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Mail & Guardian
5 days ago
- Health
- Mail & Guardian
It's the ‘Donald disease' that's making us sick
US President Donald Trump. 'Hello, sis. How are you? I hope you're fine. I mean, I'm not.' A lot has been going on out there, he told Bhekisisa in the voicemail, one of the many we recently received. 'You know, I'm a gay guy. I have sex with other men, without wearing condoms now, because when I try to fetch them from my local clinic, I'm told I get judged and told I want too many. You know what's happening in our industry.' We will call him Nkosi. Because he has sex with men and because his industry is sex work and because no one in the small community where he lives knows that he is gay or what he does for work. He even has a 'girlfriend' so people will think he's straight. Sex work has always been a dangerous profession. But ever since the administration of US President Donald The World Health Organisation says gay and bisexual men like Nkosi's chance of contracting HIV through sex That is what makes sex workers, as well as gay and bisexual men, what researchers call a ' But the Gone, too, are their health workers specially trained in how to work without discrimination. Gone is their tailor-made HIV treatment and testing services; their specialised mental health support and the condoms and lubricants they handed out for protection against HIV and other sexually transmitted infections. Gone are Preventive medicines like the daily pill are called 'So, sometimes I don't have PrEP,' says Nkosi. 'A partner can tell me he is on PrEP, but I don't trust that. Because where is he getting PrEP? Where am I going to get it? The black market? 'I don't know if it is even the real thing. Is it a counterfeit? Lube? That's another thing — you use everything, anything, as long as it's got jelly in it. The last time I did that I had an itchy penis for a week.' Nkosi calls the domino effect of the Trump administration's decision to pull funding 'the Donald disease because it is being caused by this guy, one man'. 'It's like crossing the freeway every day the way we're living now. One day, I know I'm gonna die.' What's with key populations? When Health Minister But why is there so much focus on these communities? 'Even the most self-interested people should be heavily invested in treatment and prevention of these populations,' says Francois Venter, who heads up the health research organisation, 'There's no clean, magical division between key populations and general populations. It's a Venn diagram of married men sleeping with sex workers, of drug-using populations interacting with your ostensibly innocent kids, gay men with your straight-presenting son, all needing HIV prevention and treatment programmes.' Although we have medicines like PrEP to prevent people from getting infected with HIV and antiretroviral drugs (ARVs) for HIV-infected people, which, if taken correctly, Studies, for example, show that getting people to use the anti-HIV pill, also called oral PrEP, each day, Moreover, the Some of the 1.1 million choose not to start treatment, but an even larger proportion, who do go on treatment, Pepfar programmes That's why having lost at least half of those workers — The difficulty with state clinics and key populations Government clinics are mostly Stigma and discrimination in public clinics — doled out by security guards, cleaners, health workers and patients in waiting rooms — keep people away from HIV treatment and prevention. Motsoaledi Because funding cuts mean already understaffed government health clinics now have even fewer staff, many people with HIV, or those wanting PrEP, have to travel further for treatment or wait in long queues. Here are some of their stories — we collected them via voice notes with the help of health workers who worked for Pepfar programmes that have now been defunded. Female sex worker: 'My child is going to be infected' 'Yoh, life is very hard. Since all this happened, life has been very, very hard.' 'I have tried to go to the public clinic for my medication. But as sex workers, we are not being helped. We are scared to go to the government clinic to treat sexually transmitted infections because we are seen as dirty people who go and sleep around. 'We even struggle to get condoms. We are now forced to do business without protection because it is only our source of income and it's the way that we put food on the table. My worry now is that I am pregnant and my child is going to be infected because I'm not taking my ARVs, and I have defaulted for two months now.' Transgender woman: 'The future is dark' 'I'm a transgender woman. My pronouns are she.' 'When the clinic closed, I was about to run out of medication so I went to the government clinic in my area. I introduced myself to the receptionist and the lady asked me what kind of treatment I was taking. I told her ARVs and that I'm virally suppressed [when people use their treatment correctly the virus can't replicate, leaving so little virus in their bodies that they can't infect others], so I can't transmit HIV to others. 