Frequency of HIV Testing among Gay & Bisexual Men in the UK: Implications for HIV Prevention

OBJECTIVES:

The aim of the study was to explore HIV testing frequency among UK men who have sex with men (MSM) in order to direct intervention development.

METHODS:

Cross-sectional surveys were completed by 2409 MSM in Edinburgh, Glasgow and London in 2011 and a Scotland-wide online survey was carried out in 2012/13. The frequency of HIV testing in the last 2 years was measured.

RESULTS:

Overall, 21.2% of respondents reported at least four HIV tests and 33.7% reported two or three tests in the last 2 years, so we estimate that 54.9% test annually. Men reporting at least four HIV tests were younger and less likely to be surveyed in London. They were more likely to report higher numbers of sexual and anal intercourse partners, but not "higher risk" unprotected anal intercourse (UAI) with at least two partners, casual partners and/or unknown/discordant status partners in the previous 12 months. Only 26.7% (238 of 893) of men reporting higher risk UAI reported at least four tests. Among all testers (n = 2009), 56.7% tested as part of a regular sexual health check and 35.5% tested following a risk event. Differences were observed between surveys, and those testing in response to a risk event were more likely to report higher risk UAI.

CONCLUSIONS:

Guidelines recommend that all MSM test annually and those at "higher risk" test more frequently, but our findings suggest neither recommendation is being met. Additional efforts are required to increase testing frequency and harness the opportunities provided by biomedical HIV prevention. Regional, demographic and behavioural differences and variations in the risk profiles of testers suggest that it is unlikely that a "one size fits all" approach to increasing the frequency of testing will be successful.

Full article at:   http://goo.gl/7F0D3O

By:  McDaid LM1, Aghaizu A2, Frankis J3, Riddell J1, Nardone A2, Mercey D4, Johnson AM4, Hart GJ4, Flowers P3.

• 1MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK.
• 2Public Health England, London, UK.
• 3Glasgow Caledonian University, Glasgow, UK.
• 4University College London, London, UK. 
• HIV Med. 2016 Mar 15. doi: 10.1111/hiv.12373.

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Engagement in a National Naloxone Program among People Who Inject Drugs

HIGHLINGHTS

• Access to naloxone among PWID increased significantly from 8% in 2011–2012 to 32% in 2013–2014.
• Carriage of naloxone decreased significantly from 16% in 2011–2012 to 5% in 2013–2014.
• Community services and prisons were equally efficient at targeting their naloxone supplies.

BACKGROUND:

Availability of the opioid antagonist naloxone for lay administration has grown substantially since first proposed in 1996. Gaps remain, though, in our understanding of how people who inject drugs (PWID) engage with naloxone programmes over time.

AIMS:

This paper aimed to address three specific evidence gaps: the extent of naloxone supply to PWID; supply-source (community or prisons); and the carriage of naloxone among PWID.

MATERIALS AND METHODS:

Analysis of Scotland's Needle Exchange Surveillance Initiative (NESI) responses in 2011-2012 and 2013-2014 was undertaken with a specific focus on the extent of Scotland's naloxone supply to PWID; including by source (community or prisons); and on the carriage of naloxone. Differences in responses between the two surveys were measured using Chi-square tests together with 95% confidence intervals for rate-differences over time.

RESULTS:

The proportion of NESI participants who reported that they had been prescribed naloxone within the last year increased significantly from 8% (175/2146; 95% CI: 7-9%) in 2011-2012 to 32% (745/2331; 95% CI: 30% to 34%) in 2013-2014. In contrast, the proportion of NESI participants who carried naloxone with them on the day they were interviewed decreased significantly from 16% (27/169; 95% CI: 10% to 22%) in 2011-2012 to 5% (39/741; 95% CI: 4% to 7%) in 2013-2014.

CONCLUSIONS:

The supply of naloxone to PWID has increased significantly since the introduction of a National Naloxone Programme in Scotland in January 2011. In contrast, naloxone carriage is low and decreased between the two NESI surveys; this area requires further investigation.

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By:  McAuley A1, Munro A2, Bird SM3, Hutchinson SJ4, Goldberg DJ4, Taylor A2.

