'There was nothing very new. There is a great interest in immunology; we know an enormous amount about this virus but we can't do a lot about it. What we need are models of care, what to do with our present patients and how to manage infections when they arise: there was nothing new or startling in that field.' Dr Smith felt that the most inspiring sessions at Berlin were those dealing with prevention and peer group education techniques to make people aware of HIV infection. Facts teaches at schools, colleges and theatre groups: 'Some groups of young people are very aware, but statistics speak for themselves: something like 90 per cent of first sexual intercourse between heterosexual teenagers is without any contraception or barriers.'
Education, particularly for GPs, is one of the main aims of Facts, which opened its north London centre in 1991. The centre provides community- based care to anyone with HIV and Aids - on the understanding that their own GP is involved to some degree. If someone has turned to the centre because of an unsympathetic GP - Facts reckons that about a third of all GPs in London alone intransigently turn their backs on HIV and Aids - then the centre helps the person find another.
'We want to support GPs, get them involved and train them in HIV care,' says Dr Smith, who feels that there is no reason why GPs cannot manage HIV from start to finish, with expert backup in hospitals, as well as support and training. 'We would like to see well and asymptomatic HIV patients being looked after by their GP; when they need referral they can go into hospital, like a diabetic. GPs are excellent at palliative care and terminal care,' she says.
Interestingly, Facts finds GPs outside London more enthusiastic to learn but less experienced. 'At teaching sessions there will be audiences of 70 or 80; you wouldn't get that in London. They don't feel so threatened and they often tend to manage their patients more, whatever the illness, including HIV. London GPs tend to refer to hospitals more often.'
While involving GPs, Facts stresses that it will share the burden of caring for a patient. 'Many GPs are afraid they will have all the care of someone with HIV or Aids dumped on them,' says Dr Smith. She feels government policy, in which GPs do not receive extra funding if they take on HIV patients but clinics do, needs changing. 'If the Government is serious about increasing the role of primary care then it must sort out the funding.'
At the moment, the centre is used, to varying degrees, by its 200 patients, most of whom referred themselves; about 80 per cent are male, aged between 20 and 40 years old and homosexual. More women are beginning to come the centre nowadays, reflecting the spread of the disease into the heterosexual population. Some patients have full care, some use their GPs more - especially those living outside London - and others go to a local hospital department.
Apart from conventional medicine the centre offers complementary therapies, such as massage, reflexology and hypnotherapy, all of which are over-subscribed. All the therapies are given free of charge by the therapists. No great claims are made about their efficacy. 'They are to be enjoyed and if they make the patients feel better that is great, but nothing more.'
When well, patients tend to change their lifestyles by improving their diet, exercise and sleeping patterns to keep their immune system in good shape; at the same time they favour the complementary therapies. When they become ill, the patients ask for more conventional medicine: such as AZT and white blood cell counts and drugs to prevent PCP (pneumocistis carinii pneumonia) which used to be the commonest diagnosis indicating Aids and often killed people.
As a link between GPs and hospitals, Facts sees itself as unique in the UK - it is funded to a large extent by Crusaid - and hopes to start another centre in Brighton, which has many HIV patients. 'The idea is to seed groups of trained GPs around the country,' says Dr Smith.
Facts, Health Co-ordination Centre, 23/25 Weston Park, Crouch End, London N8 9SY; telephone 081-348 9195.
Milestone in Aids fight, page 22
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