The announcement of Professor Orkin’s MBE recognises her outstanding achievements as a world-leading HIV researcher, clinician, and medical, LGBTQ+ and disability leader.
The announcement of Chloe’s MBE falls in Pride Month, and there’s no better occasion to recognise Chloe’s fantastic achievements to medicine and equality, as well as her role as a prominent clinician activist leader for HIV communities and a medical, LGBTQ+ and disability leader.
Chloe Orkin (Director of the SHARE Research Collaborative) is Professor of Infection and Inequities at Queen Mary and a Consultant Physician at Barts Health NHS Trust.
Chloe’s pioneering research led to the licensing and implementation of the first-ever injectable treatment for HIV. The treatment improves the quality of life for people living with HIV – for the first time, people living with HIV could choose to receive treatment through an injection every two months, rather than take daily pills. You can learn more about the research SHARE conduct here.
While Chair of the British HIV Association in 2017, she spearheaded the UK arm of the ‘Undetectable = Untransmissible’ (U=U) campaign, which highlighted that there is zero risk of HIV transmission for people taking effective antiretroviral treatment. The global campaign has been transformative in reducing stigma for people living with HIV.
Her ground-breaking research on the clinical features of mpox has shaped our understanding of the condition, and her work has set new standards and guidelines in the treatment of these conditions.
Orkin is equally committed to equity for healthcare professionals. She was the first LGBTQ+ President of the Medical Women’s Federation, the largest organisation representing medical women in the UK.
Chloe believes strongly in visible representation. She has spoken openly as a medical woman and an LGBTQ+ doctor. In 2022, Chloe wrote a piece for BMJ Leader discussing, for the first time openly, about her experiences of living with an invisible disability. Again, Chloe’s strong belief in visible representation made her a leader to disabled doctors and may others living with both visible and invisible disability.
Ove the past five years, Chloe has led the Faculty of Medicine and Dentistry (FMD) on Equality, Diversity and Inclusion (EDI) Lead as the EDI Lead and Athena SWAN Chair.
To mark her MBE, Chloe has written a lovely piece in the BMJ Leader detailing her experience with receiving this award. She has also kindly compiled a list of activism resources, available at the bottom of this page.
On receiving her MBE, Professor Orkin said:
“‘Serving the NHS for the past 26 years has been an enormous privilege, and it means a great deal that my contribution has been deemed valuable. By seeing someone like me receiving an MBE, I hope that others will see that they too can be recognised for their contributions to society. I look forward to serving my patients and colleagues for the rest of my career.”
Professor Sir Mark Caulfield, VP Health at Queen Mary University of London said:
“I am delighted to congratulate Chloe on receiving an MBE for her services to the NHS. Not only is Chloe an exceptional clinician and researcher, but she is also a role model and leader for many groups who have faced – and continue to face – challenge and discrimination across the world.
Chloe spearheaded change toward greater equality in our Faculty, overseeing our successful application for a Gold Athena SWAN award in medicine in 2023.
Congratulations, Chloe. This is hugely well deserved.”
Professor Yvonne Gilleece, Chair of the British HIV Association, said:
“As a past chair of the British HIV Association, Chloe has contributed so much to the development of new treatments for HIV and worked consistently to champion those facing stigma because of their HIV status, gender or ethnicity. We are delighted to see her recognised for her contribution to both medicine and society.”
Chloe has compiled a list of resources relating to her work on HIV, mpox, LGBT+ activism, and women in leadership.
Gender equity
Podcasts
Medical Women Podcast on leadership: The Medical Women Podcast: Episode 4: Stepping into leadership with Professor Chloe Orkin on Apple Podcasts
YANAF podcast: The Glass Slipper and Other Challenges for Women in Medicine – You Are Not a Frog
Research
Disability
Peer-reviewed publications on health equity
This article has been taken from Queen Mary University of London.
Tell us about your personal and professional motivation in regards to HIV research?
I am deeply interested in gender politics and am committed to improving the representation of women in clinical trials. It has always been clear to me that the importance of including women in HIV research needs to be underscored and addressed. My career has been and continues to be driven by the need to ensure that research reflects and benefits a diversity of individuals. A clear objective is transforming the landscape of HIV research to be truly representative and inclusive.
What challenges have you encountered in regards to women being adequately represented in clinical trials?
Women have always been under-represented in HIV treatment and that continues to this day. Research I presented only recently at the Conference on Retroviruses and Opportunistic Infections highlighted that in trials for long-acting injectable therapies, women were notably underrepresented with respect to the country proportion of women living with HIV.
How can such under-representation be addressed?