• 1Health Protection Scotland, Meridian Court, Cadogan Street, Glasgow G2 6QE, UK; Institute for Applied Health Research, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow G4 0BA, UK. Electronic address: andrew.mcauley@nhs.net.
• 2School of Media, Culture and Society, University of the West of Scotland, Paisley PA1 2BE, UK.
• 3MRC Biostatistics Unit, Cambridge CB2 0SR, UK; Department of Mathematics and Statistics, Strathclyde University, Glasgow G1 1XH, UK.
• 4Health Protection Scotland, Meridian Court, Cadogan Street, Glasgow G2 6QE, UK; Institute for Applied Health Research, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow G4 0BA, UK. 
• Drug Alcohol Depend. 2016 Mar 3. pii: S0376-8716(16)00106-X. doi: 10.1016/j.drugalcdep.2016.02.031. 

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Regular STI Testing amongst Men Who Have Sex with Men & Use Social Media Is Suboptimal - A Cross-Sectional Study

Sexually transmitted infections (STIs) disproportionately affect men who have sex with men, with marked increases in most STIs in recent years. These are likely underpinned by coterminous increases in behavioural risks which have coincided with the development of Internet and geospatial sociosexual networking. 

Current guidelines advocate regular, annual sexually transmitted infection testing amongst sexually active men who have sex with men (MSM), as opposed to symptom-driven testing. This paper explores sexually transmitted infection testing regularity amongst MSM who use social and sociosexual media. 

Data were collected from 2668 men in Scotland, Wales, Northern Ireland and the Republic of Ireland, recruited via social and gay sociosexual media. Only one-third of participants report regular (yearly or more frequent) STI testing, despite relatively high levels of male sex partners, condomless anal intercourse and high-risk unprotected anal intercourse. The following variables were associated with regular STI testing; being more 'out' (adjusted odds ratio = 1.79; confidence interval = 1.20-2.68), HIV-positive (adjusted odds ratio = 14.11; confidence interval = 7.03-28.32); reporting ≥10 male sex partners (adjusted odds ratio = 2.15; confidence interval = 1.47-3.14) or regular HIV testing (adjusted odds ratio = 48.44; confidence interval = 28.27-83.01). Men reporting long-term sickness absence from work/carers (adjusted odds ratio = 0.03; confidence interval = 0.00-0.48) and men aged ≤25 years (adjusted odds ratio = 0.36; 95% confidence interval = 0.19--0.69) were less likely to test regularly for STIs. 

As such, we identify a complex interplay of social, health and behavioural factors that each contribute to men's STI testing behaviours. In concert, these data suggest that the syndemics placing men at elevated risk may also mitigate against access to testing and prevention services. Moreover, successful reduction of STI transmission amongst MSM will necessitate a comprehensive range of approaches which address these multiple interrelated factors that underpin MSM's STI testing.

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By:  Frankis J1, Goodall L2, Clutterbuck D3, Abubakari R4, Flowers P5.

• 1School of Health and Life Sciences, Glasgow Caledonian University, Glasgow j.frankis@gcu.ac.uk.
• 2Cobridge Sexual Health Centre, Church Terrace, Cobridge, Stoke on Trent.
• 3Chalmers Sexual Health Centre, NHS Lothian, Edinburgh.
• 4School of Health and Life Sciences, GCU London, Glasgow Caledonian University, Glasgow.
• 5School of Health and Life Sciences, Glasgow Caledonian University, Glasgow. 
• Int J STD AIDS. 2016 Mar 4. pii: 0956462416636780.

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Economic & Health Implications from Earlier Detection of HIV Infection in the United Kingdom

Purpose: 

To model the budget and survival impact of implementing interventions to increase the proportion of HIV infections detected early in a given UK population.

Patients and methods: 

A Microsoft Excel decision model was designed to generate a set of outcomes for a defined population. Survival was modeled on the Collaboration of Observational HIV Epidemiological Research Europe (COHERE) study extrapolated to a 5-year horizon as a constant hazard. Hazard rates were specific to age, sex, and whether detection was early or late. The primary outcomes for each year up to 5 years were: annual costs, numbers of infected cases, hospital admissions, and surviving cases. Three locations in the UK were chosen to model outcomes across a range of HIV prevalence areas: Lambeth, Southwark, and Lewisham (LSL), Greater Manchester Cluster (GMC), and Kent and Medway (K&M).

Results: 

In LSL, the projected cumulative cost savings over 5 years were £3,210,206 or £5,290,206 when including the value of the 104 life-years saved. Savings were insensitive to transmission rates, but sensitive in direct proportion to the percentage shift from late to early detection. In GMC, savings were in a similar proportion to LSL, but the magnitude was smaller, as a consequence of the lower base-case HIV prevalence. In K&M, with a smaller population and lower HIV prevalence than GMC, savings were commensurately smaller (£733,202 cumulatively over 5 years).

