Is PEP effective in preventing HIV infection?

Research indicates that PEP can reduce an infected person’s chance of becoming HIV positive by 81% if it is taken within 72 hours after exposure. PEP works  even if HIV has already entered the body.

PEP should be taken as soon as possible, the earlier, the more effective.
For PEP to be effective, the person who may have been exposed to HIV should strictly adhere to a four week drug programme. If they do not follow the advised medication, they might have the risk of developing drug resistance to HIV drugs, which might affect the effectiveness of antiretroviral treatment if they become HIV positive in the future.

VCT takes only 20 minutes; however, it can only be used as a screening test .  Any positive HIV result must be confirmed by laboratory-based testing with a venous blood sample. It takes about a week to get the results and send them to the laboratory for a confirmed test.

AIDS Concern the following tests in VCT. We offer different tests to different groups.
HIV antibody  test
HIV antigen test
Syphilis antibody  test
Hepatitis C antibody  test
Gonorrhea and non-gonococcal urethritis (Chlamydia) urine test

All testing services are absolutely free, anonymous and confidential. Test paper: Alere HIV Combo
Window period Reliability (After Window period)
Antibody:90 days
Antigen testing window: 15 to 28 days
Positive: 99.72%
Negative: 100%
(After 90 days Window period)

Test paper: Alere Determine Syphilis
Window period Reliability (After Window period): 45 days
Positive: 100%
Negative: 92.31% Test paper: CiTest HCV Rapid Test
Window period Reliability (After Window period) 60 days
Positive: 99.5%
Negative: 99.9%

Home self-testing:
This type of self-test requires users to perform the test and interpret the result all on your own. Instructions are usually given in the kits and on manufacturer websites, often with pictures or photos and sometimes even video demonstration.
In Hong Kong, self-test instruments on blood test and saliva test were able to be obtained from NGO such as AIDS Concern, and in some drug stores.

Is PEP effective in preventing HIV infection?

Research indicates that PEP can reduce an infected person’s chance of becoming HIV positive by 81% if it is taken within 72 hours after exposure. PEP works  even if HIV has already entered the body.
PEP should be taken as soon as possible as its effectiveness varies according to the time of initiation. For PEP to be effective, the person who may have been exposed to HIV should strictly adhere to a four week drug programme. If they do not adhere well to the medication, they might have the risk of developing drug resistance to HIV drugs, which might affect the effectiveness of antiretroviral treatment if they become HIV positive in the future.

Does PEP have side-effects?

Yes. The side-effects of PEP can be strong but conditions vary from person to person. Generally, PEP can cause diarrhoea, headaches, nausea and vomiting but these side effects usually stop once the treatment is finished.

Who should take PrEP?

The World Health Organization (WHO) has affirmed PEP as an important secondary HIV prevention measure. A guideline  has been  published in 2014, recommending PEP regardless of whether the exposure is transmitted through occupational or non-occupational routes. The WHO recommends that individuals shall be eligible for PEP if:
a) Parenteral or mucous membrane (for example in the vagina or anus) is significantly exposed to a potentially infectious body fluid
b) Exposure to HIV  has occurred within the past 72 hours

If I have doubts about whether I am infected with HIV after potential exposure, what should I do?

HIV only enters human body when the end of the penis, vagina, inner wall of the anus, non-intact skin or other mucous membrane (e.g. oral mucosa) with wounds is exposed to contaminated blood, prostrate secretions, semen, vaginal secretions and rectal secretions. A person will not get infected with HIV when his/her intact skin is exposed to contaminated body fluids.

PEP is recommended for the following conditions:
1.    The exposure has occurred within the past 72 hours.
2.    The exposed person has not been previously infected with HIV
Please note that the risk of HIV infection may vary according to the HIV viral load of the potentially infectious body fluid, the depth of the wound in non-intact skin or mucous membrane, and the length of contact with high risk body fluids. Therefore, even if your case meets all the above conditions, doctors in the hospitals will still determine the need for PEP prescription according to your actual situation.

How to get PEP ?

Currently, public hospitals in Hong Kong would prescribe PEP for medical professionals who might have been infected with HIV through occupational exposures (e.g. a medical staff member getting cut or pricked by a needle). According to the guideline from the Centre for Health Protection, any use of PEP for non-occupational exposure (nPEP) would be ‘exceptional and should be considered only in the event of high-risk exposure to a source known to be HIV positive’ within 72 hours of exposure.The public hospitals  focus on the use of PEP for medical staff but will also give access to the public when they think it appropriate.

