In the midst of the pandemic and strict lockdown restrictions, a dedicated team of nurses have been hitting the streets of Glasgow to help some of our most vulnerable communities. Rather than retreat, the pioneering programme, designed to prevent HIV infection has stepped up its efforts to reach homeless people who inject drugs.
Sexual health teams from NHS Greater Glasgow and Clyde have been delivering assessments for HIV PrEP, a simple treatment which can prevent those at high risk of HIV from acquiring the infection. Those at risk take just one pill a day. However, reaching homeless people, who through drug use may be more difficult to track down, seemed like a tall order during lockdown. But with the help of a van and a plan, the service – believed to be a first within the UK – has been more successful than ever.
“We started the service before COVID hit, but when it did we soon realised that the restrictions presented an opportunity for us,” explained Dr Becky Metcalfe, a Consultant in Sexual Health & HIV at the Sandyford Clinic in Glasgow.
“Those who were homeless were being housed in hotels and that meant there was a chance we could reach them easier. We borrowed a van and hit the streets and were able to get to people.”
The team have been working to identify those who may be more at risk of infection through sexual contact. This, coupled with increased risk from injecting drug use, means that many of the 50 people assessed as part of the project are at higher risk of HIV infection.
Becky added: “This is a group that don’t normally come to us for help and that has been disproportionately impacted by both COVID and complexities such as addiction, homelessness, deprivation and mental health issues. It’s a very vulnerable group.
“We decided that rather than pull back, we would do more outreach. The response has been really positive. There’s been a significant HIV outbreak across the homeless population in Glasgow and having more people engaged in this preventative measure will help to tackle that.”
One of those who has benefited most has been Colin. The 28-year-old said it’s one less thing to worry about. “Sometimes I have so much going on that I forget to care about myself,” he said.
“PrEP was definitely a positive thing for me. I was putting myself at risk of HIV. The nurses helped me to get on it and then came to see me every couple of weeks to make sure I was ok. Getting tested all the time and being negative made me feel happier.”
Colin has had regular contact with some of the sexual health and HIV prevention outreach nurses, including Lynsey Boyd. She said: “It might be just a pill a day but it’s so much more than that,” She added.
“By engaging with our teams, we can signpost them to other services that can help them to deal with the many issues impacting on their lives and that’s a big win for everyone.”
The team provide sexual health screening, tests for blood borne viruses, free contraception and support to men and women who may have been victims of sexual assault. As part of drug harm reduction work, the team also distribute clean injecting equipment and naloxone, a medicine that can save the life of someone who overdoses on opioids such as heroine or methadone.
Outreach nurse Natasha Walker said that with lockdown, they quickly had to adapt the way that they worked. “We travelled daily to various hotels, hostels and street locations to meet with clients,” she said.
”We wanted to continue to provide a human connection at a time when vulnerable groups were becoming increasingly isolated and it worked, people would chap the side door of the van asking to speak to us!
Lynsey added: “The results exceeded all of our expectations and we are proud to have been able to adapt and continue to work as effectively as we did.
“Very quickly we noticed that the service was being well received by the homeless population. They engaged well with us, were happy to come in to the van and saw it as a safe and secure clinical space.”
Colin certainly agrees. He said: “Lynsey was brilliant. She made me feel comfortable talking about stuff that I was really embarrassed about. She was always helpful and I wouldn’t have known about PrEP if it wasn’t for her. They even stop and speak to me outside just for a chat!”
The successful programme has attracted interest from health authorities across the UK and Europe and as far afield as Boston in the United States.
While current restrictions remain in place, the team is continuing to hit the streets to support those most in need, using their van and a plan.
*Colin’s name has been changed to ensure confidentiality.