for Lonliness : David Evans

The Grapevine The Charter for International Health Partnerships in Wales: Recommitment ceremony and Charter Implementation Toolkit Heath organisations across Wales have recommitted to an important charter promoting and strengthening international partnerships.

A recommitment ceremony and celebration of five years of the Charter for International Health Partnerships in Wales was held on 17 October 2019 as part of the Welsh Public Health Conference in Newport, Wales. The International Health Coordination Centre and Public Health Wales were joined by all Health Boards and NHS Trusts, their partner organisations, along with the Minister for Health and Social Services Vaughan Gething AM, the Chief Medical Officer Frank Atherton, and NHS Chief Executive Dr Andrew Goodall.

The event provided an opportunity for NHS organisations to recommit to their pledge to the principles of the Charter and to celebrate all the Charter had achieved. It also provided an opportunity to bring in a number of new signatories from the wider NHS and third sector, along with the launch of a Charter Implementation Toolkit.

Background The Charter for International Health Partnerships in Wales was originally launched on 26 November 2014. It was developed by the International Health Coordination Centre at Public Health Wales, together with the Health Boards and NHS Trusts.

The Charter is a unique whole-of-NHS commitment, aiming to ensure that principles and values of the NHS are reflected in our international health activity, strengthening Wales’ reciprocal work to build evidence-based practice, and developing sustainable partnerships based on equity in the pursuit of mutual, tangible benefits and healthy prosperous lives for all, within and beyond Welsh borders.

All Health Boards and NHS Trusts in Wales signed the Charter in 2014, pledging to follow good practice, ensure sound governance and organisational responsibility, and develop reciprocal international partnerships. Since then many varied and fruitful links have been established between NHS Wales’ organisations and their partners worldwide.

These collaborations have ultimately led to greater cultural awareness, solidarity and diversity, increased leadership and health skills, promoted learning, networking and innovation, and have enhanced Wales’ international and global health role and impact.

Charter Implementation Toolkit The Charter Implementation Toolkit has been developed from lessons learned along the way, compiling examples of best practice and providing a robust governance framework to support international health activity. Designed as a ‘living document,’ the Toolkit will be continually updated to assist signatories in implementing charter principles.

Gill Richardson, Assistant Director of Policy and International Health, Public Health Wales, said: “Health professionals in Wales have been successfully working with overseas partners for many years now.

The Charter has been enormously successful in strengthening international health partnerships and promoting Wales’ profile on the world stage.

“Recommitting to the Charter and the creation of the Charter Implementation Toolkit are important steps in ensuring that good work continues.”

The Charter for International Health Partnerships in Wales can be viewed here https://ihcc.publichealthnetwork. cymru/files/5914/8467/3051/IHCC_Charter_for_IHP_Interactive_E.pdf, while the Charter Implementation Toolkit can be accessed via the following link https://ihcc.publichealthnetwork.cymru/files/1015/7122/9482/ Charter_for_Int_Health_Toolkit_English_.pdf.

Latest News £4m funding boost for Wales’ National Parks and Areas of Outstanding Natural Beauty Wales’ national parks and other cherished landscapes are to receive a £4m funding boost from the Welsh Government.

This additional investment for 2019/20, which is on top of the more than £3m of Welsh Government funding that was also provided to our National Parks and AONBs in March 2019, will enable key improvements – with many of the proposals supporting Welsh Government priorities, including decarbonisation and greening measures, improved tourism infrastructure, enhanced biodiversity and further support for access and recreation.

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Cardiff is First Major Urban Area in Uk to Become a ‘Living Wage City’ New guidance will challenge bullying in Welsh schools Children become less active each year of primary school 66 active travel projects to benefit from £14.5 million of funding Can you dance your way to better health and well-being?

Introduction of 50p minimum unit price for alcohol approved in Assembly vote

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