For individuals interested in getting medical consultation related to PEP, please go to the Accident and Emergency Department in your nearest public hospital and explain your case to the doctor, who would determine the need for PEP prescription on a case by case basis. It is important to note that doctors will want to understand if you have definitely been exposed to HIV and also if it is within 72 hours.

List of Accident and Emergency Departments

The other option is to access PEP via a private clinic or private hospital. Below are details of two clinics which AIDS Concern knows will advise and prescribe PEP. This is a listing  of known service providers but not recommendation by AIDS Concern. If you happen to know any other specialist clinics privately prescribing PEP, please let us know so that we can add them to the list. The charge for medication is about 10, 000-30, 000 dollars, depending on the patient’s situation. You may consult the clinic or hospital directly for more information.

If I have doubts about whether I am infected with HIV after potential exposure, what should I do?

HIV only enters human body when the end of the penis, vagina, inner wall of the anus, non-intact skin or other mucous membrane (e.g. oral mucosa) with wounds is exposed to contaminated blood, prostrate secretions, semen, vaginal secretions and rectal secretions. A person will not get infected with HIV when his/her intact skin is exposed to contaminated body fluids.

PEP is recommended for the following conditions:
1.    The exposure has occurred within the past 72 hours.
2.    The exposed person has not been previously infected with HIV

Please note that the risk of HIV infection may vary according to the HIV viral load of the potentially infectious body fluid, the depth of the wound in non-intact skin or mucous membrane, and the length of contact with high risk body fluids. Therefore, even if your case meets all the above conditions, doctors in the hospitals will still determine the need for PEP prescription according to your actual situation.

How to get PEP?

Currently, public hospitals in Hong Kong would prescribe PEP for medical professionals who might have been infected with HIV through occupational exposures (e.g. a medical staff member getting cut or pricked by a needle). According to the guideline from the Centre for Health Protection, any use of PEP for non-occupational exposure (nPEP) would be ‘exceptional and should be considered only in the event of high-risk exposure to a source known to be HIV positive’ within 72 hours of exposure.The public hospitals focus on the use of PEP for medical staff but will also give access to the public when they think it appropriate.

For individuals interested in getting medical consultation related to PEP, please go to the Accident and Emergency Department in your nearest public hospital and explain your case to the doctor, who would determine the need for PEP prescription on a case by case basis. It is important to note that doctors will want to understand if you have definitely been exposed to HIV and also if it is within 72 hours.

List of Accident and Emergency Departments

The other option is to access PEP via a private clinic or private hospital.

Below are details of two clinics which AIDS Concern knows will advise and prescribe PEP. This is a listing  of known service providers but not recommendation by AIDS Concern. If you happen to know any other specialist clinics privately prescribing PEP, please let us know so that we can add them to the list. The charge for medication is about 10, 000-30, 000 dollars, depending on the patient’s situation. You may consult the clinic or hospital directly for more information.

 What is the treatment for HIV?

HIV is treated with antiretroviral medications, which work by stopping the virus replicating in the body. This allows the immune system to repair itself and prevent further damage. A combination of HIV drugs is used because HIV can quickly adapt and become resistant. That is why, it is also called the cocktail therapy.

Do people living with HIV(PLHIV) need to take a lot of medication?

Today, People living with HIV(PLHIV) do not need to take a lot of medicine every day. Dose usually consists of one to three pills once or twice a day.

How to handle the adverse side effects?

It is normal to have insignificant side effects such as headache, diarrhea, vomiting, dizziness, etc. People living with HIV should not cut down, skip or stop medicine without instruction. If they feel very unwell or experience any serious side effects, they should inform their medical staff.

Do people living with HIV have a huge financial burden as HIV infection is a chronic disease?

No. Take the new fee on October 2017 as an example: it is HK$135 for the initial assessment, HK$80 for follow up and HK$15 for each prescription for a Hong Kong citizen visiting a specialist clinic in the public hospitals. The yearly fee for clinic visits is around HK$400-700, depending on the follow up frequency and medication.

Where can people living with HIV get treatment under the Hong Kong public healthcare system?

There are three Specialist Out-patient clinics in Hong Kong currently, the Kowloon Bay Integrated Treatment Centre under the Department of Health, Queen Elizabeth Hospital and Princess Margaret Hospital under the Hospital Authority. They provide the best medical treatment to people living with HIV. A person in need may visit the one near them but they must make a reservation and have a doctor’s referral.

What is the process of treatment if one is diagnosed with HIV?

A detailed health checkup will be carried out upon the first visit to the specialist clinic. A doctor will meet the person living with HIV in 2 weeks’ time to assess his/her situation and lifestyle to decide when to start medication. If the HIV status is stable, a follow up will be done after 3 to 4 months.

