In the run-up to World Aids Day on December 1, The Argus looks back at the history of the HIV/Aids epidemic in Brighton, some 40 years after the virus was first detected in the city.
We spoke to Dr Gillian Dean, who has been an HIV consultant in Brighton for more than 20 years, about the extraordinary changes in medicine to tackle the virus, as well as work to eliminate new infections and stigma around HIV by the end of the decade.
Next year will mark 30 years since Dr Gillian Dean first became an HIV consultant, first in Manchester and then Brighton from 1999.
Dr Dean said that the landscape for HIV patients now is vastly different from what it once was in the early 1990s.
She said: “There were incredibly interesting and amazing young people who we were just monitoring and we were watching their white blood cell count drop lower and lower.
"You would either see them with opportunistic infections like thrush, which you could treat, or as an inpatient in those very severe, life-threatening conditions that meant many died.
“You could just look at somebody in those days and know that they had late-stage HIV infection.”
However, a conference in Vancouver in 1996, which offered hope that the use of a combination of drugs could help those living with HIV from developing Aids, dramatically changed the condition.
“It was like the antibiotic era,” she said.
“People started on treatment and inpatient wards became less full over time.”
Treatment did not come without its drawbacks at the time, however, with the medication often having several uncomfortable side effects.
Dr Dean said: “It was at least three times a day and often with food restrictions.
“It absolutely had to be taken on time, and the side effects were also physically stigmatising.
“People often got wasting in the face or they got these sort of fat depositions. They would go out on the street and people could tell they had HIV.
“But now people are taking just one tablet a day and it’s a bit more relaxed. There’s a large proportion who can just get on with their lives.”
Brighton and Hove is an HIV “fast track city”, developing innovative and pioneering ways to work towards eradicating new infections by 2030, as well as ending the stigma that still surrounds the virus.
The Martin Fisher Foundation, founded in 2015, helped bring the city’s different organisations together to help come up with innovative ways to tackle the spread of HIV in Brighton and Hove, as well as working to create a cohesive response to eradicate new infections.
The organisation is named after Martin Fisher, who became an HIV consultant in Brighton in 1995 and built a strong department to help those affected by the virus.
Dr Dean said: “Martin was so visionary and so ahead of his time. We practised back then in a way that some departments are only starting to now, in terms of multi-disciplinary meetings and many things we take for granted now that we did back then.”
Martin died suddenly in 2015 at the age of 50.
In recent years, Brighton and Hove has rolled out several initiatives to help encourage testing, including the introduction of opt-out testing in A&E at the Royal Sussex County Hospital and the use of several vending machines that offer rapid HIV testing kits.
Dr Dean said that the location of the machines across the city in places like Jubilee Library and the city’s two universities, are vital in reaching out to a wide range of communities, particularly groups who may not test regularly for HIV.
She said: “It’s like having an outreach person standing there and giving out tests - it starts conversations and normalises the whole thing.”
While much progress has been made in rolling out widespread testing, Dr Dean said that outdated views of HIV are still prevalent, with some people’s knowledge “still back in the 1980s”.
She said: “Lots of people don’t know that you can’t pass HIV on if you’re on effective treatment and people can live long and healthy lives if they’re on treatment.
“The saddest thing is that people can’t get support with an HIV diagnosis in the same way as if they’d had a cancer diagnosis - some people might not feel comfortable talking to their friends and relatives about it, whereas they would have done otherwise.
“There is still a sizable cohort who are so stigmatised that they wouldn’t even access services - it’s heart-breaking when you think about how much support they could have.”
To help address some of those stereotypes, the Martin Fisher Foundation partnered with the Terrence Higgins Trust to raise greater awareness of how people can live normal lives with HIV with medication and support.
Dr Dean said there are roughly 120 people with undiagnosed HIV in the city and stressed the importance of being tested and being diagnosed with the virus as early as possible.
“People who have a late diagnosis are ten times more likely to die in the first year after diagnosis than if they were otherwise diagnosed early.
“Testing has never been easier and shouldn’t be scary - if you’ve got it, we can do something about it, and if you haven’t got it, you can carry on protecting yourself.”
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