It requires a particular focus on those who have been historically marginalised. This means not just advocating for more inclusive research, but also designing studies that actively prioritise diverse participation. Effective strategies include intentional recruitment and inclusive protocol design. For instance, the ILANA study I led in the UK recruited over 50% women and people of colour, embedding an approach that countered sexism, racism, and ageism within its protocol.
What guidance would you offer to young researchers or clinicians who want to focus on improving healthcare inclusivity and efficacy for women with HIV?
Remember that patients are not hard to reach, it is our services that are hard to access. We need to tailor our services to what all of our patients need.
You were the global lead author for the FLAIR study which evaluated the first-ever long-acting injectable HIV therapy. Tell us about the key findings, and how they benefited the understanding and treatment of HIV in women.
Women made up around 20% of participants in the FLAIR study. When all the studies in long-acting injectable treatment with Cabotegravir and Rilpivirine (CAB+RPV) were pooled to establish a larger sample of women, there were no differences found between men and women, the treatment was equally effective. Such studies are crucial for developing treatment options that are accessible and effective. Representation is essential to ensure everyone can benefit equally from scientific advancement.
As a global medical leader for the U=U campaign, do you see this message particularly resonating with women living with HIV, or needing adaptation?
The Undetectable=Untransmittable message is powerful, yet there’s a need for nuanced communication. Some studies have shown that women have been slightly more sceptical of the message. It is also important to say that in breastfeeding the risk is negligible, not zero unlike all other circumstances. Again, tailoring the messaging to patients with specific realities is key.
Looking ahead, how do you envision HIV research and treatment evolving, particularly in relation to women’s health and inclusivity?
Women experience many inequities. Violence against women and girls is a huge factor in determining risk of acquiring HIV, and it is also something that women living with HIV experience. Our services need to be accessible and competent in identifying people affected by VAWG to signpost them to relevant services.
In terms of research, I hope that the global efforts to include women in trials will be successful. From a treatment point of view, long-acting PrEP has the potential to transform the ability of women to be in control of their HIV prevention options.
Advances in equitable research and healthcare will overall afford women greater autonomy and control over their health.
Finally, is it important that medical and academic circles also embrace representation, and where do you see your role within this?
Representation matters immensely. It’s vital to also embrace inclusion in terms of those who lead and conduct HIV research, as well as those who participate in it. As Billie Jean King said: you have to see it, to be it. As a visible LGBTQ+ advocate, and in roles I’ve held such as President of the Medical Women’s Federation, I try to make sure that younger people see me going about my business and register that there is a place for people like them in medicine and academia too. Diversity on both sides of research and clinical trials will only enrich our understanding and approach to healthcare long-term.
Article Credit: The National HIV Story Trust – https://www.nhst.org.uk/international-womens-day-professor-chloe-orkin-on-advocating-for-inclusion-in-hiv-research/
Dr Rageshri Dhairyawan was asked by The Lancet to write a review on the 3-part drama called ‘Breathtaking’ which highlighted the experience of the Covid-19 pandemic on frontline medical staff and how they desperately worked hard to save lives. For the full article, please follow the link here.
The awards ceremony, held on 25 May 2023 at the Law Society, brought together nominators nominees and their team members to recognise exceptional work and expertise delivered by teams and individuals from across the university in eight categories. The Research and Innovation awards is to be held annually to recognise the exceptional research conducted at Queen Mary.
The SHARE collaborative found success during this ceremony by securing two awards for innovative research conducted amongst the team. The categories won were the following:
For further information on the remaining categories and other awards won, please follow the link here.
Team SHARE hosted their first virtual symposium on 5th May 2021, chaired by Ms Sheila Gupta, Vice-Principal (People, Culture and Inclusion) Queen Mary University of London.
The symposium outlined the purpose of SHARE and each research theme. Talks were presented by Prof Chloe Orkin, Prof Jane Anderson, Dr Vanessa Apea, Dr John Thornhill, Dr Rageshri Dhairyawan and Ms Angelina Namiba (HIV Community Representative).
Watch the full symposium below.
Fast-Track Cities London and the Worshipful Society of Apothecaries hosted a joint webinar on Wednesday 23 June to mark 40 years since the first description of AIDS and explore the progress that has been made in treatment for HIV. The focus was on people and their experiences of AIDS and HIV.
We heard from people with HIV, doctors and nurses about treatment then and how it has evolved, what has been achieved so far and how looking after people has changed from a patient and clinical perspective. The panel also identified remaining challenges and actions needed so people get the best health outcomes, and what needs to happen next to reach London’s 2030 goal of “Getting to Zero”.