For more information, please refer to the following videos published by AIDS Concern:
First registration at Specialist Out-patient Clinic:
https://www.facebook.com/1720959898172087/videos/1947841855483889/

First interview with specialist nurse:
https://www.facebook.com/1720959898172087/videos/1949805471954194/

First interview with doctor:
https://www.facebook.com/1720959898172087/videos/1949806948620713/

Can people living with HIV stop medication if the CD4 goes back to normal level?

It is very dangerous to stop medication without doctors’ instruction because the CD4 cell count of the infected person will fall over time. If the CD4 cell count falls below 200, there are significant risks of developing serious illnesses. The lower the CD4 cell count, the greater damage to the immune system and risk of illness. In order to keep the CD4 cell count above 200 and maintain the virus load at an undetectable lever, people living with HIV should have a healthy lifestyle and take medication on time. This can also prevent opportunistic infections.

How can undetectable viral load prevent HIV transmission?

Antiretroviral therapy, when done continuously and correctly, can effectively reduce the quantity of the virus in people living with HIV to an undetectable viral load. This reduces the risk of transmitting HIV to others. According to the research of PARTNER Study, the chance of transmission by a people living with HIV with an undetectable viral load is minimal. Thus, receiving proper treatment as early as possible can effectively manage the body condition and prevent transmission of HIV.

How can partner notification prevent HIV transmission?

Through discussing with people living with HIV about notifying their sex or drug-injecting partner(s) of their possible exposure to HIV and encouraging partners to get tested, partners who are diagnosed with HIV can receive early treatment services, and those with a HIV-negative result can be linked to appropriate and effective prevention.

Dr.Rainbow Scheme 

According to AIDS Concern’s frontline experience and research, 9% of gay men would not seek medical services related to sexual health due to fear of disclosing their sexual orientation. 20% of them do not seek medical assistance due to fear of disclosing their sexuality. 55% of the gay men would hide their sexual orientation and avoid talking about their homosexual practices when they seek the above medical services. We believe that stigma associated with the gay identity is a major barrier to effective HIV prevention and treatment as an unfriendly social environment deters people from seeking medical assistance.

Therefore, we have launched the Dr. Rainbow Scheme in 2015 with the aim to improve the health of sexual minorities by promoting a more LGBT-friendly medical environment. By attending our LGBT-friendly Healthcare Seminar, health professionals learn about the health concerns and culture of the sexual minorities, as well as the effective way of communicating with LGBT patients.

We encourage doctors to join our scheme to learn more about gay people’s culture and healthcare concerns. We are educating doctors about skills for gay friendly consultation by inviting them to attend our “Gay-friendly Healthcare Training Workshop” or “Gay-friendly Healthcare Webinar” to have more effective and sensitive communication with their gay patients.

AIDS Concern hopes that doctors’ commitment to gay-friendly medical services will contribute to the health of the local gay community. Should you have any enquiries, please feel free to contact +852 2898 4411.

Legal rights for sexual minorities

Human dignity must be universally respected and protected. Discrimination of any kind has no place in any civilised society including Hong Kong. In fact, many LGBT people experience higher levels of depression, mental health problems, drug and alcohol over-use. LGBT people have identified stigma and discrimination as important contributory factors leading to these issues which in turn increase the risk that people do not have safer sex. Therefore AIDS Concern advocates the following legal rights for sexual minorities:

– We advocate the equal treatment of every person irrespective of sexual orientation and gender identity.
– We call on Hong Kong government to take immediate action to protect LGBT persons from discrimination. This refers to the provision of goods, services, facilities and accommodation customarily available to the public, where the denial of such goods, services, facilities and accommodation is based on sexual orientation (homosexuality and bisexuality) or gender identity.
– We advocate that the Equal Opportunities Commission be given the jurisdiction to promote LGBT rights and to investigate complains, and the power to initiate proceedings in respect of breaches of the legislation.

Crucial steps for PrEP:
Before starting PrEP – TEST if you are suitable for PrEP

1. You must take an HIV test and be sure that you are HIV-negative to avoid developing drug resistance to anti-HIV medication.
2. You also need to be tested to ensure good kidney and liver function.
3. Understand your dosage for PrEP – daily or on-demand.

Daily PrEP
The easiest method for all genders is to take PrEP daily – take one Truvada pill at the same time each day. It takes different time for different body parts to build up the drug concentration to prevent HIV. If you are having receptive anal sex (bottoming), it takes 7 days of daily PrEP before you are protected from HIV.
If you are having insertive anal sex (top) or vaginal sex it takes 20 days of daily PrEP before you are protected. [Illustration]

On demand PrEP
Some people are taking PrEP before and after sex (on demand). This method only works for men having anal sex with men (MSM), not for people having vaginal sex. MSM can first take two pills (double doses) 2-24 hours before sex, then one pill 24 hours after the first dose and another 48 hours after first double dose. This is called 2-1-1 dosing.

