[Music]
three years ago a woman came to see me
in my clinic she was 34 years old she
was a secretary and she’d originally
come to the UK from Nigeria I shall call
her Margaret that morning in my clinic
Margaret sat beside me and said God will
cure me and she refused to take the
treatment that I offered her God will
cure me six months earlier Margaret had
been diagnosed with HIV and I’ve been
trying for several months to persuade
her to come back to clinic after her
diagnosis that day she’d finally agreed
to come back and talk to me Margaret had
had HIV for a long time before she was
diagnosed so she was already very unwell
she had a serious skin infection was
constantly tired with no energy to do
anything but she’d come back late that
day to tell me that she didn’t believe
in the treatment that I was offering her
and that there was nothing I could do to
change her mind I rang her I wrote to
her I begged her to come back to take
treatment I often heard the opportunity
to speak to other people who’d been in a
similar situation to her but nothing
worked a year later she was a admitted
hospital unconscious with a serious
brain infection she never woke up as I
watched her lying unresponsive in her
hospital bed hooked up to tubes and
machines I was overwhelmed by thoughts
of how unnecessary her death had been
my talk is for all women but also for
the men in this room
men who have wives girlfriends sisters
aunts mothers and other women they care
about because Margaret could have been
any one of those women as I look around
I think that I can safely assume that
most of you are adults and will have had
sex subject of sex will be hard for some
of you to talk about and easier for
others but today no matter how you feel
about talking openly about sex I’d like
you to think about it for a moment and
I’d like you to think about the last
time you had sex
maybe this morning I’d like you to think
about whether it felt good
whether you felt pressured whether you
were worried that you might catch
something and whether you used a condom
but I’d also like you to ask yourself
one question
am I sure
that I am my husband or boyfriends only
partner now going back to the sexting
hopefully if you needed to you’ll have
used a condom to prevent an unplanned
pregnancy or to reduce your risk of
catching infection like HIV and you’ll
also know that condoms have been the
mainstay of HIV prevention for many
decades
globally HIV infections and children are
going down because women with HIV are
treated in pregnancy to stop infections
in their babies but in adults despite
huge improvements in access to treatment
there’s been virtually no change in the
number of people catching HIV so now for
some HIV stats worldwide 5,000 people a
day catch HIV and 52% of those are women
Nigeria has 3.2 million people living
with HIV
second highest country in the world
after South Africa in the UK 31 percent
of people with HIV are women and 14
people catch HIV a day two to three of
whom are African Africans in the UK are
more likely to be diagnosed with
advanced HIV because they don’t test
regularly or at all and this means that
by the time they’re diagnosed their
immune systems are already badly damaged
and this is what happened to Margaret
but despite that if she’d accepted
treatment she almost certainly wouldn’t
have died one thing I learned from
conversations with Margaret is that she
didn’t feel that there was anything she
would have done to stop herself from
catching HIV so let’s explore this
further and go back to condoms it’s true
that they definitely work if you use
them but not everybody can use a condom
all of the time and anyway how many of
you have ever tried to force a man to
use a problem if he didn’t want to sing
about condoms is that they take control
away from the very people who are most
affected women many women have shared
that they don’t feel able to tell a
partner to use a condom or to refuse to
have sex with him if he won’t use one so
even if they worry that he has another
partner they cross their fingers and
hope for the best but what if I told you
that HIV infections in some people are
falling
last year something happened that I
never thought I’d see as an HIV
consultant working in London the numbers
of cases of HIV in my clinic fell they
fell my clinic diagnosed is the highest
number of people with HIV in the country
and until 2015
we were diagnosing between 50 and 70
patients a month with HIV but since June
2015 the numbers of cases of HIV have
been falling and in December 2016 we
diagnosed 22 people and this past
October only 12 12 an 81 percent
reduction and this drop in new diagnoses
wasn’t in Africans and it wasn’t in
women it was in men who have sex with
men so why did this happen
well there are several reasons for this
fall including the fact that people on
effective treatment for HIV are not
infectious so they can’t transmit HIV to
anybody else but the most dramatic
reason for the fall in my view is a pill
called prep and men who have sex with
men coming to test for HIV in my clinic
are taking prep Paula Johnson in her
inspirational TED talk asked why leave
women’s health to chance but that’s what
millions of women all over the world
have had to do leave their health to
chance but now they don’t have to so
what is prep well prep is a pill that
when taken with other medicines is used
to treat HIV but on its own has been
shown to prevent HIV and when taken
properly is close to a hundred percent
effective it’s taken every day like the
contraceptive pill and you can take it
when you need to and stop taking it when
you don’t but the one thing you have to
do for prep to work is take it
we’re prep hasn’t worked it’s because
people didn’t take it
