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• the AIDS CONTROL ACT 1987 • • Annlial REPORT for the YEAR • Ending 31 MARCH 1988 • • • • • • • -HE Alos {Controll ACT 1987 ':'HE GREATER GLASCO

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• the AIDS CONTROL ACT 1987 • • Annlial REPORT for the YEAR • Ending 31 MARCH 1988 • • • • • • • -HE Alos {Controll ACT 1987 ':'HE GREATER GLASCO • •• GREATER GLASGOW HEALTH BOARD • • • • • • • THE AIDS CONTROL ACT 1987 • • ANNLiAL REPORT for the YEAR • ending 31 MARCH 1988 • • • • • • • -HE AlOS {CONTROLl ACT 1987 ':'HE GREATER GLASCO.... ' H£ALTH BOARD REPORT • FOR THE YEAR ESDlSG 31 \lARCH 1988 • CONl'ENTS 1. THE PROBLEM AND ITS CAUSE • 2. CURRENT POSITION AND EXPECTED FUTURE TRENDS 3. CO-ORDINATION OF mv AND AIDS RELATED SERVICES PROVIDED BY • GGAS ~. THE INFECTIOUS DISEASES UNIT, RUCHILL HOSPITAL • ". '.! Health Education II -I. J Needle Exchange Cent~ II 4. ~ Counselling Clinic -1.6 Cllnical Ser vices for HIV Positive Patients II 5 . IlEALTH EDUCATION OEPAR'nl £NT ~.3 Informing the Public II S. l Informing and Training Sulff • 6. GENITO-URINARY MEDIClSE 1. THE REGIONAl. !-L-\.DIOPHll.l.\, US1TS II s. SERVICES FOR DRUG \llSUSERS B.2 Addiction Unit, Ruchill Hospital 8.4 Possil Project II 8.6 Souther n Generni D!'\Igs Project B.7 Duke Street Hospital II 9. NURSE TRAIN1:<1G 10. FA.\IILY P\..A..'lSISG SERVICES II 11. OTIiER CLlNICAL SERVICES II I'Z. LABORATORY SERVICES 12.2 Regional Virus Laboratory l'l.4 Virology Laboratory, Glasgo..... Royal Infirmary 12.5 1nstitute of Virology, Western Infirmary II 12,6 Department of PathOlogy, Ruchlll Hospital 12.7 Dopartment or Bacteriology and Immunology. Western Infirmary II .. ll. OTHER STATUTORY AGENCIES Stnl1.hclyde Regional Council 13.1 Social Work Department \3.1 Strathclyde PoUce 13.8 Education 13.9 Personnel Sel'vlces CW!tI?W District Council 13.10 Environmental Health Deportment 13.11 Polley lind Resources SU'o - COllUlUtte(! on Drug ."buse \3.12 HousIng 14. VOLUNTARY AGENCIES 14.1 Scottish AiDS Monitor 14.3 National AIDS Helpline • 14.4 Help for Ol"Ug UIIII'1I • 15. DEVELOPMENTS EXPECTED DURING 1988-89 IS .\ Needle Exchange • 15.2 Clinical Servl~ 15.4 Services for Drug Users • 15.7 Laboratory Fac:illties • 15.10 World AIDS Day 16. THE CHALLE~GES IN THE YEAR ,\HEAD • 16.2 P1"evention • 18.4 Caring Sel"V'ices • • • • • ,- • 1. THE PROBLE!'II AND ITS CAUSE 1.\ The Acquired Immunodeficiency Syndrome ( AIDS) is a condition in • which the immune system is no longer able to protect the human body against certain serious infections and cancers. AIDS is the end result of ["fenlon with the Human ImmunodefiCiency Virus (HIV). • HIV can b(' spr('ad by selnlai intercourse, by inoculation or lrons[usion of infected blood, Or from an infected wOllJ.!ln to hcr child during pregnancy. HIV Infection is appaN:!ntly lifelong and at • present there is no CUI"£!. Until eFfective treatment is developed, probably the majority of people infected with HIV will develop AIDS. At present, about S5\ of people with AIDS die within 'j yesl"S. • 1.2 Until a vaccine Is developed (and the prospects of this are cUl"rently bleak ) the spM!8d of H1V infection can only be prevented if people • avoid behaviour where there is a I"isk of infection. 2. CURRENT POSITION AND EXPECTED FUTURE TRENDS • (A more detailed account can be found in "HIV Infecllon and AIDS: Towal"ds an !nlel""agency Stl"8tegy In Strnthclyde" Chaptel" 3) 2.1 By 30 Mnrch 1988, 22S persons had been found to be mv posluve by • GGHB laborutories. However, a number of these were individuo.ls living in other Heo.lth Boo.rd nreas or who had ~n only lempornl"ily resident In the region. There are at most 180 people known to be • !tlV posItive In the GGHB area, including about 70 drug Injectors, 60 homosexuo.l men, and 16 haemophiliacs, with most of the remainder • having become infected lIS a result of heterosexual intercourse. 2.2 By 30 Mnrch 1988, a total of 21 persons had ~n diagnosed as having AIDS by clinlcal semces in Glasgow. Of these, IS had been diagnosed dUl"ing the previous 12 months. The majority of these • individuals were homosexual men. In most cases, the initial HIV infection appeared \0 have been acquired outwith Scotland, usually in an area where HIV infection is more pMlvalent, such as the United • States. Of the 21 persons with AIDS, 12 WeN! still allve at the end of the reporting period. • 2.3 Because an unknown proportion of people infected "'ith HIV have been identified, the true number of people in the Area who are alN!ady infected "'ith HIV can only be roughly estimated . • 2.4 The overall prevalenct! of my among tested in GGBB laboratories was about 5\ in 1986 and in some areas such as north Glasgow it was higher. It is there • are about 4,800 - 7,200 injectors in Glasgow . Assuming an overall prevalen ce of HIY of 5\, it is thought that there an! about 240 - 360 infect ed injector'S in the city. Probably about half of these are • women , a significant proportion of whom aI'{! reported to support their drug habit by prostitution. TheI'{! is g-rG";ng evidence that many drug injer:tors in the city are now aware that HlV infection can be caught by sharing drug injecting equipment. This is reflected in the • lar gt! number of injectors now purchasing needles and syringes from a small number of chemist shops in the city and the growing number .. attending the nE!