In the event of sex on several days in a row, one pill should be taken each day until 48 hours after the last sexual intercourse. (IPERGAY,2017)

If you are using PrEP correctly, it is very unlikely you will get HIV. Research studies show PrEP reduces the risk level of someone with HIV infecting you by more than 99%.

Consult your doctor before deciding which method is suitable to you.

Important note: PrEP may not be suitable for people with kidney and liver functioning abnormalities, such as Hepatitis B.

Remarks:
1. AIDS Concern has received legal advice on ordering PrEP online for delivery into Hong Kong. Buying PrEP online and having it mailed to you in Hong Kong is not legal. Hong Kong Customs and Excise Department has the power to stop the shipment and prosecute.

2. If you are considering buying online, you should make sure that you have the necessary medical checkups or a recent prescription for PrEP, like Liver and Kidney, HIV checking.

3. AIDS Concern has received legal advice on the act of bringing PrEP from another country into Hong Kong. Buying PrEP in another country and bringing it back to Hong Kong is, in practice, protected by a customs exemption, as long as the medication is for personal use and carried with the person who is travelling.

4. Do not be tempted to buy PrEP and take it without receiving medical checkups:

5. If you have Hepatitis B, kidney or liver function problems, taking PrEP could be dangerous.

what is combined prevention ? 

No single HIV prevention intervention offers a magic bullet. Therefore, effective HIV prevention programs require a combination of behavioral, biomedical and structural interventions.

The World Health Organisation strongly recommends combination prevention for HIV. Some of these interventions are well established in Hong Kong, but many are still under-utilised (condoms, HIV testing, PEP, comprehensive sexuality education) and some have not been introduced (PrEP, harm reduction (drugs), mental health, Undetectable equals Untransmittable, anti-discrimination law).

Male Condom

How to use a male condom:

1. Check the expiry date on the condom packing. Avoid using condoms after the effective date as they are less effective and more likely to break.

2. Make sure the packing of condom is intact. Some people may have their condoms stored in wallets, this might damage the condoms. Discard any condom that is torn or shows signs of damage. Use only condoms in good condition.

3. Carefully open the wrapper and take the condom out. Avoid using teeth or ripping the package forcefully, as this can damage the condom.

4. Make sure the rubber ring on the edge of the condom is facing outward so that it can be rolled down without difficulty.

5. Pinch the top of the condom and place it on the erect penis. Pinch the tip to release excess air and leave extra space at the top to collect semen.

6. Roll down the rubber ring of the condom from the tip of the penis towards the bottom of the penis.

7. Condoms in general come with lubricant applied. If the condom you choose does not have lubricant on its surface, apply a small amount of water-based or silicone-based lubricant to the outside of the condom.

8. After ejaculation, press down on the bottom of the condom and pull out the penis. Prevent the condom from falling due to softening of the penis.

9. Carefully remove the condom, knot it at the open end, wrap it in a paper towel, and then throw it into the trash can. (DO NOT flush the finger cot
down a toilet).

flavor of male condom

Condoms can be made with different materials. Each material has its own characteristics and prices may vary. The following guide may help you to choose a suitable condom:
Latex
Latex condoms are very flexible, thin sheaths. Latex is an effective barrier against sperm, bacteria, and virus. However, latex does not transfer heat, which can reduce pleasurable sensations. Avoid using oil or oil-based lubricant with a latex condom. Oils will break down latex, which may cause damage to the condom. Water- or silicone-based lubricants are the best options when using a latex condom.

Polyurethane
Polyurethane is a plastic material used in many contexts, from insulation to furniture and condoms. Polyurethane condoms are usually thinner than latex condoms, and they are better at transferring heat. Polyurethane condoms provide effective barriers against HIV and STIs. However, polyurethane is less flexible than latex, which makes them slightly more fragile than latex condoms.

Polyisoprene
Polyisoprene is very similar to latex, but it lacks the proteins that can sometimes cause allergic reactions. These condoms are slightly thicker than polyurethane, but they are softer and give a more natural feeling than latex.

Female condom

The internal condom, also known as the female condom, is a pouch made of polyurethane or nitrile.  The pouch is open at one end and closed at the other, with a flexible ring at both ends. The ring at the closed end is inserted into the vagina to hold the condom in place. The ring at the open end of the pouch remains outside of the vagina.