Conclusion: 

The results strengthen the rationale for implementing increased testing in high prevalence areas. However, in areas of low prevalence, it is unlikely that costs will be returned over a 5-year period.

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By:  Vladimir Zah,^1,2 Mondher Toumi¹

¹Ecole Doctoral Interdisciplinaire Sciences-Santé (EDISS), University of Lyon, Lyon, France; ²ZRx Outcomes Research Inc., Mississauga, Canada

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Impact of Opioid Substitution Therapy for Scotland's Prisoners on Drug‐Related Deaths Soon After Prisoner Release

Aim

To assess whether the introduction of a prison‐based opioid substitution therapy (OST) policy was associated with a reduction in drug‐related deaths (DRD) within 14 days after prison release.

Design

Linkage of Scotland's prisoner database with death registrations to compare periods before (1996–2002) and after (2003–07) prison‐based OST was introduced.

Setting

All Scottish prisons.

Participants

People released from prison between 1 January 1996 and 8 October 2007 following an imprisonment of at least 14 days and at least 14 weeks after the preceding qualifying release.

Measurements

Risk of DRD in the 12 weeks following release; percentage of these DRDs which occurred during the first 14 days.

Findings

Before prison‐based OST (1996–2002), 305 DRDs occurred in the 12 weeks after 80 200 qualifying releases, 3.8 per 1000 releases [95% confidence interval (CI) = 3.4–4.2]; of these, 175 (57%) occurred in the first 14 days. After the introduction of prison‐based OST (2003–07), 154 DRDs occurred in the 12 weeks after 70 317 qualifying releases, a significantly reduced rate of 2.2 per 1000 releases (95% CI = 1.8–2.5). However, there was no change in the proportion which occurred in the first 14 days, either for all DRDs (87: 56%) or for opioid‐related DRDs.

Conclusions

Following the introduction of a prison‐based opioid substitution therapy (OST) policy in Scotland, the rate of drug‐related deaths in the 12 weeks following release fell by two‐fifths. However, the proportion of deaths that occurred in the first 14 days did not change appreciably, suggesting that in‐prison OST does not reduce early deaths after release.

Full article at:  http://goo.gl/Zb7RcW

By:  Sheila M. Bird, 1 Colin M. Fischbacher, 2 Lesley Graham, 2 and Andrew Fraser 3

¹MRC Biostatistics Unit, Cambridge, UK

²NHS National Services Scotland, Edinburgh, UK

³NHS Health Scotland, Edinburgh, UK

Corresponding author.

^*Correspondence to: Sheila M. Bird, MRC Biostatistics Unit, Cambridge CB2 0SR, UK. E‐mail: ku.ca.mac.usb-crm@drib.aliehs

Published online 2015 Jun 8. doi:  10.1111/add.12969, Addiction. 2015 Oct; 110(10): 1617–1624.

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Community Pharmacy Services for People with Drug Problems Over Two Decades in Scotland: Implications for Future Development

BACKGROUND:

In Scotland community pharmacies are heavily involved in service delivery for people with drug problems (PWDP) as documented through surveys of all community pharmacies in 1995, 2000 and 2006. A further survey in 2014 enabled trends in service demand/provision to be analysed and provides insight into future development.

METHODS:

The lead pharmacist in every Scottish pharmacy (n=1246) was invited to complete a postal questionnaire covering attitudes towards PWDP and service provision and level of involvement in services (needle exchange, dispensing for PWDP and methadone supervision). Additional questions covered new services of take-home naloxone (THN) and pharmacist prescribing for opioid dependence. Telephone follow-up of non-responders covered key variables. A comparative analysis of four cross-sectional population surveys of the community pharmacy workforce (1995, 2000, 2006 and 2014) was undertaken.