'The lady told me that they can't help me and I need to bring the transfer letter. I told her that the clinic is closed so I don't have the transfer letter. I asked to speak to the manager and the manager also refused to help me. The manager! How can she let someone who is HIV-positive go home without medication? 'I had to call one of my friends and she gave me one container. If you're not taking your medication consistently, you're going to get sick, you're gonna die. And the future? The future is dark.' Migrant farm worker: 'Lose my job? Or risk my health?' 'When we were told that the clinic was closed, I was actually in another town trying to get a seasonal job on the farms. But when I went to the nearest clinic, I was told that I needed to get a transfer letter. So I ended up sharing medication with friends. But then their medication also ran out. 'Then I got a job on the farm. Before the mobile clinics came to the farms and we had our clinical sessions there. The nurse was there, the social worker was there. Now we went to the clinic and spent the whole day there because we had to follow the queues. 'And because our jobs were not permanent jobs, you know, you just get a job if you apply by the gate. So if you are not there by the gate on that day, then the boss will automatically think that you are no longer interested in the job, so they employ someone else. 'I went to the government clinic and asked to get at least three months' supply. But the clinic said no because it was my first initiation so I had to come back. So I went back to the farm to see if I could still have my job. I found that I was no longer employed because they had to take up someone else. 'What am I going to do? If I go to the clinic, I stand a chance of losing my job. If I stay at my job, I am at risk of getting sick.' Transwoman: 'I'll just stay home and die' 'Accessing treatment is difficult because of the long queues. Even that security guard keeps on telling me to go away when I ask for lubricants and he tells me every time there's no lubricants. 'We need the trans clinic back. I need to speak to somebody, a psychologist. On Tuesdays we had our psychologist come in, and the doctor. But now I don't have the funds to go and see even a psychologist. 'It is bad. It is super bad. I don't know when I last took my meds. Another friend of mine just decided, oh, okay, since the clinic is closed and I no longer have medication, I'll just stay home and die.' *These stories were edited for length and clarity. 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Daily Mail
20-05-2025
- Health
- Daily Mail
Major breakthrough as NHS launches world first jab to protect against Britain's most common STI as cases hit record high
Britons will be offered a vaccine for gonorrhoea in the coming weeks as part of a world-first launch by the NHS. Hailed as a 'landmark moment for sexual health', the move aims to tackle rising levels of the increasingly common sexually transmitted infection (STI). More than 85,000 cases of gonorrhoea were recorded in England in 2023, the highest number since records began in 1918. Even more worryingly strains of the bacteria resistant to the antibiotics usually used to treat it are also on the rise. Sexual health charities hailed the move, saying it had the potential to cut new cases of gonorrhoea by 40 per cent. NHS officials said gay and bisexual men with a recent history of multiple sexual partners or of having bacterial STI will be eligible for the new jab. They said patients will be identified and contacted in the coming weeks, with the jab to be rolled out from August 1. Gay and bisexual men were chosen as priorities for the jab based on advice from the Joint Committee on Vaccination and Immunisation (JCVI), a panel of scientists that advise the Government on the rollout of jabs. UK Health Security Agency (UKHSA) data shows there was a 9.4 per cent increase in gonorrhoea diagnoses among gay, bisexual and other men who have sex with men in 2023, with cases rising from 37,095 to 40,586. The vaccine is an existing jab, called 4CMenB, that is currently used to protect people from meningococcal B disease, a serious bacterial infection that can cause meningitis and sepsis. As the bacteria that causes this disease is closely related to the one behind gonorrhoea the antibodies created by the jab offer some protection against the STI. However, experts have warned that the jab, like any other vaccine, isn't perfect and that people who get it should still follow safe sex practices and contact a medic if they develop potential symptoms. Dr Amanda Doyle, national director for primary care and community services at NHS England, said: 'The launch of a world-first routine vaccination for gonorrhoea is a huge step forward for sexual health and will be crucial in protecting individuals, helping to prevent the