Speakers and panellists were:
Fast-Track Cities London is part of a global movement of cities to end HIV by 2030. The Mayor of London joined NHS England, London Councils and Public Health England to sign up to this commitment in 2018. It has brought together everyone working to end HIV with people living with HIV, the NHS, London’s Councils, doctors, nurses, public health experts and academics. It is the only place that brings everyone working in the HIV sector in London together. The roadmap to zero is a jointly designed action plan that shows the steps London will take to get to zero new cases of HIV, zero preventable deaths and zero stigma. Find out more here: www.fasttrackcities.london
The Worshipful Society of Apothecaries is the City of London Livery Company that represents doctors and pharmacists. The Society hosts the Diploma in HIV Medicine, which sets the professional standards for doctors involved in the care of people living with HIV. The Society has a particular interest in the history of medicine and pharmacy with its faculty of the History and Philosophy of Medicine. The Society is also a founder member of the Health Liveries group. Visit www.apothecaries.org to find out more.
On Tuesday 22 June 2021, National AIDS Trust hosted this online conversation exploring HIV and migration and the barriers faced by people born abroad living with HIV in the UK, chaired by Deborah Gold (Chief Executive at National AIDS Trust). Dr Rageshri Dhairyawan served as an advisor for this project and panellist at the virtual event.
Panellists are:
62% of all new HIV diagnoses in the UK in 2019 were among people born abroad. Half of these acquired HIV since moving to the UK. Despite this, there is currently no shared understanding of the policies and interventions needed to support people born abroad from acquiring HIV in the UK, and overcome barriers to testing and treatment for those living with HIV.
To end new transmissions of HIV by 2030, an accepted national commitment, we must make progress for all population groups, including those board abroad. National AIDS Trust wanted to understand the barriers they face when accessing HIV testing, treatment and care.
This event launched our latest report – HIV and migration, and shares our research findings and the recommendations we have made to improve the health outcomes and quality of life of those born abroad and living with, or at higher risk of, HIV.
The full report can be found here: www.nat.org.uk/publication/hiv-and-migration
The UK has passed the terrible milestone of 100,000 deaths with COVID-19. These losses have not been evenly spread throughout different communities. A disproportionate number of both severe cases and deaths have been among those from Black, Asian, and minority ethnic (BAME) backgrounds.
In England, analyses of data from the Office of National Statistics and National Health Service has revealed 2.5-fold to 4.3-fold greater COVID-19 mortality rates across a range of Black and South Asian ethnic groups compared with white groups.
As doctors working on the frontline of COVID-19 care, we wanted to understand the driving factors behind the differences in outcomes between ethnic groups within our community of East London, which was at the epicentre of the pandemic during the first wave. Our study included all of the 1,737 COVID-19 patients who were admitted to the five hospitals within Barts Health NHS Trust between January 1 and May 13 2020.
In contrast to many previous studies examining ethnicity and COVID-19 outcomes, we were also able to address how a range of factors including social and economic background, previous underlying conditions, lifestyle and demographic factors contributed to how patients fared.
In our sample, patients from Black, Asian and other minority ethnic backgrounds were significantly younger and less frail when they were admitted to hospital than white patients.
Black patients were 30% and Asian patients 49% more likely to die within 30 days of hospital admission compared to patients from white backgrounds of a similar age and baseline health. Black patients were also 80% and Asian patients 54% more likely to be admitted to intensive care and need invasive mechanical ventilation.
This graph shows predicted survival of Asian, Black and white ethnic groups to 30 days following hospital admission for a male patient aged 65. Probability of survival reduces as time passes but there are significant differences between Asian and Black compared to white patients, and these differences also increase over time.
When we accounted for the role of underlying health conditions, lifestyle, and demographic factors, the risk of death in Black and Asian populations did not drop to the same rates as white patients.
In our cohort, all ethnic groups experienced high levels of deprivation, however, worse deprivation was not associated with higher likelihood of mortality. This suggests ethnicity may affect outcomes independent of purely geographical and socioeconomic factors.
The risk factors associated with worse underlying health status are likely to be linked with wider social factors such as poor living conditions, being employed as a key worker and even language barriers that may get in the way of people adopting preventative measures to avoid getting sick. Structural racism also plays a role in generating and reinforcing inequities and must be acknowledged and addressed.
Although our study had a large number of patients, it was not possible to assess a more detailed ethnicity breakdown and so may not reflect the vast diversity that exists within ethnic categories (such as Bangladeshi, Pakistani, black African or black Caribbean). Future studies should focus on exposing specific inequalities that may exist between these sub-ethnic categories.
Similarly, we need bigger sample sizes to contextualise a number of potential factors including household composition, environmental concerns and occupation.