The correct way to put on and remove an internal condom is :

1. Carefully open the packaging so the condom does not tear.
2. Put lubricant on the outside of the closed end.
3. Squeeze together the sides of the inner ring at the closed end of the condom and insert into the vagina.
4. Push the inner ring into the vagina or anus as far as it will go, with the outer ring lying outside the vagina or anus.
5. If the outer ring is pushed inside the vagina during sex, stop and put it back in the right place.
6. Make sure the penis enters the condom and does not go between the condom and the wall of the vagina.
7. Immediately after sex, slightly twist and pull the end of the condom to remove it, taking care not to spill any semen in the vagina.
8. Safely dispose the condom.  (DO NOT flush the finger cot
down a toilet).

Other safer sex measures

Finger Cot, Dental Dam are other ways to protect you from HIV, STIs or other infections.

Using finger cots can reduce your risk of being exposed to any viruses or bacteria
in your partner’s secretions and can provide protection against the transmission of infection
in cases where there are cuts or abrasions on the skin of the finger.

How Do I Use a Finger Cot?

1. Carefully open the packaging so the condom does not tear.
2. Place the finger cot on the tip of your finger.
3. Roll the finger cot all the way to the base of the finger.
4. Smooth out any air bubbles.
5. When finished, remove used finger cot.
6. Carefully dispose of finger cot in a garbage receptacle (DO NOT flush the finger cot
down a toilet).
7. Wash hands with warm water and soap.

It is possible to pass a sexually transmitted infection to a partner through oral-genital or oral-anal sex. Dental dam (Oral dam) can be effective in reducing this risk.

How Do I Use a Dental Dam?

1. Simply unroll the dental dam and place it over the vulva or anus before performing oral sex.
2. Make sure to use the dental dam during the entire session, from start to finish.

Note that dental dams are used over the vulva or anus. When performing oral sex on a man, a person should use a condom instead of a dental dam.

Will the medication bring lots of adverse side effects?

Many drugs of cocktail therapy have been released in recent years which have insignificant side effects. Common side effects include headache, diarrhea, vomiting, dizziness, etc., but they are manageable. If an infected person suffers from long term side effects, such as kidney problems or liver damages, they may change medicines depending on doctors’ judgment.

Do people living with HIV have a huge financial burden as HIV infection is a chronic disease?

No. Take the new fee on October 2017 as an example: it is HK$135 for the initial assessment, HK$80 for follow up and HK$15 for each prescription for a Hong Kong citizen visiting a specialist clinic in the public hospitals. The yearly fee for clinic visits is around HK$400-700, depending on the follow up frequency and medication.

Where can people living with HIV get treatment under the Hong Kong public healthcare system?

There are three Specialist Out-patient clinics in Hong Kong currently, the Kowloon Bay Integrated Treatment Centre under the Department of Health while Queen Elizabeth Hospital and Princess Margaret Hospital under the Hospital Authority. They provide the best medical treatment to PLHIV. A person in need may visit the one near them but they must make a reservation and have a doctor’s referral.

What is the process of treatment if one is diagnosed with HIV?

A detailed health checkup will be carried out upon the first visit to the specialist clinic. A doctor will meet the PLHIV in 2 weeks’ time to assess his/her situation and lifestyle to decide when to start the medication. For most the case, the level of HIV has been managed by the medication in 6 months and PLHIV only need to attend the medical appointment regularly every 3 to 4 months or even longer.

For more information, please refer to the following videos published by AIDS Concern:

First registration at Specialist Out-patient Clinic:
https://www.facebook.com/1720959898172087/videos/1947841855483889/

First interview with specialist nurse:
https://www.facebook.com/1720959898172087/videos/1949805471954194/

First interview with doctor:
https://www.facebook.com/1720959898172087/videos/1949806948620713/

Can people living with HIV stop medication if the CD4 goes back to normal level?

It is very dangerous to stop medication without doctors’ instruction because the CD4 cell count of the infected person will fall over time. If the CD4 cell count falls below 200, there are significant risks of developing serious illnesses. The lower the CD4 cell count, the greater damage to the immune system and risk of illness. In order to keep the CD4 cell count above 200 and maintain the virus load at an undetectable lever, people living with HIV should have a healthy lifestyle and take medication on time. This can also prevent opportunistic infections.

How can undetectable viral load prevent HIV transmission?

When the antiretroviral therapy has been used under doctor’s instruction, the HIV has been suppressed by the medication to a very low level, we called “undetectable viral load”. This reduces the risk of transmitting HIV to others. According to the research of PARTNER Study, the chance of transmission by a people living with HIV with an undetectable viral load is minimal. Thus, receiving proper treatment as early as possible can effectively manage the body condition and prevent transmission of HIV.

