Blog posts

Stop blaming PrEP for the rise in STIs – the picture is more complex than that


Rising rates of STIs has fuelled a debate about whether growing PrEP use might be propelling the STI epidemic. Oli Stevens and Charles Witzel argue why this narrative is misleading and damaging. 

The UK recently celebrated two landmark achievements in the ongoing fight against HIV. It is now the seventh country to reach the United Nations target of 90-90-90: that 90% of people living with HIV know their status, of whom 90% are on antiretroviral treatment, and of whom 90% are unable to transmit the virus to others.

Also, London became the first city in the world to achieve 95-95-95. These are remarkable achievements and are a testament to the tireless, collective work of doctors, activists, policymakers and civil society organisations.

Zeroing in on the progress made in reducing new HIV infections between men who have sex with men (MSM), particularly the nearly one-third decrease between 2015-2017, two likely contributors stand out: a scale-up in HIV testing, rapid progress to treatment and pre-exposure prophylaxis (PrEP).

PrEP, sometimes discussed in hushed terms as a potential means of ending HIV transmissions, is a pill taken once daily or around higher-risk sex that markedly reduces the risk of contracting HIV.

This recent success also invites us to take stock and reflect on our failures, the perhaps unexpected costs of progress and the emerging roadblocks on the horizon.

The decrease in HIV transmissions has not been matched with a decrease in sexually transmitted infections (STIs). Instead, new diagnoses have risen year-on-year. The causal factors fuelling this increase are complex, driven by social and political changes. (more…)

Providing medical care during a mission to Mars: science or fiction?

50 years on from the historic Apollo Moon landings, the race to Mars is on. With this in mind, Dr Matthieu Komorowski is examining how to provide medical care during long-flight space missions.

“The extension of life beyond Earth is the single most important thing we can do as a species” once said Elon Musk, the CEO of SpaceX.

Many other eminent minds have expressed a similar vision, including Stephen Hawking, Carl Sagan, Konstantin Tsiolkovsky, Buzz Aldrin and so on. They all argue that there are too many risks that can befall life on a single planet. As nicely put by Robert Heinlein: “The Earth is just too small and fragile a basket for the human race to keep all its eggs in.”

Could we possibly support such a bold idea ourselves? Is it more important to colonise Mars than to: improve our earthly existence, achieve equality and peace for all humans, protect our delicate environment, or cure diseases and world hunger? The argument is that these endeavours, as charitable as they are, all become meaningless if the following day life is wiped out from the face of the planet by a giant asteroid or a superbug. The long-term vision of space colonisation spans way beyond the blink of our existence and space advocates insist that in the long run, there are only two possible avenues: expansion into space or extinction! (more…)

LGBT and the sciences: where does our pride STEM from?

LGBT and the sciences: where does our Pride STEM from?

In celebration of LGBT STEM Day, Dr Akif Khawaja shares the small things everyone can do to make STEM more LGBT-inclusive.

With the glitter of the Mighty Hoopla weekend – a LGBT-friendly pop music festival – having finally settled, all eyes are now set on Pride. For many this will mean another (hopefully sunny) weekend of short shorts, tank tops and daytime drinking. In addition to the parade, especially in London, pride month is chock-a-block of events highlighting all aspects of LGBT+ culture and history. This year, Pride in STEM (Science, Technology, Engineering and Mathematics) has been helping to showcase and support LGBT+ people within the STEM fields by organising LGBT STEM Day.

So, what is Pride in STEM and what is LGBT STEM Day?