Although COVID-19 has placed ethnic inequalities in health outcomes in sharp focus, these differences have been widely documented for decades.
In another study, we are working directly with local residents in East London to understand their experiences both before and during the pandemic, so we can begin to find solutions together.
As the impact of COVID-19 persists, we continue to see significant numbers of Black, Asian, and minority ethnic patients admitted to our hospitals. The aftermath of this is yet to seen in its entirety as, in addition to the high rates of premature death suffered among these population groups, these frequently working-age patients will often leave hospital with long-term chronic health conditions, returning home with a greatly reduced quality of life.
We must respond now to the ethnic disparities that have been highlighted by the COVID-19 pandemic if we want to prevent them being inflicted on future generations.
Dr Yize Wan is a Clinical Lecturer in Intensive Care Medicine at Queen Mary University of London.
Dr Vanessa Apea is a Consultant Physician in Sexual Health and HIV Medicine at Queen Mary University of London.
News items relating to this story:
Evening Standard
As medical leaders, we are encouraged to think about our values. The Faculty of Medical Leadership and management standards for medical professionals are guided by values espoused in the Seven Principles of Public Life, which include integrity and accountability. But who and what we value is just as important as our personal values. And ideally, our espoused values should match our enacted values, so that what we do matches what we say we want to do.
With regards to the health outcomes of Black, Asian and minority ethnic groups, despite our good intentions, there may be a gap between our espoused and enacted values. The health inequalities faced by these groups, which have been so conspicuously highlighted by COVID-19, existed well before this current pandemic and are present in many areas of health. Rageshri, list some examples on the full blog piece below, which make for uncomfortable reading.
Read full blog piece at: https://blogs.bmj.com/bmjleader/2020/06/15/evaluating-values-by-rageshri-dhairyawan/
People from racial minorities are more likely to become very unwell or die from COVID-19 than those of white ethnicity. Compared to the general population, those of Black African heritage are 3.24 times more likely to die from COVID-19 and Bangladeshi populations are 2.41 times more likely to die.
38-year-old Nurul Islam from Forest Gate contracted the virus in February. He says: “I’ve never felt anything like it. One night I woke up suffocating. So many things came into my mind, I was scared and panicking. But what worried me most was my children – our 14-month-old daughter also contracted COVID-19 and was unwell”.
Now research will focus on East London, a densely urbanised, multi-ethnic area which has some of the UK’s highest incidence and death rates of the COVID-19 pandemic.
The study will gain deep insight into the causes of COVID-19 based on the lived experience of East London’s racially diverse communities, through interviews and questionnaires. The researchers will work directly with local residents to understand their life before, and during, COVID-19.
The research will also address the lower vaccine uptake within racially minoritised groups. The team are already working with a number of boroughs on how trust around the vaccine can be built, and this study will help them to better understand and unpick the hesitancy within these groups.
The researchers are planning further studies into the treatment and outcomes of 3,000 patients from Black, Asian and minority ethnic backgrounds treated for COVID-19 at Barts Health NHS Trust, cross-referenced with local authority data from Tower Hamlets and Newham to explore factors like socioeconomic status, household density, and geographic health factors such as pollution.
It’s expected that the research will help the NHS and policymakers develop strategies to reduce the damaging impact of COVID-19 on Black, Asian and minority ethnic communities and could also provide useful insights for the many other health issues where ethnic differences exist.
The project is led by Professor Chloe Orkin, Professor of HIV Medicine at Queen Mary, and Dr Vanessa Apea, NIHR BME clinical co-leads for COVID-19. As clinical lead for COVID-19 Research for Barts Health NHS Trust, Professor Orkin has recently played a crucial role in setting up a COVID-19 vaccine trials centre at Bethnal Green Library.
Dr Apea, who was born in East London herself, says: “Poorer health outcomes in racially minoritised groups are not new, but have been revealed more starkly than ever by COVID-19, and must be urgently addressed. Authentic community engagement and co-creation of solutions are key to achieving health equity.”
Barts Charity funding for this study forms part of a suite of seed grants to help provide insight into a number of conditions affecting the health of East Londoners, including COVID-19.
Chief Executive of Barts Charity, Fiona Miller Smith, says: “As a charity dedicated to supporting the health of East Londoners, we are no strangers to the stark effects of health inequalities. And providing funding to better understand and ultimately overcome these inequalities is really important for us. As we are by no means out of the woods yet when it comes to COVID-19, we are rightly proud to be backing this very valuable contribution.”
Register your interest in taking part in the study at amplifyinglives.com
News items relating to this story:
Evening Standard