How can partner notification prevent HIV transmission?

Through discussing with people living with HIV about notifying their sex or drug-injecting partner(s) of their possible exposure to HIV and encouraging partners to get tested, partners who are diagnosed with HIV can receive early treatment services, and those with a HIV-negative result can be linked to appropriate and effective prevention.

Why comprehensive sexuality education is matter in HIV prevention?

According to World Health Organization, Comprehensive sexuality education (CSE) plays a central role in the preparation of young people for a safe, productive, fulfilling life in a world where HIV and AIDS, sexually transmitted infections (STIs), unintended pregnancies, gender-based violence (GBV) and gender inequality still pose serious risks to their well-being. (Slide 1)

What is Comprehensive sexuality education?

In 2018, United Nations Education, Scientific and Cultural Organization (UNESCO) published an updated version of International technical guidance on sexuality education which advocates for quality CSE to promote health and well-being, respect for human rights and gender equality, and empowers children and young people to lead healthy, safe and productive lives. (Slide 2)

The effective Comprehensive Sexuality Education should including meaningful participations of young people with the following areas: Knowledge
Provides a critical foundation information to young people Attitudinal
Help young people shape their understanding of themselves, sexuality and the world Skills-building
Enable learners to take action.

How is the situation of Comprehensive sexuality education in Hong Kong?

Since the existing Guidelines on Sex Education in Schools was published in 1997, it has been used by local schools. It vaguely suggests that “schools could consider factors such as resources, ethos, mission, students’ needs and so on before adopting the most appropriate way to implement sex education…” while the specific curriculum and class hours of sex education are not mentioned. As a result, different schools have different sex educations. In most of the cases, sex education is not a compulsory subject and is usually in the form of abstinence approach, which merely focuses on teaching about the human reproductive system, consequences of underage sex and teenage pregnancies.

AIDS Concern advocate for the implementation of comprehensive sexuality education in school in a positive manner.
Below pls find the position paper of AIDS Concern in comprehensive sexuality education
https://aidsconcern.org.hk/wp-content/uploads/2018/02/Positivesexualityeducation_ACposition_eng.pdf

How can I access to comprehensive sexuality education in Hong Kong?

AIDS Concern offer wide ranges of workshops to the public, professionals who would like to learn more about HIV, sexual health and sexuality education. The workshop will be conducted by the experienced workers in AIDS Concern.
AIDS Concern believe that sexuality education should include Knowledge (accurate knowledge on sexual health) , Attitude(openness to accept the diversity of others) and Skill (communication skills and other social skills) while sexuality education is not only about sexual behavior but include relationship with others and oneself. While the perceptions of the society towards sexuality cannot be neglected which may affect one ‘s choice in sexuality.

AIDS Concern aims at providing comprehensive sexuality education embracing gender equality , diversity and positivity in sexuality with interactive and reflective approach. After the workshop, the participants can equip correct knowledge’s on sexual health and basic skills and insights on sexuality education.

What is the approach of Advocacy in AIDS Concern?

Advocacy in AIDS Concern? AIDS Concern determines to use evidence based approach to advocate for the community stakeholders to make changes in policy, structural level. Community engagement and participation is crucial in advocacy as the community stakeholders are the agents of the issue. Advocacy is a kind of measures which include mobilization and lobby other stakeholders such as government officials, communities and business. Apart from mobilization, conducting different researches is also crucial to provide strong evidence to our strategy in preventing HIV/AIDS.

What is the focus of advocacy in AIDS Concern?
-PrEP
-Self-testing
-Comprehensive sexuality Education (CSE)
-The needs and supports of heterosexual men (MH)
-Legal rights for sexual minorities
-PEP

Background:
PrEP is a highly-effective medicine that can prevent HIV. It is also recommended by WHO as an additional prevention choice in 2015. However, Hong Kong government is still not putting PrEP as a public health issue.

Something we are in progress/we did:
Therefore, We have regular meetings with different stakeholder including community, doctors, government to consult their opinions towards PrEP implementation. For the long-term, some of the local studies’ reports will be published. We may use some of the data to advocate the government to move forward about PrEP implementation.

