Clinical Professor of Sexual Health and HIV Claudia Estcourt talks to Roisin-Alana Di Giacomo about advances in medicine and how they’re transforming how we live our lives.
If Professor Claudia Estcourt had had her wish, she would have been a vet rather than a doctor. However, an allergy to animal hair forced her, at the age of eight, to focus on doing what she describes as “the next best thing” and pursue a career in medicine.
This decision led her to the University of Newcastle and, following graduation, Claudia spent a significant period of her early career working within different healthcare systems in Paris, London and Sydney.
With family connections in Glasgow, Claudia is no stranger to the city and, when an opportunity arose to work with GCU’s Professor Paul Flowers, Public Health Psychologist within the School of Health and Life Sciences, Claudia was keen to align their research interests.
In 2016, she took up her new post where she leads the University’s Sexual Health and Blood Borne Virus research team, while continuing to practise as a clinical consultant in the city’s Sandyford Sexual Health Services.
“Patient care is just one element of what we do as clinical practitioners,” says Claudia. “We are dealing with public-health issues, such as transmission and prevention, and trying to keep people well. It’s not just about treating the individual; it’s also about educating and informing patients, their partners and our communities.”
Claudia began working in sexual health and HIV when the prognosis and patient outcomes were not as positive as they are today.
“I was first introduced to sexual health and HIV medicine at a time that coincided with the arrival of HIV and I was completely gripped. On the one hand, within sexual health, I was looking after a group of people with mostly curable STIs, whom you could cure and make feel an awful lot better by being open and non-judgemental, while at the other end of the spectrum, there were patients with HIV who were very sick and dying.
“In those days, the treatments we had available for HIV were short-lasting or had horrific side effects. Half of my week was spent dealing with people who had a virus that wasn’t fully understood and presented massive clinical and research challenges.”
HIV is now a long-term, manageable condition and far from the death sentence that it once was. However, Claudia admits that it still a serious issue. In the UK, around 6,000 people are diagnosed every year with more people than ever living with the condition due to medical advancements.
“When I see patients today, their diagnosis is much more manageable and their life expectancy is the same as those living without the condition,” she says. “Though HIV is full of surprises; we expect the unexpected, but for most people, it is a treatable infection and can be managed.”
It seems a world away from the 80s and 90s when the stigma and diagnosis meant something very different. A number of films of late have captured this period, which Claudia remembers all too well.
“For my generation, films like Pride and Dallas Buyers Club are very poignant. It is a throwback to when people could be alive, vigorous and beautiful, then, a few years later; we would be admitting them with overwhelming infections, as their immune systems crumbled. Sometimes this was at the time they were diagnosed with HIV, as they had been so very late in their infection − whereas now we have so much reason for optimism.”
Statistics show that cases of sexually transmitted infections, such as chlamydia, syphilis and gonorrhoea, are either static or on the rise due to multiple factors. Young people, particularly those under 25, remain the group most at risk of being diagnosed with a bacterial STI such as chlamydia, and there are high rates of STI (including HIV) infections among men who have sex with men.
“Anyone can get an STI but, if you do, it’s not the end of the world,” Claudia advises, with her clinician’s hat on.
“We know that young people are at the peak age of STI acquisition, having had a number of relationships over a period of time. Not everyone uses a condom one hundred per cent – we’re all human. The important message is: every time you have a change of sexual partner, or a new sexual partner, or at least once year, if you are sexually active, get tested, and nowadays that could not be easier.”
The research team is focused on how the use of e-health and self-management can address what is a recognised public-health priority. From testing to diagnosis through to online clinical management, it is hoped that better access to healthcare, as provided by online options, can improve diagnosis and patient outcomes. In addition to this, Claudia’s team, and Professor Flowers’ team, is developing interventions for the community by reaching out to the sexual partners of those diagnosed with STIs and to groups who statistically have higher rates of infection and transmission.
Claudia is clinical and practical when she discusses the challenges, the current statistics, and patients’ prognosis, but, when she speaks about her patients, she is compassionate and keen to help people in Glasgow and further afield in South Africa.
“If you thought that life was black and white, you wouldn’t be an STI and HIV doctor or researcher,” she says. “The people I work with are fascinating and brilliant because they want to make a change and improve people’s life. There are always new advances in medicine and you are always learning, as it’s very multi-disciplinary. With HIV, for example, we couldn’t have predicted that 20 years ago we would be where we are today with such effective treatment and prevention possibilities. It’s the novelty of medicine − it’s captivating, and there are always new problems to sort out.”