RESULTS:

Completed questionnaires were returned by 709 (57%) pharmacists in 2014. Key variables (questionnaire or telephone follow-up) were available from 873 (70%). The proportion of pharmacies providing needle exchange significantly increased from 1995 to 2014 (8.6%, 9.5%, 12.2%, 17.8%) as did the proportion of pharmacies dispensing for the treatment of drug misuse (58.9%, 73.4%, 82.6% and 88%). Methadone was dispensed to 16,406 individuals and buprenorphine to 1777 individuals (increased from 12,400 and 192 respectively in 2006). Attitudes improved significantly from 1995 to 2014 (p<0.001). Being male and past training in drug misuse significantly predicted higher attitude scores (p<0.05) in all four years. Attitude score was a consistently significant predictor in all four years for dispensing for the treatment of drug misuse and providing needle exchange. In 2014, 53% of pharmacists felt part of the addiction team and 27.7% did not feel their role was valued by them. Nine pharmacists prescribed for opioid dependence.

CONCLUSION:

It is possible for pharmacy workforce attitudes and service engagement to improve over time. Training was key to these positive trends. Communication with the wider addiction team could be further developed.

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By:  Matheson C1, Thiruvothiyur M2, Robertson H3, Bond C3.

• 1Centre of Academic Primary Care, Polwarth Building, University of Aberdeen, Foresterhill, Aberdeen AB25 2ZD, United Kingdom. Electronic address: c.i.math@abdn.ac.uk.
• 2Institute of Applied Health Sciences, University of Aberdeen, Foresterhill, Aberdeen AB25 2ZD, United Kingdom.
• 3Centre of Academic Primary Care, Polwarth Building, University of Aberdeen, Foresterhill, Aberdeen AB25 2ZD, United Kingdom. 

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Towards Preparedness for PrEP: PrEP Awareness & Acceptability among MSM at High Risk of HIV Transmission Who Use Sociosexual Media in Four Celtic Nations: Scotland, Wales, Northern Ireland & the Republic of Ireland: An Online Survey

OBJECTIVE:

To assess the awareness and acceptability of pre-exposure prophylaxis (PrEP) among men who have sex with men (MSM) and use sociosexual media at high risk of HIV infection in four Celtic nations.

DESIGN:

Cross-sectional study.

METHODS:

Online self-complete survey of 386 HIV-negative/status unknown MSM who reported condomless anal intercourse (CAI) with ≥2 men in the last year, recruited from gay sociosexual media.

RESULTS:

One-third (34.5%, 132/386) of the participants were aware of PrEP but over half (58.5%, 226/356) reported that they would be willing to use PrEP if it were available to them. Only men who regularly tested for HIV every 6 months were more likely to be aware of PrEP. PrEP acceptability was only associated with reporting ≥5 CAI partners in the last year.

CONCLUSIONS:

Low levels of PrEP awareness were reported across these Celtic nations. Only one-third of high-risk MSM had heard of PrEP but over one-half would be willing to take a daily pill to prevent HIV infection. Sociodemographic factors, commercial gay scene proximity and social network use were unrelated to considering PrEP use. However, those reporting most CAI partners were more likely to consider PrEP use.

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By:  Frankis JS1, Young I2, Lorimer K1, Davis M3, Flowers P1.

• 1School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK.
• 2MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK.
• 3School of Social Sciences, Monash University, Melbourne, Victoria, Australia. 
• Sex Transm Infect. 2016 Jan 22. pii: sextrans-2015-052101. doi: 10.1136/sextrans-2015-052101.

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United Kingdom PornHub 2015 Use Review

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Human Papillomavirus Prevalence and Herd Immunity after Introduction of Vaccination Program, Scotland, 2009–2013

Abstract

In 2008, a national human papillomavirus (HPV) immunization program using a bivalent vaccine against HPV types 16 and 18 was implemented in Scotland along with a national surveillance program designed to determine the longitudinal effects of vaccination on HPV infection at the population level. Each year during 2009–2013, the surveillance program conducted HPV testing on a proportion of liquid-based cytology samples from women undergoing their first cervical screening test for precancerous cervical disease. By linking vaccination, cervical screening, and HPV testing data, over the study period we found a decline in HPV types 16 and 18, significant decreases in HPV types 31, 33, and 45 (suggesting cross-protection), and a nonsignificant increase in HPV 51. In addition, among nonvaccinated women, HPV types 16 and 18 infections were significantly lower in 2013 than in 2009. Our results preliminarily indicate herd immunity and sustained effectiveness of the bivalent vaccine on virologic outcomes at the population level.