behind me is a summary of prep studies
that have been done all over the world
in men and women it shows that prep is
most effective when levels of drug are
highest in the blood and least effective
when they’re low or absent to the left
and at the bottom a full awesome studies
in sub-saharan African women and as you
can see it wasn’t effective in those
studies or as effective in those studies
as it was in the studies higher up on
the graph so why did prep work more
effectively in some studies of women
than in others well remember I said that
for prep to work you have to take it in
some of these studies women didn’t
really believe that they were at risk of
catching HIV so they didn’t take their
prep to other women because prep is an
HIV medicine they worried that some
people might think that they were
already HIV positive and so that was
also a factor but the thing about taking
prep is if you’re taking it nobody needs
to know and I’ll say it again no one
needs to know so you ask does prep have
side effects well the truth is that less
than 10 percent of people who take prep
have side effects and where side effects
occur they usually only last for a few
days the majority of people don’t have
any side effects at all but you say prep
is expensive surely it can’t it costs
too much to be given to everybody but my
answer to that is that it costs more to
treat a person for HIV for their whole
life than it does to prevent HIV for the
small proportion of their life but they
might be at risk and because of this
many countries in the world have started
prep programs and many countries in the
Western world now provide prep for free
prep isn’t widely available in the UK
and so men who have sex with men
are buying it online via a website
called I want prep now but actually the
NHS in Scotland is now providing prep
for free and the NHS in England is
providing it to ten thousand people in a
study not to prove that it works but to
see how many people need it and you can
have it too so for the first time a
woman unable to say use a condom to a
man she worries has other partners or
indeed a woman who has other partners
herself can take a pill and stop herself
from catching HIV prep puts you in
control of whether you catch HIV or not
so I call on you to share this empower
all the women you know use prep and put
the power in your hands so going back to
Margaret whom I spoke about at the
beginning why did I think about her when
I was noticing the effect of breath
because Margaret left her life to chance
but you don’t have to before I go I’d
like to leave you with a question you’ve
seen from my talk how effective prep is
and we all know that the burden of HIV
is greatest in Africa so why is it that
this wonderful and extremely effective
HIV prevention intervention is not
available to the people who need it most
[Applause]
[Music]
three years ago a woman came to see me
in my clinic she was 34 years old she
was a secretary and she’d originally
come to the UK from Nigeria I shall call
her Margaret that morning in my clinic
Margaret sat beside me and said God will
cure me and she refused to take the
treatment that I offered her God will
cure me six months earlier Margaret had
been diagnosed with HIV and I’ve been
trying for several months to persuade
her to come back to clinic after her
diagnosis that day she’d finally agreed
to come back and talk to me Margaret had
had HIV for a long time before she was
diagnosed so she was already very unwell
she had a serious skin infection was
constantly tired with no energy to do
anything but she’d come back late that
day to tell me that she didn’t believe
in the treatment that I was offering her
and that there was nothing I could do to
change her mind I rang her I wrote to
her I begged her to come back to take
treatment I often heard the opportunity
to speak to other people who’d been in a
similar situation to her but nothing
worked a year later she was a admitted
hospital unconscious with a serious
brain infection she never woke up as I
watched her lying unresponsive in her
hospital bed hooked up to tubes and
machines I was overwhelmed by thoughts
of how unnecessary her death had been
my talk is for all women but also for
the men in this room
men who have wives girlfriends sisters
aunts mothers and other women they care
about because Margaret could have been
any one of those women as I look around
I think that I can safely assume that
most of you are adults and will have had
sex subject of sex will be hard for some
of you to talk about and easier for
others but today no matter how you feel
about talking openly about sex I’d like
you to think about it for a moment and
I’d like you to think about the last
time you had sex
maybe this morning I’d like you to think
about whether it felt good
whether you felt pressured whether you
were worried that you might catch
something and whether you used a condom
but I’d also like you to ask yourself
one question
am I sure
that I am my husband or boyfriends only
partner now going back to the sexting
hopefully if you needed to you’ll have
used a condom to prevent an unplanned
pregnancy or to reduce your risk of
catching infection like HIV and you’ll
also know that condoms have been the
mainstay of HIV prevention for many
decades
globally HIV infections and children are
going down because women with HIV are
treated in pregnancy to stop infections
in their babies but in adults despite
huge improvements in access to treatment
there’s been virtually no change in the
number of people catching HIV so now for
some HIV stats worldwide 5,000 people a
day catch HIV and 52% of those are women
Nigeria has 3.2 million people living
with HIV
second highest country in the world
after South Africa in the UK 31 percent
