HIV Prevention and Care in the UK: In Conversation with Professor Rusi Jaspal

According to the World Health Organisation HIV continues to be a major global public health issue, having claimed almost 33 million lives so far. HIV disproportionately impacts segments of the LGBTQ community in particular people from BAME background.

To coincide with the upcoming International World Aids Day on 1st December Laila El-Metoui interviews Professor Rusi Jaspal to examine the HIV prevention and care in the UK. This conversation looks in to the impact of COVID19 in terms of accessing support for people with HIV. It also offers some practical advice for employees support and signposts to organisations in the UK.

Rusi Jaspal is Professor of Psychology at Nottingham Trent University and a Chartered Psychologist and Fellow of the British Psychological Society. His research cuts across the fields of psychology and public health, focussing particularly on social psychological approaches to promoting good psychological and physical health outcomes.

Looking at your recently published book Gay Men: Clinical, Social and Psychological Aspects, can you please tell us how it came about?

I have worked with Dr Jake Bayley who is a Consultant Physician in HIV and Sexual Health at Barts NHS Trust for several years. He and I had often marvelled at the tremendous innovations in HIV science and medicine but we recognised the challenges that lay ahead: low knowledge of HIV in some communities, stigma, inaccurate risk appraisal, poor engagement with healthcare and so on. We realised that HIV medicine and health and psychology had to be bridged in order to optimise HIV prevention and care efforts. If only we could understand the ‘blackbox’ of risk-taking, wouldn’t we be better positioned to prevent HIV? So we decided to write a book together HIV and Gay Men: Clinical, Social and Psychological Aspects in which we do just that – to bridge psychology and medicine. Writing for a broad audience, Jake and I summarise innovations in our respective fields – HIV medicine and HIV psychology – and present a framework for getting us closer to achieving the ambitious but achievable target of having zero HIV transmissions in the UK by 2030.

How would you describe the current HIV prevention and care for LGBT people?

I think that we are doing very well. We now have effective tools for preventing and treating HIV. The standard of HIV care in this country is excellent. For the last 5 years, we’ve seen a dramatic fall in new HIV diagnoses. Yet, some of the recent research I’ve conducted suggests that some gay men and trans women (two groups at disproportionately high risk of poor sexual health) may feel uneasy about engaging with sexual health services due to anticipated stigma and judgement. Some of the gay men I studied felt judged when they disclosed sexual risk behaviours and some of the trans women I interviewed felt that there was an inadequate understanding of their healthcare needs. This suggests that there is scope for more targeted training for healthcare practitioners so that LGBT patients feel that their identities are understood and healthcare needs are being met.

Do you think all groups have equal access or are there any differences for BAME?

A key focus of my work over the last decade has been on BAME people who identify as LGB (note that my work has focused largely on sexual minorities, rather than trans people). Much of this work is reported in my book The Social Psychology of Gay Men. Although we have seen a dramatic fall in new HIV diagnoses over the last 5 years, this is not the case for all ethnic groups. HIV rates among BAME LGB people remain relatively high. This can be attributed in part to ineffective public health and HIV prevention messaging, which hasn’t been targeted to people from these communities. LGB people from BAME communities may experience difficulties in coming out, due to multiple forms of stigma (homophobia from their parents, relatives and friends), racism from the general population, as well as homophobia from the general population. They may cut ties not only with people who can offer support but also with possible informational networks that are so pivotal in the fight against HIV. In our book, we also note the poorer health outcomes faced by BAME people living with HIV compared to the general population, that is, late HIV diagnosis, lower level of engagement with HIV care, lower likelihood of adherence to HIV medication, and greater incidence of comorbidities. Furthermore, it must be acknowledged that the identities and healthcare needs of BAME LGB people are not always fully understood by healthcare practitioners, which can make access to healthcare difficult.

How has the COVID19 pandemic affected the access to support for people with HIV?

The pandemic has had a range of effects. Access to HIV medication has thankfully remained constant and interrupted. However, I am concerned about the psychological aspects of the pandemic. We know that people living with HIV have a higher incidence of depression, anxiety, loneliness and other mental health issues. I fear that, for some people, these mental health issues will have been accentuated as the pandemic has progressed and social distancing measures have understandably become mandatory. The psychological support, upon which so many people living with HIV are reliant, has been curtailed. In research I did at the beginning of the pandemic,I found that some gay men were finding the lockdown psychologically taxing, which led them to seek sexual encounters on gay mobile social networking applications. Many felt ashamed afterwards and reported avoiding sexual health services due to fear of judgment (I.e. about why they were meeting with sexual partners during a nationwide lockdown).

Where would you signpost people for support in the UK?

Over the years, I’ve had the great fortune of working with several charities and witnessing first-hand the tremendous work they do to support people living with, and at risk of, HIV. The Terrence Higgins Trust (THT) offers a range of services up and down the country – focusing on both those living with, and at risk of, HIV. The LGBT Foundation offers different types of support to LGBT people, in relation to their identity, health and wellbeing. These are just two significant charities in the UK but there are many others – some local.

What would be your top advice to support family members, friends or colleagues with HIV?

A central theme of our new book is HIV stigma and its insidious effect on health, wellbeing and onward HIV transmission. I’d urge people to inform themselves about HIV and to acknowledge the tremendous innovation of HIV medicine, which now means that people diagnosed early are likely to have a normal life expectancy and that there is no risk of onward transmission when someone has been on treatment and undetectable for at least 6 months. I’d urge people to respond supportively to someone who discloses their HIV status, that is, to emphasise that nothing will change as a result of this new information. I’d urge people to respect that HIV disclosure is a personal matter and that nobody has the right to share this information on anyone else’s behalf.

What do you think employers can do to remove the stigma around colleagues living with HIV?

I think that more visibility is important. HIV is not talked about much these days. I think that this too has contributed to stigma – after all, when we don’t talk about something, our knowledge remains low or outdated and we end up thinking it is something best left undiscussed. HIV would be a sensitive topic to discuss as part of Equality and Diversity training in organisations. Employers should make it clear that HIV stigma and discrimination in the workplace is unacceptable and measures should be taken to support those who are targeted because of their HIV status. More generally, counselling support in the workplace would be advantageous for those who do unfortunately face stigma.

Are there any charities you would encourage people to donate to?

People often ask me how we can promote psychological wellbeing in LGBT people. My answer is always the same: there need to be effective support structures in place. For decades, local LGBT centres, charities and associations have been pivotal in providing a safe space to those who need it. People often recount their first experiences of finally walking into an LGBT centre and the respite that this finally provided! It has been disheartening to see that many LGBT charities have had to close their doors – one of the unfortunate consequences of austerity measures over the years. I’d encourage people to donate to local LGBT charities so that the personalised support that is so vital to a person’s wellbeing can continue to be provided when it is most necessary.

When considering prevention and support it is crucial to embed wellbeing elements into the care offered and be mindful of groups which may be disproportionally impacted.