Our Position Paper:
https://aidsconcern.org.hk/wp-content/uploads/2018/03/ACpositionpaperonuseofPrEP_20160602.pdf

Media Exposures (From recent):
The News Lens，2019年3月25日，《愛滋有得醫？預防資訊你要知》:
https://hk.thenewslens.com/article/116037

The News Lens，2018年8月2日，《已經2018年了，還以為愛滋病是絕症？》:
https://hk.thenewslens.com/article/101057

Gdottv，2018年3月13日，《【請廣傳】PrEP 事前預防性投藥》:
http://gdottv.com/main/archives/21681

Background:
According to the data from PRiSM 2017, the HIV testing rate in the past 12 months among MSM in HK was also 53%, in which the Hong Kong Advisory Council on AIDS(ACA) recommends the HIV testing of MSM should be tested for every 12 months. Besides, we knew some people may feel embarrassed for testing in center. More choices for testing are needed.

Something we are in progress/we did:
Therefore, we launch the HIV self-testing (“Self Test Hong Kong”) in the beginning of 2019. We also held a press conference to raise the public awareness of HIV test and emphasize our follow-up services such as counselling and referral.

Our position paper:
https://aidsconcern.org.hk/wp-content/uploads/2018/03/AIDSConcernpositionpaperonself-testing_ENG.pdf

Media Exposures (From recent):
The News Lens，21st May, 2019，《愛滋測試多選擇　推高檢測率有方法》
https://hk.thenewslens.com/article/119476

HK01，10th April, 2019，《「關懷愛滋」推愛滋病病毒自我檢測工具　冀助有需要人士定期檢驗》
https://www.hk01.com/  社會新聞/316482/關懷愛滋-推愛滋病病毒自我檢測工具-冀助有需要人士定期檢驗

Comprehensive sexuality Education (CSE)

Background:
The “Guidelines on Sex Education in Schools” was written in 1997 and the school participation was not satisfactory and causes some social problems in youth. Also, because of the rapid changes in recent years, we think that there should be some changes in the sexuality education in HK.

Something we are in progress/ we did:
We form a “Sexuality Education Alliance” with different NGOs to show our concerns. We wrote some articles and approached media for better promotion of CSE. We are also lobbying legislative councilors for more follow-up inside the legislative council. We urge the government to conduct research and review the Guidelines to know more the development of sex education in Hong Kong.

Our position paper:
https://aidsconcern.org.hk/wp-content/uploads/2018/02/Positivesexualityeducation_ACposition_eng.pdf

Media Exposures and other exposures:
Sexuality Education Alliance* x Ip Kin-yuen x Regina Ip，10th May 2019:   Facebook  

HK01，28th August 2018，《青少年以為體外射精、事後沖洗可避孕　機構：反映性教育不足》
https://www.hk01.com/ 社會新聞/228475/青少年以為體外射精-事後沖洗可避孕-機構-反映性教育不足

HK01，17th July 2017，《逾8成受訪少女非每次要求男友戴套　團體籲改善性教育》
https://www.hk01.com/ 社會新聞/105459/逾8成受訪少女非每次要求男友戴套-團體籲改善性教育

The needs and supports of heterosexual men (MH)

Background:
MH team received many enquiries from heterosexual men about their high anxiety level towards sex. In our recent data report, we found that 13% (83/653) of users self-reported that they had the different levels of anxiety induced by HIV and STIs. Among those with anxiety on HIV and STIs, almost 17% (14/83) of users felt hopelessness or suicidal thoughts. Among those with anxiety, 72%(60/83) actually had“low/no risk of HIV infection. In fact many of them have anxiety level (5.9/10) higher than those with high risk of HIV infection.

Something we are in progress/ we did:
We held a press conference to raise the importance of sexuality education and an increase budget in the promotion of sexual health to heterosexual men.

Media Exposure:
HK01，20th February, 2019，《13%「直男」發生性行為後感焦慮　機構促政府加強青少年性教育》
https://www.hk01.com/ 社會新聞/297564/13-直男-發生性行為後感焦慮-機構促政府加強青少年性教育

Legal rights for sexual minorities

Background:
To ensure the effectiveness of our prevention work and support service, we believe that it is important to safeguard the legal rights of the sexual minorities (LGBT) so that they would not be discriminated. Also, we believed treatment for HIV in Hong Kong is good but the fear and stigmatization mean that some LGBT people do not seek heath advice from doctors or others. They are fearful that they will not be treated sensitively or that their sexuality will be revealed and therefore cause them problems. Thus, working with LGBT (lesbian, gay, bisexual and transgender) groups, community
members and government to eliminate discrimination based on sexuality is a key priority to prevent HIV.

Something we are in progress/we did:
We participated in Hong Kong Pride Parade every year and met with Equal Opportunities Commission Chairperson.