Below:  Figure. Analyses for 5,715 liquid-based cytology cervical samples from vaccinated and nonvaccinated women, for which valid human papillomavirus (HPV) testing results were available, Scotland, 2009–2013. A) Proportion and 95% CIs for samples with positive results for each HPV type. B) Difference in the proportion positive and associated 95% CIs for the difference between vaccinated and nonvaccinated women, by HPV type. Other than HPV types 16 and 18, the 95% CIs of the difference were corrected for multiple testing using by using the Bonferroni correction. *Significant change.

  

Full article at:  http://goo.gl/AW79p3

By:   Ross L. Cameron, Kimberley Kavanagh, Jiafeng Pan, John Love, Kate Cuschieri, Chris Robertson, Syed Ahmed, Timothy Palmer, and Kevin G.J. Pollock

Author affiliations: Health Protection Scotland, Glasgow, Scotland, UK (R.L. Cameron, J. Love, S. Ahmed, K.G.J. Pollock); University of Strathclyde, Glasgow (K. Kavanagh, J. Pan, C. Robertson); Scottish Human Papillomavirus Reference Laboratory, Edinburgh, Scotland, UK (K. Cuschieri); University of Edinburgh, Edinburgh (T. Palmer)

  

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Drugs-Related Death Soon After Hospital-Discharge among Drug Treatment Clients in Scotland: Record Linkage, Validation, and Investigation of Risk-Factors

We validate that the 28 days after hospital-discharge are high-risk for drugs-related death (DRD) among drug users in Scotland and investigate key risk-factors for DRDs soon after hospital-discharge. 

Using data from an anonymous linkage of hospitalisation and death records to the Scottish Drugs Misuse Database (SDMD), including over 98,000 individuals registered for drug treatment during 1 April 1996 to 31 March 2010 with 705,538 person-years, 173,107 hospital-stays, and 2,523 DRDs. Time-at-risk of DRD was categorised as: during hospitalization, within 28 days, 29–90 days, 91 days–1 year, >1 year since most recent hospital discharge versus ‘never admitted’. 

Factors of interest were: having ever injected, misuse of alcohol, length of hospital-stay (0–1 versus 2+ days), and main discharge-diagnosis. We confirm SDMD clients’ high DRD-rate soon after hospital-discharge in 2006–2010. DRD-rate in the 28 days after hospital-discharge did not vary by length of hospital-stay but was significantly higher for clients who had ever-injected versus otherwise. 

Three leading discharge-diagnoses accounted for only 150/290 DRDs in the 28 days after hospital-discharge, but ever-injectors for 222/290. Hospital-discharge remains a period of increased DRD-vulnerability in 2006–2010, as in 1996–2006, especially for those with a history of injecting.

...Our key confirmatory finding is that DRD-rates by time since most recent hospitalization remained significantly higher in the 28 days after hospital-discharge than at subsequent times post-discharge (with and without covariate adjustment). The SDMD cohort’s DRD-rate while hospitalized had decreased in 2006–2010, but absolute DRD-risks soon after hospital-discharge remained similar across both periods.

New SDMD registrations in the validation period of 2006–2010 were different from those in the earlier registration period in important respects: a higher proportion of 2006–2010 registered clients were 35 years of age or older at registration than among clients whose first SDMD registration was in 1996–2006, and a higher proportion reported never having injected. This suggests that Scottish drug users are not only ageing but that newer clients are less likely to have been initiated into injecting.

The study disputed our hypothesis that individuals who are hospitalized for a longer time (at least overnight) may be at greater DRD-risk post-discharge due to loss of tolerance. However, the duration of hospital-stay was a highly skewed variable; with a few individuals experiencing very long (several months) periods. There was insufficient statistical power to properly investigate the effect of short versus long stay lengths. A further subdivision of duration of hospital-stay as 0–1 day, 2–6 days and 7+ days (results not shown) also showed no difference between stays of less than versus greater than one week.

The influence of main discharge-diagnosis on subsequent DRD-risk was also analyzed by grouping the codes into pre-specified categories as used previously by Merrall et al. [4]. We needed to consider the entire SDMD cohort in order to have sufficient power per discharge-category and, even so, only two main discharge-diagnoses exceeded 30 DRDs within 28 days after hospital-discharge. These two discharge-categories were drug-related morbidity and mental and behavioral disorders excluding psychoactive substance misuse. Even together with diseases of the respiratory system, these top three DRD-risk discharge-categories accounted for only 52% (150/290) DRDs in the 28 days after hospital-discharge.