Starting with the easy one – Pride in STEM is a charitable trust run by an independent group of LGBT+ scientists and engineers. Founded in 2016, Pride in STEM was the brainchild of Dr Alfredo Carpineti, his husband Chris, and Matt Young. They aim to support all LGBT+ people spanning all of STEM and in doing so, raise their profiles and showcase their work. Now as for LGBT STEM day, this was their latest effort to promote the dissemination of work done by LGBT+ STEM staff. It falls on Friday 5 July 2019 (I’m told purposefully chosen as 507nm is the wavelength of the green stripe in the pride flag – 5.07 … get it?!) and the day before the Pride in London Parade. (more…)

Children with eczema: the link to food allergies is not clear cut

Food allergies eczema

Children’s allergy specialist, Dr Robert Boyle, unpicks the evidence behind the value of allergy tests for children with eczema.

Around one in five children have eczema – and even mild cases can have a big impact on both the child and their family. For many, symptoms will come and go before they start primary school, but for others it can indicate the beginning of a genetic tendency to develop allergic conditions such as hay fever or asthma (or both).

We also know that children with eczema are more likely to develop food allergies, especially if the condition starts in the first few months of life and is severe. Often parents will make the allergy diagnosis themselves – at the sudden onset of vomiting, diarrhoea or rash after eating scrambled egg, for example.

This can be frightening, but doctors can usually easily confirm the cause of these immediate reactions by talking to the parents and offering a confirmatory allergy blood or skin prick test.

In the absence of such obvious physical reactions however, a different question sometimes arises for parents: “Is a food allergy contributing to my child’s eczema and would an allergy test help to find out?” (more…)

There’s a whole world inside of you: a guide to microbiome research

Kate Gallagher provides an insight into microbiome research; a promising area of science that may pave the way for new treatments for a number of conditions ranging from inflammatory bowel disease to cancer.

You may be familiar with the age-old phrase, ‘you are what you eat’. Whilst I can assure readers that despite ingesting an inordinate amount of Reese’s pieces, you probably aren’t nuts, recent developments in research into the gut microbiome are beginning to tell us that the population of microbes inhabiting our gut may be much more powerful than we’ve previously given them credit for.

What is the microbiome?

The term microbiome refers to the additional set of genes arising from the diverse and unique array of microbes that have established themselves in a variety of habitats throughout our body. This is not to be confused with the term microbiota, simply referring to their names and quantities. These communities of bacteria, viruses, fungi and yeasts can be found in significant proportions in regions such as the gastrointestinal and reproductive tracts, your oral cavity, and skin. Overall, bacterial cells in our body match the number of human cells at a 1:1 ratio, meaning the microbiome has a significant contribution towards our genetic diversity, harnessing great potential to aid our understanding of a number of medical conditions targeted by decades of research. (more…)

Is mycoprotein an ideal food for managing blood sugar levels in Type 2 Diabetes?

For Diabetes Awareness Week, Anna Cherta-Murillo explains how mycoprotein, a food made of fungus, may hold the promise for managing blood sugar levels in Type 2 Diabetes.

If I were to ask you the first thing that comes to mind when you think of fungi, you would probably say mouldy walls, gone-off food, or athlete’s foot. The Fungi kingdom is often not viewed in a positive light. However, we owe a lot to fungi; they produce life-saving antibiotics, have allowed organ transplantations in humans and can recycle many types of waste. In the area of nutrition, some fungi also have the potential to affect human health in a beneficial way, although little research has been devoted to it compared to other foods. In the Nutrition Section of the Department of Medicine at Imperial, we are putting fungi into the limelight and studying the impact of a particular type of fungus on blood sugar levels and appetite in South Asian and European people with Type 2 Diabetes (T2D).

The problem

1 out of 20 people worldwide has T2D, with South Asians being more prone to the disease compared to Europeans (Figure 1). People with T2D have higher blood sugar levels than normal, which over time can increase the chances of developing long-term complications such as blindness, kidney disease and heart failure. It is therefore important to manage blood sugar levels in people with T2D in order to keep blood sugar in the normal range. The first-line strategy to achieve this is by improving dietary intake. Healthy, balanced diets are generally characterised as being high in dietary fibre and protein, which decrease both blood sugar levels and appetite. If blood sugar levels are reduced toward normal levels, the chances of having T2D-related complications are reduced. Likewise, if appetite is decreased, intake of energy-rich foods will likely also decrease, helping to reduce body weight, which is a key risk factor for T2D. However, an ongoing problem with healthy diets is that they are not suitable for all cultures and most of the research around them has been conducted in people of European origin, therefore not being applicable to South Asians. Furthermore, people often find it difficult to stick to these diets. (more…)

