‘End the stigma – everyone is at risk of HIV’ says TV’s Dr Christian Jessen

According to the World Health Organisation (WHO), HIV has already claimed over 34 million lives. In 2015, there were approximately 36.9 million people living with HIV with a further 2 million people becoming newly infected that year. Advances in antiretroviral therapy have transformed the lives of people with HIV infection, turning it from a life-threatening disease to a manageable, chronic condition. However, a cure remains elusive.

We caught up with Embarassing Bodies’ Dr Christian Jessen to find out more…

World AIDS Day is on Thursday 1^st December 2016. What can we expect and what are you up to?

Now, with European Testing Week running up to World AIDS day, we’ve got a nice motivation runway along which we can gather speed and attention. So, what am I doing? Well, as much as possible, as much as I can fit in, I think all I can do is just keep going with the message and try to raise visibility.

I’ll tweet away and I’ll do campaigns like this. I’ve worked with the Terrence Higgins Trust and the National Aids Trust but I’m happy to help anyone focused on this cause – I think it’s important. I’ve actually become a little bit fanatical about this. Sometimes I get a press response, ‘Oh well you know we kind of did World AIDS Day last year’ – I’ve actually been told this! I mean come on guys, that’s kind of the point!

I was kind of gobsmacked, politely so, that that was the response. It makes you realise we’ve got a lot more still to do to make sure that doesn’t happen again.  

Virus visibility

I think visibility has really improved especially with Prince Harry’s charitable involvement in the global HIV crisis.

Dr Christian Jessen gives Coleen and Saira a HIV test live on air and he discusses the disease. Source: Loose Women

I did a HIV test live on Loose Women – you know the more you can do, even if it’s a little bit sensational, it doesn’t matter, you’re drawing attention to it, you’re getting people thinking about it, that’s all you can do. And in a way, that’s probably as much as you need to do.

What do you think is the biggest issue currently surrounding HIV?

I think still it’s the stigma. I think stigma comes from fear, a lack of understanding, and a degree of prejudice. We’ve made mistakes in the past, I think by targeting at-risk groups, we’ve essentially stigmatised these groups.

That’s probably quite a controversial thing to say but I think we have done, we’ve stereotyped, out of necessity because one has to. You don’t have an infinite pot of money in which to run campaigns so you have to fine tune them but the ideal campaign would be aimed at everybody and that’s sort of what World Aids Day really is, isn’t it?

Self-test at home HIV kits

Dr Christian wants everyone to get tested and is supporting Insti’s self-test HIV kit. It is available online here and will continue to be available in clinics.

With a self-test, is there a three month grace period after which you should retest after a negative result, as seen with previous HIV tests?

So generally speaking all tests these days, you can be diagnosed after about 28 days. This test, interestingly enough, goes a little bit better than that and can be done from 21 days. So that’s a sign of good improvement there.

Now, strictly speaking, the advice is there are some, a rare number of people, who it may take up to three months in order to see a positive result after contracting the virus.

It’s still quite a rare number. In my clinic, for example, I would assess you and if you’re relatively low risk and your test is negative, I would probably say I don’t think you need to worry anymore and I think you can relax. So I certainly wouldn’t tell people to wait for three months, I would say absolutely from 28 days, go for it. Get a test!

What happens if a self-test yields a positive response? What should be their first port of call?

If the test is positive, it is not a diagnosis – think of it as a screening tool.

You will then to get an official diagnosis, not because there’s any issue with sensitivity or accuracy with the home kit, we would simply encourage you to either go to your GP or a GUM clinic.

And the next stage would be confirmatory testing as standard. Whether a home test, or done in the lab, you would still need to do confirmatory testing. And you’d go for the very good level of HIV healthcare that we have in this country, that we’re so lucky to have in this country actually.

It is extraordinary. And I don’t think we realised quite how amazing it is. It is not cheap to provide HIV care for people – and viral load and resistance tests are incredibly expensive. They are done without the bat of an eyelid, as it should be.

Do you think self-test kits will help change the stigma?

I do actually, because the more you’re saying to people that you are ALL at risk, the better, quite frankly. You may never change the minds of the older generation but as long as our younger generation is growing up with this, then it’s just part of life, another of those things that we do, that we test for.

Regular screening as standard

When I talk to healthcare professionals, I say HIV should be a normal part of your everyday questioning and screening for all of your patients. HIV shouldn’t be a special thing just because someone’s got bleached hair, pierced nose or painted nails – you shouldn’t be stereotyping like I’ve just done, it should be everyone.