By contrast, behavioral risk-factors were far more discriminatory with ever injecting drug use accounting for the vast majority (77%: 222/290) of DRDs in the 28 days after discharge. This finding gives added focus to Scotland’s public health policy to make take-home naloxone (opiate antagonist) readily available, as well as training in its administration, not only in prisons and at drug treatment agencies but also at discharge from hospital, see [22] and [23]. Moreover, our new results suggest how hospital doctors can best target their harm reduction response [24]–not ineffectually according to patients’ length of hospital-stay, nor too narrowly by concentrating on a few main discharge-diagnoses, but highly efficiently by focusing on those who have ever injected. For ever injecting drug users, we note that one DRD in the 28 days after hospital-discharge per 400 discharges is about half their estimated DRD-risk in the 28 days after prison-release [25].

For the SDMD cohort of over 98,000 drug treatment clients in Scotland, we have confirmed that a high DRD risk soon after hospital-discharge applies in 2006–2010 as it did in 1996–2006 [14]. Length of hospital-stay had no effect on DRD-rate, discharge-diagnosis had an effect (as did reported misuse of alcohol) but neither was as discriminatory as the behavioral risk-factor of having ever injected.

Full article at: http://goo.gl/zRYOtN

By: 

Simon R. White, Sheila M. Bird

Medical Research Council Biostatistics Unit, Cambridge Institute of Public Health, Cambridge, United Kingdom

Elizabeth L. C. Merrall

Novartis Pharam BV, Novartis Vaccines & Diagnostics, Hullenbergweg 83–85, 1101 CL Amsterdam, Netherlands

Sharon J. Hutchinson

Health Protection Scotland, Glasgow, G3 7LN, Scotland, United Kingdom

  

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State Regulation, Family Breakdown, and Lone Motherhood: The Hidden Costs of World War I in Scotland

Using a range of parish records, records from the Registrar General of Scotland, charity organizations, and media reports, this article contributes to the historiography which evaluates the effects of World War I in Britain as well as the history of lone mothers and their children. It highlights how during the war, women, especially lone mothers, made significant gains through the welfare system, changing approaches to illegitimacy and the plentiful nature of women’s work but also how in doing so this brought them under greater surveillance by the state, local parishes, and charity organizations. Moreover, as this article will demonstrate, many of the gains made by women were short-lived and in fact the war contributed to high levels of family breakdown and gendered and intergenerational poverty endured by lone mothers and their children.

...It was not just married women who came under greater surveillance. Among the first women to come under the lens of the state agencies were single women, especially, young working-class women. These young females were among the greatest beneficiaries of women’s wartime economic progress because they were the first to be enlisted to substitute for men who were called to arms and this gave them greater spending power to enjoy the modern leisure pursuits such as dance halls, cafés, cinema-going, and access to new fashions and makeup. Woollacott argues that young women became targets of regulation due to concerns over what the press would label “khaki fever.” This was the idea that young women, especially those who resided near army camps, were attracted by the excitement of war and to men in uniform which it was feared would result in high levels of illegitimacy, prostitution, and venereal disease.³⁷ According to the Registrar General for Scotland in his Annual Report of 1916, there had been serious concerns that the war would lead to an increase in illegitimate births.³⁸ This was not only due to khaki fever, but also related to the notion that departing or returning soldiers, uncertain of their futures, would engage in premarital sex.

These fears were translated into the establishment of women’s patrols across Britain.³⁹ In Scotland, the patrols worked with the police, were sanctioned by the Scottish Office, and were run by the National Union of Women Workers.⁴⁰ In 1915, there were 425 patrols in Scotland based in twenty different locations.⁴¹Edinburgh had thirty women’s patrols by 1916.⁴² Women’s patrols monitored “girls” whose behavior was regarded as unsatisfactory, those who gathered in the vicinity of military camps, who might potentially tempt soldiers into misconduct.⁴³ The Scotsman newspaper called the patrols “an organized chaperone system” to avert the development of “loose and dissolute habits” and increased levels of illegitimacy, especially as the men who were seen as most likely to succumb to the charms of the young women were older married men—so there would be no opportunity of averting illegitimacy through marriage.⁴⁴ To this end, the Defense of the Realm Act was used to regulate women’s behavior. For example, in Cupar, Fife, there was a military curfew which forbade women from leaving their homes after 10 p.m. at night.⁴⁵