Our position paper:
https://aidsconcern.org.hk/wp-content/uploads/2018/02/LGBTRights_ACPositionPaper_eng_0612.pdf

Background:
AIDS Concern recognizes that there are serious barriers to the access to PEP for non-occupational exposure in Hong Kong and calls for the urgent action of the Hong Kong government to make sure the community understands PEP and to make sure guidelines on PEP are being implemented to prevent HIV infection. In November 2018, The Centre for Health Protection updated the “Recommendations on the use of non-occupational post-exposure prophylaxis against HIV. It recommends that providing a territory-wide approach to the appropriate and standardized use of nPEP. It supports the use of nPEP in certain circumstances with initial assessment by medical practitioner and follow-up arrangement.

Centre for Health Protection: “Recommendations on the use of non-occupational post-exposure prophylaxis against HIV” in November 2018
https://www.chp.gov.hk/files/pdf/recommendations_on_the_use_of_non_occupational_post_exposure_prophylaxis_against_hiv_november2018.pdf

Our position paper:
https://aidsconcern.org.hk/wp-content/uploads/2018/03/ACposition-paper-on-PEP_ENG_20160602.pdf

Dr. Rainbow Scheme

Background:

From our frontline experience, many LGBT shows fear and stigmatization which alter them to seek heath advice from doctors or others. They are fearful that they will not be treated sensitively or that their sexuality will be revealed and therefore cause them problems. The elimination of discrimination based on sexuality is a key priority in working to prevent HIV.

Thus, Dr. Rainbow Scheme was launched in 2015 with the aim to improve the health of sexual minorities by promoting a more LGBT-friendly medical environment. By attending our LGBT-friendly Healthcare Seminar, health professionals learn about the health concerns and culture of the sexual minorities, as well as the effective way of communicating with LGBT patients.

What we are in progress/ we did:

We have done a survey in 2016; we found that 9% of gay men would not seek medical services related to sexual health due to fear of disclosing their sexual orientation. 20% of them do not seek medical assistance due to fear of disclosing their sexuality. 55% of the gay men would hide their sexual orientation and avoid talking about their homosexual practices when they seek the above medical services.

We also provide training workshops to medical students, doctors and invite them to join the scheme, so that they can learn more about LGBT people’s culture and healthcare concerns.

Moreover, to reduce gay people’s fear of stigmatization and improve their access to healthcare, AIDS Concern will also promote the scheme in the community through different channels on the internet and large gay events. The promotional materials will not display the name or service information of the doctors who have participated in the scheme but the doctors’ names and specialty will be displayed in the AIDS Concern website.

We will continue to promote it to our community and make them easily access LGBT friendly doctors.

Other media exposures (From recent)

RTHK，《精靈一點》， 17th June 2019
https://www.rthk.hk/tv/dtt31/programme/healthpedia_tv/episode/567266

HK01，《愛滋患者需用公筷？　關懷愛滋：電視劇錯誤信息增患者自我歧視》，20th November 2018
https://www.hk01.com/ 社會新聞/261233/愛滋患者需用公筷-關懷愛滋-電視劇錯誤信息增患者自我歧視

Inmediahk，《全港首個愛滋病污名現況研究 社會醫護誤解深 呼籲正視愛滋》，21st February 2014
https://www.inmediahk.net/node/1021032

Media Exposure:
Gdottv, 22nd March 2019, 《什麼是同志友善問診?按入來去片!》
http://gdottv.com/main/archives/23159

Gdottv, 24th July 2018, 《同志友善醫療推廣計劃》
http://gdottv.com/main/archives/22699

Skypost, 11th May 2016, 《男同志求診透露性傾向醫生反責：天主不容》
https://skypost.ulifestyle.com.hk/article/1606562/男同志求診透露性傾向%20醫生反責：天主不容

Our printed material and videos :
“Gay-friendly Doctor Handbook”:
https://aidsconcern.org.hk/wp-content/uploads/2018/01/Gay-friendlydoctorhandbooke-version.pdf

For community: “同志友善醫療計劃 Dr. Rainbow Scheme”，28th May 2019
https://www.youtube.com/watch?v=zzxex23D-hI

For doctors: “同志友善醫療推廣計劃 (Dr Rainbow Scheme)”，13th March 2019
https://www.youtube.com/watch?v=ZGMXTx6Tpz4

For doctors who want to participate the scheme, please fill in the form:
https://docs.google.com/forms/d/e/1FAIpQLSfF93iXo5h7OjH2_FBtAUgOdQApHws5CuhfEjGZNusSO80sVA/viewform

Besides, we would also like to thank the following doctors and medical professionals who participated in the Dr. Rainbow Scheme, and supported our activities and online training.

AIDS Concern provides mobile testing services in different remoted area for MSM population.
AIDS Concern the following tests in mobile testing.
HIV antibody test
HIV antigen test
Syphilis antibody test
Hepatitis C antibody test