So you don’t think HIV testing is a priority for GP’s?

I don’t think so, certainly the way in which we’re taught about it. When I was taught about HIV, it was very much concerning certain groups.

There’s a question of retraining yourself and GP’s are very busy and constantly retraining on everything all the time. It is an insurmountable battle sometimes but nevertheless that is their job, our job to do that, to keep up to date. These sort of campaigns and charities do target at risk groups, and at risk groups do exist.

There are groups of people in which the virus and rates of infection are higher than in other groups, that’s true. But there’s a danger of false confidence that you’re not a risk if you don’t fall into the stereotype. And that’s a mistake.

Can women contract the virus just as easily as men?

I think more easily than men, it’s pure biology but I don’t think we should even divide it into gender risk, everyone is at risk.

What would be your advice for HIV prevention?

It’s boring but very important. The message has not changed since we started shouting about it a long time ago. I wouldn’t even rank them, they’re both equally as important.

What do you think the future of HIV medication? Will we ever find a vaccine, or a cure?

I think we’re trying very hard, I think we do. I think the research is good. In a way, it’s a bit unfair really because it’s a politically popular disease, trendy – a terrible thing to say, but true nonetheless. You’ve got the Elton Johns of the world doing incredible things and raising huge amounts of money. Over time it’s had almost more of its fair share, arguably, but this is a good thing in my book.

The treatment currently available is incredible. They have come about through really fascinating stories actually – I love the sort of the history of it. From the Ugandan sex workers who never seemed to become positive, we’ve got our integrate inhibitors. It’s quite affirming that it’s always with real people, not just faceless white coats and test tubes, disconnected from life.

I think we can manage it now incredibly well, I think we’ll continue to be able to manage it, and even better.

I think the quality of life of people living with HIV is pretty damn good already and I hope it will get pretty damn better.

I sound very negative when I say that and I hope I’m proved wrong – of all the things I want to be proved wrong about, it’s that. I just worry that the way in which it works, the actually biology of it, is such that it makes life very difficult.

Even the way in which it behaves in the body, shutting itself down and then reactivate. It’s chilling – and that’s what makes me worry that will never find a cure.

But you know what? Even if we never come up with a cure, I don’t think it matters because I think the treatments will continue to be fine, the fact that people are really barely infectious if they’re on treatment and their viral load is undetectable, almost job done. Not quite, but almost.

Dr Christian explains what HIV is, and how people can live a normal life after being diagnosed. Source: Loose Women

Of course, it’s not just about the UK, AIDS is a pandemic problem with 26 million Africans affected by the disease. What are you doing to help this worldwide issue?

Oh gee, that was a curve ball! I would like to think that my messages and TV shows are now generally read and seen around the world.

Social media is a global thing now. So hopefully any tweet has at least the potential to be read worldwide and this article you’re writing could have branches spreading to readers in other countries.

Prince Harry takes a HIV test live. Source

So I do my best, clearly the way in which other countries work, and the stigma and the perceptions due to cultural and religious differences makes it much harder in some places. It’s the harder countries we should be targeting. Things like the Prince’s public HIV test would’ve made worldwide news and that would have a made a massive difference in any country that’s heavily stigmatised. I’m very proud of Harry actually for doing that, I really am. I wish I could’ve done the test on him myself – that would’ve been even better!

World AIDS day has set a target of ending AIDS by 2030 – do you think it’s achievable?

The UN AIDS goals are to have 90% of people that are living with HIV be diagnosed by 2020. The UK’s currently at about 17% undiagnosed so it’s getting close and self testing access should help.

That’s the general target. I’m nervous about targets because when we miss them it’s so disappointing but I guess sends an even stronger message. It puts pressure on – there’s no reason why we wouldn’t be able to stop all new infections by next year actually, other than the general lethargy and all those various cultural blockages that I’ve described.

And it’s that, those are the hardest things to change, religious and cultural ideology, shame and stigma, targeting certain populations and stereotyping. It’s not easy but doable, eminently doable, and doable far sooner, I think.

Dr Christian Jessen graduated in 2000 from University College London, having trained in general medicine, infectious disease, travel medicine and sexual health/HIV. He has lived in Kenya and Uganda where he taught in schools and also researched malaria and HIV interactions in children. He has been involved in a variety of television work and is the charismatic presenter of ‘Embarrassing Illnesses’, ‘Supersize Vs Superskinny’, ‘Embarrassing Bodies’ and ‘The Ugly Face of Beauty.’ He now works at Doctorcall, on the world famous Harley Street, looking after general medical and sexual health patients.