Yet for all the fears expressed, illegitimacy did not increase significantly in Scotland during the war. Table 1 below highlights the number of illegitimate births peaked at nearly 9000 in 1912 before falling steadily to a low of 7,295 in 1917. However, the number of births in Scotland also fell during the war period. The average percentage of illegitimate births to total births in the period 1911–13 was 7.32, which remained unchanged for the war years.⁴⁶ Nevertheless, more than 50,000 illegitimate children were born in Scotland between 1914 and 1919…

Full article at: http://goo.gl/5XK6Ac

By: Annmarie Hughes1 and Jeff Meek1

¹University of Glasgow, Glasgow, UK

Annmarie Hughes, Room 208, Lilybank House, Bute Gardens, University of Glasgow, Glasgow G12 8RT, UK. Email:ku.ca.wogsalg@sehguh.eiramnna

   

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Expansion of HCV Treatment Access to People Who Have Injected Drugs Through Effective Translation of Research into Public Health Policy: Scotland's Experience

Seven years have elapsed since the Scottish Government launched its Hepatitis C Action Plan - a Plan to improve services to prevent transmission of infection, particularly among people who inject drugs (PWID), identify those infected and ensure those infected receive optimal treatment. The Plan was underpinned by industrial scale funding (around £100 million, in addition to the general NHS funding, will have been invested by 2015), and a web of accountable national and local multi-disciplinary multi-agency networks responsible for the planning, development and delivery of services. Initiatives ranged from the introduction of testing in specialist drug services through finger-prick blood sampling by non-clinical staff, to the setting of government targets to ensure rapid scale-up of antiviral therapy. 

The Plan was informed by comprehensive national monitoring systems, indicating the extent of the problem not just in terms of numbers infected, diagnosed and treated but also the more penetrative data on the number advancing to end-stage liver disease and death, and also through compelling modelling work demonstrating the potential beneficial impact of scaling-up therapy and the mounting cost of not acting. 

Achievements include around 50% increase in the proportion of the infected population diagnosed (38% to 55%); a sustained near two-and-a-half fold increase in the annual number of people initiated onto therapy (470 to 1050) with more pronounced increases among PWID (300 to 840) and prisoners (20 to 140); and reversing of an upward trend in the overall number of people living with chronic infection. 

The Action Plan has demonstrated that a Government-backed, coordinated and invested approach can transform services and rapidly improve the lives of thousands. Cited as "an impressive example of a national strategy" by the Global Commission on Drug Policy, the Scottish Plan has also provided fundamental insights of international relevance into the management of HCV among PWID.

Below:  Estimates of the number of people living with chronic HCV infection (i.e. HCV RNA positive) in Scotland during 2006, at the start of Scotland's Hepatitis C Action Plan

Below:  Modelled incident number of chronic HCV infected people, who had ever injected drugs, in Scotland developing decompensated cirrhosis (liver failure) each year according to different uptake rates of HCV antiviral therapy during 2008–2030.

Below:  Modelled prevalent number of chronic HCV infected people, who had ever injected drugs, with cirrhosis in Scotland according to different uptake rates of HCV antiviral therapy during 2008–2030.

Below:  Annual number of people in Scotland who were (a) newly diagnosed with HCV antibodies, and (b) initiated on HCV antiviral therapy, during 2003–2013

Below: Estimated number of people living with chronic HCV infection each year in Scotland during 2006–2013: (a) taking account of the impact of the national scale-up in interventions (solid line), and (b) not taking account of the impact of the national scale-up in interventions (dashed line).

Below:  Annual number of people in Scotland diagnosed HCV antibody positive and who had been hospitalised for the first time with either decompensated cirrhosis or hepatocellular carcinoma.

Full article at: http://goo.gl/UC2BNr

By: Hutchinson SJ1, Dillon JF2, Fox R3, McDonald SA4, Innes HA4, Weir A4, McLeod A5, Aspinall EJ4, Palmateer NE5, Taylor A6, Munro A6, Valerio H4, Brown G7,Goldberg DJ4.

• 1School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK; Health Protection Scotland, Glasgow, UK. Electronic address: sharon.hutchinson2@nhs.net.
• 2Ninewells Hospital and Medical School, Dundee, UK.
• 3Gartnavel General Hospital, Glasgow, UK.
• 4School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK; Health Protection Scotland, Glasgow, UK.
• 5Health Protection Scotland, Glasgow, UK.
• 6Institute for Applied Social and Health Research, University of the West of Scotland, Paisley, UK.
• 7Scottish Government, Edinburgh, UK.  

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