From Syria to South Kensington: Kinan’s journey to medical school

Kinan Wihba medical school

Kinan Wihba shares his inspiring story of how hard work and determination helped him achieve his dream of studying medicine, having fled Syria’s civil war as a refugee.

I am coming to the end of my first year at Imperial College School of Medicine (ICSM) and still cannot believe I made it this far. Applying for medicine, although exciting, is a challenging and stressful experience and current medical students would echo this statement. My path to medical school was a little different; I never thought it was feasible for me having arrived in the UK as a Syrian refugee with very little English and limited understanding of the application process. Nevertheless, I did my best and it was good enough.

Starting afresh

With every day I survived during the civil war, I grew more accustomed to the fact that I was facing death on a daily basis. I accepted that I might die very soon. So, I was beyond elated when I was reunited with my mother and older brother in the UK, where it was and still is considerably safer to live. However, with the luxury of feeling safe came the loss of my sense of belonging as I moved into this strange new place. Even though I was feeling safe, I did not feel secure; how was I going to communicate with people using a language I had never spoken before? Would I be able to find a school to continue my studies? What if I did not fit in? As much as I was excited, I was terrified and overwhelmed with the uncertainties of starting afresh. But amongst all these uncertainties, I enjoyed the solace of a few certainties one of which was my determination to become a doctor. (more…)

Think small: solving the global challenge of malnutrition by looking at metabolites

Dr Jonathan Swann’s research looks at thousands of small molecules called metabolites in an attempt to better understand a bigger problem of malnutrition and infection – a vicious combination.

Around the world, chronic undernutrition burdens the lives of over 150 million children. The effects of early life undernutrition can extend beyond infancy, stunting the physical and cognitive development of children. This stunting can often have wider societal effects including a decrease in the productivity and economic output of a community, restricting its overall progress. To make matters worse, chronic undernutrition is closely associated with repeated and persistent infections.

Such infections are common in resource-constrained settings due to inadequate water supplies and lack of access to basic healthcare. This double burden of malnutrition and infections can combine to drive inflammatory processes in the gut leading to malabsorption of nutrients and impaired immune responses, further exacerbating the malnourished state and persistence of infections. Breaking this cycle of undernutrition, infections and poverty represents a significant challenge.

(more…)

Leading from the front: what can academia learn from the Army

Army leadership

Former British Army officer and current PhD student, Nadia Soliman, discusses the importance of leadership in academia and the lessons we can learn from the Army’s renowned leadership programmes. 

In my opinion the Army and academic institutions are very similar: both are organisations that work globally, across cultures and are dependent upon their people doing remarkable things to tackle some of the greatest challenges. However, one of the stark differences between the Army and academia is how the two train and equip people for the challenges they face in their job. (more…)

What is neurodiversity and why STEM organisations should embrace it

Siena with Sally Phillips at Shine a Light Awards 2019

Siena Castellon, a 16-year-old award-winning autism advocate, makes the case for why diversity should be expanded to include neurodiversity.

Most universities have embraced diversity. They recognise that having students and faculty with diverse backgrounds, experiences and perspectives leads to increased creativity, innovation and productivity. However, most universities, focus their diversity initiatives on race, ethnicity and gender. Universities also prioritise initiatives that aim to improve social mobility, which is why many of the STEM work placements or summer school programs are only available to students from low-income families. Although it is important to address the under-representation of Black and Minority Ethnic students (BME), women and students from disadvantaged backgrounds, it is just as important to include people who are neurodivergent – a minority group that is often forgotten. (more…)