spread of infection and reduce the rising rates of antibiotic resistance strains of the bacteria.' The JCVI said the 4CMenB vaccine is between 32.7 to 42 per cent effective against gonorrhoea, and while vaccination would slash the risk of becoming infected it doesn't eliminate it completely. However, the body stressed that vaccination would still be beneficial, as previous gonorrhoea infection is thought to offer little protection against future infections. Gonorrhoea is the second most common bacterial STI in the UK after chlamydia. Symptoms gonorrhoea include green or yellow discharge from the vagina or penis, pain when urinating and pain and discomfort in the rectum. For women, symptoms can include lower abdominal pain or bleeding between periods. However, many patients don't have any symptoms. Some studies, cited by the NHS, state that almost half of women and one in 10 men with gonorrhoea are symptom-less and therefore unaware they have the infection. Left untreated, gonorrhoea can render patients infertile or leave them with agonising long term inflammation in their pelvis. WHAT IS GONORRHOEA? Gonorrhoea is a sexually transmitted infection (STI) caused by the bacteria Neisseria gonorrhoeae or gonococcus. This bacteria is usually found in discharge from the penis or vaginal fluid. It is passed through unprotected vaginal, oral or anal sex, as well as sharing vibrators or sex toys that have been used without a condom. The bacteria can infect the cervix, urethra, rectum, throat or eyes. It can also spread from pregnant women to their unborn babies. As the bacteria cannot survive outside the body for long, gonorrhoea is not spread by kissing, hugging, sharing towels, toilet seats or swimming. Around one in 10 men and half of women experience no symptoms. However, these can include: Thick green or yellow discharge from the genitals Pain when urinating Bleeding between periods in women Treatment is usually a single antibiotic injection and tablet. Gonorrhoea can be prevented by using condoms during sex and not sharing sex toys. The rollout of the jab comes amid warnings that cases of gonorrhoea that are resistant to the antibiotic ceftriaxone–usually the first line of treatment for patients who test positive for the disease– are on the rise in England. This means the bacteria that causes the STI has developed the ability to survive and multiply even when exposed to the antibiotic. Some cases are also classed as 'extensively drug resistant' – or XDR – meaning the infection did not respond to ceftriaxone or another drug used as an alternative. In March, UKHSA revealed there were 17 cases of ceftriaxone-resistant gonorrhoea between January 2024 and March 2025. In the same period, there were nine XDR cases reported, compared to five cases between 2022 and 2023. Dr Sema Mandal, consultant epidemiologist and deputy director at UKHSA, said: 'This vaccination programme is a hugely welcome intervention at a time when we're seeing very concerning levels of gonorrhoea, including antibiotic resistant gonorrhoea. 'In 2023 we saw gonorrhoea diagnoses reach their highest since records began in 1918. 'Not only will this roll-out provide much needed protection to those that need it most, but it will make the UK the first country in the world to offer this protection and a world leader in protecting people against gonorrhoea.' Health minister Ashley Dalton urged people to take up the vaccine offer 'not only keep each other safe but help tackle the growing threat of antibiotic resistance'. 'By targeting those most at risk, we can reduce transmission rates from this unpleasant disease that is becoming harder to treat and prevent thousands of cases over the next few years.' Richard Angell, chief executive of Terrence Higgins Trust, described the jab as a 'game changer'. 'This alone could cut 40 per cent of new gonorrhoea cases,' he said. Professor Matt Phillips, president of the British Association for Sexual Health and HIV, added: 'This is excellent news and a landmark moment for sexual health in England. 'A new gonorrhoea vaccination a vital part of our efforts to address the significant inequalities we are seeing in sexual health outcomes.' Neisseria gonorrhoeae, the bacteria that causes gonorrhoea, appears on the UKHSA's list of viruses and bacteria which pose the greatest threat to public health. Health officials say using condoms is the best way to protect yourself against STIs. They also encourage any person who has had condomless sex with a new or casual partner to get tested, regardless of their age, gender and sexual orientation. British medics have seen the drugs they can use to treat gonorrhoea diminish over time. Doctors used to prescribe the antibiotic ciprofloxacin to treat the STI. But in 2005 it was no longer recommended as a treatment because the bacteria had become so resistant to it. Another antibiotic — cefixime — was also dropped for treating gonorrhoea in 2011 after the bacteria again developed a resistance to it.