of people with HIV are women and 14
people catch HIV a day two to three of
whom are African Africans in the UK are
more likely to be diagnosed with
advanced HIV because they don’t test
regularly or at all and this means that
by the time they’re diagnosed their
immune systems are already badly damaged
and this is what happened to Margaret
but despite that if she’d accepted
treatment she almost certainly wouldn’t
have died one thing I learned from
conversations with Margaret is that she
didn’t feel that there was anything she
would have done to stop herself from
catching HIV so let’s explore this
further and go back to condoms it’s true
that they definitely work if you use
them but not everybody can use a condom
all of the time and anyway how many of
you have ever tried to force a man to
use a problem if he didn’t want to sing
about condoms is that they take control
away from the very people who are most
affected women many women have shared
that they don’t feel able to tell a
partner to use a condom or to refuse to
have sex with him if he won’t use one so
even if they worry that he has another
partner they cross their fingers and
hope for the best but what if I told you
that HIV infections in some people are
falling
last year something happened that I
never thought I’d see as an HIV
consultant working in London the numbers
of cases of HIV in my clinic fell they
fell my clinic diagnosed is the highest
number of people with HIV in the country
and until 2015
we were diagnosing between 50 and 70
patients a month with HIV but since June
2015 the numbers of cases of HIV have
been falling and in December 2016 we
diagnosed 22 people and this past
October only 12 12 an 81 percent
reduction and this drop in new diagnoses
wasn’t in Africans and it wasn’t in
women it was in men who have sex with
men so why did this happen
well there are several reasons for this
fall including the fact that people on
effective treatment for HIV are not
infectious so they can’t transmit HIV to
anybody else but the most dramatic
reason for the fall in my view is a pill
called prep and men who have sex with
men coming to test for HIV in my clinic
are taking prep Paula Johnson in her
inspirational TED talk asked why leave
women’s health to chance but that’s what
millions of women all over the world
have had to do leave their health to
chance but now they don’t have to so
what is prep well prep is a pill that
when taken with other medicines is used
to treat HIV but on its own has been
shown to prevent HIV and when taken
properly is close to a hundred percent
effective it’s taken every day like the
contraceptive pill and you can take it
when you need to and stop taking it when
you don’t but the one thing you have to
do for prep to work is take it
we’re prep hasn’t worked it’s because
people didn’t take it
behind me is a summary of prep studies
that have been done all over the world
in men and women it shows that prep is
most effective when levels of drug are
highest in the blood and least effective
when they’re low or absent to the left
and at the bottom a full awesome studies
in sub-saharan African women and as you
can see it wasn’t effective in those
studies or as effective in those studies
as it was in the studies higher up on
the graph so why did prep work more
effectively in some studies of women
than in others well remember I said that
for prep to work you have to take it in
some of these studies women didn’t
really believe that they were at risk of
catching HIV so they didn’t take their
prep to other women because prep is an
HIV medicine they worried that some
people might think that they were
already HIV positive and so that was
also a factor but the thing about taking
prep is if you’re taking it nobody needs
to know and I’ll say it again no one
needs to know so you ask does prep have
side effects well the truth is that less
than 10 percent of people who take prep
have side effects and where side effects
occur they usually only last for a few
days the majority of people don’t have
any side effects at all but you say prep
is expensive surely it can’t it costs
too much to be given to everybody but my
answer to that is that it costs more to
treat a person for HIV for their whole
life than it does to prevent HIV for the
small proportion of their life but they
might be at risk and because of this
many countries in the world have started
prep programs and many countries in the
Western world now provide prep for free
prep isn’t widely available in the UK
and so men who have sex with men
are buying it online via a website
called I want prep now but actually the
NHS in Scotland is now providing prep
for free and the NHS in England is
providing it to ten thousand people in a
study not to prove that it works but to
see how many people need it and you can
have it too so for the first time a
woman unable to say use a condom to a
man she worries has other partners or
indeed a woman who has other partners
herself can take a pill and stop herself
from catching HIV prep puts you in
control of whether you catch HIV or not
so I call on you to share this empower
all the women you know use prep and put
the power in your hands so going back to
Margaret whom I spoke about at the
beginning why did I think about her when
I was noticing the effect of breath
because Margaret left her life to chance
but you don’t have to before I go I’d
like to leave you with a question you’ve
seen from my talk how effective prep is
and we all know that the burden of HIV
is greatest in Africa so why is it that
this wonderful and extremely effective
HIV prevention intervention is not
available to the people who need it most
[Applause]
[Music]
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