@dle exchange cent re at Ruchill {Section 4.3), On the other hand, there is also evidence that many injectors continue to share injecting equipment, thereby placing themselves at risk of • infection. In addltlon, there is the continuing possibility that IllV • positive drug Injectors will Infect their sexual partners or, in the • case of pNlgnant women , their children. 2 .5 The overall prevalence of HIV among homosexual ~ in Glasgow appears to have remained around 4\ for the past two years. Assuming that about 2 ~ 4\ of se=ally active me n are homcsexuaJ, it is estimated that 200 - 400 homosexual men in Strathclyde are already infected with H1V, of whom prooobly at least half live in Glasgow . ""'hilst there is considerable e'v;dence that many gay men in Glasgow have adopted safer sexual practices, a significant proportion of those surveyed in 1987 still practised unprotect ed anal intel"COurse. 2.6 A small number of indlviduals In Glasgow are known to have acquired mv infection following heleI"OSe ;>( ual interwurse with per.;ons from other parts of the world where HIV infection is mo!"e common. Although there is currently no evidence that HIV is spreading Into the general population in the Glasgow area, the potential remains for its spretl.d, In particular by sexual contact between Infect ed drug injectors a nd their regular or casual sexual par tners. 2.7 Because only heat-lrested blood products sre now being given to hucmophiliacs, the number of HIV positive huemophilincs is tlot likely to I";se further. 2.8 Based on the above estimates of the prevalence of HlV infection and the Mites of progression to AIDS that have been observed in other parIS of Ihe world, it Is expected thai the annunl number of new cases of AIDS in Slrathclyde (moIl! of whom can be expected to live in and lor receive treatment in the GGHB area) wi ll rise from 22 in 1988 to 90 in 1990 and 209 Ln \992. The majoMty of these will be homose)(lJt\l men, but from 1990 onwards an increasing proportion will be drug injectors. Only small numbers of cases of AIDS among haemoph.ilincs, heterosexual contacts and ch.ildren are expected . The number of living patients ...."i!h AIDS in the l-egion is expected to rise from 25 by the end of 1988 to 125 in 1992 and the annual number of deaths from AIDS from 17 to 85. The !'eQuirements for hospital beds for all patients with HIV infection Is expected to rise from 12 in 1988 to over 75 in 1992. The situation can be expected \0 continue 10 worsen beyond 1992 if ~rren t and future preventive measures are not effective. 3 . CO-ORDINATION OF HIV AND ..I,IDS REL\TED SERVICES PROVIDED BY GGHB 3. 1 In an attempt to ensure the effective development li nd co~ordi nati on of services re\.B.ting to H!V and AIDS, the Health Boar d established a Fortlm on AIDS in early 1987. The Fortlm is chaired by Dr John ~ta c k.a y, a general practitioner an d Health Board. me mber, and its members include t"'o clinicians . a co=unity medicine specialist, two nurses, the Director of the Health Education • Department, a urnt general manager and the Regional Director of Social Work . It meelS evet")' three months . The FOl"Um has set up fou r sub- committees dealing """ith Prevention. Patient Ca re, Staff • Training, and Epiderruology and Laboratory Services, each of which meets every 1 - 2 mon ths and reports to the Forum. The Forum reports direct ly to the Boarrl's Policy and Planning Committee. • During the reporting period . the Board's AIDS Co-or dinstors have been Dr Alexander Neilson, Co=urnty Medicine Specialist and Dr .. Laurence Gruer, Senior Registrar in Co=urnty Medicine . 3.2. During the I'Cpor ting period. Dr John Mackay and Dr Laurence Gruel' we,.", members of a Joint Strategy Group which CQmprised members of .. the four Health Boords within Stt"athclyde Region and thll Regional .. Social Work Department. This Group prepared II N!port entitled ·' HIV ..• Infection and AiDS Towards an Inter-Agency Strategy in Strathclyde" wruch was issued in 1988 for consideration by the Social Work Deparunent and the four Health Boards. This initiative will lay the foundation for a corporate approach to the problem of HIV and ,>.IDS involving both statutory and voluntary service pr-ovidcrs.
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